Trauma focused psychotherapy in patients with suicidal ideation: A scoping review

•Those with suicidal ideation may be excluded from trauma focused therapy.•Trauma therapy is associated with improved trauma and depression symptoms.•This review found trauma therapy may also improve suicidal ideation.•Heterogenous study methodology warrants more rigorous future research. This scoping review focused on the use of trauma focused therapy (TFT) with participants who have suicidal ideation. Methods: Following the PRISMA extension for Scoping Reviews guidelines, MEDLINE, EMBASE, APA PsycINFO, and CINAHL databases were searched on March 18, 2021. Peer-reviewed studies in English reporting on the use of TFT with patients with suicidal ideation or Borderline Personality Disorder (BPD) were included. Results: From 3,272 publications, 43 studies were included. Most studies utilized Prolonged Exposure, Eye Movement Desensitization and Reprocessing, Cognitive Processing Therapy, and other exposure-based interventions, alone or in combination with another intervention. Approximately 50% of studies used intensive (two sessions or more per week) delivery of the intervention. Studies mainly focused on clinical improvement of symptoms, rather than suicidality. Overall, studies reported symptom improvements in Posttraumatic Stress Disorder, depression, and BPD symptoms, suicidal ideation and non-suicidal self-injury, with few critical adverse events on record. Conclusion: Despite increased research interest in this area, knowledge gaps remain. Greater attention to mixed methods studies may increase our understanding of the lived experience of those with suicidal ideation undergoing TFT. There is a need for studies to explore the effect of TFT on symptoms associated with psychiatric diagnoses other than PTSD, and for studies reporting on the significance of both sex and gender of patients. Prospective interventional studies that focus on participants with suicidal ideation, and consensus on standardized suicidal ideation outcome measures, are also needed. There is a need to compare intensive vs. non-intensive TFT, and to examine whether inclusion of emotion regulation skills is a significant determinant of suicidal risk outcomes in this context. In contrast to common apparent clinical practice decisions restricting TFT to patients without suicidal symptoms, limited evidence indicates that TFT, including intensive delivery, may not increase suicide risk. Due to methodological issues, further studies are needed to confirm this observation and to determine an