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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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In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
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“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]
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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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“10,11 The outcome also appears consistent with clinicians ’ beliefs in the effectiveness of safety planning.”
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“, 2014), cognitive behavior therapy for suicide prevention (Stanley et al., 2009), and mentalization-based treatment for adolescents (Rossouw & Fonagy, 2012), address self-harm by building intrapersonal capacities for distress tolerance, emotion regulation, mindful cognitive processing, and secure engagement in suppor…”
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“Safety planning consists of a written, prioritized list of coping strategies and sources of support that veterans can use to alleviate a suicidal crisis (Stanley, Brown, Karlin, Kemp, & VonBergen, 2008) and has been used in the context of short-term, evidence-based psychotherapies that have been found to reduce suicid…”
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“, crisis response and stabilization plans) have been incorporated into comprehensive treatment protocols for adults and adolescents (Brent, Poling, & Goldstein, 2011; Jobes, 2006; Miller, Rathus, & Linehan, 2007; Stanley et al., 2009; Rudd, Joiner, & Rajab, 2001; Wenzel, Brown, & Beck, 2009).”
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“…TAU 5 months Three 6 months Patients’ self-reported suicidal acts Reduction in SA (Specialized short-term psychotherapeutic day treatment program) Fair Stanley et al., 2009 110 84, 75.5 15.8 NR Manualized cognitive behavioral treatment 6 months One NR NR Insufficient evidence Poor Fleischhaker et…”
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Depressive disorders in childhood and adolescence
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BackgroundMethodInfluentialAn emergency department-based brief intervention for veterans at risk for suicide (SAFE VET)
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“The authors do not wish to downplay the longstanding, well-supported, positive impact of evidence-based interventions that do not incorporate LE (e.g., CognitiveBehavioral Therapy for Suicide Prevention [CBT-SP], Stanley et al., 2009; and others).”
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“Studies conducted in adults suggest that safety planning is a promising intervention to reduce the risk of suicidal behaviors (Brown et al., 2005; Stanley & Brown, 2012; Stanley et al., 2009).”
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“The primary intervention model was Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) (Stanley et al., 2009).”
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“The finding that effective strategies are more activity-based, often serving as a distraction from the suicidal crisis by promoting behavioral activation, pleasure, and a sense of mastery, is in line with approaches encouraged in brief interventions for preventing suicide, such as the Safety Planning Intervention (Sta…”
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“Suicide and DSH are preventable, and therapeutic approaches that specifically target suicidal ideation (SI) provide successful results [2-4].”
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“crisis response plan, stabilization plan), safety planning is a component of different treatment protocols for adults and adolescents at risk for suicide (e.g. Brent, Poling, & Goldstein, 2011; Jobes, 2006; Rudd, Joiner, & Rajab, 2001; Stanley et al., 2009; Wenzel, Brown, & Beck, 2009), and it is also a stand-alone in…”
BackgroundNuij, C., van Ballegooijen, W., Ruwaard, J., Beurs, D. P. D., Mokkenstorm, J. K., van Duijn, E., de Winter, R. F. P., O’Connor, R. C., Smit, J. H., Riper, H. M., et al. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.04.005 · Cited by 59
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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“There is extensive evidence that CBT is an efficacious intervention for treating existing mental health issues such as depression (Rosselló & Bernal, 2009) and suicidal ideation (Stanley et al., 2009; TADS, 2004) in general population adolescents (Compton et al.”
BackgroundSuicide assessment and treatment in pediatric primary care settings
Sisler, S. M., Schapiro, N. A., Nakaishi, M., & Steinbuchel, P. H. (2020) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12282 · Cited by 62
“Specific therapies aimed at reducing STB as an area of focus include dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), and inter-personal therapy (IPT); see Table 5 for a brief description of each and related links.”
Role of the family in suicide prevention: An attachment and family systems perspective
Prabhu, S. L., Molinari, V., Bowers, T., & Lomax, J. W. (2010) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2010.74.4.301 · Cited by 62
Suicide Prevention Interventions for Sexual & Gender Minority Youth: An Unmet Need.
Marshall, A. (2016) · PubMed Central · Cited by 55
DeVylder, J. E., Oh, A. J., Ben-David, S., Azimov, N., Harkavy-Friedman, J. M., & Corcoran, C. M. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.07.009 · Cited by 55
“These can be targeted in high risk patients through medications other than antipsychotics (Cornblatt et al., 2007), and with psychosocial treatments such as cognitive-behavioral therapy (Addington et al., 2010; Morrison et al., 2004) and suicide prevention (Stanley et al., 2009).”
