Addressing Suicidal Behavior: Cognitive Behavioral Therapy And Suicide Prevention
- For those experiencing suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline at 988
- For those experiencing abuse, please contact the Domestic Violence Hotline at 1-800-799-SAFE (7233)
- For those experiencing substance use, please contact SAMHSA National Helpline at 1-800-662-HELP (4357)
Suicide prevention is an important public health objective that can help promote safety and mental and physical wellness in communities. Experts are consistently working to find approaches that can help reduce the risk of self-harm in individuals struggling with suicidal thoughts. Cognitive behavioral therapy (CBT) is one approach that studies indicate may help reduce suicidal ideation and reduce suicidal behavior. Here, we’re discussing the potential of cognitive behavioral therapy to reduce suicide risk and discussing how brief CBT in inpatient care may help individuals with a history of self-harm avoid engaging in related behaviors again.
Causes of suicidal behavior
Self-harm can occur for many different reasons, including emotional distress, a perceived lack of control, or a desire to be heard or understood. Often, individuals who experience suicidal thoughts or behaviors are having trouble navigating mental health or life challenges. The following are common sources of suicidal behavior.
Mental health concerns
Trauma, depression, anxiety, chronic stress, eating disorders, and several other mental health challenges can cause an individual to develop suicidal thoughts. Additionally, living with substance use disorder can contribute to self-harming behaviors.
There is evidence that up to 90% of individuals who die by suicide have experienced a mental illness. This does not, however, mean that all people with mental health conditions will necessarily experience suicidal thoughts. Many people with mental illnesses never experience suicidal ideation or behavior.
Life challenges
Certain life situations can create emotional distress, physical challenges, and other concerns that may be difficult for some people to manage. Major changes in an individual’s life—such as the death of a loved one, a divorce, or the loss of a job—can cause people to struggle to adjust.
Some people who experience suicidal thoughts are seeking to assert control over their lives. Others may be looking for help but struggling to communicate their needs in a healthy way.
What is cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy (CBT) is a widely utilized form of psychotherapy that focuses on the connections between an individual’s thoughts, feelings, and behaviors. CBT is used to treat a broad range of mental health conditions, including anxiety, depression, post-traumatic stress disorder, and obsessive-compulsive disorder. The duration of the modality can depend on several factors, but it often lasts for 10–20 sessions. CBT can be administered in various formats, including individual and group therapy sessions.
CBT takes the form of discussions between the therapist and participant. It also typically involves certain exercises and coping strategies meant to alleviate symptoms of psychological disorders. The therapeutic process may begin with conversations about the client’s primary concerns, including any mental health symptoms, life challenges, interpersonal conflicts, etc. The therapist and client may then develop goals for treatment (e.g., reduced depression, improved relationships with family members).
Treatment through CBT often involves cognitive reframing, or identifying and changing negative thought processes that are underlying maladaptive emotions and actions. Often, we develop unhelpful beliefs about ourselves, other people, or the world around us, which can influence the way we feel and behave. By changing these thought patterns, we may be better able to address mental health concerns, face life challenges, and foster healthy relationships.
How CBT can help with suicidal thoughts
Because cognitive behavioral therapy focuses on addressing negative thought patterns, it can often be an effective way of addressing suicidal ideation. The use of CBT for addressing self-harm is supported by research, with many studies suggesting that cognitive behavioral therapy may lead to reductions in suicidal thoughts and behaviors.
Reframing beliefs that are underlying suicidal thoughts
Cognitive reframing can help individuals change various thought patterns that may be contributing to suicidal ideation or behavior. Examining the evidence and positive reframing are two common techniques that can help individuals restructure negative thoughts. These involve the therapist asking the participant to take a closer look at the proof underlying their assumptions, then restructuring that thought process.
For example, consider a situation in which an individual with a depressive disorder has low self-esteem related to their career, leading them to experience suicidal thoughts. Using CBT principles, a therapist may help the participant realize that their self-value is based on unrealistic expectations—and that they have already achieved quite a bit. The individual may then be prompted to frame their career progress in positive terms, focusing on their successes. By changing an underlying thought pattern, the client may come to feel less negatively about their career path, which may lead to a decrease in depression symptoms and reductions in suicidal thoughts.
Therapy and suicide prevention: Integrating CBT into inpatient care
One of the most significant risk factors for self-harm is a previous suicide attempt. Individuals who are in inpatient care after an attempted suicide may continue to experience suicidal ideation. According to some estimates, the suicide risk among patients at psychiatric hospitals is 50 times greater than that of the general population. Research also suggests that suicide rates are elevated in people who have been discharged following psychiatric hospitalization.
