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Data from Santé Publique France show that since the onset of the health crisis (covid-19), there has been an increase in emergency room visits for mood disorders among children under 15 years of age, with a notable rise in the number of visits since early September 2020 compared to previous years. Recent literature considers Dialectical Behavior Therapy (DBT) as the only approach that has demonstrated (albeit weak to moderate) effects on the recurrence of self-harming behaviors. It is within this context, and based on these various findings, that the CARES program was developed (Understanding and Acting to Regulate Emotions and Suicidal Behaviors), aimed at adolescents who have engaged in suicidal behaviors or who have active suicidal ideation.
The objective of this study is to compare the CARES program for adolescents alone to the CARES program for adolescents combined with a parent group using Non-Violent Resistance (NVR) on the occurrence of self-harming behaviors among adolescents who have engaged in suicidal acts and/or have active suicidal ideation, six months after the conclusion of the intervention.
This is a prospective, randomized, open-label, single-center, controlled study with two parallel arms, with blinded assessment of the outcome measures.
The CARES adolescent program consists of a group intervention with 8 biweekly sessions over a total duration of one month, followed by a booster session 3 months post-intervention. These sessions are conducted by nurses and psychologists trained in Cognitive Behavioral Therapies (CBT). The content of the group aims to provide adolescents with cognitive and behavioral strategies to improve their emotional distress tolerance and to expand their repertoire of solutions in times of emotional crisis.
The CARES adolescent and NVR parent program includes the same adolescent group described above, supplemented by an NVR parent group. This parent group meets once a week for one month (4 sessions), with two additional booster sessions at 1 month and 3 months post-intervention. The content of the parent program is a parent management training composed of strategies for managing their adolescent's emotional crises through emotional regulation techniques based on Non-Violent Resistance (NVR) methods (Omer, 2021).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adolescent group therapy (CARES) and parent group therapy (RNV) | Other | In the adolescent group, they will attend 8 group sessions during 1 month (2 sessions/week). There also will be a "boost" session 3 month after the last session. Parents will attend 4 group sessions during 1 month too (1 session/week). There will be 2 "boost" sessions : 1 month and 3 month after the last session Patients will be randomized in each group with blinded assessment |
|
| Adolescent groupe therapy (CARES) only | Experimental | In the adolescent group, they will attend 8 group sessions during 1 month (2 sessions/week). There will be a "boost" session 3 month after the last session Patients will be randomized in each group with blinded assessment |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cognitive behavioral group therapy for adolescents and non violent resistance group for parents | Behavioral | In the adolescents group, this cognitive-behavioral group therapy will include emotion regulation skills, distress tolerance skills, cognitive strategies, work on values and problem-solving strategies Those sessions will include psychoeducation about adolescents, about suicidal ideation and suicidal behavior, coping with adolescent emotional distress, support on how to be a parent today (screen regulation...) and manage daily life |
| Measure | Description | Time Frame |
|---|---|---|
| Occurence of suicidal behavior | Assessed with the Columbia Suicide Severity Rating Scale (C-SSRS) | Variation between initial assessment and assessment 6 month post intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical improvement assessement (clinician) | Assessment with the Clinical Global Impression-Improvement (CGI-I) | Variation between initial assessment and post-intervention and between initial assessment and 6 months post-intervention |
| Parenting stress |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Julie CABROL | Contact | 0467337196 | +33 | cares@chu-montpellier.fr |
| Allison GOUJON | Contact | 0467337195 | +33 | cares@chu-montpellier.fr |
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Adolescent group therapy (CARES) and parent group therapy (RNV) vs Adolescent groupe therapy (CARES) only
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|
| Adolescent group therapy (CARES) and parent group therapy (RNV) | Other | In the adolescent group, they will attend 8 group sessions during 1 month (2 sessions/week). There also will be a "boost" session 3 month after the last session. Parents will attend 4 group sessions during 1 month too (1 session/week). There will be 2 "boost" sessions : 1 month and 3 month after the last session Patients will be randomized in each group with blinded assessment |
|
Assessment with the Parenting Stress Index short form (PSI-4-SF) |
| Variation between initial assessment and post-intervention and between initial assessment and 6 months post-intervention |
| Parenting anxiety and depression | Assessment with the Hospital Anxiety and Depression Scale (HADS) | Variation between initial assessment and post-intervention and between initial assessment and 6 months post-intervention |
| Adolescent depression | Assessment with the Child Depression Inventory (CDI) | Variation between initial assessment and post-intervention and between initial assessment and 6 months post-intervention |
| Suicidal ideation | Assessment with the C-SSRS | Variation between initial assessment and post-intervention and between initial assessment and 6 months post-intervention |
| ID | Term |
|---|---|
| D059020 | Suicidal Ideation |
| D000092864 | Suicide Prevention |
| ID | Term |
|---|---|
| D013405 | Suicide |
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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