“Impact of Interpersonal Experiences on Maladaptive Thoughts and Behaviors:” Lessons Learned from the Pilot Study
Katie C. Lewis, PhD
This past April, in my blog post entitled “Understanding Self-Destructive Impulses in Daily Life,” I discussed the important impact that daily experiences–in particular, daily interpersonal experiences–can have on self-destructive impulses. For individuals who are contending with chronic mental health concerns and suicidal ideation, feeling at odds with friends and loved ones can increase stress and hopelessness, and prevent relationships with others from serving a protective role during times of crisis. As part of the Suicide Research and Education Strategic Initiative at Austen Riggs, I have been conducting a study that looks at how daily problems in relating may influence vulnerability to self-destructive thoughts and actions. Since receiving both institutional approval and grant support through the Wallerstein Psychoanalytic Research Fellowship this past July, we have been inviting patients at Austen Riggs to spend two weeks providing us with information about their internal thoughts and emotions during social interactions (by completing ratings on their smartphones throughout the day), to help us understand how these experiences may be related to momentary changes in distress and urges to engage in self-destructive behaviors.
While this study has been officially running since this past summer, we started this endeavor nearly a year ago by conducting a pilot study. There are several reasons to conduct a pilot study for any new research endeavor; it is often helpful, for example, to ask only a few participants to enroll in a study at first, so that there is an opportunity to resolve unexpected issues or complications that may arise. Given that our research setting is an active residential treatment facility where clinical care is our top priority, during the pilot study we also sought to ensure that participants would not experience any interference with their clinical treatment, and we asked for their feedback about how we could make participating in the study feel both meaningful and relevant to the broader therapeutic work in which they were already engaged.
Our pilot participants included six adults ranging in age from approximately 25 to 50, equally balanced between men and women. Some participants reported a history of suicidal ideation and others a history of suicide attempts. At the end of their two-week participation in the study, each person completed a questionnaire that asked about their research experience, including questions about whether they felt that completing the daily ratings had influenced their experience in the community or in treatment. Several participants also reached out for individual meetings with me to talk about their questions and ideas for improving participant experience, and we held group meetings with both the clinical staff and broader patient community at Riggs to better understand the impact of this study on daily life at Riggs.
Fortunately, the majority of pilot participants stated that participating in the study had little or no impact on their experiences in treatment or in the community; both clinical staff and the patient community in general agreed that the study itself did not have a noticeable presence in daily life at Riggs. The pilot participant group also shared several suggestions that ultimately helped to improve the study design– for example, some acknowledged that they had difficulty remembering to complete the daily ratings, and they recommended sending out daily email reminders to help future participants stay on track. Additionally, many pilot participants said that they were very curious about what their ratings of daily social interactions looked like in the “big picture” over the course of the two-week study period, and they suggested that future participants would appreciate the opportunity to receive a copy of their ratings at the end of the study. These and other insights allowed us to make meaningful changes to the study, and we have incorporated these suggestions into the current study design.
The process of soliciting feedback and encouraging discussion about the pilot study led to ongoing conversations about the importance of research, and an increased sense that research is meaningful to the broader Riggs community, rather than a process restricted only to a group of “experts” who are disconnected from the clinical implications and impact of their work. While we were able to achieve technical insights that helped us to improve our research methods and procedures, I think the most important lesson to emerge from the pilot study was the value of inviting patients and clinical staff into the research discussion. Taking this approach and incorporating these new insights enabled us to develop new ways of promoting a sense of meaning and value associated with research participation. I hope to continue to incorporate these insights into our research program, as we continue to develop projects.
Portions of this discussion were presented in June, 2017 at the 9th Annual Aeschi Conference in Vail, CO.