Changes in suicidal ideation following cognitive processing therapy in a VA residential treatment program

Stayton, Laura E.; Martin, Colleen E.; Pease, James L.; Chard, Kathleen M.

doi:10.1080/08995605.2019.1630230

Cited by 14 publications

(32 citation statements)

References 36 publications

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“…This is especially promising given the severity of symptoms and high-risk level of veterans enrolled in residential treatment. These data are consistent with previous work in both military and nonmilitary samples showing that outpatient evidence-based treatments for PTSD reduce SI (Bryan et al, 2016;Cox et al, 2016;Gradus et al, 2013;Norr et al, 2018;Resick et al, 2017) and extends to the findings across residential settings (Stayton et al, 2019).…”

Section: Discussionsupporting

confidence: 90%

“…The results also support the practice of engaging individuals with SI in PTSD treatment rather than considering SI a contraindication for treatment. A significant proportion of the sample had remitted SI and decreased severity across treatment, consistent with prior literature (Bryan, Leifker, Rozek et al, 2018; Gradus et al, 2013; Stayton et al, 2019).…”

Section: Discussionsupporting

confidence: 86%

“…Clinical practice guidelines recommend trauma‐focused psychotherapy as first‐line treatment as these protocols have the best evidence in alleviating PTSD symptoms (Management of Posttraumatic Stress Working Group, 2017). These very treatments (e.g., CPT and PE) are those that have shown effects on SI (e.g., Stayton et al, 2019), so it could be particularly helpful to emphasize treatment matching to enhance outcomes. There could be modifications made for residential treatments to enhance effectiveness for this population including intensive daily format (e.g., Bryan et al, 2018) or variable length treatment (Galovski et al, 2012); these more intensive treatments could reduce length of stay while still providing an adequate dose of therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Change in PTSD was significantly associated with change in SI even after controlling for baseline depression and change in hopelessness. SI also decreased following CPT among veterans in both an intensive outpatient treatment program and a residential PTSD program (Bryan, Leifker, Rozek et al, 2018; Stayton, Martin, Pease, & Chard, 2019). Overall, these studies indicate that PTSD treatment delivered in individual and group modalities is associated with reductions in SI.…”

Section: Introductionmentioning

confidence: 99%

“…In the only existing study of suicidality among a national sample of veterans in residential treatment for PTSD to our knowledge, baseline severity of specific PTSD clusters (i.e., arousal and re‐experiencing symptoms) and recent alcohol misuse were related to higher likelihood of having engaged in suicide attempts in 4 months before starting treatment (Watkins, Sippel, Pietrzak, Hoff, & Harpaz‐Rotem, 2017). A recent study at a single VA medical center examining SI among those who participated in CPT indicated decreasing SI across treatment (Stayton et al, 2019). To date, however, the prevalence of courses of SI among veterans seeking residential treatment for PTSD remain unknown, as do the effects of residential treatment for PTSD on the presence and courses of SI in a national sample.…”

Section: Introductionmentioning

confidence: 99%

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Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

et al. 2020

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Background Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment. Methods A total of 1,807 veterans receiving residential PTSD treatment at Department of Veterans Affairs medical facilities who completed self‐report measures at admission and discharge were included. Results The prevalence of SI courses were No SI (33.6%), Remitted SI (23.0%), SI onset (6.0%), and Chronic SI (37.4%). There were group differences between the four SI courses in PTSD symptoms at baseline, magnitude of PTSD symptom change during treatment, race/ethnicity and baseline depression, substance use, physical functioning, and pain. Chronic SI was associated with highest baseline PTSD, depression, substance use, pain and worse physical functioning. Remitted SI course was associated with greatest pre‐posttreatment PTSD improvement, followed by No SI, Chronic SI, and SI Onset. Multinomial logistic regressions revealed that PTSD symptom improvement and baseline PTSD symptoms most consistently related to symptomatic SI courses compared to less symptomatic or No SI courses. Receipt of trauma‐focused psychotherapy (none, some, or adequate) and length of stay were not related to SI courses and did not differ between groups. Conclusions Findings indicate that treating PTSD symptoms could be impactful for reducing suicidal thoughts. Although many veterans had remitted or reduced severity of SI at discharge, a significant proportion of veterans reported SI at discharge (43.4%), potentially highlighting the need for suicide specific treatment interventions within the context of PTSD treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

et al. 2020

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Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder

Blain

Pukay‐Martin

Martin

et al. 2020

Journal of Traumatic Stress

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The interpersonal theory of suicide (Joiner, 2005) may help explain high suicide rates among veterans with posttraumatic stress disorder (PTSD). It suggests that suicidal ideation results from believing that one is a burden on others (i.e., perceived burdensomeness) and does not belong among family, friends, or other social groups (i.e., thwarted belongingness). Evidence‐based PTSD treatments, including cognitive processing therapy (CPT), decrease suicidal ideation, potentially through changes in these two theory constructs. The current study examined whether (a) changes in PTSD severity and suicidal ideation and (b) changes in negative cognitions about self and suicidal ideation were indirectly associated through changes in perceived burdensomeness and thwarted belongingness across PTSD treatment. Participants (N = 107) were veterans in a residential treatment program who were diagnosed with full or subthreshold PTSD and received CPT. Changes in PTSD symptom severity and negative cognitions about self predicted changes in suicidal ideation, B = 0.18, p < .001 and B = 0.50, p < .001, respectively. Changes in PTSD symptom severity and negative cognitions about self were indirectly associated with suicidal ideation through changes in perceived burdensomeness, B = 0.16, 95% CI [0.07, 0.25]; B = 0.27, 95% CI [0.05, 0.50], but not thwarted belongingness, B = −0.002; 95% CI [−0.06, 0.06]; B = 0.06, 95% CI [−0.12, 0.21] in separate models. These findings suggest that residential CPT may be uniquely equipped to decrease suicidality by restructuring negative beliefs, including perceptions of being a burden on others, and/or by alleviating the objective burden of PTSD.

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

Roberge

Harris

Weinstein

et al. 2021

Journal of Traumatic Stress

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Individuals with posttraumatic stress disorder (PTSD) are at increased risk for suicidal thoughts and behaviors; however, clinicians often report apprehension about recommending trauma‐focused therapy to patients with an increased risk of suicide. The present study aimed to evaluate the safety, tolerability, and response to cognitive processing therapy (CPT) among a sample of military veterans with PTSD and increased suicide risk. A secondary aim was to provide a clinically useful definition of high suicide risk. Chart review was used to classify the suicide risk level of 290 veterans who participated in CPT at a Veterans Affairs clinic. Treatment outcomes in veterans with different suicide risk levels were also gathered and compared. Over 50% (n = 155) of the sample demonstrated increased suicide risk, and 1.0% (n = 3) engaged in suicidal behavior after initiating treatment. To date, hospital records show no suicide deaths since 2016 among clinic patients who received CPT. Suicide risk level was not associated with CPT tolerability, and PTSD symptom change was equivalent across groups, ps = .085–.976. Veterans across groups reported clinically significant reductions in PTSD symptoms. The tested suicide risk categorization schemes performed similarly in differentiating the odds of CPT completion and PTSD symptom reduction. These results suggest that veterans with PTSD and an increased risk of suicide, including those with previous suicide attempts and current ideation, can tolerate and benefit from CPT. Additional variables must be considered to truly determine the acute and imminent suicide risk that would deem CPT to be contraindicated.

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Changes in suicidal ideation following cognitive processing therapy in a VA residential treatment program

Cited by 14 publications

References 36 publications

Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder

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

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