Therapies

In addition to the brief interventions that focus primarily on managing suicidal ideation and behavior, and medication regimens, there are treatments that focus on broad life, psychological and behavioral changes, that include managing suicidal thoughts and reducing behavior as a component. These treatments focus on difficulties people may have with anxious or negative thoughts, moods, substance use, and social, occupational and health experiences. Some of these treatments include Cognitive Behavioral Therapy-Suicide Prevention (CBT-SP), Dialectical Behavior Therapy (DBT), Attachment Based Family Therapy (ABFT), and Prolonged Grief Therapy (PGT) for survivors of suicide loss.

Collaborative Management and Assessment of Suicidality (CAMS), developed by Dr. David Jobes, is a therapeutic framework that helps an individual determine the problems that make them consider suicide, called suicidal drivers. Using the Suicide Status Form, the individual works collaboratively with an empathic, supportive mental health clinician to have honest conversations that directly address suicidal thoughts and impulses, with the goal of developing a plan to manage suicidal drivers so that the person does not engage in suicidal behavior. CAMS involves a collaborative assessment of suicide risk including self-reflection and discussion of current risk factors, ways to reduce current risk such as reducing access to lethal means and developing a stabilization plan that increases understanding of drivers, support from others and reasons for living. This is done by increasing the person’s understanding of their drivers, relationship issues and problem solving. The clinician and person who has suicidal ideation and/or behavior sit side-by-side as they develop and track a plan for staying alive and creating a life worth living. The Suicide Status Form is reviewed, discussed, and revised at each visit. The goal of CAMS looks toward the individual developing a future with hope and plans.

CAMS intervention includes:

• Assessment and review of suicide risk
• Treatment planning together
• Gain greater understanding of personal suicidal drivers
• Determine and use problem-focused interventions that treat drivers
• Develop and engage with reasons for living

Cognitive Behavioral Therapy-Suicide Prevention (CBT-SP) was developed by Dr. Gregory Brown and is based on the therapy model developed by Dr. Aaron Beck. Suicidal behavior is viewed as a problematic coping behavior and as the primary problem or target of treatment, rather than a mere symptom of a disorder. Treatment is focused on preventing future suicidal crises. By helping a person change the ways they respond to their automatic thoughts, and by delinking negative thought-behavior-mood patterns, personal change occurs. Treatment has three phases: acute, skill building, and continuation after acute phase.

Common CBT-SP strategies include:

• Monitoring activities to work towards activities and actions that make life better
• Restructuring thinking, especially in suicidal crises
• Considering the pros and cons of decisions to improve decision-making
• Use of Coping Cards to serve as reminders of helpful strategies and thoughts in a crisis
• Developing a Hope Kit filled with reminders of their personal reasons for living

Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan, focuses on the interaction between the environment and basic biological functions that underly emotion regulation and behavioral control. A basic assumption is that in emotionally charged situations, opposite viewpoints compete, and therapy seeks to bring together opposing views, allowing for greater integration of viewpoints and emotions and less reactivity. These dialectics include experiences such as solving a problem vs. accepting a problem, improving vs. accepting yourself as you are, regulating feelings vs. feeling what you feel, quiet and meditation vs. taking action, and being independent while understanding that sometimes one is dependent. In Dr. Linehan’s words, DBT is about “developing a life worth living.” Skills are learned and strengthened with individual and group therapy and are reinforced through homework and support during crises as needed.

The goals of DBT include:

• Skill training to solve problems
• Mindfulness to be in the moment
• Emotion regulation to decrease feelings of being overwhelmed
• Interpersonal effectiveness to promote social skills
• Distress tolerance to make it through crises and acknowledge reality

Attachment Based Family Therapy (ABFT), was developed by Dr. Guy Diamond for reducing suicide risk among suicidal adolescents and is a family treatment that seeks to improve communication, perspective taking and problem solving in families. Family attachment is a key component of a positive sense of self and a model for relationships. This treatment is based on the idea that when family attachment is insecure, depression and problems regulating emotions emerge and extreme reactivity between child and parents can occur. Suicidal behavior is seen as a coping response to stress when a youth is having difficulty regulating emotions. Identifying feelings that disrupt family relationships, helping family members feel more comfortable with difficult feelings and building skills for emotional expression are part of the work in ABFT. The work is done through a series of tasks with the teen and parents separately and then together. The goal is to have “corrective” attachment conversations such that engagement and compassion is developed.

ABFT includes the following:

• Emotional experiences are validated
• Negative emotions are accepted
• Vocabulary for emotions is developed by teen
• Parental emotion is expressed
• Negotiation and compromise are used to resolve conflicts

Prolonged Grief Therapy (PGT, formerly known as Complicated Grief Therapy) aims to repair the grief process after a person experiences a death of someone in their life. Grief is the natural process of healing after bereavement. When the process of grief is complicated by trauma or other individual factors, healing can get “stuck” and the person finds themselves experiencing intense yearning for the lost loved one, and prolonged, intense, unremitting grief with guilty ruminations and feeling that life lacks meaning. Joy no longer seems possible, social isolation takes place and even after a year, the bereaved person has not reconnected with their life. Developed by Dr. Katherine Shear, PGT provides a therapeutic process for healing. Prolonged grief symptoms are targeted directly using a combination of several techniques and treatment strategies. The goal is to facilitate grief continuing in the process of healing. Prolonged Grief Therapy has been studied among people bereaved by suicide and found to be beneficial.

PGT includes:

• Information about normal and prolonged or complicated grief
• Balancing grief, adjusting to loss, coping, and personal life goals
• Addressing trauma associated with loss
• Restoration