Group therapy has proved effective in dealing with a variety of mental health issues, from depression to chronic traumatic stress in Veterans, but it has rarely been used to help individuals at risk of suicide. As Lora Johnson of the VA Medical Center in Louisville, Kentucky, explains, therapists have generally been concerned about the interactions among potentially suicidal patients in a group setting. Thus the only published research looking at the effectiveness of group therapy in dealing with suicidality was carried out in the 1970s on adolescents.
But since 2009 Johnson and her colleague Barbara Kaminer, also of the VA Medical Center, have been using group therapy to treat suicidal Veterans, including many who have attempted suicide. To design their group therapy approach, they have looked to the works of both Thomas Joiner at Florida State University and David Jobes at the Catholic University of America. Joiner’s interpersonal theory of suicide focuses on the acquired capacity for suicide, thwarted belongingness, and a sense of burdensomeness as factors that predispose one to being able to attempt or complete suicide, and Jobes developed an approach to dealing with suicidality that relies on a collaboration between the clinician and the suicidal patient in both the assessment of the patient and the planning of the treatment. Inspired by Jobes’s Collaborative Assessment and Management of Suicidality (CAMS) approach, Johnson and Kaminer created a collaborative approach in group therapy, with clinicians and patients working together to help each individual patient in a group get better while focusing on issues related mainly to thwarted belongingness and feelings of being a burden in some way to others.
This group therapy approach has seemed to work quite well for individual suicidal patients, Johnson says, but the method has not been tested with a controlled trial because Johnson and Kaminer’s initial goal was simply to find something that was feasible and acceptable in treating patients. Now, to develop objective evidence on the method’s effectiveness, they have joined with Jobes and Stephen O’Connor of Western Kentucky University to subject it to scientific study.
The first step, which is now finished, was to add a formal assessment tool to the group therapy process that they have created. When they were first carrying out their group therapy, Johnson explains, they assessed their patients very informally, essentially by asking them how they were doing but without having a fixed list of specific questions and ratings to which the group therapy participants were asked to respond. In order to do this, they used portions of the Suicide Status Form (SSF) from Jobes’s CAMS approach which assess various suicide-related factors in a very structured way. Details on the work to date were published in 2014 in the journal Military Behavioral Health.
To test the effects of adding this assessment tool to the group therapy program, study staff recruited 141 Veterans from the inpatient psychiatric ward at the VA Medical Center to participate in a controlled study. Approximately half underwent the usual group therapy, while the others took part in group therapy that included the selected portions of the SSF. The expectation was that those patients who were assessed more formally would experience more satisfaction with the therapy and would be more likely to continue taking part in it. The researchers also hypothesized, Johnson said, that the patients in the formal assessment group would show better progress in dealing with their suicidal thoughts and feelings and would also show greater improvement in symptoms overall.
In addition to studying the effects of introducing the formal assessment into the group therapy, Johnson and her colleagues are examining the interventions the group therapists are using. Ultimately, she said, she wants to begin studying the group therapy itself in order to discover which approaches work best with different patients and thus to develop one more effective tool in the fight against military suicide.
As of February 2015 Johnson’s group had completed all of its data collection from the study and was preparing to analyze the results. Their goal, she said, is to submit articles for publication before the fall, at which point other clinicians will get a much clearer view of what to expect from using group therapy for suicidal Veterans.