Cognitive Behavioral Therapy May Alter Suicidal Ideation in Anxiety Disorders

therapist with patient
therapist with patient
Cognitive behavioral therapy for anxiety-related disorders was associated with improvements in suicide ideation rather than exacerbation.

Patients with post-traumatic stress disorder (PTSD) are at a high risk for suicidal ideation, and suicidal ideation can be reduced significantly with cognitive behavioral therapy, according to research published in the Journal of Anxiety Disorders.

Researchers evaluated 355 treatment-seeking patients who were diagnosed with an anxiety-related disorder at intake, mid-treatment (about 14 weeks), and post-treatment (about 24 weeks). Diagnoses were confirmed through psychometric evaluations, suicidal ideation was measured through the Beck Depression Inventory, treatment progress was assessed through self-report questionnaires, and all participants received cognitive behavioral therapy as treatment.

At intake, suicidal ideation was highest in those with PTSD (48.9%) and lowest in individuals with panic disorder (26.9%). Time played a significant role in reducing suicidal ideation (odds ratio [OR] 0.930; 95% CI, 0.899-0.962, P <.001). From intake to mid-treatment there was a 6.7% increase in new cases of suicidal ideation, and then a 4.4% increase in new cases at post-treatment. At mid-point, 46% of participants noted improvement in suicidal ideation, while 50% noted no change. At post-treatment, 55.6% of individuals noted improvement of suicidal ideation, and 44.4% reported no change. Participants with PTSD and unspecified anxiety disorder noted significant improvements using cognitive behavioral therapy from intake to post-treatment and the rates of new onset of suicidal ideation were very low during the treatment period.

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Future studies need to address suicidal ideation over an extended period of time, include a more diverse study population, and incorporate a control component to evaluate the effects of time. 

The researchers conclude that “[cognitive behavioral therapy] for anxiety-related disorders is associated with improvements rather than exacerbation in [suicide ideation] risk over treatment.”


Brown LA, Gallagher T, Petersen J, Benhamou K, Foe EB, Asnaani A. Does CBT for anxiety-related disorders alter suicidal ideation? Findings from a naturalistic sample. J Anxiety Disord. 2018; 59:10-16. doi: 10.1016/j.janxdis.2018.08.001.