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Yao H, Gomes de Siqueira A, Rogers ML, Bloch-Elkouby S, Lawrence O, Sarli G, Foster A, Mitelman SA, Galynker I, Lok B. The impact of scaffolded and non-scaffolded suicidal virtual human interaction training on clinician emotional self-awareness, empathic communication, and clinical efficacy. BMC MEDICAL EDUCATION 2024; 24:413. [PMID: 38622653 PMCID: PMC11017492 DOI: 10.1186/s12909-024-05371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Clinicians working with patients at risk of suicide often experience high stress, which can result in negative emotional responses (NERs). Such negative emotional responses may lead to less empathic communication (EC) and unintentional rejection of the patient, potentially damaging the therapeutic alliance and adversely impacting suicidal outcomes. Therefore, clinicians need training to effectively manage negative emotions toward suicidal patients to improve suicidal outcomes. METHODS This study investigated the impact of virtual human interaction (VHI) training on clinicians' self-awareness of their negative emotional responses, assessed by the Therapist Response Questionnaire Suicide Form, clinicians' verbal empathic communication assessed by the Empathic Communication and Coding System, and clinical efficacy (CE). Clinical efficacy was assessed by the likelihood of subsequent appointments, perceived helpfulness, and overall interaction satisfaction as rated by individuals with lived experience of suicide attempts. Two conditions of virtual human interactions were used: one with instructions on verbal empathic communication and reminders to report negative emotional responses during the interaction (scaffolded); and the other with no such instructions or reminders (non-scaffolded). Both conditions provided pre-interaction instructions and post-interaction feedback aimed at improving clinicians' empathic communication and management of negative emotions. Sixty-two clinicians participated in three virtual human interaction sessions under one of the two conditions. Linear mixed models were utilized to evaluate the impact on clinicians' negative emotional responses, verbal empathic communication, and clinical efficacy; and to determine changes in these outcomes over time, as moderated by the training conditions. RESULTS Clinician participants' negative emotional responses decreased after two training sessions with virtual human interactions in both conditions. Participants in the scaffolded condition exhibited enhanced empathic communication after one training session, while two sessions were required for participants in the non-scaffolded condition. Surprisingly, after two training sessions, clinical efficacy was improved in the non-scaffolded group, while no similar improvements were observed in the scaffolded group. CONCLUSION Lower clinical efficacy after virtual human interaction training in clinicians with higher verbal empathic communication suggests that nonverbal expressions of empathy are critical when interacting with suicidal patients. Future work should explore virtual human interaction training in both nonverbal and verbal empathic communication.
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Affiliation(s)
- Heng Yao
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, 32611, FL, USA.
| | - Alexandre Gomes de Siqueira
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, 32611, FL, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, 78666, TX, USA
| | - Sarah Bloch-Elkouby
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, 10033, NY, USA
| | - Olivia Lawrence
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Giuseppe Sarli
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
- Department of Mental Health and Addiction, ASST Brianza, Vimercate, Italy
| | - Adriana Foster
- Healthcare Corporation of America (HCA) Florida, Woodmont Hospital, Tamarac, 33321, FL, USA
| | - Serge A Mitelman
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Igor Galynker
- Department of Psychiatry and Behavioral Sciences, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Benjamin Lok
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, 32611, FL, USA.
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Caro-Cañizares I, Vila MM, Durán Pacheco JI, Carballo JJ. Interpersonal theory of suicide and stressful life events in a clinical sample of adolescents in Spain. Early Interv Psychiatry 2024; 18:113-121. [PMID: 37201918 DOI: 10.1111/eip.13438] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
AIMS The interpersonal theory of suicide (ITPS) provides a theoretical model for suicidal behaviour. It includes two interpersonal variables, thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested the relationship between ITPS interpersonal variables and suicide risk (presence/absence of suicidal ideation and suicide attempts throughout life) in a clinical sample of Spanish adolescents. We also assessed the potential mediation effect of these variables in the well-established relationship between stressful life events (SLE) and suicide risk. METHODS We recruited 147 adolescents aged 11-17 from the Child and Adolescent Mental Health Outpatient Services of the Jiménez Díaz Foundation (Madrid, Spain). Different questionnaires were administered to assess suicidal behaviour and SLE (SITBI, The Stressful Life Events Scale) and to calculate proxy measures for ITPS interpersonal factors (SDQ, STAXI-NA, CDI). RESULTS TB and PB significantly correlated with suicide risk. PB played a mediating role in the relationship between SLE and suicide risk: adolescents reporting SLE were more likely to enact suicide behaviours when they experienced higher PB. Patients scoring higher PB were more likely to receive more intense treatment but tended to abandon intervention promptly. CONCLUSIONS ITPS seems useful for predicting suicide risk in an adolescent clinical sample. The results suggest an important role for PB in the SLE-suicide risk relationship and may impact the treatment process. Our exploratory findings should be addressed in future studies.
