Psychotherapy for Suicidal Thoughts in Young People

Overseen By Robert J Gregory, MD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: State University of New York - Upstate Medical University

Must not be taking: ECT, ketamine

Disqualifiers: Schizophrenia, Autism, Low BMI, others

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

Compensation: Varies

Number of Visits: 4

Duration: 6 months

106 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this clinical trial is to assess whether 6 months of treatment with Dynamic Deconstructive Psychotherapy (DDP) is more effective for reducing thoughts of suicide in suicidal adolescents and young adults than usual care in the community supplemented with Brief Intervention and Contact (BIC). DDP and BIC are two evidence-based practices shown to be more effective than usual care at reducing suicidality. Participants will be randomly assigned to receive DDP treatment with safety planning and optional medication management or BIC treatment with safety planning and optional medication management. Participants in both groups will receive the assigned treatment at SUNY Upstate Medical University's Psychiatry High Risk Program (PHRP). Each participant is anticipated to take part in this trial for up to one year.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, it mentions optional medication management, which suggests you might be able to continue some medications under supervision.

What data supports the effectiveness of the treatment Brief Intervention and Contact (BIC) and Dynamic Deconstructive Psychotherapy (DDP) for suicidal thoughts in young people?

Research shows that Dynamic Deconstructive Psychotherapy (DDP) is effective in reducing symptoms like depression and self-harming behavior in people with borderline personality disorder, which can be related to suicidal thoughts. Additionally, Dialectical Behavior Therapy (DBT), a similar therapy, has been shown to reduce self-directed violence and suicide attempts, suggesting that structured psychotherapies can be beneficial for managing suicidal thoughts. ^{1 2 3 4 5}

Is Dynamic Deconstructive Psychotherapy (DDP) safe for humans?

Research on Dynamic Deconstructive Psychotherapy (DDP) shows it is generally safe and well-tolerated, with participants showing improvement in various symptoms and a good rate of staying in treatment. ^{1 2 4 6 7}

How does the treatment Brief Intervention and Contact (BIC) and Dynamic Deconstructive Psychotherapy (DDP) differ from other treatments for suicidal thoughts in young people?

The treatment Brief Intervention and Contact (BIC) and Dynamic Deconstructive Psychotherapy (DDP) is unique because it combines brief, structured interventions with ongoing contact, aiming to provide immediate support and maintain engagement over time, which is different from other therapies that may focus solely on long-term psychotherapy or crisis intervention. ^{3 8 9 10 11}

Research Team

Robert J Gregory, MD

Principal Investigator

State University of New York - Upstate Medical University

Eligibility Criteria

This trial is for adolescents and young adults aged 14-40 with suicidal thoughts who are fluent in English. They must be willing to be video-recorded, attend outpatient treatment, and have certain scores on suicide ideation scales. It excludes those with schizophrenia, schizoaffective disorder, autism spectrum disorder, low BMI or IQ, or current treatment with DDP or specific medications.

Inclusion Criteria

I am between 14 and 40 years old.

I am willing to start outpatient treatment and have seen a psychiatrist.

I am willing to be video-recorded.

Exclusion Criteria

Previous or current clinical diagnosis of schizophrenia, schizoaffective disorder or autism spectrum disorder as ascertained by self-report on the PHRP intake packet, or on their electronic medical records, or by psychiatric evaluation at the PHRP

My BMI is below 18 if I'm an adult, or below 17 if I'm a teenager.

IQ < 80 on the Peabody Picture Vocabulary Test

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either Dynamic Deconstructive Psychotherapy (DDP) or Brief Intervention and Contact (BIC) for 6 months, with weekly sessions for DDP and scheduled follow-up visits for BIC.

6 months

Weekly visits for DDP; 1, 2, 4 weeks and 2, 3, 4, 6, 12 months for BIC

Follow-up

Participants are monitored for safety and effectiveness after treatment, with outcome measures assessed at baseline, 3, 6, 9, and 12 months.

6 months

Visits at baseline, 3, 6, 9, and 12 months

Open-label extension (optional)

Participants may opt into continuation of treatment long-term

Long-term

Treatment Details

Interventions

• Brief Intervention and Contact (BIC)
• Dynamic Deconstructive Psychotherapy (DDP)

Trial Overview The study compares Dynamic Deconstructive Psychotherapy (DDP) against Brief Intervention and Contact (BIC), both supplemented by safety planning and optional medication management. Participants will randomly receive either DDP or BIC at SUNY Upstate Medical University's Psychiatry High Risk Program for up to one year.

