None listed
Conditions
Brief summary
Suicide is the leading cause of death among Australians aged 15-24 . Increasing our understanding of risk factors and developing novel indicated interventions to reduce deaths by suicide is urgently needed. In this project, we aim to develop and test the acceptability, feasibility and safety of a novel psychological intervention for young people with suicidal thoughts, that specifically targets a distressing form of suicidal thoughts that has been underrecognized in both clinical practice and research to date: mental images of suicide. One promising psychological intervention for treating intrusive and distressing mental images is imagery rescripting. Imagery rescripting involves individuals focusing on the content of their intrusive and distressing mental images and then vividly imagining an alternative outcome. This image is generated and rehearsed with a therapist. No previous studies have used imagery rescripting to directly target suicide-related mental images and to assess the effectiveness of this intervention in young people, for whom suicide is the leading cause of death. In this pilot study we aim to examine whether this intervention is acceptable, feasible, and safe in a small pilot study.
Interventions
This study will test the acceptability, feasibility and safety of a novel intervention (Imagery Rescripting) in a small pilot study of 25 young people with mood disorders and suicidal ideation from the Youth Mood Clinic (YMC), at Orygen Specialist Programs. Young people with Depression will receive Imagery Rescripting treatment following the study protocol for treating mental images of suicide in youth with mood disorders.
Study clinicians are experienced psychologists in the YMC and are trained
This study will test the acceptability, feasibility and safety of a novel intervention (Imagery Rescripting) in a small pilot study of 25 young people with mood disorders and suicidal ideation from the Youth Mood Clinic (YMC), at Orygen Specialist Programs. Young people with Depression will receive Imagery Rescripting treatment following the study protocol for treating mental images of suicide in youth with mood disorders. Study clinicians are experienced psychologists in the YMC and are trained and supported by an expert in imagery rescripting. Training is comprised of a combination of face-to-face workshops and online videos to support the content. All clinicians are trained at least one month prior to conducting the intervention. Complementing the training is a study intervention manual. Clinicians adhere to the manual which outlines the steps for identifying the image/s to be rescripted and for supportive and safety procedures to scaffold the clinical implementation. The first clinician session focuses on psychoeducation about mental imagery and mental images of suicide or death, development of safe space imagery (which can be used in later sessions to lower distress if necessary), confirming the selection of an appropriate mental image to rescript and conducting the Suicidal Cognitions and Flashforward Interview. The next session focuses on rescripting this image. The client and therapist together select the mental image of suicide which will be rescripted. Only current images (experienced in the past two weeks) will be selected for rescripting. It is important to determine whether the image increases risk for suicidal behaviour, or decreases risk for suicidal behaviour (i.e., is protective). Only images that the young person indicates increase risk for suicidal behaviour are the focus of intervention for the current study. The third session (the second rescripting session) may be omitted if the client is adamant that they do not want to rescript again, or they can choose a second image to rescript (replacing the 4th session). An optional fourth session can be planned to rescript an additional mental image of death or suicide. Study participants therefore will receive weekly, face-to-face therapy sessions of 60 minutes duration, between 2-4 sessions in total (session number determined by clinician and patient discussion and response to treatment). Study clinicians will be supported in adhering to the intervention with fortnightly supervision sessions.
Sponsors
Orygen
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to 25 Years
Healthy volunteers
No
Inclusion criteria
1. Young people aged 16 to 25 inclusive; 2. Current or recent suicidal ideation (within last 4 weeks); 3. Engagement with Orygen Specialist Program’s Youth Mood Clinic treatment as determined by the treating clinician; 4. Familiarity with, and willingness to use available crisis supports in context of suicide risk determined by patient report and clinical information; 5. Ability to provide informed consent and comply with study procedures; 6. Willingness to nominate an emergency contact; 7. Reporting one or more mental images of suicide, which increases risk for suicide, in the past 14 days; 8. Willingness to dedicate two treatment sessions to imagery rescripting therapy to treat the suicidal mental image (with an optional third and fourth session).
Exclusion criteria
1. Presence of an intellectual disability as documented on their medical record; 2. Not able to converse in, or read in English; 3. Poorly engaged in face-to-face treatment or approaching discharge as determined by the treating clinician; 4. Currently at acute risk of suicide requiring acute risk management; 5. Actively manic or psychotic (assessed by treating clinician) as assessed by the treating clinician; 6. Active mania or psychosis as assessed by the treating clinician; 7. Has not experienced mental images of suicide; 8. Presence of organic brain disease or severe neurological impairment, as documented in medical record; 9. Experience of only mental image(s) of suicide which decreases the risk of suicidal behaviour (i.e. a protective image) as reported by participant.
Outcome results
None listed