Indirect Care

Indirect Care

Interventions and Treatments that Indirectly Address Suicidality

Indirect treatments focus on risk factors related to suicide but do not necessarily target suicidal thoughts and behaviors as part of the treatment. Indirect treatment can be adapted to be direct suicide-focused treatments (see DBT section below). This is not an exhaustive list of all treatments that may decrease thoughts, feelings, and behaviors related to suicide. This list of treatments focuses on treatments that target risk factors related to suicide and treatments that specifically address individuals at increased risk for suicide.

A word about the research

Below are listed multiple treatments and interventions. Some are considered evidence-based (multiple studies with high rigor) and other are considered empirically supported (fewer studies, potentially less rigor). Also, please note that the supportive research for each intervention or treatment is not always included. The research is constantly evolving and there are nuances within research studies that space precludes us from elaborating on the research for each intervention and treatment. Feel free to review the Evidence Base section of this website for overall research that supports suicide-specific treatment.

Interventions

Attachment-Based Family Therapy (ABFT)

ABFT is an empirically supported treatment that is personalized, process-oriented, trauma-focused and rooted in attachment theory to target adolescent depression and suicidality with the goal to address attachment ruptures at the core of the family conflict.1 There are five therapeutic tasks in ABFT which are typically covered over 10 sessions:

  1. Shift the focus from individual symptoms to the individual’s relationships with others
  2. Build an alliance with the adolescent
  3. Build an alliance with the parents/guardians
  4. Assist the adolescent in expressing their grievances to their parents
  5. Teach and practice relational skills
Acceptance and Commitment Therapy (ACT)

ACT is a mindfulness-based, action-oriented treatment. ACT centers on acknowledging that suffering is part of the human experience and so by remaining in the present moment and accepting thoughts and feelings without the need to become attached to them, judge them, or change them, one can move through difficult experiences and move towards a values-driven life. There are six core components in ACT.

  1. Cognitive diffusion
  2. Expansion and acceptance
  3. Contact with the present moment
  4. Self as context
  5. Values
  6. Committed action

ACT is delivered individually as well as in group therapy formats; it has been shown to be effective for numerous psychiatric conditions.

Digital Cognitive Behavioral Therapy for Insomnia (CBTI) via Sleepio

Sleepio is a digital application that provides CBTI. In this format of CBTI, individuals have 12 weeks to access 6 sessions of CBTI in which new sessions are “unlocked” each week with the expectation that sessions would be completed 1x/week. Sleepio is fully automated and standardized. The intervention covered behavioral components (sleep restriction, stimulus control), cognitive components (e.g., cognitive restructuring, paradoxical intention), progressive muscle relaxation, and sleep hygiene. Sessions are directed by an animated ‘virtual therapist’ who reviews and guides progress with the individual based on submitted sleep data. Participants are granted access to new sessions weekly (i.e., new session became available a week after completing a previous session).

Mentalization Based Treatment (MBT)

MBT is a psychodynamic treatment rooted in attachment and cognitive theory that aims to strengthen an individual’s capacity to understand their own and other’s states to address affect, interpersonal functioning, and triggers for suicidal behaviors.

Problem Solving Therapy (PST)

PST is a long-standing brief and focused treatment aimed at teaching skills to solve problems. There are multiple manualized versions, versions that include tele-support (e.g., phone calls), as well as brief adaptations. Typically, PST includes some form of teaching individuals how to recognize problems, select a problem to work on, identify solutions, and build an action plant to address the selected problem.

Interpersonal Therapy (IPT)

IPT focuses on providing techniques of interpersonal incident analysis and communication analysis to help individuals identify what contributes to their psychological pain and find ways to express their interpersonal needs to help alleviate suffering. When IPT is focused on those at risk for suicide, the treatment will also include adaptations to focus on the individual’s suicide risk and resiliency factors to help formulate an interpersonal conceptualization.2 3

Group Treatments

The below treatments have emerging research to support them.

Coping, Understanding, Support and Prevention (CUSP) Group

The CUSP Group is a group therapy that functions as a semi-structured, drop-in support group. Sessions last for 60 minutes and during sessions, participants are encouraged to speak about their mood, functioning, suicidal thoughts, and stressors which the two group leaders offer process, support, and education for based on the discussions.

Grady Nia Project (Nia)

Nia is a manualized 10-session, 90-minute group therapy that is culturally informed, based on the theory of triadic influence (TTI).4 Nia provides psychoeducation of the correlation between intimate partner violence (IPV) and suicide, safety planning for suicidal behaviors and IPV, and reducing interpersonal, social, and situational risk factors.5, 6, 7 

Interdisciplinary, Recovery-Oriented Intensive Outpatient Program (IR-IOP)

This intensive outpatient program is a manualized, 10-day for 60-minutes-each process-based group therapy including skills, education, and discussion for crisis management, wellness, and coping skills, emotional regulation, and problem-solving. Evidence-based suicide risk and management strategies are also included. This group therapy specifically works with individuals who are at risk of psychiatric hospitalization or re-hospitalization regardless of diagnosis.

Spiritual and Religious Group Psychotherapy

The group is 10 sessions long, for 60 minutes each, and delivered three times a week. The focus was on reading religious scripture and reliance on God and discussing suicide.

 
  • 1Diamond, G., Russon, J., & Levy, S. (2016). Attachment‐based family therapy: A review of the empirical support. Family process, 55(3), 595-610.
  • 2Heisel, M. J., Duberstein, P. R., Talbot, N. L., King, D. A., and Tu, X. M. (2009). Adapting interpersonal psychotherapy for older adults at risk for suicide: preliminary findings. Prof. Psychol. Res. Pract. 40, 156–164. doi: 10.1037/a001473
  • 3Heisel, M. J., Talbot, N. L., King, D. A., Tu, X. M., and Duberstein, P. R. (2015). Adapting interpersonal psychotherapy for older adults at risk for suicide. Am. J. Geriatr. Psychiatry 23, 87–98. doi: 10.1016/j.jagp.2014.03.010
  • 4Flay, B. R., & Petraitis, J. (1994). The theory of triadic influence: A new theory of health behavior with implications for preventive interventions. Advances in Medical Sociology, 4,19–44.
  • 5Kaslow N. J., Leiner, A. S., Reviere S., Jackson E., Bethea K., Bhaiu J., Rhodes, M., Gantt M. J., Senter, H. & Thompson, M. P. (2010). Suicidal abused African American women’s response to a culturally informed intervention. Journal of Consulting and Clinical Psychology, 78(4), 449. https://doi.org/10.1037/a0019692
  • 6Taha, F., Zhang, H., Snead, K., Jones, A. D., Blackmon, B., Bryant, R. J., ... & Kaslow, N. J. (2015). Effects of a culturally informed intervention on abused, suicidal African American women. Cultural Diversity and Ethnic Minority Psychology, 21(4), 560.
  • 7Zhang, H., Neelarambam, K., Schwenke, T. J., Rhodes, M. N., Pittman, D. M., & Kaslow, N. J. (2013). Mediators of a culturally-sensitive intervention for suicidal African American women. Journal of Clinical Psychology in Medical Settings, 20(4), 401-414.