Effectiveness of Zhong-Yong thinking based dialectical behavior therapy group skills training versus supportive group therapy for lowering suicidal risks in Chinese young adults: A randomized controlled trial with a 6-month follow-up.

Background Dialectical behavior therapy (DBT) is a first-line treatment for the prevention of suicide. Zhong-Yong thinking could be viewed as a Chinese way of dialectical thinking, has long been a culturally dictating thinking style in China. To enhance cultural adaptability, we integrated Zhong-Yong thinking into DBT group skills training and examined its efficacy in suicidal prevention compared with a supportive group therapy and a wait-list group in high-risk suicidal Chinese college students. Methods A total of 97 suicidal participants were randomized to either Zhong-Yong thinking based DBT group skills training (DBTZYT, n = 33), or supportive group therapy (SGT; n = 32), or wait-list group (WL; n = 32). DBTZYT was a 12-week program based on Zhong-Yong thinking instead of dialectical thinking, coaching participants mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Supportive group therapy was a 12-week program aiming at improving interpersonal effectiveness and emotion regulation skills. Outcome measures were assessed at pre- and post-treatment and 6-month follow-up. Results At post-treatment measures, the levels of suicidal ideation, hopelessness, psychache symptoms, and general psychopathology had significantly decreased in both intervention groups; at the 6-month follow-up measures, the intervention effects were better maintained in the DBTZYT group rather than in the SGT group. Specifically, DBTZYT was more effective in relieving participants' long-term obsessive-compulsive, anxiety, hostility, phobic, psychotic, and additional symptoms. Conclusions Zhong-Yong thinking not only could integrate with DBT skills training in Chinese young adult population, but also has special strength in enhancing DBT's efficacy.