Teachable Moment Brief Intervention (TMBI) for Intensive Suicidal Ideation: A Narrative Review of a Rare and Critical Approach in Suicide Prevention

Hardi Abdulqadir Hasan

doi:10.64048/hir.v1n2.006

Authors

Hardi Abdulqadir Hasan Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Author https://orcid.org/0009-0009-3286-3824

DOI:

https://doi.org/10.64048/hir.v1n2.006

Keywords:

Teachable Moment Brief Intervention (TMBI), Intensive suicidal ideation, Suicide prevention, Crisis intervention, Psychotherapy, Mental health intervention, Suicide risk reduction

Abstract

Suicide is a significant global public health issue, and suicidal ideation poses a substantial risk, especially when it becomes intensive, characterized by persistent and severe thoughts of suicide. Despite the high risk, effective interventions specifically targeting individuals with intensive suicidal ideation remain limited. The Teachable Moment Brief Intervention (TMBI) offers a novel approach to addressing this gap. By focusing on critical junctures, TMBI is designed to leverage teachable moments—naturally occurring events that create heightened awareness and motivation for change—to provide timely and focused intervention for those in suicidal crises. The intervention involves a single session that includes collaborative assessment, safety planning, and the identification of protective factors, all aimed at reducing suicidal ideation and promoting safety. However, the successful implementation of TMBI is not without its obstacles. Implementing TMBI faces challenges such as ensuring clinician preparedness, addressing short-term crisis management, and ensuring continuity of care. Given these challenges, future directions for TMBI involve enhancing clinician training, adapting the intervention for diverse populations, and integrating TMBI with other evidence-based strategies. Therefore, this review aims to provide a comprehensive and critical analysis of the current state of research on TMBI for intensive suicidal ideation.

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References

Bigelow, C. T. (2022). A Case Study of the Well-Being of Clinicians Who Counsel Family Suicide Survivors. Capella University.

Bryan, C. J., Butner, J. E., May, A. M., Rugo, K. F., Harris, J. A., Oakey, D. N., Rozek, D. C., & Bryan, A. O. (2020). Nonlinear change processes and the emergence of suicidal behavior: A conceptual model based on the fluid vulnerability theory of suicide. New ideas in psychology, 57, 100758. https://doi.org/10.1016/j.newideapsych.2019.100758

Calati, R., Mansi, W., Rignanese, M., Di Pierro, R., Lopez-Castroman, J., Madeddu, F., & Courtet, P. (2023). Psychotherapy for suicide prevention. In Suicide risk assessment and prevention (pp. 1173-1206). Springer. https://doi.org/10.1007/978-3-030-42003-1_70

Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., Rogers, M. L., Podlogar, M. C., Chiurliza, B., & Ringer, F. B. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological bulletin, 143(12), 1313. https://doi.org/10.1037/bul0000123

Comtois, K. A., Jobes, D. A., S. O'Connor, S., Atkins, D. C., Janis, K., E. Chessen, C., Landes, S. J., Holen, A., & Yuodelis‐Flores, C. (2011). Collaborative assessment and management of suicidality (CAMS): feasibility trial for next‐day appointment services. Depression and anxiety, 28(11), 963-972. https://doi.org/10.1002/da.20895

Curry, A., & Epley, P. (2022). “It makes you a healthier professional”: the impact of reflective practice on emerging clinicians’ self-care. Journal of Social Work Education, 58(2), 291-307. https://doi.org/10.1080/10437797.2020.1817825

Dohnke, B., Ziemann, C., Will, K., Weiss-Gerlach, E., & Spies, C. (2012). Do hospital treatments represent a ‘teachable moment’for quitting smoking? A study from a stage-theoretical perspective. Psychology & Health, 27(11), 1291-1307. https://doi.org/10.1080/08870446.2012.672649

Dulac-Arnold, G., Levine, N., Mankowitz, D. J., Li, J., Paduraru, C., Gowal, S., & Hester, T. (2021). Challenges of real-world reinforcement learning: definitions, benchmarks and analysis. Machine Learning, 110(9), 2419-2468. https://doi.org/10.1007/s10994-021-05961-4

Farrell, T. S. (2022). Reflection on reflective practice. Teacher reflection: Policies, practices, and impacts, 3-19. https://doi.org/10.21832/9781788921022-005

