Brief interventions like the ones described previously, can be very effective and particularly helpful when time is limited. They provide a tool to use to stay safe when suicidal desire arises. But moderate length interventions, ones that typically take place once or twice a week over 2-4 months, are more effective in getting to the heart of what is causing the pain and hopelessness. Also allow therapists to pull in other therapies and tools to address those underlying concerns. Let's look at two examples of these evidence-based interventions. The first one is called CAMS, collaborative assessment and management of suicidality. Rather than being a fully manualized treatment, CAMS is more of a philosophy of care. It provides a therapeutic framework for suicide specific assessment and treatment of a patient suicidal risk. A unique element of CAMS is that it's flexible and can be used in conjunction with treatments across theoretical orientations and disciplines. During CAMS, the clinician and client participate in a highly interactive assessment process and the patient is actively involved in the development of their own treatment plan. All assessment work in CAMS is collaborative. We seek to have the patient be a co-author of their treatment plan. This is demonstrated even in the body language that's employed with CAMS therapist pulling their chair up next to the patient's chair, and handing their worksheets to the patient to complete with the therapist support and guidance. The collaborative assessment process and diverse to understand what's driving the suicidal desire so that the treatment planning can line up with targeting the things that are most likely to then reduce that desire. Every session of CAMS intentionally utilizes the patient's input about what is and what's not working. A focus on the treatment targets that are most closely related to the suicidal drivers are maintained, and suicidal desire is assessed each session. Of course, as we learned about when talking about theories of suicide, what drives the pain and hopelessness for one individual is different than that for another. Additionally, the theoretical orientation and training of therapists varies considerably. That's a powerful element of CAMS, it's customizability to individual clients and individual therapists, while still keeping the focus on reducing the desire for suicide front and center. In terms of CAMS philosophy, the clinicians, honesty and forthrightness are key elements. For any patient in the space between life and death, a critical element of care is direct and respectful candor when suicide risk is present. The CAMS clinician focuses on understanding a client's suffering from an empathetic and non-judgmental perspective. The clinician never shames or blames a suicidal person for being suicidal. They work to understand the struggle from the perspective of the patient themselves. Brief cognitive behavior therapy for suicide prevention comes from a very specific therapeutic orientation. Cognitive behavior therapy. It lasts approximately 12 sessions and uses this cognitive behavioral framework to target what is called the suicidal mode. The suicidal mode is the interaction of behavioral, emotional, cognitive, and physical components that make up an individual's suicidal state at times when they are experiencing active suicide ideation. For one individual, the suicidal mode might be made up of thoughts of worthlessness and being a failure, combined with feelings of shame, fear, and self-loathing. For this individual, they may feel their heart race, they may feel agitated, they may have a hard time sleeping or settling down. Behaviorally, others might notice that this individual stop training at work and has shut down their friends and family. As this individual shuts down and pulls away, he may get more messages of failure from his boss, further igniting his ruminations and his emotions. The activation of all of these nodes of the suicidal mode is theorized to drive suicidal desire and action. Of course, for another individual, completely different thoughts, emotions, sensations, and behaviors could be at play. BCBT treatment is divided into three phases. In the first phase, BCBT focuses on deactivating that suicidal mode via creating a crisis response plan, as we described earlier, and teaching emotion regulation skills to further bolster the clients toolkit when they're faced with overwhelming emotions. These skills might include things like knowing how to identify emotions, practicing progressive muscle relaxation, learning more about distress tolerance, deep breathing, and other ways to ride out challenging situations. In addition, during these first few sessions, the therapist and the client work together to uncover the patient suicidal mode, and to use that individualized knowledge to drive treatment plan. In the second phase, the therapist and the client work to understand and undermine that suicidal belief system. This is accomplished by first, targeting cognitive risk factors. That is examining and challenging the thinking patterns that ignite that suicidal mode. Second, by identifying value-driven actions and activities. Breaking them down into approachable pieces and reinforcing, engaging in those activities. During these mental phase, clients continue to practice the emotion regulation skills they learned in phase 1 and also can modify the crisis response plan as they need to. The third phase of BCBT, which usually last just a session or two, is dedicated to a relapse prevention task. Which involves the client imagining, experiencing suicidal crisis and then effectively resolving them. The primary goal of their relapse prevention task is to practice using skills learned in treatment to effectively manage a future emotional crisis without making a suicide attempt or engaging in other problematic behavior. Often the crisis will be presented in multiple ways with different levels of difficulty. The client's ability or challenge in navigating these hypothetical crisis can give an indication of their readiness to complete therapy. Successful practice puts the client in a good position to navigate suicidal crisis that arise in the future and also builds their sense of hope and of self-efficacy. Now the field is not yet have enough data to definitively say which treatments are most effective for which people. However, these intervention I have just described have been tested and shown success with general adult populations, military service members, and with college students. The clients involved might have psychiatric diagnoses as well like mood and anxiety disorders. While these treatments may result in a reduction of some of those symptoms of depression or anxiety, the treatment target is the suicidal thoughts and behaviors themselves. That's something that sets these treatments apart. Please watch the linked clip to learn more about moderate and longer-term interventions. Then we'll look at one longer-term treatment that helps with more chronic or persistent suicidality.
