University of Pennsylvania researchers studied 120 adults who had attempted suicide -- a group known to be at high risk for repeating. Those who received the 10-week cognitive treatment were half as likely to try again -- up to 18 months after the treatment -- compared to those who got the usual care of referrals to community mental-health programs.

"There's this view that this population isn't treatable," said Gregory K. Brown, research associate professor in psychiatry and the study's lead author. "We hope our study conveys that prevention of suicide is possible."

Viewed as a Symptom

Approximately 25,000 adults die from suicide each year, making it the fourth highest cause of death in the 18-to-65 age group, and over 100,000 others attempt it, according to the Centers for Disease Control and Prevention.

More alarmingly, people who attempt suicide are up to 40 times more likely than others to try again.

However, little research has been conducted on how to treat suicidal behavior.

The fear of being sued for new treatments may be the biggest reason, said Marsha Linehan, a professor at the University of Washington who has conducted several suicide-prevention studies.

Another is that suicide is often viewed merely as a symptom of a related condition, such as depression, and is rarely treated on its own.

"You've got an eating disorder and you target eating," said Linehan. "Anxiety disorder and you target anxiety. We don't have a category called suicide."

Moreover, no clinical trials suggest that treating depression necessarily reduces suicide attempts or suicide, said Linehan.

'We Slow It Way Down'

Brown's study used targeted cognitive therapy based on a type of short-term psychotherapy developed since the 1960s by emeritus Penn professor Aaron T. Beck, a study co-author.

It is built on the idea that thoughts influence emotions and behavior, and that the way one thinks about a situation can impact the way one reacts to it.

In Brown's study, participants first worked on understanding the thoughts and feelings that triggered their suicide attempts, such as having a fight with a significant other.

"Like a movie, we slow it way down" and try to understand the event frame by frame, said Brown.

Participants then thought up alternate ways of dealing with aspects of the situation -- how to handle the fight differently, for instance -- and were taught skills to carry out these plans.

"The most important thing people need to understand is why they attempted, and develop learned skills to keep them from attempting," said Brown.

Before they could stop treatment, participants took a final step to consolidate their training. They had to envision future crises and generate solutions without thinking of self-harm.

An Unhelpful Attempt at Problem Solving

The results of this study add to the handful of rigorous, randomized controlled trials, including Linehan's related therapy, which suggest that targeting suicidal behavior itself may help prevent future tries.

"In our data and now theirs, we see far better results if you target suicidal behavior," said Linehan.

Cognitive therapy and variations such as Linehan's view suicide as an unhelpful attempt at problem solving rather than a uniquely abnormal behavior.

Brown cautions that the results of this study may not necessarily be applicable to other populations. The majority of the sample was female and African-American, reflecting the patients of the Philadelphia hospitals where they were recruited.

The vast majority of those who attempt suicide have at least one psychological disorder -- most often major depression. But, most people with disorders do not commit suicide.

"It's common to think about," said Steve D. Hollon, depression expert at Vanderbilt University, "It's less common to come up with a plan, and rarer still to act on it."

Ask About It

After a person makes a suicide attempt, they are either admitted into the hospital or are referred to outpatient treatment and allowed to go home.

Only 20 to 40 percent keep follow-up appointments with a professional, said Brown, which means that most aren't getting treatment of any kind.

Also, many people don't want to talk about it after they try, and it takes a huge amount of time and energy to keep people in treatment, said Brown.

But this focused treatment may encourage patients to seek more long-term psychotherapy for depression or other disorders, said Brown.

People contemplating suicide often feel hopeless and trapped in their problems, and believe that killing themselves is a way to escape, said Brown.

If you think a loved one might be contemplating suicide, the most important thing to do is ask about it, experts say.

"You don't make someone suicidal by asking if they have concerns about it," said Hollon.