A psychological intervention for suicide applied to non-affective psychosis: the CARMS (Cognitive AppRoaches to coMbatting Suicidality) randomised controlled trial protocol

Patricia A Gooding, Daniel Pratt, Yvonne Awenat, Richard Drake, Rachel Elliott, Richard Emsley, Charlotte Huggett, Steven Jones, Navneet Kapur, Fiona Lobban, Sarah Peters, Gillian Haddock, Patricia A Gooding, Daniel Pratt, Yvonne Awenat, Richard Drake, Rachel Elliott, Richard Emsley, Charlotte Huggett, Steven Jones, Navneet Kapur, Fiona Lobban, Sarah Peters, Gillian Haddock

Abstract

Background: Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis.

Methods: The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6 months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders.

Discussion: This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be efficacious.

Trial registration: ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666); 5th June 2017). Registration was recorded prior to participant recruitment commencing.

Keywords: Cognitive therapy; Psychological interventions; Psychological suicide mechanisms; Psychosis; Randomised controlled trial; Schizophrenia; Suicidal thoughts and behaviours; Suicide.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The CARMS Trial design

References

    1. WHO . Suicide Data. 2020.
    1. AFSP . Suicide Statistics. 2020.
    1. ONS . Suicides in the United Kingdom. 2018.
    1. Samaritans . Suicide Statistics Report. 2019.
    1. Peterson C, Sussell A, Li J, Schumacher P, Yeoman K, Stone DM. Suicide rates by industry and occupation — National Violent Death Reporting System, 32 states, 2016. MMWR Morb Mortal Wkly Rep. 2020;69(3):57–62.
    1. . Serlf harm and suicidal thoughts and attempts. 2019.
    1. NIMH . Suicide. 2019.
    1. Hawton K, van Heeringen K. Suicide. Lancet. 2009;373(9672):1372–1381.
    1. Bolton C, Gooding P, Kapur N, Barrowclough C, Tarrier N. Developing psychological perspectives of suicidal behaviour and risk in people with a diagnosis of schizophrenia: we know they kill themselves but do we understand why? Clin Psychol Rev. 2007;27(4):511–536.
    1. Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry. 2005;187:9–20.
    1. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia. Is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64(10):1123–1131.
    1. Cohen S, Lavelle J, Rich CL, Bromet E. Rates and correlates of suicide attempts in first-admission psychotic-patients. Acta Psychiatr Scand. 1994;90(3):167–171.
    1. Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia - a reexamination. Arch Gen Psychiatry. 2005;62(3):247–253.
    1. Tarrier N, Gooding P, Pratt D, Kelly J, Awenat Y, Maxwell J. Cognitive behavioural prevention of suicide in psychosis: a treatment manual. London: Routledge; 2013.
    1. DeVylder JE, Lukens EP, Link BG, Lieberman JA. Suicidal ideation and suicide attempts among adults with psychotic experiences data from the collaborative psychiatric epidemiology surveys. Jama Psychiatry. 2015;72(3):219–225.
    1. Chapman CL, Mullin K, Ryan CJ, Kuffel A, Nielssen O, Large MM. Meta-analysis of the association between suicidal ideation and later suicide among patients with either a schizophrenia spectrum psychosis or a mood disorder. Acta Psychiatr Scand. 2015;131(3):162–173.
    1. Hawton K, Witt KG, Taylor-Salisbury TL, Arensman E, Gunnell D, Hazell P, et al. Psychosocial interventions for self-harm in adults (review) Cochrane Database Syst Rev. 2016;5:1–308.
    1. Meerwijk EL, Parekh A, Oquendo MA, Allen IE, Franck LS, Lee KA. Direct versus indirect psychosocial and behavioural interventions to prevent suicide and suicide attempts: a systematic review and meta-analysis. Lancet Psychiatry. 2016;3(6):544–554.
    1. Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior a systematic review and meta-analysis. Behav Modif. 2008;32(1):77–108.
    1. Riblet NBV, Shiner B, Young-Xu Y, Watts BV. Strategies to prevent death by suicide: meta-analysis of randomised controlled trials. Br J Psychiatry. 2017;210(6):396.
