Brief CBT Reduces Suicidal Behavior Among Military Personnel

Soldiers were much less likely to attempt suicide after a 12-session outpatient CBT program.

During the past decade the rate of suicide among members of the US Armed Forces has more than doubled.1 In response to this alarming trend, researchers and clinicians have sought to identify effective strategies for preventing suicidal behaviors in this population. As many service members and veterans seek out mental health care in the months preceding their suicides, there has been considerable interest in developing and refining mental health treatment options for at-risk service members and veterans.

In several clinical trials conducted among nonmilitary samples, cognitive behavioral therapies have consistently demonstrated effectiveness for the prevention of suicidal behaviors. Cognitive behavioral therapies therefore hold considerable promise as a treatment for military and veteran populations. 

To this end, a brief cognitive-behavioral therapy (BCBT) protocol was adapted and tested in a sample of active duty US Army soldiers with active suicidal ideation and/or a suicide attempt during the past month.

BCBT is a 12-session outpatient psychotherapy that is structured into three phases. In the first phase, patients learn basic crisis management strategies and emotion regulation skills such as relaxation, mindfulness, and other self-soothing techniques. 

In the second phase, patients learn cognitive reappraisal and problem solving skills to undermine overly critical self-perceptions and schemas such as perceived burdensomeness, self-blame, and hopelessness.

In the final phase, patients participate in a guided imagery task in which they repeatedly imagine themselves successfully solving problems in life using the skills learned earlier in treatment.

A total of 152 soldiers were randomly assigned to receive BCBT (n=76) versus treatment as usual (TAU; n=76) provided by the US Army mental health care system.2 BCBT clinicians were integrated into the Army mental health clinics located at Fort Carson, Colorado. BCBT therapists were monitored and supervised by the treatment developers to ensure fidelity to the treatment model.