Clinical Trial Details
— Status: Recruiting
Administrative data
NCT number |
NCT05818696 |
Other study ID # |
PR210299 |
Secondary ID |
|
Status |
Recruiting |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
June 26, 2023 |
Est. completion date |
November 2025 |
Study information
Verified date |
June 2023 |
Source |
Ohio State University |
Contact |
Nicholas Allan, PhD |
Phone |
8502740567 |
Email |
nicholas.allan[@]osumc.edu |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
The goal of this clinical trial is to test whether inclusion of cognitive behavioral therapy
(CBT) for Uncertainty-Enhanced (CUE) with Lethal Means Counseling (LMC) is acceptable,
feasible, and efficacious in addressing secure firearm storage and associated psychological
constructs in active duty servicemembers. The clinical trial aims to:
- Assess the preliminary efficacy of a LMC intervention, augmented with CUE, on firearm
storage practices
- Examine mechanisms through which CUE and LMC increase firearm storage practices
- Assess credibility and acceptability of LMC
Participants will complete:
- One baseline visit
- Two intervention sessions-CUE and LMC
- Six brief surveys per day for 28 days using a mobile application
- One mid-point survey and five follow-up surveys
Description:
Firearms are the leading cause of death in US suicides and account for more than 60% of
military suicides. A primary driver of these high rates appears to be ready access to
firearms. Research suggests that firearm suicides could potentially be reduced by reducing
and/or limiting access to firearms. Considering these data, lethal means counseling (LMC) is
a recommended best practice for suicide prevention (e.g., National Action Alliance for
Suicide Prevention). Results of a recently completed Department of Defense-sponsored
randomized control trial (RCT) conducted by the investigators showed that safe firearm
storage practices (i.e., use of locking devices and/or safes) could be increased among
Servicemembers using a brief lethal means counseling (LMC) protocol developed in part by the
investigators. Though superior to control, 45% of Servicemembers who received LMC still
maintained at least one unsafely stored firearm, suggesting they continued to experience
barriers to behavior change. Accumulating evidence suggests that fear of the unknown-a form
of anxiety commonly experienced by people with low tolerance for uncertainty-may be an
important barrier to safe firearm storage. The primary aim of Project 5 is to test a brief
modular intervention to improve the effectiveness of LMC on safe firearm storage practices
among firearm-owning Servicemembers. In this study, the investigators will examine if LMC's
effects on firearm storage practices can be enhanced among Servicemembers who first receive
an intervention designed to reduce their intolerance of uncertainty (IU). These results could
provide important information about how LMC can be most effectively delivered to an
especially high risk subgroup of firearm-owning Servicemembers.
F1.1. Firearm Acquisition and Storage as a Strategy to Cope with Fear of the Unknown. The
coping model of protective gun ownership posits that people acquire firearms to reduce
distress experienced from inflated perceptions of environmental threat, and are unlikely to
safely store firearms because doing so is perceived to inhibit readiness to respond to
unexpected and uncertain threats. Firearm owners who acquire firearms for the primary purpose
of self-protection (i.e., protective firearm owners) report overgeneralized perceptions of
the world and other people as dangerous and/or threatening. Among firearm owners, exaggerated
threat perceptions are also associated with the intention to acquire additional firearms.
Negative affect is significantly higher among firearm owners who use no safe storage
practices (F(1,872)=6.9, p=.009). Anxiety about the unknown may therefore serve as a barrier
to safe firearm storage and decrease the effectiveness of LMC. The investigators will test
this hypothesis by testing the impact of a brief intervention designed to reduce IU when
delivered to firearm-owning Servicemembers.
F1.2. Intolerance of Uncertainty as a Risk Factor for Anxiety and Unsafe Firearm Storage. IU
involves an aversion to ambiguity and increased distress when experiencing uncertainty.
