The cognitive behavioural prevention of suicide in psychosis: A clinical trial Nicholas Tarrier a , James Kelly b , Sehar Maqsood b , Natasha Snelson b , Janet Maxwell c , Heather Law b , Graham Dunn c , Patricia Gooding c, ⁎ a Department of Psychology, Institute of Psychiatry, London, UK b Greater Manchester West Mental Health NHS Foundation Trust, UK c Faculty of Human and Medical Sciences, University of Manchester, UK abstract article info Article history: Received 10 April 2014 Accepted 26 April 2014 Available online 19 May 2014 Keywords: Psychological intervention CBT Suicide Schizophrenia Psychosis Background: Suicide behaviour in psychosis is a significant clinical and social problem. There is a dearth of evidence for psychological interventions designed to reduce suicide risk in this population. Aims: To evaluate a novel, manualised, cognitive behavioural treatment protocol (CBSPp) based upon an empirically validated theoretical model. Methods: A randomly controlled trial with independent and masked allocated and assessment of CBSPp with TAU (n = 25, 24 sessions) compared to TAU alone (n = 24) using standardised assessments. Measures of suicide probability, and suicidal ideation were the primary outcomes and measures of hopelessness, depression, psychotic symptoms, functioning, and self-esteem were the secondary outcomes, assessed at 4 and 6 months follow-up. Results: The CBSPp group improved differentially to the TAU group on two out of three primary outcome measures of suicidal ideation and suicide probability, and on secondary outcomes of hopelessness related to suicide probability, depression, some psychotic symptoms and self-esteem. Conclusions: CBSPp is a feasible intervention which has the potential to reduce proxy measures of suicide in psychotic patients. © 2014 Elsevier B.V. All rights reserved. 1. Introduction Suicide and suicide behaviour are of substantial public and social concern. It is well established that risk of suicide is considerably elevat- ed in those suffering from schizophrenia and psychotic disorders (Caldwell and Gottesman, 1990; Cohen et al., 1994; Hawton et al., 2005; Bolton et al., 2007). Suicide ideation and suicide attempts are common with up to 50% of patients experiencing suicidal ideation at any point in time or having a history of previous attempts (Hawton et al., 2005; Palmer et al., 2005). It is assumed that there is a progressive continuum from ideation, intent, action and completion (Bolton et al., 2007). Thus, suicidal ideation is a risk factor for self-harm and complet- ed suicide and a legitimate clinical target in its own right. A meta-analysis of cognitive–behavioural interventions (CBT) to reduce suicide behaviour (Tarrier et al., 2008) demonstrated that individual, but not group, CBT, was effective in significantly reducing suicide behaviour in adults, although not adolescents, in the short and medium term. This result held despite considerable variability both in the target populations and in the CBT interventions. There is, how- ever, a paucity of studies which have attempted to diminish suicide behaviour in psychosis, despite the well established high risk in this group. Cognitive behaviour therapy for psychosis (CBTp) reduces positive and negative symptoms of psychosis, depression, and anxiety but has less effect on hopelessness (Wykes et al., 2008) and suicidality (Tarrier et al., 2006). Psychological interventions are most likely to be successful when they are clearly derived from a theoretical understanding of underlying mechanisms (Bolton et al., 2007; Johnson et al., 2008a). Advances in understanding the cognitive architecture underpinning suicidality have resulted in the development of empirically validated theoretical models, such as, the Schematic Appraisal Model of Suicide (SAMS) (Johnson et al., 2008a,b) which was modified from the Cry of Pain model (Williams, 1997). The SAMS has three core psychological com- ponents, namely, the presence of negative information processing biases, extensive ‘suicide schema’, and a negative and suicide focused appraisals system (Johnson et al., 2008a). To date, empirical evidence supports a multi-tiered appraisals system together with the operation Schizophrenia Research 156 (2014) 204–210 ⁎ Corresponding author at: School of Psychological Sciences, University of Manchester, M13 9PL, UK. http://dx.doi.org/10.1016/j.schres.2014.04.029 0920-9964/© 2014 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres