Development and Initial Testing of a Couple-Based Intervention to Optimize Suicide and Self-Injury Treatment: COMPASS (Connecting, Overcoming, and Moving Past Suicide and Self-Injury)

Suicide is the 10th leading cause of death in the United States. Self-injurious thoughts and behaviors (SITBs), including suicide, thinking about suicide, and self-injury without intent to die, are thus major public health crises, with variably effective, and sometimes long and expensive, interventions. Moreover, people often cannot access SITB treatment, drop out of them, and may lose their improvements after them. Reducing SITBs requires innovative interventions that have greater impact and are faster to deliver. SITBs are particularly influenced by emotion dysregulation (i.e., intense, negative emotion and difficulties changing it) and intimate relationship dysfunction, but leading evidence-based SITB interventions typically focus on the former, while neglecting the latter. For other mental health problems, couple treatments result in comparable or better individual outcomes relative to individually-delivered treatments, with added benefits of enhanced intimate relationship functioning. SITB treatment outcomes could likely be expedited and optimized with a couple intervention that targets emotion dysregulation in a relational context and intimate relationship dysfunction. This project aims to develop, refine, and test a brief SITB intervention delivered conjointly to individuals with SITBs (i.e.,"patients") and their intimate partners (i.e., "partners")— COMPASS (Connecting, Overcoming, and Moving Past Suicide and Self-injury)— that targets both emotion dysregulation and intimate relationship dysfunction to reduce SITBs in the short- and long-term. This project involves 3 Phases: translating COMPASS outlines into a manual (Phase 1); refining COMPASS (Phase 2); and an uncontrolled pilot trial of COMPASS (Phase 3). In Phase 1, the three stages of COMPASS will be manualized to focus on (1) developing a conjoint safety plan to reduce SITB risk, (2) reducing emotion dysregulation and intimate relationship dysfunction, and (3) changing patterns that maintain SITBs. In Phase 2, COMPASS will be delivered to 5 patients with SITBs and their partners (i.e., 5 couples) who will provide feedback about whether COMPASS is clear, helpful, and useable. This feedback will be used to refine the COMPASS manual. In Phase 3, we will test whether COMPASS is safe, initially efficacious, and feasible by administering it to 15 patients with SITB and their partners (i.e., 15 couples). We will examine whether COMPASS results in changes in SITBs in patients with SITBs, and SITB risk factors (e.g., emotion dysregulation and intimate relationship dysfunction) in both patients and partners. These outcomes will be measured multiple times per day during treatment using participant's smartphones (i.e., ecological momentary assessment), and interviews/questionnaires administered at the beginning, middle, end, and at 3 months after, intervention. We predict that COMPASS will reduce SITBs in the patient with SITBs and improve emotion dysregulation and intimate relationship dysfunction in both patients with SITBs and their partners. This study offers a novel SITB treatment that directly targets SITBs and the factors that drive it. Its short duration broadens the accessibility of SITB interventions with the potential to contribute to reducing SITBs on a large scale. If results suggest that COMPASS is feasible, safe, and potentially efficacious, future directions will include a randomized clinical trial examining its efficacy relative to individual SITB interventions.