Change in Experiential Avoidance is Associated with Reduced Suicidal Ideation over the Course of Psychiatric Hospitalization

Prevalence and associated factors of passive suicidal ideation in a population treated by a community mental health unit

BACKGROUND

Suicide is a major public health problem affecting an increasing number of people. It is a complex and multicausal phenomenon whose first step is passive suicidal ideation (PSI). The identification of people with PSI could facilitate specific interventions with those who are at greater risk and/or suffering.

AIMS

To explore the frequency of passive suicidal ideation (PSI) and its association with sociodemographic, psychological, and psychopathological variables in a sample of persons seen in first consultation in a community mental health unit.

METHODS

Data from 2,354 persons seen in first consultation in a community mental health unit were analyzed. Descriptive statistics were used for quantitative variables, and frequency distribution was used for qualitative variables. Differences between groups were explored using the t-test for independent groups and Chi-square for qualitative variables.

RESULTS

The results showed a high frequency of these ideas in the analyzed sample, with a notable prevalence where more than half of the subjects (55.6%) reported experiencing these ideas in the last 2 weeks. There was a significant association of these ideas with sociodemographic variables such as age, type of cohabitation, and employment status. Likewise, significant positive associations were observed with symptom severity (depressive and anxious) and with the functional impact of these symptoms, with an increase in the PSI as symptom intensity and functional impact increase. Experiential avoidance and social support also showed a highly significant association with PSI. There was an increase in PSI as experiential avoidance increased and a decrease in PSI as social support increased.

CONCLUSIONS

The high prevalence of PSI within the clinical mental health sample highlights the critical need for targeted interventions. The significant associations with sociodemographic variables, symptom severity, functional impact, experiential avoidance, and social support emphasize the multifaceted nature of PSI and the importance of addressing these factors in clinical practice to effectively reduce PSI and improve overall mental health outcomes.

The role of suicidal mental imagery and experiential avoidance in suicidality: an exploratory study

BACKGROUND

Although research has highlighted that suicidal imagery (SuiMI) and experiential avoidance (EA) are important in understanding suicidality, there is a need to understand how they potentially interact. Previous research has highlighted that EA potentially leads to increased cognitive intrusions, but it not known whether EA leads to increased SuiMI.

AIMS

The purpose of this study was to explore the influence of SuiMI and EA on suicidality (i.e. encompassing thoughts, behaviour and suicide attempts). It was hypothesised that greater frequency of SuiMI would be associated with greater EA. It was also hypothesised that greater SuiMI would be associated with greater suicidality, and that EA would moderate this relationship.

METHOD

Hypotheses were tested by surveying 197 general university students who completed self-report measures that assessed suicide-related mental imagery (i.e. Suicidal Imagery Questionnaire, SIQ), experiential avoidance (i.e. Multi-dimensional Experiential Avoidance Questionnaire, MEAQ) and suicidality (i.e. Suicidal Behaviours Questionnaire-Revised, SBQ-R).

RESULTS

Frequency of SuiMI was positively correlated with the tendency to engage in EA. SuiMI was a significant predictor of both suicidality and EA. Exploratory analysis found that voluntary SuiMI explained greater variance in suicidality than intrusive, involuntary SuiMI, and that SuiMI only predicted EA in low-risk participants and not for those at high risk of suicide. EA did not predict suicidality and it also did not show any moderating effect on the relationship between SuiMI and suicidality.

CONCLUSION

There is evidence to suggest that suicide-related mental imagery may play an important role in suicide risk and more specifically imagery that is voluntarily engaged with. Future research is needed to explore the different types of imagery in relation to suicidal ideation in populations at higher risk of suicide.

Barriers to and Facilitators of Mental Health Treatment Among Suicidal Individuals

Many suicidal individuals do not access outpatient treatment, and those who do often do not receive empirically supported treatments for reducing suicide risk. Few studies have investigated the barriers to and facilitators of outpatient mental health (MH) treatment among suicidal individuals. We used a survey to understand the experiences of those with a history of suicidal ideation. Participants (N = 111) with a history of suicidal ideation during adulthood answered questions about their history of suicidal thoughts and behaviors (STBs), MH treatment, and their perceptions of barriers to and facilitators of treatment. We found that participants who reported a lifetime suicide attempt endorsed greater barriers to (t(106) = 2.76, p = .003) and weaker facilitators of (t(109) = -1.8, p = .037) receiving outpatient treatment for STBs; additionally, attitudinal barriers were associated with having made a suicide attempt (OR = 3.47, 95% CI [1.18, 10.20], p = .024). These results emphasize the importance of efforts to bolster facilitators and mitigate barriers to treatment for STBs. Future work should continue to elucidate treatment barriers and facilitators to improve treatment engagement for suicidal individuals.

Beliefs about mental health treatment, treatment initiation, and suicidal behaviors among veterans and service members at-risk for suicide and not in treatment

INTRODUCTION

Previous research has identified a variety of barriers to mental health care among military personnel and veterans, despite high rates of mental health symptoms. The current study is the first to examine beliefs about mental health treatment barriers among post-9/11 military personnel and veterans at elevated suicide risk not involved in treatment and whether these beliefs are associated with treatment initiation, engagement, or suicidal behaviors.

METHODS

Four hundred and twenty-two participants reported on beliefs about treatment during a cognitive behavioral treatment session and responded to follow-up questionnaires on mental health treatment initiation, engagement, and suicidal behaviors over 12 months. Beliefs identified in the therapy session were coded thematically, and rates of treatment initiation, engagement, and suicidal behavior were examined by belief category.

RESULTS

Nine belief themes emerged. Participants reporting logistical barriers and preferences about treatment type were least likely to initiate mental health treatment and participated in the fewest number of sessions, respectively. Participants endorsing beliefs about stigma or using other ways to cope were most likely to engage in suicidal behavior.

CONCLUSIONS

The current findings point to specific beliefs that may identify individuals who would benefit from systemic and individual interventions for mental health treatment engagement.

The Brief Experiential Avoidance Questionnaire: Validation of the French Version in Non-clinical Adults

Introduction

Various studies indicate the role of experiential avoidance (EA) in the onset and maintenance of mental health disorders such as depression or anxiety disorders. The Brief Experiential Avoidance Questionnaire (BEAQ) is a quick tool to assess EA.

Objective

This study aimed to translate the BEAQ into French and to validate it in a sample of non-clinical adults.

Method

The BEAQ was translated from English into French using the translation and back-translation technique. The translated questionnaire was submitted to 93 psychology students to identify unclear/ambiguous items. Then, the final French and the original versions of the BEAQ were administered to 64 bilingual individuals two weeks apart to assess the scale's content validity and test-retest reliability. Finally, the BEAQ-French and other scales were administered to 580 non-clinical adults to assess its factor structure and its convergent and discriminant validity.

Results

Results showed no significant difference between the English and French versions of the BEAQ. The BEAQ demonstrated high internal consistency and good test-retest reliability. Confirmatory factor analyses did not support the one-factor structure of the BEAQ. Exploratory factor analyses revealed a two-factor structure. The BEAQ presented satisfactory convergent and discriminant validity with related measures and measures of neuroticism, negative affect and mental health problems.

Conclusion

The results suggest that the BEAQ-French is a reliable tool for assessing EA. Unlike the original version, the BEAQ-French exhibits a two-factor rather than a one-factor structure. Further research is needed to confirm this two-factor structure and to assess more precisely the convergent validity of the scale.

Examining aspects of psychological flexibility within the integrated motivational-volitional model of suicidal behavior: A prospective investigation

BACKGROUND

According to the integrated motivational-volitional model of suicide, feelings of entrapment are related to the emergence of suicidal ideation (SI). However, this relation can be moderated by certain protective factors.

METHODS

This study examined whether aspects of psychological flexibility (i.e., experiential avoidance, experiential acceptance, harnessing) moderated the relation between aspects of entrapment and SI severity in college students experiencing SI (N = 553) both cross-sectionally and when SI severity was measured 1 week later (N = 247).

RESULTS

At baseline, experiential acceptance, but not experiential avoidance or harnessing, significantly moderated the relation between external entrapment and SI severity and internal entrapment and SI severity. No aspects of psychological flexibility prospectively moderated relations between entrapment and SI severity.

CONCLUSIONS

Aspects of psychological flexibility may influence immediate vulnerability to SI severity among young adults experiencing feelings of entrapment. Implications for clinical interventions influencing changes in psychological flexibility are discussed.

Psychological maltreatment, meaning-centered coping, psychological flexibility, and suicide cognitions: A moderated mediation model

BACKGROUND

Mental health problems are currently diversifying, increasing the possibility of suicide. Exposure to psychological maltreatment is one of the factors that increases suicidal cognitions. In addition, psychological flexibility and meaning-centered approaches may be effective in coping with suicidal cognitions.

OBJECTIVE

A hypothesized model was tested to examine the relationships among psychological maltreatment, suicidal cognitions, psychological flexibility, and meaning-centered coping.

METHOD

Data were collected from a sample of 652 participants. Mediation and moderation analyses were conducted to examine the mediating and moderating role of psychological flexibility and meaning-centered coping in the relationship between childhood psychological maltreatment and suicide cognitions among Turkish adults.

