A Hybrid Effectiveness-Implementation Trial of Treatments for Veterans With PTSD at Elevated Acute Risk for Suicide
VA Office of Research and Development
Summary
Posttraumatic Stress Disorder (PTSD) is a significant driver of suicide risk among Veterans, but there is a critical knowledge gap about how to treat PTSD among people at elevated risk for suicide. Although evidence-based treatments for PTSD reduce suicide risk, Veterans at high risk for suicidal behavior rarely receive these potentially life-saving treatments. Prior research suggests that a treatment that combines Dialectical Behavior Therapy (DBT) with the DBT Prolonged Exposure protocol (DBT PE) for PTSD improves both PTSD and suicide-related outcomes. This study will evaluate whether DBT + DBT PE improves these outcomes more than Prolonged Exposure plus suicide risk management, the gold standard VA care for this population. The proposed study will also examine factors that make it easier and harder to implement these treatments in VA settings. The results will help to inform treatment guidelines for this high-priority Veteran population.
Description
Background: Posttraumatic stress disorder (PTSD) is a significant risk factor for suicide among Veterans. Evidence-based psychotherapies (EBPs) for PTSD reduce suicide risk, but Veterans at elevated acute risk for suicide, such as those who have engaged in self-directed violence (SDV), rarely receive these treatments. This is largely due to the historical exclusion of high-risk individuals from PTSD treatment trials, which has resulted in a lack of evidence-based guidance about indicated treatments for this population. Without such guidance, clinicians are often reluctant to use EBPs for PTSD…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * PTSD * Recent and repeated self-directed violence * Current suicidal ideation * Emotion dysregulation * Veteran eligible for VHA mental health care at participating site * Age 18+ * Willing to participate in all study activities Exclusion Criteria: * Unable to maintain safety independently * Currently engaged in and/or recent (past year) history of receiving a sufficient dose of DBT or PE * Plan to move away or be unavailable for \>4 weeks in the next 18 months * Unable to sufficiently comprehend study procedures due to lack of English proficiency or moderate to severe…
Interventions
- BehavioralDialectical Behavior Therapy
Standard Dialectical Behavior Therapy (DBT), including DBT individual therapy (1 hour/week), DBT group skills training (2 hours/week), between-session coaching (as needed during business hours), and therapist consultation team (1-1.5 hours/week).
- BehavioralDialectical Behavior Therapy Prolonged Exposure protocol
DBT PE is designed to be integrated into DBT to formally treat PTSD once patients meet standardized readiness criteria. The core procedures are in vivo and imaginal exposure with processing that are delivered in individual therapy sessions (1.5 hours/week).
- BehavioralProlonged Exposure therapy
Standard PE is delivered in individual therapy sessions (1.5 hours/week) and uses the core procedures of in vivo and imaginal exposure with processing.
- BehavioralSuicide risk management
Standard VA suicide risk management procedures, including comprehensive suicide risk assessment and safety planning.
Locations (4)
- Minneapolis VA Health Care System, Minneapolis, MNMinneapolis, Minnesota
- Durham VA Medical Center, Durham, NCDurham, North Carolina
- South Texas Health Care System, San Antonio, TXSan Antonio, Texas
- VA Puget Sound Health Care System Seattle Division, Seattle, WASeattle, Washington