    1. Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, et al. Suicide strategies revisited: 10 year systematic review. Lancet Psychiatry. 2016;3(7):649–659.
    1. Johnson J, Gooding P, Tarrier N. Suicide risk in schizophrenia: explanatory models and clinical implications, the schematic appraisal model of suicide (SAMS) Psychol Psychother. 2008;81:55–77.
    1. Williams JMG. Cry of pain. UK Penguin: Harmondsworth; 1997.
    1. Klonsky ED, May AM. The Three-Step Theory (3ST): A new theory of suicide rooted in the “Ideation-to-Action” framework. Int J Cogn Ther. 2015;8(2):114–129.
    1. O'Connor RC. The integrated motivational-volitional model of suicidal behavior. Crisis. 2011;32(6):295–298.
    1. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575–600.
    1. Panagioti M, Tarrier N, Angelakis I, Gooding P. A prospective investigation of the impact of distinct PTSD symptom clusters on suicidal ideation. Cogn Ther Res. 2017;41(4):645–53. 10.1007/s10608-016-9829-2.
    1. Taylor PJ, Gooding PA, Wood AM, Johnson J, Pratt D, Tarrier N. Defeat and entrapment in schizophrenia: the relationship with suicidal ideation and positive psychotic symptoms. Psychiatry Res. 2010;178(2):244–248.
    1. Panagioti M, Gooding P, Tarrier N. A meta-analysis of the association between Posttraumatic Stress Disorder (PTSD) and suicidality: The role of comorbid depression. Compr Psychiatry. 2012;53(7):915–930.
    1. Tarrier N, Kelly J, Maqsood S, Snelson N, Maxwell J, Law H, et al. The cognitive behavioural prevention of suicide in psychosis: a clinical trial. Schizophr Res. 2014;156(2–3):204–210.
    1. Pratt D, Tarrier N, Dunn G, Awenat Y, Shaw J, Ulph F, et al. Cognitive-behavioural suicide prevention for male prisoners: a pilot randomized controlled trial. Psychol Med. 2015;45(16):3441–3451.
    1. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychol Bull. 2011;137(3):391–420.
    1. Taylor PJ, Gooding PA, Wood AM, Johnson J, Tarrier N. Prospective predictors of suicidality: defeat and entrapment Lead to changes in suicidal ideation over time. Suicide Life Threat Behav. 2011;41(3):297–306.
    1. Steeg S, Haigh M, Webb RT, Kapur N, Awenat Y, Gooding P, et al. The exacerbating influence of hopelessness on other known risk factors for repeat self-harm and suicide. J Affect Disord. 2016;190(522–528):522–528.
    1. Panagioti M, Gooding PA, Tarrier N. A prospective study of suicidal ideation in posttraumatic stress disorder: the role of perceptions of defeat and entrapment. J Clin Psychol. 2015;71(1):50–61.
    1. Acosta FJ, Vega D, Torralba L, Navarro S, Ramallo-Fariña Y, Fiuza D, et al. Hopelessness and suicidal risk in bipolar disorder. A study in clinically non-syndromal patients. Compr Psychiatry. 2012;53(8):1103–1109.
    1. Beck AT. Hopelessness as a predictor of eventual suicide. Ann N Y Acad Sci. 1986;487:90–96.
    1. Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide - a 10-year prospective-study of patients hospitalized with suicidal ideation. Am J Psychiatr. 1985;142(5):559–563.
    1. Hunter EC, O'Connor RC. Hopelessness and future thinking in parasuicide: the role of perfectionism. Br J Clin Psychol. 2003;42:355–365.
    1. Klonsky ED, Kotov R, Bakst S, Rabinowitz J, Bromet EJ. Hopelessness as a predictor of attempted suicide among first admission patients with psychosis: a 10-year cohort study. Suicide Life Threat Behav. 2012;42(1):1–10.
    1. O'Connor RC, O'Connor DB, O'Connor SM, Smallwood J, Miles J. Hopelessness, stress, and perfectionism: the moderating effects of future thinking. Cognit Emot. 2004;18(8):1099–1120.
