Amy Wenzel
Gregory K. Brown
and Aaron T. Beck
Acknowledgments vii
Introduction 3
Aaron T. Beck
I. Cognitive Theory and Empirical Research. 13
Chapter 1. Classification and Assessment of Suicide
Ideation and Suicidal Acts 15
Chapter 2. Correlates of and Risk Factors for Suicidal
Acts 31
Chapter 3. A Cognitive Model of Suicidal Acts 53
Chapter 4. Evidence-Based Treatments for the Prevention
of Suicidal Acts 79
IL Clinical Applications 101
Chapter 5. Cognitive Therapy: General Principles 103
Chapter 6. Early Phase of Treatment 127
Chapter 7. Cognitive Case Conceptualization of Suicidal
Acts 153
Chapter 8. Intermediate Phase of Treatment 173
Chapter 9. Later Phase of Treatment 199
Chapter 10. Challenges in Treating Suicidal Patients 215
III. Applications to Special Populations 233
Chapter 11. Cognitive Therapy for Suicidal
Adolescents 235
Chapter 12. Cognitive Therapy for Suicidal Older
Adults 263
Chapter 13. Cognitive Therapy for Suicidal Patients
With Substance Dependence Disorders 283
Chapter 14. Conclusion: A Public Health Model for
Suicide Prevention 311
Appendix: Outline of Cognitive Therapy for Suicidal Patients . . . . 319
References 321
Author Index 357
Subject Index 367
About the Authors 377
vi
We would like to offer our heartfelt thanks to the many researchers and
clinicians who influenced our thinking as we developed cognitive therapy
for suicidal patients. Our research staff worked tirelessly to administer the
cognitive intervention, recruit and assess patients at follow-up intervals to
monitor their progress, and provide the necessary services to retain patients
in our clinical trials. Our postdoctoral fellows and faculty who served as therapists
and assessors in these studies include Michele Berk, Sunil Bhar, Jason
Chapman, Danielle Farabaugh, Randy Fingerhut, Evan Forman, Dara Friedman-
Wheeler, Gregg Henriques, Marjan Holloway, Julie Jacobs, Elizabeth
Jeglic, Willem Kuyken, Kenneth Laidlaw, Jennifer Mayer, Christine Ratto,
Sabine Schmid, Ian Sharp, Megan Spokas, Shannon Stirman, Debbie
Warman, and Joseph Wright. Clinicians and faculty who have facilitated
the recruitment of participants for our studies include Dwight Evans, Joseph
J. Gallo, Judd Hollander, Ira R. Katz, David Oslin, Susan Rappaport, Frank
Sites, Jeffrey Staab, and the many othet physicians, nurses, and academic
associates within the University of Pennsylvania Health System and the U.S.
Department of Veterans Affairs. We also appreciate the assistance from law
enforcement, emergency medical services, and crisis response centers in the
Philadelphia area.
Other research staff who have contributed to our studies include Mark
Carey, Sarah Charlesworth, Michael Crooks, Amy Cunningham, Brian
Dearnley, Maureen Endres, Nicholas Finstrom, Allison Fox, Carly Gibbons,
John Guerry, Jessie Handelsman, Pamela Henderson, Nathaniel Herr, Heath
Hodges, Ellen J0rstad-Stein, Bambi Juryea, Rachel King, KathrynLou, Brianna
Mann, Joseph Moldover, Carly Romeo, Carlene Ryan, Daniella Sosdjan, Lisa
Starr, Sarah Tarquini, Rolando Vega, Robert Wheeler, Blair Wisco, James
Yadavaia, and David Zembroski. Moreover, our studies would not have been
possible without our dedicated executive administrator, Barbara Marinelli.
We extend a special thanks to Amy Cunningham for her extensive editing
of several drafts of this book.
The clinical chapters of this volume were based, in part, on the unpublished
treatment manual, Cognitive Therapy Treatment Manual for Suicide
Attempters, which was used in our clinical trials at the University of Pennsylvania.
We would like to thank the many clinicians to whom we have offered
ongoing supervision on this intervention and who are using this intervention
in community mental health settings throughout Philadelphia. Other
clinicians throughout the country have participated in workshops and provided
excellent feedback about the manner in which the intervention would
work in their practice settings. We also acknowledge the cognitive behavior
therapy team of the Treatment of Adolescent Suicide Attempts study, including
David Brent, John Curry, Tina Goldstein, Jennifer Hughes, Betsy Kennard,
Kim Poling, Margaret Schlossberg, Barbara Stanley, and Karen Wells, as well
as other colleagues who have made valuable contributions to our work, including
David Jobes and M. David Rudd. The thoughtful insights from all of
these clinicians often inspired us to modify our specific strategies, develop
new strategies, and adapt our strategies for special populations.
Many sponsoring agencies have supported the research described in this
volume. The agencies that have supported our recent studies include the
American Foundation for Suicide Prevention, Centets for Disease Control
and Ptevention (National Center for Injury Prevention and Control), National
Alliance for Research on Schizophrenia and Depression, National Institutes
of Health (National Institute on Drug Abuse and National Institute
of Mental Health), and the Department of Veterans Affairs. We especially
appreciate the support of Jane Pearson at the National Institute of Mental
Health.
Our acknowledgments would not be complete without mentioning the
staff of the American Psychological Association Books Department, particularly
Susan Reynolds. You made this writing experience a very positive one
for all of us.
Finally, we would like to thank our families for supporting us as we
undertook this major endeavor. We are grateful for your love and commitment.