RESULTS

The results of the study indicated significant negative and positive relationships between psychological maltreatment, suicide cognitions, psychological flexibility, and meaning-centered coping. The findings suggest that psychological flexibility and meaning-centered coping have a serial mediating effect on the relationship between psychological maltreatment and suicide cognitions. Furthermore, according to the study results, psychological flexibility plays a moderating role both between psychological maltreatment and suicidal cognitions and between meaning-centered coping and suicidal cognitions.

CONCLUSIONS

The study suggests that psychological maltreatment can be considered as a risk factor and meaning-centered coping and psychological flexibility as protective factors in suicide prevention studies.

Experiential Avoidance, Pain, and Suicide Risk in a National Sample of Gulf War Veterans

OBJECTIVE

Pain confers risk for suicidal thoughts and behaviors. Experiential avoidance (EA), which is relevant to both pain and suicide risk, has not been studied as a potential mechanism for this relationship. The present study tested the hypothesis that pain indirectly impacts suicide risk through EA in a national sample of Gulf War veterans.

METHODS

Participants included a stratified random sample of United States veterans (N = 1,012, 78% male) who had served in the Gulf War region between August 1990 and July 1991. Validated scales were used to quantify levels of pain, EA, and suicide risk.

RESULTS

Regression analyses indicated independent associations between pain, EA, and suicide risk; moreover, the association between pain and suicide risk was no longer significant once EA was included in model. Bootstrapping analyses confirmed that EA partially accounted for the cross-sectional association between pain and suicide risk, independent of common co-occurring problems, such as depression, PTSD, and alcohol use disorder symptoms.

CONCLUSIONS

EA could be a key modifiable risk factor to target in people experiencing pain.

The Mediating Roles of Affect Lability and Experiential Avoidance Between Distress Tolerance and Suicidal Ideation Among College Students

Objective: Suicidal ideation (SI) is highly prevalent among college students. Research has shown that college students are also more likely to experience low distress tolerance, affect lability, and experiential avoidance, which have been linked to SI. There is a critical need to examine the mechanisms that increase the risk of SI among college students. It is hypothesized that distress tolerance will be a strong predictor of SI, and affect lability as well as experiential avoidance will mediate this relationship. Participants and Methods: Participants (n = 820) from a Southeastern University completed an online survey, inquiring about demographic information, affect lability, SI, experiential avoidance, and distress tolerance. Data were analyzed utilizing structural equation modeling. Results: Distress tolerance was not directly related to SI. However, affect lability and experiential avoidance were found to mediate this relationship. Conclusions: Affect lability and experiential avoidance may be important predictors of SI among college students.

A preliminary investigation of the relationship between internalized stigma, experiential avoidance, and suicidal thoughts and behaviors in college students

Objective: Examine the relationship between internalized stigma, experiential avoidance (EA), and suicidal thoughts and behaviors (STBs) in a sample of college students, and explore whether EA accounts for part of the relationship between internalized stigma, EA, and STBs.Participants: College students (N=78) completed online questionnaires about demographic information, internalized stigma, EA, and STBs.Results: A simple mediation model evaluated the indirect effect of internalized stigma on STBs through EA, controlling for the presence of a mental health disorder diagnosis. Results: Internalized stigma, STBs, and EA were all positively correlated. EA partially mediated the relationship between internalized stigma and STBs.Conclusion: Despite decades of research and prevention efforts, STBs remain a pervasive problem. There is an urgent need to identify modifiable predictors of STBs. Internalized stigma is a risk factor for STBs, and recent research suggests EA might be a mechanism linking internalized stigma and STBs. Our findings suggest EA might represent a modifiable mechanism of change in the context of both anti-stigmatization and suicide prevention programs.

Non-suicidal self-injury in Chinese college students with elevated autistic traits: Associations with anxiety, rumination and experiential avoidance

Although existing studies have proved that autistic traits (AT) may have relations to non-suicidal self-injury (NSSI) behaviors, its associations with anxiety, rumination and experiential avoidance (EA) are still unclear. The current study, based on a sample of 1317 Chinese college students, explored the associations between AT, anxiety and NSSI, and the possible modulating roles of rumination and EA in these associations. The results shows that 1) a total of 334 (25.36%) students reported a history of NSSI and 30 (2.28%) students were categorized as high AT; 2) Students with high AT reported higher rates of NSSI than those with low AT (36.67% vs. 25.10%); 3) AT, anxiety, rumination and EA have positive relations with NSSI; 4) AT predicted NSSI indirectly through anxiety; 5) Rumination and EA significantly moderated the effects of AT on NSSI via anxiety. In conclusion, this study confirms the indirect effect of AT on NSSI through anxiety in Chinese college students, and further clarifies the reinforcing effects of rumination and EA on the associations between AT, anxiety and NSSI. These findings suggest that developing adaptive emotion-regulating strategies and positive coping styles might promote the prevention and treatment of NSSI behaviors among autistic individuals.

Non-suicidal self-injury and suicidal ideation among Chinese college students of childhood emotional abuse: associations with rumination, experiential avoidance, and depression

Background

Prior studies have proved the relationships between childhood emotional abuse (CEA) histories and suicidal thoughts or behaviors in adulthood, however, how emotion regulation strategies work as the mediating mechanism is necessary to be investigated. This study aimed to further verify the impacts of rumination, experiential avoidance (EA) and depression on the associations between CEA and non-suicidal self-injury (NSSI) and suicidal ideation (SI) on a sample of Chinese college students.

Methods

The Childhood Emotional Abuse Questionnaire, the Non-Suicidal Self-Injury Questionnaire, the Symptom Checklist, the Ruminative Response Scale, the Acceptance and Action Questionnaire-II and the Zung Self-Rating Depression Scale were completed by 1,317 college students.

Results

The rates of NSSI and SI of students with CEA experiences were 31.70 and 7.90% respectively, both higher than those without such experiences. The mediating roles of rumination, EA and depression between CEA and NSSI and SI were significant (p < 0.01).

Conclusion

The current study shed light on the linking roles of rumination, EA and depression in the relations between CEA and NSSI and SI. It is suggested that developing adaptive emotion-regulating strategies may be helpful to the intervention of suicidal thoughts or behaviors among individuals with CEA experiences.

How does psilocybin therapy work? An exploration of experiential avoidance as a putative mechanism of change

BACKGROUND

Psilocybin therapy is receiving attention as a mental health intervention with transdiagnostic potential. In line with psychotherapeutic research, qualitative research has highlighted the role of reductions in experiential avoidance (and increases in connectedness) within psilocybin therapy. However, no quantitative research has examined experiential avoidance as a mechanism underlying psilocybin therapy's therapeutic effects.

METHOD

Data was used from a double-blind randomized controlled trial that compared psilocybin therapy (two 25 mg psilocybin session plus daily placebo for six weeks) with escitalopram (two 1 mg psilocybin sessions plus 10-20 mg daily escitalopram for six weeks) among individuals with major depressive disorder (N = 59). All participants received psychological support. Experiential avoidance, connectedness, and treatment outcomes were measured at pre-treatment and at a 6 week primary endpoint. Acute psilocybin experiences and psychological insight were also measured.

RESULTS

With psilocybin therapy, but not escitalopram, improvements in mental health outcomes (i.e., well-being, depression severity, suicidal ideation, and trait anxiety) occurred via reductions in experiential avoidance. Exploratory analyses suggested that improvements in mental health (except for suicidal ideation) via reduction in experiential avoidance were serially mediated through increases in connectedness. Additionally, experiences of ego dissolution and psychological insight predicted reductions in experiential avoidance following psilocybin therapy.

LIMITATIONS

Difficulties inferring temporal causality, maintaining blindness to condition, and reliance upon self-report.

CONCLUSIONS

These results provide support for the role of reduced experiential avoidance as a putative mechanism underlying psilocybin therapy's positive therapeutic outcomes. The present findings may help to tailor, refine, and optimize psilocybin therapy and its delivery.

Experiential Avoidance, Posttraumatic Stress Disorder, and Self-Injurious Thoughts and Behaviors: A Moderation Analysis in a National Veteran Sample

Experiential avoidance (EA) is associated with posttraumatic stress disorder (PTSD) and self-injurious thoughts and behaviors (SITBs) across different populations, and extant literature has demonstrated a strong relationship between PTSD and SITBs. However, no study has explored the potential moderating role EA plays in the association of PTSD with nonsuicidal self-injury (NSSI), suicidal ideation, and suicide attempts. The objective of the present study was to determine if EA would moderate the association with PTSD and SITBs such that the association between PTSD and individuals SITBs would be stronger among individuals with higher EA. In a large national sample of Gulf War Era veterans (N = 1,138), EA was associated with PTSD, lifetime and past-year NSSI, current suicidal ideation, and lifetime suicide attempts in bivariate analyses. Multivariate analyses detected a significant EA by PTSD interaction on lifetime NSSI (AOR = 0.96), past-year NSSI (AOR = 1.03), and suicide attempts (AOR =1.03). Probing of the interactions revealed that the respective associations between PTSD, lifetime and past-year NSSI, and suicide attempts were stronger at lower levels of EA (i.e., better), counter to our hypotheses. These preliminary findings contextualize the relationship between these variables in a Gulf War veterans sample and signal the need to further investigate these relationships. Further, these findings highlight the need for advancement in assessment and intervention of EA and SITBs.

