Preliminary study of the Integrated skills for SUicide IMagery (I-SUIM) treatment for adults experiencing mental images of suicide.

Integrated skills for SUicide IMagery (I-SUIM) Intervention + Treatment As Usual Participants will continue TAU, with the addition of the Integrated skills for SUicide IMagery (I-SUIM) intervention to be delivered via telehealth videoconferencing. I-SUIM is an adjunctive psychotherapy intervention delivered over 3-4 sessions in individual sessions with a qualified psychologist experienced in Imagery Rescripting and working with patients experiencing suicide ideation. The first two sessions are to be completed weekly to fortnightly, with timing of optional session 4 negotiated on a case-by-case basis (but this must be held within 10-12 weeks of starting I-SUIM). Thus, the total duration of the intervention will be between 3 (if only 3 sessions are completed and are completed weekly) and up to 12 weeks. Sessions are expected to last 90 minutes each but some may finish earlier (e.g., consolidation of imagery in Session 3 if the participant does not have additional imagery requiring rescripting). I-SUIM covers seven topics: (A) Assessment, Psychoeducation, and Identifying Imagery Target, (B) Imagery Rescripting as Rehearsal of Implementation Intention, and (C) Consolidation of Rescripted Image, Troubleshooting, or Practice with Additional Images, (D) Addressing the Impact of Memory-Based Imagery, (E) Incorporating Ambivalence Imagery, (F) Imagery to Connect with Future Self, and (G) Relapse Prevention. Sessions 1-3 include prescribed content that has been carefully designed to address key mechanisms through which suicide imagery may increase the risk of suicide behaviour. 1. Session 1 will cover Topic A (Assessment, Psychoeducation, and Identifying an Imagery Target) 2. Session 2 will cover Topic B (Imagery Rescripting as Rehearsal of Implementation Intention) 3. Session 3 will cover Topic C (Consolidation of Rescripted Image, Troubleshooting, or Practice with Additional Images) and if the final session should include Topic G Relapse prevention. Session 4 is optional and somewhat flexible in content. It may include recapping of content from Topics A-C, content from Topics D-F, or other relevant strategies. Adherence to the intervention will be assessed by requiring study therapists to complete a post-session questionnaire after each session. This questionnaire will require the therapists to select the intervention components have been utilised during that session, as well as indicating (a) whether other additional strategies were used (which therapists will be asked to describe), and (b) whether participants completed requested home practice tasks between sessions where applicable. This study will include assessment of the feasibility of the evaluation protocol used in this study and proposed for use in a future fully powered efficacy trial. The evaluation protocol includes the collection of data from people experiencing suicide imagery who enrol in the trial (primary participants), their usual-care therapists (secondary participants), and the trial clinicians who administer the intervention. The evaluation protocol includes questionnaires that are administered to primary participants at baseline, post-treatment (after their final session), and at follow-up (4 weeks after their final session). At this time the primary participants also complete a research participation feedback survey. After every therapy session the trial clinicians also complete a session summary form outlining the content of the session and patient engagement, as well as other relevant clinical information (e.g., risk assessments). The evaluation protocol also includes an online survey administered to secondary participants regarding the primary participants' therapeutic engagement in usual care, observations of the primary participants' engagement with I-SUIM, and the secondary participants' experiences of communication and engagement with the trial team. After each trial clinician's final participant has completed all therapy sessions the trial clinicians also complete a survey regarding their experiences of both the I-SUIM intervention and of the trial protocol.