Cognitive behavioral therapy via remote video reduces suicide attempts

Key takeaways:

• Participants who received the brief CBT had a markedly reduced risk for suicide attempts.
• Both treatment options in the study reduced the severity of suicidal ideation.

Cognitive behavioral therapy delivered via telehealth using remote video reduced suicide attempts and suicidal ideation among high-risk adults, according to the results of a randomized clinical trial.

The analysis, published in JAMA Network Open, becomes the first to support the effectiveness of any suicide-focused psychotherapy conducted through telehealth, according to the researchers.

Suicidality remains a significant health issue in the U.S., with the number of annual suicide deaths reaching an all-time high of almost 50,000 in 2022.

“The impetus for this research question was the nearly overnight shift from mostly in-person to mostly virtual therapy appointments following the onset of the COVID-19 pandemic,” Justin C. Baker, PhD, ABPP, a clinical psychologist at The Ohio State University College of Medicine and the study’s first author, said in a press release.

“Historically, high-risk patients were considered inappropriate candidates for virtual health care, due to risk and liability concerns,” Baker added. “We wanted a way to ensure that those who needed care the most were able to receive care during the pandemic.”

The study included 96 adults (mean age, 31.8 years; 66.7% women) who reported either suicidal ideation in the past week or suicidal behavior in the past month. The researchers randomly assigned participants to:

• brief cognitive behavioral therapy (BCBT), an evidence-based treatment that taught reappraisal skills and emotion regulation; or
• present-centered therapy (PCT), a goal-oriented treatment that helped participants identify adaptive responses to stressors.

Both treatments included a 90-minute intake session followed by 12 weekly, 60-minute outpatient sessions.

Researchers conducted the trial from April 2021 to September 2023, with a 1-year follow-up, while 88.5% of participants completed at least one treatment session.

From baseline to 12 months, 12 PCT participants made 56 suicide attempts and 11 BCBT participants made 36 suicide attempts.

The researchers found that participants receiving BCBT had significantly fewer mean suicide attempts per participant compared with those receiving PCT (0.7 vs. 1.4).

Overall, BCBT participants had a 41% reduced risk for suicide attempts vs. PCT participants (HR = 0.59; 95% CI, 0.36-0.96).

Baker and colleagues noted that severity of suicidal ideation substantially decreased in both treatment groups (P<.001) but did not differ between groups.

They wrote that the reduced suicide attempts may be the result of the structured approach of BCBT, in addition to crisis response planning being a central component of the treatment.

The researchers noted that they may have undercounted suicide attempts among those who did not complete follow-up assessments and added that it is possible that some treatment differences may have made participants in one study group more inclined to report suicide attempts vs. those in the other.

“For those suffering with suicidal thoughts and behaviors, we have good, tested treatments that will lead to significant symptom reduction and improved quality of life,” Craig Bryan, PsyD, a professor in the department of psychiatry and behavioral health at The Ohio State University, said in the release. “Even with lessening restrictions, many therapists are keeping a portion of their telehealth practice post-pandemic. This study has the potential to increase access to needed evidence-based treatments for those in rural and hard-to-reach areas.”

References:

• Baker JC, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.45913.
• First-ever randomized clinical trial uses telehealth for suicide prevention. Available at: https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/first-ever-randomized-clinical-trial-uses-telehealth-for-suicide-prevention. Published Nov. 12, 2024. Accessed Nov. 20, 2024.