The research that CARES

Suicide is now the third-leading cause of death among college-aged people, according to the Surgeon General’s report released in September. A study at the UW aims to combat that statistic, preventing suicide in adolescents through alternative methods of therapy.

The Collaborative Adolescent Research on Emotions and Suicide (CARES) study is a government-funded, multi-site clinical trial for suicidal youth, held by Seattle Children’s Hospital in collaboration with the UW, the University of California Los Angeles (UCLA), and Harbor-UCLA Medical Center.

Molly Adrian, attending clinical psychologist at Seattle Children’s Hospital, said the research is a randomized controlled trial that examines the efficacy of two treatments through a six-month therapy protocol and five assessments over a yearlong period.

These two treatments include Dialectical Behavior Therapy (DBT) and Individual Group Supportive Therapy (IGST), both incorporating weekly psychotherapy and weekly group therapy. However, Adrian said the two treatments “differ in their approach and understanding [of] the problem of suicidal behavior.”

Since the treatment is randomized, the type of treatment that a certain patient will receive is determined by a computer program that uses an algorithm to match all youth who meet inclusion criteria to the type of treatment they will undergo.
The principal investigators of this study, Marsha Linehan of the UW’s psychology department and Elizabeth McCauley of Seattle Children’s Hospital, are combining their expertise in this research.

One type of treatment that the research uses, IGST, is the standard of care for suicidal behaviors. Adrian said the point of the group sessions is to develop a cohesive, supportive framework for understanding the patients’ problems in a more productive way, as well as looking at multiple perspectives on their problem to find a solution.

“I think the overall goal is just to have a safe place to talk about things and to be able to come up with adaptive solutions for handling the problem,” Adrian said.

The other type of treatment conducted in the study is DBT, which focuses on helping teens develop coping skills in order to reduce emotional distress and help solve problems, with weekly group therapy involving a chosen caregiver. DBT is a treatment created by Linehan that was initially developed to treat chronically suicidal depression but has now evolved into a treatment for multi-disordered individuals with borderline personality disorder.

McCauley said DBT has been implemented with adolescents by some therapists, but no one has concrete proof of its effectiveness.

CARES also includes five assessments administered to the patients over a yearlong period in order to determine its efficacy. Those assessments include data collection through interviews, questionnaires, and treatment records that originated outside the study such as emergency-room visits, hospitalization, or residential care.

As for now, that data is yet to be processed.

“We’ve had our first cohort complete treatment and it seems like overall people are doing well. They’re just doing their end-of-treatment follow-up, so we will look at that data soon,” Adrian said. “We’re feeling hopeful. We see people benefiting, but, you know, the jury’s out until we crunch in the numbers.”

“Anecdotally, [the patients] have been appreciative in the treatment, but it is too soon to report on treatment outcomes,” McCauley said.

Despite developmental and cognitive differences between adolescents and adults, DBT can work flexibly for both age groups.
“[We make] some simplifications at times [in the] vocabulary that’s used to present things, but I think we have been surprised in a positive way that very little change [to the treatment] has been needed,” McCauley said.

Because it’s still in its early stages, CARES is still actively looking for participants. However, there are specific inclusion criteria. The study only enrolls teens age 13 to 17 who have a history of three self-injuries in their lifetimes, with one being a suicide attempt, one being in the last eight weeks to indicate recentness, and one other that can fall in either category.

Other than self-injury behaviors, prospective patients also have to have borderline personality disorder features such as difficulties with regulation of emotions, anger problems, turbulent relationships, or identity disturbances. In addition, youth who are participating in treatment need to participate in assessment as well. McCauley said they hope to have 170 patients by the end of the study.

However, there are ways to handle and prevent suicidal behavior, both in regard to the CARES study and in general.
“I think helping to reduce the stigma around mental illnesses and suicidal behavior is a big help in being able to talk openly about suicidal behaviors,” Adrian said.

In addition, there are various actions that a person can take to help. These include listening carefully and seriously to the person’s problem and connecting them to people who have expertise in the area, such as mental-health professionals or the emergency room.

Ultimately, it is the task of the community to help those members in need.

“[What] Marsha Linehan said about the Dialectical Behavior Therapy is that it’s a ‘life worth living’ treatment,” said Chelsey Wilks, UW graduate student and CARES treatment coordinator. “We just want to make the life worth living again.”

Reach contributing writer Imana Gunawan at development@dailyuw.com. Twitter: @imanafg

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