Treating repetitive suicidal intrusions using eye movements: study protocol for a multicenter randomized clinical trial

J S van Bentum, M Sijbrandij, A J F M Kerkhof, A Huisman, A R Arntz, E A Holmes, G Franx, J Mokkenstorm, M J H Huibers, J S van Bentum, M Sijbrandij, A J F M Kerkhof, A Huisman, A R Arntz, E A Holmes, G Franx, J Mokkenstorm, M J H Huibers

Abstract

Background: Suicide is a major public health problem, and it remains unclear which processes link suicidal ideation and plans to the act of suicide. Growing evidence shows that the majority of suicidal patients diagnosed with major depression or bipolar disorder report repetitive suicide-related images and thoughts (suicidal intrusions). Various studies showed that vividness of negative as well as positive intrusive images may be reduced by dual task (e.g. eye movements) interventions taxing the working memory. We propose that a dual task intervention may also reduce frequency and intensity of suicidal imagery and may be crucial in preventing the transition from suicidal ideation and planning to actual suicidal behaviour. This study aims a) to evaluate the effectiveness of an Eye Movement Dual Task (EMDT) add-on intervention targeting suicidal imagery in depressed patients, b) to explore the role of potential moderators and mediators in explaining the effect of EMDT, and c) to evaluate the cost-effectiveness of EMDT.

Methods: We will conduct a multi-center randomized clinical trial (RCT) evaluating the effects of EMDT in combination with usual care (n = 45) compared to usual care alone (n = 45). Participants will fill in multiple online batteries of self-report questionnaires as well as complete a semi-structured interview (Intrusion Interview), and online computer tasks. The primary outcome is the frequency and intrusiveness of suicidal imagery. Furthermore, the vividness, emotionality, and content of the suicidal intrusions are evaluated; secondary outcomes include: suicidal behaviour and suicidal ideation, severity of depression, psychological symptoms, rumination, and hopelessness. Finally, potential moderators and mediators are assessed.

Discussion: If proven effective, EMDT can be added to regular treatment to reduce the frequency and vividness of suicidal imagery.

Trial registration: The study has been registered on October 17th, 2018 at the Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR7563 ).

Keywords: Dual tasks; EMDT; Mental imagery; Multicenter randomized controlled trial; Suicidal intrusions; Suicide.

Conflict of interest statement

Ethics approval and consent to participate

The Medical Ethics Committee (METc) of the VU medical center (VUmc) approved the initial study protocol (registration number 2017.237). After we conducted a small pilot study to establish safety and feasibility of the intervention, Amendment 4 was approved by the METc VUmc (registration A2017.415) on 18 October 2018. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR7563).

Patients will be approached by a researcher after they have given oral consent. The purpose of the study is explained and they receive a detailed information brochure. After one week they are asked if they want to participate in the study and provide oral and written consent. The participants will be informed that they may withdraw their consent at any time and that this does not affect their position as health care clients.

Consent for publication

Not applicable. Details, images, or videos relating to individual participants will not be published.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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