Last year, more active-duty men and women in the military died by suicide than from combat. Recently released data from the Department of Veterans Affairs further shows that about 22 military veterans die by suicide every day. That means, on average, we lose a veteran to suicide every 65 minutes. The record-high number of military suicides in 2012 has left many experts seeking solutions to this tragic increase in lives lost. New treatment methods are bringing new hope, as they're used to directly target suicidality in veterans.
I've been in the field of suicide prevention for almost 30 years. When I started out as a psychologist, there were no empirically valid treatments for suicidal people, in part, because many studies of mental health disorders actually excluded suicidal subjects. In addition, the treatments for suicidality often targeted the conditions believed to be underlying the suicidal state, such as depression. Yet, what researchers have recently discovered is that targeting the person's suicidality directly is precisely what works best to save a life.
If we see suicide risk as a skills deficit problem, we can focus treatment on helping people to develop the skills they need to stay alive. Once this is accomplished, there will likely be other psychological issues to address to help these individuals to feel better. For veterans, these problems may include trauma, stress or depression. However, addressing the "underlying disorders" alone won't necessarily work to prevent people from dying by suicide.
The number one goal of a therapist working with a suicidal client should be to help keep the person alive, so they can then benefit from treatment for their other difficulties. By focusing intervention on helping the person build the skills that help them stay alive, the therapist has time to work on the other psychological troubles the person is facing. When we look at suicide as the focus of treatment, we are better able to target the skills deficit from which suicidal people suffer. Therapists can teach healthy strategies for staying alive and collaborate with the client, sharing the responsibility for his or her survival.
One form of therapy that takes a targeted approach is Cognitive Behavioral Therapy for suicidal patients (CBT), developed by Aaron Beck and Gregory Brown. This model draws upon some of the basic skills-training aspects of Dialectical Behavioral Therapy, a form of therapy developed by Marsha Linehan that focuses on teaching skills that help a person to regulate and tolerate their emotions. One important element CBT adds could be described as state-dependent learning. Previous research had demonstrated that suicide attempters can learn skills in a non-activated state, but when they are triggered, they can't access these skills. Therefore, the final step Dr. Beck and Dr. Brown added in therapy involves inducing the suicidal state in session and essentially testing the person's ability to implement the skills they have learned, when in the suicidal mode. The therapist is there if it is necessary to help the person through the induced suicidal state. However, the goal is for the person to demonstrate their ability to calm themselves down when triggered and survive on their own. Therapy continues until they can do this on their own.
Dr. David Rudd, a lead researcher in the area of suicide has recently developed a specialized time-limited CBT approach to treat suicidal military personnel. Last month, I saw Dr. Rudd present at the 2013 American Psychological Association Convention, where he described his 12-session intervention program for those who've made past suicide attempts. This intervention targets suicide as a skills deficit that requires specific training to overcome. His model sees preventing suicide as a shared responsibility between patient and therapist. The treatment helps people learn tools to develop their ability to notice and label their emotions, as they get activated into the suicidal state. These individuals develop personalized strategies to calm themselves and keep themselves safe. Dr. Rudd says that when a person is suicidal, they are in a state of over-arousal, which is why the inability to sleep is one of the main immediate warning signs for suicide. This CBT approach has been implemented in the military, and data is showing that it reduces the reattempt rate by 50 percent.
For people who are concerned about a veteran who may be at risk for suicide, there is a strong message of hope in the fact that there are now several good, effective treatments available to help suicidal people learn the skills to stay alive. These new discoveries, paired with new methods of outreach, have made me increasingly optimistic about our ability to help save lives. There is a Veterans Crisis Line, a 24/7 hotline that you can call if you are a veteran in crisis or a friend or family member seeking help for someone in crisis. New technologies are even helping in this mission to stop suicide with our National Suicide Prevention Lifeline providing e-cards that allow you to reach out to suicidal people. These e-cards are scripted with messages designed by a specialist in the field and can be personally modified by the sender. There are websites listing warning signs and helper tasks that can help any of us save another person's life.
Almost every suicidal person is ambivalent about his or her suicide. What we can do as friends, relatives, co-workers or acquaintances is reach out, show that we care and help these people get to the help they need to stay alive.
This post is part of a special Huffington Post series, "Invisible Casualties," in which we shine a spotlight on suicide-prevention efforts within the military. Every weekday in September, we'll feature a different blog post by someone who is either an expert in the field, who has been affected by a suicide, or who has contemplated suicide. To see all the posts in the series, as well as original reporting, audio and video, click here.
If you or someone you know would like to contribute to our series, send an email to firstname.lastname@example.org.
And please, if you or someone you know needs help, call the national crisis line for the military and veterans, 1-800-273-8255, or send a text to 838255.