In individuals recently hospitalized for self-harm behaviors, identifying self-harm triggers and potential responses reduced suicidal threats and attempts.

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Individuals hospitalized for self-harm, regardless of suicidal intent, are at high risk for future suicide attempts. Few medications have specific antisuicidal effects, but now clinicians are developing psychosocial treatments to address the multiple powerful contextual factors contributing to self-harm. “Implementation intentions” (IIs) are a set of plans that identify trigger situations and formulate plans to counter them in an “if-then” fashion. They have been used successfully to treat other problem behaviors such as overeating and alcoholism. Now, researchers have randomized 226 patients recently hospitalized for self-harm to one of three interventions: unassisted IIs (patients generate their own plans), assisted IIs (patients use “help sheets” containing possible solutions), and a control (patients think about triggers and coping without forming IIs).

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At least some suicidal measures decreased in all three groups at 3 months. However, both II conditions reduced suicidal ideation, compared with the control condition, with a medium effect size. Compared with the unassisted-II condition, the assisted-II condition reduced suicidal threats (medium effect size) and actual attempts (small effect size). A measure of self-efficacy showed no change, supporting a pre-existing theory that IIs work in an automatic, nonconscious manner.

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COMMENT

This novel intervention, never before used to address self-harm behaviors and suicidal risk, reduced suicidal risk markers (ideation and threats) and actual attempts, with small-to-moderate effect sizes. Providing a help sheet that details possible strategies to cope with common suicidal triggers seems to increase the effectiveness of the intervention. The results are impressive because an active control, which caused some reduction in risk behaviors, was used as a comparator. As the authors wonder, might adding participation by a clinician further enhance these effects?