Decreases in Suicide Cognitions After Cognitive Processing Therapy Among Veterans With Posttraumatic Stress Disorder Due to Military Sexual Trauma

Abstract

Posttraumatic stress disorder (PTSD) is associated with suicidal ideation (SI) and suicidal self-directed violence (SDV). Military sexual trauma (MST) is a common precursor to PTSD among veterans. Survivors of MST are more likely to be diagnosed with PTSD and are at greater risk for SI than survivors of other forms of trauma. Suicide-specific beliefs (e.g., unlovability, unbearability, unsolvability) have been shown to be strong predictors of SI and future suicidal SDV. Suicide-specific beliefs were examined over the course of treatment and follow-up in 32 veterans (23 women, 9 men) who received cognitive processing therapy (CPT) for MST-related PTSD. Hierarchical linear models revealed that veterans who received CPT had significant reductions in suicide-specific cognitions regarding unbearability, unlovability, and unsolvability. These preliminary findings warrant replication in a randomized controlled trial with a larger sample that includes participants with more acute suicidal intent.

Treating Veterans at Risk for Suicide: An Examination of the Safety, Tolerability, and Outcomes of Cognitive Processing Therapy

“…Taken together, these results suggest that CPT is a safe treatment option for patients with low to acute suicide risk, and the severity of suicide risk does not impact patients’ abilities to respond to or complete the treatment. This aligns with previous clinical trials of CPT that have shown that suicidal ideation decreases after CPT (Bryan et al., 2016, 2018; Holliday et al., 2018; Stayton et al., 2019); however, the present study expands the literature through its examination of how baseline suicide risk level impacts treatment safety, tolerability, and PTSD symptom reduction. This provides a clinically useful view, as many clinicians face this common problem (i.e., comorbid PTSD and increased suicide risk), especially in military veterans.…”

“…Further, randomized control trials for trauma‐focused therapies, such as cognitive processing therapy (CPT), have generally omitted individuals deemed to be at acute risk for suicide (Maieritsch et al., 2016; Resick et al., 2008). More recently, clinical trials have examined suicidal ideation as an outcome of treatment (e.g., Resick, Wachen, et al., 017), and these data provide initial support for administering CPT to patients experiencing ongoing suicidal ideation and/or have a history of suicidal behavior (Bryan et al., 2016; Holliday et al., 2018; Stayton et al., 2019).…”

“…Further, the current CPT manual (Resick, Monson, et al., 2017) lists several therapist “stuck points” involving patient readiness for treatment due to suicide risk despite the empirical evidence supporting the administration of CPT with ongoing suicidal ideation and/or behavior (e.g., Bryan et al., 2016; Rozek & Bryan, 2020). Although providers may desire to delay CPT administration to patients who are at risk of suicide, empirical evidence suggests that suicidal ideation reduces over the course of treatment with CPT (Bryan et al., 2016; Holliday et al., 2018; Stayton et al., 2019). However, the paucity of data on how suicide risk itself impacts treatment tolerance and outcomes may still be a barrier for treatment providers with regard to the wider adoption of CPT implementation for higher‐risk patients.…”

More frequent negative social exchanges are associated with higher suicide ideation and risk in men service members/veterans

“…In addition to assessing for the presence of insensitive behaviors, it may be useful to help the service member learn how to effectively manage these interactions, while not increasing avoidant or solitary behavior. Improving social connections and decreasing perceptions of unlovability in veterans undergoing evidenced‐based treatment for trauma was associated with lower suicide‐specific beliefs (Holliday et al, 2018). Importantly, negative social exchanges may be consistent with the concept of thwarted belonging, which is a key component of the Interpersonal Theory of Suicide (Joiner, 2005).…”

Stress Disorders and the Risk of Nonfatal Suicide Attempts in the Danish Population

“…Our investigation clarifies the risk conferred by a diagnosis of PTSD and documents that this risk extends to the broader range of stress disorders, warranting appropriate safety precautions with this broader population. For lower‐risk patients, prior work has demonstrated that evidence‐based interventions for PTSD reduce suicidal behavior in addition to reducing PTSD symptom severity (Gradus et al., 2013; Holliday et al., 2018). Our investigation suggests the importance of effective stress‐disorder treatment across a range of stress disorders for reducing or preventing suicidal behavior.…”