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Affiliation(s)
- Irene Caro-Cañizares
- Psychology Department, Health Science School, Universidad a Distancia de Madrid UDIMA, Madrid, Spain
| | - María Marín Vila
- Psychiatry Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Juan I Durán Pacheco
- Social Psychology and Methodology Department, Psychology School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan J Carballo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, IISGM. Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Levis M, Levy J, Dufort V, Russ CJ, Shiner B. Dynamic suicide topic modelling: Deriving population-specific, psychosocial and time-sensitive suicide risk variables from Electronic Health Record psychotherapy notes. Clin Psychol Psychother 2023; 30:795-810. [PMID: 36797651 PMCID: PMC11172400 DOI: 10.1002/cpp.2842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
In the machine learning subfield of natural language processing, a topic model is a type of unsupervised method that is used to uncover abstract topics within a corpus of text. Dynamic topic modelling (DTM) is used for capturing change in these topics over time. The study deploys DTM on corpus of electronic health record psychotherapy notes. This retrospective study examines whether DTM helps distinguish closely matched patients that did and did not die by suicide. Cohort consists of United States Department of Veterans Affairs (VA) patients diagnosed with Posttraumatic Stress Disorder (PTSD) between 2004 and 2013. Each case (those who died by suicide during the year following diagnosis) was matched with five controls (those who remained alive) that shared psychotherapists and had similar suicide risk based on VA's suicide prediction algorithm. Cohort was restricted to patients who received psychotherapy for 9+ months after initial PTSD diagnoses (cases = 77; controls = 362). For cases, psychotherapy notes from diagnosis until death were examined. For controls, psychotherapy notes from diagnosis until matched case's death date were examined. A Python-based DTM algorithm was utilized. Derived topics identified population-specific themes, including PTSD, psychotherapy, medication, communication and relationships. Control topics changed significantly more over time than case topics. Topic differences highlighted engagement, expressivity and therapeutic alliance. This study strengthens groundwork for deriving population-specific, psychosocial and time-sensitive suicide risk variables.
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Affiliation(s)
- Maxwell Levis
- White River Junction VA Medical Center, Hartford, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Joshua Levy
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Vincent Dufort
- White River Junction VA Medical Center, Hartford, Vermont, USA
| | - Carey J. Russ
- White River Junction VA Medical Center, Hartford, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian Shiner
- White River Junction VA Medical Center, Hartford, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- National Center for PTSD Executive Division, Hartford, Vermont, USA
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Soulié T, Jenkin G, Collings S, Bell E. Relationship Between Clinicians' Inclination Toward Patients at Risk for Suicide (PRS) and Self-reported Countertransference. Arch Suicide Res 2023; 27:148-155. [PMID: 34520701 DOI: 10.1080/13811118.2021.1972883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We investigate the relationship between clinicians' inclination toward treating patients at risk for suicide (PRS), and self-reported countertransference (CT). We consider these observed group differences to explore two competing interpretations for observed CT patterns from a primary study; whether CT patterns are more consistent with defensive attitudes or an adaptative CT montage. METHOD We used one-way ANOVA, Tuckey post-hoc, and t-test, to compare clinicians (n = 267) grouped by self-ratings of positive, neutral or non-positive inclination toward working with PRS, with regard to their level of endorsement of the Therapist Response Questionnaire (TRQ) with PRS. We hypothesized that positively inclined clinicians would demonstrate greater CT literacy skills than other clinicians, reflected in lower endorsement of negative/hindering CT and higher endorsement of positive/facilitating CT to PRS. RESULTS Compared to non-positively inclined clinicians, positively inclined clinicians endorsed significantly lower levels of two potentially negative/hindering CT dimensions, factor 1: entrapped/rejecting and, factor 5: protective/overinvolvement, and higher levels of the only positive/facilitating CT dimension, factor 2: fulfilled/engaging. Neutral clinicians reported similar CT patterns to positively inclined clinicians. CONCLUSIONS Hypothesis of greater CT literacy from positively inclined clinicians appears supported. Observed differences in CT endorsement by inclination group tend to support the CT montage interpretation of our original findings more than the defense mechanism interpretation proposed. Similarities in CT patterns between positively inclined and neutral clinicians suggest that positive inclination to PRS, as assessed in this study, may not be countertransferential per se.
