Written Exposure Therapy for Suicide Prevention

Official title

Written Exposure Therapy for Suicide Prevention (WET-SP)

Overview

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.

Interventions

• Behavioral WET-SP
  WET-SP will consist of 5 treatment sessions; the first session lasting about one hour and each subsequent session lasting approximately 40 minutes. Each session will include a 30-minute written exposure exercise. The participant will be given general instructions for completing the narrative writings and specific instructions for completing the first session. Participants will be instructed to write about the same suicidal crisis during each session. The therapist will emphasize the importance o
• Behavioral TAU
  TAU includes initial psychiatric stabilization, nurse case management, medication management, psychoeducation groups, and discharge planning. Patients engage with the provider team daily throughout the duration of hospitalization and have structured times for psychoeducation groups, case management, medication management, hygiene, and meals.

Primary outcome measures

• Change in Suicidal ideation (SI) [Time frame: Baseline, 10 weeks]
• SI at 20 weeks [Time frame: 20 weeks]
• SI at 30 weeks [Time frame: 30 weeks]

Secondary outcome measures (1)

• Most severe SI [Time frame: Baseline,10 weeks, 20 weeks, 30 weeks]

Eligibility criteria

Inclusion criteria

• Current active duty military service member, veteran, and beneficiaries
• Admitted to Carl R. Darnall Army Medical Center (CRDAMC) for suicidal thoughts, a suicide plan, or a suicide attempt
• 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)
• Ability to read, write, and speak English

Exclusion criteria

• Active psychosis as the priority of care for hospitalization
• Moderate or greater cognitive impairment (as determined by the inability to comprehend the baseline screening questionnaires)
• Unable to provide informed consent

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

United States · 1 center

• University of Texas Health Center San Antonio — San Antonio

Identifiers

NCT: NCT05878795 · H-43849 · W81XWH-22-1-1059

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