Dynamic change patterns in suicidal ideation differ in Brief Cognitive Behavioral Therapy (BCBT) and Present-Centered Therapy (PCT).

OBJECTIVE

Although Brief Cognitive Behavioral Therapy (BCBT) is more effective than Present-Centered Therapy (PCT) for preventing suicide attempts, the two treatments have similar efficacy for reducing suicidal ideation severity. Traditional severity scores may obscure meaningful differences in how specific dimensions of suicidal ideation actually change during treatment. This study examined how quickly and consistently different dimensions of suicidal ideation changed during BCBT and PCT.

METHOD: The first five items of the Scale for Suicidal Ideation (wish to live, wish to die, reasons for living versus dying, suicidal desire, and passive desire for death) were administered at every scheduled therapy session during a randomized clinical trial comparing BCBT to PCT among high-risk U.S. military personnel and veterans. We estimated separate continuous-time multivariate change models for each item and applied eigen-decomposition to the matrix of regression coefficients to characterize dominant change patterns.

RESULTS

In both treatments, some dimensions of suicidal ideation changed quickly while others changed slowly, and change was not evenly distributed across all five dimensions. Dimensions of suicidal ideation changed faster and in greater synchrony during BCBT than PCT.

CONCLUSIONS

Suicidal ideation reductions may arise through qualitatively different change processes across treatments even when the overall magnitude of change is similar. BCBT appeared to produce faster, more coordinated change across dimensions of suicidal ideation whereas PCT produced slower change that was less consistent across dimensions. These findings highlight the value of dynamical systems approaches for understanding mechanisms of therapeutic change that go beyond mean-level severity scores.