Controlled Evaluation of a Computerized Anger-reduction Treatment for Suicide Prevention
Condition: Anger; Suicidal Ideation
MeSH terms: Suicide; Suicidal Ideation; Suicide Prevention
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether a computerized intervention designed to
      reduce anger-provoking interpretation biases will reduce suicide risk among individuals with
      elevated levels of trait anger.
    

Detailed description: 
      Problematic anger is often found among returning military veterans, especially those exposed
      to combat. Anger control problems are associated with difficulties with reintegration. One
      study of Iraq-Afghanistan combat veterans who used VA medical services (N = 754) found that
      difficulty controlling anger was the most commonly reported problem experienced since
      homecoming, occurring among 57% of the sample (Sayer et al., 2010). Problematic anger and
      hostility have also been linked to risk for suicide (Daniel et al., 2009; Lehnert,
      Overholser, & Spirito, 1994; Maiuro, O'Sullivan, Michael, & Vitaliano, 1989). From the
      perspective of the interpersonal-psychological theory of suicide (Joiner, 2005), individuals
      with problematic anger may be at increased risk for suicide because they engage in impulsive
      behaviors (e.g., aggression, substance abuse) intended to manage anger. Such behaviors may
      lead to exposure to painful and provocative events, which increase their acquired capability
      for engaging in suicidal behavior. Additionally, anger problems often lead to social
      isolation, which may contribute to greater perceived burdensomeness and a failed sense of
      belonging, established risk factors for suicide (Van Orden et al., 2010).

      Anger prone individuals are likely to hold the hostile attribution bias, which reflects the
      tendency to interpret the ambiguous actions of others as reflecting hostile intent (Wilkowski
      & Robinson, 2008). Recently, researchers have developed computerized interpretation bias
      modification (IBM) protocols intended to efficiently reduce interpretive biases. These
      treatments have shown efficacy in reducing anxiety and depression (Beard & Amir, 2008;
      Holmes, Lang, & Shah, 2009; Mathews et al., 2007). We have conducted studies using similar
      procedures that focus on hostile interpretation biases and found our program to successfully
      reduce anger and hostility.

      To evaluate the efficacy of the IBM protocol we have developed in reducing anger and suicide
      risk, we will conduct a three-arm randomized controlled trial over the internet. Military
      veterans and non-veteran community participants reporting elevated trait anger (N = 120) will
      be randomized to one of three conditions: 1) IBM; 2) progressive muscle relaxation (PMR); or
      3) healthy education videos (control). Each condition will consist of eight 15-minute
      treatment sessions. Participants will complete two sessions per week for four weeks and will
      be administered assessments at pre- and post-treatment. IBM and PMR conditions will also
      complete 3-month and 6-month follow-up assessments. To ensure an adequate test of the effects
      of this intervention on suicide risk, we will oversample for individuals with current
      suicidal ideation. We hypothesize that: 1) IBM will lead to greater reductions in anger than
      PMR and control conditions in a sample with problematic anger; 2) IBM will lead to greater
      reductions in suicidal ideation, perceived burdensomeness, and thwarted belongingness than
      PMR and control conditions; 3) efficacy of the IBM condition in reducing suicidal ideation
      will be mediated by reductions in perceived burdensomeness and thwarted belongingness; 4)
      group differences between IBM and PMR will be maintained at the 3-month and 6-month follow-up
      assessments.
    

Intervention name(s): Anger Reduction Treatment; Progressive Muscle Relaxation; Control Condition
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Eight 15-minute sessions of interpretation modification to reduce angry interpretation biases.; Eight 15-minute sessions of progressive muscle relaxation (PMR) including formulation of a plan to use PMR when angry.; Eight 15-minute sessions of informative videos on healthy living.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: suicide; anger; interpretation modification; computerized treatment