Facilitators and barriers to the implementation of pain neuroscience education in the current Lebanese physical therapist health care approach: a qualitative study

PURPOSE

The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability.

METHOD

A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis.

RESULTS

Two topics were generated and constructed by the researchers: (1) "barriers to the implementation of pain neuroscience education, with subthemes including (a) "current health care approach," (b) "basic curriculum and continuing education," (c) "patients' barriers"; (2) "facilitators to the implementation of pain neuroscience education," with subthemes containing (a) "interest in the BPS model, (b) "therapeutic alliance," and (c) "motivation for future training on BPS approach."

CONCLUSION

The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach.IMPLICATIONS FOR REHABILITATIONThe exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management.The most important barriers were the dominant characteristic of the Lebanese physical therapist's health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective.

Suicidal ideations and self-dehumanization in recently detoxified patients with severe alcohol use disorder: an experimental exploration through joint explicit-implicit measures

BACKGROUND

Metadehumanization (the feeling of being considered as less than human by others) is a pervasive phenomenon in psychiatric states, notably promoting self-dehumanization and suicide antecedents. However, its role in suicidal ideations among patients with addictive disorders remains unexplored. We thus investigated the involvement of metadehumanization/self-dehumanization in suicidal ideations and suicidal thoughts interference in severe alcohol use disorder.

METHODS

We measured metadehumanization, suicidal ideations, and desire for social contact through questionnaires among 35 recently detoxified patients with severe alcohol use disorder (26 males). We measured animalistic/mechanistic self-dehumanization using an Implicit Association Task, and suicidal thoughts interference using a Stroop Task with suicide-related words. We performed regression analyses while controlling for depression/anxiety.

RESULTS

Animalistic self-dehumanization was positively associated with suicidal thoughts interference and with decreased desire for social interactions, such link being absent for metadehumanization or mechanistic self-dehumanization.

CONCLUSIONS

This link between self-dehumanization and suicide-related factors suggests that a reduced sense of belonging to humanity is associated with self-harm antecedents. Results also emphasize the importance of using indirect measures to investigate sensitive variables, such as self-dehumanization and suicidal thoughts.

Work out of office: how and when does employees' self-control influence their remote work effectiveness?

Introduction

The purpose of this study is to understand the positive effects of employees' self-control on their self-efficacy and work effectiveness in the context of remote work, as well as social support (organizational support, interaction with supervisors, and family support) moderating role on such positive effects.

Methods

Based on social cognitive theory, this study collects two-phase data with a sample of 240 remote workers.

Results

The results show that employees' self-control positively influences their remote work self-efficacy, which in turn positively increases their remote work effectiveness. Moreover, perceived organizational support, interaction with supervisors, and family support strengthen the effect of self-control on remote work self-efficacy.

Discussion

First, this study explores the mechanism of self-control on remote work effectiveness, highlights the importance of self-control in remote work, and provides guidance for employees to improve remote work effectiveness. Second, this study discusses the mediating role of remote work self-efficacy between self-control and remote work effectiveness and reveals the psychological mechanism of employees' self-control in remote work. Finally, this study comprehensively considers three types of support from work and family and analyzes the interaction between internal control and external support on remote work self-efficacy, which provides suggestions for enhancing employees' confidence in remote work.

The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis

BACKGROUND

The relationship between callous-unemotional (CU) traits (the affective facet of psychopathy and the psychopathy that occurs during childhood and adolescence) and suicide ideation (SI) remains unclear. The mechanisms underlying this association still have a gap in the literature. The aims of this study were to determine whether and how callous-unemotional traits were associated with suicide ideation, and to evaluate the mediating effect of negative affect (includes irritability, depression, and anxiety) and the moderating effect of future orientation on the association.

METHODS

Data were extracted from a longitudinal study involving middle and high school students, with 1,913 students (55.3% girls) aged 11 to 19 years (14.9 ± 1.6 years) completing a self-reported online survey. The conditional process analysis was examined using Mplus 8.3.

RESULTS

We found that callous-unemotional traits positively predicted youths' current suicide ideation, with the observed positive relationship partly mediated by negative affect. However, callous-unemotional traits did not predict the worst-point suicide ideation, which indicated the connection fully mediated by negative affect. Furthermore, future orientation moderated these indirect effects.

