Shame-Focused Cognitive Behavioral Therapy For Reducing Suicide Risk In Adolescent Psychiatric Inpatients (SF-CBT)

The Columbia-Suicide Severity Rating Scale (C-SSRS)

It will be used to assess suicidal ideation and suicidal behaviors (Posner et al., 2011). The C-SSRS is widely utilized in suicide risk assessment. It evaluates several aspects, including the presence of a suicide attempt, an interrupted attempt (prevented by external factors), an aborted attempt (self-terminated by the individual), preparatory or related suicidal behaviors, and lethality ratings. The actual lethality is rated on a 6-point scale. The potential lethality is rated on a 3-point scale (if actual lethality = 0), where 0 = "behavior unlikely to result in injury," and 2 = "likely to result in death even with medical intervention." Additionally, the presence of non-suicidal self-injury (NSSI) will be assessed, as it is associated with future suicide attempt risk. it is highly sensitive in detecting changes in suicidal behavior during treatment and can predict future suicidal behaviors and readmission(Ji et al., 2023).

The Columbia-Suicide Severity Rating Scale (C-SSRS)

The C-SSRS will also be used to evaluate suicidal ideation and intent, with assessment time points identical to those above. Two subscales will be extracted for this study: Severity: Scores range from 1 to 5, representing "wish to be dead," "non-specific active suicidal thoughts," "suicidal thoughts with method," "suicidal intent," and "suicidal intent with a specific plan," respectively. Intensity: Evaluates the frequency, duration, controllability, deterrents, and reasons for suicidal ideation.

The External and Internal Shame Scale, EISS

Shame will be measured using the External and Internal Shame Scale (EISS), which assesses two core dimensions of shame as a transdiagnostic emotion: external shame and internal shame. Both the subscales and total scores of the EISS demonstrate good internal consistency and concurrent validity and are significantly associated with depressive symptoms (Ferreira et al., 2022).

The Compass of Shame Scale (CoSS)

Coping or defensive strategies toward shame have a significant impact on psychological functioning. The Compass of Shame Scale (CoSS) will be used to assess four coping styles individuals employ when experiencing shame: attack self, withdrawal, attack others, and avoidance. Studies have shown that the CoSS has good reliability and validity, with internal consistency coefficients ranging from 0.74 to 0.91 across subscales (Elison et al., 2006).

The Alexian Brothers Urge to Self-Injure Scale (ABUSI)

The Alexian Brothers Urge to Self-Injure Scale (ABUSI), which measures the severity of urges to engage in NSSI. The ABUSI shows good internal consistency, test-retest reliability, sensitivity to change, as well as convergent, predictive, and incremental validity (Washburn et al., 2010).

Deliberate Self-Harm Inventory (DSHI)

The Deliberate Self-Harm Inventory (DSHI), which assesses deliberate self-harming behaviors. The DSHI demonstrates high internal consistency and good structural, convergent, discriminant, and test-retest validity, supporting its reliability and validity as a measure of deliberate self-harm (Gratz, 2001).

The Intervention Usability Scale (IUS)

The Intervention Usability Scale (IUS) (Aaron R. Lyon et al., 2021) will be used to assess therapists' perceptions of the usability of the intervention. Usability is defined as the degree to which a specific user can achieve goals effectively, efficiently, and satisfactorily in a given context. The IUS comprises two dimensions-Usability and Learnability-and demonstrates good internal consistency, with Cronbach's α coefficients of 0.83 (total), 0.84 (usability), and 0.67 (learnability), indicating acceptable reliability.