The challenges of addressing suicidal behavior in psychiatric care
According to research published on a National Institutes of Health website, psychiatric hospitalizations are becoming shorter in duration, meaning there is often less time to provide individual therapy. In some cases, group therapy is the primary form of psychotherapy. Treatment during inpatient care is often focused on medication, patient safety, and symptom stabilization.
That said, when interventions are incorporated into inpatient care—like cognitive behavioral therapy—they may serve as protective factors against suicidal ideation. In addition to CBT, modalities like dialectical behavior therapy (DBT) and the Collaborative Assessment and Management of Suicidality (CAMS) can be helpful when integrated into psychiatric care plans.
DBT—which was originally developed to address suicidality—is a form of psychotherapy that focuses on reducing the power of intense emotions. CAMS is an approach centered around addressing the various sources of self-harming actions through tools like the Suicide Status Form, which evaluates warning signs of suicidal behavior.
There are also potentially effective approaches that allow an individual’s family members to participate in their treatment. For example, attachment-based family therapy is a modality that research suggests may help decrease suicidal ideation and symptoms of depression.
Research on brief cognitive behavioral therapy and suicide prevention
In a 2024 study, researchers examined the effects of a brief CBT program for individuals receiving inpatient care for suicidal behavior. The randomized controlled trial was conducted by providing half of the 200 participants with treatment as usual and the other half with treatment as usual as well as brief CBT.
After six months post-discharge, researchers report that the implementation of the brief CBT intervention reduced the likelihood of suicide attempts by 60%. Additionally, the rate of readmission decreased by 71%. These findings suggest that incorporating even a short-term psychosocial treatment may significantly reduce the suicide rate among individuals in psychiatric care.
Spreading awareness to help prevent suicide
If you’re seeking to help prevent suicide in your community, there are several ways of getting involved in awareness campaigns and other initiatives. One approach is volunteering with a suicide prevention organization, such as the American Foundation for Suicide Prevention (AFSP), the Society for the Prevention of Teen Suicide (SPTS), or the Suicide Prevention Resource Center (SPRC). For example, you could help organize a community walk through the AFSP, which holds Out of the Darkness Walks in cities around the US.
Volunteering for suicide prevention organizations
There are also many suicide prevention hotlines where a person can volunteer. For example, the 988 Suicide & Crisis Lifeline has a list of career and volunteer opportunities in various regions of the US. You can become trained as a crisis counselor, serve in a management role, or help with administrative tasks.
Developing awareness initiatives to help prevent suicide
You can also spread awareness through community outreach programs or social media platforms. You might help promote the programs of the suicide prevention organizations listed above. In addition, you could make a specific effort to check in on your friends and loved ones, act as a listening ear when they need one, and encourage them to seek mental health support if they're struggling.
Connecting with a mental health care provider
In therapy, you can learn about and implement cognitive behavioral therapy concepts as you work to cultivate emotional wellness. Those who are looking to receive CBT treatment from a qualified professional can typically find a provider in person or online, depending on their preferences. For many, online therapy can be a convenient way of finding and working with a mental health professional.
The potential benefits of online cognitive behavioral therapy
When you sign up for an online therapy platform like BetterHelp, you can get matched with a therapist from a team of mental health professionals based on your needs and preferences as outlined in a questionnaire. This process can make it easier to find a professional you feel comfortable with. You can also switch providers at any time for no additional cost. Once matched with a therapist, you can meet with them via phone, video, or in-app messaging from home or anywhere you have internet.
The effectiveness of online CBT
Research suggests that online cognitive behavioral therapy may help alleviate symptoms of mental health conditions that are associated with suicidal ideation. For example, a meta-analysis of 19 studies suggests that incorporating online CBT into routine care improved symptoms of depression and anxiety in participants. The analysis also notes that online therapy platforms can help bridge the treatment gap that exists due to barriers like availability of providers. Keep in mind, however, that individuals experiencing acute symptoms of suicidal ideation may require immediate in-person treatment rather than online care.
Takeaway
How do therapists deal with suicidal clients?
When clients are having suicidal crises in therapy, a therapist may ask them several questions to develop a treatment plan or refer the individual to crisis services. In their comprehensive evaluation, they may ask clients if they are only having suicide ideation or if they have a plan. If they have a suicide plan, the therapist may then ask for additional details, and if the client is a direct risk to themselves (or others), the therapist is mandated to help the client get emergency services. In this case, they may be sent to the emergency room or a psychiatric inpatient facility for treatment.
