BCBT is a brief psychotherapy treatment for people who are experiencing suicidal thoughts or recently attempted suicide. BCBT differs from traditional mental health treatments by focusing directly on two core problems that maintain long-term vulnerability to suicide: emotion dysregulation and cognitive rigidity.
Emotion dysregulation involves difficulty managing or changing one's feelings. People who are unable to change uncomfortable or distressing emotions are more likely to attempt suicide as a strategy for escaping these feelings. BCBT teaches people how to use personalized strategies for reducing stress and uncomfortable feelings when they are in stressful situations.
Cognitive rigidity involves difficulty changing how one thinks or behaves in different situations. People with high cognitive rigidity tend to view things in extreme, all-or-nothing ways. BCBT teaches people how to identify their unhelpful thoughts and behavior patterns and practice other, more helpful thoughts and behaviors so they can better respond to stressful situations.
BCBT is typically provided as an outpatient individual psychotherapy scheduled over 10-12 weekly sessions. BCBT can also be delivered daily in a "massed" format that is well-suited for intensive outpatient, partial hospitalization, and residential treatment programs. Abbreviated versions of BCBT have also been developed for inpatient psychiatric settings with relatively short (72 hours) lengths of stay. BCBT can be safely delivered in-person or remotely via telehealth.
Multiple published research studies show that patients who receive BCBT report faster and larger reductions in suicidal ideation and are over 60% less likely to attempt suicide than patients who receive other mental health treatments (Rudd et al., 2015; Sinyor et al., 2020).
A recent meta-analysis conducted by Fox et al. (2020) examining the effectiveness of multiple different types of mental health treatments based on hundreds of published treatment studies show that some mental health treatments are more effective than others for reducing suicide risk and suggest BCBT is more effective than other mental health treatments. Results of that meta-analysis are summarized to the right.
Negligence and malpractice liability in the case of a patient death by suicide are largely determined by foreseeability, which typically refers to the procedures used by the clinician to assess the likelihood and possibility of suicidal behavior prior to the act, and reasonable care, which typically refers to the procedures used by the clinician to reduce this risk (Berman, 2006). To address foreseeability and reasonable care, mental health clinicians are expected to:
BCBT includes procedures and clinical support tools that meet and exceed these expectations:
"Clinicians who administer [BCBT] and its procedures as designed (i.e., high fidelity) can maximize patient outcomes as well as ensure they meet, and even exceed, standard of care expectations."
Bryan, C.J. (2019). Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients. Behavioral Sciences & the Law, 37(3), 247-258.
Berman, A. L. (2006). Risk management with suicidal patients. Journal of Clinical Psychology, 62(2), 171-184.
Bryan, C. J. (2019). Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients. Behavioral Sciences & the Law, 37(3), 247-258.
Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological Bulletin, 146(12), 1117-1145.
Rudd, M. D., Bryan, C. J., Wertenberger, E. G., Peterson, A. L., Young-McCaughan, S., Mintz, J., ... & Bruce, T. O. (2015). Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up. American Journal of Psychiatry, 172(5), 441-449.
Sinyor, M., Williams, M., Mitchell, R., Zaheer, R., Bryan, C. J., Schaffer, A., ... & Tien, H. (2020). Cognitive behavioral therapy for suicide prevention in youth admitted to hospital following an episode of self-harm: A pilot randomized controlled trial. Journal of Affective Disorders, 266, 686-694.