Flocke, S. A., Antognoli, E., Step, M. M., Marsh, S., Parran, T., & Mason, M. J. (2012). A teachable moment communication process for smoking cessation talk: description of a group randomized clinician-focused intervention. BMC health services research, 12, 1-13. https://doi.org/10.1186/1472-6963-12-109

Galynker, I. (2023). The suicidal crisis: Clinical guide to the assessment of imminent suicide risk. Oxford University Press. https://doi.org/10.1093/med/9780197582718.001.0001

Grigoroglou, C., Van der Feltz-Cornelis, C., Hodkinson, A., Coventry, P. A., Zghebi, S. S., Kontopantelis, E., Bower, P., Lovell, K., Gilbody, S., & Waheed, W. (2021). Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. General hospital psychiatry, 71, 27-35. https://doi.org/10.1016/j.genhosppsych.2021.04.004

Harmer, B., Lee, S., Duong, T., & Saadabadi, A. (2020). Suicidal ideation.

Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). Transtheoretical model of health behavioral change: A systematic review. Iranian journal of nursing and midwifery research, 24(2), 83-90. https://doi.org/10.4103/ijnmr.IJNMR_94_17

Jobes, D. A. (2023). Managing suicidal risk: A collaborative approach. Guilford Publications.

Jobes, D. A., & Chalker, S. A. (2019). One size does not fit all: A comprehensive clinical approach to reducing suicidal ideation, attempts, and deaths. International journal of environmental research and public health, 16(19), 3606. https://doi.org/10.3390/ijerph16193606

Kallivayalil, R. A., & Mathew, B. S. (2022). A public health approach to suicide prevention in the Indian setting. Telangana Journal of Psychiatry, 8(2), 63-67. https://doi.org/10.4103/tjp.tjp_45_22

Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual review of clinical psychology, 12(1), 307-330. https://doi.org/10.1146/annurev-clinpsy-021815-093204

Labouliere, C. D., Green, K. L., Vasan, P., Cummings, A., Layman, D., Kammer, J., Rahman, M., Brown, G. K., Finnerty, M., & Stanley, B. (2021). Is the outpatient mental health workforce ready to save lives? Suicide prevention training, knowledge, self‐efficacy, and clinical practices prior to the implementation of a statewide suicide prevention initiative. Suicide and Life‐Threatening Behavior, 51(2), 325-333. https://doi.org/10.1111/sltb.12708

Lilienfeld, S. O., & Basterfield, C. (2020). Reflective practice in clinical psychology: Reflections from basic psychological science. Clinical Psychology: Science and Practice, 27(4), 220. https://doi.org/10.1111/cpsp.12352

Macintyre, V. G., Mansell, W., Pratt, D., & Tai, S. J. (2021). The psychological pathway to suicide attempts: a strategy of control without awareness. Frontiers in psychology, 12, 588683. https://doi.org/10.3389/fpsyg.2021.588683

Michel, K. (2021). Suicide models and treatment models are separate entities. What does it mean for clinical suicide prevention? International journal of environmental research and public health, 18(10), 5301. https://doi.org/10.3390/ijerph18105301

Ng, S. L., Mylopoulos, M., Kangasjarvi, E., Boyd, V. A., Teles, S., Orsino, A., Lingard, L., & Phelan, S. (2020). Critically reflective practice and its sources: A qualitative exploration. Medical Education, 54(4), 312-319. https://doi.org/10.1111/medu.14032

O'Brien, K. H. M., Almeida, J., Schofield, M., Hall, W., Aguinaldo, L., Ryan, C. A., & Maneta, E. (2021). A safety and coping planning intervention for suicidal adolescents in acute psychiatric care. Cognitive and Behavioral Practice, 28(1), 22-39. https://doi.org/10.1016/j.cbpra.2019.08.003

O'Connor, S. S., Mcclay, M. M., Choudhry, S., Shields, A. D., Carlson, R., Alonso, Y., Lavin, K., Venanzi, L., Comtois, K. A., & Wilson, J. E. (2020). Pilot randomized clinical trial of the Teachable Moment Brief Intervention for hospitalized suicide attempt survivors. General hospital psychiatry, 63, 111-118. https://doi.org/10.1016/j.genhosppsych.2018.08.001

