Single-Session Intervention for Suicidal Thoughts
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Shannon E. Sauer-Zavala
Disqualifiers: Manic episode, Psychotic, Substance detox, others
No Placebo Group
Trial Summary
What is the purpose of this trial?Across multiple models of suicide risk, hopelessness and perceptions of social relatedness (i.e., lack of social connection/thwarted belongingness, perceived burdensomeness) have emerged as candidate mechanisms that maintain STBs. Although these mechanisms have garnered strong empirical support in predicting STBs, there has been virtually no integration with interventions aimed for individuals at acute risk for suicide. Thus, the overarching goal of the present proposal is to evaluate a mechanism-focused intervention that explicitly targets two core mechanisms implicated in the maintenance of STBs: hopelessness and negative perceptions of social relatedness. Given that the period immediately following hospital discharge presents the highest risk for suicide attempts and up to 70% of patients admitted for a suicide attempt do not attend their first outpatient appointment, the intervention will be evaluated on an inpatient unit. Additionally, most of the extant interventions for STBs are administered across multiple sessions (i.e., 4 sessions and up to one year); however treatments of this length are unlikely to be feasible in acute care settings. Fortunately, very brief suicide prevention interventions, are effective in reducing future suicide attempts and increasing the likelihood of attending follow-up treatments. Additionally, single-session interventions (not suicide specific) have been shown to reduce hopelessness immediately and at a one-month follow-up.
The present study is an RCT comparing a novel Single Session Mechanism Focused Intervention (SSMFI) for STBs to treatment-as-usual (TAU) on a psychiatric inpatient unit for patients admitted for suicidal ideation or attempt. The engagement of the putative processes (hopelessness and negative perceptions of social relatedness) that maintain STBs will be assessed, along with the feasibility and acceptability of SSMFI for STBs on an inpatient psychiatric unit.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the Single-Session Mechanism-Focused Intervention (SSMFI) treatment for suicidal thoughts?
Research on similar brief interventions, like the Attempted Suicide Short Intervention Program and Mindfulness-based cognitive therapy, shows promise in reducing suicidal thoughts and behaviors. These treatments focus on building a strong therapeutic relationship and teaching skills to manage thoughts, which are key components that may also be effective in SSMFI.
12345Is the Single-Session Intervention for Suicidal Thoughts safe for humans?
The Safety Planning Intervention, a similar brief intervention for suicide prevention, has been shown to be safe and acceptable in various settings, with studies indicating improvements in suicidal thoughts and behaviors, as well as reductions in depression and hospitalizations.
56789How is the Single-Session Mechanism-Focused Intervention (SSMFI) treatment different from other treatments for suicidal thoughts?
The Single-Session Mechanism-Focused Intervention (SSMFI) is unique because it is designed to be a one-time, focused session that targets the underlying mechanisms of suicidal thoughts, unlike other treatments that often require multiple sessions. This approach aims to quickly stabilize individuals and prevent future crises, making it a novel option for those in urgent need of help.
510111213Eligibility Criteria
This trial is for adults admitted to the Adult Inpatient Unit at Good Samaritan Hospital who are experiencing suicidal thoughts or have recently attempted suicide. Participants must be 18 years old, speak English, and provide two contact methods for follow-up.Inclusion Criteria
I am admitted to the Adult Inpatient Unit at Good Samaritan Hospital.
I am 18 years old or older.
English speaking
+2 more
Exclusion Criteria
Current manic episode
Acutely psychotic
I understand the treatment being offered to me.
+1 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Intervention
Single Session Mechanism Focused Intervention (SSMFI) for suicidal thoughts and behaviors is administered on an inpatient unit
1 day
1 visit (in-person)
Follow-up
Participants are monitored for changes in suicidal ideation, hopelessness, and social connectedness
1 month
Assessments at 1 week and 1 month post-intervention
Participant Groups
The study compares a new Single Session Mechanism Focused Intervention (SSMFI) targeting hopelessness and social connectedness against the usual treatment for patients with suicidal thoughts/behaviors on an inpatient psychiatric unit.
2Treatment groups
Experimental Treatment
Active Control
Group I: Single-Session Mechanism Focused Intervention (SSMFI)Experimental Treatment1 Intervention
Group II: Treatment as UsualActive Control1 Intervention
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of KentuckyLexington, KY
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Who Is Running the Clinical Trial?
