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

Trial Summary

What is the purpose of this trial?

Military service members admitted to inpatient psychiatry for self-injurious thoughts and behaviors (SITBs) represent an at-risk group for continued SITBs and rehospitalizations in the post-discharge period. However, there is an absence of evidence-based interventions designed to be delivered on inpatient psychiatric units to reduce the risk of post-discharge SITBs. To address this gap, the investigator's research group developed Written Exposure Therapy for Suicide Prevention (WET-SP), a brief, scalable, suicide-specific psychotherapy based on the written disclosure paradigm. Written disclosure, in which an individual writes about a personally stressful experience and the related thoughts and feelings, yields improvements across physical and psychiatric domains. Pilot data suggest that written exposure also yields reductions in SITBs. Yet, no study has adapted the written exposure paradigm specifically to target the amelioration of distress associated with suicidal crises and examined whether implementing WET-SP reduces the risk of subsequent SITBs and suicide-related hospitalizations. 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 duty military service members following a psychiatric hospitalization due to suicidal ideation, suicide plans, or a suicide attempt. Secondary objectives are to evaluate a potential mechanism of change (i.e., decreases in thwarted belongingness \[cf. social disconnectedness\]) and moderator of outcomes (i.e., arc of narrative \[cf. linguistical parameters of the written narratives generated during treatment\]). Participants randomized to WET-SP + TAU will receive five sessions of WET-SP delivered by the study team during their psychiatric hospitalization plus treatment-as-usual (TAU). Participants randomized to TAU will receive daily contact and patient-centered care delivered by the acute psychiatric inpatient unit provider team (e.g., psychiatrists, therapists, case managers). TAU includes psychiatric assessment, initial stabilization, nurse case management, medication management, treatment of medical comorbidities, group and individual therapy, and discharge planning. Outcome assessments will be administered at pretreatment, posttreatment, and 10-, 20-, and 30-week follow-ups.

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.

What data supports the effectiveness of the treatment Written Exposure Therapy for Suicide Prevention?

Written Exposure Therapy (WET) has been shown to be effective for treating posttraumatic stress disorder (PTSD), which is often linked to suicidal thoughts. Studies indicate that WET can reduce PTSD symptoms and may help decrease suicidal ideation, making it a promising option for suicide prevention. ^{1 2 3 4 5}

Is Written Exposure Therapy safe for humans?

Written Exposure Therapy (WET) has been studied primarily for posttraumatic stress disorder (PTSD) and is generally considered safe, with studies showing it is well-tolerated by participants. While specific safety data for suicide prevention is not detailed, the therapy's use in PTSD suggests it is safe for human use. ^{1 2 3 4 6}

How is Written Exposure Therapy for Suicide Prevention different from other treatments?

Written Exposure Therapy for Suicide Prevention (WET-SP) is unique because it is a brief, 5-session treatment that doesn't require homework between sessions, making it more accessible and easier to complete compared to other therapies that often require more time and effort. ^{1 2 3 7 8}

Research Team

Brian P Marx, PhD

Principal Investigator

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

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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) 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) 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 (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, 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]

References

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

Long-term treatment gains of a brief exposure-based treatment for PTSD. [2022]

2. Korea (South) pubmed.ncbi.nlm.nih.gov

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea. [2021]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Brief novel therapies for PTSD: Written Exposure Therapy. [2022]

4. United States 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. [2021]

5. Spain pubmed.ncbi.nlm.nih.gov

Psychiatric Hospitalization for Attempted Suicide and Reattempt at the One-Year Follow-Up. [2022]

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

Effectiveness of written exposure therapy for posttraumatic stress disorder in the Department of Veterans Affairs Healthcare System. [2023]

7. United States 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. [2022]

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

Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder: A Randomized Clinical Trial. [2023]