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Storey QK, Kealy D, Seidler ZE, Oliffe JL, Rice SM, Ogrodniczuk JS. Connecting and Healing: The Role of Existential Isolation in Mediating the Impact of the Therapeutic Relationship on Canadian Men's Mental Health Outcomes. Am J Mens Health 2022; 16:15579883221136980. [PMID: 36373408 PMCID: PMC9663642 DOI: 10.1177/15579883221136980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The therapeutic relationship has emerged as one of the most important components of successful treatment outcomes, regardless of the specific form of therapy. Research has now turned its attention to better understanding how the therapeutic relationship contributes to patient improvement. Extant literature contends that a strong therapeutic relationship may help reduce a patient's sense of existential isolation (i.e., a sense of not feeling understood by others). Research indicates that existential isolation might be especially problematic for men, potentially increasing their risk for suicidality. This study investigated the association between strength of the therapeutic relationship and psychological distress and suicidality among men who received psychotherapy, and whether existential isolation mediated this association. A total of 204 Canadian men who had previously attended psychotherapy participated in a cross-sectional survey, completing measures of the quality of their most recent therapeutic relationship, existential isolation, depression and anxiety symptoms, and suicidality. Regression with mediation analysis was conducted. Two models were tested; one with depression/anxiety symptoms as the dependent variable and the other with suicidality as the dependent variable. Both mediation models emerged as significant, indicating an indirect effect for quality of the therapeutic relationship on symptoms of anxiety/depression and suicidality through existential isolation. The findings suggest that a positive therapeutic relationship can contribute to men feeling less isolated in their experiences in life (i.e., less existentially isolated), thereby helping mitigate psychological distress and suicidality.
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Affiliation(s)
- Quinn K. Storey
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zac E. Seidler
- Orygen, Melbourne, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia,Movember Foundation, Melbourne, Victoria, Australia
| | - John L. Oliffe
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon M. Rice
- Orygen, Melbourne, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John S. Ogrodniczuk
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada,John S. Ogrodniczuk, Department of Psychiatry, The University of British Columbia, 420-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z4.
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Barzilay S, Gagnon A, Yaseen ZS, Chennapragada L, Lloveras L, Bloch-Elkouby S, Galynker I. Associations between clinicians' emotion regulation, treatment recommendations, and patient suicidal ideation. Suicide Life Threat Behav 2022; 52:329-340. [PMID: 34918383 DOI: 10.1111/sltb.12824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study examines how clinicians' emotional responses to suicidal patients and their emotion regulation abilities are related to their treatment recommendations for these patients and to patients' concurrent suicidal ideation and at one-month follow-up. METHODS Adult psychiatric outpatients (N = 361) and the mental health professionals evaluating them for treatment (N = 43) completed self-report assessments following their first clinical meeting. Clinician emotion regulation traits, emotional responses to individual patients, and the recommended intensity of treatment were assessed. Patients were assessed for suicidal ideation immediately following the initial meeting and at a one-month follow-up. Moderation and mediation analyses were performed to examine the relationships between study variables. RESULTS Patient suicidal ideation at the initial clinical encounter was associated with increased negative emotions in clinicians with lower emotion regulation. Further, recommended treatment intensity was associated with clinicians' negative emotional responses but not with patient suicidal ideation among clinicians with lower emotion regulation. CONCLUSIONS Treatment intensification is related to clinicians' emotion regulation abilities. Clinicians' attention to their emotional responses may facilitate improved treatment process and ultimately may improve suicidal outcomes.
