Title: Mindfulness-Based Cognitive Therapy for Preventing Suicide in Military Veterans Investigator: Anna Kline, Ph.D. Objectives:
The aim of this proposal is to implement and evaluate a mindfulness-based group intervention for patients on the VA high risk for suicide list based on the Mindfulness Based Cognitive Therapy (MBCT) program for depression, modified to address the special needs of suicidal veterans (MBCT-S). MBCT has shown positive outcomes with depressed patients, while the mindfulness approach has demonstrated effectiveness in managing the emotional dysregulation and impulsivity that frequently accompany suicidal behavior. The primary aim of this proposal is to conduct a randomized controlled trial comparing MBCT-S to treatment as usual (TAU) to obtain data on key treatment outcomes. Primary outcomes of interest include suicide events (defined broadly to include a range of suicide-related thoughts and behaviors) and suicide attempts. Both outcomes will be operationalized using items from the Columbia Suicide Severity Rating Scale. Additionally, we will explore the effects of the intervention on suicide ideation, depression and hopelessness measured by the Beck Scale for Suicide Ideation, the Beck Depression Inventory and the Beck Hopelessness Scale. Methods: The study will involve a randomized-controlled trial, in which 164 veterans assigned to the high-risk for suicide list at the VA New Jersey Health Care System (VANJ) will be randomly assigned to MBCT-S plus treatment-as-usual (TAU) or TAU only. The two groups will be compared at baseline and at 4, 8, 24 and 52 weeks post-baseline on standardized measures of suicidal ideation, attempts and other outcomes of interest. Our large, two-campus facility, which sees 12,000 unique mental health patients per year, adds approximately 15 new patients to the high risk list per month, insuring an ample population for study enrollment at this single site. Outcomes: This study has the potential to increase the range of cost effective treatment alternatives for the sizeable number of suicidal veterans for whom evidence-based psychotherapies are severely limited. It may also initiate a new line of research addressing a key gap in interventions for suicide. If effective, the therapy will enhance the VA's existing suicide prevention efforts and reduce the number of veterans who attempt or complete suicide.
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. Our adapted version of MBCT for suicide (MBCT-S) integrates mindfulness meditation techniques with standard cognitive therapy into a low-intensity group therapy format and builds on 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.