    1. White RG, McCleery M, Gumley AI, Mulholland C. Hopelessness in schizophrenia: the impact of symptoms and beliefs about illness. J Nerv Ment Dis. 2007;195(12):968–975.
    1. Awenat YF, Shaw-Núñez E, Kelly J, Law H, Ahmed S, Welford M, et al. A qualitative analysis of the experiences of people with psychosis of a novel cognitive behavioural therapy targeting suicidality. Psychosis. 2017;9(1):38–47.
    1. Haddock G, Pratt D, Gooding PA, Peters S, Emsley R, Evans E, et al. Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial. Bjpsych Open. 2019;5(1):e14. 10.1192/bjo.2018.85.
    1. Baines R, Donovan J, de Bere SR, Archer J, Jones R. Patient and public involvement in the design, administration and evaluation of patient feedback tools, an example in psychiatry: a systematic review and critical interpretative synthesis. J Health Serv Res Policy. 2019;24(2):130–142.
    1. Bodolica V, Spraggon M. Toward patient-centered care and inclusive health-care governance: a review of patient empowerment in the UAE. Public Health. 2019;169:114–124.
    1. Haldane V, Chuah FLH, Srivastava A, Singh SR, Koh GCH, Seng CK, et al. Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PLoS One. 2019;14(5):e0216112. 10.1371/journal.pone.0216112.
    1. Lalani M, Baines R, Bryce M, Marshall M, Mead S, Barasi S, et al. Patient and public involvement in medical performance processes: a systematic review. Health Expect. 2019;22(2):149–161.
    1. Walwyn R, Roberts C. Therapist variation within randomised trials of psychotherapy: implications for precision, internal and external validity. Stat Methods Med Res. 2010;19:291–315.
    1. Batistatou E, Roberts C, Roberts S. Sample size and power calculations for trials and quasi-experimental studies with clustering. Stata J. 2014;14(1):159–75.
    1. Reynolds WM. Adult suicidal ideation questionnaire: professional manual. Odessa: Psychological Assessment Resources; 1991.
    1. Beck AT, Brown GK, Steer RA, Dahlsgaard KK, Grisham JR. Suicide ideation at its worst point: a predictor of eventual suicide in psychiatric outpatients. Suicide Life Threat Behav. 1999;29(1):1–9.
    1. Cull J, Gill W. Suicide probability scale (SPS) manual. Los Angeles: Western Psychological Services; 1988.
    1. Beck AT, Steer RA. Manual for Beck scale for suicidal ideation. New York: Psychological Corporation; 1991.
    1. Pinninti N, Steer RA, Rissmiller DJ, Nelson S, Beck AT. Use of the Beck scale for suicide ideation with psychiatric inpatients diagnosed with schizophrenia, schizoaffective, or bipolar disorders. Behav Res Ther. 2002;40(9):1071–1079.
    1. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54.
    1. Hallon LS, Steinman SA, Tolin DF, Diefenbach GJ. Psychometric properties of the difficulties in emotion regulation scale (DERS) and its short forms in adults with emotional disorders. Front Psychol. 2018;9:539.
    1. D’Zurilla TJ, Nezu AM. Maydeu-Olivares. Social problem-solving inventory-revised: technical manual. New York: Multi-Health Systems; 2002.
    1. Vaux A, Phillips J, Holly L, Thomson B, Williams D, Stewart D. The social support appraisals (SS-A) scale: studies of reliability and validity. Am J Community Psychol. 1986;14:195–219.
    1. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42:861–865.
    1. Kovacs M, Beck AT, Weissman A. Hopelessness - indicator of suicidal risk. Suicide. 1975;5(2):98–103.
    1. Littlewood D, Gooding P, Panagioti M, Kyle S. Nightmares and suicide in posttraumatic stress disorder: the mediating role of defeat, entrapment and hopelessness. J Clin Sleep Med. 2016;12(3):393–399.
    1. Panagioti M, Gooding PA, Tarrier N. Hopelessness, defeat, and entrapment in posttraumatic stress disorder their association with suicidal behavior and severity of depression. J Nerv Ment Dis. 2012;200(8):676–683.