BackgroundSinyor, M., Williams, M., Mitchell, R. H. B., Zaheer, R., Bryan, C. J., Schaffer, A., Westreich, N., Ellis, J., Goldstein, B. I., Cheung, A., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.178 · Cited by 59
Suicide in the pediatric population: screening, risk assessment and treatment
Cwik, M. F., O’Keefe, V. M., & Haroz, E. E. (2020) · International Review of Psychiatry · doi:10.1080/09540261.2019.1693351 · Cited by 54
“While machine learning algorithms may not single handedly reduce suicide rates to zero, implementing these approaches effectively, ethically, and in combination with other interventions (e.g. safety planning and facilitating support to outside clinical care) or within a public health model (e.g. surveillance, identify…”
BackgroundInfluentialSelf-citationSuicide Safety Planning: Clinician Training, Comfort, and Safety Plan Utilization
Moscardini, E. H., Hill, R. M., Dodd, C. G., Do, C., Kaplow, J., & Tucker, R. P. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17186444 · Cited by 37
Rice, S., Robinson, J., Bendall, S., Hetrick, S. E., Cox, G., Bailey, E., Gleeson, J., & Álvarez‐Jiménez, M. (2016) · PubMed Central · Cited by 53
Assessment and Management of Suicide Risk in Children and Adolescents
Pettit, J. W., Buitron, V., & Green, K. L. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.04.001 · Cited by 52
“In Step 6, which involves planning to make the environment safe and limit access to lethal means, clinicians should always work collaboratively with youths and their caregivers or an adult who can assist in making the environment safe (Stanley et al., 2009).”
BackgroundMethodThe Interpersonal Needs Questionnaire: Statistical Considerations for Improved Clinical Application
Mitchell, S. M., Brown, S. L., Roush, J. F., Tucker, R. P., Cukrowicz, K. C., & Joiner, T. E. (2019) · Assessment · doi:10.1177/1073191118824660 · Cited by 54
“, safety planning intervention [Stanley & Brown, 2012], cognitive behavior therapy for suicide prevention [Stanley et al., 2009]), request permission to obtain collateral information from family or friends, and provide the patient with a crisis line number.”
BackgroundIntegrating a functional view on suicide risk into idiographic statistical models
Kaurin, A., Dombrovski, A. Y., Hallquist, M. N., & Wright, A. G. C. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.104012 · Cited by 55
Lin, T.-J., Ko, H.-C., Wu, J. Y.-W., Oei, T. P., Lane, H.-Y., & Chen, C.-H. (2019) · Archives of Suicide Research · doi:10.1080/13811118.2018.1436104 · Cited by 64
DeVylder, J., & Hilimire, M. R. (2015) · Health & Social Work · doi:10.1093/hsw/hlv037 · Cited by 52
“Modified forms of cognitive– behavioral therapy may be particularly appropriate for the co-occurrence of psychosis and suicidality ( Stanley et al., 2009).”
BackgroundThe narrative‐crisis model of suicide and its prediction of near‐term suicide risk
Cohen, L. J., Mokhtar, R., Richards, J., Hernandez, M., Bloch‐Elkouby, S., & Galynker, I. (2022) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12816 · Cited by 51
Abbott‐Smith, S., Ring, N., Dougall, N., & Davey, J. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12928 · Cited by 50
The Multidimensional Mortality Awareness Measure and Model
Levasseur, O., McDermott, M. R., & Lafreniere, K. D. (2015) · OMEGA - Journal of Death and Dying · doi:10.1177/0030222815569440 · Cited by 47
“…behaviors associated with M-Disempowerment and constructing an adaptive cognitive schemata associated with M-Legacy may well be a viable way of moderating suicidal ideation, given the success of cognitive-behavioral therapy (CBT) with such reported by March et al. (2007) and Stanley et al. (2009).”
BackgroundMethodPerspectives of Suicidal Veterans on Safety Planning
Kayman, D. J., Goldstein, M. F., Dixon, L. B., & Goodman, M. S. (2015) · Crisis · doi:10.1027/0227-5910/a000348 · Cited by 47
“The safety plan, as recently described and illustrated with a case example (Stanley & Brown, 2012), originated as the crisis plan component of a 10-session series of cognitive behavioral therapy (CBT) sessions for persons who had recently made a suicide attempt (Brown et al., 2005; Linehan, 1993; Stanley et al., 2009).”
BackgroundThe Development and Feasibility Outcomes of a Youth Suicide Prevention Intensive Outpatient Program
Kennard, B. D., Mayes, T. L., King, J. L., Moorehead, A., Wolfe, K. L., Hughes, J. L., Castillo, B., Smith, M., Matney, J., Oscarson, B., et al. (2018) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2018.09.015 · Cited by 48
Self-citationCzyz, E. K., Horwitz, A. G., Yegüez, C. E., Foster, C. E., & King, C. A. (2017) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2017.1342546 · Cited by 44
“, 2009), which should be reviewed with the teen’s family (King et al., 2013; Stanley et al., 2009).”
BackgroundInfluentialCox, G., & Hetrick, S. (2017) · Evidence Based Mental Health · doi:10.1136/eb-2017-102667 · Cited by 42
“Alavi et al (2013) used a waitlist comparison and tested a protocol of CBT that was designed to specifically address SRBs, based on the Stanley model.(41) The main components of this include chain analysis (examines the circumstances, cognitions, emotions and behaviour leading up to and at the time of the SA), safety…”
MethodAndreasson, K., Krogh, J., Bech, P., Frandsen, H., Buus, N., Stanley, B., Kerkhof, A. J. F. M., Nordentoft, M., & Erlangsen, A. (2017) · Trials · doi:10.1186/s13063-017-1876-9 · Cited by 42
“have acknowledged that a safety plan is useful and not linked to adverse outcomes [5, 6].”
