Telehealth delivery of Cognitive Behavioral Therapy for Suicide Prevention
March 13, 2023
Takeaway: As of October 2022, 98 providers have been trained in cognitive behavioral therapy for suicide prevention (CBT-SP) and 115 out of 139 VA facilities are receiving CBT-SP.
The suicide rate for Veterans rose from 23.3 per 100,000 in 2001 to 31.7 per 100,000 in 2020. Of the on average 16.8 Veteran suicides per day in 2020, approximately 40% (6.7 per day) were among Recent Veteran VHA Users. From 2018 to 2020, age- and sex-adjusted suicide rates for Veterans fell by 10%. However, the suicide rate for Veterans in 2020 was still 57% greater than for non-Veteran adults in the U.S. Therefore, reducing the risk of death by suicide among Veterans continues to be a national priority (National Veteran Suicide Prevention Annual Report, September 2022).
The VA’s national vision for addressing suicide is grounded in the idea that prevention requires both community-based public health strategy and a clinical approach. Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) was the strongest recommended clinical intervention in the VA/DoD Clinical Practice Guideline: Assessment and Management of Patients at Risk for Suicide (2019). CBT-SP is an intervention that uses cognitive and behavioral strategies to facilitate a reduction in the likelihood of future suicidal behaviors or attempts. The objectives of CBT-SP are to:
- Build a sense of hope;
- Increase awareness of reasons for living;
- Develop alternative ways of thinking and behaving via skill-building, imagery, and rehearsal techniques; and
- Increase distress tolerance and self-efficacy to manage crises.
Mark Ilgen, PhD is a clinical psychologist and HSR&D Research Career Scientist – and is part of HSR&D’s Center for Clinical Management Research (CCMR). Dr. Ilgen's work has focused on improving treatment outcomes for patients struggling with substance use disorders and complicated co-occurring problems, particularly chronic pain, other psychiatric disorders, and suicide risk. Dr. Ilgen and colleagues in Ann Arbor and Denver developed a CBT-SP intervention to reduce suicide attempts among Veterans with substance use disorder (SUD). Subsequently, recognizing the challenge of expanding access to CBT-SP while maintaining quality of care in this specialized intervention, this team of researchers partnered with the VA Suicide Prevention Program to pilot a clinical demonstration assessing the feasibility, acceptability, impact and reach of delivering CBT-SP using VA’s expanding telehealth technology.
CBT-SP via telehealth is a manualized treatment protocol consisting of 12 to 14 sessions, each lasting 60 minutes, delivered in an individual format. Through the pilot, trained clinicians provided CBT-SP to Veterans across multi-state regions, with the Veterans using either their own technology or VA issued tablets with data plans. Veterans received a therapy workbook in the mail containing exercises they would complete with the therapist and homework they could complete between sessions.
The success of the pilot – combined with the growing use of telehealth technologies – led to the decision to expand this model nationally as part of the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative. The SP 2.0 Clinical Telehealth program incorporates multiple evidence-based interventions for suicide prevention, including CBT-SP, as well as through a massive hiring and training campaign. SP 2.0, has implemented these services for Veterans with a history of suicidal self-directed violence within the last year.
The team of collaborators from CCMR and the Rocky Mountain MIRECC continue to partner with the Office of Mental Health and Suicide Prevention (OMHSP) and the Suicide Prevention 2.0 (SP 2.0) program to expand access to CBT-SP using telehealth technology and to describe the reach and potential impact of this work. As of September 2022, 98 providers have been trained in CBT-SP. As of October 18, 2022, 115 out of 139 VA facilities are receiving CBT-SP.