Cognitive Behavioral Therapy for Suicidal Thoughts

Overseen By Jay Fournier, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Psychosis, Mania, Acute intoxication, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

Duration: 12 months

1200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to develop a tool to predict how well military personnel with suicidal thoughts will respond to standard mental health care and whether they might benefit more from a specific therapy called Brief Cognitive Behavioral Therapy (BCBT). The study will compare the effectiveness of BCBT, which involves structured therapy sessions to understand and manage suicidal thoughts, against the usual care methods (referred to as Treatment as Usual, or TAU, which may include medications like Buprenorphine). Active duty service members who have experienced recent suicidal thoughts and are already receiving mental health treatment might be a good fit. Participants will complete assessments about their feelings and behaviors throughout the trial. This unphased trial offers participants the opportunity to contribute to innovative research that could improve mental health care for military personnel.

Will I have to stop taking my current medications?

The trial does not specify whether you need to stop taking your current medications. It seems like you will continue with your usual mental health treatment, so it's best to discuss this with your healthcare provider.

What prior data suggests that Brief Cognitive Behavioral Therapy (BCBT) is safe for military personnel with suicidal ideation?

Research has shown that Brief Cognitive Behavioral Therapy (BCBT) is generally well-received for treating suicidal thoughts. Studies have found that BCBT can significantly reduce suicide attempts in those who undergo this treatment. For instance, one study discovered that BCBT delivered through video calls effectively lowered suicide attempts.

Reports of serious side effects from BCBT are rare. The therapy includes sessions that help individuals understand and change thoughts and behaviors related to suicidal feelings. Participants learn skills to manage emotions and create a crisis management plan, which helps prevent future issues.

As a type of talk therapy rather than medication, BCBT avoids the side effects often associated with drugs, making it a safe option for many. Open communication with therapists during treatment is crucial for participants to gain the most benefit and ensure safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the potential of Brief Cognitive Behavioral Therapy (BCBT) for addressing suicidal thoughts because it offers a structured, phased approach that is distinct from the usual care. Unlike standard treatments that often focus on risk assessment and safety planning, BCBT integrates a detailed exploration of the patient’s recent suicidal episode and emphasizes building cognitive flexibility and emotion regulation skills. The therapy is delivered through a series of 12 personalized sessions, allowing for tailored interventions and a focus on relapse prevention, which could lead to more sustained improvements for individuals at risk.

What evidence suggests that Brief Cognitive Behavioral Therapy (BCBT) is effective for reducing suicidal thoughts?

Research has shown that Brief Cognitive Behavioral Therapy (BCBT), which participants in this trial may receive, can help reduce suicidal thoughts and actions. Studies have found that BCBT lowers the risk of suicide attempts more effectively than standard care. In one study, individuals who received BCBT harmed themselves less often than those who did not receive this therapy. BCBT teaches people to understand their triggers, learn coping skills, and plan for crisis situations. These tools help individuals manage their emotions and thoughts better. Overall, BCBT is a promising option for those dealing with suicidal thoughts. ^{1 2 3 4 6}

Are You a Good Fit for This Trial?

This trial is for active duty service members over 18 years old who are currently receiving mental health treatment and have had suicidal thoughts within the last month. Participants must understand English and be able to consent.

Inclusion Criteria

You were receiving mental health treatment at the time of your participation in this study.

You have registered a score above zero on the Columbia Suicide Severity Rating Scale (CSSRS) Screener-Recent, implying suicidal ideation within the last month.

I am an active duty service member.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants complete self-report assessments at the beginning of the study

1 week

1 visit (in-person)

Treatment

Participants receive mental health treatment as administered by their healthcare team, including potential BCBT sessions

12 months

Weekly or biweekly sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment with assessments at 3, 6, 9, and 12 months

12 months

4 visits (in-person or virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Brief Cognitive Behavioral Therapy (BCBT)
• Treatment as usual (TAU)

Trial Overview The study aims to develop a calculator predicting responses to standard care for reducing suicidal ideation, comparing it with Brief Cognitive Behavioral Therapy (BCBT) in those predicted not to respond well.

How Is the Trial Designed?

Group I: Brief Cognitive Behavioral Therapy (BCBT) Experimental Treatment 1 Intervention

BCBT consists of 12 outpatient individual psychotherapy sessions scheduled weekly or biweekly. The first session is 90 minutes and subsequent sessions are 60 minutes. BCBT is divided into three phases. In phase 1 (5 sessions), the therapist conducts a detailed assessment of the patient's most recent suicidal episode or suicide attempt, identifies patient-specific factors that contribute to and maintain suicidal behaviors, provides a cognitive-behavioral conceptualization, collaboratively develops a crisis response plan, and teaches basic emotion regulation skills. In phase 2 (5 sessions), the therapist teaches cognitive restructuring skills to build cognitive flexibility. In phase 3 (2 sessions), a relapse prevention task is conducted, and participants must demonstrate the ability to successfully complete this task in order to terminate the treatment. Additional sessions are conducted until participants demonstrate the ability to successfully complete this task.

Group II: Treatment as Usual (TAU) Active Control 1 Intervention

TAU may include (1) routine suicide risk screening and assessment; (2) safety planning with means restriction; and (3) the Collaborative Assessment and Management of Suicidality (CAMS), an evidence-based approach to managing and treating suicidal patients.

