EVIDENCE BASED SUICIDE INTERVENTION METHODS IN PRACTICE

Vilnius, Lithuania, October 7, 2016

ASSIP:  An  Effective  Brief  Therapy  for  Patients  Who  Attempt  Suicide

Konrad Michel, Anja Gysin-Maillart

ASSIP is recommended as a routine procedure to all patients who have attempted suicide. A history of attempted suicide is the main risk factor for suicide and attempted suicide. The risk remains elevated for decades and is at its highest in the first year after a suicide attempt.

ASSIP is a specific, structured therapy focusing on the patient’s individual suicidality, aimed at a patient-oriented understanding of the background of the suicidal crisis, and at developing specific safety measures for the future. ASSIP does not replace any other recommended follow-up treatment. Therapists involved in the patient’s treatment will be informed about the procedure and receive a copy of the written summary.

Structure of ASSIP

This brief therapy consists of normally four sessions followed by subsequent contacts by letters. ASSIP is an add-on therapy to treatment as usual.

1st session: Narrative interview focusing on the background of the suicidal crisis. The interview is video-recorded, with the patient’s written consent.

2nd session: Video playback. Patient and therapist watch the recorded interview together, interrupting regularly for additional information. The patient receives a psychoeducative handout to read and comment as homework task.

3rd session: Completion of a written case formulation of the individual vulnerability and the typical triggering event(s) preceding a suicidal crisis. Individual preventive measures are developed in a collaborative manner, printed in credit-card size (“Hope Leporello”) and handed out to the patient.

4th session (optional): Mini exposure. The safety strategies are practiced using the video-recorded narrative interview.

Standardized letters. Contact with regular letters for two years; every 3 months in the first year, 6 monthly in the second year.

The concept of suicidal behaviour in ASSIP

Suicide is understood as an action. Michel and Valach (1997) developed and clinically applied a model based on the theory of goal-directed actions. Suicide in this view appears as a solution to a subjectively unbearable situation. Suicide may emerge as a possible goal when a person's major identity goals or needs are seriously threatened. Thus, suicidal behaviour is seen as part of a person's life story.

An action theoretical model implies that people who have attempted suicide, or who are about to, can explain their actions through narratives. In a study of video-recorded interviews Michel and Valach (2001) found that therapeutically effective narratives can be elicited in interviews when therapists asks patients to tell the story how they came to the point that they saw suicide as the only solution. Thus, the patient is seen as the expert of his or her „suicide story“. A personally meaningful narrative interview will be the first step to a therapeutic alliance between therapist and patient.

The main characteristics of ASSIP

• Simple structure, clear treatment goal • Simple structure, clear treatment goal • Patient-oriented, collaborative approach • Early therapeutic alliance (narrative interview) • Video-playback (patient and therapist join in understanding, taking outside view) • Individual safety planning, leporello as token • Ongoing contact based on therapeutic alliance

How effective is ASSIP?

In a recently published randomized controlled study involving 120 patients ASSIP was associated with an approximately 80% reduced risk of a repeat attempts over a 24-month follow-up. Furthermore, during follow-up, ASSIP participants spent 72% fewer days in hospital compared to the control group.

Reference: Gysin-Maillart A, Schwab S, Soravia L, Megert M, Michel K (2016) A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months follow-up randomized controlled study of the Attempted Suicide Short Intervention Program (ASSIP). PLOS Med 13(3): e1001968.