LIMITATIONS

Use of self-report measures and cross-sectional design.

CONCLUSIONS

These findings provided evidence for current debates and conflicting conclusions, and set the foundation for future research, as well as implied the important intervention goals for reducing suicide ideation in youth.

Is physical pain causally related to suicidal behavior: An experimental test

Existing evidence suggests a link between physical pain and suicide, but the nature of this relationship remains unknown. To address this critical gap in knowledge, the present study leveraged a validated virtual reality (VR) suicide paradigm to experimentally examine the causal effects of physical pain on subsequent virtual suicidal behaviors. Based on previous findings, we hypothesized that physical pain would causally drive virtual suicidal behavior only if suicide was conceptualized as having desirable anticipated consequences (e.g., a means of escaping from current pain; an opportunity to avoid future pain). We tested this by randomizing 326 participants across four different conditions: a physical pain condition, an anticipated escape condition, an anticipated avoidance condition, and a control condition. As predicted, physical pain alone did not result in statistically significant increases in VR suicide rates; however, the anticipation that virtual suicidal behavior would result in the avoidance of future physical pain had a large causal effect on VR suicide rates (B = 1.61, p < .001, IRR = 5.01). We failed to find evidence that anticipating that VR suicide would provide an escape from currently experienced physical pain increases the likelihood of VR suicide. Our findings add to a growing body of evidence suggesting that the anticipated consequences of suicide (e.g., avoidance of future physical pain) may serve as primary causes of suicidal behavior.

Suicide-related construct accessibility and attention disengagement bias in suicide ideation

Previous attempts to determine whether attention bias toward suicide-related stimuli is associated with risk for future suicide attempts have yielded mixed findings that have been difficult to replicate. Recent evidence suggests that methods used to assess attention bias toward suicide-specific stimuli have low reliability. The present study used a modified attention disengagement and construct accessibility task to examine suicide-specific disengagement biases, along with cognitive accessibility of suicide-related stimuli, among young adults with different histories of suicide ideation. Young adults (N = 125; 79% women), screened for moderate-to-high levels of anxiety or depressive symptoms completed an attention disengagement and lexical decision (cognitive accessibility) task, along with self-report measures of suicide ideation and clinical covariates. Findings using generalized linear mixed-effects modeling revealed that young adults with recent suicide ideation displayed a suicide-specific facilitated disengagement bias, compared to peers with lifetime ideation. In contrast, there was no evidence of a construct accessibility bias for suicide-specific stimuli, irrespective of suicide ideation history. These findings point to a suicide-specific disengagement bias that may depend on the recency of suicidal thoughts and suggests automatic processing of suicide-specific information. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

(Eye-)tracking the escape from the self: guilt proneness moderates the effect of failure on self-avoidance

Failure increases the motivation to escape self-awareness. To date, however, the role of self-conscious emotions (shame and guilt) in triggering escape responses after failure has not been sufficiently addressed. In this pre-registered study (N = 156 undergraduates), we adapted a classic paradigm (avoidance of one's image in a mirror) to a modern eye-tracking technology to test the hypothesis that shame proneness moderates the effect of failure on self-awareness avoidance. Individual differences in guilt and shame proneness were assessed before priming thoughts of failure or success. Then, an eye-tracking paradigm was used to monitor gaze avoidance of one's screen-reflected face during a neutral, unrelated task. Unexpectedly, results showed that guilt but not shame proneness exacerbated self-avoidance after failure. The present findings challenge the dominant view that shame fosters avoidance more so than guilt.

Awareness isn't saving lives: An experimental exploration of suicide risk reduction methods for emerging adults

OBJECTIVE

Suicide prevention campaigns commonly employ brief informational materials aimed at emerging adults. Are such programs helpful, and do design characteristics yield differences in user outcomes? Literature is reviewed from the interpersonal theory of suicide, escape theory, and terror management theory, to inform our experimental design.

METHOD

Participants (n = 977 MTurk emerging adults) reported demographics and suicide histories and were randomized to one of nine experimental cells with varying video and journaling conditions to approximate suicide prevention materials. Participants were surveyed on perceptions of the materials' risk reduction effectiveness, indicated their suicidality risk factors (e.g., hopelessness, depressiveness, purposelessness, and non-belongingness), and conducted an implicit association test of suicidality.

