Skills to Enhance Positive Affect in Suicidal Adolescents
Condition: Suicidal Ideation; Suicide, Attempted
MeSH terms: Suicide; Suicidal Ideation; Suicide, Attempted
Study type: Interventional

Summary: 
      The prevalence of suicidal behaviors in adolescents remains unacceptably high and is a
      significant public health concern. The investigators propose a new treatment approach in
      which skills to increase positive emotions are taught to the most vulnerable at-risk
      adolescents, those admitted to an inpatient psychiatric unit due to suicide risk. The
      investigators believe that teaching skills to increase positive emotions will lead to better
      problem-solving, increased social support, and other benefits which will serve as protective
      factors and decrease suicide risk.
    

Detailed description: 
      The prevalence of suicidal behaviors in adolescents remains unacceptably high. Reviews of
      published randomized controlled trials (RCTs) for adolescent suicidality conclude that
      treatments to date have been minimally efficacious. The preponderance of interventions focus
      on crisis intervention, underlying psychiatric disorders, regulating negative affect and
      reducing cognitive distortions. However, our pilot work and other recent data suggest the
      importance of considering how low positive affectivity contributes to suicide risk
      independent of other risk factors and may be another mechanism that leads to suicidal
      behaviors. Our model is based on Fredrickson's empirically-supported Broaden and Build model
      which asserts that the function of positive affect (PA) includes helping individuals thrive
      by improving social supports, problem-solving, and personal resilience. Each of these areas
      is instrumental in decreasing suicidal behavior. We propose that PA increases survival
      directly by decreasing suicidal ideation and indirectly by increasing social support and
      problem-solving. In this R34 treatment development grant we seek to develop a novel,
      individual skills-based, PA intervention, delivered adjunctively to treatment as usual (TAU),
      targeting the highest risk adolescents - those hospitalized due to suicide risk. We focus on
      three strategies that have been demonstrated to increase sustainable (vs. transient) PA in
      community and depressed adults: meditation, gratitude, and savoring. There are several ways
      to practice each strategy; we take into account patient preferences in a personalized
      approach in which patients select the practice(s) that fits best with their needs and
      circumstances. We propose using multiple means of intervention delivery that includes text
      messaging, to reinforce in-vivo practice. Our intervention, Skills To Enhance Positivity
      Program (STEP) includes two phases: a) in-person phase consisting of 3 individual in-person
      sessions and 1 joint parent session during the inpatient hospital stay to teach positive
      affect skills and develop a personalized intervention; b) remote delivery phase which
      consists of weekly telephone booster calls and daily text messages over 4 weeks
      post-discharge. The phone calls will be used to review or adjust personalized intervention
      components and reinforce use of skills. The text messages will include self-scripted
      reminders to practice skills and links to online resources. STEP will be tested in an open
      trial with 20 participants, and after further revision, in a pilot RCT, compared to TAU in a
      sample of 50 adolescents. The primary goal of this intervention is for patients to increase
      positive affect by incorporating skills and practices into their normal home-based routines,
      which we believe will lead to increases in problem-solving and social support and decreases
      in suicidal ideation. This is a novel intervention for a high-risk acute population via a
      different mechanism (i.e. PA), and conceptually distinct from other empirically examined
      theoretical approaches.
    

Intervention name(s): Positive Affect Skills Training; Treatment as Usual
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Individual sessions (3-4) delivered on the inpatient unit, focused on psycho-education regarding positive affect and mood monitoring and teaching of skills to attend to positive affect such as mindfulness, gratitude, and savoring. In-person sessions are followed by weekly phone calls and daily text messages for one month, with option to extend.; Participants will follow the intervention plan laid out in their discharge summary, but do not receive any individual sessions regarding positive affect. Upon discharge, they will receive generic text messages regarding healthy habits for one month, with option to extend.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment