Clinician-administered structured interviews were conducted by a blinded evaluator at 3, 6, 12, 18, and 24 months post-baseline. The primary outcome was suicide attempts, and secondary outcomes included severity of psychiatric symptoms including suicidal ideation, depression, anxiety, post-traumatic stress, and hopelessness.
During the two-year follow-up, soldiers receiving BCBT were 60% less likely to have made a suicide attempt than soldiers receiving TAU. An estimated 14% of soldiers receiving BCBT made a suicide attempt during follow-up compared with an estimated 40% of soldiers receiving TAU.2 This difference remained statistically significant even when adjusting for baseline symptom severity and when considering only those soldiers with a history of suicide attempt.
With respect to secondary outcomes, soldiers receiving BCBT also showed an advantage with respect to psychiatric symptom severity, although these between-group differences did not reach the level of statistical significance. Soldiers in BCBT were also less likely to be medically separated from the Army during follow-up, suggesting that BCBT contributes to positive social-occupational outcomes in addition to its clinical effects.
We reported our findings in the May 2015 issue of The American Journal of Psychiatry.
Early dissemination efforts within systems of care as well as private practice settings indicate that the therapy can be effectively implemented by clinicians from multiple mental health disciplines with varying levels of training. Because of its brevity, BCBT can be easily integrated into routine clinical practice across settings. In addition, the treatment’s transdiagnostic approach to conceptualizing and managing suicide risk provides considerable flexibility for implementation with a wide range of clinical presentations.
Indeed, subsequent analyses from this trial suggest that results do not change based on participants’ diagnoses or the medications they are taking. For clinicians with diverse patient populations, BCBT’s emphasis on suicide risk instead of psychiatric diagnosis as the primary treatment goal provides a clear and straightforward model for effective care, even for patients who present with complex comorbidities and problems.
Additional studies are currently underway to clarify the mechanisms that underlie BCBT’s effectiveness and to determine if the treatment can be refined to further enhance its beneficial effects. To learn more about receiving training in BCBT, contact the National Center for Veterans Studies at www.veterans.utah.edu or firstname.lastname@example.org.
Craig J. Bryan, PsyD, ABPP, is executive director of the National Center for Veterans Studies and assistant professor of psychology at The University of Utah. He is an Iraq War veteran whose research focuses on military suicide and PTSD.
- National Center for Telehealth & Technology. Department of Defense Suicide Event Report. Calendar Year 2013 Annual Report. Available at: http://t2health.dcoe.mil/sites/default/files/DoDSER-2013-Jan-13-2015-Final.pdf. Accessed July 2, 2015.
- Rudd MD, Bryan CJ, et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up. Am J Psychiatry. 2015; 172(5):441-449.