Evaluation of negative posttraumatic cognitions as a predictor of suicide cognitions during an intensive treatment program for PTSD.

Posttraumatic stress disorder (PTSD) is associated with elevated chronic suicide risk. Negative posttraumatic cognitions (NPCs) refer to inaccurate and unhelpful trauma-related beliefs that maintain PTSD and have been associated with suicidal ideation (SI). However, SI performs poorly when predicting suicide and suicide attempts, often no better than chance. Suicide cognitions (SCs) have emerged as a more promising cognitive predictor of suicide. These cognitions do not involve thoughts about killing oneself but rather include negative core beliefs about oneself and others anchored in a pervasive sense of hopelessness. In this study, we hypothesized that decreases in NPCs predict reductions in SCs during an intensive treatment program (ITP) for PTSD. The study sample included 349 military service members and veterans who completed a two-week ITP for PTSD between January 2024 and January 2026. Results showed that decreases in NPCs were significantly associated with reductions in SCs (b = 0.06, p < .001), even when controlling for PTSD and depression severity. Within-subject reductions in NPCs were also associated with SCs over time (b = 0.04, p < .001). Regarding NPC subtypes, within-subjects reductions in NPCs about self (b = 1.34, p < .001) and self-blame (b = 0.36, p = .001) were associated with reductions in SCs, while decreases in NPCs about the world were not. Findings suggest that targeting maladaptive posttraumatic beliefs may not only reduce PTSD severity but also SCs, which may ultimately reduce chronic suicide risk.