Brief Cognitive Behavioral Therapy (BCBT) is already approved in United States, European Union for the following indications:

Approved in United States as Brief Cognitive Behavioral Therapy (BCBT) for:

• Suicide prevention
• Reduction of suicidal ideation

Approved in European Union as Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) for:

• Suicide prevention
• Reduction of suicidal ideation

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

United States Department of Defense

Collaborator

Trials

940

Recruited

339,000+

Published Research Related to This Trial

Cognitive-behavioral therapy (CBT) is recognized as an effective treatment for depression in children and adolescents, but there is limited evidence specifically addressing its efficacy for adolescents experiencing suicidality.

The article discusses various CBT techniques aimed at reducing suicidal thoughts and behaviors in depressed adolescents, highlighting the need for more targeted treatment trials in this vulnerable group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for adolescent depression and suicidality. Spirito, A., Esposito-Smythers, C., Wolff, J., et al.[2022]

Cognitive behavior therapy (CBT) and problem-solving therapy (PST) both led to significant improvements in various measures related to hopelessness and suicidal ideation among suicide attempters, indicating their efficacy as treatment options.

Participants receiving CBT and PST reported higher satisfaction levels compared to those receiving treatment as usual (TAU), highlighting the potential benefits of these brief therapies in managing suicidal thoughts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high risk population. Stewart, CD., Quinn, A., Plever, S., et al.[2018]

Cognitive-Behavioral Therapy (CBT) significantly reduced suicidal ideation and hopelessness in depressed adolescents aged 12 to 18 who had attempted suicide, with a 54% to 77% decrease in scores after 12 weeks of treatment.

In a clinical trial involving 30 participants, those receiving CBT showed marked improvements compared to a control group that did not receive the intervention, highlighting the efficacy of CBT in this high-risk population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents with previous suicidal attempts. Alavi, A., Sharifi, B., Ghanizadeh, A., et al.[2022]

Brief cognitive behavioral therapy (BCBT) is projected to prevent 23 to 25 more suicide attempts and 1 to 3 more suicide deaths per 100 patients compared to standard treatment for suicidal US Army soldiers, indicating its efficacy in reducing suicide risk.

BCBT is estimated to save the Department of Defense between $15,000 to $16,630 per patient compared to usual treatment, suggesting it may be a cost-effective intervention for addressing suicide risk among active-duty soldiers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Economic Evaluation of Brief Cognitive Behavioral Therapy vs Treatment as Usual for Suicidal US Army Soldiers. Bernecker, SL., Zuromski, KL., Curry, JC., et al.[2022]

In a study of 76 patients with major depressive disorder, adding behavioral activation (BA) to antidepressant treatment significantly reduced suicidal ideation compared to treatment as usual (TAU).

Trial-based cognitive therapy (TBCT) also showed a greater reduction in suicidal thoughts compared to TAU, suggesting that both BA and TBCT may be beneficial adjuncts to standard antidepressant therapy in managing suicidal ideation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioural activation and trial-based cognitive therapy may be beneficial to reduce suicidal ideation in major depressive disorder: A post hoc study from a clinical trial. Hemanny, C., Sena, EP., de Oliveira, IR.[2022]

In a study involving 80 breast cancer patients with major depressive disorder, both behavioral activation treatment for depression (BATD) and problem-solving therapy (PST) significantly reduced depression and suicidal ideation after 8 weeks, with benefits lasting up to 12 months.

No completed suicides were reported during a follow-up period of approximately 2 years, suggesting that these therapies may be effective in improving hopefulness and preventing suicide in this vulnerable population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral activation and problem-solving therapy for depressed breast cancer patients: preliminary support for decreased suicidal ideation. Hopko, DR., Funderburk, JS., Shorey, RC., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8479594/

Brief Cognitive-Behavioral Therapy for Suicide Prevention ... The current study aims to examine the delivery of brief cognitive-behavioral therapy for suicide prevention (BCBT-SP) via Clinical Video Telehealth (CVT) to ...

2. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2826055

Telehealth Brief Cognitive Behavioral Therapy for Suicide ... The findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts.

3. sciencedirect.com sciencedirect.com/science/article/pii/S0005789425001145

Massed brief cognitive behavioral therapy (mBCBT) for ... Brief cognitive behavioral therapy (BCBT) for suicide prevention has been shown to significantly reduce suicide attempts in multiple ...

4. jwatch.org jwatch.org/na59343/2025/10/28/brief-cognitive-behavioral-therapy-tested-prevent-suicide

Brief Cognitive-Behavioral Therapy Tested to Prevent ... Brief cognitive-behavioral therapy (CBT) can reduce suicide attempts compared with usual care, but whether specific components of CBT are ...

5. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05282-x

Group brief cognitive behavioral therapy for suicide prevention ... This 2-arm non-inferiority randomized controlled trial compares a group therapy format of Brief Cognitive Behavioral Therapy (ie, G-BCBT) with Dialectical ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2888910/

Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) CBT-SP consists of acute and continuation phases, each lasting about 12 sessions, and includes a chain analysis of the suicidal event, safety plan development, ...