RESULTS

Suicide risk factors did not differ between experimental and control conditions, but certain conditions were rated as more effective (i.e., essay conditions prompting reflection, and the video condition featuring a personal/affective narrative). While there was no actual comparative reduction of risk, there was a perception that certain designs were more helpful.

CONCLUSION

Real-world suicide prevention campaigns often feel justified despite lacking impact. Effective suicide risk reduction requires greater time investment and deeper personal connection than brief campaigns can offer, as well as systemic changes from a public health policy perspective.

Preliminary Evidence That the Short Allele of 5-HTTLPR Moderates the Association of Psychiatric Symptom Severity on Suicide Attempt: The Example in Obsessive-Compulsive Disorder

BACKGROUND

The severity of symptoms represents an important source of distress in patients with a psychiatric disease. However, the extent to which this endogenous stress factor interacts with genetic vulnerability factors for predicting suicide risks remains unclear.

METHODS

We evaluated whether the severity of symptoms interacts with a genetic vulnerability factor (the serotonin transporter gene-linked promoter region variation) in predicting the frequency of lifetime suicide attempts in patients with a psychiatric disease. Symptom severity and 5-HTTLPR polymorphism were collected from a sample of 95 patients with obsessive-compulsive disorder (OCD). Lifetime suicide attempt was the primary outcome, and antecedent of multiple suicide attempts was the secondary outcome.

RESULTS

The gene-by-symptoms interaction was associated with an excess risk of suicide attempts (OR = 4.39, 95CI[1.44, 13.38], p < 0.009) and of multiple suicide attempts (OR = 4.18, 95CI[1.04, 16.77], p = 0.043). Symptom severity (moderate, severe, or extreme) was associated with an approximately five-fold increase in the odds of a lifetime suicide attempt in patients carrying one or two copies of the short allele of 5-HTTLPR. No such relationship was found for patients carrying the long allele.

CONCLUSION

This study provides preliminary evidence for the gene-by-stress interaction on suicide attempt when stress is operationalized as symptom severity. Progress in suicide research may come from efforts to investigate the gene-by-symptoms interaction hypothesis in a variety of diseases.

Raising doubt about the anticipated consequences of suicidal behavior: Evidence for a new approach from laboratory and real-world experiments

OBJECTIVE

Converging evidence from basic science and experimental suicide research suggest that the anticipated consequences of suicide may have direct causal effects on suicidal behavior and accordingly represent a promising intervention target. Raising doubt about individuals' desirable anticipated consequences of suicide may be one means of disrupting this target. We tested this possibility across two complementary experimental studies.

METHOD

Study 1 tested the effects of raising doubt about desirable anticipated consequences on virtual reality (VR) suicide in the lab, randomizing 413 participants across four conditions. In Study 2, 226 suicidal adults were randomized to an anticipated consequence manipulation or control condition then re-assessed at 2- and 8-weeks post-baseline.

RESULTS

In Study 1, anticipating that engaging in VR suicide would guarantee a desirable outcome significantly increased the VR suicide rate; conversely, raising doubt about the desirable anticipated consequences significantly reduced the VR suicide rate. In Study 2, raising doubt about the anticipated consequences of attempting suicide by firearm significantly reduced the perceived lethality of firearms as well as self-predicted likelihood of future suicide attempts, with effects sustained at 2-week follow-up.

CONCLUSIONS

Findings suggest that raising doubt about desirable anticipated consequences of suicide merits further research as one potential approach to inhibit suicidal behavior.

Conceptualizing death: How do suicidal adolescents view the end of their lives?

OBJECTIVE

Adolescence marks an important time to detect suicide risk, as suicidal ideation often emerges during this developmental period. Death-themed cognitions represent a promising domain of risk factors for suicidal ideation, but they have been understudied among adolescents. To address this knowledge gap, the present study examines the association between adolescents' attitudes and beliefs about death, hereafter referred to as death conceptualizations, and suicidal ideation.

METHODS

Seventy-four adolescents (12-19 years) completed a self-report measure assessing three types of death conceptualizations: Death Avoidance (i.e., suppression of death-related thoughts), Neutral Acceptance (i.e., belief that death is a natural part of life), and Escape Acceptance (i.e., belief that death is a viable escape from pain). Suicidal ideation was assessed at baseline, as well as 3 and 6 months later.

