Joel Yager, MD reviewing Franklin JC et al. J Consult Clin Psychol 2016 Jun.
Two of three month-long studies suggest modest benefits, with results dissipating after treatment cessation.
Novel strategies for reducing suicidality are clearly desirable. Assessing the potential therapeutic value of a game-like mobile “app,” investigators conducted three randomized, controlled, 4-week studies that recruited individuals with self-injurious thoughts and behaviors (SITBs) from salient websites.
The 1- to 2-minute game was intended for repeated plays, awarded progressively more points for increasingly accurate performances, and targeted two SITB risk factors using classical conditioning; the authors, who had financial interests in the app, called it “therapeutic evaluative condition” (TEC). Using paired word and pictorial associations, the game attempted to increase aversion to SITB-related stimuli (e.g., blood, wounds, and knives) and decrease aversion toward the self. Controls used a non-TEC app, and participants could play the game as much as they wished.
The studies enrolled 114, 131, and 163 individuals (range of mean ages, 23–24; women, 59%–81%; white race, 82%–83%; lifetime histories of psychiatric treatment, 72%–82%; inpatient treatment histories, 30%–33%; currently taking psychiatric medication, 43%–51%). The first two studies focused on patients with nonsuicidal self-injury; study 2 failed to reproduce study 1's positive results. Study 3 focused primarily on individuals with suicidal behavior and had positive results. Overall, even after adjustment for baseline rates of suicidal behavior, those using TEC at least once were less likely to have one suicidal behavior than nonusers and aggregated fewer total suicidal behaviors. Regarding the two targets, the impact was modest but seemed to increase aversion to SITB-related stimuli more than decrease aversion to self. Effects disappeared by the 1-month follow-up.
CITATION(S):
Franklin JC et al. A brief mobile app reduces nonsuicidal and suicidal self-injury: Evidence from three randomized controlled trials. J Consult Clin Psychol 2016 Jun; 84:544.
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