How do suicidal people tend to think about the future?
When someone is experiencing suicidal ideation or planning future suicide attempts, they may think of the future only in the short term. They might start selling their belongings, giving items away, and spending more time with loved ones to enjoy their “last moments.” They might avoid discussing plans with loved ones and instead seem withdrawn and “spaced out.” They might not seem sad, even if they are. In attempts to hide their plans, they might act as if everything is fine, which can be confusing for people who lose someone to suicide.
Some people report that their loved ones seem happier than usual right before a suicide attempt. For this reason, talking to your loved ones and being aware of the vulnerable groups who are at a high risk of suicide can be crucial. Psychotherapeutic intervention, psychosocial interventions, and inpatient hospitalization can also be helpful treatment strategies for reducing one’s risk of suicide.
What are the three Rs of suicide intervention?
The three Rs of suicide prevention are recognize, respond, and refer. In the recognize stage, loved ones and professionals look for signs of mental disorders and symptoms that put a person at a higher risk of suicide. When signs are recognized, the response begins. A response can include emergency treatment, psychoeducation to reduce suicidal ideation, and putting systemic support resources in place, such as housing, food support, and referrals to treat patients. Some people may also benefit from family support during this stage, especially suicidal adolescents who may struggle with treatment if they are frequently isolated from loved ones.
According to preliminary findings from several studies and clinical trials, dialectical behavior therapy (DBT), interpersonal therapy (IPT), and cognitive behavior therapy (CBT) are typical modalities used to treat patients with suicidal ideation. Further research is recommended to understand immediate crisis response efforts that may be more effective in reducing suicide risk, as early intervention and crisis support are essential components to reducing the chances of further suicide attempts. You can find out more information about suicide prevention from resources like the World Health Organization (WHO) and the National Institute of Mental Health (NIMH), which offer collaborative assessment advice and problem-solving techniques, essential components of suicide prevention efforts.
What are the three levels of strategies for suicide prevention?
There are three levels of suicide risk: primary, secondary, and tertiary. The strategies used to support these individuals differ based on urgency. Primary risk refers to people who have suicidal ideation but don’t necessarily require emergency or crisis support. Secondary risk refers to an emerging crisis and can be a time for someone to receive crisis intervention. Tertiary risk is the most severe and involves people who are actively planning a suicide attempt or have attempted suicide and are receiving emergency services.
What ratio of suicides have warning signs?
50% to 70% of people who die by suicide show warning signs of suicidal thoughts in the weeks before. Signs to look out for include:
- The person is giving away or selling their belongings
- The person is acting in unexpected ways
- They are talking about death frequently
- They refuse to talk about the future or plans with loved ones
- They are withdrawing from socialization and seem sad frequently
- They are showing symptoms of depression
- They’ve recently gone through a traumatic event and are struggling to cope
- They keep making self-loathing comments, such as “No one cares about me”
- They’ve had previous suicide attempts and are experiencing a sudden mood shift
What is the first rule of working therapeutically with suicidal clients?
The first rule of working with suicidal clients is to be empathetic and non-judgmental. Allow the client to share all their thoughts freely. If you are mandated to report what they’ve shared and contact crisis services, let them know why you’re doing so and what it means for them. Walk them through the process and what inpatient psychiatric support might look like if they are referred to those services. Clients who haven’t gone to the hospital for suicidal ideation before might not know what to expect and could be scared.
What is psychodynamic therapy for suicidal patients?
Psychodynamic therapy focuses on the connection between subconscious thoughts and relationships. This modality might be used to look at the causes of suicidal thoughts and help clients restructure their relationships and have more fulfilling connections. Since social connections can reduce frequent causes of suicidality, this modality may help people prevent suicide by strengthening existing relationships.
What is the treatment of choice in depression with suicidal tendencies?
The most common therapeutic modalities recommended for depression include CBT, DBT, and IPT. These three modalities can help people cope with intense emotions and reframe thoughts that may contribute to suicidality.
What are the different therapies for suicidal people?
Over 400 therapy modalities exist, and each client differs in what works for them. However, the most frequently used modalities for suicide ideation include cognitive-behavioral therapy, interpersonal therapy, mindfulness-based cognitive therapy (MBCT), and DBT.
Is DBT good for suicidal ideation?
Dialectical behavior therapy can be beneficial for suicidal ideation because the two modalities focus on tolerating distress and working through challenging emotions. DBT can be a helpful option for those with intense or sensitive emotions. This modality was initially developed to treat borderline personality disorder (BPD), a disorder frequently associated with suicidal ideation.
- Previous Article
- Next Article