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Veteran suicide death is a national crisis. Risk factors include emotion dysregulation, which occurs across mental health disorders. Dialectical behavior therapy (DBT) is an evidence-based suicide intervention that targets emotion dysregulation but is resource-intensive and not widely available at VHA. A more efficient evidence-based DBT Skills Group (DBT-SG) is associated with reduced suicidal ideation and emotion dysregulation and likely more feasible to implement at VHA. This is a randomized controlled trial to test whether DBT-SG in addition to VHA treatment-as-usual, compared to only VHA treatment-as-usual, reduces Veteran emotion dysregulation.
This is a randomized controlled trial at four VHA medical centers. Veterans will be randomized to VHA treatment-as-usual or VHA treatment-as-usual plus DBT-SG.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| DBT-SG plus VHA treatment as usual | Experimental | Dialectical Behavior Therapy Skills Group (DBT-SG) in addition to VHA treatment as usual. Group is 24 weekly sessions teaching skills in emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. |
|
| VHA treatment as usual | Active Comparator | VHA treatment as usual for Veterans at risk for suicide attempt |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DBT-SG | Behavioral | Dialectical Behavior Therapy Skills Group (DBT-SG) in addition to VHA treatment as usual. Group is 24 weekly sessions teaching skills in emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Emotion dysregulation | Emotion dysregulation will be assessed with the Difficulties in Emotion Regulation Scale, a self-report measure. The scale ranges 36-180 with a higher score indicating greater difficulties in emotion regulation. | Up to18 month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Coping | Coping skills will be assessed with the Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL), a self-report measure. The mean score ranges 0-3 with a higher score indicating greater use of coping strategies. | Up to 18 month follow-up |
| Columbia-Suicide Severity Rating Scale |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Suzanne Decker, PhD | VA Connecticut Healthcare System West Haven Campus, West Haven, CT | Principal Investigator |
| Steve Martino, PhD | VA Connecticut Healthcare System West Haven Campus, West Haven, CT | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA San Diego Healthcare System, San Diego, CA | San Diego | California | 92161-0002 | United States | ||
| VA Connecticut Healthcare System West Haven Campus, West Haven, CT |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39923893 | Derived | Decker SE, Kroll-Desrosiers A, Mattocks KM, Aunon FM, Galliford E, DeRycke EC, Doran N, Baird S, Rielage JK, Ridley J, Bannister J, Giovannelli TS, Fuehrlein BS, Shriver C, Spana E, Honsberger M, Demirelli SA, Shest E, Landes SJ, Goodman M, Martino S. Study protocol of a hybrid type 1 effectiveness-implementation multisite trial: Dialectical behavior therapy skills group for Veterans at high-risk for suicide attempt. Contemp Clin Trials. 2025 Apr;151:107828. doi: 10.1016/j.cct.2025.107828. Epub 2025 Feb 7. | |
| 39655211 |
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Study data will include sensitive information about Veteran suicide risk. In consultation with the VACHS Research Office, the investigators elect not to share final data sets for this reason except as required under FOIA. Data will be preserved at VACHS on secure electronic servers behind the VA firewall, and made available for further study or validation by qualified individuals with VA IRB approval. Contact information for the corresponding mPI will be included in publications to facilitate such requests.
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| ID | Term |
|---|---|
| D013406 | Suicide, Attempted |
| D000080103 | Emotional Regulation |
| ID | Term |
|---|---|
| D013405 | Suicide |
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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Participants will be randomly assigned to one of two study conditions for the duration of the study.
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Outcomes assessors will be masked to study condition.
| VHA treatment as usual | Behavioral | VHA treatment as usual for Veterans at risk for suicide attempt |
|
The Columbia-Suicide Severity Rating Scale is a widely used interview measure of suicide risk. The number of suicide attempts during 18month follow-up will be reported (range 0 to infinity), with a higher score indicating more suicide attempts. |
| Up to 18 month follow-up |
| West Haven |
| Connecticut |
| 06516-2770 |
| United States |
| James A. Haley Veterans' Hospital, Tampa, FL | Tampa | Florida | 33612 | United States |
| New Mexico VA Health Care System, Albuquerque, NM | Albuquerque | New Mexico | 87108-5153 | United States |
| Louis Stokes VA Medical Center, Cleveland, OH | Cleveland | Ohio | 44106-1702 | United States |
| Derived |
| Decker SE, Kroll-Desrosiers A, Mattocks K, Aunon FM, Galliford E, Doran N, Baird S, Rielage JK, Ridley J, Bannister J, Giovannelli TS, Landes SJ, Goodman M, Walker L, DeRycke E, Shriver C, Spana E, Honsberger M, Brown H, Demirelli S, Shest E, Martino S. Mixed-methods formative evaluation of implementing an adapted suicide prevention treatment: Dialectical Behavior Therapy Skills Groups in the Veterans Health Administration. Front Psychiatry. 2024 Nov 25;15:1495102. doi: 10.3389/fpsyt.2024.1495102. eCollection 2024. |
| D000068356 |
| Self-Control |
| D012919 | Social Behavior |