CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial

Abstract

The present study was aim to evaluate the acceptability and preliminary effectiveness of a mobile-health application, CALMA, based on dialectical behavioral therapy skills. CALMA was proposed as an adjunct to therapy for the reduction of non-suicidal and suicidal self-injury behaviors. A parallel design was used to compare the intervention group (DBT + CALMA) and the comparison group (DBT). Patients were randomized based on their groups following a randomized cluster design. After treatment, patients completed a follow-up assessment four weeks later. Each cluster was represented by a different DBT Skills Training Group offered weekly at FORO Foundation for Mental Health. Six DBT Skills Training groups were randomized to the intervention or comparison group. Twenty-one individuals met inclusion criteria and eighteen were included in the analysis. Acceptability was measured with the User Experience Questionnaire short version (UEQ-s) and preliminary efficacy with the Self-injurious thoughts and behaviors interview (SITBI). CALMA shows good acceptability to be used as an adjunct to therapy specific to the reduction of suicidal and non-suicidal self-directed violence. Evidence for preliminary efficacy included a high probability of decreased in more behaviors evaluated with the SITBI pre- and post-intervention for the group that received CALMA as compared to the comparison group. Our study provides initial evidence for the effectiveness and acceptability of CALMA. Future studies scaling up this intervention in a larger number of participants are necessary. CALMA may be especially useful in low and middle-income Latin American countries to improve access to evidence-based interventions openly available in Spanish and free to download.

Highlights

• CALMA is a DBT-based app aimed to reduce non-suicidal and suicidal self-directed violence.

• The app showed good acceptability by users

• A high probability of decrease in suicidal ideation, suicidal plan, suicidal gesture, thoughts about NSSI and NSSI pre- and post-intervention was observed

Keywords:

• Dialectical behavioral therapy
• mobile health application
• suicide prevention

DISCLOSURES

Federico M. Daray, Demián E. Rodante, and Ramiro Olivera Fedi are the owners of CALMA license. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Marcela I. Kaplan, Pablo H. Gagliesi, Agustina Pascali, Paula José Quintero, Emilio J. Compte, Ana I. Perez, Melina Weinstein, and Luciana C. Chiapella declare that they have no conflict of interest.

ACKNOWLEDGMENTS

The authors want to gratefully acknowledge the study patients for their collaboration, FORO Foundation for Mental Health in Buenos Aires, for allowing us to do the study in their facilities, and Sasha Rojas, for editorial assistance with the manuscript.

DISCLOSURE STATEMENT

Following Taylor & Francis policy and our ethical obligation as researchers, we are reporting that three of the authors are the owners of the CALMA license. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The rest of the authors reported no potential conflict of interest.

Additional information

Notes on contributors

Demián E. Rodante

Demián E. Rodante, Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; “Dr. Braulio A. Moyano” Neuropsychiatric Hospital, Buenos Aires, Argentina; FORO Foundation for Mental Health, Buenos Aires, Argentina.

Marcela I. Kaplan

Marcela I. Kaplan, “Dr. Braulio A. Moyano” Neuropsychiatric Hospital, Buenos Aires, Argentina; FORO Foundation for Mental Health, Buenos Aires, Argentina.

Ramiro Olivera Fedi

Ramiro Olivera Fedi, Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.

Pablo Gagliesi

Pablo Gagliesi, Agustina Pascali, Paula S. José Quintero, Emilio J. Compte, Ana I. Perez, and Melina Weinstein, FORO Foundation for Mental Health, Buenos Aires, Argentina.

Agustina Pascali

Pablo Gagliesi, Agustina Pascali, Paula S. José Quintero, Emilio J. Compte, Ana I. Perez, and Melina Weinstein, FORO Foundation for Mental Health, Buenos Aires, Argentina.

Paula S. José Quintero

Pablo Gagliesi, Agustina Pascali, Paula S. José Quintero, Emilio J. Compte, Ana I. Perez, and Melina Weinstein, FORO Foundation for Mental Health, Buenos Aires, Argentina.

Emilio J. Compte

Pablo Gagliesi, Agustina Pascali, Paula S. José Quintero, Emilio J. Compte, Ana I. Perez, and Melina Weinstein, FORO Foundation for Mental Health, Buenos Aires, Argentina.

Ana I. Perez

Pablo Gagliesi, Agustina Pascali, Paula S. José Quintero, Emilio J. Compte, Ana I. Perez, and Melina Weinstein, FORO Foundation for Mental Health, Buenos Aires, Argentina.

Melina Weinstein

Pablo Gagliesi, Agustina Pascali, Paula S. José Quintero, Emilio J. Compte, Ana I. Perez, and Melina Weinstein, FORO Foundation for Mental Health, Buenos Aires, Argentina.

Luciana C. Chiapella

Luciana C. Chiapella, Pharmacology Area, Faculty of Biochemical and Pharmaceutical Sciences, National University of Rosario, Rosario, Argentina.

Federico M. Daray

Federico M. Daray, Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.