{"id":17603,"date":"2018-07-27T16:33:00","date_gmt":"2018-07-27T21:33:00","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=17603"},"modified":"2023-03-03T15:17:09","modified_gmt":"2023-03-03T20:17:09","slug":"why-arent-promising-treatments-for-suicide-being-used","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/healthcare-trends\/why-arent-promising-treatments-for-suicide-being-used\/","title":{"rendered":"Why Aren&#8217;t Promising Treatments for Suicide Being Used?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">If you go to any doctor in the country with an infection, you\u2019ll probably be given an antibiotic, which is the standard and accepted treatment for infection. If you see a therapist for depression, however, you might receive any number of treatments, including well-meaning but ineffective ones. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cIf a physician rubs olive oil on an infected area and the infection gets worse, that person could be sued for malpractice, as they should. They didn\u2019t use the evidence-based intervention,\u201d said Matthew Nock, a Harvard psychology professor who studies suicide. \u201cThe same isn\u2019t necessarily true for psychology.\u201d<\/span><\/p>\n<p>A mental illness can be as debilitating and rooted in biology as a physical one. But treatment protocols are far more consistent and regulated for a\u00a0misfiring thyroid than a misfiring brain. When\u00a0researchers develop promising new methods to prevent or manage mental conditions, <span style=\"color: #000000;\">those methods don&#8217;t always\u00a0find their way into therapists&#8217; offices or hospitals.\u00a0<\/span>The lack of uniformity concerns Nock and others who study self-harm and suicide; just as with an infection, the consequences of ineffective treatment can be fatal.<\/p>\n<p><span style=\"font-weight: 400;\">Following the recent high-profile deaths by suicide of designer Kate Spade and chef Anthony Bourdain, calls to suicide hotlines have gone up by about 25 percent, according to the National Suicide Prevention Lifeline. Across the U.S., per the latest <a href=\"https:\/\/www.cdc.gov\/media\/releases\/2018\/p0607-suicide-prevention.html\">Centers for Disease Control and Prevention data<\/a>, the suicide rate has increased 30 percent in the past 15 years, making it the\u00a0<a href=\"https:\/\/www.nimh.nih.gov\/health\/statistics\/suicide.shtml#part_154968\">second leading cause of death<\/a> for Americans between ages 10 and 34. <\/span>While experts are quick to note that suicide\u00a0rates do ebb and flow over time, and that the current rate is about the same as it was in 1916, we\u2019re nonetheless in a flow period.<\/p>\n<blockquote><p><span style=\"font-weight: 400;\">There are no formal guidelines for treating suicidal patients.<\/span><\/p><\/blockquote>\n<p><span style=\"font-weight: 400;\">Going forward, suicide rates might climb even higher for reasons that have nothing to do with media coverage or bullying: The <\/span><a href=\"https:\/\/www.nature.com\/articles\/s41558-018-0222-x.epdf?referrer_access_token=uuWsJPC5k4PDWyFfc6eEXNRgN0jAjWel9jnR3ZoTv0Od0PBRrqjld84cND8FX46EXQXeVI2E2Repk6was59BX9PDeqt2Z7Otq3pC5-smJOzgioBc34gddJjBjUicxEjPqBP9UM-jOutm6FIoG1sg_7adH_k2fX-WoZnGe2ZTqWcbnv_gmPQunxqENlB6LNFAeh_TvphjhuawiTfRvor5rNiWrPI8IbpOe5Ihui1ezUl2gLVwKnGixOh2ksdl6r02ZY09JsUkhNaUgMzwDFIMPrtHfTSFStMI12B2wTYcCn8%3D&amp;tracking_referrer=www.theatlantic.com\"><span style=\"font-weight: 400;\">link between suicide and high temperatures<\/span><\/a><span style=\"font-weight: 400;\"> is so strong that some researchers suggest climate change will further compound suicide risk in years to come. A recent study on this phenomenon, as <\/span><a href=\"https:\/\/www.theatlantic.com\/science\/archive\/2018\/07\/high-temperatures-cause-suicide-rates-to-increase\/565826\/\"><i><span style=\"font-weight: 400;\">The Atlantic<\/span><\/i><span style=\"font-weight: 400;\"> reported<\/span><\/a><span style=\"font-weight: 400;\">, \u201cconcludes that humans can do little about this suicide-climate link beyond developing better medical care to address suicide specifically.