Participant Groups

Group I: Dynamic Deconstructive Psychotherapy (DDP) Experimental Treatment 1 Intervention

53 participants will meet with an assigned DDP therapist in-person or through televideo for 50 to 60 minutes on a weekly basis for 12 months. Participants will also meet with a psychiatric provider for a 60-minute psychiatric consultation with at least monthly 30-minute follow-up visits. In addition, participants in this arm will have the option of attending family and group therapy if interested and indicated. At baseline, 3, 6, 9, and 12 months, participants will meet with a research coordinator for 60-minute visits to complete outcome measures.

Group II: Brief Intervention and Contact (BIC) Active Control 1 Intervention

53 participants will meet with an assigned BIC therapist in-person or through televideo for an initial 60-minute visit with eight 30-minute follow-up contacts at 1, 2, 4 weeks and 2, 3, 4, 6 and 12 months after study entry. Participants will also meet with a psychiatric provider for a 60-minute psychiatric consultation with at least monthly 30 minute follow-up visits. In addition, participants in this arm will be encouraged to receive services in the community, such as weekly individual psychotherapy, family and group therapy. At baseline, 3, 6, 9, and 12 months, participants will meet with a research coordinator for 60-minute visits to complete outcome measures.

Brief Intervention and Contact (BIC) is already approved in United States for the following indications:

Approved in United States as Brief Intervention and Contact for:

• Suicidal ideation in adolescents and young adults

Who Is Running the Clinical Trial?

State University of New York - Upstate Medical University

Lead Sponsor

Trials

176

Recruited

27,600+

Findings from Research

In a study involving 77 adolescents with a history of self-harm, dialectical behavior therapy for adolescents (DBT-A) was found to be more effective than enhanced usual care (EUC) in reducing self-harm, suicidal thoughts, and depressive symptoms over a 19-week period.

DBT-A showed large effect sizes for treatment outcomes, indicating significant improvements, while EUC had only small effect sizes, highlighting the potential of DBT-A as a strong intervention for adolescents struggling with repetitive self-harming behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. Mehlum, L., Tørmoen, AJ., Ramberg, M., et al.[2022]

Dialectical Behavior Therapy (DBT) has been shown to significantly reduce self-directed violence, including suicide attempts and non-suicidal self-injury, based on a meta-analysis of 18 controlled trials.

DBT also decreased the frequency of psychiatric crisis services accessed by patients, indicating its effectiveness in managing acute suicidality, although it did not significantly impact suicidal ideation itself.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. DeCou, CR., Comtois, KA., Landes, SJ.[2019]

A study involving 24 high-risk adolescents showed that 6 months of Dialectical Behavior Therapy (DBT) in a community clinic significantly reduced suicide attempts, self-harming behaviors, and suicidal thoughts.

DBT also led to improvements in various suicide risk factors, such as emotion regulation, depression, and impulsivity, while maintaining high treatment retention and satisfaction rates, highlighting its effectiveness in community settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of Dialectical Behavior Therapy with Suicidal and Self-Harming Adolescents in a Community Clinic. Berk, MS., Starace, NK., Black, VP., et al.[2022]

Dynamic deconstructive psychotherapy (DDP) was found to be feasible and effective for individuals with both borderline personality disorder (BPD) and alcohol use disorder, showing significant improvements in various symptoms over a year-long treatment with 30 participants.

Participants receiving DDP had a treatment retention rate of 67% to 73% and demonstrated greater improvements in areas such as parasuicide behavior and alcohol misuse compared to those receiving standard treatment as usual (TAU), who showed limited changes despite higher treatment intensity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Gregory, RJ., Chlebowski, S., Kang, D., et al.[2019]

In a study of 68 clients with borderline personality disorder, both Dialectical Behavior Therapy (DBT) and Dynamic Deconstructive Psychotherapy (DDP) significantly reduced symptoms of BPD, depression, and disability after 12 months, showing effectiveness similar to controlled trials.

DDP outperformed DBT in terms of treatment outcomes, while DBT had a high dropout rate, suggesting that DDP may be a more effective option in real-world settings for treating BPD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Naturalistic Outcomes of Evidence-Based Therapies for Borderline Personality Disorder at a Medical University Clinic. Gregory, RJ., Sachdeva, S.[2019]

Dialectical Behavior Therapy (DBT) is highly effective for treating complex mental health issues, particularly for individuals with borderline personality disorder (BPD), focusing on chronic suicidality and emotion dysregulation.

The authors discuss the strengths and limitations of the BPD Compass intervention, which is a promising approach in the context of DBT, indicating ongoing developments in effective therapies for BPD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Borderline personality disorder (BPD) Compass is a promising complementary intervention to dialectical behavior therapy: Comment on Sauer-Zavala (2022). Crowell, SE., Kaliush, PR., Vlisides-Henry, RD.[2023]

A pilot study involving 17 Veterans showed that Dialectical Behavior Therapy Skills Group (DBT-SG) was feasible and acceptable, with participants attending an average of 66% of sessions and reporting satisfaction with the treatment.

Results indicated significant reductions in suicidal ideation and emotion dysregulation after the 26-week program, with improvements maintained at a 3-month follow-up, suggesting that DBT-SG may effectively enhance coping skills and reduce suicide risk in Veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for Veterans with suicidal ideation: pilot. Decker, SE., Adams, L., Watkins, LE., et al.[2022]

Psychotherapy, particularly cognitive behavioral therapy (CBT) and psychodynamic therapy, is an effective treatment for suicidality, emphasizing the importance of a collaborative 'team' approach between therapist and patient.

Both therapeutic strategies focus on understanding and modifying the patient's thoughts and behaviors related to suicidal ideation, with empirical evidence supporting their efficacy in reducing suicidality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Psychotherapy of suicidality]. Lindner, R., Schneider, B.[2022]

In a study of 53 patients undergoing long-term dynamic psychotherapy, those with suicidal ideation experienced more psychiatric diagnoses and negative reactions to treatment compared to non-suicidal patients, highlighting the complexity of their mental health needs.

The quality of the therapeutic alliance significantly influenced the improvement in suicidal ideation, suggesting that addressing negative reactions and enhancing the patient-therapist relationship can lead to better outcomes for suicidal patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Alliance, reactions to treatment, and counter-transference in the process of recovery from suicidal phenomena in long-term dynamic psychotherapy. Perry, JC., Bond, M., Presniak, MD.[2019]

Psychologists emphasized the importance of understanding the context of suicidality and using a formulation-based approach to create individualized treatment plans for suicidal adolescents, based on interviews with 12 psychologists involved in a suicide prevention program.

Involving families and broader support systems was crucial for reducing feelings of burdensomeness and enhancing safety and connectedness, highlighting the need for a systemic approach in treating suicidal youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychotherapy and youth suicide prevention: An interpretative phenomenological analysis of specialist clinicians' experiences. Janackovski, A., Deane, FP., Hains, A.[2022]

An ultra-brief acute crisis intervention based on Interpersonal Psychotherapy (IPT) was developed for children and adolescents at risk of suicide, consisting of five weekly sessions and monthly follow-ups over three months.

Preliminary results from a pilot study with 26 adolescents showed promising trends in reducing suicidal ideation, indicating that the intervention is safe, feasible, and acceptable, although further research is needed due to the small sample size.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultra-Brief Crisis IPT-A Based Intervention for Suicidal Children and Adolescents (IPT-A-SCI) Pilot Study Results. Haruvi Catalan, L., Levis Frenk, M., Adini Spigelman, E., et al.[2020]

References

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

Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Implementation of Dialectical Behavior Therapy with Suicidal and Self-Harming Adolescents in a Community Clinic. [2022]

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

A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. [2019]

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

Naturalistic Outcomes of Evidence-Based Therapies for Borderline Personality Disorder at a Medical University Clinic. [2019]

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

Borderline personality disorder (BPD) Compass is a promising complementary intervention to dialectical behavior therapy: Comment on Sauer-Zavala (2022). [2023]

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

Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for Veterans with suicidal ideation: pilot. [2022]

8. Germany pubmed.ncbi.nlm.nih.gov

[Psychotherapy of suicidality]. [2022]

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

Alliance, reactions to treatment, and counter-transference in the process of recovery from suicidal phenomena in long-term dynamic psychotherapy. [2019]

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

Psychotherapy and youth suicide prevention: An interpretative phenomenological analysis of specialist clinicians' experiences. [2022]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Ultra-Brief Crisis IPT-A Based Intervention for Suicidal Children and Adolescents (IPT-A-SCI) Pilot Study Results. [2020]