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Self-directed ViolenceNCT05974631

Evaluating Treatments for Suicidal Veterans With PTSD

A study testing Dialectical Behavior Therapy, Dialectical Behavior Therapy Prolonged Exposure protocol and Prolonged Exposure therapy in people with Self-directed Violence and Post-traumatic Stress Disorder (PTSD), run by VA Office of Research and Development at 4 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Posttraumatic Stress Disorder (PTSD) is a significant driver of suicide risk among Veterans, but there is a critical knowledge gap about how to treat PTSD among people at elevated risk for suicide. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Dialectical Behavior Therapy, Dialectical Behavior Therapy Prolonged Exposure protocol and Prolonged Exposure therapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
125 participants
Where
4 sitesUnited States
Study dates
8 Jul 2024to 31 Aug 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • PTSD
  • Recent and repeated self-directed violence
  • Current suicidal ideation
  • Emotion dysregulation
  • Veteran eligible for VHA mental health care at participating site
  • Willing to participate in all study activities

Who cannot join

  • Unable to maintain safety independently
  • Currently engaged in and/or recent (past year) history of receiving a sufficient dose of DBT or PE
  • Plan to move away or be unavailable for >4 weeks in the next 18 months
  • Unable to sufficiently comprehend study procedures due to lack of English proficiency or moderate to severe cognitive impairment

Trial locations and contacts

4 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Melanie S Harned, PhD contact

(206) 277-3650

melanie.harned@va.gov

John C Fortney, PhD contact

(206) 764-2821

John.Fortney@va.gov

United States4 sites, 4 recruiting
  • Durham VA Medical Center, Durham, NC

    Durham, North Carolina, 27705-3875

    Daniel Blalock, PhD, (919) 286-0411 ext. 174026, daniel.blalock@va.gov

    Charlotte Ready, PhD, (919) 286-0411 ext. 177062, Charlotte.Ready@va.gov

    Recruiting
  • Minneapolis VA Health Care System, Minneapolis, MN

    Minneapolis, Minnesota, 55417-2309

    Lindsay Andrews-Wiebusch, PhD, (612) 629-7656, Lindsay.Andrews-Wiebusch@va.gov

    Laura A Meis, PhD, (612) 467-4516, laura.meis@va.gov

    Recruiting
  • South Texas Health Care System, San Antonio, TX

    San Antonio, Texas, 78229-4404

    Julia Carter, PhD, 830-237-2958, julia.carter@va.gov

    Recruiting
  • VA Puget Sound Health Care System Seattle Division, Seattle, WA

    Seattle, Washington, 98108-1532

    Melanie S Harned, PhD, (206) 277-3650, melanie.harned@va.gov

    John C Fortney, PhD, (206) 764-2821, John.Fortney@va.gov

    Recruiting

Other trials in United States

About this study

Official title: A Hybrid Effectiveness-Implementation Trial of Treatments for Veterans With PTSD at Elevated Acute Risk for Suicide

Posttraumatic Stress Disorder (PTSD) is a significant driver of suicide risk among Veterans, but there is a critical knowledge gap about how to treat PTSD among people at elevated risk for suicide. Although evidence-based treatments for PTSD reduce suicide risk, Veterans at high risk for suicidal behavior rarely receive these potentially life-saving treatments. Prior research suggests that a treatment that combines Dialectical Behavior Therapy (DBT) with the DBT Prolonged Exposure protocol (DBT PE) for PTSD improves both PTSD and suicide-related outcomes. This study will evaluate whether DBT + DBT PE improves these outcomes more than Prolonged Exposure plus suicide risk management, the gold standard VA care for this population. The proposed study will also examine factors that make it easier and harder to implement these treatments in VA settings. The results will help to inform treatment guidelines for this high-priority Veteran population.

