p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 3 No. May 5, 2024
The Effect of Cognitive Therapy on Psychosis Clients with
Suicide Risk: Literature Review
Reza Fajar Amalia1*, Priyo Purnomo As’hab2
1Universitas Jenderal Soedirman, Indonesia
2Rumah Sakit Umum Daerah (RSUD) Cilacap, Indonesia
Email: reza.amalia1310@gmail.com1*
Psychosis is a mental or psychiatric disorder
characterized by hallucinations, delusions, chaotic behavior, and accompanied
by poor insight. A systematic review and meta-analysis study showed that
individuals with a diagnosis of psychosis have a high prevalence of suicide.
One of the psychotherapies given to psychosis clients with suicide risk is
cognitive therapy (CT). Objective: To determine the effect of cognitive therapy
(CT) on psychosis clients with suicide risk Articles discussed in this literature
review were obtained through article searches in electronic journal databases,
namely Science Direct, ProQuest, Wiley Online Library, EBSCOhost, Sage
Journals, and ClinicalKey. The inclusion criteria of this journal review were
human studies, English, and free fulltext. The results showed that CT in
clients at risk of suicide has a significant effect in reducing suicide risk
through mechanisms to correct thought distortions and build positive thoughts
and beliefs to produce adaptive coping mechanisms. This study has implications
for the importance of applying cognitive therapy as part of psychotherapeutic
interventions for clients with psychosis who are at risk of suicide. This
therapy not only helps reduce symptoms associated with psychosis, but also
plays a role in reducing suicidal tendencies by correcting maladaptive thoughts
and beliefs.
Keywords: Cognitive Therapy, Psychosis, Suicide Risk
INTRODUCTION
Psychosis is a mental or psychiatric
disorder characterized by hallucinations, delusions, chaotic behavior and
accompanied by poor insight (Lumingkewas
et al., 2017). Another characteristic of
psychosis mental disorder is the presence of delusions and illusions as well as
disturbances in reality tests (Liza
& Loebis, 2015). Individuals who experiencing
mental disorders are more vulnerable and at risk of committing suicide. As many
as 90% of individuals who commit suicide have mental disorders. In people with
schizophrenia, the incidence of suicide reaches 40% of suicidal ideation,
20-40% have attempted suicide and 10-15% end their lives by suicide (Stuart
Gail & Laraia Michele, 2009). A systematic review and
meta-analysis study showed that individuals with a diagnosis of psychosis had a
high prevalence of suicidal ideation (66%), self-harm (49%) and suicide
attempts (18%). Co-morbid psychiatric
problems, mood variability and family history of psychiatric problems are among
the factors associated with self-harm and suicide risk (Taylor
et al., 2019).
In addition, suicide is the third
leading cause of death in adolescents and young adults in America (Pirruccello,
2010). The number of suicide
incidents in the world is estimated to reach 1000 cases every day (American
Association of Suicidology, 2006). According to (WHO,
2019), 79% of suicide incidents occur
in countries with moderate income levels, including Indonesia with low to
moderate income levels has an estimated suicide incidence of 3.4 per 100,000
population in 2016. in Indonesia reaches 1.6-1.8 per 100,0000 population with
the most cases in the productive age. This shows an increase in the trend of
suicide in various ages and backgrounds.
Suicide is an act or behavior that is
done deliberately to kill oneself (Keltner,
2013). Suicide also includes attempts
at self-destructive or self-harming behavior. Individuals at risk of suicide
feel that their lives are difficult so they choose to end their lives. Feelings
of fear, loneliness, depression, loneliness, anger and loneliness that are felt
continuously or prolong are the risk for a person to commit suicide (Fortinash
& Worret, 2011).
Based on psychopathological assessments,
suicide is related to low serotonin levels in the brain so that it has an
impact on emotional response adaptation (Stuart
Gail & Laraia Michele, 2009). In addition, the presence of
lesions or trauma in the brain, a history of head injuries, and a family
history of suicide are risk factors for destructive behavior in oneself (Varcarolis
& Halter, 2002). Suicide is a manifestation of
a deep wound, lack of hope, and low hope for help for the suffering felt (Varcarolis
& Halter, 2002). People who commit suicide mean
that they have lost the meaning of life, either because of stressful conditions
or stressors unable
to overcome or lose the meaning of life due to mental disorders (Azizah
& Dwi Hartanti, 2016).
One of the psychotherapies given to
psychosis clients with suicide risk is cognitive therapy. Cognitive therapy
(CT) in clients with suicide risk focuses on thoughts and beliefs to build
adaptive coping. CT has a positive impact on the thought process and helps
clients to rediscover meaning in their lives (Byme, 2005). Therefore, the
purpose of this study was to determine and analyze the effect of cognitive
therapy on psychosis clients with suicide risk. so that the benefits in this
study are so that the benefits in this study are to contribute to the
development of nursing practice, especially in handling clients with suicide
risk through a cognitive therapy approach. In addition, the results of this
study are expected to be a reference for health workers in designing more
effective interventions to reduce the risk of suicide in psychosis clients.
RESEARCH METHODS
The
articles discussed in this literature review were obtained through searching
for articles in electronic journal databases, namely Science Direct, ProQuest,
Wiley Online Library, EBSCOhost, Sage Journals, and ClinicalKey. The inclusion
criteria for this journal review are human research, United Kingdom, and free
fulltext. The keywords used are
"((cognitive therapy) AND (risk for suicide) AND (psychosis)). From
the search results, 259 articles were found which were then selected through
judl and reviewed by reading abstracts. 20 relevant articles were obtained. A
total of 7 articles discussed in this literature review are relevant articles
and are available in free fulltext.
RESULTS AND DISCUSSION
The following are studies related to
cognitive therapy interventions in
people with psychosis:
Table
1. Effect of
CT on people with psychosis
|
Author
(years) |
Type
of Research |
Result |
|
(Marthur Et al, 2016) |
single case design with pre-
and post- Therapy |
Mindfulness-based cognitive Therapy have a significant effect on
depression, acceptance, and quality of life. |
|
(Morrison
et al., 2016) |
Randomised controlled trial |
CT is
beneficial for reducing self stigmahopelessness and Increase Recovery in individuals with
psychosis |
|
|
Cross sectional |
Cognitive intervention (CT)
strategies help in suicide prevention in psychotic individuals with
depression and reduce the severity of
suspicious objects |
|
(Evans
et al., 2017) |
Randomised controlled trial |
Cognitive therapy helps people
with bipolar disorder to better recognize Variability of their mood |
|
(Gujral
et al., 2016) |
Cross sectional |
Suicidal
behavior is related to disorder Cognitive Obstacles deep Decision |
|
(Taylor
et al., 2019) |
Mixed-method case series
design |
Cognitive analytic therapy is
a safe psychosis intervention through personal integration and return Function and recovery |
|
(MacKenzie
& Kocovski, 2016) |
Randomised controlled trial |
Mindfulness-based cognitive
therapy was not significantly associated with maintaining adherence to
antidepressant therapy as a prevention of relapse, but both treatments were
associated with a decrease in residual depressive symptoms and improved
quality live |
According to research by (Bang et
al., 2019), individuals with psychosis
disorders are a group or population that is at high risk (ultra high risk /
UHR) to have suicidal ideation compared to a group of healthy individuals. This
is significantly related to the symptoms of depression that may be experienced
as well as the presence of hallucinations and delusions, so it is important for
mental health practitioners to consider the symptoms that appear to assess
suicide risk and enforce interventions that are primary or suicide prevention.
This is supported by the research of (Palmier‐Claus et al., 2014) which reveals that the waham of
suspicion
is a specific risk factor in psychosis
for suicidal behavior. The feeling of suspicion is related to a stressful or
depressive mood (Bornheimer,
2016).
Other studies have shown that positive
symptoms in psychotics such as delusions and hallucinations can lead to
suicidal ideation (Bornheimer
& Nguyen, 2016). These positive symptoms can
cause negative bias in information processing in the brain, resulting in a
negative assessment of the stressor (Johnson
et al., 2008).
The treatment developed for psychosis
disorders has gone through various studies and clinical trials. The results
suggest that the combination of antipsychotic treatment and cognitive therapy
(CT or CBT) has a positive impact on clients with schizophrenia and other
psychosis (Galletly
et al., 2016).
Cognitive therapy (CT) is a type of
psychotherapy that aims to correct cognitive distortions so that a new positive
mindset can be formed. This positive distortion includes wrong logic, making
wrong excuses, or when the individual is no longer able to judge what is
happening according to the actual reality. Through CT, clients learn to
practice positive thinking skills by countering existing negative thought
distortions so that constructive thinking patterns are produced and the
resulting coping mechanism becomes adaptive.
(Brown et
al., 2005) research shows that the
application of CT to clients at risk of suicide has a significant effect on
reducing the risk of suicide attempts so that this therapy is effective as one
of the suicide prevention efforts.
Clients with psychotic disorders are
also vulnerable to stigma. A systematic review study found a strong negative
association between internalised stigma and psychosial variables such as hope,
self-esteem, empowerment and adherence to therapy (Living-ston & Boyd,
2010). Stigma in psychosis can affect delays in treatment, hindering clients
from seeking help, social isolation to suicidal behavior (Thornicroft
et al., 2009). Research by Anthony et al
(2016) stated that CT is beneficial in reducing self-stigma, despair and
increasing recovery in individuals with psychosis through increased self-esteem
and hope. This is in accordance with previous research which explained that CT can significantly reduce or
decrease internalised/self stigma (Morrison
et al., 2016).
CONCLUSION
Individuals with psychosis disorders are
a group or population that is at high risk of having suicidal ideation compared
to a group of healthy individuals. Suicide is an attempt at self-destructive or
self-harming behavior. Individuals at risk of suicide feel that their lives are
difficult so they choose to end their lives.
One of the psychotherapies given to
psychotic clients with a risk of suicide is cognitive therapy (CT). CT in
clients at risk of suicide has a significant effect on reducing suicide risk
through mechanisms to correct mind distortions and build positive thoughts and
beliefs to produce adaptive coping mechanisms.
Further research is expected to examine
the effect of CT on psychosis clients with a wider risk of suicide and on
clients with more complex characteristics so that it can be used as a basis for
providing evidence-based and holistic nursing care.
BIBLIOGRAPHY
Azizah,
R., & Dwi Hartanti, R. (2016). Hubungan antara tingkat stress dengan kualitas
hidup lansia hipertensi di wilayah kerja Puskesmas Wonopringgo Pekalongan.
Bang, M., Park, J. Y., Kim, K.
R., Lee, S. Y., Song, Y. Y., Kang, J. I., Lee, E., & An, S. K. (2019).
Suicidal ideation in individuals at ultra‐high risk for psychosis and
its association with suspiciousness independent of depression. Early
Intervention in Psychiatry, 13(3), 539–545.
Bornheimer, L. A. (2016).
Moderating effects of positive symptoms of psychosis in suicidal ideation among
adults diagnosed with schizophrenia. Schizophrenia Research, 176(2–3),
364–370.
Bornheimer, L. A., &
Nguyen, D. (2016). Suicide among individuals with schizophrenia: a risk factor
model. Social Work in Mental Health, 14(2), 112–132.
Brown, G. K., Ten Have, T.,
Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005).
Cognitive therapy for the prevention of suicide attempts: a randomized
controlled trial. Jama, 294(5), 563–570.
Evans, M., Kellett, S.,
Heyland, S., Hall, J., & Majid, S. (2017). Cognitive analytic therapy for
bipolar disorder: A pilot randomized controlled trial. Clinical Psychology
& Psychotherapy, 24(1), 22–35.
Fortinash, K. M., &
Worret, P. A. H. (2011). Psychiatric mental health nursing. Elsevier
Health Sciences.
Galletly, C., Castle, D.,
Dark, F., Humberstone, V., Jablensky, A., Killackey, E., Kulkarni, J., McGorry,
P., Nielssen, O., & Tran, N. (2016). Royal Australian and New Zealand
College of Psychiatrists clinical practice guidelines for the management of
schizophrenia and related disorders. Australian & New Zealand Journal of
Psychiatry, 50(5), 410–472.
Gujral, S., Ogbagaber, S.,
Dombrovski, A. Y., Butters, M. A., Karp, J. F., & Szanto, K. (2016). Course
of cognitive impairment following attempted suicide in older adults. International
Journal of Geriatric Psychiatry, 31(6), 592–600.
Johnson, J., Gooding, P.,
& Tarrier, N. (2008). Suicide risk in schizophrenia: Explanatory models and
clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychology
and Psychotherapy: Theory, Research and Practice, 81(1), 55–77.
Keltner, N. L. (2013). Psychiatric
nursing. Elsevier Health Sciences.
Liza, R. G., & Loebis, B.
(2015). Gangguan Psikotik Akibat Stroke Iskemik. Jurnal Kesehatan Andalas,
4(2).
Lumingkewas, P. E., Pasiak, T.
F., & Ticoalu, S. H. R. (2017). Indikator yang Membedakan Gejala Psikotik
dengan Pengalaman Spiritual dalam Perspektif Neurosains (Neuro-Anatomi). EBiomedik,
5(2).
MacKenzie, M. B., &
Kocovski, N. L. (2016). Mindfulness-based cognitive therapy for depression:
trends and developments. Psychology Research and Behavior Management,
125–132.
Morrison, A. P., Burke, E.,
Murphy, E., Pyle, M., Bowe, S., Varese, F., Dunn, G., Chapman, N., Hutton, P.,
& Welford, M. (2016). Cognitive therapy for internalised stigma in people
experiencing psychosis: A pilot randomised controlled trial. Psychiatry
Research, 240, 96–102.
Palmier‐Claus, J. E., Taylor,
P. J., Ainsworth, J., Machin, M., Dunn, G., & Lewis, S. W. (2014). The
temporal association between self‐injurious thoughts and
psychotic symptoms: A mobile phone assessment study. Suicide and Life‐Threatening
Behavior, 44(1), 101–110.
Pirruccello, L. M. (2010).
Preventing adolescent suicide: A community takes action. Journal of
Psychosocial Nursing and Mental Health Services, 48(5), 34–41.
Stuart Gail, W., & Laraia
Michele, T. (2009). Principles and practice of Psychiatric Nursing. St.
Louis, MO: Elsevier, Mosby, 223.
Taylor, P. J., Perry, A.,
Hutton, P., Tan, R., Fisher, N., Focone, C., Griffiths, D., & Seddon, C.
(2019). Cognitive analytic therapy for psychosis: A case series. Psychology
and Psychotherapy: Theory, Research and Practice, 92(3), 359–378.
Thornicroft, G., Brohan, E.,
Rose, D., Sartorius, N., & Leese, M. (2009). Global pattern of experienced
and anticipated discrimination against people with schizophrenia: a
cross-sectional survey. The Lancet, 373(9661), 408–415.
Varcarolis, E. M., &
Halter, M. J. (2002). Foundations of psychiatric mental health nursing: A
clinical approach. (No Title).
WHO. (2019). Suicide.
World Health Organization.
https://www.who.int/en/news-room/fact-sheets/detail/suicide