ECRP + BCBT for Suicide Risk Reduction

Overseen By Michael S Esterman, PhD

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: VA Office of Research and Development

Disqualifiers: Cognitive impairment, Psychotic, Manic, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 19

Duration: 12 weeks

136 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two therapies, Enhanced Crisis Response Planning (ECRP) and Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT), to reduce suicide risk in Veterans recently hospitalized for suicidal thoughts or attempts. It aims to determine if longer therapy improves coping skills and reduces negative thoughts about suicide more effectively than shorter therapy. The study will also examine brain scans to identify if changes in the brain can predict suicide attempts and if these changes vary by therapy type. Veterans who qualify have recently experienced a suicidal crisis and are willing to participate in therapy and brain scan sessions. As a Phase 2 trial, this research focuses on measuring the treatment's effectiveness in an initial, smaller group, offering participants a chance to contribute to important findings in suicide prevention.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT) is safe and effectively reduces suicide attempts. It targets factors that increase suicide risk and helps manage the emotions and thoughts contributing to this risk.

Similarly, Enhanced Crisis Response Planning (ECRP) is well-tolerated. Studies suggest it quickly reduces suicidal thoughts and attempts. In one study, participants using ECRP were 76% less likely to attempt suicide compared to those receiving standard care.

Both therapies have been studied and found effective in managing suicide risk, with no major safety concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about these interventions because they offer a more personalized and proactive approach to suicide prevention. Traditional methods often rely on medication and general therapy, but Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT) goes further by including emotion regulation skills and strategies to tackle harmful thinking patterns. Meanwhile, Enhanced Crisis Response Planning (ECRP) equips individuals with a customized crisis response plan, ensuring they have immediate support and resources when needed. This hands-on, individualized care could potentially lead to better outcomes for people at risk of suicide.

What evidence suggests that this trial's treatments could be effective for reducing suicide risk in Veterans?

Research has shown that Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT), one of the treatments in this trial, can greatly reduce suicide attempts. Participants in BCBT improved in managing suicidal thoughts and solving problems. Studies have also found BCBT effective when delivered through telehealth, further supporting its role in lowering suicide attempts.

Enhanced Crisis Response Planning (ECRP), another treatment option in this trial, shows promise as well. This approach quickly reduces suicidal thoughts and the likelihood of future suicide attempts. In one study, individuals who used a crisis response plan were 76% less likely to attempt suicide within six months compared to those who did not. Both BCBT and ECRP offer proven methods for reducing the risk of suicide. ^{1 2 3 4 6}

Who Is on the Research Team?

Michael S Esterman, PhD

Principal Investigator

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Are You a Good Fit for This Trial?

This trial is for English-speaking Veterans who've been hospitalized due to recent suicidal thoughts or attempts. They must be able to attend 12 therapy sessions and 3 MRI scans post-discharge. It's not suitable for those with significant cognitive impairments or current psychotic/manic features.

Inclusion Criteria

Veteran status

I can attend 15 sessions after leaving the hospital.

I can understand and agree to the study's consent form.

Exclusion Criteria

Significant cognitive impairment

Current psychotic or manic features

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either Enhanced Crisis Response Planning (ECRP) or Brief Cognitive Behavioral Therapy (BCBT) for suicide prevention

12 weeks

12 visits (in-person)

Neuroimaging

MRI neuroimaging scans are conducted shortly after hospital discharge and again at 4- and 12-months post-discharge

12 months

3 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 2, 4, 8, and 12 months post-discharge

12 months

4 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT)
• Enhanced Crisis Response Planning (ECRP)

Trial Overview The study compares two psychotherapies: Brief Cognitive Behavioral Therapy (BCBT) and Enhanced Crisis Response Planning (ECRP), assessing their effectiveness in improving coping skills, reducing negative thinking, and lowering suicide risk among Veterans.

How Is the Trial Designed?

Group I: Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT) Active Control 1 Intervention

This weekly, 12-session intervention involves completion of an enhanced crisis response plan, as well as emotion regulation skills training, learning strategies to identify and challenge thinking patterns that contribute to suicide risk, and increased engagement in personally meaningful activities.

Group II: Enhanced Crisis Response Planning Active Control 1 Intervention

Using supportive listening, a therapist conducts a brief interview to gather information about lifetime suicide attempt history and recent SI. The therapist then works with the client to identify a) warning signs for being in crisis, b) self-management/distraction strategies, c) reasons for living, d) sources of social support the client could contact in the event of a crisis, and e) crisis resources (e.g., veterans crisis line, contact information for current providers and local emergency resources). Steps for each of these, as well as specific contacts for social support and professional services are written on an index card provided to the patient and the patient is encouraged to keep the card in an accessible place (e.g., wallet) so it can be utilized in the event of a crisis.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

A manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) was developed and tested on 110 adolescents aged 13 to 19 who recently attempted suicide, focusing on risk reduction and relapse prevention.

