# A Hybrid Effectiveness-Implementation Multisite Trial of a Dialectical Behavior Therapy Skills Group for Veterans at High-Risk for Suicide Attempt

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2022 · —

## Abstract

Abstract.
Background: Suicide prevention is VHA’s highest priority. While VHA has responded by implementing new
screening requirements, the REACH VET machine-learning program to identify those at high risk, and new
clinical practice guidelines, these approaches do not provide Veterans at highest suicide risk with “indicated”
strategies, such as psychotherapy that specifically targets suicide attempts. Reducing Veteran suicide attempts
requires addressing underlying transdiagnostic psychological processes. Emotion dysregulation, or difficulty
managing emotions, occurs across mental health diagnoses and is associated with higher suicide risk.
Developing emotion regulation skills is a key element of effective suicide prevention. Dialectical behavior
therapy (DBT) is a well-established, multi-component, evidence-based suicide prevention psychotherapy
targeting emotion dysregulation that is not widely available at VHA given the complexities of implementing it. A
resource-efficient, group-delivered suicide prevention psychotherapy, DBT Skills Group (DBT-SG), has been
associated with reduced suicidal ideation and emotion dysregulation in VHA and non-VHA samples and was
as effective as full-scale DBT in reducing suicide attempt and ideation in a non-VHA study of individuals with
high suicide risk. We propose a hybrid type 1 trial to 1) evaluate the effectiveness of DBT-SG in a
transdiagnostic sample of Veterans at high risk for suicide, and 2) identify individual and organizational barriers
and facilitators for DBT-SG adoption in VHA facilities. Significance/ Impact: Studying DBT-SG’s clinical
effectiveness and factors affecting its implementation align with the OMHSP’s National Strategy for Preventing
Veteran Suicide, HSR&D, and legislative priorities to evaluate innovative interventions in high risk Veteran
populations, and new VHA Clinical Practice Guidelines that encourage transdiagnostic research on DBT
approaches for high-risk Veterans. Innovation: This study fills VHA and national research gaps: it is the first
multisite trial to test the effectiveness of DBT-SG at VHA while simultaneously gathering generalizable
knowledge about implementation barriers and facilitators. Outcomes on clinical effectiveness and barriers and
facilitators will be used by OMHSP Psychotherapy and Suicide Prevention offices to inform ongoing suicide
prevention initiatives. Specific Aims: (1) Test the effectiveness of DBT-SG compared to treatment-as-usual
(TAU) to reduce suicide attempt and ideation in a multisite randomized trial at 4 VAMC’s; (2) Conduct a 3-part,
mixed-methods formative evaluation to identify potential facilitators and barriers to DBT-SG’s successful
adoption in VHA facilities. Methodology: We will randomize N=254 Veterans across 4 VAMC’s with recent
suicide attempt and emotion dysregulation to DBT-SG + TAU or TAU alone to evaluate DBT-SG effectiveness.
We hypothesize that DBT-SG, relative to TAU, will be associated with (H1a, primary outcome) reduced su...

## Key facts

- **NIH application ID:** 10064683
- **Project number:** 1I01HX003249-01
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Suzanne Elizabeth Decker
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-11-01 → 2027-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10064683

## Citation

> US National Institutes of Health, RePORTER application 10064683, A Hybrid Effectiveness-Implementation Multisite Trial of a Dialectical Behavior Therapy Skills Group for Veterans at High-Risk for Suicide Attempt (1I01HX003249-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10064683. Licensed CC0.

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