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Right now, there are no formal guidelines for treating suicidal patients. Just last month, the American Medical Association <\/span><a href=\"https:\/\/www.ama-assn.org\/increasing-awareness-suicide-risks-save-lives\"><span style=\"font-weight: 400;\">announced a vague policy to \u201cincrease awareness<\/span><\/a><span style=\"font-weight: 400;\">\u201d of suicide risk factors by educating residents and doctors about them. The American Psychiatric Association\u2019s <\/span><a href=\"https:\/\/www.psychiatry.org\/patients-families\/suicide-prevention\"><span style=\"font-weight: 400;\">own recommendations<\/span><\/a><span style=\"font-weight: 400;\"> for treating suicidal patients are as nonspecific as \u201ceffective mental health care.\u201d<\/span><\/p>\n<p>Efforts to understand and prevent suicide\u00a0are also sorely underfunded: The National Institutes of Health spent about $35 million on suicide prevention in 2017, during which time 45,000 Americans died by suicide. That same year, breast cancer research received $689 million from the NIH, while the disease claimed about 40,000 lives. Even without adequate funding, experts say innovative research initiatives and effective new treatments do exist. The problem is, they\u2019re hardly being used.<\/p>\n<h3><strong>Where the promise lies\u00a0<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">One relatively new treatment for suicidal ideation is called dialectical behavior therapy, or DBT. Originally developed to manage <\/span><a href=\"https:\/\/www.nimh.nih.gov\/health\/topics\/borderline-personality-disorder\/index.shtml\"><span style=\"font-weight: 400;\">borderline personality disorder<\/span><\/a><span style=\"font-weight: 400;\">, the technique has been applied to suicide prevention in the last few years. Through DBT, which combines group and individual therapy, patients learn skills to manage their emotions, navigate relationships and become more mindful of what they\u2019re thinking and what\u2019s happening around them. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">There\u2019s also a monitoring component, in which a clinician is on call 24\/7. \u201cIf it\u2019s a Saturday night and I feel like I want to cut myself,\u201d Nock explained, \u201cI can page my clinician and say, \u2018I\u2019m having a tough time, can you walk me through the use of my skills?\u2019\u201d However, if a patient makes that call after they\u2019ve already harmed themselves, the clinician won\u2019t talk to them, so as not to reinforce the behavior. <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2205835\"><span style=\"font-weight: 400;\">The monitoring component, according to one 2015 study, may be the most effective part of<\/span><\/a><span style=\"font-weight: 400;\"> the whole DBT package.<\/span><\/p>\n<blockquote><p><span style=\"font-weight: 400;\">About 60 percent of people who die by suicide do so on the first attempt.<\/span><\/p><\/blockquote>\n<p><span style=\"font-weight: 400;\">Suicide-focused cognitive behavioral therapy, a distinct but similar method to DBT, has been shown to cut people\u2019s risk of repeat suicide attempts. Technically called CBT- SP (suicide prevention), it focuses on strengthening emotional regulation and impulse control, as well as reframing negative perspectives. \u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">At this point, suicide experts are reluctant to say one of these two methods is better than the other. The American Foundation for Suicide Prevention funds clinician trainings across the country on both. While CBT training is fairly accessible, DBT training is extensive, and many clinicians don\u2019t do it for that reason. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cYou might have been trained in how to do a treatment a certain way; now we come along and say, \u2018Here\u2019s this new way to do it,\u2019\u201d said Nock. \u201cLearning this new treatment requires you to stop work for a week, fly to Seattle, get trained and so on. Practically, it\u2019s tough to do.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Compared to behavior therapy techniques, medications are logistically easier to transport \u2014 to literally bottle up and dispense to psychiatrists across the country. That\u2019s not to say pharmacological remedies are useless. For people with bipolar or depressive disorders, lithium has been shown to decrease suicide risk. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4614623\/\"><span style=\"font-weight: 400;\">Ketamine<\/span><\/a><span style=\"font-weight: 400;\"> has also been shown to have anti-suicidal effects, sometimes <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5659073\/\"><span style=\"font-weight: 400;\">within an hour of being administered, according to one stud<\/span><\/a><span style=\"font-weight: 400;\">y. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">But research is still in the early stages, and these drugs aren\u2019t appropriate for all patients at risk for suicide. Ketamine, for example, could be dangerous for those with a history of psychosis or substance abuse. <\/span><\/p>\n<h3><strong>\u00a0Finding the 5 percent \u00a0<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">Most suicide research focuses on preventing people who\u2019ve already made one suicide attempt from making a second one. Intervening before first attempts is trickier to do. It\u2019s also considered by many suicide experts to be the \u201choly grail\u201d of suicide-reduction efforts \u2014 one that could make an enormous difference in saving lives. About 60 percent of people who die by suicide do so on the first attempt. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some researchers are fighting to include suicide screenings in routine care. \u201cIf you just wait for people to bring it up on their own, we\u2019ll probably miss half the people who need help,\u201d said psychologist Jane Pearson, chair of the <\/span><span style=\"font-weight: 400;\">Suicide Research Consortium at the National Institute of Mental Health. \u201cIf we give them a screen that everybody gets and just ask about it matter of factly, so that patients are always asked about smoking, how much they drink, if they\u2019ve thought about suicide, we\u2019ll double the rate of people who say they have a problem.\u201d <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The future of predicting suicide risk might be in machine-learning methods<\/span><b>,<\/b><span style=\"font-weight: 400;\"> such as creating algorithms to identify high-risk people and tracking medical records of patients within a healthcare network. This approach, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4286426\/\"><span style=\"font-weight: 400;\">recent research<\/span><\/a><span style=\"font-weight: 400;\"> suggests, can help identify the 5 percent of people most at risk for suicide over the next year. That 5 percent accounts for half of all suicide deaths over the next year. \u201cPeople talk about finding the suicidal person ahead of time as finding a needle in a haystack,\u201d said Nock. \u201cThis one haystack has 50 percent of all the needles.<\/span><span style=\"font-weight: 400;\">\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Technology might offer solutions to bridge the research-practice gap as well. The AFSP has developed an <\/span><a href=\"https:\/\/www.nowmattersnow.org\/\"><span style=\"font-weight: 400;\">online program for patients<\/span><\/a><span style=\"font-weight: 400;\"> designed to supplement therapy. Nock and his team have built an app called <\/span><a href=\"http:\/\/tectectech.com\/about\"><span style=\"font-weight: 400;\">Tec-Tec<\/span><\/a><span style=\"font-weight: 400;\">, which uses an aversion therapy game to reduce suicidal thoughts.<\/span><\/p>\n<blockquote><p><span style=\"font-weight: 400;\">&#8220;It\u2019s not just asking somebody whether they have ever thought about suicide; it\u2019s about understanding their history.&#8221;<\/span><\/p><\/blockquote>\n<p><span style=\"font-weight: 400;\">\u201cMuch more scalable interventions are now possible with advancements in technology,\u201d Nock said. \u201cWe need to change the way we do interventions that we know are effective \u2014 scale them up,\u201d in order to reach more people. \u201cThis could be online, via self-administered versions. Or instead of seeing a clinician for an hour a week, you\u2019re self-guided through the principles of cognitive therapy and DBT, and then you talk to a clinician for 10 to 15 minutes a week.\u201d <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Pearson says a big challenge in curbing suicide is the variety of trajectories that can lead to it. <\/span><span style=\"font-weight: 400;\">\u201cYou can have a substance abuse problem, depression, sexual abuse. A veteran could become suicidal [following] their exposure to trauma. There are so many different ways that get you there.