Cognitive-behavioral therapy (CBT) for suicide attempters

Cognitive-behavioral therapy (CBT) for suicide attempters Cognitive-behavioral therapy (CBT) has been shown to be an effective
intervention for depressive symptoms (Beck, Rush, Shaw, & Emery, 1978,
1979; Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999). Cognitive therapy postulates three primary areas of maladaptive thinking: (a) the “cognitive
triad”: the idiosyncratic and negative view of self, experience, and future;
(b) “schemas,” stable patterns of molding data or events into cognitions; and
(c) “systematic errors” in thinking that establish and maintain a depressed
mood, and the hopelessness that Beck believes is “at the core of the suicidal
wishes” (Beck et al., 1978, p. 151).
Beck and his associates (Henriques et al., 2003) have recently developed a
specifi c 10-session cognitive therapy intervention for adolescent and young
adult suicide attempters. A novel element is that the treatment can be applied
to all individuals exhibiting suicidal behavior regardless of psychiatric diagnosis.
A central premise is the notion that suicidal behavior, though dangerous,
is understandable given the patient’s frame of reference.
Rudd et al. (2001) have written a treatment guide that presents a theoretical
(CBT) model of suicidality, incorporates a system of clinical assessment,
and explains how to deal with crisis intervention and symptom management
through skill building and the development of enduring adaptive modes.

As an example of applying CBT, Gena, a sophomore who suff ered from
chronic minor depression and suicidal thoughts, revealed upon being
questioned by her therapist her beliefs that “I am a bad person and
don’t deserve to live” and “I know that I’m unlovable, so why would
anyone care if I was alive or dead?” Having these familiar but usually
subterranean beliefs brought to life was an important step for Gena.
She had never told anyone about them before and hadn’t really stopped
to examine them—they were simply always there, like a wall painting
she’d long since stopped noticing. Th e therapist then helped her to break
down these negative cognitions into their component parts, addressing
the logical inconsistencies and challenging the truncated thinking patterns.
How did Gena know she was a bad person? On what basis had she
decided she didn’t deserve to live? Was it really true that nobody—not
her family or friends or her boyfriend—cared if she was dead or alive?
Invited to examine her cognitions in this way, Gena started to question
them and noticed aft er several weeks that they seemed to come up less
oft en in her thinking. Not surprisingly, she also reported that her suicidal
thoughts became less ubiquitous and pressing.