We dedicate this book to those who continue to struggle with suicidal
desire, and our hope is that this work can help to alleviate their pain and
suffering and, ultimately, to save lives
Gregory K. Brown
and Aaron T. Beck
Acknowledgments vii
Introduction 3
Aaron T. Beck
I. Cognitive Theory and Empirical Research. 13
Chapter 1. Classification and Assessment of Suicide
Ideation and Suicidal Acts 15
Chapter 2. Correlates of and Risk Factors for Suicidal
Acts 31
Chapter 3. A Cognitive Model of Suicidal Acts 53
Chapter 4. Evidence-Based Treatments for the Prevention
of Suicidal Acts 79
IL Clinical Applications 101
Chapter 5. Cognitive Therapy: General Principles 103
Chapter 6. Early Phase of Treatment 127
Chapter 7. Cognitive Case Conceptualization of Suicidal
Acts 153
Chapter 8. Intermediate Phase of Treatment 173
Chapter 9. Later Phase of Treatment 199
Chapter 10. Challenges in Treating Suicidal Patients 215
III. Applications to Special Populations 233
Chapter 11. Cognitive Therapy for Suicidal
Adolescents 235
Chapter 12. Cognitive Therapy for Suicidal Older
Adults 263
Chapter 13. Cognitive Therapy for Suicidal Patients
With Substance Dependence Disorders 283
Chapter 14. Conclusion: A Public Health Model for
Suicide Prevention 311
Appendix: Outline of Cognitive Therapy for Suicidal Patients . . . . 319
References 321
Author Index 357
Subject Index 367
About the Authors 377
vi
We would like to offer our heartfelt thanks to the many researchers and
clinicians who influenced our thinking as we developed cognitive therapy
for suicidal patients. Our research staff worked tirelessly to administer the
cognitive intervention, recruit and assess patients at follow-up intervals to
monitor their progress, and provide the necessary services to retain patients
in our clinical trials. Our postdoctoral fellows and faculty who served as therapists
and assessors in these studies include Michele Berk, Sunil Bhar, Jason
Chapman, Danielle Farabaugh, Randy Fingerhut, Evan Forman, Dara Friedman-
Wheeler, Gregg Henriques, Marjan Holloway, Julie Jacobs, Elizabeth
Jeglic, Willem Kuyken, Kenneth Laidlaw, Jennifer Mayer, Christine Ratto,
Sabine Schmid, Ian Sharp, Megan Spokas, Shannon Stirman, Debbie
Warman, and Joseph Wright. Clinicians and faculty who have facilitated
the recruitment of participants for our studies include Dwight Evans, Joseph
J. Gallo, Judd Hollander, Ira R. Katz, David Oslin, Susan Rappaport, Frank
Sites, Jeffrey Staab, and the many othet physicians, nurses, and academic
associates within the University of Pennsylvania Health System and the U.S.
Department of Veterans Affairs. We also appreciate the assistance from law
enforcement, emergency medical services, and crisis response centers in the
Philadelphia area.
Other research staff who have contributed to our studies include Mark
Carey, Sarah Charlesworth, Michael Crooks, Amy Cunningham, Brian
Dearnley, Maureen Endres, Nicholas Finstrom, Allison Fox, Carly Gibbons,
John Guerry, Jessie Handelsman, Pamela Henderson, Nathaniel Herr, Heath
Hodges, Ellen J0rstad-Stein, Bambi Juryea, Rachel King, KathrynLou, Brianna
Mann, Joseph Moldover, Carly Romeo, Carlene Ryan, Daniella Sosdjan, Lisa
Starr, Sarah Tarquini, Rolando Vega, Robert Wheeler, Blair Wisco, James
Yadavaia, and David Zembroski. Moreover, our studies would not have been
possible without our dedicated executive administrator, Barbara Marinelli.
We extend a special thanks to Amy Cunningham for her extensive editing
of several drafts of this book.
The clinical chapters of this volume were based, in part, on the unpublished
treatment manual, Cognitive Therapy Treatment Manual for Suicide
Attempters, which was used in our clinical trials at the University of Pennsylvania.
We would like to thank the many clinicians to whom we have offered
ongoing supervision on this intervention and who are using this intervention
in community mental health settings throughout Philadelphia. Other
clinicians throughout the country have participated in workshops and provided
excellent feedback about the manner in which the intervention would
work in their practice settings. We also acknowledge the cognitive behavior
therapy team of the Treatment of Adolescent Suicide Attempts study, including
David Brent, John Curry, Tina Goldstein, Jennifer Hughes, Betsy Kennard,
Kim Poling, Margaret Schlossberg, Barbara Stanley, and Karen Wells, as well
as other colleagues who have made valuable contributions to our work, including
David Jobes and M. David Rudd. The thoughtful insights from all of
these clinicians often inspired us to modify our specific strategies, develop
new strategies, and adapt our strategies for special populations.
Many sponsoring agencies have supported the research described in this
volume. The agencies that have supported our recent studies include the
American Foundation for Suicide Prevention, Centets for Disease Control
and Ptevention (National Center for Injury Prevention and Control), National
Alliance for Research on Schizophrenia and Depression, National Institutes
of Health (National Institute on Drug Abuse and National Institute
of Mental Health), and the Department of Veterans Affairs. We especially
appreciate the support of Jane Pearson at the National Institute of Mental
Health.
Our acknowledgments would not be complete without mentioning the
staff of the American Psychological Association Books Department, particularly
Susan Reynolds. You made this writing experience a very positive one
for all of us.
Finally, we would like to thank our families for supporting us as we
undertook this major endeavor. We are grateful for your love and commitment.
We dedicate this book to those who continue to struggle with suicidal
desire, and our hope is that this work can help to alleviate their pain and
suffering and, ultimately, to save lives