RESULTS

At baseline, suicidal adolescents endorsed higher Escape Acceptance and lower Death Avoidance. Suicidal and nonsuicidal adolescents did not differ in their degree of Neutral Acceptance. Death conceptualizations, especially Escape Acceptance, also predicted future suicidal ideation.

CONCLUSIONS

Initial findings suggest that suicidal adolescents are more likely to believe that death is a viable escape from pain and that this death-related cognition is a risk factor for suicidal ideation.

An experimental investigation of the effects of self-criticism and self-compassion on implicit associations with non-suicidal self-injury

Non-suicidal self-injury (NSSI) is the intentional destruction of bodily tissue in the absence of suicidal motives. Individuals who self-injure often report doing so in order to punish the self or express self-hatred. Self-criticism, or thoughts marked by shame, self-consciousness, and inferiority, is associated with higher rates of NSSI while self-compassion, or the tendency to be sympathetic and caring with oneself, is negatively associated with NSSI. The aim of the present study was to determine whether experimentally-induced self-criticism would increase and self-compassion would decrease implicit identification with NSSI. Participants were randomly assigned to either a self-criticism induction, a self-compassion induction, or a neutral, control condition and completed a measure of strength of the automatic associations that a person holds between themselves and self-harming behaviors before and after the experimental induction. Study hypotheses were partially supported. Results showed that participants in the self-criticism induction experienced an increase in their implicit associations with NSSI while implicit associations in the self-compassion condition did not significantly change. These results highlight the importance of self-criticism in NSSI. Future research should examine increases in self-criticism as a potential precursor of NSSI in longitudinal samples.

Sensation seeking and nonsuicidal self-injurious behavior among adolescent psychiatric patients

The Benefits and Barriers model of NSSI postulates that engagement in NSSI is positively reinforced by potent benefits, however there are a host of barriers to engagement, any one of which is salient enough to prevent engagement. It is possible that individual differences in sensation seeking, a trait that describes optimal level of positive reinforcement, may alter the balance between the benefits and barriers of engagement in NSSI. There are significant associations between engagement in NSSI and sensation seeking in college undergraduates, a population with disproportionately high rates of NSSI. However, it is unclear whether these traits play a similar role in adolescents. We expected that higher levels of sensation seeking would positively relate to any NSSI history, lifetime frequency of NSSI, and earlier age at onset of NSSI among a sample of 200 adolescents in a psychiatric hospital. Consistent with previous research, results indicated that females were more likely to engage in NSSI than males. Additionally, increased sensation seeking was associated with greater likelihood of ever engaging in NSSI and a greater number of different NSSI methods tried. Though we expected sensation seeking would be significantly related to lifetime NSSI frequency and earlier onset of NSSI, it was not. Findings suggest that individual differences may alter relations between the benefits and barriers of NSSI and that measuring sensation seeking in adolescents, especially females, and especially those experiencing psychological distress, may identify those at highest risk for engaging in NSSI and may allow for targeted intervention with these individuals.

Quality of Internalized Object Representations and Suicidality in Individuals With Anaclitic and Introjective Personality Styles

Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in the context of poorer quality of object relations. The treatment implications of these findings are discussed, and areas for future research are considered.

The Effects of Abusive Supervision and Motivational Preference on Employees’ Innovative Behavior

Individual innovative behavior has an important relationship with the sustainable development of an organization. Thus, mostly drawing on social cognitive theory, this study examined the relationship between abusive supervision and employees’ innovative behavior, focusing on the mediating role of creative self-efficacy and the moderating role of motivational preference. In an analysis of time-lagged data from three technological, innovation-based enterprises in Shenzhen, this study found that abusive supervision was negatively related to employees’ innovative behavior and that this relationship was mediated by creative self-efficacy. Moreover, motivational preference was found to moderate this relationship as well as that between abusive supervision and creative self-efficacy. Employees with higher levels of motivational preference (i.e., intrinsic motivational preference weighs more than extrinsic motivational preference) are more vulnerable to abusive supervision, causing lower creative self-efficacy performance and less innovative behavior. Alternately, employees with lower levels of motivational preference (i.e., extrinsic motivational preference weighs more than intrinsic motivational preference) are less vulnerable to abusive supervision, thus resulting in a weaker negative relationship between abusive supervision and their creative self-efficacy and innovative behavior.

