Using mindfulness-based cognitive therapy to manage pain and mitigate suicide risk in Veterans

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The proposed study will develop a mindfulness-based cognitive therapy (MBCT) manual to address both functional impairment and suicide risk (MBCT-S/P). We will examine the feasibility of the study design and ask participants if the found the treatment to be acceptable. We expect this smaller study will provide critical information for a larger trial. Suicide is the 10th leading cause of death. Chronic pain is a leading cause of functional impairment in the United States and is a risk factor of suicide even after accounting for psychiatric disorders. Veterans are a vulnerable population for both suicide and chronic pain; however, there is little research examining ways to reduce functional impairment and suicide risk in a combined treatment. Therefore, this proposal examines the use of MBCT as a novel way to simultaneously address functional impairment and suicide risk. Research on patients at risk of suicide and on patients experiencing chronic pain supports the utility of MBCT separately. However, there is limited evidence investigating a combined treatment that addresses both functional impairment and suicide risk. Application of MBCT on veterans at risk for suicide who are experiencing functionally-impairing chronic pain provides a unique opportunity to simultaneously address these interactive factors. The overall goal of the broader program is to enhance functioning and to reduce veteran suicide, and the proposed project will provide data to guide the development of a larger trial. The objectives of the current proposal are to (1) combine existing MBCT intervention protocols to develop an MBCT manual aimed at addressing the unique needs of veterans experiencing functional impairment from chronic pain who are at risk for suicide, (2) examine if the recruitment, retention, and treatment delivery is feasible and if MBCT-S/P acceptable to participants, and (3) assess parameters of key outcomes among participants randomized to receive MBCT-S/P versus an Education control to inform a subsequent larger clinical trial. To achieve these objectives, we will develop a manual through an evidence-based, iterative process then conduct a randomized clinical trial in Veterans with chronic pain reporting suicidal ideation. We will randomize a total of 76 participants to receive either MBCT-S/P or Education. We will assess pain and suicide risk outcomes such as suicidal ideation, depression, and interpersonal factors at baseline and after the treatment period. We will also track participant flow, therapist adherence to the manual, participant homework completion and participant satisfaction with the treatment.