Mindfulness-Based Cognitive Therapy for Suicide Prevention

Study Overview
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Brief Summary
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The purpose of this study is to test a psychotherapeutic intervention that integrates cognitive therapy and mindfulness meditation techniques to prevent suicide in military Veterans.

Detailed Description
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Every month the VA becomes aware of approximately 1,100 Veterans in VA care who attempt suicide. While the VA has implemented a comprehensive, multifaceted suicide prevention approach, it has yet to implement nationally any evidence-based psychotherapies targeting suicide, a gap due largely to the dearth of evidence-based therapies for suicide. Primary aims of this proposal are to conduct a randomized controlled trial testing an adaptation of a cognitive-behavioral intervention, Mindfulness-Based Cognitive Therapy (MBCT), for Veterans on the VA's High Risk for Suicide List. The investigators' adapted version of MBCT for suicide (MBCT-S) integrates mindfulness meditation techniques with the VA Safety Plan to enhance patients' awareness of suicide triggers and appropriate coping strategies. This study has the potential to increase the range of cost effective treatment alternatives for the large number of suicidal Veterans for whom evidence-based therapies are severely limited.

Official Title
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Mindfulness-Based Cognitive Therapy for Preventing Suicide in Military Veterans

Conditions
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Suicide

Intervention / Treatment
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* Behavioral: Mindfulness-Based Cognitive Therapy for Suicide
* Behavioral: Treatment as usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The following criteria were formulated to recruit a sample at high risk for suicide behavior. The subject has experienced a suicidal event during the past 30 days. A suicidal event involves 1) psychiatric hospitalization due to suicidal risk, 2) psychiatric hospitalization if subject was already on the High Risk for Suicide List, 3) suicidal ideation with suicidal intent, 4) suicidal preparatory behaviors, or 5) actual, interrupted, or aborted suicide attempt. AND The subject is on or will be placed on the VA High Risk for Suicide List OR The subject had an actual, interrupted, or aborted attempt in the last year OR In the study clinician's opinion (i.e., Masters or Doctoral level study personnel with formal mental health training) in consultation with the PI, the suicidal event is significant enough to warrant treatment to reduce suicidal risk. Exclusion Criteria: cognitive deficits that decrease the likelihood of benefit from MBCT-S severe symptoms of hallucinations or delusions disorganized or disruptive behaviors medically unstable current mindfulness-based psychotherapy or receipt of 2 or more sessions of a mindfulness-based psychotherapy in the last 12 months

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Mindfulness-Based Cognitive Therapy + Treatment As Usual<br>Psychotherapeutic intervention that integrates mindfulness meditation with Safety Planning, with a specific focus on reducing suicide risk. | Behavioral: Mindfulness-Based Cognitive Therapy for Suicide<br>* Psychotherapeutic intervention that integrates mindfulness meditation with Safety Planning, with a specific focus on reducing suicide risk.<br>* Other names: MBCT-S;|
| Other: Treatment As Usual<br>VA standard care for suicide prevention | Behavioral: Treatment as usual<br>* VA standard care for suicide prevention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Suicide Event | The investigators define event broadly as a range of suicidal behaviors defined according to the VA's Self-Directed Violence Classification System (SDVCS). Based on the SDVCS, an event may include self-directed violence, with or without injury, in which evidence of suicidal intent is clear or undetermined; or suicidal preparatory behaviors. The study definition of a suicide event also includes suicidal ideation resulting in the need for emergency care or psychiatric hospitalization. | 12-months post-baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Suicide Attempt | Defined as deliberate self-directed violence with injury or potential for injury and with explicit/implicit suicidal intent | 12 months post-baseline | 
| Suicidal Ideation | clinician-administered Scale for Suicide Ideation (SSI), 0-38, higher score = higher suicidal ideation. | Baseline, 4 weeks (mid-treatment), 8 weeks (treatment-completion), 6 months and 12-months post-baseline | 
| Hopelessness | Hopelessness will be measured using the Beck Hopelessness Scale, score range 0-20, with higher scores indicating more hopelessness. | Baseline, 4 weeks (mid-treatment), 8 weeks (treatment-completion), 6 months and 12-months post-baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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suicide prevention, mindfulness-based cognitive therapy, mindfulness meditation, Veterans, safety planning