Advancing Suicide Prevention Through Single‑Session Psychotherapy

What is the "Brief Skills for Safer Living" program? 
Brief Skills for Safer Living (Brief‑SfSL) is a targeted, 90‑minute, single‑session psychotherapy designed to address suicide risk. It is adapted from the original 20‑week SfSL group program developed by Dr. Yvonne Bergmans at St. Michael’s Hospital.

Brief‑SfSL helps clients understand where their suicidal thoughts stem from and identify the emotions that trigger them. Eliciting the personal narrative is critical for understanding suicidal thoughts and where they come from; it involves gathering history, context, triggers, and information about how thoughts vary in intensity, frequency and duration. It also integrates questions about what suicide would end for them and what has kept them alive. From there, we focus on developing practical skills they can use to keep themselves safer during periods of suicidal distress—for example, tracking the intensity of their suicidal thoughts and having strategies in place to prevent escalation and manage intense emotions. The session also brings together tools for connecting with others. All of this is meant to help keep our patients emotionally and physically safe during times when they may be feeling suicidal.   

What motivated this research? 
During the COVID-19 pandemic, suicidal ideation and risk were steadily increasing while access to mental health care was decreasing. As a suicide research group, we felt it was important to determine what we could do, as a team, to help support people who were struggling. I approached Dr. Yvonne Bergmans, a close colleague of 10 years, to see if we could condense her 20-week group into one focused session!  Along with Dr. Aleksandra Lalovic, also of St. Michael's Hospital, we created Brief-SfSL.  

What was the most important finding of this study, in your opinion? 
After one targeted session that addressed suicide risk and skill development, the majority of participants reported feeling more capable of managing suicidal thoughts for as long as three months. Addressing suicide risk requires focused attention rather than treating a psychiatric disorder overall and hoping that suicide risk will improve. Over the last 5 years, several brief therapies have been developed that range from 1 to 5 sessions. They target suicide risk from different angles, and it is likely that, as clinicians, we should be trained in several of these modalities to tailor treatments to individual needs. 

How does this change service delivery in the future? 
Brief‑SfSL is intended to provide rapid, effective access to support—not to replace all future treatment needs. The goal is to implement Brief‑SfSL across hospital, community, and private‑practice settings so that a broader range of individuals can access suicide‑focused care and, ultimately, help reduce suicide risk at a population level. It can also be offered while individuals wait for longer‑term care, ensuring they are not left on year‑long waitlists without support. Our work has also shown that Brief‑SfSL can be delivered safely via remote care when appropriate safeguards are in place, allowing us to extend services to people living in rural areas who often lack access to suicide‑specific treatment.  

Any next steps? 
Yes—this project has launched several new research directions. Molly Hyde, a PhD candidate in my lab, is preparing findings from this trial examining how Brief‑SfSL influences anhedonia and reward processing. Building on the strong results from our effectiveness study, we also secured CIHR funding to conduct a definitive randomized controlled trial (RCT), which is now underway. For this RCT, Dr. Andreea Diaconescu at CAMH and I are supervising Onjoli Krywiak, a graduate student investigating whether changes in social cognition represent a key mechanism of action for Brief‑SfSL using computational modeling.

In addition to the RCT, later this year, we will launch a multi‑site non‑inferiority trial across U of T teaching hospitals comparing Brief‑SfSL to multiple sessions of Brief‑CBT for Suicide‑Prevention intervention, in collaboration with colleagues, Drs. Mark Sinyor, Darren Courtney, Rachel Mitchell, Juveria Zaheer, Daphne Korczak, Allison Crawford, Yvonne Bergmans, Ishrat Hussain, and Benoit Mulsant. 

Findings from our effectiveness trial also underscored the role of childhood trauma on suicidality and highlighted the ongoing gap in suicide‑specific treatment for this population. In response, Dr. Aleksandra Lalovic, Yvonne Bergmans, and I expanded Brief‑SfSL into a 12‑week intervention—Integrated Suicide and Trauma Therapy (ISTT)—designed specifically to address suicide risk within the context of childhood trauma. This new intervention is now being piloted at St. Michael’s Hospital. 

Lastly, to expand our training resources, we will be offering our first clinician training session on suicide risk on February 19th. Sponsored by the U of T Department of Psychiatry, this workshop will incorporate Brief‑SfSL techniques and provide practitioners with practical, suicide‑focused skills. Registration is still open to join this workshop.

What is the major take home message for the public? 
Suicide risk is responsive to change, even within brief clinical encounters. Effective care requires targeted, suicide‑specific interventions that support individuals in understanding the origins, timing, and emotional triggers of their suicidal thoughts, while equipping them with strategies to regulate the emotions that trigger these experiences.  

While we are still in clinical trials, the public can access the RCT that we are running across Canada. We will be working hard to get clinicians trained on this modality as we develop and expand our training resources for this. For example, we were asked to train crisis responders in Ireland, which we will complete in February. People can also reach out to us if they want to run training within their group. 

Are there any Departmental faculty or learners you'd like to acknowledge for this paper? 
I would like to acknowledge: Dr. Aleksandra Lalovic, St. Michael's Hospital ; Dr. Yvonne Bergmans, Dept of Psychiatry, U of T; Molly Hyde, MSc, PhD Candidate; Anna Kiriakidis, St. Michael's Hospital; Onjoli Krywiak, MSc trainee, IMS; and Dr. Andreea Diaconescu, CAMH, Dept of Psychiatry, U of T and our other fellow co-authors.