Elevated IU amplifies the experience of stress and anxiety, causing people to engage in
maladaptive cognitive and behavioral strategies to reduce distress. It is posited that IU may
impact a Servicemember's perception of threat from the environment and that this heightened
threat perception will limit their desire for safe storage practices. This is supported by a
recent study by the investigators in which IU and exaggerated threat expectancy were
significantly higher among adults intending to acquire a firearm as compared to those who
were not (partial η2=.014-.017). Among Servicemembers with elevated IU, adoption of safe
firearm storage practices may therefore be enhanced if IU is first reduced. This hypothesis
will be tested in the current study using an empirically-supported, brief web-based
intervention. The use of a web-based intervention platform significantly improves the
potential scale and reach of the intervention.
F1.3. Targeting IU to Enhance Lethal Means Counseling (LMC). IU is an ideal construct to
target in a web-based intervention given the abundance of research finding elevations in IU
across a broad spectrum of suicide risk factors. For example, IU is a strong transdiagnostic
correlate of many psychological and behavioral disorders associated with increased risk for
suicide: generalized anxiety disorder, major depression, obsessive compulsive disorder,
social anxiety disorder, panic disorder and agoraphobia, substance use disorders, eating
disorders, and posttraumatic stress disorder. Other studies have implicated IU as a risk
factor for suicidal thoughts and behaviors. IU is malleable, even in very brief
interventions. In a recent study, the investigators conducted the only RCT of a CBT-based
intervention for IU. In that study, an in-person IU Treatment (IUT) comprised of
psychoeducation and cognitive reappraisal techniques was compared to a control condition
focused on psychoeducation about health lifestyle behaviors. IUT led to significantly larger
reductions in IU, anxiety, and depression during follow-up, indicating IU can be reduced with
a brief intervention. Results of that study also showed that the majority of participants
found the intervention easy to understand, helpful, and applicable to their daily lives.
F1.4. IUT Refinement. Since completing this first RCT, this intervention has been refined to
improve the intervention. When modifying interventions, it is critical to involve relevant
stakeholders in the process. Two key alterations to IUT include a web-based delivery and
augmenting IUT with a mobile app for ecological momentary assessment (EMA) and ecological
momentary intervention (EMI). EMI is ideal for these brief interventions because it allows
for participants to gain much-needed practice of challenging negative automatic thoughts and
completing behavioral experiments in real-time, thereby improving internalization of learned
skills and strategies. The investigators recently completed a focus group with 8 people (M
age = 33.13, standard deviation [SD] = 11.50; 62.5% female) reporting IU at least 1 SD above
the community mean (M = 43.75, SD = 7.5). Participants reported the content was accessible,
easily understood, and highly relevant to their distress. Participants thought inclusion of
EMA and EMI would improve participant engagement and reported they would not perceive
completion of multiple surveys daily to be a burden. Participants also believed that
personalized content would increase engagement. Finally, participants assisted in identifying
exemplar behavioral experiments and in refining a delivery mechanism as successful completion
of behavioral experiments is a core driver in anxiety-based CBT interventions. Similar
augmentations to brief interventions for stress (d = .5), generalized anxiety disorder (ds =
.4-.6), and panic disorder (d = .5) have been successful in enhancing intervention effects,
further underscoring the promise of including EMI to optimize outcomes.
F1.5. Summary. In a recently completed RCT, the investigators showed that LMC increases
firearm storage practices among firearm-owning Servicemembers. Despite these promising
results, nearly half of Servicemembers did not fully adopt safe firearm storage practices.
Subsequent research suggests that exaggerated perceptions of the world as a dangerous and
threatening place may be a barrier to these practices. This study is designed to determine if
a brief intervention that has been shown to reduce IU-a cognitive bias that increases threat
perceptions and anxiety-can increase the effectiveness of LMC. This project will be the first
to test a brief modular intervention to improve LMC as a preventative intervention for
suicide. These results could inform community-based suicide prevention efforts in the DoD and
may also improve the effectiveness of LMC delivered within healthcare settings.