Craig Bryan, PsyD, ABPP, of the University of Utah’s National Center for Veterans Studies has published multiple studies investigating the effectiveness of the crisis response plan (CRP), a brief intervention designed to reduce suicidal behaviors. Originally developed as part of brief cognitive behavioral therapy for suicide prevention (BCBT), a 12-session outpatient therapy that reduces suicide attempts by 60% among active duty military personnel (Rudd et al., 2015), Bryan’s team subsequently tested the CRP as a stand-alone intervention when used in emergency departments and behavioral health clinics.

Typically handwritten on an index card, the CRP is collaboratively developed by a patient and mental health clinician, and contains the following key sections:

• Self-management strategies include activities that can be done by oneself to reduce stress or serve as a distraction from the crisis situation;
• Reasons for living include things that provide a sense of meaning or purpose in life;
• Social support includes people or individuals who can provide emotional support or distraction from the situation; and
• Professional crisis support includes contact information for mental health clinicians, crisis hotlines, and other professional sources of assistance.

Dr. Bryan’s team conducted a randomized clinical trial testing the efficacy of the CRP as compared to existing suicide risk management strategies offered by mental health professionals. In their study, Bryan’s team enrolled 97 active duty Soldiers who walked into an emergency department or behavioral health clinic for an unscheduled crisis appointment. Results indicated Soldiers who received a CRP were 76% less likely to attempt suicide during the next six months as compared to Soldiers who received standard treatment (Bryan et al., 2017b). Results further suggested that only seven Soldiers would need to receive the CRP instead of existing treatment to prevent a single suicide attempt during the next six months.

Subsequent research by Dr. Bryan’s team have further revealed that when suicidal patients are asked to discuss their reasons for livings and to include these reasons on their CRP, they are:

• Less likely to be hospitalized (Bryan et al., 2017a);
• Experience significant increases in positive emotions (Bryan et al., 2017a); and
• Experience increased optimism (Rozek et al., 2018).

Dr. Bryan’s team has also found that the CRP’s effect on preventing suicidal behavior is most pronounced when the suicidal patient perceives the clinician as especially understanding and empathetic (Bryan et al., 2018). Dr. Bryan’s study has also led to new information about risk and protective factors for suicide among military personnel. Specifically, risk of suicide attempt is reduced among Soldiers who report a strong sense of responsibility to family members (Bryan, Oakey, & Harris, 2018), but is increased among Soldiers who believe that attempting suicide will reduce or alleviate emotional pain (Bryan, May, & Harris, 2018).

To learn more about the CRP, watch example videos, and sign up for a training workshop, visit www.crpforsuicide.com.

Blog Author

Craig Bryan, PsyD, ABPP, Center for Veterans Studies, University of Utah 

References:

Bryan, C. J., May, A. M., & Harris, J. (2018). Examining emotion relief motives as a facilitator of the transition from suicidal thought to first suicide attempt among active duty soldiers. Psychological Services. Available online ahead of print: https://doi.org/10.1037/ser0000234

Bryan, C.J., Mintz, J., Clemans, T.A., Burch, T.S., Leeson, B., Williams, S.R., & Rudd, M.D. (2017a). The effect of crisis response planning on patient mood state and clinician decision-making: a randomized clinical trial with acutely suicidal U.S. soldiers. Psychiatric Services, 69, 108-111.

Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., ... & Rudd, M. D. (2017b). Effect of crisis response planning vs. contracts for safety on suicide risk in US Army Soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64-72.

Bryan, C. J., Oakey, D. N., & Harris, J. A. (2018). Reasons for Living Among US Army Personnel Thinking About Suicide. Cognitive Therapy and Research, 42(6), 758-768.

Bryan, C.J., Rozek, D.C., Burch, T.S., Leeson, B., & Clemans, T.A. (2018). The therapeutic and intervention approach among acutely suicidal patients. Psychiatry: Biological and Interpersonal Processes. Available online ahead of print: https://doi.org/10.1080/00332747.2018.1485371