CBT for suicide prevention in adolescents

Domain II · Behavioural & cognitive · Stanley, Brown, Brent · 2009

What it is

CBT-SP is a manualised, individual-plus-family cognitive-behavioural treatment for adolescents (13–19 in TASA) who have recently attempted suicide, usually in the context of depression. The authors describe it as built on a "risk reduction and relapse prevention approach", grounded in CBT and DBT…

Format

• Format:
• Two phases: an acute phase and a continuation phase, each about 12 sessions. The acute phase runs about 12 weeks (in TASA, 12 or more sessions were completed by 72.4% of 110 treated teens). The continuation phase follows, and many TASA participants dropped out during it.

Who practises it, and how they are trained or regulated

• Content: individual skills (cognitive restructuring, behavioural activation, problem solving, emotion regulation and distress tolerance; interpersonal skills) and family skills (family problem solving and communication). The safety plan is reviewed and revised every session.
• Throughout: suicide risk is reassessed at every contact and medication is coordinated with the prescriber. The authors' training and supervision arrangements were not found. The codebook notes say "clinicians trained to the manual; details unclear".

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?
• 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

• unsafe relationships, such as bullying, where the answer is environmental change rather than better skills.
• over-monitoring that becomes control; parents' own distress or depression (consider referring them for their own support).
• choosing skills by habit instead of by chain; too many targets at once. Signs it is working: the teen can see why each skill matters.
• dropout, which was common in TASA's continuation phase. Agree the reasons for continuing at the end of the acute phase, and use flexible scheduling.
• parental anger or blame ("attention-seeking"), or guilt. Address these in a parent-only segment if needed. Signs it is working: parents can name warning signs and the plan.

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.