Few treatments have been shown to consistently reduce suicidal thoughts and behaviors compared to a control group, and few existing interventions are amenable to large-scale dissemination. Building on our NSSI work described here, we attempted to address this issue by developing a suicide-related version of Therapeutic Evaluative Conditioning (TEC), which we called TEC for the reduction of suicidal behaviors. This TEC version was very similar to TEC-NSSI, with the exception that it included a range of suicide-related stimuli (e.g., pictures depicting pill overdoses, shooting, hanging, stabbing, etc.). Echoing the logic of TEC-NSSI, this version of TEC aimed to (1) increase aversion to suicide-related stimuli and (2) decrease aversion toward the self. We tested this app across two months in a web-based randomized controlled trial (N = 163, all with a history of suicidal behavior). As shown below, results indicated that, compared to a group that had access to a control version of TEC, the active version of TEC produced significant reductions in suicide plans, suicidal behaviors, and (perhaps surprisingly) self-cutting. There were no effects on suicide ideation.
Percent Difference in active tec group compared to control tec group
To conduct more reliable analyses, we combined suicidal behavior data from this study with the relevant data from the two TEC-NSSI studies. Results indicated that there were 91 total suicidal behaviors: 29 produced by the active TEC groups and 62 produced by the control TEC groups (p = .01). However, this effect was no longer significant after controlling for prior month suicidal behaviors (p = .07). When compared to participants who had accessed the active TEC app at least once (as described here, participants were not forced to access TEC in these studies), differences were even greater -- with 17 suicidal behaviors produced by participants who accessed active TEC at least once and 74 behaviors produced by all other participants (p<.001). This effect remained significant after controlling for prior month suicidal behaviors (p<.001).
As with the TEC-NSSI app, TEC for the reduction of suicidal behaviors would greatly benefit from further testing and many improvements. Nevertheless, these primarily studies are promising and suggest that it may be possible to create simple but highly effective large-scale interventions for suicidal behaviors.
Recommended citation for this information: Franklin, J.C., Fox, K.R., Franklin, C.R., Kleiman, E.M., Ribeiro, J.D., Jaroszewski, A.C., Hooley, J.M., & Nock, M.K. (in press). A brief mobile app reduces nonsuicidal and suicidal self-injury: Evidence from three randomized controlled trials. Journal of Consulting and Clinical Psychology.
Note: Two co-authors have a patent pending for the general design/function of TEC (JCF, CRF) and one owns an app distribution company (JCF). TEC was developed/programmed by CRF.