Protocol: Reducing Suicidal Ideation Among Turkish Migrants in the Netherlands and in the UK: Effectiveness of an Online Intervention

New Study (1)Abstract
Background: The Turkish community living in Europe has an increased risk for suicidal ideation and attempted suicide. Online self-help may be an effective way of engagement with this community. This study will evaluate the effectiveness of a culturally adapted, guided, cognitive behavioural therapy-based online self-help intervention targeting suicidal ideation for Turkish adults living in the Netherlands and in the UK.
Methods and design: This study will be performed in two phases. First, the Dutch online intervention will be adapted to Turkish culture. The second phase will be a randomized controlled trial with two conditions: experimental and waiting-list control. Ethical approval has been granted for the trials in London and Amsterdam. The experimental group will obtain direct access to the intervention, which will take 6 weeks to complete. Participants in the waiting-list condition will obtain access to the modules after 6 weeks. Participants in both conditions will be assessed at baseline, post-test and 3 months post-test follow-up. The primary outcome measure is reduction in frequency and intensity of suicidal thoughts. Secondary outcome measures are self-harm, attempted suicide, suicide ideation attributes, depression, hopelessness, anxiety, quality of life, worrying and satisfaction with the treatment.
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Written by 2013 Student Scholarship Recipient: Ozlem Eylem:

Eylem, O., van Straten, A., Bhui, K., & Kerkhofl, J.F.M. (2015). Protocol: Reducing suicidal
ideation among Turkish migrants in the Netherlands and in the UK: Effectiveness of an online intervention. International Review of Psychiatry, 27(1), 72-81. doi:

Identifying Suicide Risk

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck describes ways to identify a person at risk for suicide. He discusses immediate risk factors (such as those shown through the use of predictive scales), peripheral risk factors, and demographic risk factors. Dr. Beck also discusses his previous research involving the post-attempt suicide ideation scale and important findings from that research.

Beck Institute’s next CBT for Depression and Suicidality Workshop will take place July 15-17, 2013. For more information, visit our website.

Veterans with TBI and Suicidality

NewStudy-Graphic-72x72_edited-3Previous research has shown that, in recent years, there has been an increased rate of suicide in soldiers returning from war.  In addition, as many as 15-23% of returning soldiers have incurred traumatic brain injuries (TBI). A new study published in Rehabilitation Psychology aimed to identify risk and protective factors for suicide ideation or suicidal behavior among veterans who have experienced TBI.

Thirteen suicidal veterans in a TBI clinic completed 30 to 60 minute interviews that included structured questionnaires regarding suicidality, methods of coping/seeking support, and military service. Researchers identified a post-injury loss of sense of self, cognitive deficits secondary to TBI, and psychiatric and emotional difficulties as precipitating factors for suicide ideation or suicidal behavior. Social support, a sense of purpose and hopefulness, religion or spirituality, and mental health treatment were identified as protective factors.

This study helps to identify those precipitating factors that practitioners should target when working with a similar population. The authors note that concepts associated with perceived burdensomeness and thwarted belonging can be targeted using cognitive and behavioral strategies along with techniques that encourage the client to re-conceptualize his or her worth and meaning to others.


Brenner, L. A., Homaifar, B. Y., Adler, L. E., Wolfman, J. H., & Kemp, J. (2009). Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies. Rehabilitation Psychology, 54, 390-397.

Repeat Suicide Attempts Reduced by CBT

NewStudy-Graphic-72x72_edited-3A randomized control study in the Journal of the American Medical Association found cognitive behavioral therapy (CBT) to be effective in reducing the number of repeat suicide attempts in adults.

Past research had focused on intensive follow-up treatment or intensive case management, interpersonal psychotherapy, or cognitive behavioral therapy for the preventative treatment of suicide attempts, but empirical evidence for the efficacy of these therapies has been limited. The current study aimed to examine the efficacy of cognitive behavioral therapy as a preventative therapy for suicide, by performing a randomized control study adequate in power to detect treatment differences.

Participants consisted of patients who had attempted suicide and received a medical or psychological evaluation within 48 hours of the attempt. Participants were randomly assigned to follow-up care of either CBT or usual care (UC). Those placed in the CBT group received outpatient CBT sessions that were specifically designed for preventing future suicide attempts. The CBT aimed to address and identify the thoughts, images, and core beliefs that activated the previous suicide attempt, and to teach cognitive and behavioral strategies as better ways of coping with these thoughts and stressors.

