Behavioural therapy of suicidality

Suicidal behaviour is a serious public health issue. Suicidal behaviour includes completed suicide, suicide attempts, suicidal intent and/or plans and suicide ideation. Two prominent mechanisms, behavioural deficits, in particular poor problem-solving skills, and a certain cognitive style with overgeneralization, distortion and lack of positive expectations, have been identified in suicidal patients so far. Besides general therapy strategies, including the diagnostic process and a collaborative, confident relationship and strengthening of protective factors, specific behavioural strategies should aim at the modification of the behavioural repertoire and of cognitive strategies. The modification of the behavioural repertoire includes the direct modification of the behaviour, acquiring techniques for stress reduction and learning problem-solving strategies. Applied cognitive techniques comprise such as thought-stopping, examining options and alternatives, fantasizing consequences, externalizing inner voices, and reattribution. Psychotherapy with suicidal patients has a specific feature: It requires high activity of the therapist in terms of motivation and guidance of the patient. Regular assessment of the suicide risk at every session is a must. Nevertheless, the therapist should always be aware that it is impossible to prevent all suicidal acts.