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Affiliation(s)
- Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, New York, USA
| | - Amanda Gagnon
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, New York, USA
| | - Zimri S Yaseen
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, New York, USA
| | - Lakshmi Chennapragada
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, New York, USA
| | - Lauren Lloveras
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, New York, USA
| | - Sarah Bloch-Elkouby
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, New York, USA
| | - Igor Galynker
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, New York, USA
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7
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Stefana A, Youngstrom EA, Vieta E. Empirical support for the use and further study of the countertransference construct in the clinical care of patients with bipolar disorder. Bipolar Disord 2022; 24:84-85. [PMID: 34773350 DOI: 10.1111/bdi.13153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Alberto Stefana
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eduard Vieta
- Department of Psychiatry and Psychology at the Hospital Clinic, University of Barcelona, Barcelona, Spain
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8
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Aasan OJ, Brataas HV, Nordtug B. Experience of Managing Countertransference Through Self-Guided Imagery in Meditation Among Healthcare Professionals. Front Psychiatry 2022; 13:793784. [PMID: 35250661 PMCID: PMC8891567 DOI: 10.3389/fpsyt.2022.793784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION As a part of the therapeutic relationship, a significant, well-established predictor of outcomes in psychiatric healthcare, healthcare professionals' emotional reactions to patients may affect treatment outcomes. AIM The aim of our study was to explore and describe healthcare professionals' experiences with managing countertransference using skills from a training program on self-guided imagery in meditation (SIM). METHOD Following an exploratory descriptive design, we conducted qualitative interviews with 10 healthcare professionals who care for patients with mental illness and subjected the collected data to thematic content analysis. RESULTS Participants reported that SIM had helped them to manage countertransference and had prompted changes that we categorized into three themes: managing personal vulnerability, setting clearer boundaries, and practicing self-care. CONCLUSION The results suggest that by cultivating wellbeing and dealing with unresolved inner conflicts, SIM can help healthcare professionals to manage countertransference.
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Affiliation(s)
- Olaug Julie Aasan
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | | | - Bente Nordtug
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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9
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Rogers ML, Vespa A, Bloch-Elkouby S, Galynker I. Validity of the modular assessment of risk for imminent suicide in predicting short-term suicidality. Acta Psychiatr Scand 2021; 144:563-577. [PMID: 34333759 DOI: 10.1111/acps.13354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The Modular Assessment of Risk for Imminent Suicide (MARIS) is a clinical assessment tool, consisting of four modules assessing (1) a pre-suicidal cognitive-affective state (Module 1); (2) patients' attitudes toward suicide (Module 2); (3) clinicians' assessment of suicide risk factors (Module 3); and (4) clinicians' emotional responses to patients (Module 4) that assesses short-term suicide risk. Initial evidence provided evidence for its reliability and concurrent validity. The present study extended these findings by examining the MARIS's predictive validity in relation to suicidal thoughts and behaviors at one-month follow-up. METHODS A sample of 1039 psychiatric patients (378 inpatients, 661 outpatients) and their clinicians (N = 144) completed a battery of measures at baseline; 670 patients completed the one-month follow-up assessment. RESULTS MARIS total scores predicted suicidal thoughts and behaviors at one-month follow-up, even after controlling for baseline suicidal thoughts and behaviors. Moreover, both Module 1 and the Distress subscale of Module 4 were uniquely associated with suicidal thoughts and behaviors at one-month follow-up, controlling for baseline suicidal thoughts and behaviors. Modules 2 and 3, on the other hand, exhibited poor internal consistency. CONCLUSION Overall, both patient- and clinician-rated indices are uniquely predictive of suicidal thoughts and behaviors at one-month follow-up, highlighting the need for integrating clinicians' emotional responses into suicide risk assessment. Pending replication and extension of these findings in external samples, a briefer, two-module version of MARIS (MARIS-2) may be such an integrative, psychometrically sound, and clinically useful instrument that can be utilized to assess short-term suicide risk.
