Emotion regulation as a mediator of dialectical behaviour therapy for autistic adults with suicidal ideation.

In 30 seconds

This randomized controlled trial examined whether emotion-regulation (ER) factors mediate dialectical behaviour therapy’s (DBT’s) effect on suicidal ideation in 123 autistic adult outpatients with suicidal behaviours. Participants were assigned to DBT (n = 63) or treatment as usual (n = 60). Structural equation models tested non-sequential and sequential pathways involving six ER factors. ER mediated 67% of the total treatment effect. In the sequential model, all pathway coefficients were statistically significant (0.23 ≤ β ≤ 0.92; p < 0.01), whereas coefficients in the non-sequential model were generally small and largely not significant.

Key findings

• ER mediated 67% of DBT’s total treatment effect on suicidal ideation.
• In the sequential mediation model, pathway coefficients ranged from 0.23 ≤ β ≤ 0.92 and were all statistically significant (p < 0.01).
• In the non-sequential model, pathway coefficients were generally small (β ≤ 0.32) and largely not significant.

Why it matters

The findings suggest that changes in emotion regulation may help explain DBT’s effect on suicidal ideation among autistic adults with suicidal behaviours. The contrast between sequential and non-sequential models also points to the potential importance of how ER targets are ordered, offering a framework for understanding the therapy’s proposed process rather than establishing that this sequence is necessary.

What to keep in mind

The mediation findings depend on structural equation models and do not establish that the proposed sequence of ER changes causes reductions in suicidal ideation.