Preliminary study of the Integrated skills for SUicide IMagery (I-SUIM) treatment for adults experiencing mental images of suicide.

Pilot Feasibility Trial of Integrated skills for SUicide IMagery (I-SUIM): A psychotherapy adjunct for mental images of suicide in adults

Status

Recruiting

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12625000078459

Acronym

I-SIUM-FT

Enrollment

Registered

2025-01-24

Start date

2026-01-22

Completion date

2026-06-30

Last updated

2026-03-30

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

When people contemplate suicide they can think using words (e.g., "I want to die") and/or mental imagery (e.g., visualising and mentally rehearsing suicide methods). Despite evidence that mental images of suicide are associated with greater risk of both having a detailed suicide plan and having previously enacted suicide behaviours, compared to verbal thoughts of suicide (Lawrence et al., 2022, 2023), no evidence-based treatment for suicide images has been published to date. We have developed a 3-4 session psychotherapy treatment for suicide imagery that is delivered as an addition to the usual-care that people experiencing suicidality receive in therapy. This project aims to evaluate feasibility, acceptability, and safety of this new treatment with a sample of people who receive the treatment. The project also aims to test the feasibility of evaluation procedures in preparation for a larger study of the efficacy of this intervention in future. We anticipate that the intervention will be safe and acceptable to participants, as well as feasible to deliver. We anticipate that the trial evaluation procedures will be suitable for use in a future larger evaluation of the efficacy of the intervention. We will recruit 20 people who experience mental imagery of suicide to receive the new treatment in addition to their regular care. We will collect data about people’s experiences of the intervention, their suicidality and mood using online surveys and questionnaires. With participant consent, we will also ask for their regular therapists to complete surveys about their progress and what types of treatments they have received during the trial period.

Interventions

SUicide IMagery REScripting (SUIMRES) Intervention + Treatment As Usual (SUIMRES + TAU) Participants allocated to this arm will continue TAU as per the control arm, with the addition of the SUicide IMagery REScripting (SUIMRES) intervention to be delivered via telehealth videoconferencing. SUIMRES is an adjunctive psychotherapy intervention delivered over 3-4 sessions in individual sessions with a qualified psychologist experienced in Imagery Rescripting and working with patients experiencing suicide ideation. The first two sessions are to be completed weekly to fortnightly, with timing of optional session 4 negotiated on a case-by-case basis (but this must be held within 6-8 weeks of starting SUIMRES). Thus, the total duration of the intervention will be between 3 (if only 3 sessions are completed and are completed weekly) and up to 8 weeks. Sessions are expected to last 90 minutes each but some may finish earlier (e.g., consolidation of imagery in Session 3 if the participant does not have additional imagery requiring rescripting). SUIMRES covers seven topics: (A) Assessment, Psychoeducation, and Identifying Imagery Target, (B) Imagery Rescripting as Rehearsal of Implementation Intention, and (C) Consolidation of Rescripted Image, Troubleshooting, or Practice with Additional Images, (D) Addressing the Impact of Memory-Based Imagery, (E) Incorporating Ambivalence Imagery, (F) Imagery to Connect with Future Self, and (G) Relapse Prevention. Sessions 1-3 include prescribed content that has been carefully designed to address key mechanisms through which suicide imagery may increase the risk of suicide behaviour. 1. Session 1 will cover Topic A (Assessment, Psychoeducation, and Identifying an Imagery Target) 2. Session 2 will cover Topic B (Imagery Rescripting as Rehearsal of Implementation Intention) 3. Session 3 will cover Topic C (Consolidation of Rescripted Image, Troubleshooting, or Practice with Additional Images) and if the final session should include Topic G Relapse prevention. Session 4 is optional and somewhat flexible in content. It may include recapping of content from Topics A-C, content from Topics D-F, or other relevant strategies. Adherence to the intervention will be assessed by requiring study therapists to complete a post-session questionnaire after each session. This questionnaire will require the therapists to select the intervention components have been utilised during that session, as well as indicating (a) whether other additional strategies were used (which therapists will be asked to describe), and (b) whether participants completed requested home practice tasks between sessions where applicable. This study will include assessment of the feasibility of the evaluation protocol used in this study and proposed for use in a future fully powered efficacy trial. The evaluation protocol includes the collection of data from people experiencing suicide imagery who enrol in the trial (primary participants), their usual-care therapists (secondary participants), and the trial clinicians who administer the intervention. The evaluation protocol includes questionnaires that are administered to primary participants at baseline, post-treatment (after their final session), and at follow-up (4 weeks after their final session). At this time the primary participants also complete a research participation feedback survey. After every therapy session the trial clinicians also complete a session summary form outlining the content of the session and patient engagement, as well as other relevant clinical information (e.g., risk assessments). The evaluation protocol also includes an online survey administered to secondary participants regarding the primary participants' therapeutic engagement in usual care, observations of the primary participants' engagement with SUIMRES (for those in the SUIMRES arm), and the secondary participants' experiences of communication and engagement with the trial team. After each trial clinician's final participant has completed all therapy sessions the trial clinicians also complete a survey regarding their experiences of both the SUIMRES intervention and of the trial protocol.

