Suicidal behavior: theoretic model and practical implications in cognitive-behavioral therapy



The article presents the data on suicide incidence in Russian Federation. The author discusses the necessity of developing prevention programs and carrying out complex team-based specialist work to ensure safe environment at schools. It is noted that prevention and postvention methods should be scientifically grounded. History of development of a special psychotherapeutic cognitive-behavioral protocol for suicide prevention and postvention is presented. The author examines the problem of diathesis (predisposition) to suicidal behavior and formulates the main principles of cognitive-behavioral psychotherapy of patients predisposed to suicidal behavior. Key stages of cognitive-behavioral therapy of suicidal behavior, techniques and approaches to working with such clients are described. Various targets that should be taken into account during crisis interventions are discussed. The article presents empirical research data of the effectiveness of cognitive psychotherapy of suicidal behavior and the results of the empirical study of factors of suicidal behavior in students based on multi-factor psychosocial model of affective spectrum disorders. It is emphasized that individual psychotherapy should be combined with other methods of suicide prevention and postvention. Perspectives of further development of methods of working with suicidal behavior are outlined.

General Information

Keywords: suicidal behavior, cognitive psychotherapy, effectiveness of cognitive psychotherapy, predisposition to suicidal behavior, suicidal crisis, perfectionism, social anxiety, multfactor model of affective spectrum disorders

Journal rubric: Workshop and Methods

Article type: scientific article


For citation: Kholmogorova A.B. Suicidal behavior: theoretic model and practical implications in cognitive-behavioral therapy. Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2016. Vol. 24, no. 3, pp. 144–163. DOI: 10.17759/cpp.2016240309. (In Russ., аbstr. in Engl.)


  1. Ambrumova A.G. Psikhologiya samoubiistva [Psychology of suicide]. Sotsial’naya i klinicheskaya psikhiatriya [Social and clinical psychiatry]. 1997. № 4. pp. 14—20.
  2. Voitsekh V.F. Dinamika i struktura samoubiistv v Rossii [Dynamics and structure of suicides in Russia]. Sotsial’naya i klinicheskaya psikhiatriya [Social and clinical psychiatry], 2006, no. 3. pp. 22—28.
  3. Volikova S.V., Nifontova A.V., Kholmogorova A.B. Shkol’noe nasilie (bulling) i suitsidal’noe povedenie detei i podrostkov [Bulling and suicidal behavior in children and adolescents]. Voprosypsikhologii [Voprosypsikhologii], 2013, no. 2, pp. 24—31. (In Russ., аbstr. in Engl.).
  4. Garanyan N.G. Perfektsionizm i vrazhdebnost’ kak lichnostnye faktory depres- sivnykh i trevozhnykh rasstroistv: avtoref. dis. … dokt. psikhol. nauk [Perfectionism and hostility as personal factors of depressive and anxiety disorders: Ph. D. (Psychol- ogy) thesis]. Moscow, 2010. 42 p.
  5. Garanyan N.G., Kholmogorova A.B., Evdokimova Ya.G. et al. Predekzamenatsion- nyi stress i emotsional’nye narusheniya u studentov mladshikh kursov [Stress caused by exams and emotional maladjustment in junior university students]. Sotsial’naya i klinicheskaya psikhiatriya [Social and clinical psychiatry], 2007, no. 2, pp. 38—42.
  6. Garanyan N.G., Kholmogorova A.B., Yudeeva T.Yu. Perfektsionizm, depressiya i trevoga [Perfectionism, depression and anxiety]. Mosk. psikhoterapevtich. zhurn. [Moscow psychotherapeutic journal], 2001, no. 4, pp. 18—48.
  7. Krasnova V.V., Kholmogorova A.B. Sotsial’naya trevozhnost’ i suitsidal’naya nap- ravlennost’ u studentov [Social anxiety and suicidal ideation in students]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova [Neuroscience and Behavioral Physiology], 2013. Vol. 112, no. 4, pp. 50—53. (In Russ., аbstr. in Engl.).
  8. Linehan M. Kognitivno-povedencheskaya terapiya pogranichnogo rasstroistva li- chnosti: per. s angl. [Cognitive-behavioral therapy of borderline personality disorder ]. Moscow: Publ. «Vil’yams», 2007. 50 p. (In Russ.).
  9. Liniya smerti [Line of death]. Rossiiskaya gazeta, 15.03.2013, no. 56.
  10. Langle A. Dotyanut’sya do zhizni…Ekzistentsial’nyi analiz depressii [Reach to life ... Existential analysis of depression]. Moscow: Genezis, 2010. 128 p. (in Russ.)
  11. Tukaev R.D. Psikhicheskaya travma i suitsidal’noe povedenie. Analiticheskii obzor literatury s 1986 po 2001 gody [Mental trauma and suicidal behavior. Analytical re- view of literature from 1986 to 2001]. Sotsial’naya i klinicheskaya psikhiatriya [Social and clinical psychiatry], 2003, no. 1, pp. 151—163.
  12. Kholmogorova A.B. Integrativnaya psikhoterapiya rasstroistv affektivnogo spectra [Integrative psychotherapy of affective spectrum disorders]. Moscow: ID «MED- PRAKTIKA-M», 2011. 480 p.
  13. Kholmogorova A.B., Volikova S.V. Osnovnye itogi issledovanii faktorov suitsidal’nogo riska u podrostkov na osnove psikhosotsial’noi mnogofaktornoi modeli rasstroistv affektivnogo spektra [Elektronnyi resurs] [The main results of studies of suicide risk factors in adolescents based on the psychosocial multi- factor model of affective spectrum disorders]. Meditsinskaya psikhologiya v Ros- sii: elektron. nauch. zhurn. [Med. psihol. Ross.], 2012, no. 2. Available at: http:// (Accessed: 22.08.2016).
  14. Kholmogorova A.B., Garanyan N.G. Mnogofaktornaya model’ depressivnykh, trevozhnykh i somatoformnykh rasstroistv kak osnova ikh integrativnoi psikhotera- pii [Multifactor model of depressive, anxiety and somatoform disorders as a basis of integrative psychotherapy]. Sotsial’naya i klinicheskaya psikhiatriya [Social and clinical psychiatry], 1998, no. 1, pp. 94 — 101.
  15. Kholmogorova A.B., Garanyan N.G., Gorshkova D.A., Mel’nik A.M. Suitsidal’noe povedenie v studencheskoi populyatsii [Suicidal Behavior in the Student Popula- tion]. Kul’turno-istoricheskaya psikhologiya [Cultural-Historical Psychology], 2009, no. 3, pp. 101—110 (In Russ., аbstr. in Engl.)
  16. Kholmogorova A.B., Garanyan N.G., Evdokimova Ya.G., Moskova M.V. Psikho- logicheskie faktory emotsional’noi dezadaptatsii u studentov [Psychological factors of emotional disadaptation of students]. Voprosy psikhologii [Voprosy psikhologii], 2009, no. 3, pp. 16—26. (In Russ., аbstr. in Engl.)
