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

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to determine if Dynamic Deconstructive Psychotherapy (DDP) is more effective than Brief Intervention and Contact (BIC) in reducing suicidal thoughts in young people. DDP involves weekly therapy sessions, while BIC includes an initial session followed by several shorter check-ins. Both groups receive safety planning and optional medication management. This trial may suit those dealing with suicidal thoughts and open to outpatient therapy. Participants will engage in the study for up to one year at SUNY Upstate Medical University's Psychiatry High Risk Program. As an unphased study, this trial offers a unique opportunity to contribute to important research that could shape future mental health treatments.

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.

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

Research has shown that Dynamic Deconstructive Psychotherapy (DDP) is generally well-tolerated. In studies with teenagers, DDP significantly reduced suicide attempts and thoughts. One study found that 65% of teens completed at least six months of DDP, and their suicide attempts dropped by 84%. Another study reported a 47% decrease in suicidal thoughts among those who received DDP.

Research also supports the safety and effectiveness of the Brief Intervention and Contact (BIC) program. BIC has successfully reduced suicidal thoughts and attempts. In various settings, brief interventions like BIC help more people access mental health services and improve their overall mental health.

Both treatments are backed by solid research, indicating they are safe and effective options for managing suicidal thoughts in young people. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for suicidal thoughts in young people because they offer new approaches to therapy. Dynamic Deconstructive Psychotherapy (DDP) stands out due to its structured, long-term engagement with a therapist over 12 months, which is more intensive than typical short-term therapies. Brief Intervention and Contact (BIC) offers a flexible, community-oriented approach, encouraging participants to integrate various support services alongside structured follow-up sessions. Both methods provide personalized attention either in-person or via televideo, offering more accessibility and adaptability compared to standard care options. These approaches might lead to more effective and lasting reductions in suicidal thoughts by addressing individual needs more comprehensively.

What evidence suggests that this trial's treatments could be effective for reducing suicidal thoughts in young people?

In this trial, participants will receive either Dynamic Deconstructive Psychotherapy (DDP) or Brief Intervention and Contact (BIC). Research has shown that DDP can reduce suicide attempts by 84% in teenagers who complete at least six months of treatment. This therapy also decreases suicidal thoughts by 47% in this group. Studies have found DDP to be very effective in treating suicidal behavior. Meanwhile, BIC significantly reduces deaths by suicide compared to standard care, with fewer deaths occurring in the BIC group. BIC effectively lowers suicide attempts and thoughts and helps improve access to mental health services. Both treatments have proven more effective than standard care. ^{3 4 6 7 8}

Who Is on the Research Team?

Robert J Gregory, MD

Principal Investigator

State University of New York - Upstate Medical University

Are You a Good Fit for This Trial?

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.

CSSRS suicide ideation of ≥ 2 and PHQ-9 item 9 of ≥ 1

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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