Reconnecting: Improving Interoception to Reduce Suicidal Ideation in the Military
Condition: Suicidal Ideation; Interoception
MeSH terms: Suicidal Ideation
Study type: Interventional

Summary: 
      Background: Interoception is defined as the "sense of the physiological condition of the
      entire body" and is crucial for recognizing emotions and sensations (e.g., hunger,
      temperature, pain) and responding accordingly. The investigator's lab has conducted several
      independent studies and two pilot studies that support the hypothesis that disrupted
      interoception leads one to be disconnected from the body, and thus more able to harm the body
      should one desire to do so. Research suggests that interoceptive deficits may not only
      differentiate those who are thinking about suicide from those who engage in suicidal
      behavior, but it may also provide information about who is at imminent risk for suicidal
      behavior. The identification of novel, short-term risk factors, like interoceptive deficits,
      allows for the development of new treatment applications for suicide, which is important for
      several reasons: 1) suicide rates have increased in recent years, especially among military
      populations, and 2) existing treatment approaches are often ineffective, lengthy, expensive,
      or impractical for large-scale dissemination. This project evaluates a novel, brief
      intervention for interoceptive deficits and suicidal behavior with the potential to be
      acceptable and feasible for a military population.
    

Detailed description: 
      Background: Interoception is defined as the "sense of the physiological condition of the
      entire body" and is crucial for recognizing emotions and sensations (e.g., hunger,
      temperature, pain) and responding accordingly. The investigator's lab has conducted several
      independent studies and two pilot studies that support the hypothesis that disrupted
      interoception leads one to be disconnected from the body, and thus more able to harm the body
      should one desire to do so. Research suggests that interoceptive deficits may not only
      differentiate those who are thinking about suicide from those who engage in suicidal
      behavior, but it may also provide information about who is at imminent risk for suicidal
      behavior. The identification of novel, short-term risk factors, like interoceptive deficits,
      allows for the development of new treatment applications for suicide, which is important for
      several reasons: 1) suicide rates have increased in recent years, especially among military
      populations, and 2) existing treatment approaches are often ineffective, lengthy, expensive,
      or impractical for large-scale dissemination. This project evaluates a novel, brief
      intervention for interoceptive deficits and suicidal behavior with the potential to be
      acceptable and feasible for a military population.

      Specific Aims and Hypotheses:

      Aim 1: Determine whether the interoception training procedure (Reconnecting to Internal
      Sensations and Experiences [RISE]) decreases interoceptive deficits, suicidal ideation
      compared to a control condition. H1: Participants receiving the interoceptive training will
      demonstrate decreased interoceptive deficits relative to controls and relative to their
      pre-training levels.

      H2: Participants receiving the interoceptive training will demonstrate decreased suicidal
      ideation relative to controls and relative to their pre-training levels.

      H3: Group differences between the interoceptive training and control conditions will be
      maintained at one- and three-month follow-ups.

      Aim 2: Establish the feasibility and acceptability of the RISE intervention in a military
      sample.

      H4: Participants and clinic personnel will find the intervention to be feasible and
      acceptable.

      Study Design: Potential participants will be recruited from military bases' IOPs. Eligible
      participants will be invited to complete the baseline assessment and will be assigned to one
      of two conditions: 1) RISE, or 2) control (reading health related material). Participants in
      the RISE condition will complete four 45-minute online sessions of training that focus on
      multiple aspects of interoception including: body awareness, body sensations and movement,
      eating, health and self-care, emotional awareness, and understanding the self in relation to
      others. Outcome assessments will be administered at post-treatment and at one- and
      three-month-follow-ups.

      Due to the COVID-19 pandemic, which temporarily paused data collection at two of the study
      sites (Wright Patterson Medical Center & Madigan Army Medical Center), a fully online arm of
      the study was added in June 2020. Data collection was later able to be resumed at all study
      sites. When we added this fully arm, we increased our planned recruitment goal from 132 to
      200. Data collection was ultimately concluded with an enrolled N of 195.

      Military Benefit: Interoceptive deficits are an important treatment target for military
      personnel for several reasons. First, experiences particular to military populations (e.g.,
      stress, trauma) are believed to lead to interoceptive deficits. Second, the broad construct
      of interoceptive deficits and the individual components of interoceptive deficits are related
      to suicidal ideation and behavior among Service members. Third, our research finds that
      interoceptive deficits are easily modifiable, and that increasing interoception reduces risk
      factors for suicide. Fourth, the entire intervention can be delivered electronically and is
      brief, which allows it to circumvent barriers to treatment associated with traditional
      face-to-face therapy. Fifth, because of its portability, the intervention can be provided to
      deployed Service members and it can be delivered as a standalone intervention or as an add-on
      to existing treatments. In sum, our proposed intervention has implications not only for the
      reduction of suicidal behavior, but also for improvements in military performance and future
      functioning.
    

Intervention name(s): RISE (Reconnecting to Internal Sensations and Experiences); RISE (Reconnecting to Individual Strength and Energy)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The overarching goal of RISE is to increase interoception by reconnecting people with their internal sensations; Aims to reduce life stressors and improve physical health
Intervention MeSH terms: Risedronic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: interoception; suicidal ideation; suicide; military; intervention; clinical trial