BSTT: Brief Suicide & Trauma Therapy for Suicide Risk
Study Details
Study Description
Brief Summary
The investigators have developed an integrated suicide intervention, Brief Suicide and Trauma Therapy (BSTT). BSTT combines Brief-Skills for Safer Living (Brief-SfSL)-a promising method to enhance coping skills and reduce suicidality-with a trauma therapy component to alleviate the specific impacts of childhood trauma on suicide risk. The aim of this pilot is to test 12-weeks of BSTT to alleviate suicide risk among individuals with a history of childhood trauma and current suicidality.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
In the last 10 years, despite available treatments, suicide rates have not significantly decreased, and individuals who have experienced any type of childhood maltreatment are at increased odds for suicide attempt. Effective suicide prevention requires learning skills to cope with suicidality in addition to addressing the antecedent factors that contribute to suicide risk. In the context of those with childhood trauma and suicidality, addressing antecedent factors may require treatments that target symptoms associated with developmental trauma. Thus, the investigators have developed an integrated suicide intervention, Brief Suicide and Trauma Therapy (BSTT). BSTT combines Brief-Skills for Safer Living (Brief-SfSL)-a promising method to enhance coping skills and reduce suicidality-with a trauma therapy component to alleviate the specific impacts of childhood trauma on suicide risk. The aim of this pilot is to test 12-weeks of BSTT to alleviate suicide risk among individuals with a history of childhood trauma and current suicidality.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Brief Suicide and Trauma Therapy (BSTT) This novel suicide intervention integrates Brief Skills for Safer Learning (B-SfSL) with trauma therapy. BSTT incorporates the guiding principles of taking a non-pathologizing approach to treatment, emphasizing safety, attending to the therapeutic relationship, empowering clients, and incorporating solution-focused concepts. |
Other: Brief Suicide and Trauma Therapy
12-week trauma therapy
|
Outcome Measures
Primary Outcome Measures
- Change in suicidal ideation using Beck Scale for Suicide Ideation [From baseline to 3 months post-intervention]
Beck Scale for Suicide Ideation is a 21-item self-report scale that quantifies suicidal ideation. Items are scored 0 to 2 and yield a total score ranging from 0 to 38. Higher scores reflect greater severity of suicidal ideation.
Secondary Outcome Measures
- Change in anxiety symptoms using the Generalized Anxiety Disorder 7-item scale (GAD-7) [From baseline to 3 months post-intervention]
The GAD-7 is a brief 7-item self-report scale measuring anxiety symptoms. Total scores range from 0 to 21, with higher scores reflecting more severe anxiety.
- Feasibility of BSTT [From baseline to 12-weeks. Also re-assessed at 3 months post-intervention]
Feasibility and Acceptability survey and interview created in-house with questions designed to collect quantitative and qualitative feedback from participants with respect to the feasibility and acceptability of the BSTT intervention.
- Change in depression symptoms using the Quick Inventory of Depressive Symptoms 16-item scale (QIDS [From baseline to 3 months post-intervention]
The QIDS is a 16-item validated depression scale. Total scores range from 0-27, with higher scores reflecting more severe depression.
- Change in attachment security using the Experience in Close Relationships 12-item scale (ECR) [From baseline to 3 months post-intervention]
The ECR is a validated 12-item scale to assess adult attachment style. The ECR is comprised of 2 subscales measuring attachment avoidance and attachment anxiety, where higher scores are reflective of greater attachment difficulties. The ECR is often analyzed by percentile.
- Change in emotion regulation using the Difficulties in Emotion Regulation Scale 36-item scale (DERS) [From baseline to 3 months post-intervention]
The DERS is a 36-item validated scale measuring six aspects of emotion regulation. The DERS is comprised of 6 subscales, where higher scores are reflective of greater difficulties in emotion regulation. The DERS is often analyzed by percentile.
