scholarly journals A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP)

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nicolas J. C. Stapelberg ◽  
Candice Bowman ◽  
Sabine Woerwag-Mehta ◽  
Sarah Walker ◽  
Angela Davies ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicide Attempt ◽  
Suicide Prevention ◽  
Intervention Program ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Behavioural Therapy ◽  
Psychological Interventions ◽  
Cognitive Behavioural ◽  
Short Intervention

Abstract Background Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. Methods This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. Discussion This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. Trials registration ClinicalTrials.govNCT04072666. Registered on 28 August 2019

scholarly journals A Lived Experience Co-Designed Study Protocol for a Randomised Control Trial: The Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as Additional Interventions After a Suicide Attempt Compared to a Standard Suicide Prevention Pathway (SPP).

2021 ◽  
Author(s):  
Nicolas JC Stapelberg ◽  
Candice Bowman ◽  
Sabine Woerwag-Mehta ◽  
Sarah Walker ◽  
Angela Davis ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicide Attempt ◽  
Suicide Prevention ◽  
Cognitive Behavioural Therapy ◽  
Intervention Program ◽  
Attempted Suicide ◽  
Behavioural Therapy ◽  
Psychological Interventions ◽  
Cognitive Behavioural ◽  
Short Intervention

Abstract Background Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently there are limited treatment options with limited underpinning research for those who present to Emergency Departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves outcomes for consumers presenting to a Mental Health Service with a suicide attempt. Methods This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP) and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospital with suicide attempt and/or suicidal ideations. Death by suicide rates will also be examined. Self-reported level of suicidality, depression, anxiety, stress, resilience, problem-solving skills, self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, 6,12, and 24 months. Discussion This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. Trials registration : NCT04072666 - Registered on 28th August 2019 on Clinical Trials US Gov (https://www.clinicaltrials.gov/ct2/show/NCT04072666?term=NCT04072666&draw=2&rank=1) and ANZCTR (https://www.anzctr.org.au/TrialSearch.aspx)

Family, Health, and Poverty Factors Impacting Suicide Attempts in Cambodian Women

Crisis ◽  
2019 ◽  
Vol 40 (2) ◽  
pp. 141-145
Author(s):  
Desiree M. Seponski ◽  
Charity M. Somo ◽  
Sovandara Kao ◽  
Cindy J. Lahar ◽  
Sareth Khann ◽  
...  
Keyword(s):  
Data Collection ◽  
Suicide Attempt ◽  
Suicide Prevention ◽  
Emotional Distress ◽  
Family Conflict ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Family Health ◽  
Life Saving ◽  
Study Results

Abstract. Background: Our recent report demonstrates that 5.5% of Cambodian women have previously attempted suicide. Despite these high rates and critical need for intervention, research on suicide attempts in Cambodia is lacking, and life-saving information on suicide prevention is therefore unknown. Aims: This study explores factors impacting Cambodian women suicide attempts. Method: A total of 1,801 women participated in the large national survey during which 100 of these women (5.5%) reported at least one suicide attempt. Of the 100 participants 76 provided qualitative reasons for the suicide attempts. Only the 76 who provided the reasons for suicide attempt were included for analysis in this study. Results: Four major themes emerged: (1) family conflict, (2) emotional distress, (3) poverty, and (4) illness. Family conflict, emotional distress, poverty, and illness were all interrelated with each other; for example, women without money were unable to pay for treatment of otherwise treatable illnesses. Limitations: Owing to the nature of the data collection, member checking could not be conducted. Conclusion: Cumulative and intertwined personal, interpersonal, and contextual-level factors impacting suicide attempts included emotional distress, illness, family conflict, and poverty. Findings highlight points of intervention at individual, familial, and contextual levels to prevent suicide.

Using targeted cognitive behavioural therapy in clinical work: a case study

2021 ◽  
Vol 14 ◽  
Author(s):  
Olivia Harris ◽  
Claudia Kustner ◽  
Rachel Paskell ◽  
Chris Hannay
Keyword(s):  
Mental Health ◽  
Cognitive Behavioural Therapy ◽  
Therapeutic Process ◽  
Specific Phobia ◽  
Behavioural Therapy ◽  
Mental Health Practitioners ◽  
Psychological Interventions ◽  
Cognitive Behavioural ◽  
Co Morbidity ◽  
Health Practitioners

