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

Abstract

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.

Addressing co‐occurring suicidal thoughts and behaviors and posttraumatic stress disorder in evidence‐based psychotherapies for adults: A systematic review

“…Overall patterns of outcomes remained the same regardless of the format in which CPT was delivered (i.e., massed or daily treatment, weekly, individual, or group), trauma type, or to whom it was delivered, although the populations within studies were predominantly military personnel and/or veterans (Blain et al., 2020; Bryan et al., 2018; Resick et al., 2017; Stayton et al., 2019; Johnson et al., in press; Holliday et al., 2018; Horwitz et al., 2018; Roberge et al., 2021; Bryan et al., 2016; Resick et al., 2015). One study included civilians (Johnson et al., in press), and another study looked at women rape survivors only (Gradus et al., 2013).…”

“…There were 11 studies that included CPT. Eight studies examined CPT only (Blain et al., 2020; Bryan et al., 2018; Resick et al., 2017; Stayton et al., 2019; Johnson et al., in press; Holliday et al., 2018; Horwitz et al., 2018; Roberge et al., 2021) and three studies compared CPT to another EBT (Bryan et al., 2016; Gradus et al., 2013; Post et al., in press; Resick et al., 2015). Ten CPT studies showed reductions in both PTSD‐ and suicide‐related outcomes, with the majority reporting significant reductions and, generally, few or no reports of suicidal ideation or behaviors at posttreatment or follow‐up assessments.…”

Comparison of mental health outcomes of augmenting medications for patients with posttraumatic stress disorder: A national veterans affairs study

“…Trials could also compare augmenting medications to nonpharmacological interventions, such as psychosocial stabilization interventions and evidence‐based psychotherapy for PTSD, which do not carry the health risks of medication 41,42 . Evidence‐based psychotherapy for PTSD has been found to help improve complex symptoms such as suicide risk and psychotic symptoms 43–46 . Thus, clinicians may consider offering these treatments to patients as soon as possible to help prevent crisis situations as well as improve PTSD symptoms.…”

“…41,42 Evidence-based psychotherapy for PTSD has been found to help improve complex symptoms such as suicide risk and psychotic symptoms. [43][44][45][46] Thus, clinicians may consider offering these treatments to patients as soon as possible to help prevent crisis situations as well as improve PTSD symptoms.…”

Introduction to the Special Issue on Posttraumatic Stress and Suicide

“…Moreover, some anecdotal reports from returning veterans suggest that the loss of perceived usefulness and the meaningful role derived from their military service is integrally implicated in the loss of a sense of having a life worth living. The subsequent article by this research team takes a translational bent by examining whether directly addressing these maladaptive appraisals improves outcomes for traumatized veterans under treatment (Blain et al., 2021). The results show that, among veterans undergoing cognitive processing therapy (CPT) for PTSD, treatment‐related changes in levels of PTSD symptoms and negative self‐cognitions were associated with reduced suicidal ideation.…”