Shannon E. Sauer-ZavalaLead Sponsor
References
The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. [2022]The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and clinician. This process is designed to enhance the therapeutic alliance and increase treatment motivation in the suicidal patient. Central to the CAMS approach is the use of the Suicide Status Form (SSF), which is a multipurpose clinical assessment, treatment planning, tracking, and outcome tool. The original development of CAMS was largely rooted in SSF-based quantitative and qualitative assessment of suicidal risk. As this line of research progressed, CAMS emerged as a problem-focused clinical intervention that is designed to target and treat suicidal "drivers" and ultimately eliminate suicidal coping. To date, CAMS (and the clinical use of the SSF) has been supported by six published correlational studies and one randomized clinical trial (RCT). Currently, two well-powered RCTs are under way, and various new CAMS-related projects are also being pursued. The clinical and empirical evolution of CAMS-how it was developed and what are the next steps for this clinical approach-are described here.
A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide. [2018]This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP-Attempted Suicide Short Intervention Program). Key elements are an early therapeutic alliance, narrative interviewing, psychoeducation, a joint case conceptualization, safety planning, and regular letters over 24 months. In a randomized controlled trial, ASSIP was highly effective in reducing the risk of suicide reattempts. The therapeutic elements in this treatment are described and possible implications for future directions in clinical suicide prevention discussed.
Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. [2022]Once suicidal thoughts have emerged as a feature of depression they are likely to be reactivated as part of a suicidal mode of mind whenever sad mood reappears. This article reviews the methods and the usefulness of mindfulness-based cognitive therapy (MBCT) as a treatment for the prevention of the reactivation of the suicidal mode. MBCT integrates mindfulness meditation practices and cognitive therapy techniques. It teaches participants to develop moment-by-moment awareness, approaching ongoing experience with an attitude of nonjudgment and acceptance. Participants are increasingly able to see their thoughts as mental events rather than facts (metacognitive awareness). A case example illustrates how mindfulness skills develop with MBCT and how they relate to the cognitive processes that fuel suicidal crises. An ongoing controlled trial will provide further evidence, but pilot work suggests that MBCT is a promising intervention for those who have experienced suicidal ideation in the past.
[Psychotherapy after a suicide attempt-current evidence and evaluation]. [2022]Suicide attempts are considered one of the most important risk factors for suicide. Based on this, various psychotherapeutic treatments for persons after a suicide attempt have been developed and evaluated in recent years. In this article, the current state of efficacy research is outlined, examples of successful suicide-focused psychotherapies are presented, and the current state of research and knowledge is critically reflected upon. The results of two recent Cochrane reviews of psychotherapy following self-injurious behavior in childhood, adolescence, and adulthood, as well as findings from 14 other meta-analyses of psychological suicide prevention published in the past five years, are presented.Cognitive behavioral therapy and dialectical behavioral therapy have been shown to be effective. Overall, however, the averaged effect sizes are of small magnitude and various methodological problems make it impossible to draw far-reaching conclusions. In principle, suicide-specific psychotherapy is of particular importance in individual-centered suicide prevention; however, the empirical foundation and dissemination of appropriate programs are still insufficient.
Brief and Ultra-Brief Suicide-Specific Interventions. [2023]The rising rates of suicide warrant effective treatments that can quickly help stabilize suicidal individuals and prevent future suicidal crises from occurring. Across the past few decades, there has been a rise in the development of ultra-brief (1-4 sessions) and brief suicide-specific interventions (6-12 sessions) to meet this need. This article reviews several prominent ultra-brief and brief interventions, including the Teachable Moment Brief Intervention, Attempted Suicide Short Intervention Program, Safety Planning Intervention, Crisis Response Planning, Cognitive Therapy for Suicide Prevention, Brief Cognitive-Behavioral Therapy for Suicide Prevention, Collaborative Assessment and Management of Suicidality, and the Coping Long-Term With Active Suicide Program. A brief review of each interventions' evidence base is also provided. Current challenges and directions for future research in testing the efficacy and effectiveness of suicide prevention initiatives are discussed.
A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial. [2023]People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions.
[SAFETY PLANNING INTERVENTION FOR SUICIDE PREVENTION]. [2022]Safety planning is a short-term therapeutic intervention aimed at enhancing the resources that suicidal individuals harness when dealing with imminent and future suicidal crises. Structured as a six-step action plan, the Safety Planning Intervention (SPI) includes identifying early signs of an emerging suicidal crisis, improving internal coping strategies and the ability to engage relevant social and therapeutic relationships, and removing dangerous means for suicide. The program can be applied in multiple settings, including emergency rooms and outpatient clinics. Studies examining this mode of intervention have demonstrated that it is highly effective in lowering suicidal behavior. Accompanied by a brief case vignette, we will outline key principles underlying safety planning, compare it to other available interventions and discuss remaining questions that warrant future assessment.
