Triple Chronotherapy + Transdiagnostic Sleep and Circadian Intervention (TranS-C+) for Suicidal Young Adults

Suicide is currently the second leading cause of death among college students, and suicidal thoughts and behaviors (STBs) in this group have increased substantially in recent years. This life stage coincides with critical developmental milestones, highlighting a pressing need for efficacious treatments for suicidal college students that yield fast-acting and sustained effects to minimize disruption to young adults’ developmental trajectories. Yet most efficacious treatments for suicide risk take months. 

A promising but understudied approach to fast-acting treatment of STBs is Triple Chronotherapy (TCT). This non-invasive approach involves 1 night of sleep deprivation, 3–4 nights of sleep phase advance and morning bright light therapy. Open studies demonstrate improvement in STBs with TCT, though data on sustained effects of TCT on STBs are limited, and no randomized trials have been conducted to date. Additionally, preliminary data suggest rapid short-term improvements with TCT may be sustained via ongoing bright light therapy and behavioral sleep treatment. With growing evidence that sleep health impairments are proximal risk factors for STBs, and thus, are ideal targets for suicide preventive interventions, we adapted a manualized behavioral intervention for suicidal youth that effectively targets multidimensional sleep/circadian health, the Transdiagnostic Sleep and Circadian Intervention (TranS-C), by enhancing morning light (bright light therapy) and decreasing evening light (blue-blocking glasses), yielding a manualized TranS-C+. In an open pilot with acutely suicidal adolescents, we demonstrated acceptability, feasibility, and increased regularity of rest activity rhythms with TranS-C+. 

As the next step in this line of work, we propose a treatment package including TCT (4-day protocol) and TranS-C+ (6-8 outpatient sessions) that holds promise to safely and non-invasively yield rapid and sustained improvement in depression and STBs among suicidal college students. We aim to conduct a 3-arm randomized controlled trial (TCT+ versus TranS-C+ Alone versus a Psychoeducation Sleep Feedback Control) to examine short-, medium- and long-term effects on STBs. The sample will include 90 acutely suicidal college students (age 18-25) who report sleep difficulties and are engaged in treatment in the College-Services for Teens at Risk Intensive Outpatient Program (COSTAR IOP, Director MPI Goldstein). 

Following baseline clinical assessment and IOP disposition, participants randomized to TCT+ will initiate the   4-day TCT protocol at the Sleep and Behavioral Neuroscience Center (SBNC, Director MPI Franzen). Participants in TCT+ and TranS-C+ Alone will begin TranS-C+ sessions, morning bright light therapy (via Re-Timer goggles), and decreasing evening light (blue-blocking glasses). All participants will complete objective ambulatory sleep data via wrist-worn actigraph, and daily diaries of sleep (morning diary) and STBs (evening diary) via smartphone throughout IOP (~2 months). Depression and STB outcomes will be obtained on days 1–5 and months 1,2,3 and 6 by a blinded assessor. We will also explore associations between various sleep health domains and STB outcomes, as well as two potential TCT treatment mechanisms: cognitive and emotional processes via daily behavioral tasks. Pending promising findings, we will pursue a subsequent study to examine underlying mechanisms. This work may identify novel approaches to fast-acting and sustained STB treatment that are non-invasive and safe.