Massed Brief Cognitive Behavioral Therapy (mBCBT) for Suicide Prevention: Results of a Pragmatic Clinical Trial

• Suicidal patients often attempt suicide early in therapy. • Suicide-focused brief cognitive behavioral therapy (BCBT) reduces suicide risk. • Daily BCBT sessions daily (“massed” BCBT) could accelerate suicide risk reductions. • In massed BCBT, clinical outcomes improved within 2-3 weeks. • Follow-up care after massed BCBT may be needed to preserve early gains. Brief cognitive behavioral therapy (BCBT) for suicide prevention has been shown to significantly reduce suicide attempts in multiple clinical settings and populations. Despite its efficacy, some patients will nonetheless engage in suicidal behaviors, typically within months of starting treatment, before they have received all treatment components. Accelerating the pace of BCBT with daily sessions during a compressed timeframe (e.g., 1-3 weeks) could lead to faster reductions in suicide risk. To date, no studies have examined the potential benefits of intensive or “massed” suicide prevention therapies. In this nonrandomized observational study, we examined change in multiple clinical outcomes (suicidal cognitions, suicidal ideation, depression, anxiety, and social-occupational functioning) during and after BCBT among treatment-seeking adult patients with recent suicidal ideation and/or suicidal behaviors. Of 55 patients, 30 chose to attend daily sessions of BCBT over 2 weeks (massed BCBT, or mBCBT) and 25 chose to attend weekly sessions (standard BCBT). Patients in both formats reported improvements in suicidal cognitions, suicidal ideation, depression, and social-occupational functioning by treatment end (week 3 in mBCBT and week 10 in standard BCBT). Anxiety symptoms improved more in standard BCBT than mBCBT. Relative to baseline, clinical gains at the end of mBCBT were maintained at the 3-month follow-up (week 15) but were smaller in magnitude than the gains reported 3 months after standard BCBT (week 22). Results suggest clinical outcomes improved in the short term during mBCBT. Additional research is warranted to evaluate change trajectories over longer follow-up periods.