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Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide

Published online by Cambridge University Press:  19 October 2011

M. Ghahramanlou-Holloway ,
S. S. Bhar ,
G. K. Brown ,
C. Olsen  and
A. T. Beck
M. Ghahramanlou-Holloway*
Affiliation:
Department of Medical and Clinical Psychology, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
S. S. Bhar
Affiliation:
Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
G. K. Brown
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
C. Olsen
Affiliation:
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
A. T. Beck
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
*
*Address for correspondence: M. Ghahramanlou-Holloway, Ph.D., Departments of Medical & Clinical Psychology and Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room B3050, Bethesda, MD 20814-4799, USA. (Email: [email protected])
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Abstract

Background

Cognitive therapy has been found to be effective in decreasing the recurrence of suicide attempts. A theoretical aim of cognitive therapy is to improve problem-solving skills so that suicide no longer remains the only available option. This study examined the differential rate of change in problem-solving appraisal following suicide attempts among individuals who participated in a randomized controlled trial for the prevention of suicide.

Method

Changes in problem-solving appraisal from pre- to 6-months post-treatment in individuals with a recent suicide attempt, randomized to either cognitive therapy (n=60) or a control condition (n=60), were assessed by using the Social Problem-Solving Inventory-Revised, Short Form.

Results

Improvements in problem-solving appraisal were similarly observed for both groups within the 6-month follow-up. However, during this period, individuals assigned to the cognitive therapy condition demonstrated a significantly faster rate of improvement in negative problem orientation and impulsivity/carelessness. More specifically, individuals receiving cognitive therapy were significantly less likely to report a negative view toward life problems and impulsive/carelessness problem-solving style.

Conclusions

Cognitive therapy for the prevention of suicide provides rapid changes within 6 months on negative problem orientation and impulsivity/carelessness problem-solving style. Given that individuals are at the greatest risk for suicide within 6 months of their last suicide attempt, the current study demonstrates that a brief cognitive intervention produces a rapid rate of improvement in two important domains of problem-solving appraisal during this sensitive period.

Keywords

Attemptscognitive therapypreventionproblem solvingsuicide
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 6 , June 2012 , pp. 1185 - 1193
Copyright
Copyright © Cambridge University Press 2011

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References

Beck, AT, Kovacs, M, Weissman, A (1976). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology 47, 343–352.Google Scholar
Beck, AT, Steer, RA (1988). Manual for the Beck Hopelessness Scale. Psychological Corporation: San Antonio, Texas.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). The Beck Depression Inventory-Second Edition. Psychological Corporation: San Antonio, Texas.Google Scholar
Becker-Weidman, EG, Jacobs, RH, Reinecke, MA, Silva, SG, March, JS (2010). Social problem-solving among adolescents treated for depression. Behavior Research and Therapy 48, 11–18.Google Scholar
Biggam, FH, Power, KG (1999). Suicidality and the state-trait debate on problem solving deficits: a re-examination with incarcerated young offenders. Archives of Suicide Research 5, 27–42.Google Scholar
Bonner, RL, Rich, AR (1988). Negative life stress, social problem-solving self-appraisal, and hopelessness: implications for suicide research. Cognitive Therapy and Research 12, 549–556.Google Scholar
Brown, GK, Beck, AT, Steer, RA, Grisham, JR (2000). Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. Journal of Consulting and Clinical Psychology 68, 371–377.CrossRefGoogle ScholarPubMed
Brown, GK, Have, TT, Henriques, GR, Xie, SX, Hollander, JE, Beck, AT (2005). Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. Journal of the American Medical Association 294, 563–570.CrossRefGoogle ScholarPubMed
Clum, GA, Febbraro, GA (1994). Stress, social support, and problem-solving appraisal/skills: prediction of suicide severity within a college sample. Journal of Psychopathology and Behavioral Assessment 16, 69–83.CrossRefGoogle Scholar
Cooper, J, Kapur, N, Webb, R, Lawlor, M, Guthrie, E, Mackway-Jones, K, Appleby, L (2005). Suicide after deliberate self-harm: a 4-year cohort study. American Journal of Psychiatry 162, 297–303.Google Scholar
Courtet, P, Gottesman, I, Jollan, F, Gould, T (2011). The neuroscience of suicidal behaviors: what can we expect from endophenotype strategies? Translational Psychiatry 10, 1–14.Google Scholar
DeRubeis, RJ, Evans, MD, Hollon, SD, Garvey, MJ, Grove, WM, Tuason, VB (1990). How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology 58, 862–869.Google Scholar
Dixon, WA, Heppner, P, Anderson, WP (1991). Problem-solving appraisal, stress, hopelessness, and suicide ideation in a college population. Journal of Counseling Psychology 38, 51–56.Google Scholar
Dixon, WA, Heppner, P, Rudd, M (1994). Problem-solving appraisal, hopelessness, and suicide ideation: evidence for a mediational model. Journal of Counseling Psychology 41, 91–98.CrossRefGoogle Scholar
D'Zurilla, TJ, Nezu, AM, Maydeu-Olivares, (2002). Social Problem-Solving Inventory-Revised: Technical Manual. Multi-Health Systems: New York.Google Scholar
Evans, J, Williams, J, O'Loughlin, S, Howells, K (1992). Autobiographical memory and problem-solving strategies of parasuicide patients. Psychological Medicine 22, 399–405.CrossRefGoogle ScholarPubMed
Ghahramanlou-Holloway, M, Brown, GK, Beck, AT (2008). Suicide. In Adapting Cognitive Therapy for Depression: Managing Complexity and Comorbidity (ed. Whisman, M. A.), pp. 159–184. Guilford Press: New York.Google Scholar
Goldacre, M, Seagroatt, V, Hawton, K (1993). Suicide after discharge from psychiatric inpatient care. Lancet 342, 283–286.CrossRefGoogle ScholarPubMed
Gunnell, D, Frankel, S (1994). Prevention of suicide: aspirations and evidence. British Medical Journal 308, 1227–1233.Google Scholar
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205–228.Google Scholar
Hawton, K, Fagg, J (1988). Suicide, and other causes of death, following attempted suicide. British Journal of Psychiatry 152, 359–366.CrossRefGoogle ScholarPubMed
Heppner, PP, Petersen, CH (1988). The development and implications of a personal problem-solving inventory. Journal of Counseling Psychology 29, 66–75.Google Scholar
Ho, T-P (2003). The suicide risk of discharged psychiatric patients. Journal of Clinical Psychiatry 64, 702–707.Google Scholar
Howat, S, Davidson, K (2002). Parasuicidal behaviour and interpersonal problem solving performance in older adults. British Journal of Clinical Psychology 41, 375–386.Google Scholar
Jenkins, GR, Hale, R, Papanastassiou, M, Crawford, MJ, Tyrer, P (2002). Suicide rate 22 years after parasuicide: cohort study. British Medical Journal 325, 1155.Google Scholar
Lau, MA, Segal, ZV, Williams, MG (2004). Teasdale's differential activation hypothesis: implications for mechanisms of depressive relapse and suicidal behaviour. Behavior Research and Therapy 42, 1001–1017.Google Scholar
Linehan, MM, Camper, P, Chiles, JA, Strosahl, K, Shearin, E (1987). Interpersonal problem solving and parasuicide. Cognitive Therapy and Research 11, 1–12.CrossRefGoogle Scholar
Orbach, I, Bar-Joseph, H, Dror, N (1990). Styles of problem solving in suicidal individuals. Suicide and Life Threatening Behavior 20, 56–64.Google Scholar
Owens, D, Horrocks, J, House, A (2002). Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry 181, 193–199.Google Scholar
Platt, JJ, Spivack, G, Bloom, MR (1971). Means-ends Problem-solving Procedure (MEPS): Manual and Tentative Norms. Research and Evaluation Report, No. 29. Department of Mental Health Sciences, Hahnemann Medical College and Hospital.Google Scholar
Pollock, LR, Williams, JM (2001). Effective problem solving in suicide attempters depends on specific autobiographical recall. Suicide and Life Threatening Behavior 31, 386–396.Google Scholar
Pollock, LR, Williams, JM (2004). Problem solving in suicide attempters. Psychological Medicine 34, 163–167.Google Scholar
Priester, MJ, Clum, GA (1993). Perceived problem-solving ability as a predictor of depression, hopelessness, and suicide ideation in a college population. Journal of Counseling Psychology 40, 79–85.CrossRefGoogle Scholar
Rotheram-Borus, MJ, Trautman, PD, Dopkins, SC, Shrout, PE (1990). Cognitive style and pleasant activities among female adolescent suicide attempters. Journal of Consulting and Clinical Psychology 58, 554–561.CrossRefGoogle ScholarPubMed
Rudd, MD, Rajab, MH, Dahm, PF (1994). Problem-solving appraisal in suicide ideators and attempters. American Journal of Orthopsychiatry 64, 136–149.Google Scholar
Sadowski, C, Kelley, ML (1993). Social problem solving in suicidal adolescents. Journal of Consulting and Clinical Psychology 61, 121–127.Google Scholar
Schotte, DE, Clum, GA (1982). Suicide ideation in a college population: a test of a model. Journal of Consulting and Clinical Psychology 50, 690–696.CrossRefGoogle Scholar
Schotte, DE, Clum, GA (1987). Problem-solving skills in suicidal psychiatric patients. Journal of Consulting and Clinical Psychology 55, 49–54.Google Scholar
Spitzer, RL, Gibbon, M, Williams, JB (1995). Structured Clinical Interview for Axis I DSM-IV Disorders (SCID). American Psychiatric Association Press: Washington, DC.Google Scholar
Townsend, E, Hawton, K, Altman, DG, Arensman, E, Gunnell, D, Hazell, P, House, A, van Heeringen, K (2001). The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine 31, 979–988.Google Scholar
Wenzel, A, Brown, GK, Beck, AT (2009). Cognitive Therapy for Suicidal Patients: Scientific and Clinical Applications. American Psychological Association: Washington, DC.Google Scholar
Williams, J, Barnhofer, T, Crane, C, Beck, A (2005). Problem solving deteriorates following mood challenge in formerly depressed patients with a history of suicidal ideation. Journal of Abnormal Psychology 114, 421–431.Google Scholar