Targeting problem-solving with a cognitive remediation intervention for suicide prevention in veterans: A pilot study

Despite research identifying cognitive deficits that are specific to individuals with major depressive disorder and a history of suicidal behavior (SB), no known study has investigated cognitive remediation (CR) for suicide risk reduction in this patient population. The aim was to evaluate feasibility, acceptability and outcomes of a brief-format (10-week), group-based CR program adapted from the evidence-based CR intervention NEAR (Neuropsychological Educational Approach to Cognitive Remediation) for veterans with major depressive disorder and SB. Nine US Veteran outpatients participated in 20 sessions of remotely-delivered NEAR-Suicidal Behavior (NEAR-SB). Feasibility and acceptability were assessed. Outcomes for suicidal ideation/behavior, depression, adaptive-functioning, and problem-solving were measured at pre-treatment, post-treatment, and 10-weeks post-treatment, and effect sizes (Hedges' g) were calculated for both follow-up time points. NEAR-SB was feasible and acceptable in terms of engagement, satisfaction, therapy fidelity, and retention. Clinical, cognitive, and adaptive functioning outcomes improved at completion and 10-weeks post-treatment. Greater improvement in problem-solving post-treatment was associated with greater reduction in depression. Pilot data supports further research with a randomized clinical trial to confirm efficacy of incorporating the NEAR-SB program for veterans with MDD and SB and to pilot a control condition.