Motivational Interviewing for Suicidal Thoughts

(MI-SI Trial)

Recruiting at 3 trial locations

Overseen By Richard J Servatius, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Psychosis, Mania, Dementia, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 7

Duration: 3 sessions

470 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial tests a special type of counseling called MI-SI-R, which helps Veterans who are thinking about suicide find reasons to live. The study involves 470 high-risk Veterans who have had suicidal thoughts or attempts. The goal is to see if this counseling, combined with usual care, reduces suicide attempts and suicidal thoughts more effectively than usual care alone. Motivational interviewing to address suicidal ideation (MI-SI) has been previously tested for its acceptability and effectiveness in reducing suicidal thoughts among hospitalized veterans.

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 healthcare provider.

What data supports the effectiveness of the treatment Motivational Interviewing for Suicidal Thoughts?

Research shows that Motivational Interviewing (MI) is effective in helping people change behaviors and has been used successfully in managing suicidal thoughts. Studies indicate that MI can reduce the severity of suicidal thoughts and increase engagement with mental health services, making it a promising approach for addressing suicidality. ^{1 2 3 4 5}

Is Motivational Interviewing for Suicidal Thoughts safe for humans?

Research on Motivational Interviewing (MI) for addressing suicidal thoughts, including its use with hospitalized veterans and adolescents, suggests it is generally safe. The studies focus on enhancing motivation and self-efficacy (belief in one's ability to succeed) for safety plan use, and no specific safety concerns have been reported in these contexts. ^{2 3 6 7 8}

How is the treatment Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R) different from other treatments for suicidal thoughts?

Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R) is unique because it focuses on enhancing a person's own motivation to change their behavior by exploring and resolving ambivalence (mixed feelings), which is different from traditional treatments that may not emphasize personal motivation as much. It is a patient-centered counseling style originally developed for issues like alcohol abuse and smoking cessation, now being adapted to help individuals with suicidal thoughts. ^{1 2 3 9 10}

Research Team

Peter C. Britton, PhD MS

Principal Investigator

VA Finger Lakes Healthcare System, Canandaigua, NY

Eligibility Criteria

This trial is for Veterans over 18 who've recently attempted suicide or have severe suicidal thoughts. They must be English-speaking, able to understand the study, and give informed consent. It's not for those with active mania, current psychosis, dementia, or impaired decision-making capacity.

Inclusion Criteria

I am 18 years old or older.

High-risk status confirmed by suicide attempt within a month on the Columbia-Suicide Severity Rating Scale or a score > 5 on the Scale for Suicidal Ideation

Admitted to an inpatient unit, referred by a suicide prevention coordinator, or identified as high-risk via data extraction

Exclusion Criteria

Current psychosis

Active mania

Dementia

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Motivational Interviewing to Address Suicidal Ideation (MI-SI-R) in three sessions delivered in-person, virtually, or by telephone, along with Enhanced Usual Care (EUC) including safety plans, care coordination, and access to a 24-hour crisis hotline

3 sessions

3 visits (in-person, virtual, or telephone)

Follow-up

Participants are monitored for safety and effectiveness after treatment through telephone follow-up assessments

12 months

4 follow-up assessments (telephone) at 1, 3, 6, and 12 months

Treatment Details

Interventions

• Enhanced usual care (EUC)
• Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R)

Trial Overview The trial tests a revised motivational interviewing technique (MI-SI-R) against enhanced usual care in reducing suicide risk among Veterans. Participants are randomly assigned to one of these two approaches to compare effectiveness.

Participant Groups

Group I: Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R) Experimental Treatment 2 Interventions

Motivational Interviewing to Address Suicidal Ideation (MI-SI-R) was developed to help Veterans resolve ambivalence about living by increasing the motivation to live, and is delivered in three sessions in person, virtually, or by telephone.

Group II: Enhanced usual care (EUC) Active Control 1 Intervention

Enhanced usual care (EUC) includes safety plans administered or reviewed by research therapists, care coordination, and access to a 24-hour crisis hotline.

Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R) is already approved in United States for the following indications:

Approved in United States as Motivational Interviewing to Address Suicidal Ideation (MI-SI) for:

• Suicidal ideation in veterans at high risk for suicide

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Syracuse VA Medical Center

Collaborator

Trials

14

Recruited

1,200+

Portland VA Medical Center

Collaborator

Trials

44

Recruited

7,800+

Ralph H. Johnson VA Medical Center

Collaborator

Trials

21

Recruited

5,700+

Findings from Research

Motivational Interviewing (MI) can be effectively used in managing clinical crises, particularly with suicidal patients, as demonstrated in a case example.

The combination of MI with Collaborative Assessment and Management of Suicidality shows promise in improving patient outcomes, although there are both benefits and limitations to these approaches in practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivational interviewing in the assessment and management of suicidality. Zerler, H.[2022]

Motivational interviewing (MI) is an evidence-based intervention designed to enhance intrinsic motivation for behavior change, and it can be particularly useful in helping individuals navigate the stages of change related to suicidal behavior.

