A Novel Cognitive Reappraisal Intervention for Suicide Prevention

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ABSTRACT The goal of the parent R33 is to test a novel emotion-regulation based psychosocial intervention designed to reduce suicide risk in middle-aged and older adults (50-90 years old) who have been discharged after a suicide-related hospitalization (i.e. for suicidal ideation or suicide attempt). Suicide rates in this group are alarmingly high, and reducing suicide rates in at-risk populations is a major NIMH priority. We developed a novel psychosocial intervention called “Cognitive Reappraisal Intervention for Suicide Prevention (CRISP),” which aims to improve cognitive reappraisal (i.e. modifying the appraisal of a situation to alter its emotional significance) (target), and reduce suicide risk (outcome). Our conceptual framework views suicidal ideation and behavior as failed attempts to regulate negative emotions and by improving cognitive reappraisal, an effective emotion regulation strategy, we expect to reduce suicide risk. Our theory is supported by studies showing that unsuccessful attempts to regulate negative emotions and decreased cognitive reappraisal are associated with increased suicidal ideation and behavior. The R33 phase aims to provide further evidence of target engagement of the optimized CRISP in a larger sample, evaluate the relationship of cognitive reappraisal with suicide risk as measured with Columbia Suicide Severity Rating Scale-C-SSRS and estimate implementation parameters for a large-scale clinical trial. A different sample of 75 middle-aged and older adults (using the same inclusion/exclusion criteria as for the R61 phase) will be randomized (2 to 1) to CRISP (N=60) or to Supportive Therapy (ST, a control treatment not designed to improve emotion regulation) (N=30). Assessments will be conducted on admission, at discharge, and at 6, 12 and 24 weeks post-discharge. Primary aims are: 1) CRISP participants will show improvement in cognitive reappraisal from discharge to end of treatment; and 2) improvement in cognitive reappraisal will be associated with suicide risk over 24 weeks. This administrative supplement aims to counterbalance the effect of COVID-19 on recruitment, therapy, and assessments. Due to COVID-19, we were unable to recruit any participants because we could not administer EEGs, which was the primary outcome of our study. We have recruited 35 out of 90 participants (38%) as of 8/30/2021. Because of a newly developed EEG safety protocol and the vaccination of our staff, we are planning to resume recruitment in September 2021. We have accumulated an unobligated balance which, if approved for no-cost extension, will fund the recruitment of 25 additional participants. This administrative supplement will fund the recruitment, therapy, and assessments of the remaining 30 participants.