- Change in coping strategies using the Brief-Coping Orientation to Problems Experienced (Brief-COPE) [From baseline to 3 months post-intervention]
The Brief-COPE is a 28-item scale to assess the frequency of using specific coping strategies. It is comprised of 14 2-item subscales to assess use of different coping mechanisms. Some of the subscales are related to avoidant coping and some are related to approach coping. Higher scores for the avoidant scales suggest poorer coping strategies, while higher scores on the approach scales suggest positive coping strategies.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Beck Scale for Suicidal Ideation > 10
-
Presence of childhood trauma defined by a minimum moderate score on any of the Childhood Trauma Questionnaire subscales (emotional abuse, physical, abuse, sexual abuse, emotional neglect, and physical neglect
-
Presence of any psychiatric diagnosis
-
Ability to provide informed consent
-
Not receiving other psychotherapy concurrently
-
Ability to undergo psychotherapy in English
Exclusion Criteria:
-
The presence of cognitive impairment that would limit consent or understanding of BSTT
-
The presence of active psychosis
-
Unwilling or unable to provide informed consent
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | St. Michael's Hospital | Toronto | Ontario | Canada | M5B 1M8 |
Sponsors and Collaborators
- Unity Health Toronto
Investigators
- Principal Investigator: Sakina Rizvi, PhD,MACP,RP, Unity Health Toronto
Study Documents (Full-Text)
None provided.More Information
Publications
- Alloy LB, Abramson LY, Smith JM, Gibb BE, Neeren AM. Role of parenting and maltreatment histories in unipolar and bipolar mood disorders: mediation by cognitive vulnerability to depression. Clin Child Fam Psychol Rev. 2006 Mar;9(1):23-64. doi: 10.1007/s10567-006-0002-4.
- Angelakis I, Gillespie EL, Panagioti M. Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis. Psychol Med. 2019 May;49(7):1057-1078. doi: 10.1017/S0033291718003823. Epub 2019 Jan 4.
- Bergmans Y, Links PS. Reducing potential risk factors for suicide-related behavior with a group intervention for clients with recurrent suicide-related behavior. Ann Clin Psychiatry. 2009 Jan-Mar;21(1):17-25.
- Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Stokes J, Handelsman L, Medrano M, Desmond D, Zule W. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003 Feb;27(2):169-90. doi: 10.1016/s0145-2134(02)00541-0.
- Berube A, Turgeon J, Blais C, Fiset D. Emotion Recognition in Adults With a History of Childhood Maltreatment: A Systematic Review. Trauma Violence Abuse. 2023 Jan;24(1):278-294. doi: 10.1177/15248380211029403. Epub 2021 Jul 9.
- Bremness A, Polzin W. Commentary: Developmental Trauma Disorder: A Missed Opportunity in DSM V. J Can Acad Child Adolesc Psychiatry. 2014 May;23(2):142-5. No abstract available.
- Briggs S, Netuveli G, Gould N, Gkaravella A, Gluckman NS, Kangogyere P, Farr R, Goldblatt MJ, Lindner R. The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: systematic review and meta-analysis. Br J Psychiatry. 2019 Jun;214(6):320-328. doi: 10.1192/bjp.2019.33. Epub 2019 Feb 28.
- Brom D, Stokar Y, Lawi C, Nuriel-Porat V, Ziv Y, Lerner K, Ross G. Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study. J Trauma Stress. 2017 Jun;30(3):304-312. doi: 10.1002/jts.22189. Epub 2017 Jun 6.
- Bryan CJ, Clemans TA, Hernandez AM, Mintz J, Peterson AL, Yarvis JS, Resick PA; STRONG STAR Consortium. EVALUATING POTENTIAL IATROGENIC SUICIDE RISK IN TRAUMA-FOCUSED GROUP COGNITIVE BEHAVIORAL THERAPY FOR THE TREATMENT OF PTSD IN ACTIVE DUTY MILITARY PERSONNEL. Depress Anxiety. 2016 Jun;33(6):549-57. doi: 10.1002/da.22456. Epub 2015 Dec 4.
- Cao H, Ma R, Li X, Liang Y, Wu Q, Chi P, Li JB, Zhou N. Childhood Emotional Maltreatment and Adulthood Romantic Relationship Well-Being: A Multilevel, Meta-Analytic Review. Trauma Violence Abuse. 2022 Jul;23(3):778-794. doi: 10.1177/1524838020975895. Epub 2020 Dec 3.
- Cloitre M, Courtois CA, Charuvastra A, Carapezza R, Stolbach BC, Green BL. Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. J Trauma Stress. 2011 Dec;24(6):615-27. doi: 10.1002/jts.20697. Epub 2011 Dec 6.
- Copeland WE, Shanahan L, Hinesley J, Chan RF, Aberg KA, Fairbank JA, van den Oord EJCG, Costello EJ. Association of Childhood Trauma Exposure With Adult Psychiatric Disorders and Functional Outcomes. JAMA Netw Open. 2018 Nov 2;1(7):e184493. doi: 10.1001/jamanetworkopen.2018.4493. Erratum In: JAMA Netw Open. 2020 May 1;3(5):e207276.
- Coventry PA, Meader N, Melton H, Temple M, Dale H, Wright K, Cloitre M, Karatzias T, Bisson J, Roberts NP, Brown JVE, Barbui C, Churchill R, Lovell K, McMillan D, Gilbody S. Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLoS Med. 2020 Aug 19;17(8):e1003262. doi: 10.1371/journal.pmed.1003262. eCollection 2020 Aug.
- Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry. 2022 Jul 22;13:800687. doi: 10.3389/fpsyt.2022.800687. eCollection 2022.
- Doyle C, Cicchetti D. From the Cradle to the Grave: The Effect of Adverse Caregiving Environments on Attachment and Relationships Throughout the Lifespan. Clin Psychol (New York). 2017 Jun;24(2):203-217. doi: 10.1111/cpsp.12192. Epub 2017 Apr 11.
- Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58. doi: 10.1016/s0749-3797(98)00017-8.
- Fereidouni Z, Behnammoghadam M, Jahanfar A, Dehghan A. The Effect of Eye Movement Desensitization and Reprocessing (EMDR) on the severity of suicidal thoughts in patients with major depressive disorder: a randomized controlled trial. Neuropsychiatr Dis Treat. 2019 Aug 27;15:2459-2466. doi: 10.2147/NDT.S210757. eCollection 2019.
- Fischer A, Rosner R, Renneberg B, Steil R. Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients. Borderline Personal Disord Emot Dysregul. 2022 Jan 3;9(1):1. doi: 10.1186/s40479-021-00172-8.
- Freeman A, Mergl R, Kohls E, Szekely A, Gusmao R, Arensman E, Koburger N, Hegerl U, Rummel-Kluge C. A cross-national study on gender differences in suicide intent. BMC Psychiatry. 2017 Jun 29;17(1):234. doi: 10.1186/s12888-017-1398-8.
- Grummitt LR, Kreski NT, Kim SG, Platt J, Keyes KM, McLaughlin KA. Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review. JAMA Pediatr. 2021 Dec 1;175(12):1269-1278. doi: 10.1001/jamapediatrics.2021.2320.
- Guo Y, Ji Y, Huang Y, Jin M, Lin Y, Chen Y, Zhang L, Zhu C, Yu F, Wang K. The Relationship Between Suicidal Ideation and Parental Attachment Among Adolescents: The Mediator of Anhedonia and Peer Attachment. Front Psychol. 2021 Oct 18;12:727088. doi: 10.3389/fpsyg.2021.727088. eCollection 2021.
- Hakamata Y, Suzuki Y, Kobashikawa H, Hori H. Neurobiology of early life adversity: A systematic review of meta-analyses towards an integrative account of its neurobiological trajectories to mental disorders. Front Neuroendocrinol. 2022 Apr;65:100994. doi: 10.1016/j.yfrne.2022.100994. Epub 2022 Mar 21.
- Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther. 2014 Apr;55:7-17. doi: 10.1016/j.brat.2014.01.008. Epub 2014 Feb 11.
- Hawton K, Casanas I Comabella C, Haw C, Saunders K. Risk factors for suicide in individuals with depression: a systematic review. J Affect Disord. 2013 May;147(1-3):17-28. doi: 10.1016/j.jad.2013.01.004. Epub 2013 Feb 12.
- Herzog JI, Schmahl C. Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan. Front Psychiatry. 2018 Sep 4;9:420. doi: 10.3389/fpsyt.2018.00420. eCollection 2018.
- Itzhaky L, Gratch I, Galfalvy H, Keilp JG, Burke AK, Oquendo MA, Mann JJ, Stanley BH. Psychosocial risk factors and outcomes associated with suicide attempts in childhood: A retrospective study. J Psychiatr Res. 2020 Jun;125:129-135. doi: 10.1016/j.jpsychires.2020.03.008. Epub 2020 Mar 18.
- Karatzias T, Murphy P, Cloitre M, Bisson J, Roberts N, Shevlin M, Hyland P, Maercker A, Ben-Ezra M, Coventry P, Mason-Roberts S, Bradley A, Hutton P. Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychol Med. 2019 Aug;49(11):1761-1775. doi: 10.1017/S0033291719000436. Epub 2019 Mar 12.
- Michel K, Valach L, Gysin-Maillart A. A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide. Int J Environ Res Public Health. 2017 Mar 1;14(3):243. doi: 10.3390/ijerph14030243.
- Miniati M, Callari A, Pini S. Adult Attachment Style and Suicidality. Psychiatr Danub. 2017 Sep;29(3):250-259. doi: 10.24869/psyd.2017.250.
- Mitchell TO, Li L. State-Level Data on Suicide Mortality During COVID-19 Quarantine: Early Evidence of a Disproportionate Impact on Racial Minorities. Psychiatry Res. 2021 Jan;295:113629. doi: 10.1016/j.psychres.2020.113629. Epub 2020 Dec 3.
- Miu AC, Szentagotai-Tatar A, Balazsi R, Nechita D, Bunea I, Pollak SD. Emotion regulation as mediator between childhood adversity and psychopathology: A meta-analysis. Clin Psychol Rev. 2022 Apr;93:102141. doi: 10.1016/j.cpr.2022.102141. Epub 2022 Feb 21.
- Novick AM, Levandowski ML, Laumann LE, Philip NS, Price LH, Tyrka AR. The effects of early life stress on reward processing. J Psychiatr Res. 2018 Jun;101:80-103. doi: 10.1016/j.jpsychires.2018.02.002. Epub 2018 Feb 13.
- O'Connor RC, Kirtley OJ. The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond B Biol Sci. 2018 Sep 5;373(1754):20170268. doi: 10.1098/rstb.2017.0268.
- Oon-Arom A, Wongpakaran T, Satthapisit S, Saisavoey N, Kuntawong P, Wongpakaran N. Suicidality in the elderly: Role of adult attachment. Asian J Psychiatr. 2019 Aug;44:8-12. doi: 10.1016/j.ajp.2019.07.014. Epub 2019 Jul 5.
- Oral R, Ramirez M, Coohey C, Nakada S, Walz A, Kuntz A, Benoit J, Peek-Asa C. Adverse childhood experiences and trauma informed care: the future of health care. Pediatr Res. 2016 Jan;79(1-2):227-33. doi: 10.1038/pr.2015.197. Epub 2015 Oct 13.
