Comparing brief interventions for suicidal individuals not engaged in treatment: A randomized clinical trial

Abstract

Background Non-treatment-engaged individuals experiencing suicidal thoughts have been largely overlooked in the intervention literature, despite reviews suggesting most individuals who die by suicide were not in treatment immediately prior to their death. Most intervention studies recruit individuals from treatment providers, potentially neglecting those individuals who are not already engaged in services. These individuals clearly represent a group in need of additional empirical attention. Methods A randomized clinical trial was conducted to compare a single-session dialectical behavior therapy skills-based intervention to a relaxation training control condition. Ninety-three non-treatment-engaged subjects participated in a single in-person assessment, received one of the intervention protocols, and completed follow-up phone interviews for three months including measures of suicidal ideation, emotion dysregulation, and coping skills, as well as other relevant assessments. Results Both conditions reported significantly reduced levels of suicidal ideation, depression, and anxiety; however, analyses revealed no significant differences between conditions on the main outcome measures of suicidal ideation, emotion dysregulation, skills use, depression, or anxiety. Limitations The two interventions may have been too similar to permit detection of differential effects with this sample size. Specifically, the control condition may have been too active and there may have been stylistic overlap by providers who delivered both interventions. Conclusions Encouragingly, half of subjects contacted other mental health services during the follow-up period. Although the two interventions under investigation did not yield differential results, the significant changes in important domains across interventions suggest that brief interventions may hold promise for this difficult-to-reach population.

Development and pilot evaluation of an online psychoeducational program for suicide prevention among university students: A randomised controlled trial

“…This may lead to a limited sampling of students who are reluctant to seek help. While noting that such interventions may impact more broadly on provision of help to others, future studies may highlight the brief, and one-time nature of the intervention, and use a language familiar to young people to help better reach the non-help-seeking population ( Ward-Ciesielski, 2013 , Ward-Ciesielski et al, 2017 ). Another limitation of the program is that no quiz or feedback was provided to the participants.…”

Dialectical Behaviour Therapy for Emotion Regulation Difficulties: A Systematic Review

“…Studies included individuals undergoing treatment for general ER difficulties ( k = 4), BPD ( k = 3) or obesity or binge-eating related difficulties ( k = 3). A further study recruited individuals seeking treatment for suicidal ideation (Ward-Ciesielski, Tidik, Edwards, & Linehan, 2017), and another looked at a sample with suicidal ideation and comorbid heavy alcohol use (Wilks et al, 2018). One study examined a sample seeking treatment for opioid dependence (Azizi, Borjali, & Golzari, 2010), with a final study investigating a DBT intervention in non-treatment-seeking adolescents (Burckhardt et al, 2018).…”

“…There was variability in the treatments delivered in TAU conditions. Of the eight studies that employed a TAU comparison condition, three studies delivered various forms of supportive psychotherapy (Neacsiu, Eberle, Kramer, Wiesmann, & Linehan, 2014; Safer, Robinson, & Jo, 2010; Ward-Ciesielski et al, 2017); one study delivered a positive psychology intervention (Uliaszek et al, 2016); one study delivered psychoeducation within a group setting in addition to medication (Dixon-Gordon, Chapman, & Turner, 2015); one study provided inpatient treatment as usual by a multidisciplinary team comprising of both pharmacological treatment in addition to psychoeducation groups in addition to individual treatment delivered by either an occupational therapist, social worker or psychologist (Gibson et al, 2014). Another study (Chugani et al, 2013) provided individual psychotherapy but did not specify what this entailed; and lastly, Azizi et al, (2010) involved two separate forms of TAU: either cognitive therapy or medication (naltrexone).…”

“…For example, one study (Dixon-Gordon et al, 2015) used a psychoeducation group as a comparison, where the content involved understanding the link between nutrition and exercise and the impact of mood, a skill that is covered throughout DBT in the Emotion Regulation module. Another study (Ward-Ciesielski et al, 2017) used a relaxation training control where participants were encouraged to engage in a sensory awareness exercise, which may overlap with the content of the DBT Distress Tolerance and Mindfulness modules.…”

“…The effectiveness of DBT may be underrated in the current review simply because individuals are not attending sessions and engaging in skills practice outside of session. Aside from Ward-Ciesielski et al, (2017), who administered one session, across the remaining interventions either the majority of participants did not receive the full dose of treatment or this information was not reported. Future research needs to focus on how to maximise engagement in treatment to ensure that the efficacy of DBT is not being underrepresented.…”