Cognitive Behavioral Therapy for Suicide Prevention

This intensive two-day module provides training in the assessment and treatment of suicidal ideation and behavior. Participants will receive in-depth training in cognitive-behavioral therapy for suicide prevention and will have the opportunity to practice assessment and intervention strategies. Video demonstrations and participant role-plays will be used in class to practice key assessment and treatment techniques. The module lays the foundation for working with suicidal patients by providing a detailed review of the epidemiology of suicide both in the civilian population and within the military/veteran community. Participants will be introduced to the Self-Directed Violence Classification System (SDVCS), a nomenclature supported by the DoD/VA for self-directed violence and suicidal behavior and will have the opportunity to practice using the nomenclature during the workshop. In addition, a review of several theories of suicide will be covered as well as a risk and protective factors for suicidal behavior. The module is designed for behavioral health providers working with Service members and Veterans who are seeking in-depth training in empirically supported treatment options they can immediately incorporate into their clinical practice. The training will provide hands on practical activities and is geared towards an actively involved audience through discussion and in workshop activities. Participants must attend both days, as the course material is cumulative.

A. Epidemiology of Suicide

  1. Global
  2. National
  3. Military
  4. Veteran

B. Stigma

  1. Historical Context
  2. Definition
  3. Myths About Suicide
  4. Brief Discussion About Reducing Stigma
  5. Video

C. Nomenclature

  1. Why Develop a Nomenclature
  2. Review/Teach the Nomenclature
  3. Nomenclature Exercise

D. General Population Risk and Protective Factors

  1. Risk Factors
  2. Warning Signs
  3. Protective Factors

E. Military Risk and Protective Factors

  1. Protective Factors
  2. Risk Factors
  3. Comorbid Conditions as Risk Factors

F. Theories of Suicide

  1. Joiner’s Interpersonal-Psychological Theory of Suicide Risk (IPT)
  2. Rudd’s Fluid Vulnerability Theory of Suicide Risk (FVT)
  •  Baseline Risk
  • Acute Risk

G. Crisis Intervention: Hospitalization

H. Evidence-Based Approaches to Suicide Risk Management

  1. Clinical Practice Guidelines
  2. Empirically-Supported Treatments

I. Cognitive Therapy for Suicidal Patients (CT-SP)

  1. Introduction to CT for Suicidal Patients – Overview of TX
  2. Early Phase
  • i. Therapeutic Relationship/Rapport
  • ii. Risk Assessment
  • iii. Session Structure
  • iv. Narrative Description
    • v. Crisis Intervention
      ​1. Safety Planning
      2. Hope Box
      3. Means Safety Counseling

vi. Treatment Planning & Developing Treatment Goals

  1. Constructing a Timeline of the Suicidal Crisis
  2. Timeline activity
  3. Treatment planning

c. Intermediate Phase

  1. Behavioral Strategies
  2. Coping Strategies
  3. Cognitive Strategies

d. Later Treatment Phase

  1. Review and Consolidation of Skills
  2. Relapse Prevention
  • Preparation phase
  • Review of most recent suicidal crisis
  • Review of recent suicidal crisis with skills
  • Review of future suicidal crisis
  • Debriefing and follow-up

iii. Review of Treatment Goals and Additional Treatment Planning

J. Special Considerations

  1. Losing a patient to suicide – Impact on providers
  2. Available resources

Learning Objectives:

1. Differentiate between rates of suicide in civilian and military populations and identify the clinical implications of these differences.
2. Categorize suicidal and non-suicidal thoughts and behaviors in relation to clinical assessment.
3. Communicate several warning signs for suicide that inform decisions about clinical interventions.
4. Apply at least one psychological theory of suicide to the process of clinical assessment and treatment planning.
5. Incorporate suicide risk and protective factors unique to military populations into overall risk assessment for suicide.
6. Scrutinize unique challenges associated with suicide risk assessment and prediction in the clinical setting.
7. Assess risk for suicide in a manner that is sensitive to both proximal and distal risk factors.
8. Collaborate with a patient to complete a safety plan.
9. Use means safety counseling in patient interactions to improve clinical outcomes.
10. Create a timeline of a patient's suicidal crisis for use in treatment.
11. Evaluate key negative thoughts associated with the intent to die by suicide as related to clinical practice.
12. Apply CBT formulation of suicide using the expanded case conceptualization model of the suicidal crisis.
13. Implement cognitive, behavioral and affective coping strategies utilized in CBT-SP to help patients cope with suicide urges.
14. Characterize the modifications to standard behavioral activation when applied within the CBT-SP protocol.
15. Utilize the guided imagery exercise as part of the relapse prevention protocol for CBT-SP.
Notes: Demonstrations, role-plays, videos, and case examples will be incorporated throughout the presentation