One barrier to large-scale suicide prevention is that most existing interventions cannot easily reach the millions of people who may be at high risk for suicidality. To take a step toward addressing this long-standing problem, Dr. Joseph C. Franklin and colleagues developed a brief, game-like, app-based intervention for nonsuicidal and suicidal self-injurious behaviors (Franklin et al., 2016). This intervention is called Therapeutic Evaluative Conditioning, or TEC.

The app is designed to condition more positive association with the self, and more negative associations with suicide and self-injury. The idea is that if people like themselves more and find self-injury and suicide to be aversive, they will be less inclined to harm themselves. Across three web-based randomized controlled trials, results indicated that TEC significantly reduced self-cutting (32%-40% reductions) and suicide plans (21%-59% reductions) over the course of one month. Although suicidal behaviors were too rare in these studies to allow for any confident conclusions about effects on these behaviors, results indicated that TEC was associated with reductions in these behaviors as well (33%-77% reductions). However, there were no effects on suicide ideation, treatment gains were not maintained at the one-month post-treatment follow-up, and several study design features may limit generalizability of these findings (e.g., paying participants to play TEC). These findings indicate the potential promise of scalable, app-based interventions for suicidality and self-injury, but they also highlight important limitations. Most notably, the central mechanisms that drive suicidality remain poorly understood. As a consequence, it is difficult to design interventions that can consistently and effectively interrupt these mechanisms to prevent suicidality. New ideas and stringent tests of those ideas (e.g., with experimental methods) are needed to shed light on how suicidality really works. Information from these studies can then be used to craft more promising interventions that may eventually be scaled in an app-based format like TEC. In the meantime, a mobile app version of TEC is available for free for anyone with an Apple- or Android-compatible device (see tectectech.com).

References

Franklin, J. C., Fox, K. R., Franklin, C. R., Kleiman, E. M., Ribeiro, J. D., Jaroszewski, A. C.,…Nock, M. K. (2016). A brief mobile app reduces nonsuicidal and suicidal self-injury: Evidence from three randomized controlled trials. Journal of Consulting and Clinical Psychology, 84(6), 544-557.