Despite limited research on MI specifically for suicidality, the article suggests its potential applications in suicide risk assessment and as a supportive tool in longer-term treatment for suicidal individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivational Interviewing and the Transtheoretical Model of Change: Under-Explored Resources for Suicide Intervention. Hoy, J., Natarajan, A., Petra, MM.[2022]

Motivational interviewing to address suicidal ideation (MI-SI) was found to be acceptable among psychiatrically hospitalized veterans, with 70% completing the treatment sessions and 85% participating in follow-up assessments.

Participants experienced significant reductions in suicidal ideation severity after treatment, and 73% engaged in ongoing mental health or substance abuse treatment in the two months following discharge, indicating MI-SI's potential effectiveness in reducing suicide risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An open trial of motivational interviewing to address suicidal ideation with hospitalized veterans. Britton, PC., Conner, KR., Maisto, SA.[2022]

Motivational interviewing (MI) training significantly reduced suicidal ideation among 70 suicide attempters, with the experimental group showing a mean score of 8.86 compared to 15.85 in the control group after 12 weeks (P = 0.0001).

The MI training also led to a notable increase in the use of mental health services among the experimental group, indicating that such interventions can effectively encourage individuals to seek help after a suicide attempt (P = 0.01).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of motivational interviewing-based training on the rate of using mental health services and intensity of suicidal ideation in individuals with suicide attempt admitted to the emergency department. Sedghy, Z., Yoosefi, N., Navidian, A.[2020]

A study involving 36 pediatric residents demonstrated that standardized patient simulations effectively helped trainees practice motivational interviewing (MI) techniques to address tobacco use with parents, enhancing their communication skills.

Residents reported high self-evaluation scores (average 6.79 out of 8) and received positive feedback from standardized patients (average 7.08 out of 8), indicating that the simulation was beneficial for both experienced and novice trainees in applying MI concepts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Motivational Interviewing to Address Tobacco Cessation: Two Standardized Patient Cases for Pediatric Residents. Boykan, R., Blair, R., Baldelli, P., et al.[2020]

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 involving 164 participants, motivational interviewing (MI) was shown to be effective in reducing heavy drinking days, particularly when clients exhibited increasing levels of change talk about alcohol.

Therapist skills in MI were linked to better sexual risk outcomes, specifically reducing the likelihood of condomless sex among clients with low levels of change talk about sexual risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of therapist MI skill and client change talk class membership predicting dual alcohol and sex risk outcomes. Janssen, T., Magill, M., Mastroleo, NR., et al.[2020]

In a study involving 891 first-year college students, 18.7% were identified as at risk for self-harm or potentially lethal alcohol use, highlighting the prevalence of these issues in this population.

Outreach efforts successfully contacted 59.9% of at-risk participants, with 78% of those accepting mental health resources, demonstrating the effectiveness of proactive safety protocols in research settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An example of implementing a safety protocol in remote intervention and survey research with college students. Mehus, CJ., Stevenson, B., Weiler, L., et al.[2023]

Motivational Interviewing (MI) has been shown to significantly increase smoking cessation rates compared to brief advice or usual care, with a relative risk of 1.27 based on a meta-analysis of 14 studies involving over 10,000 smokers.

The effectiveness of MI is enhanced when delivered by primary care physicians or counselors, particularly in longer sessions (over 20 minutes), suggesting that the method can be a valuable tool in smoking cessation efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivational interviewing for smoking cessation. Lai, DT., Cahill, K., Qin, Y., et al.[2022]

Staff in Swedish prisons who received ongoing training in motivational interviewing (MI) showed significantly greater competency in MI skills compared to those conducting usual prison planning interviews, indicating that continuous training is beneficial.

However, overall competency levels among staff were low, suggesting that even with training, more extensive and ongoing support is necessary to achieve proficiency in MI techniques for effectively helping substance-misusing prisoners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Learning motivational interviewing in a real-life setting: a randomised controlled trial in the Swedish Prison Service. Forsberg, L., Ernst, D., Farbring, CÅ.[2022]

References

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

Motivational interviewing in the assessment and management of suicidality. [2022]

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

Motivational Interviewing and the Transtheoretical Model of Change: Under-Explored Resources for Suicide Intervention. [2022]

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

An open trial of motivational interviewing to address suicidal ideation with hospitalized veterans. [2022]

4. India pubmed.ncbi.nlm.nih.gov

The effect of motivational interviewing-based training on the rate of using mental health services and intensity of suicidal ideation in individuals with suicide attempt admitted to the emergency department. [2020]

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

Using Motivational Interviewing to Address Tobacco Cessation: Two Standardized Patient Cases for Pediatric Residents. [2020]

6. 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]

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

The role of therapist MI skill and client change talk class membership predicting dual alcohol and sex risk outcomes. [2020]

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

An example of implementing a safety protocol in remote intervention and survey research with college students. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Motivational interviewing for smoking cessation. [2022]

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

Learning motivational interviewing in a real-life setting: a randomised controlled trial in the Swedish Prison Service. [2022]