Running head: SUICIDAL OLDER ADULTS 1

COGNATIVE BEHAVIOIAL THERAPY WITH SUICIDIAL OLDER ADULTS

Barb Gibbs

March 25, 2017

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Cognitive Behavioral Therapy with Suicidal Older Adults

The article evaluated the benefit of implementing cognitive behavioral therapy (CBT)

with suicidal older adults. It described how CBT can empower older adult clients by developing

skills to improve their daily self-management and in turn increase the satisfaction of their life.

The article stated that of the suicides carried out, approximately one quarter are by individuals

that are 60 years of age or older.

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The article defines the need for methods of intervention for older adults as one quarter of

all suicides carried out in the United States are by older adults age 60 or older, who are also more

successful than the younger population. It is believed the suicide success rate is higher in older

adults as they are not attempting suicide for attention, as is often seen in the younger population,

their goal is to take their own lives and therefore, their method is more lethal (Coon, 2004). The

article defines the characteristics that are common with older adult suicides. It also describes a

CBT approach specific to suicidal older adults. This can include, but not limited to struggles with

affective disorder, suicidal ideations or suicide carried out by older adults.

The article made light of the way in which older adults provide fewer warning signs of

their suicidal attempt than the younger suicidal population. Silent suicides which can be

through starvation or becoming noncompliant with necessary medical treatments has brought

with it a growing concern for the suicidal older adults. (Coon, 2004). Coon further discusses the

number of older adult suicides reported may actually be incorrect as the probability that the

number of actual suicides is much higher, since some officials may report the suicide as an

accidental death when possible to save the family from the suicides social stigma (Coon, 2004).

When reviewing suicide in older adults, it is not thought to be just a direct correlation to

aging itself. When a human ages, it is not normal for them to be overcome with feeling of

despair and hopelessness as they have the ability to adapt to the regular rate of aging. When an

older adult has one of the following factors, along with aging, suicidality can become a factor;

depression, chronic illness, significant injury, social isolation, alcohol or drug abuse, grief,

sudden change or stressors in family dynamics. (Coon, 2004).

CBT can prove beneficial in suicidal older adults when they are faced with late life

distress or affective disorder. The model of CBT appropriate for intervening with suicidal older
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adults, include a) a rationale for adapting CBT to intervene with this population; b) a

description of CBT approaches to intervene with suicidal elders; c) exclusion criteria for

identifying which client might not benefit from CBT; and d) suggestions for modification to help

address diverse group of elders (Coon, 2004).

Key terms were defined in the article. Some of the terms defined are suicide, older adults,

cognitive behavioral therapy, assessment, treatment.

There are many sources which were used in this article to assist in providing the

necessary information to understand the purpose of this study. The sources used were scholarly

in nature and appear to be experts in the field. One such source would be the use of information

obtained from a study complied by Journal of Psychiatric Research specific to how Mini-

mental state: A practical method for grading the cognitive state of patients for the clinician

(Folstein, 1975). The references citied in the article span from the 1975 (Folstein, Mini-mental

state) to 2002 (Blazer, Depression in late life), with the majority of references from the 20th

century. The authors of the article were very efficient in providing sources to substantiate

information stated in the article, such as the use of the Journal of Psychiatric Research and

Psychotherapy: Theory, Research, and Practice as well as Suicide in the elderly.

I found the review of the information provided in the article was not too broad, nor too

narrow. The information provided in the review, not only supported the need for the study, but it

also assisted in providing background information for the problem being discussed in the article.

It remained on point by providing not only informative information such as the models of

cognitive behavioral therapy, but also characteristics of suicidal elders, allowing the review to

stay on track and relevant to the topic. I did not find the article to hold any bias opinions. The

author only stated factual information by citing his references throughout. Although much of
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CBT can be thought of as case management, one must realize the implementation of CBT will

allow the older adult to empower themselves, this can be a very useful tool for a social worker.

It is a fact that not all older adults have suicidal ideations or go as far to attempt suicide.

This article helps explain what the deciding factors may be to explain why some older adults

become suicidal. This can be through an unexpected deterioration of the persons health. For

example, through an injury that suddenly limits their mobility and ability to socialize causing a

feeling of isolation and uselessness. It is also thought to be brought on through a change in the

family dynamics, grief, alcohol or drug use or cognitive impartment. CBT has shown a

promising approach to assist an older adult who is experiencing suicidality.

CBT intervention models are grouped into four separate groupings: 1) symptom

reduction and stabilization techniques such as hospitalization, pharmacotherapy, complimentary

medicine, and distraction; 2) behavioral interventions including behavioral contracts, stress

management training, pleasant event schedules, and social and communication skills training; 3)

cognitive interventions such as Daily Thought Records and problem-solving techniques; and 4)

situational interventions including social service interventions, information support mobilization,

conflict management, and occupational enhancement (Coon, 2004). These interventions have

been designed to initiate the internal coping mechanism as well as external support for the older

adult.

Symptom reduction and stabilization techniques are necessary to stabilize the crises

before CBT can be successfully implemented. This can be done by medications and other

symptom reduction techniques (Coon, 2004). At times, hospitalization may be necessary to

stabilize the older adult who is experiencing a crisis.

