An Autobiographical Memory-Based Intervention for Suicidality

Not Applicable

Completed

• Conditions: Suicidal Ideation; Mental Health Disorder
• Interventions: Other: Autobiographical Memory Based Intervention

• Registration Number: NCT06225531
• Lead Sponsor: Lancaster University

Brief Summary

The study involves a short therapy intervention for people who are experiencing thoughts of suicide. The intervention will focus upon different memories from the person's life. These memories will vary in the emotions they evoke - some memories will be associated with neutral emotions, whereas others will bring up positive emotions. The intervention will have a particular focus upon memories of times when the participants have moved away from thinking about suicide, with the aim of reinforcing memories of what helped them to reconnect with life. The intervention will also introduce relaxation techniques, in addition to involving a safety planning component. The project aims to consider whether this intervention is acceptable and feasible for this population.

Detailed Description

This study is looking at whether an autobiographical memory-based intervention is acceptable and suitable for people with thoughts of suicide within a secondary mental health population. Autobiographical memory involves the recollection of past events in a person's own life, and this has been linked to a person's sense of identity, goals, and orientation in the present. Memories linked to negative emotions have been shown to be durable, accessible, and easily and vividly remembered. The power that memories of suicidal ideation and suicide attempts hold is therefore concerning. This intervention aims to support participants to more readily access positive and neutral autobiographical memories, using memory tasks and worksheets. By focusing upon individuals' moves away from suicidal thinking, it also aims to shift the focus onto remembering what led people to reconnect with life.

The study is an experimental case series using a non-concurrent A-B multiple baseline design, in which the participants first attend 3-5 baseline sessions prior to attending 6 intervention sessions. Sessions are one-to-one. The initial baseline session and all intervention sessions will take place face-to-face. The follow-up baseline sessions can be conducted in-person, online via Microsoft Teams, or via telephone, depending on participant preference.

The initial baseline session will involve assessing risk and updating participants' safety plan. The intervention involves 6 sessions of approximately one hour. The first session will focus upon familiarisation to concepts in the intervention, using imagery-based metaphors to support understanding. Sessions 2-4 will focus on different memories - neutral, positive, and memories of moves away from suicidal thinking. Memory tasks will broadly follow the 5 stages outlined in the broad-minded affective coping (BMAC) procedure, but with a focus on these specific memories. In the final 2 sessions, participants will have a choice around which memory to focus on. The final session will also involve post-intervention planning. Outcome measures will be completed in all baseline and intervention sessions.

The study aims to recruit 5-7 participants from community mental health teams (CMHTs) in which supervisory support can be arranged. The intervention will be conducted by the principle investigator (AP), a trainee psychologist, under the supervision of clinical psychologists within the CMHTs (JK and NI) who are also members of the research team.

Study Timeline

• Study First Submitted: 2024-01-05
• Study First Submitted QC: 2024-01-16
• Study First Posted: 2024-01-26
• Study Start: 2024-05-15
• Primary Completion: 2024-08-21
• Study Completion: 2024-08-21
• Status Verified: 2024-11
• Last Update Submitted: 2024-11-11
• Last Update Posted: 2024-11-12

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 3

Inclusion Criteria

• Individual has experienced suicidal ideation and/or suicidal behaviours within the previous 3 months. This will be screened for by asking the questions:

  1. Have you had thoughts or images of ending your life within the past three months? or
  2. Have you attempted to end your life within the past 3 months?

• Currently under a Community Mental Health Team (CMHT) within which supervisory support can be arranged.

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Exclusion Criteria

• Moderate/severe learning disability
• Organic cerebral disease/injury which significantly affects language comprehension or expression
• Non-English speaking
• Acute psychosis which would affect engagement
• Receiving psychological treatment or participating in another research intervention
• At imminent risk of acting upon thoughts of suicide or of harm to others. This will be screened for by assessing for the presence of active intent or plans to harm themselves or others within the next month. If these individuals consent to be contacted again after a month, the researcher will consider approaching them again to assess for changes to imminent risk. If the individual met the eligibility criteria at this point, the individual would be invited to take part in the study.
• A history of violence or harm to others to a degree in which clinicians have assessed one-to-one sessions to be unsafe
• Currently within an inpatient setting or open to a home-based treatment team.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Autobiographical Memory Based Intervention	Autobiographical Memory Based Intervention	All participants will be placed into the intervention arm, in which the participants will receive 6 autobiographical memory based intervention sessions, lasting approximately one hour. Baseline lengths will vary from 3 - 5 sessions, with the initial session lasting approximately one hour, and follow up sessions lasting approximately 30 minutes. This randomisation is 1) to enable the effects of treatment to be separated from the effects of time seen clinically and 2) in order to control for the therapeutic value of contact.

Primary Outcome Measures

Name	Time	Method
Acceptability - Qualitative Feedback	Up to 14 weeks	Qualitative feedback around the acceptability of the intervention - collected at the end of the Adverse Effects in Psychotherapy Scale with the question 'If you would like to describe your experience of taking part in the study in your own words, please use the following space'.
Feasibility - rates of recruitment, attendance, and completion	Up to 14 weeks	To assess whether the intervention is feasible within this population, the investigators will consider the proportion of participants approached who met the eligibility criteria, and proportion of these who consent to taking part in the study. The investigators will also collect data on attendance rates, where reasonable attendance will be set as ≥ 3 sessions out of the 6-session intervention, in accordance with the criteria set out in a similar case series study. Therapy completion rates will also be recorded, where the investigators will look at the number of participants who completed the final set of therapy measures.
Acceptability - Therapeutic Alliance	Up to 14 weeks	This is to consider the therapeutic relationship between the practitioner and participant. Measured using the Working Alliance Inventory - Short Revised, scored out of 60 where a high score indicates strong alliance.
Acceptability - Adverse effects	Up to 14 weeks	This is to assess for any negative outcomes of the intervention. Measured using the Adverse Effects in Psychotherapy questionnaire, with statements scored on a 5 point scale from 'not at all' to 'very much'
Acceptability - Clinical Global Impression	Up to 14 weeks	This is a measure of the practitioner's overall clinical impression of the participant during the session. This is measured using the Clinical Global Impressions Scale, where severity is scored on a scale of 1-7 (where 7 indicates a negative impression/change).
Acceptability - Overall	Up to 14 weeks	The overall acceptability of the intervention will be measured using an adapted Acceptability Scale. This includes measures of multiple key areas which are important for an intervention to be classified as acceptable by a participant. Statements are assessed on a 5 point scale from 'strongly disagree' to 'strongly agree'.

Secondary Outcome Measures

Name	Time	Method
Suicidality	Up to 14 weeks	Measured using the Columbia Suicide Severity Rating Scale. The scale uses yes/no questions, plus an overall score of actual lethality (where 0 is least severe and 5 is most) and of potential severity (where 0 is lowest risk and 2 is highest risk) in relation to the individual's i) most recent suicide attempt, ii) most lethal attempt, and iii) first attempt.
Entrapment	Up to 14 weeks	Entrapment has been closely linked to suicidal ideation and suicide risk. The investigators will measure this using a 4-item Entrapment Scale - Short-Form. This is scored out of 16, where a high score indicates high levels of entrapment.
Perceived Burdensomeness / Thwarted Belonging	Up to 14 weeks	Interpersonal factors have also been linked to suicidal ideation and suicide risk. This will be measured using the Interpersonal Needs Questionnaire. This is scored out of 105, where a high score indicates greater levels of perceived burdensomeness and thwarted belonging.

Trial Locations

Locations (1)

Greater Manchester Mental Health NHS Foundation Trust; 🇬🇧 Manchester, United Kingdom