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Affiliation(s)
- Megan L Rogers
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Allison Vespa
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | | | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, New York, USA
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10
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Bloch-Elkouby S, Barzilay S, Gorman BS, Lawrence OC, Rogers ML, Richards J, Cohen LJ, Johnson BN, Galynker I. The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up. J Affect Disord 2021; 295:1280-1291. [PMID: 34706442 DOI: 10.1016/j.jad.2021.08.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/10/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory-2 (SCI-2). METHODS The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. RESULTS The SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. DISCUSSION The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients' readiness to disclose suicidal ideation.
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Affiliation(s)
- Sarah Bloch-Elkouby
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States.
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Bernard S Gorman
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Olivia C Lawrence
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Megan L Rogers
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Jenelle Richards
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Lisa J Cohen
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Benjamin N Johnson
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
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Wood MJ, Wilson HMN, Parry SL. Exploring the development and maintenance of therapeutic relationships through e-Health support: A narrative analysis of therapist experiences. MEDICINE ACCESS @ POINT OF CARE 2021; 5:23992026211018087. [PMID: 36204492 PMCID: PMC9413613 DOI: 10.1177/23992026211018087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: Amid COVID-19 disruptions, e-therapy has become even more essential and has rapidly expanded across statutory, private and third sectors to meet growing demands for digital mental health support. A challenge in digital therapeutic care is how to develop and maintain a supportive, collaborative therapeutic relationship, built upon mutual trust and respect; intrinsic values of relationships that are often implied through complex non-verbal cues. Online practitioners are eager to learn how to adapt to online delivery, although platform-specific training is limited. The aim of the current study was to focus upon the therapist experience of online therapeutic relationships with young people, exploring a range of factors through their perspectives, including the impact of anonymity. Methods: Eight e-therapy practitioners were recruited from Kooth, an online mental health service. Narrative interviews undertaken via Skype facilitated reflective conversational one-to-one discussions, based upon the practitioners’ individual experiences, led by the interviewee. Following transcription and anonymisation, a narrative analysis was undertaken to explore participants’ experiences, perspectives and reflections. Results: Four analytic layers arose from the narratives, which explored the challenging learning experience of translating existing therapeutic skills to online working, rapidly building therapeutic relationships, managing risk in the online therapeutic relationship, and techniques for maintaining a digital therapeutic relationship. Conclusion: The study provides novel insights into the flexibility and adjustments therapists can make to improve online interventions and delivery through the development and maintenance of positive therapeutic relationships. Recommendations are also made in relation to platform-specific training, communicative adaptations, risk management and practitioner support.
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Affiliation(s)
| | | | - Sarah L Parry
- DClinPsy, Manchester Metropolitan University, Manchester, UK
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12
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Foster A, Alderman M, Safin D, Aponte X, McCoy K, Caughey M, Galynker I. Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:257-261. [PMID: 33786778 DOI: 10.1007/s40596-021-01421-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
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13
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Soulié T, Levack W, Jenkin G, Collings S, Bell E. Learning from clinicians' positive inclination to suicidal patients: A grounded theory model. DEATH STUDIES 2020; 46:485-494. [PMID: 32223544 DOI: 10.1080/07481187.2020.1744201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite experts' contention that clinicians' positive inclination is essential to successful treatment of patients at risk for suicide (PRS), research in the area is lacking. This study used grounded theory to develop a model of clinicians' positive inclination based on interviews with 12 clinicians who "liked" working with PRS. The core process identified, a state of emotional synchrony through deep connection between clinicians and PRS, appeared to provide an intersubjective emotion regulation, associated with distress reduction in patients and deep satisfaction in clinicians. Findings suggest clinicians' deep sense of satisfaction and PRS' clinical improvement in treatment could be interdependent.
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Affiliation(s)
- Tess Soulié
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Department of Psychology, University of Quebec at Montreal, Montreal, Canada
| | - William Levack
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Gabrielle Jenkin
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Sunny Collings
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Elliot Bell
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
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