Jobes, D. A., & Rizvi, S. L. (2024).
Frontiers in psychiatry, 15, 1354430.
Abstract
Around the world, suicide ideation, attempts, and deaths pose a major public and mental health challenge for patients (and their loved ones). Accordingly, there is a clear need for effective clinical treatments that reliably reduce suicidal thoughts and behaviors. In this article, we review the Collaborative Assessment and Management of Suicidality (CAMS) and Dialectical Behavior Therapy (DBT), two clinical treatments that rise to the highest levels of empirical rigor. Both CAMS and DBT are now supported by randomized controlled trials (RCTs), with independent replications, and meta-analyses. There are also supportive data related to training clinical providers to use CAMS and DBT with adherence. RCTs that investigate the use of both interventions within clinical trial research designs and the increasing use of these complementary approaches within routine clinical practice are discussed. Future directions for research and clinical use of CAMS and DBT are explored as means to effectively treat suicidal risk.
Here are some thoughts:
This review's real value is putting CAMS and DBT side by side on equal empirical footing, showing them as complementary rather than competing: CAMS for acute, driver-focused ideation in 4-12 sessions, DBT for chronic, multi-attempt presentations tied to emotion dysregulation over 6+ months. The evidence patterns mirror this division nicely. The Swift et al. meta-analysis found CAMS significantly reduces suicidal ideation and hopelessness but had no significant effect on attempts specifically, while DeCou et al.'s DBT meta-analysis found the reverse, reduced self-directed violence but no significant ideation effect. The Pistorello SMART trial adds a useful clinical heuristic: patients with no attempt history did better with CAMS, while those with multiple attempts and borderline features responded better to treatment as usual than to CAMS, consistent with DBT's stronger footing for that chronic population.
A couple of things worth flagging. Several CAMS trials were genuinely mixed, underpowered, or favored treatment as usual early in follow-up, and Jobes discloses a financial interest as founder of CAMS-care, LLC, which doesn't invalidate the independently replicated RCTs but is worth naming given how the mixed findings are framed. The Hope Institute section is the most practically interesting piece for service delivery: a next-day-appointment outpatient model achieving stabilization in 5-6 weeks, positioned against the paper's opening point that inpatient hospitalization itself lacks strong evidence outside the immediate post-attempt window.
