Suicide frequently asked questions: suicide prevention, brief cognitive behavioral therapy and more

An interview with Craig Bryan, PsyD, director of the Division of Recovery and Resilience in the Department of Psychiatry and Behavioral Health at the Ohio State Wexner Medical Center.
Question Suicide rates continue to climb in the United States despite an increase in mental health awareness and availability of treatment. What are we getting wrong about suicide prevention?

We don’t appreciate how factors besides mental illness increase risk of suicide, influencing a person’s decision to try to end their life. Factors like personal decision-making styles, level of intensity in reaction to life stressors, lack of impulse control or the availability of lethal means, like firearms, all play a part in suicide.

Question As part of your research, you study people who have survived a suicide attempt. What have you learned from those survivors that supports your assertion that there’s more to suicide than underlying mental health conditions?

Reports from survivors allowed us to gauge how much time passed between their thinking of suicide and their attempt. One quarter of them reported the time frame was five minutes or less. People need effective intervention before everything builds up to the point that they think ending their lives is the best way to end the emotional pain and pressure.

Question Can you walk us through the Wexner Medical Center’s new “TALK to #endsuicidesilence” campaign and how we can use TALK help someone in crisis?

The campaign encourages all of us to learn to talk about suicide so that no one feels alone. TALK stands for:

  • TELL them you care. If you’re concerned about someone, start the conversation by letting them know you care and want to help.
  • ACT immediately. If you suspect someone is having suicidal thoughts or is about to harm themselves, call 911 immediately and ask for help.
  • LISTEN without judgment. When someone talks about suicide, they need to be heard to feel understood.
  • KNOW that treatment works. Let your loved one, friend or colleague know there are confidential treatment options available to help them.
Question You’ve developed a research study intervention to help people cope in times of intense emotional distress. Can you explain how it works?

While working with suicidal military personnel who were in acute crisis and having suicidal thoughts, we developed a variation of cognitive behavioral therapy that we refer to as brief cognitive behavioral therapy, or BCBT. Over the course of a few weeks, participants attend daily therapy sessions that challenge cognitive distortions and build personal coping strategies designed to inhibit an action when someone is feeling intense emotional distress.

Read more about Dr. Bryan’s work in suicide prevention

Question What were the results of these studies?

Results from our randomized clinical trial indicated BCBT reduced suicide attempts by 60% as compared to traditional treatment. We recently conducted a second randomized clinical trial showing that crisis response planning, another key component of BCBT, reduced suicide attempts by 76% among military personnel as a stand-alone emergency intervention.

Question What about the general patient population. Is BCBT an effective treatment for other mental health conditions?

Yes, we’re now using BCBT in our clinic to help a variety of patients with PTSD, trauma and anxiety and depression. Most of the skills we teach are fairly simple and include breathing exercises, spending time with supportive people and identifying unhelpful thoughts and coming up with more helpful alternatives.

Question This is definitely a paradigm shift from traditional ways of thinking about suicide prevention and treatment. How is this kind of care different?

It builds in support upstream from an acute crisis and provides care that proactively addresses the untold suicide risk factors affecting our loved ones and ourselves. Instead of focusing on alleviating death and keeping people alive, we help people find reasons to live.

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