Cognitive-Behavioural Problem Solving in the Treatment of Patients who Repeatedly Attempt Suicide a Controlled Trial

Abstract

In a controlled trial, 20 patients at high risk of repeated suicide attempts were randomly allocated to either cognitive-behavioural problem solving or a 'treatment-as-usual' control condition. The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

“…For information on the effectiveness of the remaining interventions not covered in this report the reader is instead referred to our review in the Cochrane Library. 13 A total of 29 trials were therefore included in the present review (Figure 1; Supplementary Document SD3), comprising 18 trials of cognitive behavioural-based psychotherapy (CBT), [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] three trials of dialectical behaviour therapy (DBT), [36][37][38] and four trials each of case management [39][40][41][42] and postcards. [43][44][45][46] (Insert Figure 1 about here)…”

“…[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Data on the proportion of patients repeating self-harm by the end of treatment was only available for one trial, 27 in which there was no apparent effect (23/171 vs. 27/142, OR 0·66, 95% CI 0·36 to 1·21, N=313). However, CBT-based therapy was associated with fewer participants repeating self-harm at the six month (OR 0·54, 95% CI 0·34 to 0·85, N=1,317; Figure 2) and 12 month follow-up assessments (OR 0·80, 95% CI 0·65 to 0·98, N=2,232; Figure 2).…”

A review of the literature on the prevention of suicide through interventions in Accident and Emergency Departments

“…Where follow-up takes the form of an out-patient appointment, the specialist nurse is responsible for checking up on attendance. · Time-limited, problem-solving therapy (following the model described in Salkovskis et al, 1990) for patients with clear indication of risk of repeat DSH. · Problem-solving/supportive counselling for patients identi®ed by A&E staff as having psychological problems, possibly targeting those with chronic and disabling physical illness.…”

“…These criteria have been used in several research studies to identify those at most serious risk of repeat DSH (e.g. Salkovskis et al, 1990). However, their use in clinical practice is limited as they do not identify all those at risk of suicide.…”

“…Their role has included the assessment of all DSH patients in A&E; provision of problem-solving counselling interventions for DSH patients ± if necessary in their own homes and involving family members; ensuring appropriate referral to relevant agencies; following up patients who discharge themselves; and establishing close links with A&E staff, medical wards where patients are admitted, and appropriate psychiatric services. Only one of these services has been fully evaluated (Salkovskis et al, 1990), and the results of this study are discussed above.…”