RECRUITINGINTERVENTIONAL

Evaluating Treatments for Suicidal Veterans With PTSD

A Hybrid Effectiveness-Implementation Trial of Treatments for Veterans With PTSD at Elevated Acute Risk for Suicide

About This Trial

Posttraumatic Stress Disorder (PTSD) is a significant driver of suicide risk among Veterans, but there is a critical knowledge gap about how to treat PTSD among people at elevated risk for suicide. Although evidence-based treatments for PTSD reduce suicide risk, Veterans at high risk for suicidal behavior rarely receive these potentially life-saving treatments. Prior research suggests that a treatment that combines Dialectical Behavior Therapy (DBT) with the DBT Prolonged Exposure protocol (DBT PE) for PTSD improves both PTSD and suicide-related outcomes. This study will evaluate whether DBT + DBT PE improves these outcomes more than Prolonged Exposure plus suicide risk management, the gold standard VA care for this population. The proposed study will also examine factors that make it easier and harder to implement these treatments in VA settings. The results will help to inform treatment guidelines for this high-priority Veteran population.

Who May Be Eligible (Plain English)

Who May Qualify: - PTSD - Recent and repeated self-directed violence - Current suicidal ideation - Emotion dysregulation - Veteran eligible for VHA mental health care at participating site - Age 18+ - Willing to participate in all study activities Who Should NOT Join This Trial: - Unable to maintain safety independently - Currently engaged in and/or recent (past year) history of receiving a sufficient dose of DBT or PE - Plan to move away or be unavailable for \>4 weeks in the next 18 months - Unable to sufficiently comprehend study procedures due to lack of English proficiency or moderate to severe cognitive impairment Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language

Inclusion Criteria: * PTSD * Recent and repeated self-directed violence * Current suicidal ideation * Emotion dysregulation * Veteran eligible for VHA mental health care at participating site * Age 18+ * Willing to participate in all study activities Exclusion Criteria: * Unable to maintain safety independently * Currently engaged in and/or recent (past year) history of receiving a sufficient dose of DBT or PE * Plan to move away or be unavailable for \>4 weeks in the next 18 months * Unable to sufficiently comprehend study procedures due to lack of English proficiency or moderate to severe cognitive impairment

Treatments Being Tested

BEHAVIORAL

Dialectical Behavior Therapy

Standard Dialectical Behavior Therapy (DBT), including DBT individual therapy (1 hour/week), DBT group skills training (2 hours/week), between-session coaching (as needed during business hours), and therapist consultation team (1-1.5 hours/week).

BEHAVIORAL

Dialectical Behavior Therapy Prolonged Exposure protocol

DBT PE is designed to be integrated into DBT to formally treat PTSD once patients meet standardized readiness criteria. The core procedures are in vivo and imaginal exposure with processing that are delivered in individual therapy sessions (1.5 hours/week).

BEHAVIORAL

Prolonged Exposure therapy

Standard PE is delivered in individual therapy sessions (1.5 hours/week) and uses the core procedures of in vivo and imaginal exposure with processing.

BEHAVIORAL

Suicide risk management

Standard VA suicide risk management procedures, including comprehensive suicide risk assessment and safety planning.

Locations (4)

Minneapolis VA Health Care System, Minneapolis, MN

Minneapolis, Minnesota, United States

Durham VA Medical Center, Durham, NC

Durham, North Carolina, United States

South Texas Health Care System, San Antonio, TX

San Antonio, Texas, United States

VA Puget Sound Health Care System Seattle Division, Seattle, WA

Seattle, Washington, United States