SAN ANTONIO – For many people, it’s a ray of hope rooted in research.
Recent research is presenting a new way of thinking about suicide prevention, and both experts and patients believe it’s already saving lives.
Retired U.S. Air Force veteran Nancy Dickinson spent a chunk of her 23 years of service deployed in war zones, such as Iraq.
“My folks who were in medical maintenance facilities trying to keep the generators going were getting bombed all day, all night,” Dickinson said.
Dickinson brought that trauma back with her when she retired from active duty and settled in San Antonio.
“I knew if I did not get help, it was going to go downhill fast. I dealt with the suicide stuff,” Dickinson said.
She knows too well that many active duty and veterans don’t make that call for help.
“It breaks my heart that I’ve got brothers and sisters that are scared to ask for help. And we are losing as many as we are every single day. It’s not okay,” Dickinson said.
That’s why Dickinson wants everyone to know about an innovative therapy that changed her life.
“We’ve historically thought of suicide as a symptom of mental illness, or an outcome of mental illness, even though the majority of people who die by suicide do not have mental illness,” said Dr. Craig Bryan, who is a psychiatrist, professor, and researcher at The Ohio State University.
Bryan works closely with UT Health San Antonio’s STRONG STAR program, focusing on military mental health care. It’s a consortium made up of 50 institutions, including the military.
“Everything that we’ve learned about suicide, we’ve been doing all these things, and it doesn’t seem to be working. So perhaps it’s time for us to rethink this whole approach, and maybe we will be more successful if we do it,” Bryan said.
At a San Antonio conference this week, Bryan got to present his book titled ‘Rethinking Suicide,’ filled with years of research and a breakdown of targeted therapy.
The therapy is called Brief Cognitive Behavior Therapy for Suicide Prevention (BCBT).
It’s just 10-12 sessions focusing on stress response, not solely on anxiety, depression, or post-traumatic stress disorder (PTSD). That means it can apply to anyone who meets just one criteria: having suicidal thoughts or making suicide attempts.
“We look at how you react or respond to stressful situations. How do you think about yourself, about the situations that you’re in? And we help people to identify those unhelpful patterns typically overly critical or overly negative thoughts. We say, let’s perhaps start to adopt a more balanced perspective, which then leads them to make different decisions,” Bryan said.
Patients then spend weeks practicing and rehearsing coping strategies.
“Over time, a person then starts to react and respond. You still get upset. Life happens. But people make different decisions,” Bryan said.
The therapy includes what’s called crisis response planning, making an exact checklist of what to do if thoughts get negative.
“It overrides that tunnel vision and people can then easily do something that helps them to kind of kickstart the problem-solving process. To manage what I’m feeling, to reach out to others for support,” Bryan said.
While crisis response planning is a part of BCBT, doctors can also extract that and use it separately for other patients.
“It’s remarkably effective. It reduces suicide attempts by like 76% of just compared to traditional suicide prevention strategies,” Bryan explained.
If patients do have mental health conditions, like PTSD, for example, they also treat those appropriately at the same time.
“Historically, there’s been sort of a mindset amongst mental health clinicians that we should not treat PTSD when someone is suicidal; it’s too risky. And the work that we’ve done during my time here at STRONG STAR about a decade ago and continuing to this day, we now know that actually that’s wrong,” Bryan said.
The paradigm shift is so promising that the military partly funds it.
“Many service members and veterans are volunteering for research studies to help us make those therapies even better than what they are right now,” Bryan said.
It will be a full circle of progress.
“We can learn from them, and as we make new discoveries to improve quality of life, to prevent suicide, to improve recovery from trauma, we’re going to give it back to them,” Bryan said.
However, progress in terms of integration into military healthcare has been slow.
“It’s not currently being integrated. That’s, I think, one of the key problems. There is right now a big disconnect between military funding and finding the solutions, but then not actually using them. So we hope that over the coming years, we’ll be able to work with the military to change that,’ Bryan said.
While the military integration isn’t there yet, Dr. Bryan’s team is already training other clinicians on this therapy.
UT Health San Antonio has created the infrastructure for that training, and the USAA Educational Foundation is funding it.
“The most important part is afterward, the clinicians continue to meet with some of our experts to receive supervision to coach them on how to effectively use the therapy. It’s harder for you to actually use the procedures reliably when you have someone in your room, in your office, who’s saying, ‘I’m thinking about killing myself.’ And so we provide very close, ongoing support and supervision to kind of like help clinicians,” Bryan said.
Knowing firsthand how many lives this could save, Dickinson is thrilled to see this shift in thinking, opening the door to more discussion and less stigma.
“It’s been 20 years, and I still go to counseling. I am still on PTSD medications. It has changed my life,” she said.
Dickinson hopes anyone else who is suffering from suicidal thoughts, with or without mental illness, will reach out for help.
If you are struggling with thoughts of suicide, there is help. Call or text 988 for help, or visit the 988 Lifeline website.
Military members or veterans can contact STRONG STAR at 210-562-6700 or visit the website.