Synergistic effect of autonomy and relatedness satisfaction on cognitive deconstruction

We connected self-determination theory (SDT) and escape theory to deepen the understanding of the antecedents of cognitive deconstruction by introducing autonomy and relatedness satisfaction. Based on three laboratory experiments, results showed a limited determining role of autonomy satisfaction (Experiment 1); however, the causal relationship strengthened when autonomy satisfaction was in conjunction with relatedness satisfaction (Experiments 2 and 3). Relatedness satisfaction constantly predicts all symptoms of cognitive deconstruction. Importantly, all independent explanatory powers of the two require satisfactions when explaining that the symptoms of cognitive deconstruction were qualified by their interaction terms. Regardless of relatedness satisfaction, autonomy satisfaction always positively relates to time orientation. The relationship between autonomy satisfaction and meaninglessness is only negative when relatedness satisfaction is low. The relationship between autonomy satisfaction and delayed gratification is only positive when relatedness satisfaction is high.

Factors associated with fear of intimacy among a representative sample of the Lebanese population: The role of depression, social phobia, self-esteem, intimate partner violence, attachment, and maladaptive schemas

PURPOSE

To assess fear of intimacy (FOI) in the Lebanese population, and its correlates such as depression, social phobia, self-esteem, attachment, and maladaptive schemas.

DESIGN/METHODS

This cross-sectional study, conducted between November 2017 and May 2018, enrolled 707 community-dwelling participants.

RESULTS

Higher FOI scores were associated with an increase in the defectiveness schema (β = 0.483), social phobia score (β = 0.16), mistrust schema (β = 0.519), vulnerability schema (β = 0.482), emotional deprivation schema (β = 0.548), attachment style D (dismissing) (β = 0.913) and failure schema, whereas lower FOI was significantly associated with an increase in the entitlement schema (β = -0.362), insufficient schema (β = -0.377), and the self-esteem score (β = -0.288).

PRACTICE IMPLICATIONS

Implementing educational programs are needed to enable persons to develop healthy intimate relationships, taking into account attachment styles and inappropriate early schemas.

Suicidal Ideation in Elite Schools: A Test of the Interpersonal Theory and the Escape Theory of Suicide

OBJECTIVE

The present study compared the ability of two contemporary theories of suicidal behavior-the interpersonal and escape theories of suicide-to predict suicidal ideation. The interpersonal theory proposes that the interaction of perceived burdensomeness and thwarted belongingness predicts suicidal ideation. The escape theory proposes that feelings of failure predict suicidal ideation and that escape motivation mediates this relationship. The present study intended to determine which of the two theories more successfully explains suicidal ideation.

METHOD

A sample of 306 students from elite schools in Morocco (193 women, M_age  = 21.21 years, predominantly Muslims) completed a questionnaire assessing feelings of failure and escape motivation, perceived burdensomeness and thwarted belongingness, suicide ideation, and control variables.

RESULTS

In line with previous research, separate tests revealed support for the two theories. Interestingly, when entered simultaneously in a multiple regression analysis, the two frameworks explained a unique and cumulative part of the variance in suicidal ideation. Moreover, the effects remained significant after controlling for past suicide attempts, depression, hopelessness, and stress.

CONCLUSIONS

The findings suggest that combining the interpersonal and escape theories of suicide could help better explain the emergence of suicidal ideation among college students.

The Mirror Effect: A Preregistered Replication

When individuals are exposed to their own image in a mirror, known to increase self-awareness, they may show increased accessibility of suicide-related words (a phenomenon labeled “the mirror effect”; Selimbegović & Chatard, 2013). We attempted to replicate this effect in a pre-registered study (N = 150). As in the original study, self-awareness was manipulated using a mirror and recognition latencies for accurately detecting suicide-related words, negative words, and neutral words in a lexical decision task were assessed. We found no evidence of the mirror effect in pre-registered analyses. A multiverse analysis revealed a significant mirror effect only when excluding extreme observations. An equivalence TOST test did not yield evidence for or against the mirror effect. Overall, the results suggest that the original effect was a false positive or that the conditions for obtaining it (in terms of statistical power and/or outlier detection method) are not yet fully understood. Implications for the mirror effect and recommendations for pre-registered replications are discussed.

