In a pilot study, a therapy called Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) showed that “the rate of suicidal events among participants who chose the new therapy was lower than rates typically found in surveys of suicidal teenagers” according to a Jan. 31 news release from Columbia University Medical Center. The news release suggests that CBT-SP merits more rigorous research.
Because of the pilot study’s design (the participants chose their own treatment among three choices: talk therapy, antidepressants, or both), the therapy’s effectiveness is still uncertain, and a randomized, controlled clinical trial is needed.
“Our pilot study was really just step one,” [Barbara Stanley, a Columbia clinical psychologist] says, “but it showed us that research with these kids is feasible, not futile.”
The therapy could be especially important because it is designed for use with teens who have made a nonfatal suicide attempt, which is one of the highest-risk groups for suicide. It is also an approach that can go hand-in-hand with medical treatment for depression, and there is evidence that medicine in combination with “talk therapy” is an effective approach to treating suicidal patients.
“The brains of depressed people who attempt suicide are different from those that do not,” Dr. Stanley says. “Our point of view is that while they need treatment for depression, they also need therapy tailored to help with their suicidal thoughts and behaviors.”
Because most suicidal teenagers are depressed, researchers believed that successful treatment of depression would also eliminate suicidal thoughts. But recent studies — including analyses of brain chemistry by Columbia neuroscientist J. John Mann — suggest there is something different about being suicidal.
CBT-SP addresses teenagers’ suicide attempts very directly, giving them a chance to talk frankly about what led to the attempt so the therapist and the youth can develop a customized strategy that “heads off” as early as possible the kinds of reactions in the teen’s life that might lead to suicidal behavior.
“From the moment they come through the door, we talk about the attempt. We put that time period under a microscope to understand all the thoughts, feelings, and behaviors that led up to it,” [says Stanley]. “Then we identify what skills they lack that could prevent them from attempting suicide again.”
With CBT-SP, the therapist not only helps them understand their feelings and behaviors, but also teaches them specific skills they can use to enhance their capabilities to cope.
The report on the study of CBT-SP are published in the October 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
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