Single-Session Intervention for Suicidal Thoughts

Overseen By Shannon Sauer-Zavala, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Shannon E. Sauer-Zavala

Disqualifiers: Manic episode, Psychotic, Substance detox, others

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

Compensation: Varies

Number of Visits: 2

128 Participants Needed

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. ^{1 2 3 4 5}

Is 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. ^{5 6 7 8 9}

How 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. ^{5 10 11 12 13}

Research Team

Shannon Sauer-Zavala, PhD

Principal Investigator

University of Kentucky

Eligibility 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.

English speaking

I can provide two ways to be contacted for study follow-up.

Exclusion Criteria

Current manic episode

Acutely psychotic

I understand the treatment being offered to me.

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

Treatment Details

Interventions

• Single-Session Mechanism-Focused Intervention (SSMFI)

Trial Overview 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.

Participant Groups

Group I: Single-Session Mechanism Focused Intervention (SSMFI) Experimental Treatment 1 Intervention

Group II: Treatment as Usual Active Control 1 Intervention

Who Is Running the Clinical Trial?

Shannon E. Sauer-Zavala

Lead Sponsor

Trials

5

Recruited

400+

Findings from Research

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based intervention that enhances the therapeutic alliance between clinicians and suicidal patients, focusing on collaborative assessment and treatment planning.

CAMS utilizes the Suicide Status Form (SSF) to assess and track suicidal risk, and has been supported by multiple studies, including one randomized clinical trial, with two more currently underway to further validate its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. Jobes, DA.[2022]

The Attempted Suicide Short Intervention Program (ASSIP) is a brief therapy designed for individuals who have attempted suicide, focusing on building a therapeutic alliance and incorporating narrative interviewing and safety planning.

In a randomized controlled trial, ASSIP was found to be highly effective in significantly reducing the risk of suicide reattempts, highlighting its potential as a valuable intervention in clinical suicide prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide. Michel, K., Valach, L., Gysin-Maillart, A.[2018]

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for preventing the reactivation of suicidal thoughts in individuals with a history of depression, as it helps them develop awareness and acceptance of their thoughts.

The therapy combines mindfulness practices with cognitive techniques, allowing participants to view their thoughts as transient mental events rather than absolute truths, which may reduce the risk of suicidal crises.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. Williams, JM., Duggan, DS., Crane, C., et al.[2022]

Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) have been identified as effective psychotherapeutic treatments for individuals who have attempted suicide, based on recent Cochrane reviews and meta-analyses.

Despite the effectiveness of these therapies, the overall impact is small, and there are significant methodological issues in the research, indicating a need for better empirical support and wider dissemination of suicide-specific psychotherapy programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Psychotherapy after a suicide attempt-current evidence and evaluation]. Teismann, T., Gysin-Maillart, A.[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 START trial is a pilot study involving 70 participants with serious mental illnesses, such as bipolar disorder and schizophrenia, aimed at evaluating a brief cognitive behavioral intervention designed to reduce suicidal ideation over a 6-month period.

The intervention includes both in-person sessions and mobile phone interactions, focusing on early warning signs and recovery planning, which may enhance engagement and effectiveness in suicide prevention for individuals with psychotic disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial. Depp, C., Ehret, B., Villa, J., et al.[2023]

The Safety Planning Intervention (SPI) is a structured six-step action plan designed to help individuals at risk of suicide by enhancing their coping strategies and social support, and by removing access to means of self-harm.

Research shows that SPI is highly effective in reducing suicidal behavior, making it a valuable tool in various settings such as emergency rooms and outpatient clinics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[SAFETY PLANNING INTERVENTION FOR SUICIDE PREVENTION]. Perlstein, J., Katzir, N., Lotan, A., et al.[2022]

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]

Safety planning is a crucial intervention for adolescents at risk of suicide, but many do not utilize their plans after leaving psychiatric hospitals, highlighting a need for improved strategies.

The article proposes enhancing safety planning with motivational interviewing techniques to boost adolescents' motivation and confidence in using their safety plans, aiming to reduce the risk of recurrent suicidal crises.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Micol, VJ., Prouty, D., Czyz, EK.[2023]

In a study of 92 suicidal patients, those who received care showed significant improvements in overall symptoms and a reduction in suicidal ideation over time.

The study found that specific ratings on the Suicide Status Form (SSF), particularly regarding overall risk, hopelessness, and self-hate, played a crucial role in predicting changes in suicidal thoughts, highlighting the importance of these factors in treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical improvements of suicidal outpatients: Examining suicide status form responses as predictors and moderators. Jobes, DA., Kahn-Greene, E., Greene, JA., et al.[2015]

A meta-analysis of 6 studies involving 3536 participants found that safety planning-type interventions (SPTIs) significantly reduce suicidal behavior, with a relative risk of 0.570 compared to control groups, indicating they are effective in preventing suicide attempts.

However, the same analysis showed no significant effect of SPTIs on reducing suicidal ideation, suggesting that while SPTIs are beneficial for preventing actions, additional strategies may be necessary to address thoughts of suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety planning-type interventions for suicide prevention: meta-analysis. Nuij, C., van Ballegooijen, W., de Beurs, D., et al.[2022]

The intervention designed for adolescents at risk of suicide is based on effective strategies used for suicidal adults, focusing on reducing suicide risk and addressing emotional distress and interpersonal issues.

This program consists of five intensive weekly sessions followed by three months of email follow-up, aiming to provide immediate support and foster hope for both adolescents and their parents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultra-brief crisis interpersonal psychotherapy based intervention for suicidal children and adolescents. Klomek, AB., Catalan, LH., Apter, A.[2021]

A scoping review identified 12 unique group therapies targeting suicidal thoughts and behaviors, showing that all reported reductions in suicide-related outcomes, although most studies lacked sufficient power to confirm effectiveness.

The findings suggest that suicide-focused group therapies are generally feasible and acceptable, highlighting the need for more rigorous randomized controlled trials to better assess their efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide-Focused Group Therapy. Chalker, SA., Martinez Ceren, CS., Ehret, BC., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. [2022]

2. Switzerland pubmed.ncbi.nlm.nih.gov

A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

[Psychotherapy after a suicide attempt-current evidence and evaluation]. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Brief and Ultra-Brief Suicide-Specific Interventions. [2023]

6. Canada pubmed.ncbi.nlm.nih.gov

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]

7. Israel pubmed.ncbi.nlm.nih.gov

[SAFETY PLANNING INTERVENTION FOR SUICIDE PREVENTION]. [2022]

8. England pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

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]

10. England pubmed.ncbi.nlm.nih.gov

Clinical improvements of suicidal outpatients: Examining suicide status form responses as predictors and moderators. [2015]

11. England pubmed.ncbi.nlm.nih.gov

Safety planning-type interventions for suicide prevention: meta-analysis. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Ultra-brief crisis interpersonal psychotherapy based intervention for suicidal children and adolescents. [2021]

13. Canada pubmed.ncbi.nlm.nih.gov

Suicide-Focused Group Therapy. [2022]