Background: The suicide rate among active duty service members is more than double the
civilian population in the United States. Also, approximately 1 in 20 service members
report suicidal ideation each year, and 1 in 100 service members report a non-fatal
suicide attempt annually. Suicidal behavior rates are compounded by a number of mental
health services access barriers such as clinician shortages. The purpose of this
randomized controlled trial (RCT) is to demonstrate that a new group therapy intervention
protocol, Group Brief Cognitive-Behavioral Therapy (G-BCBT) for Suicide, will positively
impact suicidal behavior, mental health, and self-regulatory skill outcomes for service
members experiencing recent suicidal behavior.
Hypotheses/Objectives: The overall objective of the proposal is to evaluate the effects
of a G-BCBT protocol on suicidal ideation, suicide attempts, mental health, and
self-regulatory skills. Investigators expect that G-BCBT will result in improved service
member suicidal behavior (Aim 1), ability to use coping strategies (Aim 2), and overall
mental health (exploratory analysis). The combination of tailored means safety counseling
and training in evidence-based emotion regulation and cognitive flexibility skills will
improve service members' self-control. The group format will provide opportunities to
learn and practice skills, thereby enhancing self-efficacy. G-BCBT outcomes are expected
to be no worse than Dialectical Behavior Therapy (DBT) group skills training, an existing
gold standard intervention that is twice the length of time as G-BCBT. Secondary
hypotheses are that G-BCBT will (a) demonstrate non-inferior improvements in
self-regulatory skills, and (b) self-regulatory skills will moderate G-BCBT's impact on
suicidal ideation.
Specific Aims: Investigators expect this project will yield mental health and coping
skills benefits for service members. These expected outcomes will be attained through the
following aims: Aim 1: Pilot a group format of BCBT for its impact on suicidal behavior
among active duty military service members; Aim 2: Assess the relationship between G-BCBT
and self-regulatory factors.
Study Design: This study employs a single-site 4-year, 2-arm phase III RCT design. Data
will be collected at Naval Medical Center Portsmouth. University of North Carolina at
Charlotte will coordinate the study and conduct intervention evaluation. The Ohio State
University will conduct fidelity monitoring and provide treatment subject matter
expertise for both conditions. A total of 136 active duty service members will be
randomly assigned to one of two conditions: (1) G-BCBT or (2) DBT. Service members in the
G-BCBT condition will complete a 12-week protocol comprising tailored means safety
counseling followed by emotion regulation and cognitive flexibility skills training.
Service members assigned to the DBT condition will complete a 24-week protocol covering
mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness
skills training. All participants will complete assessments at baseline, after each
session, upon treatment completion, and 3- and 6-months post-intervention completion.
Data will address suicidal behavior, mental health, self-regulatory skills, treatment
process factors, and demographic and suicide-related covariates.
Clinical Impact: G-BCBT will be tested as an evidence-based suicide-specific intervention
requiring less resources compared to available options. This study will result in the
following knowledge products that will be distributed to military healthcare system and
community stakeholders: G-BCBT protocol, revised BCBT manual, train-the-trainer
materials, technical report, suicide prevention white paper, and G-BCBT fidelity
assessment materials. This study supports in the 2015 Department of Defense (DoD)
Strategy for Suicide Prevention and 2019 Veterans Affairs/DoD Clinical Practice
Guidelines for the Assessment and Management of Patients at Risk for Suicide. G-BCBT
lethal means counseling and coping skills training will enhance service member quality of
life and operational readiness.
This randomized controlled clinical trial will test a new suicide-specific group therapy
intervention, Group-Brief Cognitive-Behavioral Therapy for Suicide (G-BCBT), by comparing
it to an established gold standard.