The therapy was well-received, with 72.4% of participants completing 12 or more sessions, indicating its feasibility for preventing recurrence of suicidal behavior in this high-risk group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. Stanley, B., Brown, G., Brent, DA., et al.[2022]

The article reviews various ultra-brief and brief suicide-specific interventions, highlighting their potential to quickly stabilize individuals at risk of suicide, which is crucial given the rising suicide rates.

Several interventions, such as the Safety Planning Intervention and Cognitive Therapy for Suicide Prevention, have shown promising evidence for effectiveness, indicating a need for continued research to optimize these approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief and Ultra-Brief Suicide-Specific Interventions. Stanley, B., Brodsky, B., Monahan, M.[2023]

The Safety Planning Intervention (SPI) is effective in reducing suicidal ideation and behavior, as well as improving depression and treatment engagement among adults experiencing suicide-related distress, based on a systematic review of 26 studies.

The SPI is adaptable and can be delivered in various formats (in-person or online) and as a standalone or combined intervention, making it a flexible tool in suicide prevention practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Ferguson, M., Rhodes, K., Loughhead, M., et al.[2022]

Brief cognitive behavioral therapy (BCBT) is projected to prevent 23 to 25 more suicide attempts and 1 to 3 more suicide deaths per 100 patients compared to standard treatment for suicidal US Army soldiers, indicating its efficacy in reducing suicide risk.

BCBT is estimated to save the Department of Defense between $15,000 to $16,630 per patient compared to usual treatment, suggesting it may be a cost-effective intervention for addressing suicide risk among active-duty soldiers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Economic Evaluation of Brief Cognitive Behavioral Therapy vs Treatment as Usual for Suicidal US Army Soldiers. Bernecker, SL., Zuromski, KL., Curry, JC., et al.[2022]

In a study of 108 active duty US Army personnel with PTSD, both group cognitive processing therapy-cognitive only version (CPT-C) and group present-centered therapy (PCT) significantly reduced rates of suicide ideation, with improvements maintained for up to 12 months post-treatment.

There were no reported suicide attempts during or after treatment in either group, and exacerbation of preexisting suicide ideation was uncommon, suggesting that group CPT-C is safe and does not increase suicide risk among participants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

EVALUATING POTENTIAL IATROGENIC SUICIDE RISK IN TRAUMA-FOCUSED GROUP COGNITIVE BEHAVIORAL THERAPY FOR THE TREATMENT OF PTSD IN ACTIVE DUTY MILITARY PERSONNEL. Bryan, CJ., Clemans, TA., Hernandez, AM., et al.[2019]

A clinical trial comparing behavior therapy to insight-oriented therapy for repeated suicide attempters showed that behavior therapy was more effective in reducing depression, anxiety, and suicidal ideation over a nine-month follow-up period.

The success of the behavior therapy package was attributed to its structured approach and assertive follow-up, which likely enhanced patient outcomes during the ten-day inpatient treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavior therapy vs insight-oriented therapy for repeated suicide attempters. Liberman, RP., Eckman, T.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8479594/

Brief Cognitive-Behavioral Therapy for Suicide Prevention ... The treatment lasts for approximately 12 sessions. The goal of BCBT-SP is to teach patients to better understand their patterns of suicide risk, solve problems, ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S0005789425001145

Massed brief cognitive behavioral therapy (mBCBT) for ... Brief cognitive behavioral therapy (BCBT) for suicide prevention has been shown to significantly reduce suicide attempts in multiple ...

3. jwatch.org jwatch.org/na59343/2025/10/28/brief-cognitive-behavioral-therapy-tested-prevent-suicide

Brief Cognitive-Behavioral Therapy Tested to Prevent ... These results are impressive, showing a benefit from brief CBT beyond that of another effective psychotherapy in a high-risk population.

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2826055

Telehealth Brief Cognitive Behavioral Therapy for Suicide ... The findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts.

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39531231/

Telehealth Brief Cognitive Behavioral Therapy for Suicide ... The findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts.

6. academic.oup.com academic.oup.com/milmed/article/190/Supplement_2/219/8256275

Implementation of Brief Cognitive Behavioral Therapy for ... BCBT-SP differs from typical CBT treatments in that it is intentionally brief (up to 12 sessions) and directly targets risk factors associated ...