Automatic social comparison: Cognitive load facilitates an increase in negative thought accessibility after thin ideal exposure among women

Women are routinely exposed to images of extremely slim female bodies (the thin ideal) in advertisements, even if they do not necessarily pay much attention to these images. We hypothesized that paradoxically, it is precisely in such conditions of low attention that the impact of the social comparison with the thin ideal might be the most pronounced. To test this prediction, one hundred and seventy-three young female participants were exposed to images of the thin ideal or of women’s fashion accessories. They were allocated to either a condition of high (memorizing 10 digits) or low cognitive load (memorizing 4 digits). The main dependent measure was implicit: mean recognition latency of negative words, relative to neutral words, as assessed by a lexical decision task. The results showed that thin-ideal exposure did not affect negative word accessibility under low cognitive load but that it increased it under high cognitive load. These findings are consistent with the hypothesis that social comparison with the thin ideal is an automatic process, and contribute to explain why some strategies to prevent negative effects of thin-ideal exposure are inefficient.

Treatment of Intrusive Suicidal Imagery Using Eye Movements

Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions.

Understanding suicide among older adults: a review of psychological and sociological theories of suicide

OBJECTIVES

Older adults die by suicide at a higher rate than any other age group in nearly every country globally. Suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviors in later life. Theory-driven investigations hold promise in addressing these gaps by systematically identifying testable, and thus falsifiable, mechanisms that may better explain this phenomenon and also point to specific interventions.

METHOD

In this article, we comprehensively review key extant psychological and sociological theories of suicide and discuss each theory's applicability to the understanding and prevention of suicide among older adults.

RESULTS

Despite a modest number of theories of suicide, few have undergone extensive empirical investigation and scrutiny, and even fewer have been applied specifically to older adults.

CONCLUSION

To advance the science and contribute findings with a measurable clinical and public health impact, future research in this area, from conceptual to applied, must draw from and integrate theory.

Delay and death-thought accessibility: a meta-analysis

The dual-process component of Terror Management Theory (TMT) proposes that different types of threats lead to increases in death-thought accessibility (DTA) after different delay intervals. Experimental studies of terror management threats' effect on DTA were collected and coded for their use of explicitly death-related (vs. not explicitly death-related) threats, and for their use of delay and task-switching during the delay. Results reveal that studies using death-related threats achieved larger DTA effect-sizes when they included more task-switching or a longer delay between the threat and the DTA measurement. In contrast, studies using threats that were not explicitly death-related achieved smaller DTA effect-sizes when they included more task-switching between the threat and the DTA measurement. These findings provide partial support for the dual-process component's predictions regarding delay and DTA. Limitations and future directions are discussed.

The Role of Self-Esteem in Suicides Among Young Men

This study explores self-esteem in suicide among young males with no earlier history of suicide attempt(s) or treatment in mental health services. The data come from an ongoing psychological autopsy study; 10 cases of young men aged 18 to 30, were selected to generate a phenomenologically based understanding of the psychological mechanisms and processes involved in the suicidal process. The analyses are based on in-depth interviews with 61 closely connected individuals, as well as suicide notes. We used Interpretative Phenomenological Analysis. For these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with personal defeats. According to their significant others, the deceased seemed to have experienced intolerable discrepancies between their actual performances and their ideal self standards. Four themes emerged from the analysis: (a) striving to find a viable path to life as an adult man; (b) experiencing a sense of failure according to own standards; (c) emotional self-restriction in relationships; and (d) strong feelings of loneliness and rejection of self. Improved understanding of suicides outside the mental illness paradigm may have important implications for preventive strategies.

Single exposure to disclaimers on airbrushed thin ideal images increases negative thought accessibility

Disclaimers on airbrushed thin ideal images can attract attention to the thin ideal standard promoted by the advertisements, which can be damaging rather than helpful. In this study, 48 female college students were exposed to a thin ideal image including a disclaimer, a neutral sentence, or nothing. Two weeks and two months after this, they were again exposed to the same image but with no accompanying text in any of the conditions. Negative thought accessibility was assessed three times, after each exposure to the thin-ideal image, using reaction time measures. Participants randomly assigned to the disclaimer condition systematically showed greater accessibility of negative thoughts than those in the other two conditions, irrespective of the time of measurement. These results suggest that disclaimers on airbrushed images may have some counter-productive effects by accentuating the problems that they precisely aim to address.

