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6: Cognitive Behavioral Therapy for Suicide Prevention to Reduce Suicidal Ideation

Risk Management and Treatment » Non-pharmacologic Interventions
6: Cognitive Behavioral Therapy (including problem solving) for Suicide Prevention to Reduce Suicidal Ideation

We suggest offering cognitive behavioral therapy (including problem solving- based psychotherapies) focused on suicide prevention to reduce suicidal ideation for patients with a history of self-directed violence.

Strength:

Weak for

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Recommendation 6 applies to cognitive behavioral therapy (CBT) focused on suicide prevention and includes problem-solving based psychotherapies. Resources specific to CBT for suicide prevention can be found on Recommendation 5. Resources for problem-solving therapy (PST) are included below. PST is one type of CBT specifically aimed at improving a patient’s ability to cope with stressful life experiences through active problem solving.

Training and Clinical Resources

This section includes recommended trainings and/or clinical resources about PST for suicide prevention.

VA-provided PST resources
CPG WebinarUpdated Moving Forward: Overcoming Life's Challenges Web Course
PST resources from professional organizations
Problem-Solving Therapy for Depression | Society of Clinical Psychology
Problem Solving Therapy Canada
PST Canada Workshop recommended pre-reading
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Manuals

This section includes recommended manuals about PST for suicide prevention.

CPG WebinarProblem-Solving Therapy: A Treatment Manual Supplement
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Webinars

This section includes recommended webinars about PST for suicide prevention.

CPG Webinar Emotion-Focused Problem Solving Therapy and Suicidality Presented by Dr. Art Nezu
CPG Webinar Problem Solving Therapy for Suicide Prevention in VA Presented by Dr. Shannon Sisco
CPG Webinar Suicide Prevention 2.0 Clinical Telehealth Program Presented by Dr. Jessica A Walker
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Podcasts

This section includes recommended podcasts about PST for suicide prevention.

PTSD Bytes Podcast Series
Podcast iconProblem Solving Therapy with Dr. Shannon Sisco
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Articles

This section includes recommended articles about PST for suicide prevention.

Barnes, S. M., Monteith, L. L., Gerard, G. R., Hoffberg, A. S., Homaifar, B. Y., & Brenner, L. A. (2017). Problem-solving therapy for suicide prevention in veterans with moderate-to-severe traumatic brain injury. Rehabilitation psychology, 62(4). 600-608. https://doi.org/10.1017/S104161022000397X
Beaudreau, S. A., Karel, M. J., Funderburk, J. S., Nezu, A. M., Nezu, C. M., Aspnes, A., & Wetherell, J. L. (2021). Problem-solving training for Veterans in home based primary care: an evaluation of intervention effectiveness. International psychogeriatrics, 1-12. Advance online publication. https://doi.org/10.1037/rep0000154
Evans, K., Tyrer, P., Catalan, J., Schmidt, U., Davidson, K., Dent, J., Tata, P., Thornton, S., Barber, J., & Thompson, S. (1999). Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological medicine, 29(1). 19–25. https://doi.org/10.1017/s003329179800765x
Fitzpatrick, K. K., Witte, T. K., & Schmidt, N. B. (2005). Randomized controlled trial of a brief problem-orientation intervention to suicidal ideation. Behavior Therapy, 35(4). 323-333. https://doi.org/10.1016/S0005-7894(05)80114-5
Hawton, K., Townsend, E., Arensman, E., Gunnell, D., Hazell, P., House, A., & van Heeringen, K. (2000). Psychosocial versus pharmacological treatments for deliberate self harm. The Cochrane database of systematic reviews, (2). CD001764. https://doi.org/10.1002/14651858.CD001764
Husain, N., Afsar, S., Ara, J., Fayyaz, H., Rahman, R. U., Tomenson, B., Hamirani, M., Chaudhry, N., Fatima, B., Husain, M., Naeem, F., & Chaudhry, I. B. (2014). Brief psychological intervention after self-harm: randomised controlled trial from Pakistan. The British journal of psychiatry : the journal of mental science, 204(6). 462–470. https://doi.org/10.1192/bjp.bp.113.138370
Nezu, A. M., Nezu, C. M., Stern, J. B., Greenfield, A. P., Diaz, C., & Hays, A. M. (2017). Social problem solving moderates emotional reactivity in predicting suicide ideation among U.S. Veterans. Military Behavioral Health, 5. 417-426. https://www.tandfonline.com/doi/abs/10.1080/21635781.2017.1337595
Salkovskis, P. M., Atha, C., & Storer, D. (1990). Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. The British journal of psychiatry: the journal of mental science, 157. 871-876. https://doi.org/10.1192/bjp.157.6.871
Stewart, C. D., Quinn, A., Plever, S., & Emmerson, B. (2009). Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high risk population. Suicide & life-threatening behavior, 39(5). 538–547. https://doi.org/10.1521/suli.2009.39.5.538
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