Developing a Mobile Intervention to Reduce Suicidal Cognitions in Veterans

Study Overview
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Brief Summary
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Suicide cognitions are conceptualized as enduring, chronic vulnerability factors that predispose individuals to suicidal crises. Therefore, modification of these beliefs may reduce suicidal thoughts and behaviors. The goal of this research is to develop, refine, and pilot-test a mobile intervention to reduce cognitions that contribute to elevated suicide risk and to assess the impact of reductions in suicide cognitions and anger cognitions on suicide risk and functioning.

Detailed Description
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Suicide cognitions are conceptualized as enduring, chronic vulnerability factors that predispose individuals to suicidal crises. Therefore, modification of these beliefs may reduce suicidal thoughts and behaviors. In addition to suicide cognitions, another potentially modifiable risk factor for suicide is anger. The goal of this research is to develop, refine, and pilot-test a mobile interpretation bias modification intervention to reduce cognitions that contribute to elevated suicide risk and to assess the impact of reductions in suicide cognitions and hostile interpretation bias (a cognitive bias that is associated with anger) on suicide risk and functioning.

Official Title
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Developing a Mobile Intervention to Reduce Suicidal Cognitions in Veterans (COR 19-490)

Conditions
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Suicide

Intervention / Treatment
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* Behavioral: Mobile Intervention for Suicidal Thoughts (MIST)
* Behavioral: Mobile Intervention for Reducing Anger (MIRA)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veterans 18 years or older Diagnosed with PTSD, established via the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) Report a score of 12 on the 5-item Dimensions of Anger Reactions Scale Can read at least 6th grade level material Report a score of 1-3 (indicating ideation without intent) on the Columbia-Suicide Severity Rating Scale (C-SSRS) Have attended a mental health appointment within the past month, with another scheduled in the following month (i.e., be engaged in treatment with a mental health provider) Exclusion Criteria: Diagnosed with bipolar or psychotic disorder. Current substance use disorder. Current imminent suicide risk or homicidal ideation requiring immediate intervention.

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
Intervention Model: Single Group Assignment
Interventional Model Description: Participants will use the Mobile Intervention for Suicidal Thoughts (MIST) intervention for 4 weeks, followed by the Mobile Intervention for Reducing Anger (MIRA) for another 4 weeks.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: MIST intervention followed by MIRA intervention<br>These are both mobile interventions that use interpretation bias modification (IBM) techniques to reduce cognitive biases. The MIST app targets suicidal cognitions and the MIRA app targets hostile interpretation bias (which contributes to anger). The MIRA application has already been developed, but the MIST application is newly developed based on the same procedures. All participants will complete the MIST intervention and provide feedback so that we can refine it. We will also be collecting EMA data on to examine how changes to suicide cognitions and hostile interpretation bias (by use of the two apps) affects suicidal ideation and functioning. | Behavioral: Mobile Intervention for Suicidal Thoughts (MIST)<br>* This is an interpretation bias modification intervention that is designed to target cognitive factors that contribute to suicide risk. Participants will be instructed to complete at least 5 treatment sessions per week for a period of 4 weeks. Each session takes approximately 10 minutes.<br>Behavioral: Mobile Intervention for Reducing Anger (MIRA)<br>* This is an interpretation bias modification intervention that is designed to target hostile interpretation bias. Participants will be instructed to complete at least 5 treatment sessions per week for a period of 4 weeks. Each session takes approximately 10 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants recruited | Participant feasibility goal will be met if recruitment is 75% or greater of recruitment expectation. | Through study completion (approximately 10 months) | 
| Percentage of enrolled participants who complete the MIST intervention | Treatment retention feasibility goal will be met if attrition from the MIST intervention is no more than 25%. | Post-MIST assessment visit (approximately one month after enrollment) | 
| Patient satisfaction or MIST app: Client Satisfaction Questionnaire | Patient satisfaction will be assessed with item #7 from the Client Satisfaction Questionnaire. This item is scored on a scale of 1 to 4, with one indicating lower satisfaction and 4 indicating greater satisfaction. The patient satisfaction goal will be met if 80% or greater of participants indicate score a 3 or 4 on this item. | Post-MIST assessment visit (approximately one month after enrollment) | 
| MIST App utilization | MIST app utilization goal will be met if MIST app utilization rates are greater than 50% of expected use. | Post-MIST assessment visit (approximately one month after enrollment) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Suicide, Suicide cognitions, Anger, Mobile intervention