Suicidal behaviors (SB) are a major health problem in France:10,000 suicides and 220,000 suicide attempts every year. SB management is therefore a major public health issue. Recently, investigators have demonstrated the interest of acceptance and commitment therapy (ACT) as an add-on treatment to reduce intensity and severity of suicidal ideation in depressed patients having a history of suicide attempt within previous year (i.e actual SB disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)). Based on structural and functional findings, it is admitted orbitofrontal and ventral prefrontal cortices play a role in suicidal vulnerability. Interestingly, previous functional MRI (fMRI) studies have also reported the modulation of these regions by ACT in subjects suffering from chronic pain. fMRI could thus be an interesting tool to identify biomarkers of SB and its improvement by ACT. The aim of study is to investigate neural biomarkers of ACT efficiency in patients with SB disorder. Patients having a history of SB within previous year were randomized in an ACT program (21 patients) or relaxation program (21 patients) during 7 weeks. Before and after the completion of the group, they performed 3 tasks during fMRI: implicit emotional visualization, Cyberball game, motivational task Investigators will compare cerebral activations between groups, between pre and post intervention as well as measure baseline cerebral activations associated with improvement of suicidal ideation during follow up.
42 patients having a history of suicide attempt within the year preceding inclusion have been recruited. First visit or inclusion (within 2 weeks preceding the beginning of the program): clinical, biological assessment and fMRI acquisition Second visit (within 2 weeks +/- 1 week following completion of the program): clinical assessment and fMRI acquisition Third visit (within 3 months +/- 2 weeks following completion of the program): clinical assessment
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
42
relaxation program consists of 7 weekly, 2 hours sessions led by two therapist. Each group will consist of 7 participants.
7 weekly, 2 hours sessions led by two therapist. Each group will consist of 7 participants. The ACT program aims at * decreasing the tendency to try to escape unpleasant mental experiences * increasing psychological flexibility * developing acceptance of psychological events and engagement in valued actions
Montpellier Hospital University
Montpellier, France
Variation of cerebral activation when viewing angry versus neural faces during an implicit emotional visualization task
Comparison between inclusion and 2 weeks after group completion of cerebral activation within ACT group
Time frame: At 2 weeks after group completion
Variation of cerebral activation when viewing angry versus neural faces during an implicit emotional visualization task
Comparison between inclusion and 2 weeks after group completion of cerebral activation within relaxation group
Time frame: At 2 weeks after group completion
Baseline activation when viewing angry vs. neutral faces during an implicit emotional visualization task
comparison between subjects with suicidal ideation vs. without suicidal ideation at 3 months after therapy
Time frame: At 3 months after therapy
Activation of specific brain regions when viewing sad, happy and disgust faces versus neutral faces during an implicit emotional visualization task
comparison between the two groups and before/after therapy / Association between baseline activation and improvement of suicidal ideation
Time frame: At the inclusion, and 2 weeks after the end of the therapy
Activation of specific brain regions during Cyberball game, a validated exclusion task
comparison between the two groups and before/after therapy / Association between baseline activation and improvement of suicidal ideation
Time frame: At the inclusion, and 2 weeks after the end of the therapy
Activation of specific brain regions during a motivational task
comparison between the two groups and before/after therapy / Association between baseline activation and improvement of suicidal ideation
Time frame: At the inclusion, and 2 weeks after the end of the therapy
Change of activation of default mode network (DMN) during resting state acquisition
Comparison between groups
Time frame: Baseline acquisition and 2 weeks after therapy
Baseline activation of DMN during resting state acquisition
Comparison between subjects with suicidal ideation versus without at 3 months after therapy
Time frame: Baseline acquisition and clinical assessment at 3 months after therapy
Baseline fraction of anisotropy
Comparison between subjects with suicidal ideation versus without at 3 months after therapy
Time frame: Baseline acquisition and clinical assessment at 3 months
Evolution of suicidal ideation measured by the Columbia Suicide Severity Rating Scale (CSSRS)
Comparison between the beginning and the end within each group and comparison between the two groups
Time frame: At the inclusion, 2 weeks after the end of the therapy and 3 months after the end of the therapy
Evolution of depressive state during the follow up measured by the Inventory of Depressive Symptomatology (IDSC-30)
Comparison between the beginning and the end within each group and comparison between the two groups
Time frame: At the inclusion, 2 weeks after the end of the therapy and 3 months after the end of the therapy
Evolution of psychologic pain during the follow up
Comparison between the beginning and the end within each group and comparison between the two groups by Likert scale
Time frame: At the inclusion, 2 weeks after the end of the therapy and 3 months after the end of the therapy
Evolution of anger during the follow up.
Comparison between the beginning and the end within each group and comparison between the two groups by the STAXI scale (Spielberger State-Trait Anger Expression Inventory)
Time frame: At the inclusion, 2 weeks after the end of the therapy and 3 months after the end of the therapy
Evolution of clinical global impression during the follow up.
Comparison between the beginning and the end within each group and comparison between the two groups by the CGI (Clinical Global Impressions scale)
Time frame: At the inclusion, 2 weeks after the end of the therapy and 3 months after the end of the therapy
Evolution of suicidal ideation measured by the Scale for Suicide Ideation (SSI)
Comparison between the beginning and the end within each group and comparison between the two groups
Time frame: At the inclusion, 2 weeks after the end of the therapy and 3 months after the end of the therapy
Evolution of depressive state during the follow up measured by the Quick Inventory of Depressive Symptomatology (QIDS-RS)
Comparison between the beginning and the end within each group and comparison between the two groups
Time frame: At the inclusion, 2 weeks after the end of the therapy and 3 months after the end of the therapy
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