By Jeffrey Soares, USAMRMC Public
Affairs
The protection and treatment of
warfighters was a primary focus of the 2012 Military Health System Research
Symposium held in Fort Lauderdale, Fla., Aug. 12-16, and the prevention of
suicide among military personnel both during active duty and upon their return
was of paramount importance to both researchers and attendees.
In a breakout session dealing with
advances in military suicide and psychological health research Aug. 15, Dr.
Laura Neeley of the Uniformed Services University of the Health Sciences in
Bethesda, Md., offered insight regarding her study of Post Admission Cognitive
Therapy, or PACT, for the prevention of suicide in military personnel with
histories of trauma.
Working with Dr. Marjan Holloway,
Neeley’s research supports a link between psychological trauma and
suicide-related behaviors. Neely said PACT
may help patients to cope effectively with suicidal thoughts and actions.
“The goal of our research,” Neeley
explained, “is to develop and empirically evaluate a brief inpatient cognitive
behavioral treatment for individuals with psychological trauma who have
attempted suicide.”
The PACT program has three phases. Phase I begins with an analysis of the
patient’s current suicide attempt, and this leads into a cognitive
conceptualization of the events leading up to the attempted suicide. This involves retracing the thoughts of the individual
to determine a mood set and behavior.
Phase II moves into cognitive restructuring, to review the negative
automatic thoughts of the individual while looking for ways to modify these
negative thoughts.
Neeley said that when someone is in a highly
emotional state, it is sometimes difficult to generate alternative ways of
thinking, so she suggests the use of coping cards. These cards contain positive statements that
provide support to the person who may be in jeopardy of self-destruction.
“Patients can carry these cards in their
pocket,” Neeley said, “and every time that they have an [event] that leads to
an emotional reaction, they can take [one] out and read it to themselves, to
start working on changing their thinking patterns, and working on emotional
regulation.”
This second phase also includes the
implementation of a hope kit, in which patients keep positive reminders inside
of a box that they can pull out to remind themselves of the good things in life
-- things worth living for. These items
can include photos, coping cards, journals, gifts or other things associated
with good memories for the patient.
Finally, sessions in Phase III focus on
relapse prevention and safety planning.
“In the final stage, we go through the
suicide story again, but this time we rewrite it so the patient can incorporate
her newly learned skills,” Neeley said.
In this stage, the patient must look for
ways to challenge thoughts of negativity and suicide, and in doing so, should
realize their own self-worth as well as the worthiness of people and things
around them.
“We also have them create a safety plan
for when they’re discharged,” Neeley said, “so that they know exactly what to
do when they’re in crisis.”
Created by the patient, this safety plan
not only contains certain scenarios of negative actions that the patient should
watch for, but more importantly, it contains a list of positive reactions to
use in order to squelch negative thoughts, as well as a list of contact persons
who may help to calm down and reassure the patient.
Neeley said the patient’s own readiness
to change may often provide a roadblock which is difficult to overcome. In the
case of her clinical study patient, “We focused on changing her negative
automatic thoughts, which related to a sense of poor self-efficacy, coping with
trauma and other life domains.”
Neeley believes the results of this
study support the need for evidence-based psychotherapy research for
traumatized suicidal individuals.
Currently, her group is working on an inpatient cognitive behavioral
treatment protocol for the treatment of trauma and suicide behavior.
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