Read the detailed description

Background: Posttraumatic stress disorder (PTSD) is a significant risk factor for suicide among Veterans. Evidence-based psychotherapies (EBPs) for PTSD reduce suicide risk, but Veterans at elevated acute risk for suicide, such as those who have engaged in self-directed violence (SDV), rarely receive these treatments. This is largely due to the historical exclusion of high-risk individuals from PTSD treatment trials, which has resulted in a lack of evidence-based guidance about indicated treatments for this population. Without such guidance, clinicians are often reluctant to use EBPs for PTSD with suicidal individuals. A treatment that combines Dialectical Behavior Therapy (DBT), a suicide-focused EBP, with the DBT Prolonged Exposure (DBT PE) protocol for PTSD has been developed for this high-risk population and shows promise in reducing both SDV and PTSD while being feasible, acceptable, and safe to deliver. However, a large-scale randomized controlled trial (RCT) is needed. This study will compare the effectiveness of DBT + DBT PE to the current VHA gold standard of care for this population, Prolonged Exposure therapy augmented with suicide risk management (PE + SRM), while also examining the potential for implementation of both interventions in VHA.

Significance: There is a critical gap in knowledge about how to treat PTSD among individuals at high risk for suicidal behavior. As a result, VA/DoD Clinical Practice Guidelines do not specify indicated treatment strategies for this population. Experts have recommended two approaches to facilitate the safe and effective use of EBPs for PTSD with individuals at elevated acute suicide risk, including combining these treatments with suicide-focused EBPs or augmenting them with suicide risk management strategies. This project will help to fill this critical gap by rigorously evaluating these two approaches among Veterans with SDV. The results will provide important information to inform guidelines about indicated treatments for this high-risk population.

Innovativeness: This will be the first large-scale RCT to evaluate treatments for PTSD among Veterans who have engaged in SDV, an HSR\&D high priority group. The DBT + DBT PE intervention is the first treatment designed to address both SDV and PTSD, and results will indicate if this novel treatment improves outcomes compared to the current VHA gold standard of care. To facilitate more rapid implementation of these findings into clinical practice, implementation barriers and facilitators for both treatments will also be evaluated.

Specific Aims: This study will randomize 125 Veterans with PTSD, recent and repeated SDV, current suicidal ideation, and emotion dysregulation to DBT + DBT PE (intervention) or PE + SRM (control). Aim 1 will test the hypothesis that DBT + DBT PE will be superior to PE + SRM in improving clinical outcomes and engagement in trauma-focused treatment. Exploratory analyses will examine Veteran characteristics that may predict better engagement and outcomes in DBT + DBT PE versus PE + SRM. Aim 2 will examine barriers and facilitators to implementation of both treatments.

Methods: This is a multi-site hybrid type 1 effectiveness-implementation trial. Veterans will be treated in outpatient settings at four VA sites and assessed at 5 points over 16 months. A mixed-methods approach will be used to evaluate barriers and facilitators to implementation, including conducting interviews with 45 key stakeholders (Veterans, providers, and leadership).

Primary Outcomes/Endpoints: Primary outcomes will be reductions in SDV episodes at 16-month follow-up and reductions in PTSD severity at post-treatment.

Implementation/Next Steps: This project will provide much-needed information about how to safely and effectively treat PTSD among Veterans at elevated acute risk for suicide. If one or both treatments are found effective, Aim 2 will provide vital information about how to maximize future implementation success. Future implementation activities would be coordinated with the investigators' national operational partners.

Being tested
Dialectical Behavior Therapy, Dialectical Behavior Therapy Prolonged Exposure protocol, Prolonged Exposure therapy, Suicide risk management
Keywords
Stress Disorders, Post-Traumatic, Suicide, Self-Injurious Behavior
Medical subject headings
Stress Disorders, Post-Traumatic, Suicide, Self-Injurious Behavior

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Dialectical Behavior TherapyBehavioural

    Also called DBT

    Standard Dialectical Behavior Therapy (DBT), including DBT individual therapy (1 hour/week), DBT group skills training (2 hours/week), between-session coaching (as needed during business hours), and therapist consultation team (1-1.5 hours/week).

