Cognitive-Behavioral Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility, and Acceptability
Open accessAbstract
Objective To describe the elements of a manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide.Method The CBT-SP was developed using a risk reduction and relapse prevention approach and theoretically grounded in principles of cognitive-behavioral therapy, dialectical behavioral therapy, and targeted therapies for suicidal youths with depression. The 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, skill building, psychoeducation, family intervention, and relapse prevention.Results The CBT-SP was administered to 110 recent suicide attempters with depression aged 13 to 19 years (mean 15.8 years, SD 1.6) across five academic sites. Twelve or more sessions were completed by 72.4% of the sample.Conclusions A specific intervention for adolescents at high risk for repeated suicide attempts has been developed and manual based, and further testing of its efficacy seems feasible.
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Therapeutic approaches that specifically target suicidal ideation provide successful results.
“Suicide and DSH are preventable, and therapeutic approaches that specifically target suicidal ideation (SI) provide successful results [2-4].”
From Efficacy of acceptance and commitment therapy in reducing suicidal ideation and deliberate self-harm: Systematic review (2018) · cites this paper as [2]
The Introduction says interventions targeting suicidal ideation may be beneficial and reports reduced ideation in some subgroups, but it also describes trials with no overall effect. The Discussion says this CBT-SP feasibility study cannot establish treatment efficacy. The claim overstates these qualified findings as successful results for targeted therapeutic approaches generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCBT for suicide prevention and CBT for suicidal patients have positive effects on suicidal ideation.
“CBT for suicide prevention and CBT for suicidal patients have also had positive effects on SI [2,3].”
From Efficacy of acceptance and commitment therapy in reducing suicidal ideation and deliberate self-harm: Systematic review (2018) · cites this paper as [2]
The Introduction reports reduced suicidal ideation in a non-depressed subgroup receiving a home-based intervention, but says there was no overall benefit for ideation. The Results and Discussion evaluate CBT-SP’s feasibility and acceptability, not whether it reduced suicidal ideation. The broad claim of positive effects therefore goes beyond what this paper reports. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe goal of safety planning is to reduce imminent risk of suicidal behaviour by constructing a predetermined set of coping strategies and sources of support.
“The goal of safety planning is to reduce the imminent risk of suicidal behaviour by constructing a predetermined set of coping strategies and sources of support in a plan.10,11”
From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [10]
The observed effect is in line with the hypothesis that safety plans reduce imminent risk of suicidal behaviour by presenting alternative coping strategies and sources of support.
“The observed effect is in line with the hypothesis that safety plans reduce the imminent risk of engagement in suicidal behaviour by presenting alternative coping strategies and sources of support.10,11”
From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [10]
All available interventions (CBT, DBT) include interpersonal aspects, but these aspects are not necessarily the focus of the treatment.
“All available interventions [CBT (6) DBT (4)] include interpersonal aspects but these aspects are not necessarily the focus of the treatment.”
From Ultra-Brief Crisis IPT-A Based Intervention for Suicidal Children and Adolescents (IPT-A-SCI) Pilot Study Results (2020) · cites this paper as [6]
SPI is included as a best practice strategy by the Suicide Prevention Resource Center and the American Foundation for Suicide Prevention.
“SPI is a brief intervention that has been included as a best practice strategy by the Suicide Prevention Resource Center (SPRC)/American Foundation for Suicide Prevention (AFSP).60-61”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [60]
SPI was initially developed as part of the CBT-SP intervention in the NIMH-funded Treatment of Adolescent Suicide Attempters study.
“SPI was initially developed as part of the CBT-SP intervention in the NIMH-funded Treatment of Adolescent Suicide Attempters (TASA) study.62,60”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [60]
Existing interventions for suicidal patients (e.g., cognitive behavioral therapy and dialectical behavior therapy) typically target negative emotions and cognitions.
“Existing interventions for suicidal patients (e.g., cognitive behavioral therapy [5,6] and dialectical behavior therapy [7,8]) typically target negative emotions and cognitions.”