Suicidal Behaviour Among Nigerian Undergraduates: Associations with Gambling Disorder and Emotional Dysregulation

Background: There is a high prevalence of suicidal behavior among Nigerian youths. However, the connections between suicidal behavior and precipitating factors, such as gambling disorder and emotional dysregulation (ED) in this population, are not well researched. Objectives: The present study examined the associations between gambling disorder, ED, and suicidal behavior in Nigerian university undergraduate students. Methods: This study was carried out during October 2020 - April 2021 on 1338 undergraduates with a mean ± SD age of 19.84 ± 3.22 years selected using random and purposive sampling for the universities and participants respectively. Participants responded to the Attitudes Towards Gambling Scale, Difficulties in Emotion Regulation Scale, and Redeemer's University Suicidality Scale. Descriptive statistics (simple percentages) and inferential statistics (Pearson’s correlation and regression analysis) were used for data analysis. Results: The Pearson's correlation revealed that suicidal behaviour had significant positive correlations with the nonacceptance of emotional responses or distress (r = 0.22, P = 0), difficulties engaging in goal-directed behaviours (r = 0.21, P = 0), difficulties in impulse control (r = 0.27, P = 0), the lack of emotional awareness (r = 0.14, P = 0), limited access to emotional regulation strategies (r = 0.33, P = 0), the lack of emotional clarity (r = 0.32, P = 0), and difficulties in emotional regulation (r = 0.4, P = 0). Problematic gambling (PG) independently predicted suicidal behavior, while PG and ED dimensions jointly predicted suicidal behavior. The ED dimensions contributed 15% incrementally to the prediction of suicidal behavior and beyond the 2% variance accounted for PG in undergraduates. Conclusions: Our results showed positive links between PG, ED, and suicidal behavior among Nigerian undergraduates. It suggests that the combination of PG and ED increases the severity of suicidal behavior among students.

The Roles of Emotion Regulation Self-Efficacy and Emotional Avoidance in Self-Injurious Thoughts and Behaviors

Little research has examined the role of emotion regulation self-efficacy (ERSE; i.e., beliefs in one's own ability to regulate emotions) in self-injurious thoughts and behaviors (SITBs) or the factors that may underlie this relation. This study investigated whether low ERSE relates to SITBs both directly and indirectly through avoidance of negative emotions. Participants (N = 364) completed measures of ERSE, emotional avoidance, suicide attempt history, nonsuicidal self-injury (NSSI), and current severity of suicidal ideation through Amazon's Mechanical Turk. Low ERSE was significantly associated with history of suicide attempts, recent NSSI, and current severity of suicidal ideation both directly and indirectly through avoidance of negative emotions. Furthermore, low ERSE was significantly associated with a greater number of SITB types both directly and indirectly through emotional avoidance.

An Ecological Momentary Intervention Study of Emotional Responses to Smartphone-Prompted CBT Skills Practice and the Relationship to Clinical Outcomes

The practice of therapeutic skills outside of sessions in which they are learned is one presumed key component of cognitive behavioral therapy (CBT). Yet, our understanding of how skills practice relates to clinical outcomes remains limited. Here, we explored patients' emotional responses to CBT skills practice in a pilot study pairing smartphone-app-delivered skills reminders and guided practice (ecological momentary intervention [EMI]) using ecological momentary assessment (EMA). Participants (n = 25) were adults recently hospitalized for a suicide attempt or severe suicidal thinking. They received brief inpatient CBT (1 to 3 sessions covering core CBT skills from the Unified Protocol), followed by 1 month of EMI and EMA after discharge. On average, participants reported modest reductions in negative affect after skills use (i.e., immediate responses; median time elapsed = 4.30 minutes). Additionally, participants tended to report less negative affect when the timepoint preceding the current assessment included EMI skills practice, rather than EMA alone (i.e., delayed responses; median time elapsed between prompts = 2.17 hours). Immediate effects were unrelated to longer-term clinical outcomes, whereas greater delayed effects were associated with lower symptom severity at follow-up. Future studies should further examine how CBT skills use in daily life may alleviate symptoms.

Experiential avoidance in non-suicidal self-injury and suicide experiences: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aimed to (i) examine the associations between experiential avoidance (EA), non-suicidal self-injury (NSSI), and suicide experiences, and (ii) identify sample- and methodological-related variables affecting the strength of these associations.

METHOD

Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random-effect meta-analyses were applied. The I² statistic and the Egger's test assessed heterogeneity and publication bias. Meta-regression analyses were used to evaluate the impact of moderator variables on the strength of these associations.

RESULTS

Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong.

DISCUSSION

The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.

The role of emotion dysregulation in the association between posttraumatic stress disorder symptoms and suicidal thoughts and behaviors among veterans

OBJECTIVE

Although research has established a link between posttraumatic stress disorder (PTSD) symptoms and suicidal thoughts and behaviors (STBs), little is known about factors that may accentuate this relation. This study evaluated the influences of negative and positive emotion dysregulation on the association between PTSD symptoms and STBs among veterans.