Abstract Research shows high levels of complex co-morbidities within psychiatric populations, and there is an increasing need for mental health practitioners to be able to draw on evidence-based psychological interventions, such as cognitive behavioural therapy (CBT), to work with this population effectively. One way CBT may be utilised when working with complexity or co-morbidity is to target treatment at a particular aspect of an individual’s presentation. This study uses a single-case A-B design to illustrate an example of using targeted diagnosis-specific CBT to address symptoms of a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia. Results show the intervention to have been effective, with a change from a severe to mild phobia by the end of intervention. Clinical implications, limitations and areas for future research are discussed. Key learning aims (1) There are high levels of co-morbid, complex mental health problems within psychiatric populations, and an increasing need for mental health practitioners to be able to work with co-morbidity effectively. (2) Cognitive behavioural therapy (CBT) remains one of the most well-evidenced psychological interventions with a large amount of research highlighting the effectiveness of diagnosis-specific CBT. (3) One way evidence-based diagnosis-specific CBT approaches could be utilised when working with more complex co-morbidity may be to target an intervention at a specific set of symptoms. (4) An example of using a targeted CBT intervention (to tackle a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia and ongoing hallucinations) is presented. The outcomes show significant changes in the specific phobia symptoms, suggesting that CBT can be effectively used in this targeted manner within real-world clinical settings. The impact of co-morbid mental health difficulties on therapeutic process and outcomes are highlighted. (5) The use of cognitive restructuring techniques was identified as key to engagement and therapeutic process, supporting the importance of including cognitive techniques in the treatment of phobias compared with purely behavioural exposure-based interventions.

Family, Health, and Poverty Factors Impacting Suicide Attempts in Cambodian Women

Crisis ◽  
2018 ◽  
pp. 1-5
Author(s):  
Desiree M. Seponski ◽  
Charity M. Somo ◽  
Sovandara Kao ◽  
Cindy J. Lahar ◽  
Sareth Khann ◽  
...  
Keyword(s):  
Data Collection ◽  
Suicide Attempt ◽  
Suicide Prevention ◽  
Emotional Distress ◽  
Family Conflict ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Family Health ◽  
Life Saving ◽  
Study Results

Abstract. Background: Our recent report demonstrates that 5.5% of Cambodian women have previously attempted suicide. Despite these high rates and critical need for intervention, research on suicide attempts in Cambodia is lacking, and life-saving information on suicide prevention is therefore unknown. Aims: This study explores factors impacting Cambodian women suicide attempts. Method: A total of 1,801 women participated in the large national survey during which 100 of these women (5.5%) reported at least one suicide attempt. Of the 100 participants 76 provided qualitative reasons for the suicide attempts. Only the 76 who provided the reasons for suicide attempt were included for analysis in this study. Results: Four major themes emerged: (1) family conflict, (2) emotional distress, (3) poverty, and (4) illness. Family conflict, emotional distress, poverty, and illness were all interrelated with each other; for example, women without money were unable to pay for treatment of otherwise treatable illnesses. Limitations: Owing to the nature of the data collection, member checking could not be conducted. Conclusion: Cumulative and intertwined personal, interpersonal, and contextual-level factors impacting suicide attempts included emotional distress, illness, family conflict, and poverty. Findings highlight points of intervention at individual, familial, and contextual levels to prevent suicide.

Cognitive Behavioural Therapy Suicide Prevention (CBT-SP) imagery intervention: a case report

2019 ◽  
Vol 12 ◽  
Author(s):  
Marie Carey ◽  
Catherine Wells
Keyword(s):  
Mental Health ◽  
Problem Solving ◽  
Health Service ◽  
Suicide Prevention ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
List Type ◽  
Adult Mental Health ◽  
Cognitive Behavioural ◽  
A Priority

Abstract Very little clinical work or research to date has focused on the prioritization of suicidal imagery intervention in the stabilization of risk. Current Cognitive Behavioural Therapy Suicide Prevention (CBT-SP) does not specifically address suicidal imagery as a priority intervention. This paper prioritizes imagery modification as the central task of therapy with the suicidal client. This is a single subject case review describing specific imagery interventions used to destabilize the comforting component of suicidal images, de-glamourize the suicidal image as a problem-solving method and the reconstruction of new images to offset the emotional grasp of both ‘flash-forward’ violent suicidal images and suicidal ‘daydreaming’ rumination. It is hypothesized that when suicidal images become less emotionally charged, the desire to act upon suicide decreases. Focusing on imagery intervention as a priority aims to stabilize risk in a more clinically specific and targeted way. Rob is a 19-year-old depressed young man with chronic suicidal ideation/images with repeated suicide attempts. All GP referrals are of a crisis nature since the age of 16. He was referred to a CBT clinician with specific training and experience in CBT-SP who proposed the following brief imagery intervention. Socialization to treatment rationale was pivotal at the outset to help facilitate strong therapeutic alliance, ‘buy-in’ to the intended de-glamourization of suicide planning/daydreaming/rumination and the effects of intrusive ‘flash-forward’ images on emotional well-being. Therapy was facilitated weekly, supported by telephone contact, on an out-patient basis in the HSE (Health Service Executive) Irish Adult Mental Health service. The care plan and interventions were supported by access to the 24-hour acute Adult Mental Health services, as required. There was no requirement for direct client engagement with the acute services. Rob engaged with five treatments of CBT-SP imagery intervention and full stabilization of risk to self by suicide was achieved. At the time of writing, Rob is alive, has no engagement with the services and no further GP referral requests for intervention. Despite Rob leaving therapy before full completion, brief targeted suicidal imagery intervention was observed to stabilize the risk of suicidal behaviour. This young man has completed his schooling, engaged in ‘life’ planning rather than ‘death’ planning and has not required further intervention from this service. Further research is required to engage frontline clinicians on the merits of suicidal imagery assessment in routine clinical practice. Key learning aims (1) To assess for imagery and violent day dreaming in suicidal patients. (2) Conceptualizing suicidal rumination and daydreaming as being a maladaptive problem-solving technique in overcoming psychological pain. (3) Use of suicide-specific assessment. (4) Ask about the presence of suicidal imagery as part of routine mental health assessment with the suicidal client.