- Pirkis J, John A, Shin S, DelPozo-Banos M, Arya V, Analuisa-Aguilar P, Appleby L, Arensman E, Bantjes J, Baran A, Bertolote JM, Borges G, Brecic P, Caine E, Castelpietra G, Chang SS, Colchester D, Crompton D, Curkovic M, Deisenhammer EA, Du C, Dwyer J, Erlangsen A, Faust JS, Fortune S, Garrett A, George D, Gerstner R, Gilissen R, Gould M, Hawton K, Kanter J, Kapur N, Khan M, Kirtley OJ, Knipe D, Kolves K, Leske S, Marahatta K, Mittendorfer-Rutz E, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Pearson M, Phillips MR, Platt S, Plener PL, Psota G, Qin P, Radeloff D, Rados C, Reif A, Reif-Leonhard C, Rozanov V, Schlang C, Schneider B, Semenova N, Sinyor M, Townsend E, Ueda M, Vijayakumar L, Webb RT, Weerasinghe M, Zalsman G, Gunnell D, Spittal MJ. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry. 2021 Jul;8(7):579-588. doi: 10.1016/S2215-0366(21)00091-2. Epub 2021 Apr 13. Erratum In: Lancet Psychiatry. 2021 Jun 4;: Lancet Psychiatry. 2021 Nov;8(11):e21.
- Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007 Jul;164(7):1035-43. doi: 10.1176/ajp.2007.164.7.1035.
- Roy A. Relationship of childhood trauma to age of first suicide attempt and number of attempts in substance dependent patients. Acta Psychiatr Scand. 2004 Feb;109(2):121-5. doi: 10.1046/j.0001-690x.2003.00234.x.
- Rozek DC, Baker SN, Rugo KF, Steigerwald VL, Sippel LM, Holliday R, Roberge EM, Held P, Mota N, Smith NB. Addressing co-occurring suicidal thoughts and behaviors and posttraumatic stress disorder in evidence-based psychotherapies for adults: A systematic review. J Trauma Stress. 2022 Apr;35(2):729-745. doi: 10.1002/jts.22774. Epub 2021 Dec 31.
- Schottenbauer MA, Glass CR, Arnkoff DB, Tendick V, Gray SH. Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry. 2008 Summer;71(2):134-68. doi: 10.1521/psyc.2008.71.2.134.
- Smith KE, Pollak SD. Early life stress and development: potential mechanisms for adverse outcomes. J Neurodev Disord. 2020 Dec 16;12(1):34. doi: 10.1186/s11689-020-09337-y.
- Stagaki M, Nolte T, Feigenbaum J, King-Casas B, Lohrenz T, Fonagy P; Personality and Mood Disorder Research Consortium; Montague PR. The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality. Child Abuse Negl. 2022 Jun;128:105576. doi: 10.1016/j.chiabu.2022.105576. Epub 2022 Mar 18.
- Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016 Mar 19;387(10024):1227-39. doi: 10.1016/S0140-6736(15)00234-2. Epub 2015 Sep 15.
- Ueda M, Nordstrom R, Matsubayashi T. Suicide and mental health during the COVID-19 pandemic in Japan. J Public Health (Oxf). 2022 Aug 25;44(3):541-548. doi: 10.1093/pubmed/fdab113.
- Valle LA, Silovsky JF. Attributions and adjustment following child sexual and physical abuse. Child Maltreat. 2002 Feb;7(1):9-25. doi: 10.1177/1077559502007001002.
- Ward-Ciesielski EF, Wilks CR. Conducting Research with Individuals at Risk for Suicide: Protocol for Assessment and Risk Management. Suicide Life Threat Behav. 2020 Apr;50(2):461-471. doi: 10.1111/sltb.12602. Epub 2019 Nov 8.
- Zortea TC, Dickson A, Gray CM, O'Connor RC. Associations between experiences of disrupted attachments and suicidal thoughts and behaviours: An interpretative phenomenological analysis. Soc Sci Med. 2019 Aug;235:112408. doi: 10.1016/j.socscimed.2019.112408. Epub 2019 Jul 10.
- Zortea TC, Gray CM, O'Connor RC. The Relationship Between Adult Attachment and Suicidal Thoughts and Behaviors: A Systematic Review. Arch Suicide Res. 2021 Jan-Mar;25(1):38-73. doi: 10.1080/13811118.2019.1661893. Epub 2019 Sep 23.
- BSTT-01