METHODS

Four-hundred and sixty-five trauma-exposed military veterans in the community (M age  = 38.00, 71.4% male, 69.5% White) completed online questionnaires.

RESULTS

Negative emotion dysregulation did not moderate the relation between PTSD symptoms and STBs. Results showed significant interactive effects of PTSD symptoms and positive emotion dysregulation on STBs, such that PTSD symptoms were more strongly related to STBs at high (vs. low) levels of positive emotion dysregulation. This effect was sustained across domains of positive emotion dysregulation.

CONCLUSIONS

Findings suggest a potential need to consider positive emotion dysregulation in the assessment and treatment of STBs among veterans with PTSD symptoms.

The after-effects of momentary suicidal ideation: A preliminary examination of emotion intensity changes following suicidal thoughts

Research using ecological momentary assessments has highlighted the importance of negative emotions as predictors of day-to-day suicidal thoughts. Yet only one study has examined the real-time consequences of these thoughts. This preliminary investigation examined changes in emotion intensity following suicidal thoughts. It also explored associations between these changes and endorsement of suicide functions as an escape and/or as a solution, examined both as momentary thoughts and intractable beliefs about suicide. Thirty-nine community participants endorsing suicidal ideation were followed for two-weeks and completed multiple daily surveys related to suicidal thoughts, functions of suicide, and emotion intensity. Participants reported heightened emotion intensity immediately following a suicidal thought across six emotions, with delayed reductions in stress and anxiety following ideation onset. When assessed in the moment, suicide as a solution to a problem predicted increases in hopelessness, sadness, stress and general negative affect immediately following a thought, while suicide as an escape predicted increases in anger immediately after a thought. When measured as intractable beliefs, only stronger belief in suicide as a solution to a problem predicted delayed reductions in stress following ideation. Increased intensity of negative emotions immediately following suicidal ideation suggests a potential vicious cycle of heightened emotion intensity and suicidality.

The effects of alexithymia, experiential avoidance, and childhood sexual abuse on non-suicidal self-injury and suicidal ideation among Chinese college students with a history of childhood sexual abuse

BACKGROUND

Although previous studies have shown that childhood sexual abuse (CSA) experiences might be related to suicide-related thoughts and behaviours in later life, the effects of alexithymia and experiential avoidance (EA) on this relationship have remained unclear. The present study aimed to expand prior findings among Chinese college students with a history of CSA in order to further test the effects of alexithymia on the relationship between CSA and non-suicidal self-injury (NSSI) and suicidal ideation (SI), and its indirect effects on NSSI and SI through EA.

METHODS

The Childhood Sexual Abuse Questionnaire, the Toronto Alexithymia Scale-20, the Acceptance and Action Questionnaire-II, the Non-Suicidal Self-Injury Questionnaire, and the Symptom Checklist were completed by 6,834 college students (3,829 female).

RESULTS

Overall, 1404 (20.76%) Chinese college students reported experiences of CSA; students with CSA experiences reported higher rates of SI and NSSI than those without CSA (12.82% vs. 4.50%, 35.11% vs. 20.82%). CSA, alexithymia, and EA were positively related to NSSI and SI. The effect of alexithymia on the relationship between CSA and NSSI and SI were significant. The effects of EA on the relationship between alexithymia and NSSI and SI were significant, too.

LIMITATIONS

The major limitations of this study are its cross-sectional design and the use of self-report scales, especially retrospective self-reports (e.g., the Childhood Sexual Abuse Questionnaire).

CONCLUSIONS

This study cast light on the effects of alexithymia, EA, and CSA on NSSI and SI in Chinese college students with a history of CSA. These findings can contribute to the prevention and treatment of suicide-related thoughts and behaviours.

Rapid and sustained decreases in suicidality following a single dose of ayahuasca among individuals with recurrent major depressive disorder: results from an open-label trial

RATIONALE

Suicidality is a major public health concern with limited treatment options. Accordingly, there is a need for innovative interventions for suicidality. Preliminary evidence indicates that treatment with the psychedelic ayahuasca may lead to decreases in depressive symptoms among individuals with major depressive disorder (MDD). However, there remains limited understanding of whether ayahuasca also leads to reductions in suicidality.

OBJECTIVE

To examine the acute and post-acute effect of ayahuasca on suicidality among individuals with MDD.

METHODS

We conducted a secondary analysis of an open-label trial in which individuals with recurrent MDD received a single dose of ayahuasca (N = 17). Suicidality was assessed at baseline; during the intervention; and 1, 7, 14, and 21 days after the intervention.

