Cognitive Therapy for the Prevention of Suicide Attempts: A Randomized Controlled Trial

Department of Graduate Psychology, James Madison University, Harisonburg, Virginia, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2005; 294(5):563-70. DOI: 10.1001/jama.294.5.563
Source: PubMed


Suicide attempts constitute a major risk factor for completed suicide, yet few interventions specifically designed to prevent suicide attempts have been evaluated.
To determine the effectiveness of a 10-session cognitive therapy intervention designed to prevent repeat suicide attempts in adults who recently attempted suicide.
Randomized controlled trial of adults (N = 120) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt. Potential participants (N = 350) were consecutively recruited from October 1999 to September 2002; 66 refused to participate and 164 were ineligible. Participants were followed up for 18 months.
Cognitive therapy or enhanced usual care with tracking and referral services.
Incidence of repeat suicide attempts and number of days until a repeat suicide attempt. Suicide ideation (dichotomized), hopelessness, and depression severity at 1, 3, 6, 12, and 18 months.
From baseline to the 18-month assessment, 13 participants (24.1%) in the cognitive therapy group and 23 participants (41.6%) in the usual care group made at least 1 subsequent suicide attempt (asymptotic z score, 1.97; P = .049). Using the Kaplan-Meier method, the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 (95% confidence interval [CI], 0.62-0.85) and in the usual care group was 0.58 (95% CI, 0.44-0.70). Participants in the cognitive therapy group had a significantly lower reattempt rate (Wald chi2(1) = 3.9; P = .049) and were 50% less likely to reattempt suicide than participants in the usual care group (hazard ratio, 0.51; 95% CI, 0.26-0.997). The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months (P= .02), 12 months (P = .009), and 18 months (P = .046). The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months (P = .045). There were no significant differences between groups based on rates of suicide ideation at any assessment point.
Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide.

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Available from: Gregg Henriques, May 06, 2014
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    • "It was, however, underpowered for the following reasons: it was restricted to a study sample unrepresentative of the population of people attending hospital because of self-harm; many of the participants in the active treatment arm did not receive the intervention; and the intervention itself was not, on theoretical or empirical grounds, adequately designed for use in self-harm. Two American trials showed benefits with highly selected participants and intensive forms of expert therapy: 1) ten sessions of cognitive therapy reduced non-fatal repetition in people judged to have made suicide attempts [20] and 2) intensive dialectical behaviour therapy reduced repetition of self-harm in young women with a diagnosis of borderline personality disorder [21]. Costs, in terms of time in therapy and therapist expertise, preclude the widespread use of either of these interventions for subgroups of patients in UK hospitals, and the cost-effectiveness of such interventions for self-harm is unknown. "
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    ABSTRACT: Background Around 150,000 people each year attend hospitals in England due to self-harm, many of them more than once. Over 5,000 people die by suicide each year in the UK, a quarter of them having attended hospital in the previous year because of self-harm. Self-harm is a major identifiable risk factor for suicide. People receive variable care at hospital; many are not assessed for their psychological needs and little psychological therapy is offered. Despite its frequent occurrence, we have no clear research evidence about how to reduce the repetition of self-harm. Some people who have self-harmed show less active ways of solving problems, and brief problem-solving therapies are considered the most promising psychological treatments. Methods/Design This is a pragmatic, individually randomised, controlled, feasibility study comparing interpersonal problem-solving therapy plus treatment-as-usual with treatment-as-usual alone, for adults attending a general hospital following self-harm. A total of 60 participants will be randomised equally between the treatment arms, which will be balanced with respect to the type of most recent self-harm event, number of previous self-harm events, gender and age. Feasibility objectives are as follows: a) To establish and field test procedures for implementing the problem-solving intervention; b) To determine the feasibility and best method of participant recruitment and follow up; c) To assess therapeutic delivery; d) To assess the feasibility of obtaining the definitive trial’s primary and secondary outcomes; e) To assess the perceived burden and acceptability of obtaining the trial’s self-reported outcome data; f) To inform the sample size calculation for the definitive trial. Discussion The results of this feasibility study will be used to determine the appropriateness of proceeding to a definitive trial and will allow us to design an achievable trial of interpersonal problem-solving therapy for adults who self-harm. Trial registration Current Controlled Trials (ISRCTN54036115)
    Trials 05/2014; 15(1):163. DOI:10.1186/1745-6215-15-163 · 1.73 Impact Factor
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    • "Although the initial RCT for ABFT demonstrated that this intervention can lead to clinically significant improvements in suicidal ideation, further research is needed to establish ABFT as an evidence-based treatment for adolescent suicidality. There is strong evidence that cognitive behavioral approaches can be effective in treating adult suicidality (Brown et al., 2005; Tarrier, Taylor, & Gooding, 2008). Clinicians and researchers have begun to adapt and study cognitive behavioral treatments for adolescents, and the initial results show that CBT for adolescent suicidality warrants further study. "
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    ABSTRACT: Suicide continues to be one of the leading causes of death for adolescents, with limited evidence of empirically-supported treatment approaches for reducing risk of suicide, suicide attempts, and suicidal ideation in thispopulation. The purpose of the current article is to present the Collaborative Assessment and Management of Suicidality (CAMS) therapeutic framework as a potentially useful approach to working with suicidal adolescents given the egalitarian dynamic between therapist and client, as well as the focus on targeting the client’s unique drivers of suicide. The published literature was reviewed to determine the current state of science for empirically-supported psychotherapies developed specifically for suicidal adolescents. We conclude that while initial CAMS research and clinical projects are promising, the therapeutic framework requires the development of a rigorous line of research to achieve important benchmarks for establishment as an empirically-supported psychosocial intervention for suicidal adolescents.
    • "Of note, DBT skills training includes skills that can be useful in managing hopelessness; for instance, the skill termed Meaning within the set of IMPROVE skills of the distress tolerance module encourages clients to find meaning in situations that may be seen as hopeless. Developing a crisis response plan (Rudd, Joiner, & Rajab, 2001) or safety plan (Brown et al., 2005; Stanley & Brown, 2012) can be useful . These intervention techniques are designed to ensure patient safety during an acute crisis by identifying warning signs or triggering factors and then delineating a predetermined set of steps to take during a crisis designed to reduce risk. "
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    ABSTRACT: Accurate assessment and management of risk is crucial to the prevention of suicidal behavior. In the present article, the interpersonal theory of suicide (T. E. Joiner, 2005, Why people die by suicide, Cambridge, MA: Harvard University Press; K. A. Van Orden, et al., 2010, The interpersonal theory of suicide, Psychological Review, 117, 575–600) is used as the main backdrop for conceptualizing targets for suicide risk assessment and attendant management strategies. In addition to providing an overview of the theory and its corroborating empirical evidence, we discuss its tenets in relation to three other leading theories of suicidal behavior. The shared features and unique strengths of the empirical approaches are noted. Following this, leading risk factors for imminent suicidal behavior are discussed and possible links to existing empirical perspectives are highlighted. In particular, evidence is reviewed for marked social withdrawal and key indicators of overarousal (namely, agitation, nightmares, and insomnia). We offer recommendations for appropriate empirically based assessment and intervention strategies and close with a discussion of future directions for research.
    Journal of Psychotherapy Integration 03/2013; 23(3). DOI:10.1037/a0031416
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