The BEAR Program for Women With Trauma Who Have Suicidal Thoughts

A Pilot Study of the Building Empowerment and Resilience Program for Suicidal Ideation

The current study aims to test the feasibility of a new form of group therapy for women who have a history of interpersonal trauma and current suicidal ideation. The Building Empowerment and Resilience (BEAR) Therapeutic group has been adapted for women who have experienced trauma and have current suicidal ideation. It incorporates psychological skills, psychoeducation about trauma and gender-based violence, and physical self-defense training, all within a therapeutic process. It will be implemented with women who have experienced interpersonal trauma (physical, sexual, or emotional abuse/neglect) and experience various mental health difficulties, including suicidal ideation. We aim to assess the feasibility to recruit and implement the BEAR group. Our ultimate aim is to assess whether the program can effect self-efficacy and suicidal ideation.

In the US, approximately 36% of women experience some type of sexual violence in their lifetime. Sexual violence can have a significant and lifelong impact on a women's life, with particularly high rates of mental health issues (e.g., depression, anxiety, PTSD). Women who are sexually assaulted have a three-fold risk of lifetime suicidal ideation and more than a five-fold elevated risk of suicide attempts compared to women who have not been sexually assaulted. Women who are victimized are at higher risk of subsequent sexual victimizations, and with that, worsened well-being and an even higher suicide risk.

Empowerment self-defense (ESD) training has consistently been shown to reduce the risk of both attempted and completed sexual assault by approximately 50%. Survivors of rape who participate in such training demonstrate decreases in PTSD symptoms and self-blame for past assaults. Increases in perceived self-efficacy is one of the positive outcomes of ESD work. Perceived self-efficacy is one's beliefs about their competency and capabilities to perform and is a key factor of how people think, behave, feel, and motivate themselves and how they respond in various situations, including risky or traumatic situations. Higher coping self-efficacy buffers individuals who experience trauma from posttraumatic distress, and separately, higher self-efficacy has been shown to be a protective factor against suicidality in several populations.

The purpose of the current study is to test the feasibility of the Building Empowerment and Resilience (BEAR) program which was adapted for women who have a history of sexual violence and currently endorse suicidal thinking. The Building Empowerment and Resilience-SI (BEAR-SI) Therapeutic program incorporates psychological skills, psychoeducation, and physical self-defense training, all within a therapeutic process. Our experience indicates survivors of sexual violence seek a more active intervention as they often continue to feel quite vulnerable with therapy alone. The program specifically addresses the sequalae of sexual assault and teaches skills for maintaining personal safety and for coping with unwanted thoughts, including suicidal thinking. Our goal is to determine the feasibility of the adapted BEAR program and if it enhances self-efficacy and decreases suicidal thoughts. This is a 12-week, in-person therapy group. We will examine pre- and post-group outcomes, as well as 3- and 12-month follow up.

Inclusion Criteria:

• Women ages 18-75
• History of physical, sexual, and/or sexual emotional violence, with subsequent interpersonal or psychological distress (e.g., depression or anxiety) related to this history.
• Current suicidal thinking

Exclusion Criteria:

• Active, significant substance abuse, which could interfere with participation
• Significant medical conditions that would preclude safe participation in the study
• No history of interpersonal trauma
• Acute psychiatric instability
• History of assaultive behavior or is judged to be a potential risk to assault others.
• No current suicidal ideation or behaviors
• Unable to commit to the group for 12 weeks in-person