RESULTS

Among individuals with suicidality at baseline (n = 15), there were significant acute (i.e., 40, 80, 140, and 180 min after administration) and post-acute (1, 7, 14, and 21 days after administration) decreases in suicidality following administration of ayahuasca. Post-acute effect sizes for decreases in suicidality were large (Hedges' g = 1.31-1.75), with the largest effect size 21 days after the intervention (g = 1.75).

CONCLUSIONS

When administered in the appropriate context, ayahuasca may lead to rapid and sustained reductions in suicidality among individuals with MDD. Randomized, double-blind studies with larger sample sizes are needed to confirm this early finding.

Experiential Avoidance in the Context of the Integrated Motivational-Volitional Model of Suicidal Behavior

Background: According to the integrated motivational-volitional model of suicide, the perception of defeat and entrapment are the variables involved in the development of suicidal ideation. However, entrapment is not an inevitable consequence of feeling defeated. This transition is moderated by a set of variables relating to the ability to resolve the state of defeat. Aim: We aimed to study the potential moderating role of experiential avoidance in the relationship between defeat and entrapment in young adults. Method: A sample of 644 participants residing in Spain (51.2% female; M_age = 25.91, SD_age = 5.14; range = 18-35 years old), selected by sex, age, and education level quotas, completed an online questionnaire consisting of: Defeat Scale; Entrapment Scale; and Acceptance and Action Questionnaire-II; and other sociodemographic variables. Results: Defeat and experiential avoidance had a statistically significant effect on entrapment. The interaction variable (defeat × experiential avoidance) was also statistically significant according to a moderating effect. Limitations: Due to the cross-sectional design, we could not establish causal associations between the variables. Conclusion: People who experience a high degree of defeat and experiential avoidance are more likely to progress to a state of entrapment, being more vulnerable to having suicidal ideation.

Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation

Psychedelic therapy shows promise as a novel intervention for a wide range of mental health concerns but its therapeutic action is incompletely understood. In line with acceptance and commitment therapy's (ACT's) transdiagnostic model, qualitative research has suggested that reductions in experiential avoidance are an important component of therapeutic outcomes associated with psychedelics. However, limited research has quantitatively explored the association between decreases in experiential avoidance and therapeutic outcomes associated with psychedelics. Therefore, in two prospective studies, using convenience samples of individuals with plans to use a psychedelic, we explored the impact of psychedelic use on experiential avoidance, depression severity, and suicidal ideation, as well as relationships between changes in these outcomes. Participants (Study 1, N=104; Study 2, N=254) completed self-report questionnaires of depression severity, suicidal ideation, and experiential avoidance: 1) before using a psychedelic (in ceremonial and non-ceremonial contexts), as well as 2) 2-weeks and 3) 4-weeks after psychedelic use. Across both studies, repeated measures ANOVAs indicated significant decreases in experiential avoidance, depression severity, and suicidal ideation after psychedelic use. Furthermore, decreases in experiential avoidance were significantly associated with decreases in depression severity and suicidal ideation. These results suggest that psychedelics may lead to significant decreases in experiential avoidance, depression severity, and suicidal ideation. Additionally, these findings imply that reduced experiential avoidance may be a transdiagnostic mechanism mediating treatment success within psychedelic therapy. We conclude that integrating psychedelics with psychotherapeutic interventions that target experiential avoidance (e.g. ACT) may enhance therapeutic outcomes.

Psychological Inflexibility Predicts Suicidality Over Time in College Students

OBJECTIVE

It is essential to identify modifiable risk factors that can be targeted to reduce suicidal ideation (SI) and behavior in college students. Psychological inflexibility, a pattern of responding to internal experiences in a literal and rigid way, and attempting to control those experiences even when it interferes with valued living, could theoretically lead to SI or increase its intensity.

METHOD

Psychological inflexibility and its component processes were tested as a predictor of SI in a longitudinal survey of college students (n = 603, age M = 20.62, 68.9% female, and 94.0% White) in a series of cross-sectional and longitudinal hierarchical regression models, controlling for relevant predictors such as distress and baseline SI. Interactions were also tested between psychological inflexibility and distress, cognitive defusion, values obstruction, and values progress in predicting SI.

RESULTS

Psychological inflexibility predicted SI cross-sectionally and longitudinally, controlling for distress and baseline SI. Psychological inflexibility interacted with distress, cognitive fusion, and values progress such that distress, cognitive fusion, and values progress had the strongest association with suicidal ideation among those who were high in psychological inflexibility.

CONCLUSIONS

Psychological inflexibility may be a useful mechanism to target for suicide prevention in college students.

