Symposia
Suicide and Self-Injury
Shirley Yen, Ph.D. (she/her/hers)
Associate Professor
Harvard Medical School
Newton, Massachusetts
Christopher Kahler, Ph.D. (he/him/his)
Professor
Brown University School of public Health
Providence, Rhode Island
Anthony Spirito, ABPP, Ph.D. (he/him/his)
Professor
Alpert Medical School of Brown University
Mattapoisett, Massachusetts
Katherine Tezanos, Ph.D. (she/her/hers)
Post-doctoral Fellow
Alpert Medical School of Brown University
Providence, Rhode Island
Megan Ranney, MD, MPH (she/her/hers)
Deputy Dean
Brown University School of public Health
Providence, Rhode Island
The development of STEP was funded by an R34, and entailed two phases, an open development phase, and a pilot RCT. Based on a review of the literature and findings that positive psychology interventions delivered individually had stronger effect sizes compared to a group format, we developed an individual intervention to be delivered during the inpatient admission in 4 sessions, followed by remote delivery of exercise practice reminders. The 4 sessions were 1) psychoeducation on the function of positive affect and rationale underlying the STEP intervention; 2) teaching three core strategies to increase attention to positive affect and experiences (mindfulness meditation, gratitude and savoring) and selecting the best way of practicing each skill; 3) in-vivo practice and preparation for home practice including examining potential barriers; 4) family session to engage parents as suporters.
Participants were adolescents hospitalized for suicidality, between 14-18 years old. We obtained assent/consent and enrolled 20 adolescents into the Open Development Trial (mage=15.9; SD=1.5), and 52 into the RCT (mage=15.6; SD=1.5). Randomization was to either STEP (n=26) or enhanced treatment as usual (ETAU) which received healthy habits text messages (n=26). Participants were predominantly female (67%) and White (76.5%). Over 50% of our sample had a prior suicide attempt history.
As this was treatment development, interventionists were the Principal Investigator (Yen) and a clinical psychology postdoctoral fellow, trained and supervised by the PI. Sessions were audio-recorded and reviewed as part of supervision. STEP was feasible and acceptable to adolescents and parents, with average session attendance above 80% (81% in the Open Trial, 89% in the Pilot RCT). Mean satisfaction ratings from adolescent participants and their parents were uniformly high for each component of STEP. There were no suicide deaths, and 1 suicide attempt in the open trial, much lower than expected rates based on prior naturalistic studies. In the pilot RCT, there were no suicide deaths and 50% less suicidal events (attempts or emergency interventions to intervene a suicide attempt) compared to ETAU and 50% less participants reporting suicide events. We will also present data on secondary outcomes and exploratory mechanisms.
These results are based on very small sample sizes, and there was mixed support for several of our outcomes. Future larger trials are under way to confirm the effectiveness of STEP in reducing suicidal behaviors.