By Catherine Lee
CatholicU, Fall 2021
Psychology Professor David Jobes has spent his career — more than 35 years — dedicated to suicide prevention. He has developed the widely used clinical intervention, Collaborative Assessment and Management of Suicidality, which was recently deemed highly effective by an independent meta-analysis.
En route to the Mayo Clinic in Rochester, Minn., Stephen O’Connor, Ph.D. 2010, and fellow Catholic University doctoral student, Melinda Moore, Ph.D. 2011, met at the airport in Minneapolis. O’Connor says they were “pinching themselves,” marveling at their good fortune. Psychology Professor David Jobes had invited them to join him at the famed hospital for trainings in the assessment, treatment, and prevention of suicide.
It was July 2007, and O’Connor’s wedding was just a week away. But he wasn’t going to miss the opportunity to watch Jobes train clinicians in his approach to working with patients who are suicidal. As part of the training, Jobes interviewed a woman who had scarred herself extensively and attempted suicide many times. O’Connor says he was “blown away” by the conversation.
Jobes interviewed the woman with the chief of psychiatry and other clinicians watching on the other side of a two-way mirror. Jobes had never met the patient before. O’Connor describes the interview as “a high-stakes training experience,” noting that it’s not easy, while other clinicians watch, to have that kind of conversation with a patient who clearly struggles and could easily become defensive.
“He was very respectful, very gentle, and very honest with her in eliciting her story,” says O’Connor, who is now chief of the Suicide Prevention Research Program at the National Institute of Mental Health (NIMH). “Somehow Dave was able to get through to her. I don’t think a lot of trainers would put themselves through that. It takes a special kind of bravery and a willingness to be critiqued. But he does it because he cares about people.”
Jobes, associate director of clinical training and director of the University’s Suicide Prevention Laboratory, has been talking to suicidal patients for more than 35 years while developing his evidence-based clinical intervention — the Collaborative Assessment and Management of Suicidality (CAMS). This past spring, he marked a significant milestone: A rigorous meta-analysis of CAMS showed that his approach is “well supported” for reducing suicidal ideation per Centers for Disease Control criteria.
It also showed that the intervention — developed and tested in Jobes’ Suicide Prevention Laboratory at CatholicU — significantly lowers general distress, decreases hopelessness and increases hope and treatment acceptability for people with serious thoughts of suicide.
“This independent meta-analysis shows that CAMS provides highly effective care for the largest challenge we face in suicide prevention today: the massive population of people who struggle with serious suicidal thoughts,” says Jobes.
Conducted by a team of psychology researchers at Idaho State University, the meta-analysis investigated nine national and international studies — primarily randomized controlled trials — with data from 749 patients who were suicidal. CAMS was compared to treatment as usual or, in one study, with Dialectical Behavior Therapy, a type of psychotherapy used to treat chronically suicidal individuals and people with borderline personality disorder. The study focused on ideation in response to a sobering reality: In the United States, 12 million adults struggle each year with suicidal thoughts.
Globally, approximately 800,000 individuals die by suicide each year, according to the World Health Organization. Suicide is the 10th leading cause of death in the United States, where in 2019, there were 47,511 deaths by suicide and more than 1.4 million adults tried to take their lives.
Lanny Berman, Ph.D. 1970, a renowned expert in suicide, describes Jobes’ contribution to the field as “extraordinarily powerful and impactful.”
Berman was an American University (AU) psychology professor when he first met Jobes in the mid-1980s; Jobes was a graduate student in his department. Jobes worked on several research projects with Berman who became his advisor and mentor and later a friend and professional colleague. These days, the two suicidologists meet at professional conferences and swap stories about their research.
Berman, now an adjunct professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, says that to truly understand the mind of a person who is suicidal, “you have to peel back the layers to get to the root of their distress, not just see them as someone on a ledge who intends to jump.
“Dave has run with that better than anyone else in the field,” says Berman. “He’s also investing in training — which is crucial in suicidology — trying to get clinicians to better understand that what they’re [used to] doing is insufficient to treat suicidal patients.”
Jobes has presented his research at psychiatry grand rounds at Oxford University, the University of Michigan, and several Department of Veterans Affairs medical centers. Close to 20,000 clinicians have been trained in CAMS worldwide. CAMS-care, a company created in 2014, provides training and educational materials for clinicians who work with suicidal risk. The company has developed a training hub in England as part of a National Health Service network of community services. Other potential hubs are being considered in China, Mexico, Norway, Australia, New Zealand, and the Netherlands.