    1. Gilbert P, Allan S. The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view. Psychol Med. 1998;28:585–598.
    1. Kay SR, Fiszbein A, Opier LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261–276.
    1. Haddock G, McCarron J, Tarrier N, Faragher EB. Scale to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS) Psychol Med. 1999;29:879–889.
    1. Morosini PL, Magliano L, Brambilla L. al. e. Development, reliability and acceptability of a new version of the DSM-IV social and occupational functioning assessment scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101:323–329.
    1. Addington D, Addington J, Schissel B. A depression rating scale for schizophrenics. Schizophr Res. 1990;3:247–251.
    1. Santor DA, Ascher-Svanum H, Lindenmayer J-P, Obenchain RL. Item response analysis of the positive and negative syndrome scale. BMC Psychiatry. 2007;7(1):66.
    1. Bowling A. Research methods in health: Open University press Philadelphia, PA, USA. 2002.
    1. Johnston K, Buxton MJ, Jones DR, Fitzpatrick R. Assessing the costs of healthcare technologies in clinical trials. Health Technol Assess. 1999;3(6):1–76.
    1. Ridyard CH, Hughes DA. Methods for the collection of resource use data within clinical trials: a systematic review of studies funded by the UK health technology assessment program. Value Health. 2010;13(8):867–872.
    1. Beecham J, Knapp M. Costing psychiatric interventions. Costing psychiatric interventions. In: Thornicroft, Graham, ed. Measuring Mental Health Needs (Second Edition). Royal College of Psychiatrists, London. 2001. p. 200–24.
    1. Kalra L, Evans A, Perez I, Knapp M, Swift C, Donaldson N. A randomised controlled comparison of alternative strategies in stroke care. Health Technol Assess. 2005;9(18):1–79.
    1. Hurley MV, Walsh NE, Mitchell HL, Pimm TJ, Williamson E, Jones RH, et al. Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain. Arthritis Rheum. 2007;57(7):1220–1229.
    1. Patel A, Maissi E, Chang HC, Rodrigues I, Smith M, Thomas S, et al. Motivational enhancement therapy with and without cognitive behaviour therapy for type 1 diabetes: economic evaluation from a randomized controlled trial. Diabet Med. 2011;28(4):470–479.
    1. Robertson W, Stewart-Brown S, Stallard N, Petrou S, Griffiths F, Thorogood M, et al. Evaluation of the effectiveness and cost-effectiveness of families for health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial. Trials. 2013;14:81.
    1. Barton GR, Hodgekins J, Mugford M, Jones PB, Croudace T, Fowler D. Measuring the benefits of treatment for psychosis: validity and responsiveness of the EQ-5D. Br J Psychiatry. 2009;195(2):170–177.
    1. Saha S, Bejerholm U, Gerdtham UG, Jarl J. Cost-effectiveness of supported employment adapted for people with affective disorders. Nordic J Psychiatry. 2018:(3):236–9. 10.1080/08039488.2017.
    1. Knapp M, Windmeijer F, Brown J, Kontodimas S, Tzivelekis S, Haro JM, et al. Cost-utility analysis of treatment with olanzapine compared with other antipsychotic treatments in patients with schizophrenia in the pan-European SOHO study. Pharmacoeconomics. 2008;26(4):341–358.
    1. Mulhern B, Mukuria C, Barkham M, Knapp M, Byford S, Soeteman D, et al. Using generic preference-based measures in mental health: psychometric validity of the EQ-5D and SF-6D. Br J Psychiatry. 2014;205(3):236–243.
    1. Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. 2018;27(1):7–22.
    1. Feng Y, Devlin N, Herdman M. Assessing the health of the general population in England: how do the three- and five-level versions of EQ-5D compare? Health Qual Life Outcomes. 2015;13(1):1–16.
    1. Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013;22(7):1717–1727.
    1. Golicki D, Niewada M, Buczek J, Karlińska A, Kobayashi A, Janssen MF, et al. Validity of EQ-5D-5L in stroke. Qual Life Res. 2014;24(4):845–850.
