Treating Suicidal Behavior An Effective, Time-Limited Approach

Structured yet flexible, this empirically supported approach to treating suicide behavior is specifically tailored to today's managed care environments. Outlined are intervention techniques that focus on symptom management, restructuring the patient's suicidal belief system and building key skills such as interpersonal assertiveness and problem solving.

Grounded in a comprehensive model of suicidality, this volume describes an empirically supported cognitive-behavioral treatment approach. The clinician is guided to assess suicidal behavior and implement interventions tailored to the severity, chronicity, and diagnostic complexity of the patient's symptoms. Provided are session-by-session guidelines and clear-cut strategies for defusing the initial crisis; reducing suicidal behavior; restructuring suicide-related beliefs; and building interpersonal assertiveness, distress tolerance, problem solving, and other key skills. A special chapter covers risk assessment. Enhancing the book's utility are tables, figures, and sample handouts and forms, some of which may be reproduced for professional use.

I. Establishing a Foundation for Treatment1. What Do We Really Know about Treating Suicidality?: A Critical Review of the LiteratureThe Available Literature: A Limited DatabaseA Critical Review of Intervention Studies: Do Simple Procedural Changes Make a Difference?Implications for Clinical PracticeA Critical Review of Treatment Studies: An Emerging Trend for Cognitive Behavioral TherapyImplications for Clinical PracticeThe Therapeutic Relationship in Treating Suicidality: Attachment, Hope, and SurvivalImplications for Clinical PracticeUnanswered Questions: The Challenge Awaits Us2. A Cognitive-Behavioral Model of SuicidalityExisting Theoretical Models of Suicidal Behavior: A Brief OverviewStatic and Dynamic Variables Predicting SuicidalityApplication of Theory and Empirical Findings in Treatment: The Problem of Limited Clinical RelevanceBasic Assumptions of Cognitive Theory and Therapy: Implications for SuicidalityThe Essential Requirements for a Cognitive-Behavioral Model of Integrating Empirical Findings and Ensuring Clinical RelevanceThe Suicidal Mode as a Cognitive-Behavioral Model of Suicidality: An Elaboration and Specific Application of Beck's Theory of Modes and PsychopathologyDefining the Suicidal Mode: Characteristics of the Various SystemsCompleting the Suicidal Mode: Individual Case ConceptualizationImplications of the Suicidal Mode for the Organization, Content, and Process of TreatmentTheoretical Flexibility of the Suicidal Mode for Psychotherapy IntegrationThe Therapeutic Relationship in Cognitive-Behavioral Therapy: Three Fundamental Assumptions3. An Overview of the Treatment ProcessCompleting the Clinical Picture: Understanding Severity, Chronicity, and Diagnostic ComplexityIdentifying Treatment ComponentsAn Overview of the Goals for Each Treatment ComponentAn Overview of the Steps in Treatment PlanningUnderstanding the Treatment Process: Treatment Components and Corresponding LevelsDefining the Component LevelsSymptom Management ComponentCycling through Components and LevelsThe Role of MedicationsSkill-Building ComponentPersonality Development ComponentVariation in Therapist RoleA Clinical Example of Acute Suicidality: The Case of Mr. EMonitoring the Treatment ProcessProcess Tasks and MarkersProvocations and Resistance in the Therapeutic Relationship: How a Clear Organizational Framework HelpsQuantifying Change: How to Measure and Monitor Change in TreatmentTreatment Withdrawal and NoncomplianceEnsuring Treatment FidelityTermination: When, Why, and HowInterpersonal Process Groups and Booster SessionsThe Role of the Treatment TeamThe Need for Long-Term Care in a Time-Limited WorldII. Assessment and Treatment4. Treatment Course and Session-by-Session GuidelinesThe Beginning of Treatment: Sessions 1-4Sessions 5-10: Symptom Management, Cognitive Restructuring, Reducing and Eliminating Suicidal BehaviorsSessions 10-19: Emphasis on Skill BuildingSessions 19-20: A Shift Toward Personality Development and Longer-Term Treatment5. The Evaluation Process and the Initial InterviewsRisk Assessment Goals: The Importance of Establishing a Baseline for Ongoing MonitoringTreatment Conceptualization and Consent: Setting the StageThe Use and Role of Psychometric TestingEstablishing the Therapeutic Relationship6. Assessing Suicide RiskDistinguishing between Risk Assessment and Prediction: Defining the Nature of Clinical ResponsibilitiesThe Importance of Precise Terminology: Saying What We