Group-Based Adaptations of Brief Cognitive Behavioral Therapy Effectively Mitigate Suicide Ideation in Military Personnel

Posted May 24, 2023

Robert Cramer, Ph.D., University of North Carolina at Charlotte
Justin C. Baker, Ph.D., ABPP, The Ohio State University
Cmdr. Shawna G. Grover, Ph.D., ANP-BC, ACNS-BC, AOCNS, Navy Medicine Readiness and Training Command (NMRTC) Portsmouth
Capt. Michael J. Franks, Jr., Psy.D., MP, ABPP, NMRTC Portsmouth

Since 2014, the rate of death by suicide among active-duty military personnel has increased significantly. This rate exceeds that seen among U.S. males and is almost double the suicide rate in the U.S. general population. As shown in the February 2023 Suicide Prevention and Response Independent Review Commission (SPRIRC) report, this pressing issue has been further compounded by widespread clinician shortages, systemic barriers preventing access to health care services for active-duty Service Members, and high-cost interventions against suicide. Current standards of care, such as psychotropic medications, fail to equip Service Members with enhanced stress-coping abilities and adequate resilience against future suicide distress. Group therapy treatment formats allow for greater access to mental health services, and show promise to reduce suicidal ideation. Dialectical Behavioral Therapy (DBT), the current gold standard in group therapy intervention for suicidal behavior, requires extensive time and resources. Brief Cognitive Behavioral Therapy (BCBT) is an evidence-based approach against suicidal thoughts and behaviors that focuses on a tailored enhancement of self-regulatory skills and requires less resources and half the time needed for DBT.

Endowed with a fiscal year 2021 (FY21) Peer Reviewed Medical Research Program Clinical Trial Award (with Planning Phase) for the Topic Area of suicide prevention, Drs. Robert Cramer and Justin Baker, in partnership with Cmdr. Shawna Grover and Capt. Michael Franks, seek to uniquely pilot a group-based adaptation of BCBT (G-BCBT) to investigate its ability to reduce suicidal behavior, and improve the use of coping strategies and overall mental health. This is a collaborative effort between the University of North Carolina at Charlotte, The Ohio State University, and Navy Medicine Readiness and Training Command Portsmouth. The researchers’ unique evidence-based intervention advances self-efficacy and self-control to mitigate suicide risk for Service Members by empowering them with emotion regulation and cognitive flexibility skills. G-BCBT is hypothesized to reduce suicidal ideation and the likelihood of suicide attempts as compared with its more resource-demanding counterpart, DBT.

This single-site, four-year randomized controlled trial will divide 136 at-risk active-duty Service Members into G-BCBT and DBT groups. Military personnel assigned to the DBT group will follow a pre-existing protocol organized into three phases, which all include dedicated time for mindfulness orientation, a core pillar of DBT. Service Members assigned to the G-BCBT condition will complete a 12-week protocol similarly organized into three phases: (1) development of a personalized crisis response plan, understanding of an individuals’ underlying self-regulatory deficits, and focus on emotion regulation strategies; (2) use of CBT worksheets focused on reappraising unhealthy suicidal beliefs and creating coping cards, and (3) relapse prevention and mastering skills learned to navigate future stress.

The primary outcome for this study is a reduction in suicidal ideation measured by a comparison of Beck Scale for Suicide Ideation (BSSI) scores between G-BCBT and DBT groups 6 months post treatment.

The BCBT intervention is well established in providing self-efficacy enhancing methods. Drs. Cramer and Baker stand to enhance BCBT as an effective tool against suicidal behavior via adaptation of the intervention into a group format. Currently, Drs. Cramer and Baker, in partnership with Cmdr. Grover and Capt. Franks, are looking to develop training materials for clinicians, revise the current BCBT manual based on their findings, and enhance the visibility of G-BCBT by sharing knowledge products with national leaders in military health care. The success of this exciting clinical trial could produce accessible materials, counseling, and coping skills training that enhances Service Member quality of life, operational readiness, and resilience to future mental health challenges.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense nor the U.S. Government. This study is supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Congressionally Directed Medical Research Programs, Peer Reviewed Medical Research Program, Clinical Trial Award, under Award No. W81XWH2210234. This work was prepared as part of the official duties of military service study team members. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties. The study protocol (NMCP.2022.0063) was approved by the Navy Medical Center Portsmouth Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.

Preventing Suicide in the U.S. Military: Recommendations from the Suicide Prevention and Response Independent Review Committee. 2023. U.S. Department of Defense.

Personal and Technical Abstracts: Piloting a Brief Cognitive Behavioral Therapy (BCBT) Group Intervention for Suicidal Behavior Among Active-Duty Military Personnel

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Last updated Wednesday, May 24, 2023