    1. Golicki D, Niewada M, Karlinska A, Buczek J, Kobayashi A, Janssen MF, et al. Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients. Qual Life Res. 2015;24(6):1555–1563.
    1. Mulhern B, Feng Y, Shah K, Janssen MF, Herdman M, van Hout B, et al. Comparing the UK EQ-5D-3L and English EQ-5D-5L value sets. Pharmacoeconomics. 2018;36(6):699–713.
    1. Horvath AO, Greenberg LS. Development and validation of the working Alliance inventory. J Couns Psychol. 1989;36(2):223–233.
    1. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–1182.
    1. Dunn G, Fowler D, Rollinson R, Freeman D, Kuipers E, Smith B, et al. Effective elements of cognitive behaviour therapy for psychosis: results of a novel type of subgroup analysis based on principal stratification. Psychol Med. 2012;42(5):1057–1068.
    1. Dunn G. Pragmatic trials of complex interventions: methodological challenges. Epidemiol Psychiatr Sci. 2013;22:105–109.
    1. Emsley RA, Dunn G, White IR. Mediation and moderation of treatment effects in randomised controlled trials of complex interventions. Stat Methods Med Res. 2010;19(3):237–270.
    1. Johnson J, Wood AM, Gooding P, Taylor PJ, Tarrier N. Resilience to suicidality: the buffering hypothesis. Clin Psychol Rev. 2011;31(4):563–591.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
    1. Boyatzis RE. Transforming qualitative information. Cleveland: Sage; 1998.
    1. Henwood K, Pidgeon N. Qualitative research and psychological theorizing. Br J Psychol. 1992;83(1):97–111.
    1. Peters S. Qualitative research methods in mental health. Evid Based Mental Health. 2010;13:35–40.
    1. Beecham J, Knapp M. Costing psychiatric interventions. Measuring mental health needs. Measuring mental health needs. 2000. pp. 200–224.
    1. Kalra L, Evans A, Perez I, Knapp M, Swift C, Donaldson N. A randomised controlled comparison of alternative strategies in stroke care. Health Technol Assess. 2005;9(18):1–79.
    1. Robertson W, Stewart-Brown S, Stallard N, Petrou S, Griffiths F, Thorogood M, et al. Evaluation of the effectiveness and cost-effectiveness of families for health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial. Trials. 2013;14(1):81.
    1. Personal Social Services Research Unit P . Unit Costs of Health and Social Care. 2016.
    1. Do H. NHS reference costs 2015 to 2016. London: Department of Health; 2016.
    1. Hansson C, Joas E, Palsson E, Hawton K, Runeson B, Landen M. Risk factors for suicide in bipolar disorder: a cohort study of 12 850 patients. Acta Psychiatr Scand. 2018;138(5):456–463.
    1. Bang M, Park JY, Kim KR, Lee SY, Song YY, Kang JI, et al. Suicidal ideation in individuals at ultra-high risk for psychosis and its association with suspiciousness independent of depression. Early Interv Psychiatry. 2019;13(3):539–545.
    1. Chouinard VA, Shinn AK, Valeri L, Chouinard PA, Gardner ME, Asan AE, et al. Visual hallucinations associated with multimodal hallucinations, suicide attempts and morbidity of illness in psychotic disorders. Schizophr Res. 2019;208:196–201.
    1. Simon GE, Yarborough BJ, Rossom RC, Lawrence JM, Lynch FL, Waitzfelder BE, et al. Self-reported suicidal ideation as a predictor of suicidal behavior among outpatients with diagnoses of psychotic disorders. Psychiatr Serv. 2019;70(3):176–183.
    1. Haddock G, Pratt D, Gooding P, Peters S, Emsley R, Evans E, et al. Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial. Br J Psychiatry Open. 2019;5(1):e14.
    1. Pratt D, Gooding P, Eccles S, Awenat Y, Tarrier N. Cognitive Behavioural suicide prevention for male prisoners: case examples. Cogn Behav Pract. 2016;23(4):485–501.
