2 - (SYM 12) Reducing Suicide Risk in Patients with PTSD While Involving a Support Person

Patients with PTSD and mild SI who received Prolonged Exposure therapy (PE) report significant improvements in suicide risk. However, PE is rarely offered to individuals with PTSD who are at a high risk for suicide because of fears of exacerbating this risk. The Coping Long-Term with Active Suicide Program (CLASP) is a brief suicide prevention intervention to reduce risk of suicide attempts. In this study, we present a case series of a treatment that integrates PE and CLASP (CLASP-PE) in civilians and veterans. CLASP-PE includes a support person (romantic partner, family member, or close friend) wherever possible to assist the participant as they navigate suicidal crises and practice approaching rather than avoiding trauma cues. Participants (N = 14) were civilians or veterans recruited from two sites who were diagnosed with PTSD and reported past month suicidal ideation with intent, a plan, or a history of a suicide attempt. We report some example case reports for brevity. For participant 1, PTSD symptoms decreased from 66 to 6 on the Posttraumatic Diagnostic Scale (PDS); depression decreased from of 52 to 1 on the Beck Depression Inventory (BDI); suicidal ideation decreased from 7 to 0 on a 5-item version of the Beck Scale for Suicide Ideation (BSS). For participant 2, PTSD symptoms decreased from 56 to 14 on the PTSD Checklist (PCL); depression decreased from 32 to 3 on the BDI; suicidal ideation decreased from a score of 14 to 0 on the full BSS. For participant 3 (who dropped out after 4 sessions), the participant reported a reduction on the PCL from 38 to 13 by session 3; this participant did not have notable changes on suicidal ideation or depression by session 4. For the remaining participants, two dropped out after two sessions; no participants reported a suicide attempt or psychiatric hospitalization during the study. No participants reported a suicide attempt or psychiatric hospitalization during participation. Qualitative feedback suggested that participants appreciated the involvement of a support person in their treatment as this provided them with more support in completion of their homework practice. This case series suggests that CLASP-PE could effectively decrease PTSD severity, suicidal ideation and attempts, and depression. These findings justify a randomized clinical trial to compare the efficacy of an intervention that simultaneously addresses PTSD and suicide risk among patients at high risk for suicide, ideally involving a support person, relative to an intervention that solely addressed suicide risk alone.