Abstract Introduction Insomnia contributes to the development and course of suicidal thought and behavior and is a component in some suicide prevention programming. One such multicomponent intervention is Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT). BCBT is a 10-12 session suicide prevention intervention that incorporates a sleep module consisting of stimulus control and sleep hygiene into the behavioral elements of its protocol. Our team recently undertook a study to identify BCBT’s most potent components and whether the sequencing of behavioral or cognitive facets of treatment impacted treatment outcomes. Methods Veterans with recent suicidal ideation (SI) or behavior (N = 49) were enrolled in a pilot study that utilized a randomized counterbalance design. All participants received BCBT and were randomized (balanced on sex and history of suicide attempts) to receive one of two sequences: Behavioral before Cognitive (Beh+Cog) or Cognitive before Behavioral (Cog+Beh). To maintain participant safety, in all instances of treatment, the first module consisted of suicide risk assessment, crisis response planning, and means safety counseling. Participants completed weekly assessments prior to each intervention session, collecting data on suicidal thought and behavior, insomnia severity, and depression. Results A piecewise regression was used to examine changes in insomnia, suicidal ideation, suicide cognitions, and depressive symptomatology across groups. The introduction of behavioral components first was associated with more rapid decreases in insomnia severity (Est=-9.93, SE=6.09, p=.027) and SI (Est=11.55, SE=4.93, p=.018) compared to the Cog+Beh group. Severity of depression and suicide cognitions were observed to significantly decrease for both groups in sessions 1-5, but between group differences were not observed. Conclusion Preliminary findings from this ongoing trial suggest that participants that who receive behavioral treatment components first (including stimulus control) report more rapid reductions in both insomnia severity and SI. Findings support a growing literature highlighting the importance of addressing insomnia as part of a broader suicide prevention strategy. Support (if any) This work was supported, in part, by the Innovations Hub, Center of Excellence for Suicide Prevention, VHA Office of Suicide Prevention. Authors’ views do not necessarily represent those of the Department of Veterans Affairs or the United States Government.
Bishop et al. (2026) studied this question.