Integrated skills for SUicide IMagery (I-SUIM) Intervention + Treatment As Usual Participants will continue TAU, with the addition of the Integrated skills for SUicide IMagery (I-SUIM) intervention to be delivered via telehealth videoconferencing. I-SUIM is an adjunctive psychotherapy intervention delivered over 3-4 sessions in individual sessions with a qualified psychologist experienced in Imagery Rescripting and working with patients experiencing suicide ideation. The first two sessions are to be completed weekly to fortnightly, with timing of optional session 4 negotiated on a case-by-case basis (but this must be held within 10-12 weeks of starting I-SUIM). Thus, the total duration of the intervention will be between 3 (if only 3 sessions are completed and are completed weekly) and up to 12 weeks. Sessions are expected to last 90 minutes each but some may finish earlier (e.g., consolidation of imagery in Session 3 if the participant does not have additional imagery requiring rescripting). I-SUIM covers seven topics: (A) Assessment, Psychoeducation, and Identifying Imagery Target, (B) Imagery Rescripting as Rehearsal of Implementation Intention, and (C) Consolidation of Rescripted Image, Troubleshooting, or Practice with Additional Images, (D) Addressing the Impact of Memory-Based Imagery, (E) Incorporating Ambivalence Imagery, (F) Imagery to Connect with Future Self, and (G) Relapse Prevention. Sessions 1-3 include prescribed content that has been carefully designed to address key mechanisms through which suicide imagery may increase the risk of suicide behaviour. 1. Session 1 will cover Topic A (Assessment, Psychoeducation, and Identifying an Imagery Target) 2. Session 2 will cover Topic B (Imagery Rescripting as Rehearsal of Implementation Intention) 3. Session 3 will cover Topic C (Consolidation of Rescripted Image, Troubleshooting, or Practice with Additional Images) and if the final session should include Topic G Relapse prevention. Session 4 is optional and somewhat flexible in content. It may include recapping of content from Topics A-C, content from Topics D-F, or other relevant strategies. Adherence to the intervention will be assessed by requiring study therapists to complete a post-session questionnaire after each session. This questionnaire will require the therapists to select the intervention components have been utilised during that session, as well as indicating (a) whether other additional strategies were used (which therapists will be asked to describe), and (b) whether participants completed requested home practice tasks between sessions where applicable. This study will include assessment of the feasibility of the evaluation protocol used in this study and proposed for use in a future fully powered efficacy trial. The evaluation protocol includes the collection of data from people experiencing suicide imagery who enrol in the trial (primary participants), their usual-care therapists (secondary participants), and the trial clinicians who administer the intervention. The evaluation protocol includes questionnaires that are administered to primary participants at baseline, post-treatment (after their final session), and at follow-up (4 weeks after their final session). At this time the primary participants also complete a research participation feedback survey. After every therapy session the trial clinicians also complete a session summary form outlining the content of the session and patient engagement, as well as other relevant clinical information (e.g., risk assessments). The evaluation protocol also includes an online survey administered to secondary participants regarding the primary participants' therapeutic engagement in usual care, observations of the primary participants' engagement with I-SUIM, and the secondary participants' experiences of communication and engagement with the trial team. After each trial clinician's final participant has completed all therapy sessions the trial clinicians also complete a survey regarding their experiences of both the I-SUIM intervention and of the trial protocol.

Study design

Allocation

Non-randomised trial

Intervention model

Single group

Primary purpose

Treatment

Masking

Open (masking not used)

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

Individuals will be eligible to participate if they: - Currently (in the past month) experience suicide ideation that consists of mental images (mentally picturing or imagining suicide or the impacts of suicide on yourself or other people) - have an existing AHPRA-registered therapist (e.g. psychologist, psychiatrist) whom they see regularly (or have access to if required) for treatment within Australia, who agrees to referring the patient to the trial, and who also consents to act as a secondary participant (i.e., complete a short survey after the trial), - have a written safety plan created in partnership with this therapist that will be shared with the trial team (e.g., BeyondNow Safety Plan), - have existing coping strategies for managing periods of distress that will be shared with the trial team. The imagery intervention may enhance the application of coping skills, but should not serve as a foundational introduction to coping skills, - consent to communication between their usual-care therapist and the trial team regarding their care, progress, and risk issues. - are an adult aged over 18 years who can read and speak English Fluently, - reside in Australia and will do so for the duration of the trial, - can access the internet in a private location on a device suitable for attending telehealth consultations, AND - can attend telehealth consultations during Monday to Friday business hours NSW or WA time (09:00-17:00).

Exclusion criteria

Individuals will be ineligible to participate if they: - feel as though their mental imagery of suicide is helpful and protective against suicide (this intervention will seek to treat suicide imagery that is unhelpful or not protective). - have experienced active intention to suicide or taken behavioural steps to prepare to suicide in the past three months, OR - have experienced a significant mental health crisis over the past three months (requiring emergency department attendance, inpatient admission, or engagement with acute care team services), unless this was in relation to a specific external event (e.g., redundancy, bereavement) which has been resolved to the extent that the patient, usual-care therapist, and trial intake psychologist agree that the patient is stable and ready to participate OR - based on the clinical judgement of (a) their usual-care therapist or (b) the trial team, are deemed to not be suitable for the trial at this time (e.g., require further practice with coping strategies or stabilisation, presence of higher priority symptoms that are more important to address prior to the imagery or might interfere with engagement in the trial or trial involvement might compromise treatment of such, or therapy-interfering behaviours), OR - have a usual-care therapist that does not consent to referral or participation in the trial as a secondary participant (i.e., completing the post-trial questionnaire), OR - are current patients of a member of the trial research team.

Outcome results