This project will evaluate for impacts of Group Brief Cognitive-Behavioral Therapy (G-BCBT) on active-duty military Service Members. The study addresses the FY21 PRMRP Topic Area of suicide prevention. It directly fits two FY21 PRMRP Areas of Encouragement. First, G-BCBT evaluation comprises research on treatment strategies to prevent suicidality. Second, G-BCBT includes tailored means safety planning, thereby determining strategies for an efficacy of lethal means safety and restriction methods, especially in military populations.

According to the 2019 Department of Defense (DoD) Annual Suicide Report, the active-duty Service Member suicide death rate increased from 22.1/100,000 to 25.9/100,000. The suicide death rate is more than double that of the civilian population in the United States. Twelve-month estimates of reported suicidal ideation among Service Members range from 3%-5%. Suicidal behaviors among Service Members are associated with a variety of challenges, such as combat exposure and separation from family. Service Member suicidal behaviors and associated risk factors create a number of challenges such as an unmet demand for mental health services.

Our team has conducted considerable military suicide prevention work. Our findings demonstrated that 48% of treatment-seeking Service Members at Naval Medical Center Portsmouth (NMCP), the intervention site for this trial, satisfied criteria for elevated suicide risk. We also identified protective factors for suicide, namely beliefs in the use of coping skills and willingness to experience emotion. This set of findings points to an opportunity to intervene. Co-Investigator Bryan from our team conducted a clinical trial establishing Brief Cognitive-Behavioral Therapy (BCBT) for Suicide, an evidence-based individual therapy shown to reduce suicidal behavior among active-duty Service Members. We expect that the group format adaptation of BCBT (i.e., G-BCBT) will result in improved Service Member suicidal behavior (Aim 1), ability to use coping strategies (Aim 2), and overall mental health (exploratory analysis). The combination of tailored means safety counseling and training in evidence-based emotion regulation and cognitive flexibility skills will improve Service Members’ self-control. The group format will provide opportunities to learn and practice skills, thereby enhancing self-efficacy. G-BCBT outcomes are expected to be no worse than Dialectical Behavior Therapy (DBT) group skills training, an existing gold standard intervention that is twice the length of time as G-BCBT.

The 4-year project will be accomplished through a military-academic partnership comprising NMCP, University of North Carolina at Charlotte, and The Ohio State University. The project will help facilitate easy implementation of G-BCBT in military healthcare settings. Successful completion of the G-BCBT trial will establish the intervention as an evidence-based and cost-effective alternative to more resource-heavy individual and group therapy options. Clinical benefits for Service Members receiving G-BCBT are anticipated to include reductions in suicidal behavior, improved resilience and coping skills, enhanced mental health and quality of life. Coping skills training will better equip Service Members to handle challenges encountered during and after their military career, and help Service Members return to operational readiness.

This project meets clinical and research goals in the Department of Defense suicide risk management practice guidelines and suicide prevention strategic plan. Our deliverables will communicate study findings to many audiences. Knowledge products directly benefiting military healthcare professionals will include a G-BCBT protocol, updated BCBT manual, train-the-trainer materials, fidelity assessment materials, suicide prevention policy brief, and technical report. Additional outputs benefiting scientific and community mental health audiences will include scientific journal articles, professional conference abstracts, clinician training materials, infographic summary of results, and a magazine opinion article.