Grit and perseverance in suicidal behavior and non-suicidal self-injury

Data indicate persistence facilitates suicidal behavior. Non-suicidal self-injury (NSSI) is characterized by difficulty persisting while upset. The relationship between NSSI and suicidal behavior thus may hinge upon persistence. Participants were 604 undergraduates (79.5% women; 42.4% African American; 6.1% with 1 + prior suicide attempt). Data were collected online via self-report and analyzed using hierarchical multiple regression. As expected, higher levels of grit and perseverance predicted more frequent suicide attempts. Furthermore, grit and perseverance moderated the relationship between NSSI and suicide attempts, which increased in magnitude as individuals reported greater persistence. Findings depict suicidal behavior as a deliberate pursuit of death.

Does the thought of death contribute to the memory benefit of encoding with a survival scenario?

Four studies tested whether the thought of death contributes to the survival processing advantage found in memory tests (i.e., the survival effect). In the first study, we replicated the "Dying To Remember" (DTR) effect identified by Burns and colleagues whereby activation of death thoughts led to better retention than an aversive control situation. In Study 2, we compared an ancestral survival scenario, a modern survival scenario and a "life-after-death" scenario. The modern survival scenario and the dying scenario led to higher levels of recall than the ancestral scenario. In Study 3, we used a more salient death-thought scenario in which people imagine themselves on death row. Results showed that the "death-row" scenario yielded a level of recall similar to that of the ancestral survival condition. We also collected ratings of death-related thoughts (Studies 3 and 4) and of survival-related and planning thoughts (Study 4). The ratings indicated that death-related thoughts were induced more by the dying scenarios than by the survival scenarios, whereas the reverse was observed for both survival-related and planning thoughts. The findings are discussed in the light of two contrasting views of the influence of mortality salience in the survival effect.

Psychological models of suicide

Suicidal behavior is highly complex and multifaceted. Consequent to the pioneering work of Durkheim and Freud, theoreticians have attempted to explain the biological, social, and psychological nature of suicide. The present work presents an overview and critical discussion of the most influential theoretical models of the psychological mechanisms underlying the development of suicidal behavior. All have been tested to varying degrees and have important implications for the development of therapeutic and preventive interventions. Broader and more in-depth approaches are still needed to further our understanding of suicidal phenomena.

Experimental test of escape theory: accessibility to implicit suicidal mind

This study tested the Escape Theory prediction that individuals blaming themselves for failure experience increased accessibility to implicit suicidal mind. One hundred and thirty-eight undergraduate medical students were randomly assigned to three groups: failure-related priming, success-related priming, and control. Following experimental conditions, participants completed a death/suicide Implicit Association Test. Results revealed significant differences between groups in accessibility to implicit suicidal mind. Furthermore, priming manipulation interacted with individual differences in locus of control (LOC). Significant differences in accessibility to implicit suicidal mind were observed in individuals with internal LOC, while effects of priming manipulation were eliminated in individuals with external LOC.

Goal Commitments and the content of thoughts and dreams: basic principles

A few empirically supported principles can account for much of the thematic content of waking thought, including rumination, and dreams. (1) An individual’s commitments to particular goals sensitize the individual to respond to cues associated with those goals. The cues may be external or internal in the person’s own mental activity. The responses may take the form of noticing the cues, storing them in memory, having thoughts or dream segments related to them, and/or taking action. Noticing may be conscious or not. Goals may be any desired endpoint of a behavioral sequence, including finding out more about something, i.e., exploring possible goals, such as job possibilities or personal relationships. (2) Such responses are accompanied and perhaps preceded by protoemotional activity or full emotional arousal, the amplitude of which determines the likelihood of response and is related to the value placed on the goal. (3) When the individual is in a situation conducive to making progress toward attaining the goal, the response to goal cues takes the form of actions or operant mental acts that advance the goal pursuit. (4) When circumstances are unfavorable for goal-directed operant behavior, the response remains purely mental, as in mind-wandering and dreaming, but still reflects the content of the goal pursuit or associated content. (5) Respondent responses such as mind-wandering are more likely when the individual is mentally unoccupied with ongoing tasks and less likely the more that is at stake in the ongoing task. The probability of respondent thought is highest during relaxed periods, when the brain’s default-mode network dominates, or during sleep. The article briefly summarizes neurocognitive findings that relate to mind-wandering and evidence regarding adverse effects of mind-wandering on task performance as well as evidence suggesting adaptive functions in regard to creative problem-solving, planning, resisting delay discounting, and memory consolidation.