From Feasibility and utility of positive psychology exercises for suicidal inpatients (2014) · cites this paper as [5]
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“The primary intervention model was Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) (Stanley et al., 2009).”
BackgroundInfluentialMeyer, R. E., Salzman, C., Youngstrom, E. A., Clayton, P. J., Goodwin, F. K., Mann, J. J., Alphs, L. D., Broich, K., Goodman, W. K., Greden, J. F., et al. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10cs06070ablu · Cited by 67 · see citing works
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Coping strategies that reduce suicidal ideation: an ecological momentary assessment study
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“Suicide and DSH are preventable, and therapeutic approaches that specifically target suicidal ideation (SI) provide successful results [2-4].”
Testoni, I., Ronconi, L., Palazzo, L., Galgani, M., Stizzi, A., & Kirk, K. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00441 · Cited by 64 · see citing works
On the Relationship between Classic Psychedelics and Suicidality: A Systematic Review
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Suicidal Ideation and Suicide Attempts After Direct or Indirect Psychotherapy
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Suicide Prevention Strategies for Improving Population Health
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Dysregulation and Suicide in Children and Adolescents
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Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk
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Campus Suicide Prevention: Bridging Paradigms and Forging Partnerships
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Empirically Supported Interventions for Sexual and Gender Minority Youth
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Suicide assessment and treatment in pediatric primary care settings
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Role of the family in suicide prevention: An attachment and family systems perspective
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Suicide Prevention Interventions for Sexual & Gender Minority Youth: An Unmet Need.
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Suicide in the pediatric population: screening, risk assessment and treatment
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Self-citationSuicide Safety Planning: Clinician Training, Comfort, and Safety Plan Utilization
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Assessment and Management of Suicide Risk in Children and Adolescents
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The Interpersonal Needs Questionnaire: Statistical Considerations for Improved Clinical Application
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Integrating a functional view on suicide risk into idiographic statistical models
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The narrative‐crisis model of suicide and its prediction of near‐term suicide risk
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The Multidimensional Mortality Awareness Measure and Model
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Perspectives of Suicidal Veterans on Safety Planning
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The Development and Feasibility Outcomes of a Youth Suicide Prevention Intensive Outpatient Program
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Self-citationSuicide Prevention Public Service Announcements (PSAs): Examples from Around the World
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The Relationship Between Self-criticism and Suicide Probability.
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- Authors
- Stanley, B., Brown, G., Brent, D. A., Wells, K., Poling, K., Curry, J., Kennard, B. D., Wagner, A., Cwik, M. F., Klomek, A. B., Goldstein, T., Vitiello, B., Barnett, S., Daniel, S., & Hughes, J.
- Affiliations
- Johns Hopkins University (US)
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 48
- Issue
- 10
- Pages
- 1005-1013
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC2888910
- OpenAlex
- W1982466664
- Cited by
- 423
- References
- 31
- Citations by year
- 2026: 24 · 2025: 27 · 2024: 34 · 2023: 32 · 2022: 44 · 2021: 55 · 2020: 25 · 2019: 24 · 2018: 23 · 2017: 18 · 2016: 22 · 2015: 23 · 2014: 21 · 2013: 9 · 2012: 17
- FWCI
- 14.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (P20AA015630)
- National Institute of Mental Health (MH66750, U10MH066762, U10MH066778, U10MH066750, MH66769, MH66762, MH66778, U10MH066775, U10MH066769, R01MH061017, MH66775)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- suicide prevention, cognitive behavioral therapy, adolescents, suicide attempters, depression, relapse prevention, risk mitigation, safety planning, dialectical behavior therapy, family intervention, treatment feasibility, acceptability, manual-based intervention
- MeSH terms
- Suicide Prevention, Adaptation, Psychological, Adolescent, Combined Modality Therapy, Depressive Disorder, Major, Major Depressive Disorder, Family Therapy, Feasibility Studies, Female, Humans, Interview, Psychological, Life Change Events, Male, Patient Acceptance of Health Care, Personality Inventory, Suicide, Suicide, Attempted, Cognitive Behavioral Therapy, Imagery, Psychotherapy, Dysthymic Disorder, Secondary Prevention
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