A Novel Cognitive Reappraisal Intervention for Suicide Prevention (CRISP)
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| ClinicalTrials.gov Identifier: NCT03026127 |
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Recruitment Status :
Recruiting
First Posted : January 20, 2017
Last Update Posted : May 19, 2022
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Suicide Prevention | Behavioral: Cognitive Reappraisal Intervention for Suicide Prevention Behavioral: Supportive Therapy | Not Applicable |
The Investigators developed a novel psychosocial intervention called "Cognitive Reappraisal Intervention for Suicide Prevention (CRISP)," which aims to improve cognitive reappraisal ability (i.e. the ability to modify the appraisal of a situation to alter its emotional significance) (target), and reduce suicide risk (outcome). The conceptual framework views suicidal ideation and behavior as failed attempts to regulate negative emotions and by improving cognitive reappraisal, an effective emotion regulation strategy, the investigators expect to reduce suicide risk. This 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 R61 phase is a proof-of-principle phase and its goals are to optimize CRISP and test its engagement with cognitive reappraisal. Certified social workers will administer 12 weekly sessions of CRISP to 40 middle-aged and older adults (50-90 years old) after a suicide-related hospitalization. Research assistants, unaware of the study aims, will conduct assessments at study entry (hospital admission), discharge, 6 and 12 weeks post-discharge. Target engagement will be assessed with EEG assessments during a standard pictured-based stimuli and our novel cognitive reappraisal paradigm.
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 90 middle-aged and older adults (using the same inclusion/exclusion criteria as for the R61 phase) will be randomized to CRISP or to Supportive Therapy (ST, a control treatment not designed to improve emotion regulation). 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 ability from discharge to end of treatment; and 2) improvement in cognitive reappraisal ability will be associated with suicide risk over 24 weeks.
| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 90 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Single (Outcomes Assessor) |
| Primary Purpose: | Prevention |
| Official Title: | A Novel Cognitive Reappraisal Intervention for Suicide Prevention |
| Actual Study Start Date : | March 28, 2017 |
| Estimated Primary Completion Date : | August 2023 |
| Estimated Study Completion Date : | August 2024 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: CRISP
Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) is a psychosocial intervention aimed to reduce suicide risk in middle-aged and older adults who have been hospitalized for suicidal ideation or suicide attempt. CRISP offers a combination of emotion regulation techniques, including changing the subject's perspective or the way he/she thinks to improve emotion reactions. Additional strategies taught include the provision of environmental adaptation tools (notes, checklists, calendars, etc), phone calls, and a tablet application called WellPATH.
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Behavioral: Cognitive Reappraisal Intervention for Suicide Prevention
Cognitive Reappraisal Intervention for Suicide Prevention, or CRISP, is a psychosocial intervention aimed to reduce suicide risk in middle-aged and older adults who have been hospitalized for suicidal ideation or suicide attempt. CRISP offers a combination of emotion regulation techniques, including changing the subject's perspective or the way he/she thinks to improve emotion reactions. Additional strategies taught include the provision of environmental adaptation tools (notes, checklists, calendars, etc), phone calls, and a tablet application called WellPATH.
Other Name: CRISP |
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Active Comparator: Supportive Therapy (ST)
Supportive Therapy focuses on: 1. facilitating expression of affect; 2. conveying to the patient that he or she is understood; 3. offering empathy; and 4. highlighting positive experiences. The ST manual aims to standardize nonspecific therapeutic factors.
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Behavioral: Supportive Therapy
ST focuses on: 1. facilitating expression of affect; 2. conveying to the patient that he or she is understood; 3. offering empathy; and 4. highlighting positive experiences. The ST manual aims to standardize nonspecific therapeutic factors
Other Name: ST |
- Emotion Regulation, as measured by the Electroencephalogram (EEG), Autobiographical Affective Regulation Task (AART), and a standard picture-based emotion regulation task. [ Time Frame: Baseline, 6, 12, and 24 weeks ]A composite measure of the above tasks with the EEG will be analyzed to assess the patient's cognitive reappraisal ability.
- Change in Suicide Severity, as measured by the Columbia Suicide Severity Rating Scale (CSSR-S) [ Time Frame: Baseline, Weeks 1-24 ]The CSSR-S assesses risk for suicide, specifically severity of thoughts, intensity of thoughts, behavior and lethality. Questions are scored in categories, 1-10, with lower numbers indicating less severity and higher numbers more severity.
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| Ages Eligible for Study: | 50 Years to 90 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- 50 years and older
- Diagnosis (based on SCID-5 Clinical Trials Version to assess DSM-5 diagnoses): Any DSM-5 depression or anxiety diagnosis, including major depressive disorder, bipolar depression, depressive disorder Not Elsewhere Classified, anxiety disorder Not Elsewhere Classified, adjustment disorder with anxiety and depressed mood (but without any of the diagnoses shown under Exclusion Criteria)
- Recent hospitalization for suicidal ideation or suicide attempt. At hospital admission, Columbia Suicide Severity Rating Scale greater or equal to 3, "Active Suicidal Ideation with any methods or a suicide attempt."
- Patients with any degree of suicidal ideation at discharge (Columbia Suicide Severity Rating greater or equal to 0) will be included.
- Patients who are on psychotropics and on after-care community psychotherapy will also be included.
Exclusion Criteria:
- History or current diagnosis of Psychotic Disorders; Current Diagnosis of Bipolar I or Bipolar II, with current episode hypomanic, manic or mixed; Diagnosis of Dementia.
- Cognitive Impairment: Mini Mental State Exam (MMSE) < 24.
- Acute or severe medical illness (i.e. delirium; decompensated cardiac, liver, or kidney failure; major surgery; stroke or myocardial infarction during the three months prior to entry.
- Aphasia, sensory problems, and/or inability to speak English.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03026127
| Contact: Dimitris Kiosses, PhD | 9149974381 | dkiosses@med.cornell.edu | |
| Contact: Laurie Evans, MS | 9146829100 ext 1012570 | lad9011@med.cornell.edu |
| United States, New York | |
| Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine | Recruiting |
| White Plains, New York, United States, 10605 | |
| Contact: Dimitris Kiosses, PhD 914-997-4381 dkiosses@med.cornell.edu | |
| Contact: Laurie Evans, MS 914-682-9100 ext 1012570 lad9011@med.cornell.edu | |
| Principal Investigator: | Dimitris Kiosses, PhD | Weill Medical College of Cornell University |
| Responsible Party: | Weill Medical College of Cornell University |
| ClinicalTrials.gov Identifier: | NCT03026127 |
| Other Study ID Numbers: |
1603017115 5R33MH110542 ( U.S. NIH Grant/Contract ) 1R61MH110542 ( U.S. NIH Grant/Contract ) |
| First Posted: | January 20, 2017 Key Record Dates |
| Last Update Posted: | May 19, 2022 |
| Last Verified: | May 2022 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | Yes |
| Plan Description: | De-identified data from this study is submitted to the National Database for Clinical Trials related to Mental Illness (NDCT). The NDCT is run by NIH and allows researchers studying mental health to collect and share information with each other. Researchers must apply to NIH in order to be allowed access to the data for 1 year's time; after which they must re-apply. |
| Time Frame: | Data will be available as per NIH's data sharing policy. |
| Access Criteria: | Access criteria is determined by NIH and can be requested by applying online. |
| URL: | https://nda.nih.gov/ |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
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Suicide Middle-aged and Older Adults Cognitive Reappraisal Emotion Regulation |
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Suicide Self-Injurious Behavior Behavioral Symptoms |