Shame-Focused Cognitive Behavioral Therapy For Reducing Suicide Risk In Adolescent Psychiatric Inpatients (SF-CBT)
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Shame-Focused Cognitive Behavioral Therapy (SF-CBT), Supportive Therapy (ST).
- Who it may be relevant to
- Registry conditions: Adolescent Suicide, Suicidal Ideation, Suicidal Behavior, Shame. Basic parameters: 13 years — 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- China
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
A Pilot Randomized Controlled Trial Of Shame-Focused Cognitive Behavioral Therapy For Suicide Prevention In Adolescent Psychiatric Inpatients
Overview
This pilot randomized controlled trial (RCT) aims to evaluate the feasibility, acceptability, and preliminary efficacy of Shame-Focused Cognitive Behavioral Therapy (SF-CBT) among high-risk psychiatric inpatient adolescents. Shame has been identified as a critical psychological mechanism underlying suicidal ideation and behavior, yet few interventions directly target it. SF-CBT is a structured, manualized intervention designed to reduce shame, improve coping strategies, and lower suicide risk. Approximately 42 adolescents aged 13-18 years, admitted for recent suicide attempt or severe suicidal ideation, will be randomized in a 2:1 ratio to receive either SF-CBT or supportive therapy (ST). Both conditions include 7 individual sessions for adolescents and 3 structured psychoeducation sessions for parents/guardians. Primary outcomes include feasibility metrics (recruitment, retention, adherence, fidelity, adverse events) and acceptability ratings from adolescents, parents, and therapists. Secondary outcomes include changes in suicidal ideation, suicidal behavior, shame, and coping styles, assessed at baseline, post-treatment, and 1-, 3-, and 6-month follow-ups. Findings will inform refinement of the intervention manual, establish feasibility benchmarks, and provide effect size estimates to guide a subsequent large-scale RCT.
Detailed description
Adolescent suicide is a major public health concern in China and worldwide. Shame, a powerful and often overlooked psychological driver of suicide risk, has rarely been the focus of intervention efforts. This study introduces and tests Shame-Focused Cognitive Behavioral Therapy (SF-CBT), a manualized and structured therapy designed specifically to reduce shame, enhance adaptive coping, and mitigate suicide risk in high-risk inpatient adolescents.
Objectives The primary objective is to test the feasibility and acceptability of SF-CBT in an inpatient psychiatric setting. Secondary objectives are to explore its preliminary efficacy in reducing shame, suicidal ideation, and suicidal behavior, and to evaluate the maintenance of effects at 1-, 3-, and 6-month follow-ups.
Design and Participants This is a single-site, single-blind pilot RCT conducted at Peking University Sixth Hospital adolescent psychiatric ward. Forty-two adolescents (ages 13-18) admitted with recent suicidal ideation or attempt and elevated baseline shame will be recruited. Exclusion criteria include acute mania, psychotic disorders, severe cognitive impairment, or expected hospitalization shorter than 14 days. Eligible participants will be randomized (2:1) to SF-CBT (\~28) or ST (\~14).
Intervention
SF-CBT: Seven 50-60 minute individual sessions covering motivation building, emotion recognition and chain analysis, shame-coping strategies, self-esteem enhancement, and relapse prevention. Parents/guardians will attend 3 psychoeducation sessions on empathic communication, crisis management, and family boundary-setting, supported by AI-based scenario simulations.
Supportive Therapy (ST): Seven supportive counseling sessions focusing on emotional support and inpatient adjustment. Parent psychoeducation sessions identical to SF-CBT arm.
Outcomes
Primary outcomes: Feasibility (recruitment and retention rates, adherence, fidelity, adverse events) and acceptability (satisfaction ratings by adolescents, parents, therapists).
Secondary outcomes: Suicidal ideation and behavior (C-SSRS, SIQ), shame (EISS), and shame-coping (CoSS), assessed at baseline, post-treatment, and 1-, 3-, and 6-month follow-ups.
Analysis and Significance Feasibility benchmarks (e.g., ≥70% recruitment, ≥80% completion) will guide readiness for a full-scale RCT. Preliminary efficacy will be explored using multilevel models, with effect sizes reported to inform sample size estimation.
This pilot study will establish the feasibility and safety of SF-CBT in high-risk adolescent inpatients and provide initial evidence for its impact on shame and suicide risk. Results will directly inform a larger RCT and contribute to evidence-based, mechanism-driven suicide prevention strategies for adolescents.
Interventions
- Behavioral Shame-Focused Cognitive Behavioral Therapy (SF-CBT)
A structured, manualized individual psychotherapy program consisting of 7 sessions (50-60 minutes each), delivered during hospitalization. The intervention includes modules on motivation building, emotional recognition, behavior chain analysis, shame coping strategies, self-esteem enhancement, and relapse prevention. In addition, caregivers participate in 3 psychoeducation sessions covering empathic communication, crisis response, and boundary management, supplemented by AI-assisted scenario sim - Behavioral Supportive Therapy (ST)
A supportive counseling program consisting of 7 sessions (50-60 minutes each), focusing on relationship building, emotional support, and adaptation to hospitalization. Caregivers in this arm also receive 3 psychoeducation sessions identical to those in the experimental arm, covering communication, crisis management, and boundary setting, with AI-assisted practice.
Primary outcome measures
- The Columbia-Suicide Severity Rating Scale (C-SSRS) [Time frame: Time Frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- The Columbia-Suicide Severity Rating Scale (C-SSRS) [Time frame: Time Frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
Secondary outcome measures (12)
- The External and Internal Shame Scale, EISS [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- The Compass of Shame Scale (CoSS) [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- The Alexian Brothers Urge to Self-Injure Scale (ABUSI) [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- Deliberate Self-Harm Inventory (DSHI) [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- Patient Health Questionnaire-9, PHQ-9 [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- The Generalized Anxiety Disorder-7 (GAD-7) [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- Emotional Awareness Questionnaire, EAQ [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- A self-developed Adolescent Irritability Scale [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- Rosenberg Positive Self-Esteem Scale, RSES [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- Instability of Self-Esteem Scale, ISES [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- The Self-Compassion Scale-Youth Version (SCS-Y) [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
- The 2-Way Social Support Scale (2-Way SSS) [Time frame: Baseline, Week 4, Month 2, Month 5, and Month 7]
Eligibility criteria
Inclusion criteria
- Adolescents aged 13-18 years, male or female.
- Recent suicide risk, defined as:
At least one suicide attempt in the past month, or Current suicidal ideation within the past month (with or without plan/intent) and at least one previous attempt.
- Elevated shame level (baseline score ≥ 9 on the External and Internal Shame Scale, EISS).
- Adequate cognitive capacity to participate in interviews and assessments.
- Parent/legal guardian (or designated responsible adult authorized by guardian) provides informed consent and agrees to participate.
Exclusion criteria
- Current manic episode.
- History of schizophrenia spectrum disorder, intellectual disability, or organic brain disease.
- Severe psychiatric or medical conditions that impair capacity for consent or participation.
- Expected to receive electroconvulsive therapy (ECT) during hospitalization.
- Anticipated inpatient stay shorter than 14 days (to ensure intervention completion).
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
- Single blind
- Primary purpose
- Treatment
Study locations
China · 1 center
- Peking University Sixth Hospital — Beijing
Identifiers
NCT: NCT07294001 · SF-CBT-YouthSuicide-2025 · IRB Approval No. 2025-69