  • Dialectical Behavior Therapy Prolonged Exposure protocolBehavioural

    Also called DBT PE

    DBT PE is designed to be integrated into DBT to formally treat PTSD once patients meet standardized readiness criteria. The core procedures are in vivo and imaginal exposure with processing that are delivered in individual therapy sessions (1.5 hours/week).

  • Prolonged Exposure therapyBehavioural

    Also called PE

    Standard PE is delivered in individual therapy sessions (1.5 hours/week) and uses the core procedures of in vivo and imaginal exposure with processing.

  • Suicide risk managementBehavioural

    Also called SRM

    Standard VA suicide risk management procedures, including comprehensive suicide risk assessment and safety planning.

Study groups in NCT05974631
Study groupRoleWhat they receive
DBT + DBT PEExperimentalThis condition combines one year of standard Dialectical Behavior Therapy (DBT) with the DBT Prolonged Exposure (DBT PE) protocol for PTSD.
Receives: Behavioral: Dialectical Behavior Therapy; Behavioral: Dialectical Behavior Therapy Prolonged Exposure protocol
PE + SRMActive comparatorThis condition provides up to 18 sessions of Prolonged Exposure therapy (PE) for PTSD augmented with suicide risk management (SRM).
Receives: Behavioral: Prolonged Exposure therapy; Behavioral: Suicide risk management

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Self-Injurious Thoughts and Behaviors Interview - Revised Short Form (SITBI-R-SF)

    Number of self-directed violence episodes

    Measured: Baseline to 16 months

  2. Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R)

    Total Severity Score (range = 0 - 200, higher is worse)

    Measured: Baseline to 16 months

Secondary outcomes (6)
  1. Columbia - Suicide Severity Rating Scale (C-SSRS), Suicide Ideation subscales

    Total Score (range = 0 - 5, higher is worse)

    Measured: Baseline to 16 months

  2. PROMIS Global Mental Health

    Total Score (range = 4 - 20, higher is better)

    Measured: Baseline to 16 months

  3. Difficulties in Emotion Regulation Scale-16 (DERS-16)

    Total Score (range = 16 - 80, higher is worse)

    Measured: Baseline to 16 months

  4. World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)

    General Disability Score (range = 12 - 60, higher is worse)

    Measured: Baseline to 16 months

  5. Self-Injurious Thoughts and Behaviors Interview Revised Short Form (SITBI-R-SF)

    Non-suicidal self-injury frequency and remission; Suicide attempt frequency and remission

    Measured: Baseline to 16 months

  6. Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R)

    PTSD diagnostic status

    Measured: Baseline to 16 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Aug 2023
  2. Study start8 Jul 2024
  3. Primary completion30 Apr 2027 (estimated)
  4. Study completion31 Aug 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
2-arm randomized clinical trial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
125 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05974631
Sponsor's protocol ID
SDR 22-185
Status last verified
Jul 2026
First submitted
5 Jul 2023
Last updated
16 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified, anonymized data that underlie results in a publication may be shared.

Publications

  • Harned MS, Ready CB, Andrews Wiebusch LM, Landes SJ, Blalock DV, Waddell ZE, Carter JM, Hembree EA, Meis LA. Evaluating psychotherapies for veterans with PTSD at elevated acute risk of suicide: Protocol for a multi-site type 1 hybrid effectiveness-implementation trial. Contemp Clin Trials. 2026 Aug 15:108433. doi: 10.1016/j.cct.2026.108433. Online ahead of print.

    PubMed 42603614

Questions about this trial

What is this clinical trial studying?

A study testing Dialectical Behavior Therapy, Dialectical Behavior Therapy Prolonged Exposure protocol and Prolonged Exposure therapy in people with Self-directed Violence and Post-traumatic Stress Disorder (PTSD), run by VA Office of Research and Development at 4 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 16 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Melanie S Harned, PhD ((206) 277-3650, melanie.harned@va.gov), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Self-Injurious Thoughts and Behaviors Interview - Revised Short Form (SITBI-R-SF) (time frame: Baseline to 16 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05974631, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jul 2026.

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