  17. Kholmogorova A.B., Evdokimova Ya.G. Interpersonal’nye faktory emotsional’noi dezadaptatsii u studentov v usloviyakh megapolisa [Interpersonal factors of emo- tional disadaptation of students in a megalopolis]. Psikhologicheskie problemy sem’i i lichnosti v megapolise. Materialy pervoi mezhdunarodnoi nauchno-prakticheskoi konferentsii [Psychological problems of family and individual in a megalopolis: Pro- ceedings of the First International Scientific and Practical Conference]. Moscow: Publ. “Institut psikhologii RAN”, 2007, pp. 141—145.
  18. Beck A.T., Brown G.K., Steer R.S., et al. Suicide ideation at its worst point: A pre- dictor of eventual suicide in psychiatric outpatients. Suicide and Life-Threatening Behaviors, 1999. Vol. 29, pp. 1—9.
  19. Beck A.T., Schuyler D., Herman I. Development of Suicidal Intent Scales / A. Beck, Y. Resnik, D. Lettieri (Eds.) // The Prediction of Suicide. Philadelphia: The Charles Press, 1974, p. 45—56.
  20. Beck AT., Steer R.A., Beck J.S., Newman C.F. Hopelessness, depression, suicidal ideation and clinical diagnosis of depression. Suicide & Life-Threat. Behaviour, 1993. Vol. 23, no. 2, pp. 139—145.
  21. Beidel D.C., Turner S.M. Shy children, phobic adult: nature and treatment of social phobia. Washington, DC: American Psychological Association, 1998. 398 p.
  22. Bertolote J.M., Fleischmann A., De Leo D., et al. Suicide and mental disor- ders: do we know enough? British Journal of Psychiatry, 2003. Vol. 183, no. 5, pp. 382—383.
  23. Brown G.K., Ten Have T., Henriques G.R., et al. Cognitive therapy for the preven- tion of suicide attempts: A randomized controlled trial. JAMA, 2005. Vol. 294, no. 5, pp. 563—570.
  24. Brown G.K., Steer R.A., Henriques G.R., et al. The internal struggle between the wish to die and the wish to live: A risk factor for suicide. American Journal of Psychia- try. 2005. Vol. 162, no. 10, pp. 1977—1979.
  25. Henriques G., Beck A.T., Brown G.K. Cognitive therapy for adolescent and young adult suicide attempters. American Behavioral Scientist, 2003. Vol. 46, no. 9, pp. 1258—1268.
  26. Henriques G., Wenzel A., Brown G.K., et al. Suicide attempters’ reaction to surviv- al as a risk factor for eventual suicide. American Journal of Psychiatry. 2005. Vol. 162, no. 11. pp. 2180—2182.
  27. Hewitt P.L., Flett G.L., Sherry S.B., et al. Trait perfectionism dimensions and sui- cidal behavior / T.E. Ellis (ed.). Cognition and suicide : Theory, research, and ther- apy. Washington, DC: APA Books, 2006. pp. 215—235.
  28. Jobes D.A., Mann R.E. Reasons for living versus reasons for dying: Examining the internal debate of suicide. Suicide and Life-Threatening Behavior, 1999. Vol. 29, no. 2, pp. 97—104.
  29. Reinecke M.A. Problem solving: A conceptual approach to suicidality and psycho- therapy. In T.E. Ellis (ed.). Cognition and suicide: Theory, research, and therapy. Washington, DC: APA Books, 2006, pp. 237—260.
  30. Van Orden K.A., Witte T. K., Cukrowicz K.C., et al. The interpersonal theory of suicide. Psychological Review. 2010. Vol. 117, no. 2, pp. 575—600.
  31. Wenzel A., Brown G.K., Beck A.T. Cognitive therapy for suicidal patients: Scientific and clinical applications. Washington: American Psychological Association, 2009, 377 p.
  32. Wenzel A., Jager-Hyman S. Cognitive Therapy for Suicidal Patients: Current Status. The Behavior Therapist, 2012. Vol. 35, no. 7, pp. 121—130.
  33. Zubin J. Observations on nosological issues in the classification of suicidal behavior. In A. Beck. Resnik Y., Lettieri D. (eds.). The Prediction of Suicide. Philadelphia: The Charles Press, 1974, pp. 3—28.

Information About the Authors

Alla B. Kholmogorova, Doctor of Psychology, Professor, Dean of the Faculty of Counseling and Clinical Psychology, Moscow State University of Psychology & Education, Leading Researcher, Moscow Research Institute of Psychiatry (A Branch of the National Medical Research Centre for Psychiatry and Narcology), Moscow, Russia, ORCID:, e-mail:



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