Crisis Response Planning Can Reduce Suicide Risk for PTSD Among Veterans

Craig J. Bryan, PsyD

Credit: The Ohio State University College of Medicine

Crisis response planning reduces the suicide risk for PTSD among US military veterans, according to a new study.¹

“This study shows that crisis response planning can rapidly reduce suicide risk,” said lead investigator Craig J. Bryan, PsyD, from the department of psychiatry and behavioral health at Ohio State University, in a press release.² “It is the first study to prove this technique works when used during massed therapy for PTSD.”

Approximately 23% of military veterans have PTSD following their term of service—and PTSD is associated with a greater risk of suicidal thoughts and behaviors. Veterans may develop PTSD from combat exposure, but also from transportation accidents, sexual assault, domestic abuse, and early life trauma such as child abuse.¹

Although cognitive processing therapy is a way to treat PTSD, cognitive response planning exists as a low-cost, brief treatment option lasting < 30 minutes on average. The treatment involves a clinician identifying a patient’s personal warning signs and early indicators of an upcoming crisis and providing self-regulatory strategies. A 2017 study found crisis response planning reduces suicide attempts by up to 76% than traditional crisis management procedures.³

Bryan and colleagues conducted a pragmatic parallel-arm clinical trial to assess the effectiveness of crisis response planning in conjunction with a 2-week cognitive processing therapy for PTSD to see if it would lead to faster or greater reductions in suicidal ideation compared to massed therapy with usual suicide risk management.¹ Investigators randomized 157 US military veterans to receive crisis response planning or self-guided safety planning. After this, participants started massed cognitive processing therapy where participants had 1-hour virtual or in-person therapy sessions for 10 days in outpatient clinical settings.

The team found cognitive response planning was an effective way to reduce the suicide risk among patients with PTSD. At baseline, 32.5% of the sample experienced suicidal ideation. Participants receiving crisis response planning had significantly greater and quicker reductions in the severity of suicidal ideation (F (11,672) = 15.8; P < .001).

A total of 106 participants denied suicidal ideation at baseline. However, after the intervention, more self-guided safety planning participants reported new-onset suicidal ideation during follow-up assessments (11.9% vs. 8.5%, respectively) (odds ratio [OR], 0.69; 95% CI, 0.19 – 2.52). As for PTSD symptoms, they significantly reduced over time in both groups with no difference.

After crisis response planning, the severity of suicidal thoughts had approximately half of the suicidal thoughts of patients with self-guided safety planning.² Additionally, fewer participants in the crisis response planning attempted suicide.

“Next we want to learn if using [crisis response planning] with other treatments can similarly reduce suicidal thoughts and suicide attempts across patient groups and clinic types,” said lead author Justin Baker, an assistant professor in Ohio State’s department of psychiatry and behavioral health and the clinical director of the STRIVE program.

Due to these results, the STRIVE program obtained a new research grant from the US Department of Defense to continue evaluating crisis response planning therapy among high-risk military veterans.

“[Crisis response planning], a brief safety planning-type intervention, is effective for rapidly reducing suicidal ideation among patients receiving massed therapy for PTSD in outpatient clinical settings,” investigators concluded.¹ “[Crisis response planning] may also reduce suicide attempts and prevent new-onset suicidal ideation, though additional research with larger samples is needed to confirm this possibility.”

^References

1. ^{Bryan CJ, Bryan AO, Khazem LR, et al. Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. J Anxiety Disord. Published online December 21, 2023. doi:10.1016/j.janxdis.2023.102824}
2. ^{Study: New Treatment Method Helps Reduce Suicide Among Military and Veterans. News Wise. February 14, 2024. https://www.newswise.com/articles/study-new-treatment-method-helps-reduce-suicide-among-military-and-veterans. Accessed February 19, 2024.}
3. ^{Bryan CJ, Mintz J, Clemans TA, et al. Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. J Affect Disord. 2017;212:64-72. doi:10.1016/j.jad.2017.01.028}