Crisis Response Planning for Suicide Prevention

Not currently recruiting at 1 trial location

Overseen By Stephanie Gorka, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Manic episodes, Schizophrenia, Substance use, others

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

Compensation: Varies

Number of Visits: 11

Duration: 1 hour

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a special crisis response plan, known as Crisis Response Planning, can reduce suicidal thoughts more effectively than regular crisis counseling. Participants will receive either a one-hour personalized crisis plan or a standard crisis counseling session. Researchers will track changes in participants' mood, stress levels, and suicide risk over six months. Individuals with suicidal thoughts who do not have major medical or neurological issues may be suitable for this trial. As an unphased trial, this study offers participants the chance to contribute to innovative research that could enhance crisis intervention strategies.

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 is best to discuss this with the trial coordinators.

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

Studies have shown that Crisis Response Planning (CRP) is a promising method to reduce suicidal thoughts and attempts. Research indicates that CRP can lower suicide attempts by up to 76% compared to traditional methods, suggesting that the treatment is generally well-tolerated. Significant negative side effects from CRP have not been reported, making it a safe option for many people.

For Crisis Risk Counseling, studies suggest it also helps reduce suicidal thoughts. This approach involves supportive listening and creating a safety plan, which participants find helpful. Most report feeling satisfied and find it useful, indicating it is a well-accepted and safe intervention.

Overall, both treatments have proven effective and safe for reducing suicidal thoughts and attempts, with no major adverse effects reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Crisis Response Planning (CRP) is unique because it actively involves patients in identifying their personal warning signs and coping strategies for emotional crises. Unlike typical treatments that primarily focus on risk assessment and crisis resources, CRP encourages patients to collaboratively create a personalized action plan with their therapist, which is then documented on an index card for easy reference. This hands-on, personalized approach empowers patients and provides them with a tangible tool to manage suicidal ideation in real-world situations. Researchers are particularly excited about CRP's potential to enhance patient engagement and self-management, which could lead to more effective prevention of suicidal behavior.

What evidence suggests that this trial's treatments could be effective for suicide prevention?

Research has shown that Crisis Response Planning (CRP), one of the treatments in this trial, can effectively reduce suicidal thoughts and attempts. One study found that CRP lowered suicide attempts by up to 76% compared to traditional crisis help. It also quickly reduces suicidal thoughts and improves mood.

Crisis Risk Counseling, another treatment option in this trial, is also helpful. Most people who use crisis hotline services feel supported, with 88.1% reporting it stopped them from attempting suicide. However, CRP has stronger evidence for reducing actual suicide attempts and thoughts. Both treatments in this trial aim to reduce the risk of suicide by offering support and resources to those in crisis. ^{1 2 3 4 6}

Who Is on the Research Team?

Stephanie Gorka, PhD

Principal Investigator

Ohio State University

Are You a Good Fit for This Trial?

Adults with current suicidal intent, as indicated by a score of 5 or more on the Beck's Scale for Suicidal Ideation. Participants must be generally healthy and able to give informed consent. Excluded are those with certain mental health conditions, pregnant women, individuals under drug influence during scans, people uncomfortable in small spaces, non-English speakers, and anyone with metal implants.

Inclusion Criteria

I am generally healthy without major medical or neurological issues.

Willing and able to give informed consent

Individuals in the acutely suicidal group: endorse current suicide intent as indicated by a total score of 5 or greater on the Beck's Scale for Suicidal Ideation.

Exclusion Criteria

Currently pregnant or trying to become pregnant

I do not have any health conditions that would affect my participation in the study.

Inability to tolerate small, enclosed spaces without significant anxiety

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a 1-hour session of either crisis response planning (CRP) or standard crisis risk management

1 hour

1 visit (in-person)

Post-Intervention Monitoring

Daily assessments of mood and suicidality for 10 days, then monthly assessments for six months

6 months

Daily assessments for 10 days, monthly assessments thereafter

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Monthly assessments

What Are the Treatments Tested in This Trial?

Interventions

• Crisis Response Planning
• Crisis Risk Counseling
• CRP
• TAU

Trial Overview The study compares two suicide prevention strategies: a one-hour session of Crisis Response Planning (CRP) versus standard crisis risk management. The impact on emotion regulation and suicide risk is assessed immediately after and six months post-intervention. Daily mood checks occur for the first ten days then monthly up to six months.

How Is the Trial Designed?

Group I: Crisis Response Planning (CRP) Experimental Treatment 1 Intervention

The crisis response planning (CRP) session will last between 30 minutes to 1-hour. It will occur face-to-face with a trained study therapist. The CRP session involves the following standard suicide intervention strategies: supportive listening, provision of crisis resources, and referral to a mental health professional (if not already established). The CRP active component involves a collaborative process in which the therapist invites the patient to share the events, symptoms, and contextual factors leading up to and surrounding the participant's suicidal crisis. Next, the patient and therapist identify the patient's personal warning signs for an emotional crisis, self-management coping skills, patient's reasons for living, and sources of social support. These components are written, by the patient, on an index card. The index card serves as a concrete reference for patients in the real-world.

Group II: Control Active Control 1 Intervention

Individuals who have not experienced suicidal ideation will not complete a suicide intervention.

Group III: Crisis Risk Counseling Active Control 1 Intervention

The crisis risk counseling session will last between 30 minutes to 1-hour. It will occur face-to-face with a trained study therapist. It will include the following standard suicide intervention strategies: supportive listening, provision of crisis resources, and referral to a mental health professional (if not already established). The therapist will conduct a semi-structured suicide risk assessment interview, after which subjects will complete a self-guided safety plan worksheet. The worksheet takes approximately 10-minutes to complete and will be done independently.

Crisis Response Planning is already approved in United States for the following indications:

Approved in United States as Crisis Response Planning for:

• Suicide Prevention
• Posttraumatic Stress Disorder (PTSD) Management

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

Published Research Related to This Trial

A systematic review of 22 studies found that suicide safety planning (SSP) is effective in reducing suicidal behavior and ideation, highlighting its importance as a suicide prevention strategy.

SSP can be delivered in various formats, including standard, enhanced, and electronically, but more research is needed to explore its impact on mental illness symptoms and resilience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy. Marshall, CA., Crowley, P., Carmichael, D., et al.[2023]

In a study involving 97 active-duty U.S. Army personnel, both standard and enhanced crisis response plans (CRPs) were found to be highly acceptable and useful, with over 80% of participants retaining their written plans for up to 6 months.

More frequent use and better recall of the enhanced CRP, which includes reasons for living, were linked to significantly lower levels of suicidal thoughts compared to treatment as usual, highlighting its potential effectiveness in reducing suicide ideation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of crisis management interventions among suicidal patients: Results of a randomized controlled trial. Bryan, CJ., May, AM., Rozek, DC., et al.[2022]

Coping planning is proposed as a new approach to suicide prevention, shifting the focus from traditional safety planning to enhancing patients' coping skills and self-efficacy during acute distress.

This strategy emphasizes 'caring', 'collaborating', and 'connecting' to reinforce patients' strengths and provide necessary support, potentially leading to better outcomes and reduced risk of suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping planning: a patient-centred and strengths-focused approach to suicide prevention training. Stallman, HM.[2022]

Crisis response planning significantly reduced the incidence of suicide attempts among active duty Army Soldiers, with only 5% of participants using this plan attempting suicide compared to 19% using a contract for safety, indicating a 76% reduction in attempts.

Participants who received crisis response planning experienced a faster decline in suicidal thoughts and fewer days in inpatient care, demonstrating its effectiveness in improving mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. Bryan, CJ., Mintz, J., Clemans, TA., et al.[2022]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12429010/

Comparing the Impacts of Crisis Response Plan and Self‐ ... More frequent CRP use was linked with lower risk of suicidal ideation and greater positive affect. This may reflect better plan use due to ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0887618523001627

Crisis response planning rapidly reduces suicidal ideation ... Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts.

3. suicidepreventiontherapy.com suicidepreventiontherapy.com/crisis-response-planning-1

Crisis Response Planning (CRP) - Suicide Prevention Therapy CRP is a specific kind of safety planning-type intervention that has been shown to reduce suicide attempts by up to 76% as compared to traditional crisis ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10189833/

Effectiveness of Suicide Safety Planning Interventions Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI).

5. jamanetwork.com jamanetwork.com/journals/jamapediatrics/fullarticle/2834286

Safety Planning Interventions for Suicide Prevention in ... This systematic review and meta-analysis investigates the effectiveness of safety planning as a standalone intervention for suicide ...

6. continuum.militaryfamilies.psu.edu continuum.militaryfamilies.psu.edu/program/Crisis%20Response%20Planning%20(CRP)

Crisis Response Planning (CRP) Results indicated that the S-CRP and E-CRP groups experienced significant reductions in suicide attempts, significantly faster decline in suicide ideation, and ...