Pilot Randomized Control Trial of a Conditioning Paradigm to Increase Affinity for Sacredneses of Life and Decreasee Experiences of Suicide-Related Thoughts and Behaviors

Suicide-related experiences are a form of self-directed violence that affects millions of people every year. Through decades of research, interventions targeting these experiences have developed with varied empirical support. However, many treatments require regular attendance to sessions with a trained behavioral health professional. Limitations of in-person services have led to the development of digital-based interventions, such as Therapeutic Evaluative Conditioning (TEC). TEC is based in evaluative conditioning principles and is a brief (1-2 minutes) web-based intervention designed to increase aversion to self-injurious behaviors while decreasing aversion to the self through a match game-like task. Initial assessment of the intervention demonstrated promising results although treatment effects did not remain a month following treatment. Separately, sanctification, or the process through which aspects of life are perceived as having divine character and significance, can come from a theistic or nontheistic background and does not require a belief in a God or higher power to be experienced. When something is discovered as sacred, that sacredness becomes a priority for the individual, with motivation to conserve what is viewed as sacred. The primary aim of the current study is to develop and test the effectiveness of an adapted version of the TEC paradigm designed to increase affinity for sacredness of life and increase the connection to life as a mechanism for decreasing suicide-related experiences (TEC – Sacredness of Life). Participants were recruited via online web forums with inclusionary criteria of a history of depressive symptoms and/or suicide-related experiences. Participants were randomized to one of two groups, intervention and control. The intervention group received the active condition, which included a matching game- like paradigm pairing positively valenced stimuli with stimuli representing the sacredness of life, as well as self-related words with life-related stimuli. Tasks were completed online, and consisted of assessments at baseline, weekly intervals (one month), and one month following treatment completion. Results did not support the effectiveness of TEC – Sacredness of Life, with all results suggesting a non-significant relationship between the conditioning paradigm and all study outcomes of interest, except for self-report measure of perceived sacredness of life and reasons for living. For these two outcomes, a significant relationship was found between condition and outcome, such that those in the control condition endorsed higher levels of perceived sacredness of life and reasons for living at the end of the treatment month. This relationship was no longer significant at one month following the completion of the intervention month. This study is foundational work in a novel approach to address the public health priority of prevention and treatment of suicide-related thoughts and behaviors. Discussion includes lessons learned and directions for further intervention development.