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Current Psychiatry Research and Reviews


ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

Systematic Review Article

Effectiveness of Cognitive Behavioural Therapy for Suicide in Schizophrenia: A Systematic Review

Author(s): Rafael Penadés *, Florencia Forte , Gisela Mezquida , Alexandre González-Rodríguez, Clemente García-Rizo , Rosa Catalán and Miguel Bernardo

Volume 18, Issue 1, 2022

Published on: 27 January, 2022

Page: [36 - 45] Pages: 10

DOI: 10.2174/2666082218666211220164527

Price: $65


Background: Suicide is probably one of the worst potential complications for people with schizophrenia. Even though the use of antipsychotic medication is essential in reducing suicidal behaviour, the use of psychological treatments seems to be in the same way necessary. Cognitive Behavioural Therapy (CBT) is an evidence-based form of psychotherapy that is constantly trying to synchronise with the latest recommendations from the research. The goal of the present work is to systematically review the scientific evidence from published studies testing the effectiveness of CBT designed to deal with suicide in patients with schizophrenia.

Methods: We searched using multiple terms related to suicide prevention based on CBT in schizophrenia. Two databases (Medline and SCOPUS) were scrutinised for the electronic search, and different reference lists from previous reviews were also hand-checked.

Results: We identified 5 randomised and controlled trials of CBT that included suicide-related cognitions or behaviours as a primary outcome measure. CBT focusing on suicidal cognitions and behaviours was found to be effective in reducing suicidal ideation. As the number of studies fulfilling the inclusion criteria is small, and the assessment of outcomes is heterogeneous, we did not perform a meta-analysis and present results in a narrative way.

Conclusion: Research on CBT focused on suicide prevention in patients with schizophrenia is promising, but current evidence is notoriously insufficient. Although those therapies seemed to be efficacious in the prevention of suicide, scarcity of randomised clinical trials specifically focusing on suicide is probably the most important issue to be faced. Given the current evidence, clinicians should be familiar with CBT techniques focusing on suicidal cognitions. However, suicide prevention and treatment in those with schizophrenia is complex, and many other factors such as possible earlier use of clozapine, optimizing adherence to medication, and other psychosocial aspects should be addressed. A combination of different strategies appears to be mandatory.

Keywords: Suicidal prevention, CBT, cognitive behavioural therapy, schizophrenia, psychotic disorders, suicide.