The Relationship Between Negative Life Events and Suicidal Behavior

Background: Individuals who experience negative life events may be at increased risk for suicidal behavior. Intrapersonal characteristics, such as basic psychological needs, however, may buffer this association. Aims: To assess the potential moderating role of overall basic psychological needs, and the separate components of autonomy, competence, and relatedness, on the association between negative life events and suicidal behavior. Method: Our sample of 439 college students (311 females, 71%) completed the following self-report surveys: Life Events Scale, Basic Psychological Needs Scale, Beck Depression Inventory – II, and the Suicide Behaviors Questionnaire-Revised. Results: In support of our hypotheses, negative life events were associated with greater levels of suicidal ideation and attempts, and satisfaction of basic psychological needs, including autonomy, relatedness, and competence, significantly moderated this relationship, over and above the effects of the covariates of age, sex, and depressive symptoms. Conclusions: Suicidal behavior associated with the experience of negative life events is not inevitable. Therapeutically bolstering competence, autonomy, and relatedness may be an important suicide prevention strategy for individuals experiencing life stressors.

Love and suicide: the structure of the Affective Intensity Rating Scale (AIRS) and its relation to suicidal behavior

BACKGROUND

Suicide has been linked to intense negative affect. However, little is known about the range of affects experienced by suicidal persons, or the separate effects of affect valence and intensity. We examine a novel self-report scale, the 17-item Affective Intensity Rating Scale (AIRS), and its relation to suicidality in a high-risk sample.

METHODOLOGY/PRINCIPAL FINDINGS

Patients presenting with suicidality were recruited from the Emergency Department in a large urban hospital, and completed a battery of assessments there. Structure of the AIRS was assessed using Maximum Likelihood Factor Analysis with Oblimin rotation. Convergent and divergent validity were assessed by regressing AIRS subscales against Brief Symptom Inventory subscales. Relation to suicidality was assessed by regression of suicide attempt status against scale and subscale scores, and individual items and two-way item interactions, along with significant clinical and demographic factors. 176 subjects were included in analyses. Three reliable subscales were identified within the AIRS measure: positive feelings towards self, negative feelings towards self, and negative feelings towards other. Only individual AIRS items associated significantly with suicide attempt status; strong 'feelings of love' associated positively with actual suicide attempt, while 'feelings of calm' and 'positive feelings towards self' associated negatively. Interaction analyses suggest 'calm' moderates the association of 'love' with suicide attempt.

CONCLUSIONS/SIGNIFICANCE

Factor analysis of the AIRS is consistent with a circumplex model of affect. Affective dimensions did not predict suicidal behavior, but intense feelings of love, particularly in the absence of protective feelings of calm or positive self-view associated with current attempt.

Self-referential thinking, suicide, and function of the cortical midline structures and striatum in mood disorders: possible implications for treatment studies of mindfulness-based interventions for bipolar depression

Bipolar depression is often refractory to treatment and is frequently associated with anxiety symptoms and elevated suicide risk. There is a great need for adjunctive psychotherapeutic interventions. Treatments with effectiveness for depressive and anxiety symptoms as well as suicide-related thoughts and behaviors would be particularly beneficial. Mindfulness-based interventions hold promise, and studies of these approaches for bipolar disorder are warranted. The aim of this paper is to provide a conceptual background for such studies by reviewing key findings from diverse lines of investigation. Results of that review indicate that cortical midline structures (CMS) appear to link abnormal self-referential thinking to emotional dysregulation in mood disorders. Furthermore, CMS and striatal dysfunction may play a role in the neuropathology underlying suicide-related thoughts and behaviors. Thus, combining studies of mindfulness interventions targeting abnormal self-referential thinking with functional imaging of CMS and striatal function may help delineate the neurobiological mechanisms of action of these treatments.