    1. Pratt D, Gooding P, Kelly J, Johnson J, Tarrier N. Case formulation in suicidal behaviour. In: Tarrier N, editor. Case formulation in cognitive behaviour therapy: the treatment of challenging and complex cases. London: Routledge; 2015.
    1. Johnson J, Tarrier N, Gooding P. An investigation of aspects of the cry of pain model of suicide risk: the role of defeat in impairing memory. Behav Res Ther. 2008;46(8):968–975.
    1. Littlewood D, Gooding P, Panagioti M, Kyle S. Investigating psychological mechanisms in relation to sleep problems and suicide. J Clin Sleep Med. 2016;12(6):931.
    1. Owen R, Dempsey R, Jones S, Gooding P. Defeat and entrapment in bipolar disorder: exploring the relationship with suicidal ideation from a psychological theoretical perspective. Suicide Life Threat Behav. 2018;48(1):116–128.
    1. Owen R, Gooding P, Dempsey R, Jones S. A qualitative investigation into the relationships between social factors and suicidal thoughts and acts experienced by people with a bipolar disorder diagnosis. J Affect Disord. 2015;176:133–140.
    1. Palmier-Claus JE, Taylor PJ, Gooding P, Dunn G, Lewis SW. Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: an experience sampling study. Br J Clin Psychol. 2012;51(1):72–83.
    1. Panagioti M, Gooding P, Taylor PJ, Tarrier N. Negative Self-Appraisals and Suicidal Behavior Among Trauma Victims Experiencing PTSD Symptoms: The Mediating Role of Defeat and Entrapment. Depress Anxiety. 2012;29(3):187–194.
    1. Pratt D, Gooding P, Johnson J, Taylor P, Tarrier N. Suicide schemas in non-affective psychosis: an empirical investigation. Behav Res Ther. 2010;48(12):1211–1220.
    1. Taylor PJ, Wood AM, Gooding P, Tarrier N. Appraisals and suicidality: the mediating role of defeat and entrapment. Arch Suicide Res. 2010;14(3):236–247.
    1. O'Connor RC, Nock MK. The psychology of suicidal behaviour. Lancet Psychiatry. 2014;1(1):73–85.
    1. O'Connor RC, Portzky G. Looking to the future: a synthesis of new developments and challenges in suicide research and prevention. Front Psychol. 2018;9:2139.
    1. Panagioti M, Gooding P, Taylor PJ, Tarrier N. A model of suicidal behavior in posttraumatic stress disorder (PTSD): the mediating role of defeat and entrapment. Psychiatry Res. 2013;209(1):55–59.
    1. Awenat Y, Peters S, Shaw-Nunez E, Gooding P, Pratt D, Haddock G. Staff experiences and perceptions of working with in-patients who are suicidal: qualitataive analysis. Br J Psychiatry. 2017;211(2):103–108.
    1. Awenat YF, Moore C, Gooding PA, Ulph F, Mirza A, Pratt D. Improving the quality of prison research: a qualitative study of ex-offender service user involvement in prison suicide prevention research. Health Expect. 2018;21(1):100–109.
    1. Awenat YF, Peters S, Gooding PA, Pratt D, Shaw-Nunez E, Harris K, et al. A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths. Bmc Psychiatry. 2018;18:334.
    1. Berry K, Haddock G, Kellett S, Awenat Y, Szpak K, Barrowclough C. Understanding outcomes in a randomized controlled trial of a Ward-based intervention on psychiatric inpatient wards: a qualitative analysis of staff and patient experiences. J Clin Psychol. 2017;73(10):1211–1225.
    1. Bucci S, Morris R, Barrowclough C, Berry N, Haddock G, Lewis S, et al. Staff and Service User Perspectives of Digital Technology for Early Psychosis. Early Interven Psychiatry. 2018;12:31.
    1. Le Geyt G, Awenat Y, Tai S, Haddock G. Personal accounts of discontinuing neuroleptic medication for psychosis. Qual Health Res. 2017;27(4):559–572.
    1. Witt K, de Moraes DP, Salisbury TT, Arensman E, Gunnell D, Hazell P, et al. Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm: impact of content and quality on outcomes in a systematic review. J Affect Disord. 2018;235:434–447.

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