Psychological Medicine

Original Articles

Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide

M. Ghahramanlou-Hollowaya1 c1, S. S. Bhara2, G. K. Browna3, C. Olsena4 and A. T. Becka3

a1 Department of Medical and Clinical Psychology, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

a2 Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia

a3 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

a4 Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA


Background Cognitive therapy has been found to be effective in decreasing the recurrence of suicide attempts. A theoretical aim of cognitive therapy is to improve problem-solving skills so that suicide no longer remains the only available option. This study examined the differential rate of change in problem-solving appraisal following suicide attempts among individuals who participated in a randomized controlled trial for the prevention of suicide.

Method Changes in problem-solving appraisal from pre- to 6-months post-treatment in individuals with a recent suicide attempt, randomized to either cognitive therapy (n=60) or a control condition (n=60), were assessed by using the Social Problem-Solving Inventory-Revised, Short Form.

Results Improvements in problem-solving appraisal were similarly observed for both groups within the 6-month follow-up. However, during this period, individuals assigned to the cognitive therapy condition demonstrated a significantly faster rate of improvement in negative problem orientation and impulsivity/carelessness. More specifically, individuals receiving cognitive therapy were significantly less likely to report a negative view toward life problems and impulsive/carelessness problem-solving style.

Conclusions Cognitive therapy for the prevention of suicide provides rapid changes within 6 months on negative problem orientation and impulsivity/carelessness problem-solving style. Given that individuals are at the greatest risk for suicide within 6 months of their last suicide attempt, the current study demonstrates that a brief cognitive intervention produces a rapid rate of improvement in two important domains of problem-solving appraisal during this sensitive period.

(Received January 04 2011)

(Revised September 02 2011)

(Accepted September 12 2011)

(Online publication October 19 2011)


c1 Address for correspondence: M. Ghahramanlou-Holloway, Ph.D., Departments of Medical & Clinical Psychology and Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room B3050, Bethesda, MD 20814-4799, USA. (Email: