A New Psychosocial Treatment for Suicidality

Summary and Comment |
January 22, 2016

A New Psychosocial Treatment for Suicidality

  1. Peter Roy-Byrne, MD

In individuals recently hospitalized for self-harm behaviors, identifying self-harm triggers and potential responses reduced suicidal threats and attempts.

  1. Peter Roy-Byrne, MD

Individuals hospitalized for self-harm, regardless of suicidal intent, are at high risk for future suicide attempts. Few medications have specific antisuicidal effects, but now clinicians are developing psychosocial treatments to address the multiple powerful contextual factors contributing to self-harm. “Implementation intentions” (IIs) are a set of plans that identify trigger situations and formulate plans to counter them in an “if-then” fashion. They have been used successfully to treat other problem behaviors such as overeating and alcoholism. Now, researchers have randomized 226 patients recently hospitalized for self-harm to one of three interventions: unassisted IIs (patients generate their own plans), assisted IIs (patients use “help sheets” containing possible solutions), and a control (patients think about triggers and coping without forming IIs).

At least some suicidal measures decreased in all three groups at 3 months. However, both II conditions reduced suicidal ideation, compared with the control condition, with a medium effect size. Compared with the unassisted-II condition, the assisted-II condition reduced suicidal threats (medium effect size) and actual attempts (small effect size). A measure of self-efficacy showed no change, supporting a pre-existing theory that IIs work in an automatic, nonconscious manner.


This novel intervention, never before used to address self-harm behaviors and suicidal risk, reduced suicidal risk markers (ideation and threats) and actual attempts, with small-to-moderate effect sizes. Providing a help sheet that details possible strategies to cope with common suicidal triggers seems to increase the effectiveness of the intervention. The results are impressive because an active control, which caused some reduction in risk behaviors, was used as a comparator. As the authors wonder, might adding participation by a clinician further enhance these effects?

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / Research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (President)


Reader Comments (2)

SONIA HYMAN Physician, Psychiatry, retired

This something that many psychiatrists have been doing for years, but it's great to have it formalized and experimentally tested.

helen pliler pt former license retired Other, retired

your methods are not new but i am sure any attention can help. most people who need help are not given hospital care especially now days
everyone is treated at the local pharmacy by some pretty indifferent bored pharmacists who never explain anything about what has been prescribed. many communities don't have psychiatric professionals of any degree and no one gets a chance to grieve let alone try to find out why where or what is causing their pain they just know it is intolerable. what I want to know is why there is not more research on how we need close companions who hug each other and listen to each other and like elephant families, need closeness to nurture us and like a mother and babys need does not end just because we go to school or nurturing is important at every age or we don't survive alone

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