Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) for Middle-Aged and Older Adults Hospitalized for Suicidality

Am J Geriatr Psychiatry. 2018 Apr;26(4):494-503. doi: 10.1016/j.jagp.2017.11.009. Epub 2017 Dec 27.


Middle-aged and older adults constitute a high suicide-risk group. Among adults aged 50 years old and older, suicide rates increased and suicide deaths almost doubled during the period from 2000 to 2015. Suicide rates are elevated for patients hospitalized for suicidality (i.e., active suicidal ideation or suicide attempt) and the 3 months post-hospitalization is the time of the highest suicide risk. Psychosocial interventions for middle-aged and older adults hospitalized for suicidality are sparse. In this article, we present the main aspects, stages, techniques and a clinical case study of Cognitive Reappraisal Intervention for Suicide Prevention (CRISP), a psychosocial intervention targeting cognitive reappraisal to reduce suicide risk in middle-aged and older adults who have been recently hospitalized for suicidal ideation or a suicide attempt. CRISP is based on the theory that hospitalization for suicidality is preceded by an emotional crisis ("perfect storm"); this emotional crisis is related to personalized (patient- and situation-specific) triggers; and identifying these personalized triggers and the associated negative emotions and providing strategies for an adaptive response to these triggers and negative emotions will reduce suicidal ideation and improve suicide prevention. CRISP therapists identify these triggers of negative emotions and use cognitive reappraisal techniques to reduce these negative emotions. The cognitive reappraisal techniques have been selected from different psychosocial interventions and the affective neuroscience literature and have been simplified for use with middle-aged and older adults. CRISP may fill a treatment need for the post-discharge high-risk period for middle-aged and older adults hospitalized for suicidality.

Trial registration: NCT03026127.

Keywords: Suicide; cognitive reappraisal; emotion regulation; emotions; hospitalization; psychosocial intervention; suicide prevention.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aftercare / methods*
  • Aged
  • Aged, 80 and over
  • Female
  • Hospitalization
  • Humans
  • Male
  • Mental Health Services
  • Middle Aged
  • Primary Prevention
  • Risk Assessment
  • Risk Factors
  • Suicide / prevention & control*
  • Suicide / psychology*
  • Suicide / statistics & numerical data
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / psychology*
  • Suicide, Attempted / statistics & numerical data
  • United States

Associated data