O’Connor, S. S., Comtois, K. A., Wang, J., Russo, J., Peterson, R., Lapping-Carr, L., & Zatzick, D. (2015). The development and implementation of a brief intervention for medically admitted suicide attempt survivors. General hospital psychiatry, 37(5), 427-433. https://doi.org/10.1016/j.genhosppsych.2015.05.001

Pennington, C. G. (2021). Applying the transtheoretical model of behavioral change to establish physical activity habits. Journal of Education and Recreation Patterns, 2(1). https://doi.org/10.53016/jerp.v2i1.6

Pringle, J., & Rice-Stubbs, M. (2023). Brief Interventions. Motivational Interviewing: A Guide for Medical Trainees, 119. https://doi.org/10.1093/med/9780197583876.003.0007

Pyle, M., Loftus, L., Emsley, R., Freeman, D., Gillard, S., Gumley, A., Sierpatowska, J., Wood, L., O’Connor, R. C., & Pfeiffer, P. (2024). Study protocol for an adaptive, multi-arm, multi-stage (MAMS) randomised controlled trial of brief remotely delivered psychosocial interventions for people with serious mental health problems who have experienced a recent suicidal crisis: Remote Approaches to Psychosocial Intervention Delivery (RAPID). Trials, 25(1), 460. https://doi.org/10.1186/s13063-024-08293-5

Richard, A., Gagnon, M., & Careau, E. (2019). Using reflective practice in interprofessional education and practice: a realist review of its characteristics and effectiveness. Journal of interprofessional care, 33(5), 424-436. https://doi.org/10.1080/13561820.2018.1551867

Rudd, M. D. (2006). Fluid vulnerability theory: A cognitive approach to understanding the process of acute and chronic suicide risk. https://doi.org/10.1037/11377-016

Rugo‐Cook, K. F., Kerig, P. K., Crowell, S. E., & Bryan, C. J. (2021). Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review. Journal of Traumatic Stress, 34(6), 1080-1098. https://doi.org/10.1002/jts.22782

Saber, A. F., Ali, A., Hasan, H. A., Ahmed, S. K., & Hussein, S. (2024). Cognitive Behavioral Therapy for Suicidal Ideation: Extending the Stepped Care Model. Journal of Contemporary Psychotherapy, 1-8. https://doi.org/10.1007/s10879-024-09639-5

Simon, J. D., Gandarilla Ocampo, M., Drake, B., & Jonson-Reid, M. (2022). A review of screened-out families and child protective services involvement: A missed opportunity to prevent future maltreatment with community-based services. Child maltreatment, 27(4), 693-706. https://doi.org/10.1177/10775595211033597

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: a brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001

Stellrecht, N. E., Gordon, K. H., Van Orden, K., Witte, T. K., Wingate, L. R., Cukrowicz, K. C., Butler, M., Schmidt, N. B., Fitzpatrick, K. K., & Jr, T. E. J. (2006). Clinical applications of the interpersonal‐psychological theory of attempted and completed suicide. Journal of Clinical Psychology, 62(2), 211-222. https://doi.org/10.1002/jclp.20224

Stone, D. M., Holland, K. M., Bartholow, B. N., Crosby, A. E., Davis, S. P., & Wilkins, N. (2017). Preventing suicide: A technical package of policies, programs, and practice.

Suárez-Pinilla, P., Pérez-Herrera, M., Suárez-Pinilla, M., Medina-Blanco, R., López-García, E., Artal-Simón, J. Á., & de Santiago-Díaz, A. I. (2020). Recurrence of suicidal thoughts and behaviors during one year of follow-up: An exploratory study. Psychiatry research, 288, 112988. https://doi.org/10.1016/j.psychres.2020.112988

Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, T. E. (2010). The interpersonal theory of suicide. Psychological review, 117(2), 575. https://doi.org/10.1037/a0018697

Wilson, K. C. (2023). The S9 Model: A Comprehensive Framework for Conceptualizing Student Suicidality James Madison University].

Woods, P., & Jeffrey, B. (2019). Teachable moments: The art of teaching in primary schools. Routledge. https://doi.org/10.4324/9780429326967

Zhou, Y., Lutz, P. e., Ibrahim, E. C., Courtet, P., Tzavara, E., Turecki, G., & Belzeaux, R. (2020). Suicide and suicide behaviors: A review of transcriptomics and multiomics studies in psychiatric disorders. Journal of Neuroscience Research, 98(4), 601-615. https://doi.org/10.1002/jnr.24367