Inpatient Cognitive Behavior Therapy Approaches for Suicide Prevention

Abstract

Within the current healthcare system, individuals recognized to be at imminent risk for suicide are likely to be referred for inpatient psychiatric care. The hospitalization setting provides a safe and supportive environment for specialty acute care services and stabilization. However, the majority of current interventions that are delivered to suicidal patients during this sensitive timeframe do not directly target suicide risk. Cognitive Behavior Therapy (CBT) is an evidence-based psychotherapeutic intervention that can easily be adapted for use in psychiatric inpatient settings. A specialized outpatient CBT protocol for suicide prevention has been developed and empirically evaluated by Drs. Aaron Beck and Gregory Brown at the University of Pennsylvania. This brief and targeted outpatient CBT program has been found to be efficacious in reducing the likelihood of subsequent suicide attempts by 50 %. Post-Admission Cognitive Therapy (PACT) is an inpatient adaptation of the CBT protocol for suicide prevention, developed by Dr. Marjan Ghahramanlou-Holloway at the Uniformed Services University of the Health Sciences. PACT is currently undergoing empirical validation, but it is important to note that the components of PACT are all cognitive behavioral practices recognized to reduce suicide risk. PACT is a promising inpatient CBT program that can be delivered in individual format to suicidal Curr Treat Options Psych (2015) 2:371-382 patients during their hospital stays. This intervention provides an opportunity to collaboratively review the suicide narrative, to conceptualize underdeveloped and overdeveloped skills directly tied to suicide risk, and to plan for safety and relapse prevention. Moreover, based on their conceptualization of the suicide mode activation for each patient, PACT clinicians choose cognitive behavioral strategies to modify thoughts, emotions, and/or behaviors that are most likely to result in a recurrence of suicidal behaviors. This paper provides a brief review of inpatient-based CBT options, introduces providers to the PACT inpatient protocol, and describes several promising alternate interventions.

A Lived Experience Co-Designed Study Protocol for a Randomised Control Trial: The Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as Additional Interventions After a Suicide Attempt Compared to a Standard Suicide Prevention Pathway (SPP).

“…Both ASSIP and the Brief CBT for Suicide Prevention have an existing evidence base and both have been shown to be cost effective in their own right (17,33). In addition, the effect and cost-effectiveness of both interventions are not known when delivered in the context of a clinical Suicide Prevention Pathway, which has, itself, been shown to reduce representations with suicide attempts compared to traditional treatment (34).…”

Treating Suicidal Thoughts and Behaviors Within an Emotional Disorders Framework: Acceptability and Feasibility of the Unified Protocol in an Inpatient Setting

“…Given the strong need for evidence-based interventions for STBs within inpatient programs (e.g., G. K. Brown & Jager-Hyman, 2014; Ghahramanlou-Holloway, Cox, & Greene, 2012; Ghahramanlou-Holloway, Neely, & Tucker, 2015; O’Connor et al, 2015), we made several modifications to the published UP (Barlow, Ellard, et al, 2011; Barlow, Farchione, et al, 2011) so that the resultant intervention would be deliverable within an inpatient setting. First, given that most patients are hospitalized for relatively brief periods of time (e.g.…”

Reducing Suicide by Providing Cognitive Behavioral Therapy for Suicide Prevention

“…There were five systematic reviews Calati & Courtet, 2016;Ghahramanlou-Holloway et al, 2015;Mewton & Andrews, 2016;Tarrier et al, 2008). The five systematic reviews all had large RCT reviews ranging from 16 to 32.…”

“…All five systematic reviews identified studies from PsycINFO, Cochrane Library and/or Web of Science databases. One systematic review cited the intervention of reducing suicide ideation and attempts by introducing CBT-SP while patients are on the acute in-patient psychiatric units (Ghahramanlou-Holloway et al, 2015). The strength of all five systematic reviews was each had serial monitoring of the effectiveness of CBT-SP.…”

“…TAU did not include CBT-SP but can include one or more of the following: multidisciplinary therapy, psychotherapy only, pharmacotherapy only, treatment by primary care provider, or minimal to no follow-up (Witt et al, 2018). It is only through enhancement of coping skills and reduction of isolation by providing support and stressing the importance of adherence to mental health and/or substance abuse disorder treatment, can the ultimate goal of reduced suicide attempts be met (Ghahramanlou-Holloway et al, 2015).…”