An Autobiographical Memory-Based Intervention for Suicidality

November 11, 2024 updated by: Alexandra Powell, Lancaster University

Exploring the Feasibility and Acceptability of an Autobiographical Memory-Based Intervention for People With Suicidality: A Case Series

The study involves a short therapy intervention for people who are experiencing thoughts of suicide. The intervention will focus upon different memories from the person's life. These memories will vary in the emotions they evoke - some memories will be associated with neutral emotions, whereas others will bring up positive emotions. The intervention will have a particular focus upon memories of times when the participants have moved away from thinking about suicide, with the aim of reinforcing memories of what helped them to reconnect with life. The intervention will also introduce relaxation techniques, in addition to involving a safety planning component. The project aims to consider whether this intervention is acceptable and feasible for this population.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study is looking at whether an autobiographical memory-based intervention is acceptable and suitable for people with thoughts of suicide within a secondary mental health population. Autobiographical memory involves the recollection of past events in a person's own life, and this has been linked to a person's sense of identity, goals, and orientation in the present. Memories linked to negative emotions have been shown to be durable, accessible, and easily and vividly remembered. The power that memories of suicidal ideation and suicide attempts hold is therefore concerning. This intervention aims to support participants to more readily access positive and neutral autobiographical memories, using memory tasks and worksheets. By focusing upon individuals' moves away from suicidal thinking, it also aims to shift the focus onto remembering what led people to reconnect with life.

The study is an experimental case series using a non-concurrent A-B multiple baseline design, in which the participants first attend 3-5 baseline sessions prior to attending 6 intervention sessions. Sessions are one-to-one. The initial baseline session and all intervention sessions will take place face-to-face. The follow-up baseline sessions can be conducted in-person, online via Microsoft Teams, or via telephone, depending on participant preference.

The initial baseline session will involve assessing risk and updating participants' safety plan. The intervention involves 6 sessions of approximately one hour. The first session will focus upon familiarisation to concepts in the intervention, using imagery-based metaphors to support understanding. Sessions 2-4 will focus on different memories - neutral, positive, and memories of moves away from suicidal thinking. Memory tasks will broadly follow the 5 stages outlined in the broad-minded affective coping (BMAC) procedure, but with a focus on these specific memories. In the final 2 sessions, participants will have a choice around which memory to focus on. The final session will also involve post-intervention planning. Outcome measures will be completed in all baseline and intervention sessions.

The study aims to recruit 5-7 participants from community mental health teams (CMHTs) in which supervisory support can be arranged. The intervention will be conducted by the principle investigator (AP), a trainee psychologist, under the supervision of clinical psychologists within the CMHTs (JK and NI) who are also members of the research team.

Study Type

Interventional

Enrollment (Actual)

3

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
      • Manchester, United Kingdom, M25 3BL
        • Greater Manchester Mental Health NHS Foundation Trust

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Individual has experienced suicidal ideation and/or suicidal behaviours within the previous 3 months. This will be screened for by asking the questions:

    1. Have you had thoughts or images of ending your life within the past three months? or
    2. Have you attempted to end your life within the past 3 months?
  • Currently under a Community Mental Health Team (CMHT) within which supervisory support can be arranged.

Exclusion Criteria:

  • Moderate/severe learning disability
  • Organic cerebral disease/injury which significantly affects language comprehension or expression
  • Non-English speaking
  • Acute psychosis which would affect engagement
  • Receiving psychological treatment or participating in another research intervention
  • At imminent risk of acting upon thoughts of suicide or of harm to others. This will be screened for by assessing for the presence of active intent or plans to harm themselves or others within the next month. If these individuals consent to be contacted again after a month, the researcher will consider approaching them again to assess for changes to imminent risk. If the individual met the eligibility criteria at this point, the individual would be invited to take part in the study.
  • A history of violence or harm to others to a degree in which clinicians have assessed one-to-one sessions to be unsafe
  • Currently within an inpatient setting or open to a home-based treatment team.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Autobiographical Memory Based Intervention

All participants will be placed into the intervention arm, in which the participants will receive 6 autobiographical memory based intervention sessions, lasting approximately one hour.

