Abstract
BackgroundThe need to develop effective and accessible interventions for suicidal individuals engaging in heavy episodic drinking (HED) cannot be understated. While the link between alcohol use and suicidality is a complex one that remains to be elucidated, emotion dysregulation may play a key role in alcohol-related suicide risk in these individuals.ObjectiveIn the current study, an 8-week Internet-delivered dialectical behavior therapy (DBT) skills training intervention was developed and preliminarily evaluated for suicidal individuals who engage in HED to regulate emotions. The aim of the study is to evaluate the feasibility and effectiveness of the therapist-assisted and Internet-delivered intervention, and to inform the design of a subsequent full-scale study.MethodsThe study was a pilot randomized controlled trial comparing participants receiving immediate-treatment (n=30) to waitlist controls (n=29) over a period of 16 weeks. Intervention effects will be assessed longitudinally using hierarchical linear modeling and generalized estimating equations, along with analyses of effect sizes and clinically significant change. The primary outcomes are suicidal ideation, alcohol problems, and emotion dysregulation. Secondary outcomes include alcohol-related consequences, reasons for living, skills use, and depression.ResultsThe trial is ongoing. A total of 60 individuals returned their informed consent and were randomized, of whom 59 individuals were intended to treat. A total of 50 participants in the study were retained through the 16-week enrollment.ConclusionsThere is a dearth of evidence-based treatment for individuals presenting with high risk and complex behaviors. Furthermore, computerized interventions may provide a beneficial alternative to traditional therapies. The particular clinical features and treatment needs of suicidal individuals who also engage in HED constitute key domains for further investigation that are needed to consolidate the design of appropriate interventions for this high-risk population.Trial RegistrationClinicaltrials.gov NCT02932241; https://clinicaltrials.gov/ct2/show/NCT02932241 (Archived by WebCite at http://www.webcitation.org/6uJHdQsC2)
Highlights
Suicide is the tenth leading cause of death across all age groups and is among the top four causes of death for Americans aged 10 to 54 years [1]
Suicide risk may be elevated in individuals who engage in heavy episodic drinking (HED) to reduce acute negative affect [9]
This study focuses on sensitive topics such as alcohol use and suicidal behavior, and the phone screen and outcome assessments contain questions that could potentially be distressing to participants
Summary
Suicide is the tenth leading cause of death across all age groups and is among the top four causes of death for Americans aged 10 to 54 years [1]. Given the behavioral complexity of suicidal individuals who drink alcohol to regulate emotions, an alcohol-focused treatment may not be sufficient to increase coping skills and/or distress tolerance techniques. This problem suggests the need for novel treatment approaches for HED and suicide that focus on increasing emotion regulation capabilities. Objective: In the current study, an 8-week Internet-delivered dialectical behavior therapy (DBT) skills training intervention was developed and preliminarily evaluated for suicidal individuals who engage in HED to regulate emotions. The particular clinical features and treatment needs of suicidal individuals who engage in HED constitute key domains for further investigation that are needed to consolidate the design of appropriate interventions for this high-risk population. Trial Registration: Clinicaltrials.gov NCT02932241; https://clinicaltrials.gov/ct2/show/NCT02932241 (Archived by WebCite at http://www.webcitation.org/6uJHdQsC2)
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