Development and Initial Testing of a Group Psychotherapy Circles of Hope for Adolescents with Suicidal Thoughts

Suicide is a leading cause of death among adolescents. While individual skill-based and time-limited psychotherapy has been shown to be effective in reducing suicidal thoughts and behaviors among adolescents, there is a paucity of group therapy interventions for this population. Thus, this project aims to develop and test a brief group therapy intervention – ‘Circles of Hope’, delivered to adolescents with suicidal thoughts. The intervention integrates fostering core social-emotional skills for managing suicidal crises and coping with risk factors for suicide with the therapeutic benefits of group processes , including enhanced group connectedness among participants. Circles of Hope is comprised of 8 group sessions (90 min each), and 3 individual adolescent-parents sessions (2 prior to group sessions and 1 after the group sessions). Each group session opens with a practice of a self-regulation skill, includes monitoring suicide risk, presents a unique theme for the session, includes group reflection and discussion on the presented theme, and ends with concluding remarks of the therapists. The intervention focuses on enhancing 4 core skills for suicide prevention: (1) crisis management to cope with suicidal thoughts, (2) emotion regulation strategies to cope with intense emotions, (3) enhancing effective interpersonal communication skills, and (4) recognizing strengths and values to ignite hope.

The pilot study includes 3 phases: translating the “Circles of Hope†outlines into a manual (Phase 1); refining the intervention and manual (Phase 2); and an uncontrolled pilot trial of Circles of Hope to assess feasibility, acceptability and initial efficacy (Phase 3). In Phase 1, the outline and guidelines for each session of Circles of Hope will be manualized. In Phase 2, Circles of Hope will be delivered to two groups of adolescents (about 6 group members) struggling with suicidal thoughts or behaviors. Their feedback about feasibility and acceptability , alongside specific steps taken to increase engagement, will be used to refine the manual.

In Phase 3, we will test feasibility, acceptability, and initially efficacious by administering it to 7 groups (n=42). We will examine whether Circles of Hope results in reduction of suicidal thoughts and behaviors, risk factors (depression and emotion dysregulation) and increase in levels of protective factors (help seeking, social efficacy, self-esteem, well-being) compared to pre-intervention levels. Outcome assessment will be administered at 3 time points: prior (T1), post, and 3 months after the intervention (T3).

Circles of Hope is expected to show feasibility, high acceptability and initial indications of reducing suicide ideation and behavior, depressive symptoms, and emotion dysregulation, as well as increasing willingness to seek help in crisis, social efficacy, self-esteem and well-being of participants after the intervention compared to levels prior to the intervention. We expect the effects to be evident after 3 months as well.

This study offers a novel suicide-focused group treatment for adolescents experiencing suicidal ideation that directly targets suicidality, as well as key risk and protective factors. Its group format and short duration broaden accessibility with the potential to contribute to reducing suicidal thoughts and behaviors on a large scale. If results suggest that Circles of Hope is feasible, acceptable, and potentially effective, future directions will include a larger-scale RCT.