Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review

Abstract

Objective: To study whether cognitive behavioural therapy decreases suicide attempts in people with previous suicide attempts. Design: Systematic review and meta-analysis. Setting: Randomised trials that compare cognitive behavioural therapy with treatment as usual. Participants: Patients who had engaged in any type of suicide attempt in the six months prior to trial entry resulting in presentation to clinical services. Main outcome measure: Suicide attempt. Results: We included ten trials, eight from Cochrane reviews and two from our updated searches (1241 patients, 219 of whom had at least one new suicide attempt). Cognitive behavioural therapy compared to treatment as usual reduced the risk of a new suicide attempt; risk ratio 0.47; 95% confidence interval 0.30-0.73; p ¼ 0.0009; I 2 ¼ 57%. Only seven suicides were reported (3 versus 4). One trial had an unusually large effect; if this trial is excluded, the risk ratio becomes 0.61 (0.46-0.80) and the heterogeneity in the results disappears (I 2 ¼ 0%). Conclusions: Cognitive behavioural therapy reduces not only repeated self-harm but also repeated suicide attempts. It should be the preferred treatment for all patients with depression.

Resilience as a focus of suicide research and prevention

“…Cognitive behaviour therapy (CBT) may help to develop resilient personality features . CBT is defined as structured, present‐oriented psychotherapy focused toward resolving current problems and teaching individual skills to change maladaptive thinking and behaviours . CBT can work as a tool to assist patients to modify their perceptions to those of capability and control, of hopes for the future, and of their own resilience.…”

Study of Risk Factors Associated with Suicide Attempt in Patients with Bipolar Disorder Type I

“…[57][58][59] Cognitive behavioral therapy has been found to reduce both repeated suicidal attempts and NSSH behaviors. 60 Other therapies such as emotion regulation group therapy and dynamic deconstructive psychotherapy have been found to be effective, though evidence is limited. 61 Behavioral interventions which addressed the suicidal ideas directly were found to have effects posttreatment as well as in long term indicating the need to discuss suicidal ideations on evaluation.…”

Patients not patents: Drug research and development as a public enterprise

“…Another example is the high and increasing usage of psychiatric drugs, which has been accompanied by an increase in disability pensions in all countries where this relationship has been investigated . In most situations, psychotherapy should be the preferred option, and in contrast to drugs, it reduces the risk of suicide …”

“…22 In most situations, psychotherapy should be the preferred option, 12 and in contrast to drugs, it reduces the risk of suicide. 23 The industry's justification for patents and high drug prices is that patents are needed to recoup the high costs of drug development and thus ensure a needed supply of new drugs. Around 15 years ago, the industry narrative put the cost of developing a new drug at about US $1 billion, 18,24 while independent analysts arrived at a figure that was 10% of this.…”