Starting CBT Therapies Within a Year of PTSD Diagnosis Linked to Fewer Suicides Among Veterans

Lifetime prevalence of PTSD is about one-third higher among United States military veterans than the general population of the same age and sex. The suicide rate is about two-thirds higher. PTSD is a major risk factor for suicide.

Yet two short-term, cognitive behavioral therapies that have been shown to reduce PTSD symptoms and used throughout the VA system for 18 years were never previously examined in large studies for their ability to prevent suicides.

A study published in JAMA Network Open on Dec. 26, 2024, found substantially lowered suicide risk among veterans with PTSD who completed either treatment.

Senior author Rebecca K. Sripada, Ph.D., a research scientist and clinical psychologist at the VA Ann Arbor (Michigan) Healthcare System and an associate professor in psychiatry at the University of Michigan, and colleagues, all affiliated with the Department of Veterans Affairs (VA) examined the medical records of 847,217 veterans nationwide who were diagnosed with PTSD for the first time between 2016 and 2019. By the end of 2020, 1,552 had died by suicide.

Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy are cognitive behavioral therapies tailored for PTSD. They work by teaching patients to challenge unhelpful thought patterns and learned associations, which reduces the emotional impact of trauma. The standard course of treatment is eight sessions, although not necessarily within a specific time frame.

The researchers compared veterans who had initiated either treatment at the VA within 365 days of their diagnosis and completed the standard course within 180 days against those who had not. They also considered veterans who continued CPT or PE beyond eight sessions as well as those who participated in different kinds of psychotherapy.

Completion of either type of cognitive behavioral therapy was associated with a 23% reduction in suicide risk. Extending the course of treatment did not provide further benefit.

“Many individuals undergoing CPT or PE experience a rapid reduction in symptoms within the first few sessions,” Sripada said in a VA press release. Other kinds of psychotherapy were not associated with as large a reduction in suicide risk.

Two-thirds of the cohort received psychotherapy. But,the authors pointed out, only 8.7% got CPT or PE. The study was unable to differentiate between veterans in VA care who were offered the therapies and declined vs. those who were not offered either treatment.

“Study findings support recommendations of CPT/PE as treatment for veterans with new diagnoses of PTSD,” the authors concluded.