The proposed research is designed to develop and test the feasibility of a comprehensive behavioral treatment for the reduction of suicidal behaviors among patients previously hospitalized due to parasuicide (attempted suicide). The experimental treatment proposed is long-term, multi-modal behavior therapy and comprises both weekly, individual therapy as well as short-term, group therapy modules. Three treatment groups will be compared: 1) an experimental, Multi-Modal Behavioral Treatment (MBT), 2) a control, Supportive Crisis-Management (standard) Treatment (ST), and 3) a control, Community Referral Treatment (CRT). Individual therapy in the experimental treatment is designed specifically for suicidal patients and focuses on changing outcome expectancies for parasuicide, crisis management, and support for continuing in and complying with the behaviorial group modules. Experimental patients will participate in the following four 12 week group therapy modules: 1) Affect Control training, 2) Interpersonal Problems Solving training, 3) Distress Tolerance training, and 4) Self-Management training. The ST group will also be in individual and group therapy weekly. The CRT group will be referred to community agencies as is usual on discharge from inpatient, psychiatric status. Pre-, post-, and follow-up assessments will measure suicidal behaviors and the skills of affect regulation, interpersonal problem solving, distress tolerance, and self-management skills. In addition, intermediate assessments will allow determination of whether the group therapy modules are effective in achieving the specific behavioral goals targeted. The relative effectiveness of the treatments for first time versus multiple parasuicidal patients will also be analyzed. Finally, this research will compare parasuicide patients vs. non-parasuicide patients on several behavioral and personality variables and will continue follow-up research with previously hospitalized suicidal and non-suicidal patients.
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