Inpatient Cognitive Behavior Therapy Approaches for Suicide Prevention

Abstract

Within the current healthcare system, individuals recognized to be at imminent risk for suicide are likely to be referred for inpatient psychiatric care. The hospitalization setting provides a safe and supportive environment for specialty acute care services and stabilization. However, the majority of current interventions that are delivered to suicidal patients during this sensitive timeframe do not directly target suicide risk. Cognitive Behavior Therapy (CBT) is an evidence-based psychotherapeutic intervention that can easily be adapted for use in psychiatric inpatient settings. A specialized outpatient CBT protocol for suicide prevention has been developed and empirically evaluated by Drs. Aaron Beck and Gregory Brown at the University of Pennsylvania. This brief and targeted outpatient CBT program has been found to be efficacious in reducing the likelihood of subsequent suicide attempts by 50 %. Post-Admission Cognitive Therapy (PACT) is an inpatient adaptation of the CBT protocol for suicide prevention, developed by Dr. Marjan Ghahramanlou-Holloway at the Uniformed Services University of the Health Sciences. PACT is currently undergoing empirical validation, but it is important to note that the components of PACT are all cognitive behavioral practices recognized to reduce suicide risk. PACT is a promising inpatient CBT program that can be delivered in individual format to suicidal patients during their hospital stays. This intervention provides an opportunity to collaboratively review the suicide narrative, to conceptualize underdeveloped and overdeveloped skills directly tied to suicide risk, and to plan for safety and relapse prevention. Moreover, based on their conceptualization of the suicide mode activation for each patient, PACT clinicians choose cognitive behavioral strategies to modify thoughts, emotions, and/or behaviors that are most likely to result in a recurrence of suicidal behaviors. This paper provides a brief review of inpatient-based CBT options, introduces providers to the PACT inpatient protocol, and describes several promising alternate interventions.