Nonsuicidal Self Injury Clinical Trial
Official title:
Evaluating an Online, Single-Session Intervention Targeting Self-Injurious Behavior in Adolescents
Participants (aged 13-16) will be randomized to: (1) an online, active control group program
encouraging feelings disclosure (i.e. supportive therapy single session intervention [SSI]),
or (2) an online program targeting nonsuicidal self-injury (NSSI; i.e. Project "SAVE"-Stop
Adolescent Violence Everywhere-SSI). Investigators will test whether SAVE results in
significantly greater:
1. Reductions in NSSI 3 months post-treatment [primary outcome]
2. Reductions in self-reported likelihood of future NSSI immediately post-treatment
[secondary outcome]
3. Reduction in suicide ideation frequency 3 months post-treatment [secondary outcome]
Most mental health problems emerge by age 14, often leading to chronic impairments and
adverse impacts for individuals, families, and societies. Similarly, suicidal thoughts and
behaviors are relatively rare during childhood but increase significantly during the
transition to adolescence. Self-injurious thoughts and behaviors (SITBs), which include
suicidal thoughts and behaviors and nonsuicidal self-injury (NSSI; intentional self-harm
enacted without suicidal intent), are among the best predictors of future suicidal thoughts
and attempts in the current state of literature on the topic. There is also significant
escalation from suicidal thoughts to suicidal behaviors during this developmental period.
Most youth who transition from suicidal thoughts to suicidal behaviors will do so within 1-2
years after the onset of suicide ideation, which tends to begin in adolescents. Taken
together, adolescence is a key developmental period for effective depression and suicide
intervention and prevention. The goal of these studies is to test Single Session
Interventions (SSIs) (defined below) that are designed to boost coping and resilience in
adolescents. The investigators hope that this research will be valuable in ensuring that
these SSIs are accessible to more adolescents.
Despite significant strides in the development of psychosocial treatments for youth mental
health problems, up to 80% of youth in the United States with mental health needs receive no
services at all. Even when services are accessed, the definition of "treatment" is incredibly
broad, with evidence-based interventions being the exception, not the rule. More typically,
"treatment" may involve a single, unstructured contact with a medical doctor, counselor,
emergency hotline, religious leader, or other health professional (e.g., occupational
therapist), the benefits of which are unknown.
This reality poses a critical challenge to the field of clinical intervention science-one
that has been articulated many times before. Eight years ago, Kazdin and Blase (2011) called
for a "rebooting" of psychotherapy research and practice, stating that "mental health
professionals are not likely to reduce the prevalence, incidence, and burden of mental
illness without a major shift in intervention research and clinical practice" via a portfolio
of novel approaches to service delivery. Yet again, Kazdin (2019) asked us to reconsider how
psychotherapy can and should be delivered: He argues that without removing requirements of a
face-to-face format, an 'expert' with years of training, and a physical office, the
need-to-access gap will likely stay stagnant. Indeed, Kazdin (2019) asserts the need to think
about therapeutic action through an entirely new lens, asserting that "interventions may or
may not rely on the psychological treatments that continue to dominate research."
Any action-focused path to reducing the need-to-access gap will require moving beyond the
dominant settings, formats, and systems that have constrained intervention delivery to date.
Indeed, as Chorpita (2019) asserts, "it may well be time we move past thinking about
'treatments' as our only form of solutions" (p. 475), with "treatments" referencing the
dominant design of current psychosocial therapies: weekly, clinician-delivered interventions
in brick-and mortar clinical settings, which are too often inaccessible to those they are
designed to serve.
Brief, online interventions:
Even among youths who do access services, treatment is often brief: U.S. youths who begin
therapy attend an average of ~4 sessions, and the modal number of sessions attended is one.
This creates a need to quantify and capitalize on what can be accomplished, given appropriate
targeting and structure, in a short period of time.
Single-session interventions (SSIs) have been found to benefit youth and help reduce
depression symptoms. SSIs are brief and could be easily accessed online, thus, potentially
limiting barriers to accessing treatment. Therefore, SSIs could markedly increase the
capacity to address teen mental illness and SITBs in a cost-effective manner (Barak & Grohol,
2011). Indeed, SSIs can successfully reduce mental health problems: In a meta-analysis of 50
randomized trials including 10,508 youth participants (ages 4-19) SSIs significantly reduced
psychopathology of multiple types (mean g = 0.32), including self-administered SSIs-those
that did not involve a therapist (e.g., online SSIs; mean g = 0.32). To date, two types of
SSIs have been shown to reduce depressive symptoms in adolescents and/or young adults.
However, only one of these two SSIs is designed for online administration (the other is
administered by a therapist and therefore more challenging to disseminate). In the present
series of studies, the investigators aim to test the efficacy of SSIs self-administered
online to reduce depression and SITBs in a large sample of teenagers.
The Current Research
The goal of this study is to test single session interventions (SSIs) that are designed to
boost coping and resilience in adolescents. Specifically, participants (aged 13-16) will be
randomized to: (1) an online, active control group program encouraging feelings disclosure
(i.e. supportive therapy SSI), or (2) an online program targeting nonsuicidal self-injurious
behavior (i.e. Project "SAVE"-Stop Adolescent Violence Everywhere-SSI).
The investigators will test whether participants randomized to the SAVE SSI report:
1. Lower self-reported likelihood of future NSSI immediately post-intervention
2. Lower self-reported frequency of non-suicidal self-injury (in the past 3 months) at 3
month follow-up
3. Lower self-reported frequency of suicide ideation (in the past 3 months) at 3 month
follow-up
;
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