Cognitive Behavior Therapy With and Without Narrative Assessment and Suicide Attempts: A Systematic Review and...

Area of Science:

• Psychiatry and Behavioral Sciences
• Clinical Psychology
• Public Health

Background:

• No current evidence-based method exists to identify drivers of suicide attempts.
• Cognitive Behavior Therapy (CBT) is a common intervention for mental health conditions.
• Identifying factors contributing to suicide attempts is crucial for effective prevention.

Purpose of the Study:

• To evaluate if CBT interventions incorporating narrative assessment reduce suicide attempts more than those without.
• To synthesize evidence from randomized clinical trials on CBT and suicide attempt reduction.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials.
• Data sourced from the Metapsy Suicide Prevention Database up to April 2025.
• Cochrane Risk of Bias 2 tool used for quality assessment; random-effects model for meta-analysis.

Main Results:

• Twenty-three studies with 3262 participants were included.
• CBT with narrative assessment significantly reduced suicide attempt risk (RR, 0.68).
• CBT without narrative assessment did not significantly reduce suicide attempt risk (RR, 1.17).

Conclusions:

• CBT interventions incorporating narrative assessment are associated with reduced suicide attempts.
• Narrative assessment may be a key component for identifying and addressing suicide attempt drivers.
• Further head-to-head trials are needed to confirm causal relationships.