Written Exposure Therapy for Suicide Prevention: A Randomized Clinical Trial


Evaluate the efficacy of Written Exposure Therapy for Suicide Prevention compared with treatment as usual in reducing severity and incidence of self-injurious thoughts and behaviors among hospitalized active duty military personnel at risk for suicide. Evaluate a method of predicting who will benefit from the therapy.

Military personnel admitted to inpatient psychiatry for self-injurious thoughts and behaviors (SITBs) represent an at-risk group for continued SITBs and rehospitalizations following discharge. However, there is an absence of evidence-based interventions designed to be delivered on inpatient psychiatric units to reduce the risk of post-discharge SITBs.

To address this need, STRONG STAR investigators have developed Written Exposure Therapy for Suicide Prevention (WET-SP), a brief, suicide-specific psychotherapy based on Written Exposure Therapy, in which an individual writes about a personally stressful experience and the related thoughts and feelings. WET has shown to be effective in improving mental and physical health, and data from pilot study research suggests that it also helps to reduce SITBs.

However, no study has adapted WET-SP specifically to target distress associated with suicidal crises and examined whether the intervention reduces risk of subsequent SITBs and suicide-related hospitalizations. 

Testing the therapy at a military hospital

STRONG STAR investigators led by Brian Marx, PhD, with VA’s National Center for PTSD and Boston University School of Medicine, will address that research gap with a study involving 124 patients admitted for acute psychiatric care at Carl R. Darnall Army Medical Center at Fort Cavazos (formerly Fort Hood), TX. Half will be randomly assigned to receive WET-SP delivered by the study team, plus the psychiatric unit’s treatment as usual (TAU). The other half will be assigned simply to receive TAU, which includes daily contact and patient-centered care delivered by the acute psychiatric unit provider team. TAU also includes psychiatric assessment, initial stabilization, nurse case management, medication management, treatment of medical comorbidities, group and individual therapy, and discharge planning.

Assessments to measure the outcomes for both groups of patients will be administered at pretreatment, posttreatment, and 10-, 20-, and 30-week follow-ups. The investigators also will explore whether a computerized analysis of the narrative content of WET-SP can predict which patients will benefit from the treatment.

Expected benefits

If WET-SP demonstrates success, it will address a critical healthcare crisis by reducing suicidal ideation and preventing post-discharge suicidal behaviors and rehospitalization for suicide-related concerns.

Although WET-SP must be delivered by a clinician, it is easy to train, offering a relatively low-cost yet high-yield therapeutic approach for military settings.

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