16: Self Directed Technologies - MIRECC / CoE
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16: Self Directed Technologies

Risk Management and Treatment » Technology-based Modalities
16: Treatment

There is insufficient evidence to recommend for or against technology-based behavioral health treatment modalities for individuals with suicidal ideation. These include self-directed digital delivery of treatment protocols with minimal or no provider interaction (e.g., compact disc, web-based), and provider-delivered virtual treatment.

Strength:

Neither for nor against

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Self-directed, technology-based behavioral health treatment modalities for individual with suicidal ideation were reviewed by the CPG Workgroup. Available research focused on electronic delivery of treatment protocols in lieu of face-to-face delivery, however none of the available studies assessed the effectiveness of telehealth as it is routinely practiced across the VA and DoD. This review found that at follow-up, no significant between-group differences were observed in reporting of suicidal ideation or suicide attempts, however at the post-intervention assessment there was evidence of a reduction in suicidal ideation.

Training Resources

This section includes links to recommended training resources about technology-based treatment modalities.

VA Veteran Training
Path to Better Sleep
Moving Forward
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Webinars

This section includes links to recommended webinars about technology-based treatment modalities.

CPG Webinar Digital Delivery of Treatment Protocols as Upstream and Downstream Suicide Prevention Strategies: State of the Science Presented by Drs. Lisa A. Brenner & Carolyn Greene
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Articles

This section includes links to recommended articles about technology-based treatment modalities.

Büscher R, Torok M, Terhorst Y, Sander L. Internet-Based Cognitive Behavioral Therapy to Reduce Suicidal Ideation: A Systematic Review and Meta-analysis. JAMA Network Open, 2020;3(4):e203933. doi:10.1001/jamanetworkopen.2020.3933. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765056
Christensen, H., Farrer, L., Batterham, P. J., Mackinnon, A., Griffiths, K. M., & Donker, T. (2013). The effect of a web-based depression intervention on suicide ideation: secondary outcome from a randomised controlled trial in a helpline. BMJ open, 3(6). e002886. https://doi.org/10.1136/bmjopen-2013-002886
Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial. JAMA psychiatry, 72(12). 1192-1198. https://doi.org/10.1001/jamapsychiatry.2015.1880
King, C. A., Eisenberg, D., Zheng, K., Czyz, E., Kramer, A., Horwitz, A., & Chermack, S. (2015). Online suicide risk screening and intervention with college students: a pilot randomized controlled trial. Journal of consulting and clinical psychology, 83(3). 630-636. https://doi.org/10.1037/a0038805
Leavey, K., & Hawkins, R. (2017). Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cognitive behaviour therapy, 46(5). 353-374. https://doi.org/10.1037/a0038805
Witt, K., Spittal, M. J., Carter, G., Pirkis, J., Hetrick, S., Currier, D., Robinson, J., & Milner, A. (2017). Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC psychiatry, 17(1). 297. https://doi.org/10.1186/s12888-017-1458-0
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Podcasts

This section includes links to recommended podcasts that are relevant to technology-based treatment modalities.

Rocky Mountain MIRECC Short Takes on Suicide Prevention
Short Takes podcast icon Insomnia, Treatment, and Finding a Path to Better Sleep with Drs. Carolyn Green and Andrew Moon