Suicide Clinical Trial
Official title:
Suicide Safety Planning Group Treatment - "Project Life Force"
For suicidal individuals, minimizing future risk and fostering recovery are critical public
health concerns, especially among Veterans, as very few effective interventions exist. This
proposal tests a novel group psychotherapy treatment that combines emotion regulation skill
based, and psychoeducational approaches, with suicide safety planning development and
implementation.
"Project Life Force" (PLF), a novel suicide safety planning group intervention has been
designed to fill this critical gap and provide a mechanism to develop and enhance suicide
safety planning over time. PLF, a 12-session, group psychotherapy intervention, combines
Dialectical Behavioral Therapy (DBT) skill based and psychoeducational approaches, to enhance
suicide safety planning development and implementation. Veterans revise their plans over
several weeks while learning distress tolerance, emotion regulation, and friendship
building/interpersonal skills to incorporate into their safety plans and also receive lessons
on gun safety and minimizing access to lethal means. Sessions are augmented with 1) training
in the use of a suicide safety planning mobile App to promote accessibility and maximize
implementation, and 2) didactic information to bolster recovery, including fostering improved
connection with the treatment team, and Veteran's family.
Despite the enrichment of VA suicide prevention services and implementation of the national
suicide hotline, Veteran suicide completions have risen to 22 per day and suicide attempts
numbered over 15,000 in 2012. These data underscore the urgency of developing additional
interventions targeting suicidal Veterans. The construction of a Suicide Safety Plan (SSP); a
"best practice", is mandated throughout the VA system, and a vital component of the VA's
coordinated effort at suicide prevention and recovery. The investigators' pilot data on
patterns of SSP use in suicidal Veterans over a 30 day time frame demonstrates that only 65%
of Veterans used their safety plans, coping strategies listed on the plan were often
mismatched or inadequate to the individual's needs, and limited access to the SSP during
times of stress negatively impacted its utility. To the investigators' knowledge, there are
currently no recommended guidelines or mechanisms for refinement of the SSP in adult
populations beyond its initial development. "Project Life Force" (PLF), a novel suicide
safety planning group intervention has been designed to fill this critical gap and provide a
mechanism to develop and enhance suicide safety planning over time. PLF, a 12-session, group
psychotherapy intervention, combines Dialectical Behavioral Therapy (DBT) skill based and
psychoeducational approaches, to enhance suicide safety planning development and
implementation. Veterans revise their plans over several weeks while learning distress
tolerance, emotion regulation, and friendship building/interpersonal skills to incorporate
into their safety plans and also receive lessons on gun safety and minimizing access to
lethal means. Sessions are augmented with 1) training in the use of a suicide safety planning
mobile App to promote accessibility and maximize implementation, and 2) didactic information
to bolster recovery, including fostering improved connection with the treatment team, and
Veteran's family. Importantly, the group format mitigates loneliness and fosters increased
"belongingness", both key risk factors for suicide. Additionally, PLF's weekly format
facilitates VA-mandated monitoring for any Veteran placed on the suicide "high risk" list.
Data from this project will test the intervention's feasibility, acceptability and
preliminary efficacy and provide pilot data for a larger randomized clinical trial. The
project is comprised of two phases. In Phase 1, the investigators will finalize the PLF
intervention and accompanying manual and handouts. In Phase 2, the investigators will conduct
an open label trial of PLF in 50 suicidal Veterans to evaluate the feasibility and
acceptability of the intervention. The investigators will also test whether PLF affects
outcomes of suicide ideation, depression, hopelessness, and outpatient compliance by
examining clinically meaningful differences in these measures before and after PLF.
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