Article

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

ABSTRACT

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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    • "Downloaded by [Abby Adler] at 09:07 13 January 2016 The qualitative data consisted of transcripts of initial therapy sessions from two randomized controlled trials (RCTs) of cognitive therapy for suicide attempts: a university-based study (study 1; Brown et al., 2005) and a community-based study currently being analyzed (study 2; see Figure 1 for a flow diagram of patients included in the present study). For both clinical trials, patients who attempted suicide were evaluated in an emergency room within 48 hours following the suicide attempt and randomized to receive Cognitive Therapy (CT) plus case management or case management only. "
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    ABSTRACT: This study used a mixed methods approach to examine pathways to suicidal behavior by identifying cognitive warning signs that occurred within one day of a suicide attempt. Transcripts of cognitive therapy sessions from 35 patients who attempted suicide were analyzed using a modified grounded theory approach. Cognitive themes emerging from these transcripts included: state hopelessness, focus on escape, suicide as a solution, fixation on suicide, and aloneness. Differences in demographic and baseline diagnostic and symptom data were explored in relation to each cognitive theme. We propose a potential conceptual model of cognitive warning signs for suicide attempts that requires further testing.
    Full-text · Article · Jan 2016 · Archives of Suicide Research
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    • "Downloaded by [Abby Adler] at 09:07 13 January 2016 The qualitative data consisted of transcripts of initial therapy sessions from two randomized controlled trials (RCTs) of cognitive therapy for suicide attempts: a university-based study (study 1; Brown et al., 2005) and a community-based study currently being analyzed (study 2; see Figure 1 for a flow diagram of patients included in the present study). For both clinical trials, patients who attempted suicide were evaluated in an emergency room within 48 hours following the suicide attempt and randomized to receive Cognitive Therapy (CT) plus case management or case management only. "

    Full-text · Dataset · Jan 2016
    • "These findings have since been replicated in a number of additional studies (e.g. Brown et al., 2005; Smith et al., 2010). "
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    ABSTRACT: Purpose – The purpose of this paper is to examine the role of suicide-related mental imagery in suicidal behavior. It was hypothesized that greater frequency and vividness of suicide-related imagery would be associated with more suicidal behaviors, and acquired capability for suicide was expected to mediate this relationship. Hypotheses were tested by surveying 237 undergraduate students (59 percent female; mean age=20) who completed self-report measures that assessed suicidal cognitions, acquired capability for suicide, and history of self-harm behaviors. Design/methodology/approach – Hypotheses were tested by surveying 237 undergraduate students (59 percent female; mean age=20) who completed self-report measures that assessed suicidal cognitions, acquired capability for suicide, and history of self-harm behaviors. Findings – Results suggested that frequency and vividness of suicide-related imagery were positively correlated with suicidality. Acquired capability was not related to study variables; thus additional mediational analysis was unwarranted. Originality/value – Few studies have examined suicidal imagery and how it relates to actual self-harm behavior. The current study provides an exploratory view of features of imagery related to suicidal thoughts; findings imply that understanding mental imagery may play an important role in clinical risk assessment and treatment for suicidality.
    No preview · Article · Jul 2015 · Journal of Aggression
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