Continuous Identity Cognitive Therapy: Feasibility and Acceptability of a Novel Intervention for Suicidal Symptoms

Temporal self-appraisals associated with suicide-related thoughts and behaviors

BACKGROUND

Temporal self-appraisal (TSA) is the trajectory of self-appraisal over time, including how a person views their past and future selves in relation to their present self. In this study, we examined the TSA of individuals with and without a history of suicide-related thoughts and behaviors (STBs).

METHODS

Using Amazon Mechanical Turk for recruitment, we studied 397 participants on validated measures of TSA, STBs, and mood.

RESULTS

The non-STB group (n = 291) had a TSA trajectory similar to that previously found for nonclinical populations, with perceived self-improvement over time. In contrast, the TSA of the STB group (n = 106) had two distinct qualities: their TSA profiles were more negative at all time points (past, present, and future) than the non-STB group, and they displayed similar anticipated present-to-future growth as the non-STB group but perceived minimal past-to-present change. These differences persisted when controlling for depression, anxiety, and stress, suggesting a distinct STB-related TSA profile independent of comorbid affective states.

LIMITATIONS

This study is limited by the use of self-report measures and cross-sectional design.

CONCLUSIONS

By investigating TSA, this study provides insights into the unique aspects of self-appraisal associated with having a history of STBs and emphasizes the need for therapeutic interventions that foster self-continuity and positive self-appraisal across time. Future research should focus on clarifying the mechanisms underlying this distinct self-appraisal pattern in the STB group and the effects of interventions that enhance temporal self-appraisal.

Long COVID coping and recovery (LCCR): Developing a novel recovery-oriented treatment for veterans with long COVID

Background

Long COVID has affected 13.5% of Veterans Affairs (VA) Healthcare System users during the first pandemic year. With 700,000+ United States Veterans diagnosed with COVID-19, addressing the impact of Long COVID on this population is crucial. Since empirically-based mental health interventions for Long COVID are lacking, a vital need exists for a tailored recovery-oriented intervention for this population. This study intends to assess the feasibility and acceptability of a novel recovery-oriented intervention, Long COVID Coping and Recovery (LCCR), for Veterans with Long COVID, aiming to support symptom management and quality of life. LCCR is an adaptation of Continuous Identity Cognitive Therapy (CI-CT), a suicide recovery-oriented treatment for Veterans.

Methods

In a two-year open-label pilot, three single-arm treatment trials will be conducted with 18 Veterans suffering from Long COVID. Each trial includes 16 weekly 60-min sessions delivered via VA Video Connect (VVC) and/or VA WebEx. Primary objectives include optimizing LCCR for Veterans with Long COVID and assessing the acceptability and feasibility of the intervention, using attendance and retention rates, drop-out statistics, and client satisfaction levels. Additionally, potential benefits of LCCR will be explored by evaluating alterations in quality of life, resilience, mental health status (anxiety, depression, suicide risk/behavior), and personal identity. The protocol has been tailored based on Veterans' needs assessment interviews and stakeholder feedback.

Conclusion

If the LCCR intervention proves feasible and acceptable, a manualized version will be created and a randomized controlled trial planned to examine its efficacy in the broader Veteran population.

Future self-continuity and depression among college students: The role of presence of meaning and perceived social support

INTRODUCTION

Future self-continuity has been shown to have a protective effect against depression. This study aims to investigate the longitudinal relationship between future self-continuity and depression among college students, and to explore the mediating role of the presence of meaning and the moderating role of perceived social support.

METHODS

We conducted two studies in China in 2022 and 2023. Study 1 was a longitudinal cross-lagged study that examined the relationship between future self-continuity and depression among 173 participants (49.13% females, Mage  = 19.39, SD = 1.63). Study 2 was a cross-sectional study that explored the mediating role of the presence of meaning and the moderating role of perceived social support among 426 participants (48.59% females, Mage  = 19.30, SD = 1.60).

