Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD
- Bryan, C. J., Bryan, A. O., Khazem, L. R., Aase, D. M., Moreno, J. L., Ammendola, E., Bauder, C. R., Hiser, J., Daruwala, S. E., & Baker, J. C. (2024). Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. Journal of Anxiety Disorders, 102, Article 102824. https://doi.org/10.1016/j.janxdis.2023.102824
- This study compared two approaches to reducing suicidality for 157 Service members and Veterans in a trauma-focused therapy program. Participants were randomly assigned to receive self-guided safety planning (treatment as usual; n = 81) or clinician-collaborated crisis response planning (n = 76). Participants completed surveys on active (i.e., specific thoughts about ending one's life) and passive (i.e., general desire for death) suicidal ideation as well as posttraumatic stress disorder (PTSD) symptoms at 5 time points (i.e., treatment start, midtreatment, end of treatment, 6 months posttreatment, and 12 months posttreatment). In general, participants with active suicidal ideation in the crisis response planning group reported more rapid reductions in suicidal ideation and greater reductions overall in PTSD symptoms compared to the safety planning group.
- Posttraumatic stress disorder (PTSD) is common among U.S. military veterans and is associated with increased risk of suicidal thoughts and behaviors. Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts in emergency and acute care settings. CRP’s effectiveness when combined with trauma-focused therapies remains unknown. In this randomized pragmatic clinical trial with one-year follow-up, 157 U.S. military personnel and veterans were randomly assigned to receive CRP or self-guided safety planning (SP) prior to beginning massed cognitive processing therapy (CPT) for PTSD. Among 51 (32.5 % of sample) participants endorsing suicidal ideation at baseline, reductions in the severity of suicidal ideation were significantly larger and faster in CRP (F(11,672)= 15.8, p < .001). Among 106 participants denying suicidal ideation at baseline, 8.5 % of CRP participants versus 11.9 % of SP participants (OR=0.69, 95 % CI=0.19–2.52) reported new-onset suicidal ideation during any follow-up assessment. PTSD symptoms significantly reduced over time with no differences between groups. Results support the effectiveness of CRP for rapidly reducing suicidal ideation and managing suicide risk during outpatient treatment for PTSD.
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