Future oriented group training for suicidal patients: a randomized clinical trial
Discussion
We have developed our Future Oriented Group Training based on the presumption that suicide ideation is characterized by diminished positive future thinking. Our intervention intends to stimulate realistic future perspectives. When suicidal individuals are able to envision a worthwhile future, their hopelessness and suicidal thinking and behavior are expected to decrease.
Extensive research the last twenty years has provided information about the different aspects and dynamics of suicidal thinking and behavior, but only a few interventions for suicidal patients have been evaluated in randomized clinical trials. The ones we know of (for instance Brown et al. [52]) have been developed for patients coming into care after a suicide attempt. Our training aims to help patients early on in the suicidal process, and we include both patients with suicidal ideation and after a suicide attempt in our study.
Future Oriented Group Training combines different elements that have proven to be effective in the treatment of suicidal thinking and behavior, like cognitive therapy and problem solving. Relatively new is the emphasis in the training on future thinking and goal oriented behavior. The intervention is designed to be easy to implement and is suitable for a broad range of comorbid psychiatric disorders.
Treatment programs like our training encompass several potentially effective elements. In the RCT we cannot distinguish which specific factor contributes to what extend to the overall treatment effect. This is also a characteristic of well established treatments, like Dialectical Behavioral Therapy [53]. We obtain an indication of changes in specific areas by gathering data on explanatory factors, like coping, problem solving, and future orientation, but we cannot tell which element of the training is responsible for these changes. Further research might be helpful to discriminate the efficacy of the separate elements.
Stimulating future thinking is a way of helping suicidal individuals to recreate a meaningful life, by working on purposeful goals and overcoming inefficient behavioral and cognitive patterns. The goal of our Future Oriented Group Training is to help our patients to make life livable and maybe even enjoyable again by realistically focusing on what the future might have to offer.
2009 October 7
Background
In routine psychiatric treatment most clinicians inquire about indicators of suicide risk, but once the risk is assessed not many clinicians systematically focus on suicidal thoughts. This may reflect a commonly held opinion that once the depressive or anxious symptoms are effectively treated the suicidal symptoms will wane. Consequently, many clients with suicidal thoughts do not receive systematic treatment of their suicidal thinking. There are many indications that specific attention to suicidal thinking is necessary to effectively decrease the intensity and recurrence of suicidal thinking. We therefore developed a group training for patients with suicidal thoughts that is easy to apply in clinical settings as an addition to regular treatment and that explicitly focuses on suicidal thinking. We hypothesize that such an additional training will decrease the frequency and intensity of suicidal thinking. We based the training on cognitive behavioural approaches of hopelessness, worrying, and future perspectives, given the theories of Beck, McLeod and others,concerning the lack of positive expectations characteristic for many suicidal patients. In collaboration with each participant in the training individual positive future possibilities and goals were challenged.
Discussion
We have developed our Future Oriented Group Training based on the presumption that suicide ideation is characterized by diminished positive future thinking. Our intervention intends to stimulate realistic future perspectives. When suicidal individuals are able to envision a worthwhile future, their hopelessness and suicidal thinking and behavior are expected to decrease.
Extensive research the last twenty years has provided information about the different aspects and dynamics of suicidal thinking and behavior, but only a few interventions for suicidal patients have been evaluated in randomized clinical trials. The ones we know of (for instance Brown et al. [52]) have been developed for patients coming into care after a suicide attempt. Our training aims to help patients early on in the suicidal process, and we include both patients with suicidal ideation and after a suicide attempt in our study.
Future Oriented Group Training combines different elements that have proven to be effective in the treatment of suicidal thinking and behavior, like cognitive therapy and problem solving. Relatively new is the emphasis in the training on future thinking and goal oriented behavior. The intervention is designed to be easy to implement and is suitable for a broad range of comorbid psychiatric disorders.
Treatment programs like our training encompass several potentially effective elements. In the RCT we cannot distinguish which specific factor contributes to what extend to the overall treatment effect. This is also a characteristic of well established treatments, like Dialectical Behavioral Therapy [53]. We obtain an indication of changes in specific areas by gathering data on explanatory factors, like coping, problem solving, and future orientation, but we cannot tell which element of the training is responsible for these changes. Further research might be helpful to discriminate the efficacy of the separate elements.
Stimulating future thinking is a way of helping suicidal individuals to recreate a meaningful life, by working on purposeful goals and overcoming inefficient behavioral and cognitive patterns. The goal of our Future Oriented Group Training is to help our patients to make life livable and maybe even enjoyable again by realistically focusing on what the future might have to offer.