RESULTS

Study 1 showed that future self-continuity (T1) could significantly predict depression (T2), but depression (T1) could not predict future self-continuity (T2). Study 2 showed that after controlling for gender, the presence of meaning mediated the relationship between future self-continuity and depression, whereas perceived social support moderated the first half of the mediated model's pathway and the direct pathway.

CONCLUSIONS

These findings suggest that enhancing the future self-continuity of college students and increasing the level of presence of meaning are effective measures for alleviating depression. Meanwhile, educators and families are called upon to provide more social support to college students.

Feasibility and acceptability of continuous identity cognitive therapy as a recovery-oriented suicide treatment for Veterans: A study protocol

Background

Suicide is a leading cause of death among Veterans, with rates significantly higher than the general population. To address this issue, it is crucial to develop and implement more effective treatments for Veterans with suicidal thoughts and/or behaviors, particularly those in the post-acute suicidal episode (PASE) stage. The present study aims to establish the feasibility and acceptability of a novel, recovery-oriented treatment called Continuous Identity Cognitive Therapy (CI-CT) for PASE Veterans.

Methods

This 3-year open-label pilot study will include three one-arm trials and a pilot randomized controlled trial (RCT). A total of 57 Veterans with a history of an acute suicidal episode within the previous year will be recruited. Primary outcome measures will include changes in personal recovery, suicidal thoughts, and behaviors. Secondary outcomes will include changes in self-identity, life satisfaction, and hopefulness. Feasibility and acceptability will be assessed through attendance and retention rates, drop-out rates, and client satisfaction.

Conclusion

This study aims to develop and evaluate the feasibility and acceptability of a novel recovery-oriented intervention for Veterans experiencing PASE. If the intervention is found to be feasible and acceptable, a manualized version will be finalized and a large-scale multi-site RCT will be designed to assess its clinical efficacy on a broader Veteran population. The results of this trial will aid in the development of effective treatment and provide valuable insights into the preliminary feasibility, acceptability, and effectiveness of this approach in reducing suicidal thoughts and behaviors and promoting recovery and rehabilitation in this population.

Self-Continuity

Self-continuity is the subjective sense of connection between one's past and present selves (past-present self-continuity), between one's present and future selves (present-future self-continuity), or among one's past, present, and future selves (global self-continuity). We consider the motivational character of the three forms of self-continuity, their regulatory properties, and the internal or external factors that consolidate them. We also review their consequences for attitudes and judgments or decisions, motivation, intentions and behavior, and psychological and physical health. We further detail the psychological and behavioral benefits of self-discontinuity (i.e., a sense of disconnect among temporal selves). We next turn to the brain regions that are activated synchronously with self-continuity. We consider developmental perspectives on self-continuity, discuss collective self-continuity (along with its consequences and regulatory properties), and elaborate on cultural differences in self-continuity. This inaugural Annual Reviews chapter demonstrates the breadth, excitement, and sense of synergy among self-continuity researchers and points to promising research directions.

Theoretical model of recovery following a suicidal episode (COURAGE): scoping review and narrative synthesis

BACKGROUND

Despite a significant need, there are currently no rigorously developed empirically based models for what personal recovery from a suicidal episode looks like.

AIMS

To develop a theoretical model of personal recovery after a suicidal episode, based on a comprehensive literature review and stakeholder feedback.

METHOD

A scoping review of all empirical studies on this topic was conducted, followed by a thematic analysis to create a preliminary framework. Consultation-based revisions were then made based on feedback from a stakeholder panel to develop the final theoretical model.

RESULTS

The final model comprised seven themes: choosing life, optimising identity, understanding oneself, rediscovering meaning, acceptance, growing connectedness and empowerment (acronym 'COURAGE'). Although there are some similarities between COURAGE and other models of personal recovery, there are components, such as 'choosing life' and 'understanding oneself', that are specific to recovery after an acute suicidal episode.

CONCLUSIONS

To our knowledge, this is the first study to use a comprehensive literature review with stakeholder feedback to develop a conceptual model of personal recovery after an acute suicidal episode. This model has important implications for both researchers and clinicians to consider. Looking ahead, COURAGE can inform the reconceptualisation of assessment, research and clinical care of individuals who have experienced a suicidal episode.