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Behavioral interventions can be done with a no suicide contract between the older adult

and the therapist. In the contract, the older adult will include their goal, such as to take care of

their pain and not to die. The older adult will define that their goal is to continue to live by

reducing the unhappiness they are experiencing. It is also important in the no suicide contract

to proclaim that their life is worth the time and effort to achieve their goals to continue living.

This could also include, when applicable, stress management, anger management, as well as

assertive communication skill training.

When Cognitive interventions are employed, this will require the older adult to

understand that both negative thoughts and beliefs are confronted immediately though their Daily

Thought Records. In turn, the older adult can be encouraged to compile a list of reasons to

continue to live. Furthermore, the older adult may benefit from compiling a list of items they

have been meaning to complete. Along with stating the importance of staying alive to complete

these items.

Reconnecting older adults with external resources, both formal and informal is a form of

situational interventions. This can range from locating groups and or organizations that the older

adult would find interest in and have benefit from, to aiding them in re-establishing their family

and friend networks. While situational interventions are similar to case management activities,

their goal is to help empower elders to perform their activities themselves through active skill-

training (e.g. problem-solving skills, assertiveness, skills, or social skills training) (Coon, 2004).

Most older adults in our society are known to suffer from some sort of chronic illness.

This illness can range from diabetes, arthritis, cardiac or respiratory problems, hypertension, or

an injury that is slow to heal, or doesnt heal properly. These illnesses are unable to be cured,

with it causing at the least a mild level of disability for the older adult. The severity of the illness
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is shown to have a direct correlation to the risk of suicidal ideations in older adults (Coon, 2004).

CBT is needed to aide these older adults when dealing with challenges brought on by an illness.

It is also important to make it clear to the older adult that they are not a burden to others and the

suicidal ideations and depression they are experiencing are to be thought of as separate from any

physical challenges they are currently experiencing.

I found the article to be informative and relevant to the nature of the topic. It presented

facts and information necessary to understand suicide in older adults. The information collected

was relevant and it did not stray from the topic of the article, it was on point and completely

relevant. The article was done in a manner in which it maintained ethics and the privacy and

confidentially of the participants. The article stayed on track by only discussing subjects relating

to the topic. There was no evidence of bias. The results stated in the article were a direct

correlation of the information discussed in the article, therefore all the information contained

therein was related to the subject.

This CBT could have proven useful for a recent client. He was a 60 year old caucasian

male who was baker acted for suicidal ideations with a plan of starvation. The client has suffered

a severe shoulder injury within the past year. Due to the injury and unsuccessful surgery, the

patient was no longer able to work or use his right arm. He is currently not ambulatory and is

refusing to eat, stating his plan is to commit suicide by starvation. The patient has stated that he

is a burden and useless since he cant work or take care of the duties he used to as a husband.

The client could have benefited from the CBT model discussed in this article. He could have

utilized situational interventions to employ the support of his family and friends. I also believe he

would have benefited from cognitive interventions by defining his negative thoughts and beliefs

he has had since his injury, as well as compile a list of reasons he has for living. Most important,
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I feel he could have benefited from behavioral interventions by creating a no suicide contract

by defining the steps needed to address the pain he still experienced from his injury, understand

that he is worth the time and effort needed for rehabilitation therapy so he could regain some

functionality as well as learn new ways in which to perform his daily living activities. The client

could have also benefited from anger management to help him process the anger he has from

losing his ability to function at the same level prior to his injury.

In conclusion, the article took the perspective that a rational response to aging is not

suicide and the outcome of suicide can be prevented. The implementation of CBT for a suicidal

older adult can prove beneficial. The CBT models will allow the social worker to aid the older

adult in recognizing the separation of their suicidal ideations and their illness or barrier they are

facing. It provides tools such as situational interventions that puts the power back into the older

adults hands by empowering them to perform activities such as reconnecting with family or

friends, or finding a group or organization they can join. It will also allow the social worker to

help the older adult identify negative thoughts and beliefs, allowing them to confront them

through cognitive interventions. This will help to reinforce to the suicidal older adult how

important it is to work through and learn how to cope with adversities they may be facing. The

author did state substantially more controlled research needs to be initiated on the effectiveness

of various CBT approaches across a variety of geriatric patient populations including those from

different cultural contexts (Coon, 2004).

The information obtained in this study can have a positive impact for clinicians working

directly with suicidal older adults. This article also emphasized the importance of defining the

needs of the older adult, what situation has occurred in their life for them to have suicidality.

This information can aid in assisting a suicidal older adult in coping with the illness or injury that
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has brought with it feelings of depression and suicidal ideations. With clear understanding of the

older adults history, this information is important to aid in assisting them in realizing their life is

worth living. It can help not only the older adult, but also family and friend to better understand

why they are having suicidal ideations

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References

Coon, D., DeVries, H., Gallagher-Thompson, D., (2004). COGNITIVE BEHAVIORAL

THERAPY WITH SUICIDAL OLDER ADULTS. Behavioural and Cognitive

Psychotherapy, 32, 48-493