Written Exposure Therapy for Suicide Prevention

Overseen By Denise M Sloan, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Boston University

Disqualifiers: Active psychosis, Cognitive impairment, others

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

Compensation: Varies

Number of Visits: 10

Duration: 1-2 weeks

160 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new therapy designed to reduce self-injury and suicidal thoughts in military service members following psychiatric hospitalization. The therapy, Written Exposure Therapy for Suicide Prevention (WET-SP), involves writing about personal stressful experiences to help manage emotions and thoughts. Participants will be divided into two groups: one receiving the new therapy along with usual care, and the other receiving only the usual care (Treatment-as-Usual, TAU). Those recently hospitalized for suicidal thoughts or attempts and who can read and write in English might be suitable for this trial. As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research that could shape future therapies.

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 mentions medication management as part of the usual care, so it's likely you can continue your current medications, but you should confirm with the trial coordinators.

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

Research shows that Written Exposure Therapy for Suicide Prevention (WET-SP) is likely safe. Early results suggest this therapy can reduce thoughts and behaviors related to self-harm, indicating that most participants find it manageable.

Previous studies have safely used similar therapy methods with individuals who have post-traumatic stress disorder (PTSD). These methods proved effective even for those with mood disorders or substance use issues, suggesting the therapy is generally safe and manageable.

Although specific data on WET-SP is limited, it is based on a well-tested approach, providing some confidence in its safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Written Exposure Therapy for Suicide Prevention (WET-SP) because it offers a novel approach that differs from traditional interventions, which often involve medication and lengthy psychotherapy sessions. WET-SP is designed to be quick and accessible, with just five sessions conducted over consecutive days, making it possible for patients to complete the therapy even during a short hospital stay. This method focuses on written exercises that help individuals process their experiences and emotions, potentially leading to faster emotional relief and a reduction in suicidal thoughts. Unlike other treatments that might take weeks to show results, WET-SP aims to deliver benefits swiftly, which could be crucial for those in acute crisis situations.

What evidence suggests that Written Exposure Therapy for Suicide Prevention could be effective for reducing self-injurious thoughts and behaviors?

Research has shown that Written Exposure Therapy (WET) can improve both mental and physical health. Early studies suggested it helps reduce thoughts and behaviors related to self-harm. In this trial, participants in one arm will receive Written Exposure Therapy for Suicide Prevention (WET-SP) alongside Treatment-as-Usual (TAU). This is especially important for military service members at risk after psychiatric hospitalization. WET involves writing about stressful experiences and feelings, which can help lower distress during suicidal crises. This therapy can be easily provided in short sessions, making it suitable for hospital settings. ^{1 3 5 6 7}

Who Is on the Research Team?

Brian P Marx, PhD

Principal Investigator

Dept of Psychiatry, Chobanian & Avedisian BU School of Medicine and VA Boston Healthcare System

Are You a Good Fit for This Trial?

Active duty military service members hospitalized for suicidal thoughts, plans, or attempts and showing significant suicidal ideation. Participants must be able to read, write, and speak English.

Inclusion Criteria

Current active duty military service member

I was admitted to CRDAMC for suicidal thoughts or actions.

Elevated levels of suicidal ideation severity in the past two weeks, as indicated by a score >3 on the Depressive Symptom Index-Suicidality Subscale (DSI-SS; Joiner et al., 2002; Stanley et al., 2021)

Exclusion Criteria

My main reason for hospital care is not due to active psychosis.

I have trouble understanding basic questionnaires.

I am unable to understand and agree to the study's details on my own.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive five sessions of Written Exposure Therapy for Suicide Prevention (WET-SP) during psychiatric hospitalization, plus treatment-as-usual (TAU)

1-2 weeks

Daily sessions during hospitalization

Follow-up

Participants are monitored for safety and effectiveness after treatment with assessments at 10, 20, and 30 weeks

30 weeks

Assessments at 10, 20, and 30 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Treatment-as-Usual (TAU)
• Written Exposure Therapy for Suicide Prevention (WET-SP)

Trial Overview The trial is testing WET-SP—a brief psychotherapy aimed at reducing distress from suicidal crises—against the usual care (TAU). It involves writing about stressful experiences during hospitalization with follow-ups after discharge.

How Is the Trial Designed?

Group I: Written Exposure Therapy-for Suicide Prevention (WET-SP) +TAU Experimental Treatment 2 Interventions

Participants randomized into this arm will be offered WET-SP which will consist of 5 treatment sessions, conducted daily while the participant is hospitalized, allowing for the largest dose of treatment possible while inpatient. If a patient is discharged prior to the completion of WET-SP, the remaining sessions will be conducted in outpatient sessions. Participants in this arm will also be offered TAU.

Group II: Treatment as usual (TAU) Active Control 1 Intervention

Participants randomized into this arm will be offered TAU which consists of daily contact and patient centered care by the acute psychiatric inpatient unit provider team (e.g., psychiatrists, therapists, case managers, behavioral health techs). Participants will engage with the provider team daily throughout the duration of hospitalization.

Who Is Running the Clinical Trial?

Boston University

Lead Sponsor

Trials

494

Recruited

9,998,000+

United States Department of Defense

Collaborator

Trials

940

Recruited

339,000+

School of Medicine, Anschutz Medical Campus, Colorado University

Collaborator

Trials

1

Recruited

160+

The University of Texas Health Science Center at San Antonio

Collaborator

Trials

486

Recruited

92,500+

University of Colorado, Denver

Collaborator

Trials

1,842

Recruited

3,028,000+

Published Research Related to This Trial

Written exposure therapy (WET) significantly reduced PTSD symptoms in Korean patients, with 60.9% of participants no longer meeting PTSD criteria at 6 weeks, increasing to 77.8% at 24 weeks, demonstrating its efficacy.

The therapy also improved depressive symptoms and global functioning, with a low dropout rate of 8%, indicating that WET is a feasible and effective treatment option for PTSD in diverse populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea. Park, JE., Choi, KS., Han, YR., et al.[2021]

Written Exposure Therapy (WET) significantly reduced PTSD symptoms (effect size d = .84), depression symptoms (d = .47), and functional impairment (d = .36) in a study involving 277 veterans, demonstrating its effectiveness in a clinical setting.

The treatment was effective regardless of whether it was delivered in-person or via telehealth, with telehealth showing a lower dropout rate, suggesting it may be a more accessible option for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of written exposure therapy for posttraumatic stress disorder in the Department of Veterans Affairs Healthcare System. LoSavio, ST., Worley, CB., Aajmain, ST., et al.[2023]

Written Exposure Therapy (WET) is as effective as Cognitive Processing Therapy (CPT) for treating PTSD, maintaining similar outcomes even 60 weeks after treatment, with large effects on PTSD symptoms for both therapies.

Both WET and CPT significantly reduced depressive symptoms over the study period, although CPT showed a quicker reduction; however, the overall difference in effectiveness for depression was small.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term treatment gains of a brief exposure-based treatment for PTSD. Thompson-Hollands, J., Marx, BP., Lee, DJ., et al.[2022]

Written Exposure Therapy (WET) is an effective 5-session treatment for PTSD that shows significant symptom improvement and requires less time from both patients and therapists compared to traditional therapies.

WET has similar efficacy to Cognitive Processing Therapy (CPT) but with a much lower dropout rate (6% for WET vs. 39% for CPT), making it a promising option for diverse populations, including veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief novel therapies for PTSD: Written Exposure Therapy. Thompson-Hollands, J., Marx, BP., Sloan, DM.[2022]

A randomized clinical trial is being conducted to evaluate the effectiveness of Written Exposure Therapy, a five-session treatment for PTSD, in reducing suicidal ideation and behaviors among military personnel in acute psychiatric care.

The study aims to determine if this therapy, combined with Crisis Response Planning, can effectively lower PTSD symptoms and improve outcomes compared to standard treatment, addressing the urgent need for effective interventions in high-risk patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Written exposure therapy for posttraumatic stress symptoms and suicide risk: Design and methodology of a randomized controlled trial with patients on a military psychiatric inpatient unit. Marx, BP., Fina, BA., Sloan, DM., et al.[2021]

In a study of 191 individuals hospitalized for suicide attempts, those receiving usual treatment plus a telephone follow-up program (TAU + T) showed a lower recurrence of suicide attempts compared to those receiving usual treatment alone (TAU).

Overall, 31.4% of participants attempted suicide again within a year, but the follow-up program appeared to help reduce this risk, particularly for those with a history of previous attempts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychiatric Hospitalization for Attempted Suicide and Reattempt at the One-Year Follow-Up. Goñi-Sarriés, A., Yárnoz-Goñi, N., López-Goñi, JJ.[2022]

Written exposure therapy, a brief 5-session intervention, was found to be noninferior to the more intensive cognitive processing therapy in treating PTSD among military service members, indicating it can be an effective alternative.

The study involved 169 active-duty military participants, with a high completion rate of 76.5% for written exposure therapy, suggesting it may be a more efficient treatment option with lower dropout rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder: A Randomized Noninferiority Trial. Sloan, DM., Marx, BP., Resick, PA., et al.[2022]

Written exposure therapy (WET) was found to be noninferior to prolonged exposure therapy (PE) in reducing PTSD symptoms among 178 veterans, demonstrating similar effectiveness with fewer sessions required.

Participants in the WET group had significantly lower dropout rates (12.5%) compared to those in the PE group (35.6%), suggesting that WET may be a more accessible treatment option for PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder: A Randomized Clinical Trial. Sloan, DM., Marx, BP., Acierno, R., et al.[2023]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40645368/

Written Exposure Therapy for Suicide Prevention (WET-SP) The primary objective of this study is to evaluate the efficacy of a novel, brief, scalable, cognitive behavioral therapy-WET-SP-in reducing the incidence ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT05878795

Written Exposure Therapy for Suicide Prevention The primary objective of this randomized controlled trial (RCT) is to evaluate the efficacy of WET-SP, in reducing the incidence and severity of SITBs in active ...

3. strongstar.org strongstar.org/research/strongstar/written-exposure-therapy-for-suicide-prevention-a-randomized-clinical-trial/

Written Exposure Therapy for Suicide Prevention WET has shown to be effective in improving mental and physical health, and data from pilot study research suggests that it also helps to reduce SITBs.

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40052305/

A Randomized Controlled Trial With High-Risk Patients ... Written Exposure Therapy, a brief treatment for posttraumatic stress disorder (PTSD), was augmented with Crisis Response Planning (WET + CRP) to address PTSD ...

5. ptsd.va.gov ptsd.va.gov/professional/treat/txessentials/written_exposure_therapy.asp

Written Exposure Therapy for PTSD - PTSD: National ... A growing number of studies indicate that WET is effective for PTSD, even among patients with complicated presentations and other comorbid disorders.

6. trialx.com trialx.com/clinical-trials/listings/323546/written-exposure-therapy-for-suicide-prevention/

Written Exposure Therapy for Suicide Prevention Pilot data suggest that written exposure also yields reductions in SITBs. Yet, no study has adapted the written exposure paradigm ...

7. researchgate.net researchgate.net/publication/393645438_Written_Exposure_Therapy_for_Suicide_Prevention_WET-SP_Design_and_methodology_of_a_randomized_controlled_trial_among_military_service_members_psychiatrically_hospitalized_for_suicide_risk

Written Exposure Therapy for Suicide Prevention (WET-SP) Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated.