1. Overview
    Dialectical Behavior Therapy(DBT) 

2. Efforts by NowMattersNow
    Online DBT Skills  NowMattersNow Facebook Suicide Prevention Tool 

3. Ongoing Research Related to NowMattersNow.org

4. References

NowMattersNow.org was developed to address healthcare patient preferences and gaps in accessibility by making evidence-based content from taxpayer-funded research more readily available, both for healthcare providers working with suicidal patients and for the public at large. The website includes content based on interventions known to be most effective for preventing suicidal behavior and suicide attempts (^[1] (DBT) skills), reducing suicidal thoughts (crisis lines, web-based self-help), and suicide death (caring messages and lethal means restriction). Those with lived expertise guided the development of NowMattersNow.org and the majority of the content is videos of people with lived experience ([https://www.nowmattersnow.org/team Team Now Matters Now]).^[2] This “peer-delivered” public resource is not considered therapy or peer support, nor is it expected to replace therapy or peer support­, but the creators have expressed a goal of introducing evidence-based concepts and ideas to those who might not otherwise be exposed.

Overview

The NowMattersNow.org website was developed by Drs. Ursula Whiteside and Julie Richards, Team Now Matters Now, and Civilization (a media design and website development company) as part of research projects funded by the National Institute of Mental Health ^[3] (grant number [https://projectreporter.nih.gov/project_info_description.cfm?aid=8354574&icde=39571410&ddparam=&ddvalue=&ddsub=&cr=3&csb=default&cs=ASC&pball= R34 MH097836]) and the American Foundation for Suicide Prevention (grant number [https://afsp.org/our-work/research/research-grants/unexpected-suicide-attempts-treatment-utilizers-denying-ideation-month-prior-attempt/ PDF 011811]).^[4] The NowMattersNow.org website was launched on World Suicide Prevention Day in 2014 (September 10) and has had over 150,000 unique visitors as of January 2018. The NowMattersNow.org website’s landing page states: “Have you had suicidal thoughts? Problems that felt unsolvable? You are in excellent company—we’ve been there.” Users can proceed to the website by pressing a button that brings them to the “Home” page. This page presents panels with images of individuals with lived experience (whose videos are featured on the website). Panels represent various topics: DBT skills (Opposite Action, Mindfulness, Mindfulness of Current Emotion, Paced Breathing) and other suicide prevention-related topics: “Lethal Means,” “Caring Messages,” and “Suicidal Thoughts”. Clicking on the text within an individual panel leads users to an associated webpage dedicated to videos on that topic comprising personal stories and didactic content. The home page also includes menu self-help options on the top left that include “About” (a text-based description of the website and a brief video), “Team” (bios and photos of members of Team Now Matters Now), and “More.” On the far right is an option for “Crisis Lines” (a list of phone, text, and instant messaging crisis options nationally and internationally).

Dialectical Behavior Therapy(DBT)

Key elements of Dialectical Behavior Therapy (DBT; an intensive clinical intervention with proven efficacy for reducing risk for self-harm) support development of NowMattersNow.org. Developed by Dr. Marsha Linehan, DBT is an effective treatment developed to reduce suicidal behaviors (i.e., suicide attempts, non-suicidal self-injury, suicidal ideation) by teaching individuals how to effectively manage intense emotions and tolerate distress.^[5] Predicated on the assumption that suicidal behaviors are both the short and long- term result of seemingly uncontrollable emotions, DBT is an intensive intervention involving individual psychotherapy, phone coaching, therapist consultation team, and skills group training.^[6][7] Reductions in suicidal behaviors have been replicated across five DBT randomized clinical trials targeting suicidal individuals.^{[8][9][10][11][12][13][14]} Results of a NIMH-funded component analysis of DBT (R01 MH034486; Dr. Whiteside was a research therapist on this study), suggest that DBT skills training is effective at reducing suicidal behaviors (when offered in tandem with typical case management).^[15] In this study, use of the behavioral skills taught in DBT mediated changes in suicidal behaviors over time.^[16] In a review of three DBT RCT trials, DBT skills use fully mediated the decrease in suicide attempts and depression and the increase in control of anger over time. DBT skills use also partially mediated the decrease of non-suicidal self-injury over time.^[17] This suggested that interventions focused on DBT skills alone as a treatment for suicidal populations were needed, and thus NowMattersNow.org was developed. Skills training has also been adapted into brief interventions and applied in population-based interventions. The teaching of DBT skills has been demonstrated in brief formats and including 30-minute skills video trainings,^[18] and 50-minute individual motivational interventions.^[19]

Efforts by NowMattersNow

Online DBT Skills

Dr. Whiteside developed a successful one-session adaptation of DBT skills which served as the foundation for DBT skills intervention NowMattersNow.org.^[20] Three DBT skills (mindfulness, opposite action, and mindfulness of current emotion) from the skills group component of DBT were taught as ways of managing intense emotions and participants in this condition reported decreases in depression and anxiety symptoms (from clinical to non-clinical) and improved abilities to manage intense emotions. Patients in this study reported DBT skill use and usefulness even three months following the intervention.^[21] While still in their infancy, internet interventions delivering adaptations of empirically supported in-person interventions (e.g., CBT and motivational interviewing) also have promise. Such interventions have demonstrated effects over usual care and in some cases comparable to in-person treatment.^{[22][23][24][25][26]} Intervention websites, both with and without human support, are scalable for population-based uses in ways that in-person interventions are not.^[27] The evidence supporting online adaptations of high-intensity treatments such as CBT, warrants the development and feasibility testing of an online DBT skills intervention. Advantages of intervention websites include 24-hour accessibility, greater perceived privacy, and intervention access from a location of their choice (e.g., home, mobile phone, library). NowMattersNow.org is not harmful and has preliminary support for positive impact.

Individuals with lived experience, and consumers were involved in the development of NowMattersNow.org and elements that were chosen were based on those that both audiences said would be helpful.^[28] Unpublished data collected for quality improvement data generally support the safety of NowMattersNow.org and indicate the potential for benefit of the website. Among 1000 visits where people rated their suicidal thoughts as “completely overwhelming” (the highest possible score) when they arrived at the site, 27% reported a reduction in suicidal thoughts after being on the website for several minutes. In another sample, those who rated their suicidal thoughts as what might be described as mild to moderate, only 1.5% reported an increase to thoughts that were completely overwhelming. While very important, this percentage is small enough that it falls within the margin of error. Future research is needed and we are seeking IRB approval to analyze this data for publication.

NowMattersNow Facebook Suicide Prevention Tool

In addition to the work done on their website, NowMattersNow helped to develop a Facebook project which enabled users to help potential suicidal friends' instantly through the Facebook team.^[29] The added tool allows one to report posts of people that they deem to be dangerous to themselves, before the flagged post is monitored by an operational team under Facebook whom are available 24/7. If the post is reviewed as potential dangerous, the Facebook Team reaches out to the individual to offer help or advice. The goal behind this tool was aimed to provide an easy option for friends to get help for each other when they are unsure on how to approach the situation.^[30]

Ongoing Research Related to NowMattersNow.org

Further, Dr. Whiteside is co-investigator on a project that includes the video content form NowMattersNow.org and is guided via online messaging – the study involves nearly 20,000 patients considered “high-risk” for suicide based on responses to a suicide question on a depression questionnaire.^[31] The outcomes of this study, still forthcoming, will determine whether the intervention was associated with decreases in suicide attempts.

References

• Kurunegala Electoral District (1947–1989)
• Kurungaleeswarar Temple
• Kurungalore
• Kurung language
• Kurun Princess Hexiao
• Kurun Princess Rong'an
• Kurun Princess Shou'an
• Kurunta (god)
• Kurunthancode block
• Kuruozek mine
• Kurupam (ST) (Assembly constituency)
• Kurupam (vidhan Sabha constituency)
• Kurupam (Vidhan Sabha constituency)
• Kuruppinte Kanakku Pustakom
• Kuruppinte Kanakkupusthakam
• Kuruption
• Kurupuram
• Kuru River
• Kurur Neelakandan Namboodiripad
• Kururu (disambiguation)
• Kururu language
• Kurushabad
• Kurushi Final
• Kurushi (song)
• Kurushi (Yoko Ono song)