TREATMENT MODALITIES FOR PATIENTS AT RISK FOR SUICIDE

Patients who are suicidal warrant some form of emotional support or psychotherapy with a focus on learning more adaptive ways of coping in the future. They may also warrant medications for treatment of specific mental disorders such as major depression. Following assessment, each practitioner in each setting determines which treatment modality would be of most benefit for that particular patient.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) can be used with both adults and adolescents. It combines cognitive and behavioral therapies based on the premise that emotions are difficult to directly change, so CBT targets emotions by changing thoughts and behaviors that are contributing to distressing emotions.

CBT builds on a set of skills that enable a person to be aware of thoughts and emotions; identify how situations, thoughts, and behavior influence emotions; and improve feelings by changing dysfunctional thoughts and behaviors. It is designed to be provided by individual therapists on a one-to-one basis; however, because adolescents’ suicidal crises occur within an environment that may include problematic relationships, abuse, family dysfunction, or poor school performance, CPT includes family interventions if needed (SPRC, 2019e).

Dialectical Behavior Therapy

Dialectic behavior therapy (DBT) is a type of cognitive-behavioral therapy that focuses on current situations and solutions and is used for individuals with severe and persistent suicidality. DBT involves a greater commitment on the part of both therapist and the patient, and involves four major components:

• Weekly individual (one-to-one) therapy sessions
• Weekly skills-training sessions, usually in the form of groups, meeting once a week for 24 weeks
• PRN consultation (phone coaching) between patient and therapist outside of sessions
• Weekly therapist consultation meetings in which the CBT therapists meet to discuss their DBT cases
  (ABCT, 2019)

Problem-Solving Therapy

Problem-solving therapy (PST) is a brief psychosocial treatment for patients experiencing distress related to inefficient problem-solving skills. PST aims to assist individuals to adopt a realistically optimist view of coping, to understand the role of emotions more effectively, and to creatively develop an action plan aimed at reducing psychological distress and enhance well-being. Interventions include psychoeducation, interactive problem-solving exercises, and motivational homework assignments (SPRC, 2017a).

Collaborative Assessment and Management of Suicidality

Collaborative assessment and management of suicidality (CAMS) is an evidence-based, suicide-specific clinical intervention that has been shown through extensive research to effectively assess, treat, and manage suicidal patients in a wide range of clinical settings. It is a flexible therapeutic framework in which patient and provider work together to assess suicidal risk and patient-defined problems (“drivers”) that made suicide compelling. That information is then used to plan and manage suicide-specific treatment (SPRC, 2017b).

Milieu Therapy

Milieu therapy is a type of psychotherapy that has been used in psychiatric hospitals, psychiatric wards in general hospitals, and group living situations for many years. Its goal is to control the environment to keep patients safe, improve their ability to learn new mental health skills, and encourage attitudes such as respect and positivity. The environment is typically well-ordered and complex enough to take normal daily activities and interactions into account. Recently it has been adapted to assist people who are receiving psychiatric treatment within their home community as well (Petti, 2019).

Group Therapy

Group therapy involves one or more psychologists leading a group of about 5 to 15 patients that meets for an hour or two each week. Groups are designed to target a specific problem, such as depression, and others focus more generally on improving social skills, thereby helping patients deal with issues such as anger, shyness, loneliness, or self-esteem. Groups can act as a support network and sounding board, and members may help with specific ideas for improving a problem situation or life challenge, holding members accountable along the way (APA, 2019c).

Creative Arts Therapy

Creative arts therapy facilities self-awareness, regulation, and resilience. Art therapy promotes the entire well-being of an individual—emotional, physical, cognitive, and social. Art therapists assist patients at risk as well as suicide survivors to explore coping strategies and implement prevention and creative strategies to support safety and reduce the risk of self-harm (AATA, 2018).

Dance movement therapy changes one’s biochemistry and promotes feelings of well-being. Dancing is known to lift mood by elevating the neurotransmitters serotonin and norepinephrine. Dance movement therapy reinforces social cohesion and a feeling of belonging essential to suicide prevention. It also emphasizes the importance of creativity and laughter as important life skills (Payne et al., 2019).

Occupational Therapy

Occupational therapists educate patients to actively participate in identifying a patient’s strengths and risk factors as well as physical, cognitive, and psychological components that may interfere with or facilitate engagement in meaningful activity and occupational performance. Therapists assist patients in developing self-awareness, identifying coping strategies and resources, and building skills in recognizing and challenging negative thoughts (Novalis, 2017).