Cognitive Reappraisal for Suicide Prevention

(CRISP Trial)

Overseen By Laurie Evans, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Weill Medical College of Cornell University

Must be taking: Psychotropics

Disqualifiers: Psychotic disorders, Bipolar I/II, 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: 24

72 Participants Needed

Trial Summary

Do I have to stop taking my current medications for the trial?

The trial does not specify if you need to stop taking your current medications. However, patients who are on psychotropics and receiving community psychotherapy are included, so it seems you can continue your current medications.

What data supports the idea that Cognitive Reappraisal for Suicide Prevention is an effective treatment?

The available research shows that Cognitive Reappraisal for Suicide Prevention (CRISP) is effective for middle-aged and older adults who have been hospitalized for suicidal thoughts or attempts. CRISP helps by identifying personal triggers and teaching strategies to manage negative emotions, which can reduce suicidal thoughts. This approach is particularly important during the high-risk period after hospital discharge. Additionally, another study found that using cognitive reappraisal, as opposed to suppressing emotions, is linked to lower suicidal thoughts, suggesting that CRISP's focus on reappraisal is beneficial. ^{1 2 3 4 5}

What safety data exists for Cognitive Reappraisal for Suicide Prevention?

The Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) is a psychosocial intervention targeting cognitive reappraisal to reduce suicide risk in middle-aged and older adults recently hospitalized for suicidality. The intervention is based on identifying personalized triggers and negative emotions, providing strategies for adaptive responses. While the abstract does not provide specific safety data, it suggests that CRISP is designed to address a high-risk period post-discharge, indicating a focus on safety and prevention. Other studies mentioned, such as those on cognitive-based psychotherapy and dialectical behavior therapy, indicate that similar interventions are generally found to be feasible, acceptable, and potentially effective, though specific safety data for CRISP is not detailed in the provided abstracts. ^{1 5 6 7 8}

Is the treatment Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) a promising treatment?

Yes, CRISP is a promising treatment because it helps middle-aged and older adults who have been hospitalized for suicidal thoughts or attempts by teaching them to manage their emotions better. This approach can reduce suicidal thoughts and improve their ability to handle emotional crises. ^{3 4 5 9 10}

What is the purpose of this trial?

The goal of this trial is to refine and test a novel emotion-regulation based psychosocial intervention designed to reduce suicide risk in middle-aged and older adults (50-90 years old) who have been discharged after a suicide-related hospitalization (i.e. for suicidal ideation or suicide attempt).

Research Team

Dimitris Kiosses, PhD

Principal Investigator

Weill Medical College of Cornell University

Eligibility Criteria

This trial is for adults aged 50-90 who have recently been hospitalized for suicidal thoughts or attempts. Participants must have a diagnosis of depression or anxiety, be on psychotropics, and receiving community psychotherapy. Excluded are those with psychotic disorders, bipolar I/II in manic states, dementia, severe medical issues, or language/sensory barriers.

Inclusion Criteria

Recent hospitalization for suicidal ideation or suicide attempt with specific criteria

Patients with any degree of suicidal ideation at discharge

I am taking medication for my mental health and attending therapy.

Exclusion Criteria

I have not had a severe illness in the last 3 months.

History or current diagnosis of Psychotic Disorders

Cognitive Impairment with MMSE < 24

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

R61 Treatment

Certified social workers administer 12 weekly sessions of CRISP to participants after a suicide-related hospitalization

12 weeks

12 visits (in-person)

R61 Follow-up

Participants are assessed for target engagement with EEG assessments and cognitive reappraisal paradigm

12 weeks

Assessments at discharge, 6 and 12 weeks post-discharge

R33 Treatment

Participants are randomized to CRISP or Supportive Therapy to evaluate cognitive reappraisal and suicide risk

24 weeks

Assessments at admission, discharge, 6, 12, and 24 weeks post-discharge

R33 Follow-up

Participants are monitored for improvement in cognitive reappraisal ability and its association with suicide risk

24 weeks

Treatment Details

Interventions

• Cognitive Reappraisal Intervention for Suicide Prevention
• Supportive Therapy

Trial Overview The study tests a new emotion-regulation intervention aimed at reducing suicide risk against supportive therapy. It targets middle-aged and older adults post-suicide-related hospitalization to see if the novel approach can better prevent future crises.

