An Open-Phase Pilot Trial of an Integration of Prolonged Exposure Therapy and the Coping Long-Term With Active...

Posttraumatic stress disorder (PTSD) is associated with an increased risk for suicidal ideation and behavior, yet clinical practice guidelines for addressing suicide risk in the context of PTSD are not yet available. This open trial evaluated the safety and preliminary efficacy of an integration of a trauma-focused treatment, prolonged exposure therapy (PE), with the coping long-term with an active suicide program (CLASP). CLASP-PE was delivered to patients with PTSD who reported suicidal ideation with intent, a plan, or a past-month attempt. Veterans or active-duty military personnel with a confirmed PTSD diagnosis and suicide risk (N = 14; 86% male) began the CLASP-PE protocol, which was delivered via telemedicine in 10-16 sessions, including a session with a support person as feasible. Two participants only provided baseline data; of the remaining 12, 8 participants (n = 66.7%) completed their treatment sessions. Participants reported significant reductions in PTSD symptoms (p < .05), suicidal ideation (p < .05), and depression symptoms (p < .001). The degree of reduction in PTSD symptoms and depression symptoms in treatment predicted the degree of reduction in suicidal ideation in treatment. No suicide attempts or serious adverse events occurred in treatment. A case vignette is shared. CLASP-PE was safe, with preliminary evidence supporting its efficacy. Additional randomized controlled trial research is needed to evaluate its impact compared to a control group. If replicated, the CLASP-PE protocol would be a useful and safe clinical tool for individuals with PTSD who are experiencing significant suicide risk.