Session-Specific Effects on Suicidality in Group Therapy: No Evidence for Contagion

Abstract

Objective

Explicitly addressing suicidality in group therapy is often avoided due to the fear of contagion effects. However, there is some evidence that this fear is not valid. Therefore, the present study aims at contributing to this question by investigating the session-specific effects of two modules on suicidality that are part of the Metacognitive Training for Depression (D-MCT/S).

Methods

Forty-four patients with depression participated in the two modules on suicidality of the D-MCT/S. Before and after each group session, patients filled out a questionnaire asking for symptoms of suicidality, associated cognitions (e.g., hopelessness), and associated emotions (e.g., anger). Data were analyzed by linear mixed-effect models.

Results

Approximately 84% of the patients had experienced lifetime suicidal ideation. No within- or between-session effects were found for the modules on suicidality. Sample size was large enough to find small to medium effects (within-session analyses) and medium to large effects (between-session analyses).

Conclusion

The modules on suicidality did not specifically change suicidal symptoms or associated cognitions and emotions immediately or by the next session. Most importantly, our results disconfirm evidence on deterioration when suicidality is addressed in a highly structured group setting. Whether the current findings also apply to other forms of group therapies needs to be investigated in future studies.

HIGHLIGHTS

• Session-specific investigations allow a thoroughly examination of an intervention

• Metacognitive Training for Depression showed no contagion effect on suicidality

Keywords:

• CBT
• depression
• group intervention
• mechanism
• psychotherapy
• suicidality

ETHICAL APPROVAL

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

ACKNOWLEDGMENTS

We would like to thank Birte Jessen, Saija Beck, and Sophie Banasiak for their support with the data collection.

DISCLOSURE STATEMENT

Metacognitive Training for Depression [LJ] and the modules on suicidality [LJ, SA, and JP] were developed by the authors. FM, JP, and LJ give workshops on metacognitive training for which they receive reimbursement. No potential conflict of interest was reported by the author(s).

AUTHOR CONTRIBUTIONS

FM analyzed the data and wrote the draft of the manuscript. LJ designed and supervised the study and edited the manuscript. JP coordinated data collection, conducted the intervention, and edited the manuscript. AR recruited patients, conducted assessments, and edited the manuscript. JR helped analyze the data and edited the manuscript. SA and JG designed the study and edited the manuscript. LJ, SA, and JG aquired funding for the study.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the Deutsche Bahn Stiftung [FZ_EXT_3_METACOGNITION] granted to Lena Jelinek, Sönke Arlt, and Jürgen Gallinat.

Notes on contributors

Franziska Miegel

Franziska Miegel and Judith Peth, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Julian Rubel, Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany. Anne Runde, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Sönke Arlt, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany. Jürgen Gallinat and Lena Jelinek, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Judith Peth

Franziska Miegel and Judith Peth, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Julian Rubel, Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany. Anne Runde, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Sönke Arlt, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany. Jürgen Gallinat and Lena Jelinek, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Julian Rubel

Franziska Miegel and Judith Peth, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Julian Rubel, Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany. Anne Runde, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Sönke Arlt, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany. Jürgen Gallinat and Lena Jelinek, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Anne Runde

Franziska Miegel and Judith Peth, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Julian Rubel, Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany. Anne Runde, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Sönke Arlt, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany. Jürgen Gallinat and Lena Jelinek, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Sönke Arlt

Franziska Miegel and Judith Peth, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Julian Rubel, Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany. Anne Runde, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Sönke Arlt, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany. Jürgen Gallinat and Lena Jelinek, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Jürgen Gallinat

Franziska Miegel and Judith Peth, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Julian Rubel, Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany. Anne Runde, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Sönke Arlt, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany. Jürgen Gallinat and Lena Jelinek, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Lena Jelinek

Franziska Miegel and Judith Peth, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Julian Rubel, Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany. Anne Runde, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Sönke Arlt, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, Evangelical Hospital Alsterdorf, Hamburg, Germany. Jürgen Gallinat and Lena Jelinek, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.