Baseline lengths will vary from 3 - 5 sessions, with the initial session lasting approximately one hour, and follow up sessions lasting approximately 30 minutes. This randomisation is 1) to enable the effects of treatment to be separated from the effects of time seen clinically and 2) in order to control for the therapeutic value of contact.
Other: Autobiographical Memory Based Intervention

The intervention involves 6 sessions of therapeutic input based around autobiographical memories. Memory based activities will broadly follow the 5 stages outlines in the broad-minded affective coping (BMAC) procedure, but with a focus on specific memories. It will follow the following structure:

Session 1 - Introduction and Familiarisation Session 2 - Neutral Memories Session 3 - Positive Memories Session 4 - Memories of Moves Away from Suicidality Session 5 - Practice of Preferred Memory (from Sessions 2-4) Session 6 - Continued Practice and Post-Intervention Planning

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Acceptability - Therapeutic Alliance
Time Frame: Up to 14 weeks
This is to consider the therapeutic relationship between the practitioner and participant. Measured using the Working Alliance Inventory - Short Revised, scored out of 60 where a high score indicates strong alliance.
Up to 14 weeks
Acceptability - Adverse effects
Time Frame: Up to 14 weeks
This is to assess for any negative outcomes of the intervention. Measured using the Adverse Effects in Psychotherapy questionnaire, with statements scored on a 5 point scale from 'not at all' to 'very much'
Up to 14 weeks
Acceptability - Clinical Global Impression
Time Frame: Up to 14 weeks
This is a measure of the practitioner's overall clinical impression of the participant during the session. This is measured using the Clinical Global Impressions Scale, where severity is scored on a scale of 1-7 (where 7 indicates a negative impression/change).
Up to 14 weeks
Acceptability - Overall
Time Frame: Up to 14 weeks
The overall acceptability of the intervention will be measured using an adapted Acceptability Scale. This includes measures of multiple key areas which are important for an intervention to be classified as acceptable by a participant. Statements are assessed on a 5 point scale from 'strongly disagree' to 'strongly agree'.
Up to 14 weeks
Acceptability - Qualitative Feedback
Time Frame: Up to 14 weeks
Qualitative feedback around the acceptability of the intervention - collected at the end of the Adverse Effects in Psychotherapy Scale with the question 'If you would like to describe your experience of taking part in the study in your own words, please use the following space'.
Up to 14 weeks
Feasibility - rates of recruitment, attendance, and completion
Time Frame: Up to 14 weeks
To assess whether the intervention is feasible within this population, the investigators will consider the proportion of participants approached who met the eligibility criteria, and proportion of these who consent to taking part in the study. The investigators will also collect data on attendance rates, where reasonable attendance will be set as ≥ 3 sessions out of the 6-session intervention, in accordance with the criteria set out in a similar case series study. Therapy completion rates will also be recorded, where the investigators will look at the number of participants who completed the final set of therapy measures.
Up to 14 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Suicidality
Time Frame: Up to 14 weeks
Measured using the Columbia Suicide Severity Rating Scale. The scale uses yes/no questions, plus an overall score of actual lethality (where 0 is least severe and 5 is most) and of potential severity (where 0 is lowest risk and 2 is highest risk) in relation to the individual's i) most recent suicide attempt, ii) most lethal attempt, and iii) first attempt.
Up to 14 weeks
Entrapment
Time Frame: Up to 14 weeks
Entrapment has been closely linked to suicidal ideation and suicide risk. The investigators will measure this using a 4-item Entrapment Scale - Short-Form. This is scored out of 16, where a high score indicates high levels of entrapment.
Up to 14 weeks
Perceived Burdensomeness / Thwarted Belonging
Time Frame: Up to 14 weeks
Interpersonal factors have also been linked to suicidal ideation and suicide risk. This will be measured using the Interpersonal Needs Questionnaire. This is scored out of 105, where a high score indicates greater levels of perceived burdensomeness and thwarted belonging.
Up to 14 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Sessional Mood Scale
Time Frame: Up to 14 weeks
Participants' mood from 1-10 will be rated at the start of each session to assess for weekly changes, where 10 indicates the most positive mood.
Up to 14 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Lancaster University

Investigators

  • Principal Investigator: James Kelly, ClinPsyD, Lancaster University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 15, 2024

Primary Completion (Actual)

August 21, 2024

Study Completion (Actual)

August 21, 2024

Study Registration Dates

First Submitted

January 5, 2024

First Submitted That Met QC Criteria

January 16, 2024

First Posted (Actual)

January 26, 2024

Study Record Updates

Last Update Posted (Estimated)

November 12, 2024

Last Update Submitted That Met QC Criteria

November 11, 2024

Last Verified

November 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 316697

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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