Suicide Safety Planning Group Treatment: "Project Life Force"

Despite the enrichment of VA suicide prevention services and implementation of the national
suicide hotline, Veteran suicide completions have risen to 22 per day and suicide attempts
numbered over 15,000 in 2012. These data underscore the urgency of developing additional
interventions targeting suicidal Veterans. The construction of a Suicide Safety Plan (SSP); a
"best practice", is mandated throughout the VA system, and a vital component of the VA's
coordinated effort at suicide prevention and recovery. The investigators' pilot data on
patterns of SSP use in suicidal Veterans over a 30 day time frame demonstrates that only 65%
of Veterans used their safety plans, coping strategies listed on the plan were often
mismatched or inadequate to the individual's needs, and limited access to the SSP during
times of stress negatively impacted its utility. To the investigators' knowledge, there are
currently no recommended guidelines or mechanisms for refinement of the SSP in adult
populations beyond its initial development. "Project Life Force" (PLF), a novel suicide
safety planning group intervention has been designed to fill this critical gap and provide a
mechanism to develop and enhance suicide safety planning over time. PLF, a 12-session, group
psychotherapy intervention, combines Dialectical Behavioral Therapy (DBT) skill based and
psychoeducational approaches, to enhance suicide safety planning development and
implementation. Veterans revise their plans over several weeks while learning distress
tolerance, emotion regulation, and friendship building/interpersonal skills to incorporate
into their safety plans and also receive lessons on gun safety and minimizing access to
lethal means. Sessions are augmented with 1) training in the use of a suicide safety planning
mobile App to promote accessibility and maximize implementation, and 2) didactic information
to bolster recovery, including fostering improved connection with the treatment team, and
Veteran's family. Importantly, the group format mitigates loneliness and fosters increased
"belongingness", both key risk factors for suicide. Additionally, PLF's weekly format
facilitates VA-mandated monitoring for any Veteran placed on the suicide "high risk" list.

Data from this project will test the intervention's feasibility, acceptability and
preliminary efficacy and provide pilot data for a larger randomized clinical trial. The
project is comprised of two phases. In Phase 1, the investigators will finalize the PLF
intervention and accompanying manual and handouts. In Phase 2, the investigators will conduct
an open label trial of PLF in 50 suicidal Veterans to evaluate the feasibility and
acceptability of the intervention. The investigators will also test whether PLF affects
outcomes of suicide ideation, depression, hopelessness, and outpatient compliance by
examining clinically meaningful differences in these measures before and after PLF.

Inclusion Criteria:

- Veterans > 18

- Able to give consent

- Recent Completion of a VA suicide safety plan

Exclusion Criteria:

- IQ<80

- Does not speak English

- Inability to tolerate group therapy format

- There is no exclusion based on medical or psychiatric treatment status.

- There are no special restrictions with regard to gender, ethnic status or race