This study aims to evaluate the acceptability, safety, and efficacy of a smartphone-delivered intervention called Therapeutic Evaluative Conditioning for Suicide (TEC-S) in reducing suicidal thoughts and behaviors (STB) among adults with recent and frequent suicide ideation.
The present study is a two-arm randomized controlled trial (RCT) designed to evaluate the safety, acceptability, and efficacy of Therapeutic Evaluative Conditioning for Suicide (TEC-S), a smartphone-delivered intervention aimed at reducing suicidal thoughts and behaviors (STB). Participants in this study will be 60 adult participants (ages 18+) who report recent and frequent STB, residing within the greater-Boston, Ma area. Participants will be randomized to receive either the control condition, which consists of 3x/daily ecological momentary assessment (EMA) of emotions and STBs and optional inactive TEC (n = 30), or the experimental condition, consisting of 3x/daily EMA and optional active TEC-S (n = 30). Evaluative conditioning uses classical conditioning to alter attitudes. The aim of TEC-S is to alter attitudes toward suicide and, in turn, reduce STB. EMAs will monitor STB, safety, and acceptability, and efficacy. Weekly behavioral and self-report assays will assess hypothesized treatment mechanisms. The study's aim is to determine if the active TEC-S condition reduces STB and to explore if altered attitudes toward suicide mediates this effect.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
Therapeutic Evaluative Conditioning for Suicide (active TEC-S) is a behavioral treatment where participants are given optional access to a computerized task/game where they repeatedly pair suicidal behavior stimuli (pictures, words) with other negative stimuli and self-related stimuli with positive stimuli.
Therapeutic Evaluative Conditioning (inactive TEC-S) is a behavioral treatment where participants are given optional access to a computerized task/game where they repeatedly pair positive and negative stimuli (pictures, words) with each other.
Massachusetts General Hospital
Boston, Massachusetts, United States
Desire to die by suicide (Likert)
Right now, how strongly do you want to kill yourself? \[0 (not at all) to 10 (extremely)\]; assessed via 3x/day ecological momentary assessment (Kleiman et al., 2018)
Time frame: Through completion of treatment phase (day 1 through 30)
Suicide intent (Likert)
Right now, how strong is your intention to kill yourself today? \[0 (I am definitely not going to kill myself today) to 10 (I am definitely going to kill myself today)\]; assessed via 3x/day ecological momentary assessment
Time frame: Through completion of treatment phase (day 1 through 30)
Suicide urge (Likert)
Right now, how strong is your urge to kill yourself \[0 (not at all) to 10 (very strong)\]; assessed via 3x/day ecological momentary assessment.
Time frame: Through completion of treatment phase (day 1 through 30)
Suicide thought incidence
Since the last survey, have you had suicidal thoughts? (yes/no); assessed daily via ecological momentary assessment
Time frame: Through treatment phase completed (day 1 through 30)
Suicide planning incidence
Since the last survey, have you made a plan to kill yourself? (yes/no); assessed daily via ecological momentary assessment
Time frame: Through completion of treatment phase (day 1 through 30)
Suicide preparation incidence
Since the last survey, have you made any preparations to kill yourself? (yes/no); assessed daily via ecological momentary assessment.
Time frame: Through completion of treatment phase (day 1 through 30)
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Suicide attempt incidence
Since the last survey, have you attempted to kill yourself? (yes/no); assessed daily via ecological momentary assessment
Time frame: Through completion of treatment phase (day 1 through 30)
Suicidal behaviors (composite)
A composite variable consisting of (i) suicide plan incidence, (ii) suicide preparation incidence, (iii) suicide attempt incidence, each assessed via ecological momentary assessment
Time frame: Through completion of treatment phase (day 1 through 30)
Suicide aversion (AMP)
Suicide aversion assessed implicitly/behaviorally via the Affect Misattribution Procedure (AMP; Payne et al., 2005)
Time frame: Through completion of treatment phase (day 1 through 30)
Suicide aversion (Likert)
Valence ratings of suicide-related pictures using a 9-point scale (-4 \[extremely unpleasant\] to 0 \[neutral\] to 4 \[extremely pleasant\]); assessed weekly (Jaroszewski et al., 2022).
Time frame: Through completion of treatment phase (day 1 through 30)
Self affection (AMP)
Self affection assessed implicitly/behaviorally via the Affect Misattribution Procedure (AMP; Payne et al., 2005)
Time frame: Through completion of treatment phase (day 1 through 30)