Marjan Holloway, PhD, Beck Institute Faculty

During the COVID-19 pandemic, military suicides increased by as much as 20 percent compared to the same period in 2019. Historically, suicide has been one of the three leading causes of death among service members in the United States. These stark statistics provide a window into the unique vulnerabilities and treatment needs of our military community, which envelops the active, reserve, and National Guard components of the Air Force, Army, Marine Corps, and Navy and their families, as well as our nation’s veterans.

These unique needs underscored Beck Institute’s decision in 2006 to create the Soldier Suicide Prevention Training Fund, specifically for providers serving the military and the VA communities. Our goal is to get evidence-based treatment into the hands of those who work directly with service members, veterans, and their families. Today, our Military and Veteran Suicide Prevention Training Fund represents an effort to reach the wider military community and all those who are in need of effective mental health treatment.

What Are the Unique Stressors Faced by Military Personnel and Veterans?

Members of the military community in need of mental health treatment may experience the same stressors as civilians, but they will inevitably be vulnerable to a host of other stressors that may be invisible to the civilian population. To illustrate this, we’ll use an example from a client who we’ll call Jessica.

Jessica is a current service member who was deployed domestically during the COVID-19 pandemic to perform duties as outlined by her military occupational specialty. While civilians are avoiding travel, Jessica’s job required her to fly out of state on short notice, leaving her family and young child behind during a time of unprecedented stress.

Woman in military uniform and her daughter in park

Jessica’s story is, unfortunately, not unique. Service members often face unexpected transitional challenges and given the evolving and dynamic nature of their assigned mission, need to adapt quickly and effectively. From the provider perspective, this is a moment when the cognitive-behavioral approach calls for a discussion of one’s thoughts, associated images, feelings, physical sensations, and behaviors. Jessica may be thinking, “Why me?” – experiencing an image of something horrible happening to her young child during her absence, feeling extremely helpless and tense, and acting stoically as to hide her uncertainties about the nature of the assignment and the risk it may pose. Members of the civilian population often don’t have the same experience of relinquishing control to one’s occupation.

How Can CBT Help Prevent Suicide in the Military Community?

Beck Institute’s trainings for providers working with the military community aim to communicate an understanding of and appreciation for the needs and diversity of the community. The focus on suicide prevention, as opposed to depression or posttraumatic stress disorder (PTSD), originates from the aforementioned fact that suicide is among the top three leading causes of death for those in the military, and is even deadlier than combat. While legislation and programs targeting suicide prevention are a start, it is clear that direct mental health care is still an urgent need.

The goal of cognitive behavior therapy for suicide prevention is to de-activate the suicide mode.

  1. The philosophy of the treatment is that suicidal thoughts and/or behaviors must be targeted directly.
  2. The treatment is transdiagnostic. This does not mean that psychiatric diagnoses are neglected; in fact, the cognitive behavioral conceptualization carefully takes into account the role of psychopathology in the trajectory to suicidal behaviors. However, specific psychotherapeutic strategies are tailored to the underlying condition of suicidality, across all psychiatric disorders.
  3. The treatment is adjunctive. This means that the intervention can be added to existing programs of care – for instance, to trauma-focused care, to Alcoholics Anonymous (AA) support groups, to marital therapy, and to psychiatric medication management.
  4. The treatment is guided by a cognitive behavioral case formulation, emphasizes skill building, and teaches relapse prevention.

For those in the military community, the suicide mode may be triggered by personal biopsychosocial vulnerabilities and interpersonal dynamics but also by experiences within the military organizational system (e.g., military sexual assault).

By continuing to offer comprehensive CBT training to clinicians around the world, Beck Institute hopes to equip providers with the tools to improve their clients’ lives through evidence-based practices. Through our Military and Veterans Suicide Prevention Training Fund, we hope to reach providers serving those who serve or have served in the military and their families, with the goal of inclusivity and commitment to care that has proven to be effective.

Read more about working with military veterans: