Oliver, Eunice Hope G.

March 1, 2017

APY 222- BS4D 6:00 PM- 7:00 PM

Title of the Research Journal: Brief Cognitive-Behavioral Therapy Effects on Post-Treatment

Suicide Attempts in a Military Sample: Results of a Randomized Clinical Trial With 2-Year
Follow-Up

Researchers: M. David Rudd, Ph.D., A.B.P.P., Craig J. Bryan, Psy.D., A.B.P.P., Evelyn G.
Wertenberger, Ph.D., L.C.S.W., Alan L. Peterson, Ph.D., A.B.P.P., Stacey Young-McCaughan,
R.N., Ph.D., Jim Mintz, Ph.D., Sean R. Williams, L.C.S.W., Kimberly A. Arne, L.C.S.W., Jill
Breitbach, Psy.D., A.B.P.P., Kenneth Delano, Ph.D., Erin Wilkinson, Psy.D., Travis O. Bruce,
M.D.

Date and Place of Publication: May 2015, ajp.psychiatryonline.org

Methods of Research: Quantitative

Research Questions:

The primary aim was to determine whether brief CBT significantly reduced post
treatment suicide attempt rates during the 24-month follow-up period. The first hypothesis was
that the hazard ratio for a subsequent suicide attempt would be significantly lower in the brief
CBT group compared with the treatment as usual group, and the second hypothesis was that the
proportion of soldiers making a suicide attempt during follow-up would be significantly lower
among those receiving brief CBT compared with those receiving treatment as usual.

Research Findings:

 Results of this randomized clinical trial demonstrated that brief CBT was effective in
preventing suicide attempts among active-duty soldiers who were experiencing suicidal
ideation with intent and/or had made a suicide attempt during the month immediately
preceding treatment.
 Eight participants in brief CBT (estimated proportion: 13.8%) and 18 participants in
treatment as usual (estimated proportion: 40.2%) made at least one suicide attempt during
the 2-year follow-up period (Wald x2 =5.28, df=1, p=0.02, hazard ratio=0.38, 95% confi-
 dence interval [CI]=0.16–0.87, number needed to treat=3.88), which suggests that
soldiers in brief CBT were approximately 60% less likely to make a suicide attempt
during the follow-up period than soldiers in treatment as usual.
 In terms of depression, anxiety, and posttraumatic stress symptoms, the Hedge’s g values
indicated larger declines among participants in brief CBT, although none of the between-
group differences were statistically significant.
 A decreased likelihood for medical retirement that fell short of statistical significance was
observed among participants in brief CBT compared with participants in treatment as
usual (26.8% compared with 41.8%; odds ratio=0.51, 95% CI=0.25–1.04, p=0.06).

Recommendations:

Additional research is needed to determine whether brief CBT may also have a positive
effect on military readiness and social-occupational outcomes. Also, additional studies targeting
female soldiers are needed. Finally, although the follow-up rate for our primary outcome
variable, suicide attempts, was very good, there was considerable attrition for follow-up self-
reported measures because of the highly mobile nature of military personnel, which prohibited
participants from following up in person.
Reflective Questions:

1. How I am beginning to think differently?

After I read the journal, I realized that even a brief cognitive-behavioral therapy
can be very effective in treating suicidal ideation or suicide attempts. I learned that with a
short period of time, the therapy's result came out positive because of the well-organized
and efficient way of conducting sessions with the clients. This only shows that there will
be a relevant change in my behavior and cognitive structures if I will take a step by step
process and really focus on the desired goals even with a time constraint. Since
cognitive-behavioral therapy was used, it is evident in the sessions that it has a directive
approach and the client was actively engaged where in behavioral techniques are being
practiced. Unlike psychoanalysis, this study demonstrated that cognitive-behavioral
therapy is more transparent, more evidenced based and not reliant on the therapist's
interpretation (Wedding & Corsini, 2014). It's ultimate goal is for the clients to be
competent, have skill mastery and to successfully complete every task in the course of the
treatment so that the they can live a more productive and fulfilled life.

2. What I want to explore further?

Cognitive-behavioral therapy is a goal-oriented approach. With this study, I

learned how effective the development of core skills and formulation of goals in a
therapy is. If this approach had good results on post-treatment suicide attempts in a
military sample, I would want to explore its effectiveness with the Philippine military
personnel. I think it would of great help to our military people if research regarding its
positive effects on military readiness and social-outcomes will be conducted. In addition,
it would be interesting to look at its efficacy with our female soldiers. Given that females
have different needs and physiological responses, it would be necessary to have an
additional research. regarding this matter.
Moreover, I would want to further explore on how t identify the cognitive-
behavioral strategies/techniques with different clients who have unique needs and cultural
backgrounds. In line with this, it would be also interesting to research more on other
 psychotherapeutic techniques to consider as a sole treatment or one that can be used hand
in hand with cognitive-behavioral approach.

3. Insights/ Realizations

I realized how detailed, organized and goal-oriented the cognitive-behavior

therapy is compared to other approaches like psychoanalysis and analytic therapy. It
focuses on formulation of goals and acquiring life skills instead of free association and/or
looking back at our childhood experiences. Also, it doesn't have an assumption that
observable behaviors are manifestations of the unconscious. According to Wedding &
Corsini (2014), behaviorists also believe that people are not always conscious of the their
behaviors. In this light, I think behaviorists accept this assumption but they believe that
these human processes are still products of conditioning.
Like the Adlerian therapy, cognitive-behavioral therapy in this study has been
shown as an approach that gives emphasis on the significance of changing one's beliefs
that minimize one's self-worth. It was also shown that behaviorists share the view with
the Adlerian therapists that abnormal behaviors are best interpreted in terms of
"problems in living" rather than as proofs of mental illness. Additionally, although the
therapy was carried out in a brief period of time, I realized that this kind of treatment is
very efficient in certain kind of settings where time is limited and clients are always on
the move.