Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility and Acceptability

  • Type :#article
  • Date read: 2023-03-29
  • Bibtex: @stanley2009
  • Bibliography: Stanley, B., Brown, G., Brent, D., Wells, K., Poling, K., Curry, J., Kennard, B. D., Wagner, A., Cwik, M., Klomek, A. B., Goldstein, T., Vitiello, B., Barnett, S., Daniel, S., & Hughes, J. (2009). Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility and Acceptability. Journal of the American Academy of Child and Adolescent Psychiatry, 48(10), 1005–1013.


Objective To describe the elements of a manualized cognitive behavior psychotherapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide.

Method CBT-SP was developed using a risk reduction, relapse prevention approach and theoretically grounded in principles of cognitive behavior therapy, dialectical behavioral therapy and targeted therapies for suicidal, depressed youth. CBT-SP consists of acute and continuation phases, each lasting about 12 sessions, and includes a chain analysis of the suicidal event, safety plan development, skill building, psychoeducation, family intervention, and relapse prevention.

Results CBT-SP was administered to 110 depressed, recent suicide attempters aged 13–19 years (mean 15.8±1.6) across five academic sites. Twelve or more sessions were completed by 72.4% of the sample.

Conclusions A specific intervention for adolescents at high risk for repeated suicide attempts has been developed and manualized, and further testing of its efficacy appears feasible.

Example citation

My notes

  • Very long treatment. Acute and continuation phases, “both of which are generally completed within six months”. 12-16 weekly sessions for the acute phase.
  • They specifically do not address “chronic, unremitting ideation”
  • Goal: Reduce suicidal risk factors, enhance coping and prevent suicidal behavior
  • A good approach for us as well: “CBT-SP is narrow in focus and is not designed to address all of the adolescent’s problems. This approach recognizes that the teen may need further treatment. Instead, it focuses on developing skills (cognitive, behavioral and interactional skills) that will enable the adolescent to refrain from further suicidal behavior.”
  • Components:
    • Cognitive restructuring
    • Emotion regulation
    • Distress tolerance (from DBT)
    • Behavioral activation
    • Problem-solving strategies

These processes include deficits in the adolescent’s abilities or motivations to cope with suicidal crises. For example, such deficits may include the inability to regulate emotions, the inability to resolve problems, the inability to tolerate distress, the inablity to address negative thoughts or beliefs such as hopelessness or worthlessness. These risk factors are identified by conducting a detailed chain analysis of the sequence of events, and their reactions to these events, that led to the suicidal crisis. A core feature of the treatment is the development of an individualized case conceptualization that identifies problem areas to be targeted and the specific interventions to be employed during periods of acute emotional distress.

Treatment structure

  • Components:
    • Cognitive restructuring
    • Emotion regulation
    • Distress tolerance (from DBT)
    • Behavioral activation
    • Problem-solving strategies

Initial phase of acute treatment (sessions 1-3)

  • Chain analysis
  • Safety Planning
    • First step is to write down a safety plan
    • Then to use distraction or other strategies
    • Third, contaxt external sources (trusted person, agency)
  • Psychoeducation
  • Developing reasons for Living and Hope
    • Why use coping strategies at all? People who care about you, things you can look forward to in the future, things you like to do, things you care about.
  • Case Conceptualization

To conduct a chain analysis of a suicide attempt, the therapist asks the teen to describe the events that led to and followed the suicide attempt as well as the details of the actual attempt. A good metaphor for this process is to ask the teen to describe the “frames in the film” of the suicide attempt.

Maybe do a chain analysis of most recent intense episode of SI for the ICBT protocol?

Middle phase of acute treatment (sessions 4-9)

  • Individual skill modules
    • Behavioral activation
    • Mood monitoring
    • Emotion regulation and distress tolerance techniques
    • Cognitive restructuring
    • Problem solving
    • Goal setting
    • Mobilizing social support
    • Assertiveness skills
  • Family skill modules

End of Acute Treatment and Continuation Phase (sessions 10-12)

  • Relapse prevention
    • Preparation
    • Review of index event
    • Review of index event using skills learned
    • Review of a future high risk scenario
    • Debriefing and follow-up

Continuation phase (12 weeks, ~6 sessions)

  • Review of warning signs
  • Goals achieved
  • Impact of trt on the family
  • Strategies for handling future episodes
  • Current need for further treatment

PDF: stanley_2009_cognitive_behavior_therapy_for_suicide_prevention_(cbt-sp)_-_treatment_model,.pdf