Jobes’ passion for suicidology is intense and infectious. “For Dave, suicidology is far more than just teaching and research,” says Tara Kraft Feil, B.A. 2009, who worked in his lab her entire time at CatholicU and now serves as a clinical psychologist at a medical center in Bismarck, N.D. “For Dave, it’s a deep life purpose.”
As an undergraduate at the University of Colorado in Boulder, Jobes was interested in existentialism and had planned to major in philosophy. But his favorite professor steered him toward psychology. His interest in existentialism — the view that humans define their own meaning in life and try to make rational decisions despite existing in an irrational universe — would later inform CAMS and Jobes’ belief that a patient who is suicidal can play a critical role in their own treatment.
During his time in graduate school at AU, Jobes embraced the field of suicidology. He learned from the experts who had mentored Berman, among them psychiatrist Robert Litman and psychologists Norman Farberow and Edwin Shneidman. Widely considered the founders of modern-day suicidology, they established the LA Suicide Prevention Center in 1958 — the first center of its kind in the country.
Jobes worked with Berman on a psychological autopsy project that looked at national data from medical examiners in order to improve the procedures for certifying suicide as a manner of death. At the time, coroners and medical examiners relied on a range of criteria from suicide notes to medical records to interviews with survivors to determine if suicide was the manner of death. The criteria were inconsistent from one jurisdiction to the next; the project resulted in the creation of consistent empirically based standards for more valid and reliable certifications.
Eager to get into clinical work, Jobes took a job in 1987 at the Catholic University Counseling Center as a staff psychologist, joining the psychology department part time as an assistant professor. The director of the Counseling Center — psychologist Peter Cimbolic — was determined not to lose any students to suicide. His mandate to Jobes: Don’t let any students fall through the cracks. Together they published a book in 1990 on issues related to suicide among young people.
Early in his career, Jobes received small grants that funded the preliminary development of CAMS. Later, larger grants funded clinical trials of CAMS to prove the efficacy of his approach, including numerous grants from the federal Departments of Defense and Veterans Affairs to support studies involving active-duty service members and veterans who were suicidal.
In the late 1990s, John Drozd, B.A. 1992, now a psychologist and neuroscientist, was serving as a captain at Peterson Air Force Base in Colorado Springs, where he attended a continuing education workshop on clinical suicidology led by Jobes.
Early on in his clinical training, Drozd had been taught to hospitalize patients with suicidal thoughts. By the time he attended Jobes’ workshop, Drozd was seeing three to four airmen a week with suicide ideation — an alarmingly high rate. Within a week of the workshop, Drozd had started using an early version of CAMS — a radical approach at the time with an emphasis on keeping patients out of inpatient care if possible.
“When you provide a safe space where patients can talk about what’s driving their emotions, it’s a profound experience,” says Drozd.
The patient engages in metacognition — the ability to think about the way they think — and becomes the observer of self, as writer and spiritual teacher Eckhart Tolle notes. This process “leads to enlightenment, a transcendence,” says Drozd. “In a similar way, CAMS provides people with a tool that often for the first time in their lives allows them to look at their suffering through a different lens.”
Realizing the value of CAMS, the defense department awarded Jobes a $3.4 million grant for the Operation Worth Living study at Fort Stewart in Hinesville, Ga. Plagued by a dramatic increase in suicides — fallout from the wars in Iraq and Afghanistan — the Army was desperate to find a remedy, explains Jobes. The study found that CAMS participants were significantly less likely to have suicidal thoughts three months after treatment in comparison to soldiers who had received typical clinical care.
On a June morning earlier this year, Jobes stops at his lab in the basement of O’Boyle Hall to pick up some files. The lab is quiet and empty. But conference posters and group photos of Jobes and his students show signs of the work that’s normally done there by a close-knit, inquisitive community of researchers.
Jobes, dressed in a crisp white shirt and jeans, his silvery-white hair combed neatly back, gestures toward a sofa and laughs. “A student might catch a quick nap there, but normally this place is bustling,” he says. Typically, 20 to 30 students ranging from undergraduates to master’s and doctoral students work in the lab each semester. The graduate students are encouraged to mentor undergraduates, offering advice about academic posters and research papers.
Undergraduates help with data coding, which involves entering information such as research questionnaire results and interview transcripts into computers for statistical analysis. Graduate students are trained in the lab to watch videos of clinicians conducting CAMS in clinical trials to rate them for adherence to the CAMS process.