The authors found that participants in the CBT group were 50% less likely to reattempt suicide than the participants in the UC group. In addition, the CBT group measured significantly lower for depression as well as hopelessness than the UC group. The authors concluded that “the short-term feature of cognitive therapy would make it particularly applicable for the treatment of suicide attempters at community mental health centers, which typically provide relatively short-term therapy.”

Reference: Brown, G. K, Have, T. T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294, 563-570

Cognitive Therapy is Helping Veterans

Guest Blogger: John Milwee, Psy.D., Veterans Administration therapist and Beck Institute alumnus

Veterans returning from the conflicts in Afghanistan and Iraq may face many challenges as they begin to reintegrate into their roles as parents, employees, friends, and neighbors. In recent months a great deal of media attention has been focused on those returning Veterans who suffer with symptoms of Post-Traumatic Stress Disorder (PTSD) associated with their combat experience. Alarming statistics are frequently reported that describe the number of these Veterans who, when untreated, commit suicide. Read more

CBT and rapid-cycling Bipolar Disorder

People diagnosed with rapid-cycling bipolar disorder experience four or more separate episodes of depression and hypomania within the span of one year. Therapists have recently implemented cognitive behavioral therapy (CBT) to focus on treating depressive symptoms and reducing suicidal risk when caring for patients diagnosed with rapid-cycling bipolar disorder.

In a study reported in the Journal of Psychiatric Practice, researchers trained rapid-cycling bipolar disorder patients to utilize CBT skills to identify and respond to negative core beliefs, such as “Nobody cares about me” or “I am incompetent.” Addressing these beliefs is essential when administering CBT because they are likely to intensify the depressive episodes. Through implementing CBT, patients were also able to develop anxiety-management strategies and reduce symptoms of depression.

Study authors: N. A. Reilly-Harrington, T. Deckersbach, R. Knauz, Y. Wu, T. Tran, P. Eidelman, H. G. Lund, G. Sachs, A. A. Nierenberg

Antidepressants used in combination with CBT reduces risk of teen suicide

The use of the antidepressant fluoxetine (Prozac) alone has been associated with increased suicidality among teens and children, leading to black-box warnings on antidepressants in those populations. This in turn has caused serious concern in parents and has discouraged prescription, according to some researchers. A recent report on this issue focused on combining Cognitive Behavioral Therapy (CBT) with the fluoxetine and found that “adding CBT to medication enhances the safety of medication. Taking benefits and harms into account, combined treatment appears superior to either monotherapy as a treatment for major depression in adolescents.”

In a related report, the researchers added that cognitive behavior therapy “should be made readily available as part of comprehensive treatment for depressed adolescents” and added that such a shift in the current practice would be of “considerable public health relevance.”

Adolescent Depression & Suicide Prevention: National Review of Cognitive Behavioral Therapy

A national review of treatments for depressed adolescents (ages 13-17), with special focus on preventing teen suicide, finds Cognitive Behavioral Therapy (CBT) to be highly effective. Age-appropriate adaptations of CBT yielded these key results: “CBT achieved a higher remission rate among youth (60%) than either systemic behavior family therapy (37.9%) or nondirective support therapy (39.4%).” Additionally, CBT yielded no adverse effects.

(The reporting agency is a program of the US Department of Health and Human Services Substance Abuse & Mental Health Services Administration.)

Research Results: Cognitive Therapy Reduces Suicide Attempts by 50%

In light of all the recent discussion about antidepressant drugs that increase the risk of attempted suicide, we thought we’d highlight the study that came out last year, which showed that Cognitive Therapy (developed by Aaron T. Beck, M.D. in the 1960s) can reduce attempted suicide by 50% among those who have recently attempted suicide. This study, funded by the NIH and the CDC, followed 120 patients, half of whom were randomly assigned to 10 Cognitive Therapy treatment sessions, and the other half of whom received usual community services. At the 18 month follow-up, those who had not received CT treatment were twice as likely to attempt suicide as those who had received CT treatment. Check out the NY Times coverage of this study (you have to be registered to view the article – registration is free).