The role of ‘dose’ of therapy and therapy formulation level in improvements in social support appraisals and concomitant reductions in suicidal ideation severity over six months, in people with psychosis

<b>Objective</b><br/>The objectives were to examine the role of two therapy process variables (formulation level and therapy ‘dose’) in a mechanism involving links between improved social support appraisals and reduced suicidal ideation severity over time in people with psychosis, and to determine which aspects of social support were key to improvements in suicidal ideation.<br/><br/><b>Methods</b><br/>Participants (N = 106) had non-affective psychosis and recent suicidal experiences, and had received a suicide-focused talking therapy. A model was tested in which, across six months, changes in social support appraisals were associated with changes in suicidal ideation severity with sequential mediators of therapy ‘dose’ (number of sessions) and therapy formulation level (1 to 5). Multivariate techniques were used to probe which social support items clustered around suicidal ideation improvements and the two therapy process variables.<br/><br/><b>Results</b><br/>The highest levels of formulation (levels 4 and 5) were attained by 77% of participants, with median therapy attendance of 17 sessions. Therapy ‘dose’ and therapy formulation level acted as sequential mediators in a significant indirect pathway in which improvements to social support appraisals led to consequent improvements in suicidal ideation severity, with social support from family being key. Aspects of social connectedness of particular importance included feeling important to others, being able to rely on family, being relied upon by family, and being cared for by family.<br/><br/><b>Conclusions</b><br/>People with some of the most severe mental health problems can fully engage with suicide-focused therapy. Individualized formulation is recommended which is to focus upon transitions within social connectedness appraisals.<br/><br/>