Blaire Ehret, Ph.D. 2017, was volunteering at the LA Suicide Prevention Center when she first learned about CAMS. Then a senior at a university in Los Angeles, she discovered Jobes’ book, Managing Suicidal Risk: A Collaborative Approach, while researching graduate psychology programs. “When I applied to graduate school, there weren’t a lot of people doing this kind of research,” says Ehret. “I read Dave’s book in about 24 hours and thought, ‘This is a really good fit for me.’”
Ehret, now a clinical psychologist for the VA San Diego Healthcare System in California, notes that Jobes treats students in his lab and classroom “as junior colleagues.” In his ethics course, Jobes would present complex case scenarios “and the whole class would just erupt” with a range of opinions. “It’s the way I imagine a law school course would be, really making you think for yourself,” she says.
But it’s not all work in the lab. Ehret, who’s still in touch with Jobes, describes him as “a school dad. We’re all part of Dave’s family. He creates that type of environment.” In fact, most students who have worked with Jobes have met his wife, Colleen Kelly, J.D. 1993, two sons, and dog Bailey at summer barbecues and holiday parties that he hosts at his home in Bethesda, Md.
Traditional mental health approaches to treating suicidal risk see suicidal ideation as a symptom of major mental disorders, Jobes says. To rid someone of these thoughts, clinicians commonly treat the disorder. In contrast, CAMS focuses specifically on suicidal ideation and patient-identified “drivers” — the issues that compel them to consider suicide. Typical drivers might include a faltering marriage, intense self-hatred, or an inability to hold down a job.
In a 2016 interview with psychalive.org, Jobes noted that the interaction between a patient and a clinician who is not properly trained to treat suicidal risk often turns into a power struggle. When the clinician asserts that they are not going to let the patient take their life, patients become wary and defensive. For a patient who sees suicide as a way out because life has become unbearable, such a clinical approach “undermines the idea that they can actually work together constructively,” says Jobes.
In contrast, the beauty of CAMS is “the strength of the alliance” that develops between the patient and therapist as they work together, says Jobes. At their first meeting, the therapist asks if they can sit next to the patient. The patient thus becomes “a co-author of their treatment plan,” notes Jobes. The clinician’s job is “to climb into the skin of the patient and see their suicidal struggle through the eyes of the patient,” he says.
The treatment process begins with the patient filling out parts of the CAMS Suicide Status Form and rating their psychological pain, self-hate, and hopelessness, among other factors, on a 1-5 scale. The patient also lists their reasons for living and their reasons for dying.
Additional specific details are added to the form that include their suicidal history, thoughts, planning, and preparations. The patient and clinician discuss drivers and revisit the form at each session, revising the treatment plan as needed depending on how the patient has been feeling since their last session.
Typically, CAMS reduces suicidal ideation in six to eight sessions. “There’s no better approach for treating suicidal ideation than CAMS,” says Jobes. “And if we’re better at identifying and treating serious suicidal thoughts upstream, we’d have fewer attempts and completions downstream.”
On sabbatical for the 2021–2022 academic year, Jobes is working on the third edition of his book. His current research projects include an $11 million study funded by NIMH of 700 students with suicidal ideation at Oregon, Nevada-Reno, Duke, and Rutgers universities — reportedly the largest ever campus-based suicide study funded by the federal agency. He is also working on an ongoing clinical trial of CAMS at the San Diego VA Medical Center. He won’t be teaching in the fall, but he will work on CAMS research with several master’s candidates and two new doctoral students.
A new emerging area of research focuses on helping patients who were once suicidal figure out how to live. “We’ve proven that we can clinically help people with suicidal thoughts who have hit rock bottom to pivot and consider how they might live,” says Jobes. “If we can help them cultivate love and work, we can help them develop a life worth living with purpose and meaning.”
Last May, Jobes did a Facebook Live interview for a video podcast called Suicide ‘n’ Stuff, a platform for the “lived experience” community — people who have suffered with suicidal thoughts and attempts. The community is increasingly vocal in its criticism of traditional ways of treating suicidal risk. The two women who co-host the podcast are highly supportive of CAMS as a better patient-centered approach.
“I’ll go anywhere and do anything to talk about suicide prevention,” says Jobes. “I’m humbled by the work I get to do. It’s a blessing that I never take for granted.”