SAFETY First: A Promising New Intervention for Suicidal Youth
A Swedish trial explores the impact of a family-based CBT program on self-harm and emotional regulation.
Suicide is the third leading cause of death among 15–29-year-olds globally. And yet, access to treatments that specifically target suicidal behavior in youth remains scarce. A new study out of Sweden sheds light on a potential path forward: the SAFETY program, a family-based cognitive behavioral therapy designed to reduce suicidal behaviors in adolescents.
What is SAFETY?
Short for Safe Alternatives for Teens and Youths, SAFETY is a 12-week cognitive behavioral therapy that integrates elements of dialectical behavior therapy (DBT) and family engagement. Originally developed in the U.S., the intervention aims to reduce suicide attempts and non-suicidal self-injury (NSSI) through skills training, emotional regulation strategies, and enhanced family communication.
The Study
This randomized feasibility trial, published in BMJ Mental Health, is the first to evaluate SAFETY outside the U.S. A feasibility trial is an initial investigation that helps to assess whether a planned clinical trial is realistic, practical, and likely to succeed.
Conducted within Sweden's child and adolescent mental health services (CAMHS), the study included 30 youth (93% female, average age 14.6) who had exhibited suicidal behavior within the past three months.
Participants were randomly assigned to either SAFETY or an active control condition involving supportive therapy. Both interventions were delivered by licensed clinicians trained in cognitive behavioral methods.
The study wasn't powered to test efficacy per se, but the early indicators are promising:
High compliance: Most participants completed the majority of sessions.
Low attrition: Only 7% dropped out before the final follow-up.
Reduced self-injury: Non-Suicidal Self-Injury (NSSI) incidents dropped by 95% in the SAFETY group versus 69% in the control.
Emotional gains: SAFETY participants showed moderate-to-large improvements in anxiety, depression, quality of life, and emotion regulation.
Although suicide attempts still occurred (2 in the SAFETY group and 4 in the control), the overall pattern suggests a potential advantage for the SAFETY approach.
Why This Matters
Therapies like DBT are effective but often resource-intensive and inaccessible. SAFETY, with its structured, brief format and emphasis on family involvement, could offer a scalable alternative.
Importantly, the intervention was well-received by families and clinicians alike, with high treatment satisfaction and credibility scores reported across the board.
Caveats and Next Steps
As a feasibility trial, this study was not designed to definitively prove effectiveness. Larger, fully powered randomized controlled trials are necessary to validate these early findings.
Still, the low dropout rate, strong engagement, and positive trends across multiple domains suggest that SAFETY warrants further investment and study, particularly in diverse clinical settings where traditional treatments may be out of reach.
While further research is necessary, for mental health professionals working with at-risk youth, SAFETY represents a potentially impactful tool that integrates evidence-based techniques with family dynamics.
Attribution: This summary was created by the team at Psychvox and is based on insights from the article “Preventing suicide with Safe Alternatives for Teens and Youths (SAFETY): a randomised feasibility trial” by Moa Karemyr and colleagues. All rights to the original research remain with the authors and the publisher. This summary is intended for educational purposes only and does not imply endorsement by the original authors. The article is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0).