Sandplay Therapy with Suicidal Ideation and Self-Injury–Focused Engagement (SPT-SAFE) for Adolescents: An Exploratory Early Cohort Analysis of an Ongoing Randomized Controlled Trial

Background/Objectives: Suicidal ideation and non-suicidal self-injury (NSSI) represent major public health concerns among adolescents, yet developmentally appropriate, school-based interventions remain limited. This study reports findings from an explora-tory analysis of an early cohort of an ongoing randomized controlled trial evaluating Sandplay Therapy with Suicidal Ideation and Self-Injury–Focused Engagement (SPT-SAFE) compared with Treatment as Usual–Risk Management Counseling (TAU-RMC) in a school-based high-risk intervention setting. Methods: Adolescents aged 12–19 years presenting with suicidal ideation and/or NSSI were randomly assigned to SPT-SAFE (n = 31) or TAU-RMC (n = 30). Outcomes of interest were NSSI frequency, assessed using the Functional Assessment of Self-Mutilation (FASM), and suicidal ideation severity, assessed using the Suicidal Ideation Questionnaire–Junior (SIQ-JR). Prespecified baseline-adjusted analyses of covariance (ANCOVA) were conduct-ed as the primary analytic approach. Sensitivity analyses using linear mixed-effects mod-els (LMMs) were performed to examine outcome trajectories over time. Results: In the prespecified baseline-adjusted ANCOVA, suicidal ideation showed a be-tween-group difference favoring SPT-SAFE. For NSSI frequency, the between-group effect also favored SPT-SAFE but was small and did not reach conventional statistical signifi-cance. Sensitivity analyses using LMMs demonstrated directionally consistent patterns, with greater reductions over time observed in the SPT-SAFE group across outcomes. No serious adverse events were reported. Conclusions: Findings from this exploratory early cohort analysis suggest a preliminary and hypothesis-generating signal of benefit associated with SPT-SAFE in a school-based setting, characterized by directionally consistent patterns across complementary analytic approaches. Results should be interpreted as provisional pending completion of recruit-ment, longer-term follow-up, and further evaluation of comparative effectiveness, durabil-ity of treatment effects, and mechanisms of change.