Graphical Abstract
WHO World Health Organization annual report 2019 WHO Country Office Lebanon: health for all.Regional Office for the Eastern Mediterranean Cairo PP - Cairo. World Health Organization 2019. Available from: 333249
Fenton WS, McGlashan TH, Victor BJ, Blyler CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry 1997; 154(2): 199-204.
[] [PMID: 9016268]
Ösby U, Correia N, Brandt L, Ekbom A, Sparén P. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000; 45(1-2): 21-8.
[] [PMID: 10978869]
Yates K, Lång U, Cederlöf M, Boland F, Taylor P, Cannon M, et al. Association of psychotic experiences with subsequent risk of suicidal ideation, suicide attempts, and suicide deaths: A systematic review and meta-analysis of longitudinal population studies. JAMA Psychiatry 2019; 76: 180-9. Available from:
De Hert M, McKenzie K, Peuskens J. Risk factors for suicide in young people suffering from schizophrenia: A long-term follow-up study. Schizophr Res 2001; 47(2-3): 127-34.
[] [PMID: 11278129]
Pompili M, Amador XF, Girardi P, et al. Suicide risk in schizophrenia: Learning from the past to change the future. Ann Gen Psychiatry 2007; 6: 10.
Simms J, McCormack V, Anderson R, Mulholland C. Correlates of self-harm behaviour in acutely ill patients with schizophrenia. Psychol Psychother Theory, Res Pract 2007; 80(1): 39-49.
Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: A reexamination. Arch Gen Psychiatry 2005; 62(3): 247-53.
[] [PMID: 15753237]
Siris SG. Suicide and schizophrenia. J Psychopharmacol 2001; 15: 127-35.
Sher L, Kahn RS. Suicide in schizophrenia: An educational overview. Medicina 2019; 55(7): 361.
Heilä H, Isometsä ET, Henriksson MM, Heikkinen ME, Marttunen MJ, Lönnqvist JK. Suicide and schizophrenia: A nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia. Am J Psychiatry 1997; 154(9): 1235-42.
Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry 2005; 187: 9-20.
[] [PMID: 15994566]
Burns AMN, Erickson DH, Brenner CA. Cognitive-behavioral therapy for medication-resistant psychosis: A meta-analytic review. Psychiatric Services 2014; 65: 874-80.
Turner DT, van der Gaag M, Karyotaki E, Cuijpers P. Psychological interventions for psychosis: A meta-analysis of comparative outcome studies. Am J Psychiatry 2014; 171(5): 523-38.
[] [PMID: 24525715]
van der Gaag M, Valmaggia LR, Smit F. The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: A meta-analysis. Schizophr Res 2014; 156(1): 30-7.
[] [PMID: 24731619]
Wykes T, Steel C, Everitt B, Tarrier N. Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophr Bull 2008; 34(3): 523-37.
NICE. Psychosis and Schizophrenia in Adults: Treatment and Management NICE Clinical Guideline 178. NICE 2014.
Dixon LB, Dickerson F, Bellack AS, et al. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull 2010; 36(1): 48-70.
[] [PMID: 19955389]
Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: A systematic review. JAMA 2005; 294(16): 2064-74.
[] [PMID: 16249421]
Méndez-Bustos P, Calati R, Rubio-Ramírez F, Olié E, Courtet P, Lopez-Castroman J. Effectiveness of psychotherapy on suicidal risk: A systematic review of observational studies. Front Psychol 2019; 10: 217.
Mewton L, Andrews G. Cognitive behavioral therapy for suicidal behaviors: Improving patient outcomes.Psychology Research and Behavior Management. Dove Medical Press Ltd. 2016; 9: pp. 21-9.
Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: A systematic review and meta-analysis. Behav Modif 2008; 32(1): 77-108.
[] [PMID: 18096973]
Bornheimer LA, Zhang A, Li J, Hiller M, Tarrier N. Effectiveness of suicide-focused psychosocial interventions in psychosis: A systematic review and meta-analysis. Psychiatr Serv 2020; 71(8): 829-38.
[] [PMID: 32340594]
Crawford MJ, Thomas O, Khan N, Kulinskaya E. Psychosocial interventions following self-harm: Systematic review of their efficacy in preventing suicide. Br J Psychiatry 2007; 190: 11-7.
Donker T, Calear A, Grant JB, et al. Suicide prevention in schizophrenia spectrum disorders and psychosis: A systematic review. BMC Psychol 2013; 1(1): 6.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996; 17(1): 1-12.
[] [PMID: 8721797]
Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry 2002; 180: 523-7.
[] [PMID: 12042231]
Nordentoft M, Jeppesen P, Abel M, et al. OPUS study: Suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis. One-year follow-up of a randomised controlled trial. Br J Psychiatry 2002; 43: s98-106.
Grawe RW, Falloon IRH, Widen JH, Skogvoll E. Two years of continued early treatment for recent-onset schizophrenia: A randomised controlled study. Acta Psychiatr Scand 2006; 114(5): 328-36.
[] [PMID: 17022792]
Garety PA, Fowler DG, Freeman D, Bebbington P, Dunn G, Kuipers E. Cognitive-behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: Randomised controlled trial. Br J Psychiatry 2008; 192(6): 412-23.
[] [PMID: 18515890]
Barrowclough C, Haddock G, Wykes T, et al. Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: Randomised controlled trial. BMJ 2010; 341(7784): c6325.
[] [PMID: 21106618]
Chan SKW, So HC, Hui CLM, et al. 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychol Med 2015; 45(6): 1181-93.
[] [PMID: 25233868]
Haddock G, Pratt D, Gooding PA, et al. Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: Randomised controlled trial. BJPsych Open 2019; 5(1): e14.
[] [PMID: 30762509]
Bateman K, Hansen L, Turkington D, Kingdon D. Cognitive behavioral therapy reduces suicidal ideation in schizophrenia: Results from a randomized controlled trial. Suicide Life Threat Behav 2007; 37(3): 284-90.
[] [PMID: 17579541]
Peters E, Landau S, McCrone P, et al. A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service. Acta Psychiatr Scand 2010; 122(4): 302-18.
[] [PMID: 20491720]
Power PJR, Bell RJ, Mills R, et al. Suicide prevention in first episode psychosis: The development of a randomised controlled trial of cognitive therapy for acutely suicidal patients with early psychosis. Aust N Z J Psychiatry 2003; 37(4): 414-20.
[] [PMID: 12873325]
Tarrier N, Kelly J, Maqsood S, et al. The cognitive behavioural prevention of suicide in psychosis: A clinical trial. Schizophr Res 2014; 156(2-3): 204-10.
[] [PMID: 24853059]
Tarrier N, Haddock G, Lewis S, Drake R, Gregg L. Suicide behaviour over 18 months in recent onset schizophrenic patients: The effects of CBT. Schizophr Res 2006; 83(1): 15-27.
[] [PMID: 16460916]
Miloseva L, Milosev V, Rihter K. Cognition and suicide: Effectiveness of cognitive behaviour therapy. Int J Cogn Res Sci Eng Educ 2016; 4(1): 79-83.
Meerwijk EL, Parekh A, Oquendo MA, Allen IE, Franck LS, Lee KA. Direct versus indirect psychosocial and behavioural interventions to prevent suicide and suicide attempts: A systematic review and meta- analysis. Lancet Psychiatry 2016; 3(6): 544-54.
[] [PMID: 27017086]
Depp C, Ehret B, Villa J, Perivoliotis D, Granholm E. A brief mobile-augmented suicide prevention intervention for people with psychotic disorders in transition from acute to ongoing care: Protocol for a pilot trial. JMIR Res Protoc 2021; 10(2): e14378.
[] [PMID: 33555265]
Gooding PA, Pratt D, Awenat Y, et al. A psychological intervention for suicide applied to non-affective psychosis: The CARMS (Cognitive AppRoaches to coMbatting Suicidality) randomised controlled trial protocol. BMC Psychiatry 2020; 20(1): 306.
[] [PMID: 32546129]

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