Brief cognitive behavioural therapy for suicide prevention

Domain II · Behavioural & cognitive · Bryan, Rudd · 2015

What it is

Brief cognitive behavioural therapy for suicide prevention (BCBT) is a time-limited, skills-based individual psychotherapy. It treats suicidal behaviour as its own treatment target, separate from psychiatric diagnosis. It grew out of Beck's cognitive therapy, by way of Rudd's model of the suicidal…

Format

• Format. BCBT is individual outpatient therapy, usually 12 sessions, weekly or every two weeks. In the 2015 trial, session 1 was 90 minutes and later sessions were 60 minutes, with BCBT added to usual care. The Brazilian trial protocol uses 12 weekly 60-minute sessions. Delivery has been tested in…
• Standard session structure (every session after the first):

Who practises it, and how they are trained or regulated

• Progress is competency-based. Treatment ends when the patient has shown emotion-regulation and cognitive-flexibility skills, usually through using the crisis plan and other BCBT skills.
• Explicit criteria for moving from Phase I to Phase II are not given in the sources. A reasonable working rule is to move on when the patient has a crisis plan they report using (or can say how they would use it), has practised at least one emotion-regulation skill between sessions, and has a reasons-for-living list or survival kit in place. Move on sooner if the session count requires it, and keep reviewing the…
• Version followed: the 12-session outpatient protocol in Bryan & Rudd (2018), Brief Cognitive-Behavioral Therapy for Suicide Prevention (Guilford, 1st ed.). I reconstructed its structure from the manual's published table of contents, the trial description in Rudd et al. (2015), Craig Bryan's own training slides (about 2020–2026) and Focus (2022). The manual's text is not drawn on. A second edition with a separate…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Patients who get more absorbed in rumination. Use an external focus.
• Cards written in the therapist's words. Have the patient phrase them.
• Plans that target only diagnoses. Keep suicide as the explicit target.
• Plans that are too ambitious, or activities that involve alcohol or isolation.
• The patient or clinician treating it as legal protection. It is a clinical tool.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.