# Skills to Enhance Positivity (STEP) for Adolescents at Risk for Suicide

> **NIH NIH R01** · BROWN UNIVERSITY · 2022 · $741,255

## Abstract

PROJECT SUMMARY
SKILLS TO ENHANCE POSITIVITY IN ADOLESCENTS AT RISK FOR SUICIDE
 Rates of suicide and suicidal behavior in adolescents have been steadily increasing over the past two
decades. Unfortunately, reviews of published randomized controlled trials (RCTs) for adolescent suicidality
conclude that treatments to date have been minimally efficacious, particularly when compared to adult trials.
The preponderance of interventions focus on crisis intervention, underling psychiatric disorders, regulating
negative affect, and reducing cognitive distortions. However, our pilot work and other recent data suggest the
importance of considering how low positive affectivity may be a mechanism that contributes to suicidal
behaviors independent of other risk factors. Therefore, we developed an intervention, Skills to Enhance
Positivity (STEP; MH R34101272), premised on the Broaden and Build theory of positive affect, to increase
attention to, and awareness of positive affect and experiences. Results from our pilot RCT (N=52) with
inpatient suicidal adolescents found that compared to a Healthy Habits / Enhanced Treatment as Usual
(ETAU) condition, those randomized to STEP had 50% fewer individuals reporting a suicidal event, 50% fewer
suicidal events overall, and a larger decrease in participants reporting active suicidal ideation (SI) over follow
up (49% STEP vs. 19.2% ETAU). STEP also appears to have engaged the target mechanism as STEP
participants had faster reaction times to positive probes on an attentional bias task compared to ETAU, and
only those in the STEP condition reported significant pre-post differences on gratitude and satisfaction with life.
These promising results in which we were able to demonstrate engagement of the target (positive affect) and a
decrease in clinical outcomes (suicidal events) suggest the need to test the clinical effectiveness of STEP by
having clinical staff implement the intervention. Furthermore, recognizing the need to speed translation, we
propose a Hybrid Type I Effectiveness-Implementation design. Specifically, we propose to test the
effectiveness of STEP in reducing suicidal events and ideation in 216 adolescents, admitted to inpatient
psychiatric care due to suicide risk. Participants will be randomized to either STEP or ETAU. STEP involves 4
in-person sessions (3 individual, 1 family) focused on teaching psychoeducation of positive and negative affect,
mindfulness meditation, gratitude, and savoring. Digital health messages with mood monitoring prompts and
skills reminders will be sent daily for the first month post-discharge and three times a week for the following two
months. ETAU condition will receive daily reminders to log into a safety resource app. We hypothesize that
those randomized to STEP (vs. ETAU) will have less suicide events, ideation, and depression, and experience
increased positive affect and attention to positive affect, and decreased negative affect, and attention to
negative affect, as me...

## Key facts

- **NIH application ID:** 10453555
- **Project number:** 5R01MH123556-02
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Anthony Spirito
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $741,255
- **Award type:** 5
- **Project period:** 2021-07-19 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10453555

## Citation

> US National Institutes of Health, RePORTER application 10453555, Skills to Enhance Positivity (STEP) for Adolescents at Risk for Suicide (5R01MH123556-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10453555. Licensed CC0.

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