Safety and Tolerability of a Brief Cognitive-Behavioral Therapy for Chronic Pain Group for Veterans at Increased Risk for Suicide

Introduction: Chronic pain is a significant risk factor for suicide, especially among Veterans. The aim of this study is to evaluate the safety (i.e., the occurrence of suicidal behavior after treatment) and tolerability (i.e., treatment completion) of a Brief Cognitive-Behavioral Therapy for Chronic Pain (Brief CBT-CP) group in primary care among a sample of Veterans with chronic noncancer pain deemed to be at an increased risk for suicide.

Materials and methods: Chart review was used to assess suicide history and treatment completion among Veterans who participated in a Brief CBT-CP group within a Primary Care-Mental Health Integration Clinic at a Veteran Affairs Medical Center. Suicide risk was stratified into 3 categories: Minimal (no current suicidal ideation or history of suicidal behavior), Elevated (current suicidal ideation or history of suicidal behavior), and High Risk (current suicidal ideation and history of suicidal behavior). Safety was assessed as the absence of suicidal behavior during and after Brief CBT-CP sessions. Tolerability was defined as completion of at least 4/6 sessions.

Results: Of the 261 Veterans who participated in a Brief CBT-CP group, 24.9% of Veterans were identified to be at Elevated Risk for suicide, and 1.5% of Veterans were identified to be at High Risk. Brief CBT-CP was identified as safe, as no deaths (by suicide or otherwise) or suicidal behaviors were observed while Veterans engaged in the treatment sessions. In fact, following completion of Brief CBT-CP, a 24.2% reduction in relative risk of suicidal behaviors was observed in the overall sample. Brief CBT-CP was also tolerable, with nearly 90% of Veterans completing at least 4 sessions (n = 229).

Conclusions: Brief CBT-CP appears to be a safe and well-tolerated treatment for Veterans with chronic noncancer pain who are also at risk for suicide.