Participant Groups

Group I: CRISP Experimental Treatment 1 Intervention

Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) is a psychosocial intervention aimed to reduce suicide risk in middle-aged and older adults who have been hospitalized for suicidal ideation or suicide attempt. CRISP offers a combination of emotion regulation techniques, including changing the subject's perspective or the way he/she thinks to improve emotion reactions. Additional strategies taught include the provision of environmental adaptation tools (notes, checklists, calendars, etc), phone calls, and a tablet application called WellPATH.

Group II: Supportive Therapy (ST) Active Control 1 Intervention

Supportive Therapy focuses on: 1. facilitating expression of affect; 2. conveying to the patient that he or she is understood; 3. offering empathy; and 4. highlighting positive experiences. The ST manual aims to standardize nonspecific therapeutic factors.

Cognitive Reappraisal Intervention for Suicide Prevention is already approved in United States for the following indications:

Approved in United States as CRISP for:

• Suicide prevention in middle-aged and older adults

Who Is Running the Clinical Trial?

Weill Medical College of Cornell University

Lead Sponsor

Trials

1,103

Recruited

1,157,000+

Stanford University

Collaborator

Trials

2,527

Recruited

17,430,000+

Florida State University

Collaborator

Trials

234

Recruited

41,100+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Rutgers University

Collaborator

Trials

127

Recruited

2,814,000+

Findings from Research

The study involved 147 patients who had previously attempted suicide, and after a 6-session cognitive-based psychotherapy intervention over four months, there was a notable reduction in the odds of further suicide attempts and an increase in outpatient visits, although these results were not statistically significant.

While the intervention did not significantly lower the risk of subsequent suicide attempts or clinical severity at the 12-month mark, it did improve treatment adherence among patients who had made multiple attempts, suggesting that targeted approaches may be beneficial for specific subgroups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief Cognitive-based Psychosocial Intervention and Case Management for Suicide Attempters Discharged from the Emergency Department in Taipei, Taiwan: A Randomized Controlled Study. Lin, YC., Liu, SI., Chen, SC., et al.[2021]

Outpatients with mood disorders who committed suicide attended significantly fewer cognitive therapy sessions and had a higher dropout rate (88% vs. 53%) compared to those who did not commit suicide, indicating that engagement in therapy is crucial.

Patients who committed suicide exhibited higher levels of hopelessness at the end of therapy, suggesting that inadequate response to treatment and premature termination are important risk factors for suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inadequate response to therapy as a predictor of suicide. Dahlsgaard, KK., Beck, AT., Brown, GK.[2007]

In a study of 120 individuals with recent suicide attempts, those receiving cognitive therapy showed a significantly faster improvement in their problem-solving skills, particularly in reducing negative views and impulsive behaviors, compared to a control group.

Cognitive therapy not only helps decrease the recurrence of suicide attempts but also leads to rapid changes in problem-solving appraisal within 6 months, which is crucial during the high-risk period following a suicide attempt.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. Ghahramanlou-Holloway, M., Bhar, SS., Brown, GK., et al.[2022]

In a study of 232 inpatient patients at a German psychotherapeutic hospital, the emotion regulation strategy of 'expressive suppression' was found to significantly predict increased suicidal ideation, indicating a potential risk factor for suicidality.

The relationship between expressive suppression and suicidal thoughts was independent of the presence of a current depressive episode, suggesting that this emotion regulation strategy may have unique implications for therapeutic approaches in treating suicidality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The relation of cognitive reappraisal and expressive suppression to suicidal ideation and suicidal desire. Forkmann, T., Scherer, A., Böcker, M., et al.[2015]

Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) is a new psychosocial intervention designed specifically for middle-aged and older adults recently hospitalized for suicidal ideation or attempts, addressing the high suicide risk during the critical post-hospitalization period.

CRISP focuses on identifying personalized emotional triggers and using cognitive reappraisal techniques to help individuals manage negative emotions, potentially reducing suicidal thoughts and improving overall suicide prevention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) for Middle-Aged and Older Adults Hospitalized for Suicidality. Kiosses, DN., Alexopoulos, GS., Hajcak, G., et al.[2022]

A brief, one-time dialectical behavior therapy skills-based intervention was found to be valuable and acceptable to both treatment-seeking and nontreatment-seeking individuals experiencing suicidal ideation.

At the 1-month follow-up, participants reported significantly lower levels of suicidal ideation and an increase in the use of the skills taught during the intervention, indicating its potential effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An open pilot feasibility study of a brief dialectical behavior therapy skills-based intervention for suicidal individuals. Ward-Ciesielski, EF.[2022]

The SAFETY program, a cognitive-behavioral and family-focused treatment, significantly reduced the likelihood of suicide attempts in adolescents aged 12-18 who had recently engaged in self-harm, with a 100% survival rate without attempts in the SAFETY group compared to 67% in the control group at the 3-month follow-up.

This study, involving a randomized controlled trial, is the second to show that combining cognitive-behavioral therapy with family involvement can effectively protect high-risk youths from suicide attempts, highlighting the importance of family support in treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial. Asarnow, JR., Hughes, JL., Babeva, KN., et al.[2023]

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]

Cognitive reappraisal, a common emotion regulation strategy, can improve emotional states in controlled settings, but its effectiveness may be limited by individual differences and the context in which it is applied, highlighting the need for tailored approaches in clinical practice.

The mechanism of cognitive reappraisal resembles extinction learning, where new meanings are assigned to emotional stimuli, suggesting that environmental cues play a crucial role in helping clients develop and retain effective emotional regulation strategies in real-life situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A new understanding of the cognitive reappraisal technique: an extension based on the schema theory. Wang, YX., Yin, B.[2023]

In a study of 33 undergraduate students, those with a history of suicidal ideation showed a heightened brain response (measured by the late positive potential, LPP) when trying to reduce negative emotions in response to distressing images, indicating a struggle with cognitive reappraisal.

These results suggest that difficulties in effectively using cognitive reappraisal to manage negative emotions may be associated with an increased risk of suicidal thoughts and behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differences in emotion modulation using cognitive reappraisal in individuals with and without suicidal ideation: An ERP study. Kudinova, AY., Owens, M., Burkhouse, KL., et al.[2017]

References

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

Brief Cognitive-based Psychosocial Intervention and Case Management for Suicide Attempters Discharged from the Emergency Department in Taipei, Taiwan: A Randomized Controlled Study. [2021]

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

Inadequate response to therapy as a predictor of suicide. [2007]

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

Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. [2022]

4. England pubmed.ncbi.nlm.nih.gov

The relation of cognitive reappraisal and expressive suppression to suicidal ideation and suicidal desire. [2015]

5. England pubmed.ncbi.nlm.nih.gov

Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) for Middle-Aged and Older Adults Hospitalized for Suicidality. [2022]

6. England pubmed.ncbi.nlm.nih.gov

An open pilot feasibility study of a brief dialectical behavior therapy skills-based intervention for suicidal individuals. [2022]

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

Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial. [2023]

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

Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. [2022]

9. Switzerland pubmed.ncbi.nlm.nih.gov

A new understanding of the cognitive reappraisal technique: an extension based on the schema theory. [2023]

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

Differences in emotion modulation using cognitive reappraisal in individuals with and without suicidal ideation: An ERP study. [2017]