Addressing Suicidal Behavior in the U.S. Military: Strategies for Assessment, Crisis Intervention, and Treatment

This intensive 2-day module provides training in the assessment and treatment of suicidal ideation and behavior for behavioral health providers working with Service members. Risk and protective factors will be discussed. Participants will have the opportunity to practice classification of suicidal ideation and behaviors. Suicide risk assessment, including special considerations, will be addressed. Empirically-supported strategies for suicide prevention will be reviewed. Participants will receive in-depth training in cognitive-behavioral therapy for suicide and will have the opportunity to practice assessment and intervention strategies. Role-plays will be done in class to practice assessment and treatment techniques, and participants must attend both days.

A.  Epidemiology of Suicide

            1.  Global

            2.  National

            3.  Military

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

            1.  Joiner’s Interpersonal-Psychological Theory of Suicide Risk (IPT)

            2.  Rudd’s Fluid Vulnerability Theory of Suicide Risk (FVT)

                        a.  Baseline Risk

                        b.  Acute Risk

G.  Crisis Intervention

            1.  Hospitalization

            2.  Suicide Crisis Line

H.  Evidence-Based Approaches to Suicide Risk Management

            1.  Clinical Practice Guidelines

            2.  Empirically-Supported Treatments

I.  Cognitive Therapy for Suicidal Patients

            1.  Introduction to CT for Suicidal Behavior – Overview of TX

            2.  Early Phase

                        a.  Therapeutic Relationship/Rapport

                        b.  Risk Assessment

                        c.  Session Structure

                        d.  Narrative Description

                        e.  Crisis Intervention

                        f.  Means Restriction

                        g.  Treatment Planning & Developing Treatment Goals

                                    * Constructing a Timeline of the Suicidal Crisis

                                                - Timeline activity

                                    *  Cognitive Case Conceptualization

            3.  Intermediate Phase

                        a.  Behavioral Strategies

                        b.  Affective Coping Strategies

                        c.  Cognitive Strategies

                        d.  Identification of Core and Intermediate Beliefs

            4.  Later Treatment Phase

                        a.  Review and Consolidation of Skills

                        b.  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

                        c.  Review of Treatment Goals

                        d.  Additional Treatment Planning

J.  Challenges of Managing Suicide Risk and Intervention in a Deployed Setting

            1.  Specific Challenges

            2.  Acquired Capability/Firearm Accessibility

            3.  Treatment of Re-Experiencing Symptoms

            4.  Sleep Problems

            5.  Agitation and Hyperarousal

            6.  Social Support

            7.  IPT Treatment Implications

            8.  Limited Access to Care

            9.  Motivation for Treatment

            10.  Considerations for Managing Suicide Risk While Deployed

K.  Special Considerations

            1.  Therapist Attitudes

            2.  Provider Self-Care

Learning Objectives:

  1. Articulate a few common misperceptions about suicide and suicide attempts.
  2. Consider some of the negative consequences of the stigma associated with suicide and suicide attempts.
  3. Discriminate between rates of suicide in civilian and military populations.
  4. Categorize suicidal and non-suicidal thoughts and behaviors.
  5. Communicate several warning signs for suicide.
  6. Point out some of the similarities and differences in suicide risk factors between civilian and military populations.
  7. Apply at least one psychological theory of suicide which describes either a model of suicide risk, or a process of risk assessment.
  8. Scrutinize a few of the unique challenges associated with suicide risk assessment and prediction.
  9. Assess risk for suicide in a manner that is sensitive to both proximal and distal risk factors.
  10. Collaborate with a patient to complete a safety plan.
  11. Evaluate key negative automatic thoughts associated with the intent to die by suicide.
  12. Create a timeline of a patient's suicidal crisis.
  13. Utilize Cognitive Behavioral Therapy for Suicide in the treatment of suicidal behavior.
  14. Anticipate some of the specific challenges associated with assessing and managing suicide risk during deployment.

Notes: Demonstrations, role-plays, videos, and case examples will be incorporated throughout the presentation. recommend prerequisite for this course is Identification, Prevention, and Treatment of Suicidal Behavior for Service Members and Veterans