5 - (OP8) Development and Application of Enhanced Brief Cognitive-behavioral Therapy (E-BCBT) for Suicidal Inpatients: Preliminary Results from a Pilot Randomized Controlled Trial

Introduction: Suicide is a critical public health concern, with South Korea reporting the highest suicide rate among OECD countries. Mood disorders are among the strongest risk factors for suicide, and suicidal crisis is a frequent reason for psychiatric hospitalization. Hospitalization provides a crucial opportunity to deliver targeted interventions addressing suicidal ideation and behavior. However, evidence-based psychotherapies targeting suicidality have not been sufficiently examined in Korean inpatient settings. This study aimed to develop and pilot-test Enhanced Brief Cognitive-Behavioral Therapy for Suicidal Inpatients (E-BCBT), adapted for the Korean context.

Methods: E-BCBT integrates two established CBT-based suicide prevention protocols: Brief Cognitive-Behavioral Therapy for Suicidal Inpatients (BCBT-I) and Post-Admission Cognitive Therapy (PACT). The protocol helps patients understand their suicidal crisis mode and acquire coping strategies. E-BCBT consists of five 50-minute sessions: Sessions 1–2 focus on crisis response planning and reasons for living; Sessions 3–4 target cognitive and behavioral coping skills; Session 5 addresses relapse prevention. A pilot RCT compared E-BCBT to treatment as usual (TAU), with assessments at baseline, discharge, and three monthly follow-ups. Outcomes included suicidal behavior, suicidal ideation, depressive symptoms, anxiety, hopelessness, interpersonal needs, emotion regulation difficulties, automatic thoughts, and death-related implicit associations.

Results: In paired observations (n = 10 per group), suicidal behavior, clinician-rated suicidal ideation, depressive symptoms, and anxiety decreased significantly in both conditions. However, self-reported suicidal ideation, hopelessness, automatic thoughts, interpersonal needs, and emotion regulation difficulties improved significantly only in E-BCBT. Death-related implicit associations showed no significant changes in either group. One death occurred in the E-BCBT group at one-month follow-up.

Discussion: These findings suggest E-BCBT can be feasibly implemented in Korean psychiatric inpatient settings. The differential pattern in self-reported suicidal ideation warrants further investigation in adequately powered trials. This study represents the first attempt to evaluate a brief CBT protocol for suicidal inpatients in Korea, providing a foundation for future research.