Brief CBT

What is Brief Cognitive Behavioral Therapy (BCBT)?

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.

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How is BCBT delivered?

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.

Clinical settings for BCBT

Outpatient Mental Health
Telehealth
Intensive Outpatient and Partial Hospital Programs (IOP/PHP)
Residential Programs
Inpatient Psychiatric Units

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How does BCBT compare to other mental health treatments?

A meta-analysis conducted by van Ballegooijen et al. (2025) found that cognitive behavioral therapies like BCBT that directly target suicidal thoughts and behaviors are more effective than other types of psychotherapy. Cognitive behavioral therapy is also the only type of psychotherapy to reduce both suicidal ideation and suicide attempts.

A separate 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. Multiple published research studies show that patients who receive BCBT report faster and larger reductions in suicidal ideation and are 45-65% less likely to attempt suicide than patients who receive other mental health treatments, regardless of treatment setting (Baker et al., 2024; Diefenbach et al., 2024; Rudd et al., 2015; Sinyor et al., 2020).

EFFECTIVENESS OF MENTAL HEALTH TREATMENTS FOR SUICIDE RISK

BCBT: 62% reduction
Problem solving : 34% reduction
Other CBTs: 19% reduction
Medication alone: 6% reduction
Eclectic therapy: no reduction
Psychoanalysis: no reduction

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How does BCBT reduce malpractice liability?

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:

Screen all patients for suicide risk ;
Conduct a reasonable assessment of a patient's suicide risk level; and
Provide appropriate interventions and treatments to mitigate this risk.

BCBT includes procedures and clinical support tools that meet and exceed these expectations:

Patient information sheets that augment typical informed consent procedures;
Strategies for effectively screening for suicide risk and integrating results into risk formulation and treatment planning;
Suicide risk assessment documentation templates;
Integration of crisis response planning (CRP);
Collaborative approach to conducting lethal means counseling (LMC); and
Suicide-focused interventions and skills training.

"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.

References

Baker, J. C., Starkey, A., Ammendola, E., Bauder, C. R., Daruwala, S. E., Hiser, J., ... & Bryan, C. J. (2024). Telehealth brief cognitive behavioral therapy for suicide prevention: A randomized clinical trial. JAMA Network Open, 7, e2445913-e2445913.

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.

Diefenbach, G. J., Lord, K. A., Stubbing, J., Rudd, M. D., Levy, H. C., Worden, B., ... & Tolin, D. F. (2024). Brief cognitive behavioral therapy for suicidal inpatients: a randomized clinical trial. JAMA Psychiatry, 81, 1177-1186.

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.

van Ballegooijen, W., Rawee, J., Palantza, C., Miguel, C., Harrer, M., Cristea, I., ... & Cuijpers, P. (2025). Suicidal ideation and suicide attempts after direct or indirect psychotherapy: a systematic review and meta-analysis. JAMA Psychiatry, 82, 31-37.

Suicide Prevention Therapy

The most effective mental health treatment for reducing suicide risk.

What is Brief Cognitive Behavioral Therapy (BCBT)?

How is BCBT delivered?

Clinical settings for BCBT

How does BCBT compare to other mental health treatments?

EFFECTIVENESS OF MENTAL HEALTH TREATMENTS FOR SUICIDE RISK

How does BCBT reduce malpractice liability?

References

Suicide Prevention Therapy

The most effective mental health treatment for reducing suicide risk.

What is Brief Cognitive Behavioral Therapy (BCBT)?

How is BCBT delivered?

Clinical settings for BCBT

How does BCBT compare to other mental health treatments?

EFFECTIVENESS OF MENTAL HEALTH TREATMENTS FOR SUICIDE RISK

How does BCBT reduce malpractice liability?

References

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