BackgroundSelf-citationSuicide Prevention Public Service Announcements (PSAs): Examples from Around the World
Ftanou, M., Cox, G., Nicholas, A., Spittal, M. J., Machlin, A., Robinson, J., & Pirkis, J. (2016) · Health Communication · doi:10.1080/10410236.2016.1140269 · Cited by 41
“Promotion of professional support may lead to de-stigmatization of help-seeking behaviors, early intervention, and access to evidence-based therapies that are known to assist with building reliance, changing suicidal thinking patterns, and mastering problems (Brown et al., 2005; King, Strunk, & Sorter, 2011; Stanley e…”
BackgroundDaniel, S. S., & Goldston, D. B. (2011) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.05.003 · Cited by 41
Self-citationSpottswood, M., Lim, C. T., Davydow, D., & Huang, H. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.892205 · Cited by 40
Asarnow, J. R., Berk, M. S., Zhang, L., Wang, P., & Tang, L. (2016) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12309 · Cited by 40
Layman, D. M., Kammer, J., Leckman‐Westin, E., Hogan, M., Grumet, J. G., Labouliere, C. D., Stanley, B., Carruthers, J. W., & Finnerty, M. T. (2021) · Psychiatric Services · doi:10.1176/appi.ps.202000525 · Cited by 40
Self-citationDuprey, E. B., Handley, E. D., Manly, J. T., Cicchetti, D., & Toth, S. L. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104926 · Cited by 45
“Cognitivefocused interventions that have evidence of effectiveness with suicidal adolescents, such as CBT for suicide prevention, may be particularly useful (Stanley et al., 2009).”
BackgroundMental Health Treatment Patterns Among Adults With Recent Suicide Attempts in the United States
Han, B., Compton, W. M., Gfroerer, J., & McKeon, R. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.302163 · Cited by 39
The relationship between self‐criticism and suicide probability
O’Neill, C., Pratt, D., Kilshaw, M. A., Ward, K., KELLY, J. A., & Haddock, G. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2593 · Cited by 51
Future Directions in Research on Psychotherapy for Adolescent Depression
Curry, J. F. (2014) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2014.904233 · Cited by 38
“The CBT manual for the Treatment of Adolescent Suicide Attempters project was even further enlarged by incorporation of a number of dialectical behavior therapy elements and more detailed safety planning (Stanley et al., 2009).”
MethodInfluentialSelf-citationFond, G. B., Llorca, P., Boucékine, M., Zendjidjian, X. Y., Brunel, L., Lançon, C., Auquier, P., & Boyer, L. (2016) · Scientific Reports · doi:10.1038/srep20256 · Cited by 37
Grant, C., Ballard, E. D., & Olson-Madden, J. H. (2015) · The Family Journal · doi:10.1177/1066480715572962 · Cited by 35
Mediators between adverse childhood experiences and suicidality
Rytilä‐Manninen, M., Haravuori, H., Fröjd, S. A., MARTTUNEN, M. J., & Lindberg, N. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2017.12.007 · Cited by 35
Prioritizing Research to Reduce Youth Suicide and Suicidal Behavior
Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Grupp-Phelan, J., & Campo, J. V. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.06.001 · Cited by 34
“There is an urgent need to develop, test, and refine the most promising interventions to reduce adolescent suicide attempts, which include (1) attachment-based family therapy to target family processes associated with depression and suicide(40); (2) integrated CBT for suicidal, alcohol- or substance-abusing adolescent…”
BackgroundBruijniks, S. J. E., Franx, G. C., & Huibers, M. J. H. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1768-x · Cited by 40
“adaptions to treatment protocols to deal with suicidal problems [30, 31] or to target problems with memory”
BackgroundThe Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness
Macintyre, V. G., Mansell, W., Pratt, D., & Tai, S. J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.588683 · Cited by 32
Nichter, B., Stein, M. B., Monteith, L. L., Herzog, S., Holliday, R. P., Hill, M. L., Norman, S. B., Krystal, J. H., & Pietrzak, R. H. (2021) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12822 · Cited by 34
“Similarly, suicide-specific cognitive-behavioral interventions, such as cognitive-behavioral therapy for suicide prevention (Stanley et al., 2009), have shown promising preliminary results for decreasing prospective risk for suicidal ideation and suicide attempts among active duty service members…”
Kwon, C., & Lee, B. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1217299 · Cited by 38
Han, D. H., Lee, J. J., Moon, D.-S., Cha, M.-J., Kim, M. A., Min, S., Yang, J. H., Lee, E. J., Yoo, S.-K., & Chung, U. (2016) · Journal of Korean Medical Science · doi:10.3346/jkms.2016.31.1.114 · Cited by 37
“A total CDI score of 36 or higher indicates severe depression (17).”
Background
Metadata
- 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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