These findings provide clinical backing for cognitive-behavioral therapy as an effective psychotherapy option for reducing the risk of suicide attempts and suicidal ideation in high-risk patients. Dialectical Behavior Therapy The APA guidelines for the assessment and practical management of suicidal ideation and behavior recognize dialectical behavior therapy as a psychotherapy option for the treatment of suicidal ideation and behavior (Harmer et al., 2022). This therapy option combines individual psychotherapy with group practice of behavioral skills for the treatment of borderline personality disorder in suicidal patients. Preliminary research investigating the effectiveness of dialectical therapy used a study population of suicidal patients with a history of self-injurious behaviors who met the clinical criteria for borderline personality disorder. Most of these studies provide clinical evidence suggesting that patients treated with dialectical therapy report a lower posttreatment incidence of self-injurious behavior compared to the control group. Also, the few incidents of self-injurious behavior recorded in the study group were less medically severe. During the year of treatment and the initial six months of follow-up monitoring, the study group also displayed Psychodynamic and Psychoanalytic Psychotherapies Clinical reports and observations on the experiences of suicidal patients with psychodynamic and psychoanalytic psychotherapies have prompted the recognition of these therapy options in suicidal ideation and behavior management (Harmer et al., 2022). The direct clinical effect of these therapies has been measured in patients assigned to psychoanalytically oriented hospitalization groups with a therapy period lasting for about 18 months. In most cases, patients assigned to these groups report a significantly lower incidence of self-mutilation. Also, there are Developed by the Department of Veterans Affairs (VA) and the Department of Defense (DoD), the VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide were originally designed for the VA and DoD population. Drawing evidence from multiple research studies through 2011, the first version of these guidelines was published in 2013. The guidelines were intended to provide healthcare professionals with a framework by which to evaluate, treat, and manage patients at risk for suicide. In 2018, an updated version of the guidelines was published. The updated guidelines include objectives and evidence-based recommendations for the assessment and management of suicidal ideation and behavior in both adult and adolescent populations employed by the VA/
an improved measure of social adjustment and functioning compared to the control group. The different research focuses on the benefits of dialectical behavioral therapy and has demonstrated multiple results reproducible as a clinical intervention in suicidal patients. Fowr instance, dialectical behavioral therapy is associated with a significant reduction in suicidal, self-damaging impulsive behaviors and self-mutilating compared to control groups. Since these behavioral features are closely linked with suicidal ideation and attempts in many people, it is expected that dialectical behavioral therapy can effectively reduce the risk and incidence of suicidal ideation and attempted suicide. Considering the evidence available on dialectical behavioral therapy so far, it is clear why the most popular guidelines available today reference and recommend this therapy option.
noticeable reductions in the number of suicide attempts during the follow-up period of therapy. By extension, other beneficial outcomes were measured during and after the treatment period. These include fewer inpatient days, fewer depressive symptoms, fewer command hallucinations, and significant improvement in social and interpersonal functioning. Most available data on the clinical effects of psychodynamic and psychoanalytic psychotherapies support the improvement of suicide risk factors, including depression and borderline personality disorders. VA/DOD CLINICAL PRACTICE GUIDELINES FOR THE ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR SUICIDE
DoD. As spelled out in the guidelines, the expected outcome of a successful implementation of the guidelines is to: ● Assess the individual’s condition and determine, in collaboration with the patient, the best treatment method ● Optimize health outcomes and improve quality of life ● Minimize preventable complications and morbidity ● Emphasize the use of patient-centered care (PCC) Subsequently, the VA/DoD guideline recommendations gained popular acceptance in medical circles, with different healthcare institutions adopting the recommendations made in these guidelines.
VA/DOD GUIDELINE ALGORITHMS
This guidelines include multiple algorithms designed to facilitate the understanding and easy visual presentation of the clinical pathways and decision-making process recommended for managing patients at risk of suicide. Representations in this form are becoming popular in different clinical guidelines, with formats designed to promote efficient diagnostic and therapeutic decision making. Figure 5 depicts the clinical algorithm in a step-by-step decision tree, with standardized
symbols displaying each step in the algorithm and explaining the clinical and research relationship between each step. ● Rounded rectangles represent a clinical state or condition. ● Hexagons represent a decision point in the guideline, formulated as a yes/no question. ● Rectangles represent an action in the process of care. ● Ovals represent a link to another section within the guidelines.
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