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

What this Trial Is About

Researchers are investigating treatments for Veterans with Posttraumatic Stress Disorder (PTSD) who are at high risk for suicide due to recent self-directed violence and current suicidal thoughts. This study compares two therapies: a combined Dialectical Behavior Therapy (DBT) plus DBT Prolonged Exposure (DBT PE) protocol against the current standard care, Prolonged Exposure therapy with suicide risk management (PE + SRM). The goal is to see which approach better reduces PTSD symptoms and suicidal behaviors, while also exploring challenges in applying these treatments in VA settings. Participants will be randomly assigned to one of two treatment groups. One group receives one year of standard DBT, including individual therapy, group skills training, coaching, and team consultation, combined with the DBT PE protocol for PTSD delivered in weekly individual sessions. The other group receives up to 18 weekly sessions of Prolonged Exposure therapy together with suicide risk management strategies. The study is conducted across three VA outpatient sites. Veterans will be assessed at five points over 16 months to track changes in self-injurious thoughts and behaviors and PTSD severity. Additional evaluations include mental health, emotion regulation, disability, and suicide ideation scales. Researchers will also interview veterans, providers, and leaders to understand factors affecting treatment implementation. Overall participation lasts 16 months, with ongoing safety monitoring and outcome measurements.

Evaluating Treatments for Suicidal Veterans With PTSD