Decreasing Suicide Risk Among Service Members With Posttraumatic Stress Using Written Exposure Therapy
Principal Investigator: 

Brian Marx

VA Boston Healthcare System, National Center for PTSD

Randomized trial comparing a new formulation of Written Exposure Therapy that includes crisis response planning + treatment as usual (TAU) with TAU only among high-risk, suicidal service members with PTS admitted to the Carl R. Darnall Army Medical Center

Although there is support that evidence-based PTSD treatments can reduce suicidal ideation, it is challenging to provide most of these treatments to high-risk service members in an acute inpatient unit. These treatments require more time and resources than are typically afforded during inpatient stays. There is an urgent need to reduce suicide risk by treating posttraumatic stress (PTS) among high-risk service members who have been admitted for acute psychiatric inpatient care because many patients die by suicide shortly after discharge. Fortunately, one evidence-based treatment can be implemented within an inpatient setting: Written Exposure Therapy (WET). WET is also included in the 2017 VA/DOD Clinical Practice Guidelines for managing PTSD. 

However, WET has yet to be tested with patients at high risk for suicide requiring inpatient hospitalization management. As part of risk management strategies for the experimental treatment of WET with this population, Dr. Brian Marx and colleagues are including increased suicide risk monitoring and management by the inclusion of crisis response planning (CRP) in the WET condition. This new formulation of WET is referred to as WET-for suicide (WET-S). 

Dr. Marx will conduct a randomized controlled trial examining whether WET-S and treatment as usual (TAU) compared to TAU will result in significantly greater reductions in suicide-related outcomes and PTS symptom severity among high risk, suicidal service members with PTS at 1-month and 4-month follow-ups. Specifically, he will recruit 124 service members within an acute psychiatric inpatient unit. If WET-S and TAU reduces the presence, frequency, and severity of suicide related outcomes and PTS symptom severity, the team will develop a toolkit for WET-S implementation through a needs assessment with key stakeholders and evaluation of contextual factors among DoD inpatient facilities. 

The military’s mission readiness would benefit from a brief intervention that meaningfully reduces future suicide risk among service members with PTS. Because WET-S is brief and requires fewer resources, it is highly scalable. This would allow service members to receive treatment in a variety of settings with a high degree of privacy. This privacy and flexibility may also help reduce stigma. WET-S can be disseminated easily across DOD to reduce suicidal behavior among service members.