The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. [2022]The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.HighlightsThe Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).
Enhancing motivation and self-efficacy for safety plan use: Incorporating motivational interviewing strategies in a brief safety planning intervention for adolescents at risk for suicide. [2023]Suicide is one of the leading causes of death among adolescents in the United States, and risk for recurring suicidal thoughts and behavior remains high after discharge from psychiatric hospitals. Safety planning, a brief intervention wherein the main focus is on identifying personal coping strategies and resources to mitigate suicidal crises, is a recommended best practice approach for intervening with individuals at risk for suicide. However, anecdotal as well as emerging empirical evidence indicate that adolescents at risk for suicide often do not use their safety plan during the high-risk postdischarge period. Thus, to be maximally effective, we argue that safety planning should be augmented with additional strategies for increasing safety plan use to prevent recurrent crises during high-risk transitions. The current article describes an adjunctive intervention for adolescents at elevated suicide risk that enhances safety planning with motivational interviewing (MI) strategies, with the goal of increasing adolescents' motivation and strengthening self-efficacy for safety plan use after discharge. We provide an overview of the intervention and its components, focusing the discussion on the in-person individual and family sessions delivered during hospitalization, and describe the theoretical basis for the MI-enhanced intervention. We then provide examples of applying MI during the process of safety planning, including example strategies that aim to elicit motivation and strengthen self-efficacy for safety plan use. We conclude with clinical case material and highlight how these strategies may be incorporated into the safety planning session. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Clinical improvements of suicidal outpatients: Examining suicide status form responses as predictors and moderators. [2015]This investigation used hierarchical linear modeling (HLM) to examine whether index responses on the Suicide Status Form (SSF) moderated the predicted session-to-session change over course of care in overall symptoms and suicidal ideation. Ninety-two suicidal patients at a university counseling center were studied. Overall, suicidal patients improved symptomatically and decreased their suicidal ideation over the course of care. SSF index ratings of overall risk of suicide significantly moderated the predicted session-to-session change in suicidal ideation over the course of care; patient ratings of frequency of suicidal thoughts were also moderated by index SSF ratings of hopelessness and self-hate. These findings partially replicated earlier data of differential treatment response outcomes and provide valuable assessment and treatment information that is relevant to future research and successful clinical care of suicidal outpatients.
Safety planning-type interventions for suicide prevention: meta-analysis. [2022]Safety planning-type interventions (SPTIs) for patients at risk of suicide are often used in clinical practice, but it is unclear whether these interventions are effective.
Ultra-brief crisis interpersonal psychotherapy based intervention for suicidal children and adolescents. [2021]Suicidal behaviors in adolescence are a major public health concern. The dramatic rise in self-injurious behaviors among adolescents has led to an overwhelming increase in the number of those presenting to the emergency rooms. The intervention described below was constructed on the basis of brief and focused interventions that were found to be effective among suicidal adults using an adaptation of interpersonal psychotherapy for adolescents. The intervention has four main objectives: first, a focused treatment for reducing suicide risk; second, a short and immediate response; third, building a treatment plan based on understanding the emotional distress and interpersonal aspects underlying suicidal behavior; and lastly, to generate hope among adolescents and their parents. The intervention includes intensive five weekly sessions, followed by 3 mo of email follow-up.
Suicide-Focused Group Therapy. [2022]Background: Although there are several studies focusing on group models for therapy specific to suicidal thoughts and behaviors, scoping reviews providing an overview of these studies' findings are limited. Aims: The aim of this paper was to conduct a scoping review of group therapies that explicitly target suicidal thoughts and behaviors (i.e., suicide-focused) for adults and their suicide-related outcomes. Methods: Following the PRISMA-ScR guidelines, a literature search using PubMed, Cochrane Library, and PsycINFO to identify relevant records published between 2000 and 2021 as well as a review of reference lists from relevant records was conducted. Results: There were 14 records identified with 12 unique suicide-focused group therapies. Even with variable methodological designs, sample sizes (M = 136, SD = 98), and population targeted, all records showed reductions in suicide-related outcomes by the end of the therapy; although most were not powered to determine effectiveness. Limitations: This review only included records written in English and excluded support groups that were led by peers as the focus was on therapy groups and gray literature. Conclusions: There are few evaluated therapy groups that explicitly address suicidal thoughts and behaviors. Available data indicate suicide-focused group therapy are generally feasible, acceptable, and may reduce suicidal-related outcomes. This is encouraging for future research; recommendations to include randomized controlled trials of the efficacy of suicide-focused group therapy are discussed.