A Pilot Study of Psychotherapist Trainees' Alpha-Amylase and Cortisol Levels During Treatment of Recently Suicidal Clients With Borderline Traits

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist-patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research.     

Treatment Fidelity of a Randomized Controlled Trial for Suicidal Risk

Treatment fidelity is a crucial consideration within randomized controlled trials (RCTs). The present study relies on data from a feasibility RCT conducted with 62 treatment-seeking suicidal college students. Issues of experimental fidelity were germane in this investigation because the same clinicians provided both the experimental (the Collaborative Assessment and Management of Suicidality—CAMS) and the control (treatment as usual—TAU) care. The first aim of the current study was to determine adherence to the CAMS model within the experimental (CAMS) and control (TAU) treatment conditions. A second exploratory aim was included to examine how treatment fidelity impacted treatment outcomes (i.e., depression, suicidal ideation, hopelessness, and potential treatment moderators). The CAMS Rating Scale (CRS.3-R) was used to determine treatment adherence to the CAMS model and to ensure between-group fidelity within the trial. The CRS.3-R was completed throughout the course of care based on reviews of a selected number of video recordings of both CAMS and TAU sessions to measure treatment fidelity. Mean CRS.3-R scores revealed differences across treatment conditions such that clinicians were successfully able to provide each treatment separately without contamination. Further, higher CRS.3-R scores in CAMS sessions resulted in decreased hopelessness over the treatment period. Higher CRS.3-R scores in TAU sessions resulted in an increased likelihood of suicidal ideation and less reduction in hopelessness over the treatment period. Overall, clinicians can serve as their own controls in a RCT and levels of adherence to the CAMS model have different effects on suicidal ideation and hopelessness.