Re-writing the software.
A hell of a lot safer than psych drugs which can acutally increase suicidality. And preferable to an abusive program. However, I don't know how effective it actually is for those whose depression stems from problems of living such as poverty and homelessness. Sometimes the cure for a person's distress requires some practial, common sense action (meeting basic needs immediately, followed by job training, etc). I mean, how do you convince someone that their depression will lift if the just think 'non-negative' thoughts about their economic status and inability to provide for self and family?
http://www.nytimes.com/2005/08/09/healt ... nted=printAugust 9, 2005
Talk Therapy Succeeds in Reducing Suicide Risk
By BENEDICT CAREY
After a year of debate over whether antidepressant drugs increase the risk of suicide, a new study finds that a standard brand of talk therapy may offer the best chance to save those at the highest risk of taking their own
lives.
The therapy cut almost by half the risk of suicide attempts in extremely suicidal patients, many of whom were already taking drugs for depression, the researchers found.
The study, published in the Aug. 3 issue of The Journal of the American Medical Association, is the largest and most rigorous test of a
psychotherapy technique in people whose attempts to end their lives have been serious enough to land them in hospitals, experts said.
Studies of depression treatments typically exclude such patients, in part because they are 30 to 40 times as likely to kill themselves as people who have not made serious suicide attempts.
"That you could cut by half the number of attempts in this population in just 8 to 10 sessions of therapy is something to write home about," said Steven D. Hollon, a professor of psychology at Vanderbilt University, who was not a part of the study.
Dr. Hollon added: "These are the kinds of people who wouldn't qualify for 90 percent of the treatment trials out there. But if you don't ever include them, you don't know what works for them. No guts, no glory."
In the study, Dr. Gregory K. Brown, a psychologist, and Dr. Aaron T. Beck, a
psychiatrist, both of the University of Pennsylvania, led a research team that recruited 120 people who were seen in the emergency room of the university hospital after trying to kill themselves.
The patients had multiple problems, including drug addiction, depression and homelessness, and half were followed closely by case managers and referred for counseling services, if necessary.
Once every week or so, the other half arrived for cognitive therapy, a counseling technique in which people learn to head off or diffuse self-defeating thoughts before acting on them. The researchers intended the therapy to address the patients' lives, their specific hopes and fears and the factors that had prompted them try to end their lives, Dr. Brown said.
A man who "felt like giving up" after a relationship problem learned that this thought itself had the effect of giving him permission to use drugs, which invariably make the situation worse, Dr. Brown said.
As they neared the end of the therapy, the participants relived their most painful moments, let themselves feel the tug of suicide and then devised strategies to divert themselves from thinking more about it.
"We would then see if these techniques reduced the sense of hopelessness, and if so, they could be discharged from therapy," Dr. Beck said. "It was a kind of dress rehearsal."
The patients who stumbled at rehearsal continued seeing the therapist for a longer time, he said.
The investigators followed the two groups, detailing repeat suicide attempts in interviews. After a year and a half, 13 of the men and women who received cognitive therapy tried again to kill themselves, compared with 23 in the other group. No one in either group completed a suicide.
Over all, those who received cognitive therapy scored significantly lower on measures of depressive mood and hopelessness.
Researchers working with people whose problem has been diagnosed as borderline personality disorder, which carries a high risk of suicide, have also reported reduced numbers of attempts with the therapy. But therapy aimed at borderline patients is long term, typically lasting a year or more.
In the new study, the course of therapy was short for a reason, Dr. Beck said. Highly suicidal people, particularly those with drug problems who are socially marginalized, do not typically have the patience or energy for longer courses of therapy.
The researchers are setting up a study of the therapy in community mental health centers, training counselors to use the technique with people hospitalized after suicide attempts.
"We'll see what happens in the real world," Dr. Beck said. "That will be the true test."