Know and Knowing What We SayEssential Components of a Clinical Risk Assessment InterviewTips on Eliciting Information on Intent and Self ControlRisk Categories: Baseline, Acute, Chronic High Risk, and Chronic High Risk with Acute ExacerbationRating Severity: A Continuum of SuicidalityClinical Documentation and the Process of Risk: The Concept of Risk MonitoringThe Role of Chronicity and Time in Risk AssessmentClinical Decision Making, Management, and TreatmentOngoing Monitoring of Treatment Outcome and EvaluationThe Persistence of Suicidal Thoughts: A Potentially Misleading Marker of Treatment Outcome7. Crisis Intervention and Initial Symptom ManagementKeys Tasks of Crisis InterventionEnsuring the Patient's SafetySelf-Monitoring during CrisesTeaching the Patient to Rate Discomfort: A Self-Monitoring TaskCompleting the Suicidal Thought RecordDepicting the Suicidal Cycle: The Suicidal Mode in ActionUsing Mood GraphsImproving Distress Tolerance and Reducing Impulsivity: The Importance of Repeatedly Emphasizing That Bad Feelings Do Not Last ForeverTargeting Source Hopelessness: A Different Kind of Problem SolvingSymptom Matching: Improving Level of Functioning over the Short TermThe Importance of Structure: Providing a Crisis Response Plan8. Reducing and Eliminating Suicide-Related BehaviorsIdentifying Behavioral Targets in Treatment: Understanding the Suicidal ModeDistinguishing between Suicidal Acts and Instrumental BehaviorsDealing with Mixed MessagesIdentifying the Suicidal CycleThe Process of Behavioral Change: Reducing and Eliminating Suicidal BehaviorInhibiting the Suicidal Cycle during Crisis States: Late-Cycle InterventionSubstitute Behaviors and Purposeful Hypervigilance:Early-Cycle InterventionShaping Behavior: A Process of Gradual ChangeExposure-Based Strategies: Role Playing, Cue Exposure, and Behavioral RehearsalContingency Management and Treatment SuccessTargeting Treatment DisruptionsProvocation(s): The Currency of Interpersonal Relatedness in SuicidalityHandling Provocation in TreatmentThe Evolution of Hope and the Elimination of Suicidal Behavior: A Few Concluding Words9. Cognitive Restructuring: Changing the Suicidal Belief System and Building a Philosophy for LivingPrivate Meaning and the Suicidal Belief System: The Role of Automatic Thoughts and Intermediate and Core BeliefsA Straightforward Strategy for Cognitive ChangeDealing with Poor Motivation and Treatment NoncomplianceBuilding a Philosophy for Living: Change and Acceptance as New RulesPrevailing, Facilitating, and Compensatory Modes in Chronic Suicidality: Developing Adaptive Modes and Acknowledging Personal Qualities and CharacteristicsThe Therapeutic Belief System: Therapy-Specific BeliefsOutlining the Therapeutic Belief SystemThe Therapeutic Belief System of the Therapist Treating Suicidality: Monitoring Thoughts, Feelings, and Behaviors in TreatmentEvaluating the Relationship: Patience, Determination, and Consistency10. Skill Building: Developing Adaptive Modes and Ensuring Lasting ChangeConceptualizing Skill Deficits in Cognitive-Behavioral Therapy for SuicidalityTargeting Skill DeficitsA Model for Problem Solving: Learning to Identify, Evaluate, and Pursue Alternatives to SuicideEmotion Regulation Ability: The Art of Feeling Better When SuicidalSelf-MonitoringDistress ToleranceInterpersonal Skills: Learning to Be Assertive, Attentive, and ResponsiveAnger Management: Early Identification, Appropriate Expression, and the Importance of Empathy, Acceptance, and ForgivenessSkill Building and Personality Change: One and the Same?Changing Interpersonal Process: Integrating Group TreatmentEpilogue

M. David Rudd, PhD, ABPP, is Professor of Psychology and Director of Clinical Training at Baylor University. He also maintains a part-time private practice. Dr. Rudd received his doctorate from the University of Texas at Austin and completed postdoctoral training at the Beck Institute in Philadelphia. He is the author of over 60 articles and book chapters. Thomas E. Joiner, PhD, is Professor of Psychology and Director of the Psychology Clinic at Florida State University. He completed his doctoral training at the University of Texas at Austin. Dr. Joiner has authored over 100 articles and book chapters in the areas of depression, eating disorders, and suicidality. M. Hasan Rajab, PhD, is Associate Professor in the Department of Psychiatry and Behavioral Science at Texas A&M Health Science Center. Dr. Rajab completed his doctoral training in biostatistics at Texas A&M University. He is the author of several articles addressing a range of issues in methodology and biostatistics.