Exploring the concurrent use of standardised and idiographic measures to assess cognitive behavioural therapy in a university student with autistic spectrum condition – a single case experimental design

2021 ◽  
Vol 14 ◽  
Author(s):  
Nicola Birdsey ◽  
Linda Walz
Keyword(s):  
Mental Health ◽  
Experimental Design ◽  
Social Anxiety ◽  
University Students ◽  
Single Case ◽  
Cognitive Model ◽  
Behavioural Therapy ◽  
University Student ◽  
Cognitive Behavioural ◽  
Spectrum Condition

Abstract Limited research has directly addressed the challenges of higher education for students with autism, who face additional difficulties in navigating social, personal and academic obstacles. With more students experiencing mental health difficulties whilst at university, therapeutic interventions on offer need to be suitable for those accessing support. Cognitive behavioural therapy (CBT) is widely used to support university students, as it is firmly established as an effective treatment for a range of issues, including social and generalised anxiety in typically developing populations (NICE, 2013; NICE, 2019). However, the efficacy of CBT for individuals with autistic spectrum condition (ASC) is less well known, despite the high prevalence rates of anxiety in this population. This paper seeks to address a gap in the literature and uses a single-case (A-B) experimental design over 16 sessions to reduce co-morbid social and generalised anxiety in a university student with high-functioning ASC. Clark’s (2001) cognitive model of social anxiety and Wells’ (1997) cognitive model of generalised anxiety were employed to formulate anxiety experienced in this case. Standardised outcome measures were used for social anxiety, i.e. the Social Phobia Inventory (SPIN), and generalised anxiety, i.e. the Generalised Anxiety Disorder-7 (GAD-7), in conjunction with idiographic ratings to assess the impact of therapy. Findings indicate that CBT was an acceptable and useful intervention with mixed results; discrepancies were found between clinical change recorded on standardised measures compared with idiographic ratings. This paper discusses the use of standardised measures of anxiety for individuals with ASC and identifies directions for further research. Key learning aims (1) To appreciate the unique mental health challenges of university students with ASC. (2) To identify psychological interventions that are suitable for individuals with ASC. (3) To consider the value in employing more than one evidence-based cognitive model of anxiety when clients present with co-morbid mental health issues. (4) To question the utility of using standardised outcome measures compared with idiographic measures in therapy.

scholarly journals Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e050661
Author(s):  
Håvard Kallestad ◽  
Simen Saksvik ◽  
Øystein Vedaa ◽  
Knut Langsrud ◽  
Gunnar Morken ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Patient Education ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Group Differences ◽  
Post Intervention ◽  
Cognitive Behavioural ◽  
Randomised Controlled

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

Tranquility: An evaluation and co-design of an internet-based cognitive-behavioural therapy (iCBT) program for anxiety and depression (Preprint)

2021 ◽  
Author(s):  
Alissa Pencer ◽  
Victoria C. Patterson ◽  
Meghan A. Rossi ◽  
Lori Wozney
Keyword(s):  
Mental Health ◽  
Cognitive Behavioural Therapy ◽  
Design Process ◽  
Behavioural Therapy ◽  
Anxiety And Depression ◽  
High Fidelity ◽  
Case Examples ◽  
Cognitive Behavioural ◽  
Therapeutic Principles ◽  
Preliminary Study

BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is a necessary step towards increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to therapeutic principles of CBT or usability standards. Additionally, many existing iCBT programs do not include treatments targeting both anxiety and depression – commonly co-occurring conditions. OBJECTIVE Evaluate the usability and fidelity of Tranquility, a novel iCBT program for anxiety, to CBT principles, and engage in a co-design process to adapt Tranquility to include treatment elements for depression. METHODS CBT experts (n = 6) and mental health informed peers (n = 6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression using two simulated client case examples. Mental health informed peers engaged in two co-design focus groups to discuss adaptations to the existing anxiety program and the integration of interventions for depression. Both groups completed online surveys assessing Tranquility’s usability and the likelihood that they would recommend the program. RESULTS CBT experts’ mean rating of Tranquility’s fidelity to CBT was 91%, indicating a high fidelity to CBT. Five out of six CBT experts and all mental health informed peers (88% of participants) rated Tranquility as satisfactory, indicating that they may recommend Tranquility to others, and they rated its usability highly (M = 76.56, SD = 14.07). Mental health informed peers provided suggestions about how to leverage engagement with Tranquility (e.g., add incentives, notification control). CONCLUSIONS This preliminary study demonstrated Tranquility’s strong fidelity to CBT and usability standards. Results highlight the importance of involving stakeholders in the co-design process and future opportunities to increase engagement.

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