\u201d <\/span><\/p>\n<p><span style=\"font-weight: 400;\">In the meantime, many leaders in the field are pressuring professional organizations like the American Psychological Association to require suicide-prevention training in clinical doctoral programs, and for medical residency programs to mandate it too. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cThere\u2019s no requirement for suicide training, so clinicians don\u2019t learn how to work with people who are suicidal,\u201d said Jill Harkavy-Friedman, vice president of research at the AFSP. \u201cSuicide cuts across every domain, and everybody should have a full assessment. It\u2019s not just asking somebody whether they have ever thought about it; it\u2019s about understanding their history. Just like any other health condition \u2014 you should keep a steady eye and get help if the need emerges.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Campaigns for early intervention and mandatory suicide training dovetail with an approach called the <\/span><a href=\"https:\/\/aims.uw.edu\/collaborative-care\"><span style=\"font-weight: 400;\">Collaborative Care model<\/span><\/a><span style=\"font-weight: 400;\">. The underlying idea is to integrate behavioral healthcare with medical healthcare, so that providers across different specialties talk to one another and coordinate care for patients. Initial studies suggest this model could improve treatment for depression and reduce suicidal thoughts in some patients.\u00a0<\/span><\/p>\n<h3><b>Lasting help for fleeting thoughts\u00a0<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">If someone is having suicidal thoughts, finding evidence-based treatment can prove daunting. Nock suggests using the <\/span><a href=\"https:\/\/www.nimh.nih.gov\/health\/find-help\/index.shtml\"><span style=\"font-weight: 400;\">NIMH<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"http:\/\/www.abct.org\/Home\/\"><span style=\"font-weight: 400;\">Association for Behavioral and Cognitive Therapies<\/span><\/a><span style=\"font-weight: 400;\"> websites or reaching out to a therapist in your area who practices evidence-based treatments like CBT-SP or DBT and asking them about their approach and training.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cWe know from decades of research that suicidal thoughts and behaviors very often are transient in nature,\u201d said Nock.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In a forthcoming study, he and colleagues found that in about half of people who have thoughts of suicide, the thoughts don\u2019t persist. \u201cThey have them, they go away,\u201d Nock said. \u201cPeople go through suicidal periods. If we can keep them alive through that, they go on to live a happy, healthy, high-functioning life, often. If we don\u2019t help them through that period, they never have that opportunity.&#8221;<\/span><\/p>\n<hr \/>\n<h1 class=\"p1\" style=\"text-align: center;\"><span class=\"s1\">Ready to book a therapy appointment? Visit <a href=\"https:\/\/www.zocdoc.com\/psychologists\"><span class=\"s2\">Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"<p>Researchers say our best tools for curbing suicide aren&#8217;t reaching hospitals or therapists&#8217; offices. <\/p>\n","protected":false},"author":11,"featured_media":17604,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[229],"tags":[136,90,33,41,132],"class_list":["post-17603","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare-trends","tag-culture","tag-feature","tag-healthcare","tag-mental-health","tag-research","reviewer-dr-nassim-assefi"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Why Aren&#039;t Promising Treatments for Suicide Being Used? - Healthcare Trends<\/title>\n<meta name=\"description\" content=\"Researchers say our best tools for curbing suicide aren&#039;t reaching hospitals or therapists&#039; offices.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.zocdoc.com\/blog\/healthcare-trends\/why-arent-promising-treatments-for-suicide-being-used\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why Aren&#039;t Promising Treatments for Suicide Being Used? 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