It's the thought that counts: belief in suicide as an escape moderates the relationship between emotion dysregulation and suicidal ideation cross-sectionally and longitudinally

BACKGROUND

Previous research has illustrated a relationship between emotion dysregulation and suicidal ideation, both cross-sectionally and longitudinally. However, it is not yet understood how this relationship manifests. The aim of this study was to explore if two beliefs about suicide, (1) suicide as a way to escape from emotional pain and (2) suicide as a solution to a problem, moderate the relationship between emotion dysregulation and suicidal ideation.

METHODS

One hundred one community participants completed questionnaires examining emotion dysregulation, suicidal ideation, and beliefs in the functions of suicide. Inclusion criteria were used to over-sample individuals within the community experiencing higher levels of suicidal ideation and emotion dysregulation. Hierarchical linear regressions with interaction terms were used to assess moderation effects. The moderating role of beliefs in the function of suicide was examined both cross-sectionally and longitudinally.

RESULTS

Suicide as an escape significantly moderated the relationship between global emotion dysregulation and suicidal ideation cross-sectionally, while it moderated the relationship between a facet of emotion dysregulation and suicidal ideation longitudinally. Greater endorsement of this belief resulted in a stronger relationship between emotion dysregulation and suicidal ideation. The function of suicide as a solution to a problem did not moderate the emotion dysregulation-suicidal ideation relationship.

CONCLUSIONS

These findings underscore the importance of not only addressing emotion dysregulation but also addressing the underlying belief that suicide is an escape in individuals who experience both emotion dysregulation and suicidal ideation. Intervention efforts to address belief in suicide as an escape along with emotion dysregulation are delineated.

[Impact of Parents' Problem Drinking on Suicidal Ideation of Their University Student Children: The Multiple Mediating Effects of Childhood Trauma, Experiential Avoidance and Depression]

PURPOSE

The purpose of this study was to construct and test a hypothetical model about impact of parents' problem drinking on suicidal ideation of their children who are university students and the multiple mediating effects of childhood trauma, experiential avoidance, and depression based on stress-vulnerability model.

METHODS

A purposive sample of 400 university students was recruited from three universities in provincial areas and the data were collected between October and November 2016. The collected data were then analyzed using SPSS 20.0 and AMOS 20.0 programs. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed. Multiple mediating effects analysis using phantom variable and bootstrapping were implemented to verify the mediating effect of the research model.

RESULTS

We found no significant direct effect on depression and suicidal ideation of parents' problem drinking, but multiple mediating effects of childhood trauma and experiential avoidance between parents' problem drinking and depression (B=.38, p=.001). The path from parents' problem drinking to suicidal ideation was significantly mediated by childhood trauma and depression (B=.02, p=.016) and by childhood trauma, experiential avoidance, and depression (B=.05, p=.011), but experiential avoidance did not have a significant direct effect on suicidal ideation (B=.02, p=.616).

CONCLUSION

Based on the results of this study, it can be suggested that in order to decrease depression and prevent suicide of university students, considering of parents' problem drinking and childhood trauma, intervention methods that decreased chronic use of experiential avoidance and strengthen acceptance should be developed and made available to them.

Emotional rigidity negatively impacts remission from anxiety and recovery of well-being

OBJECTIVES

Emotional rigidity is described in clinical literature as a significant barrier to recovery; however, few there are few empirical measures of the construct. The current study had two aims: Study 1 aimed to identify latent factors that may bear on the construct of emotional rigidity while Study 2 assessed the potential impact of the latent factor(s) on anxiety remission rates and well-being.

METHOD

This study utilized data from 2472 adult inpatients (1176 females and 1296 males) with severe psychopathology. Study 1 utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to identify latent factors of emotional rigidity. Study 2 utilized hierarchical logistic regression analyses to assess the relationships among emotional rigidity factors and anxiety remission and well-being recovery at discharge.

RESULTS

Study 1 yielded a two-factor solution identified in EFA was confirmed with CFA. Factor 1 consisted of neuroticism, experiential avoidance, non-acceptance of emotions, impaired goal-directed behavior, impulse control difficulties and limited access to emotion regulation strategies when experiencing negative emotions. Factor 2 consisted of lack of emotional awareness and lack of emotional clarity when experiencing negative emotions. Results of Study 2 indicated higher scores on Factor 1 was associated with lower remission rates from anxiety and poorer well-being upon discharge. Factor 2 was not predictive of outcome.

CONCLUSIONS

Emotional rigidity appears to be a latent construct that negatively impacts remission rates from anxiety. Limitations of the present study include its retrospective design, and inefficient methods of assessing emotional rigidity.

Thwarted interpersonal needs mediate the relation between facets of mindfulness and suicide ideation among psychiatric inpatients

Previous research suggests a negative association between mindfulness and suicide ideation, yet limited research has examined the specific role of mindfulness on suicide ideation or attempted to link this construct with theory-driven risk factors for suicide among high-risk individuals. The current study examined the mediating role of thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness) in the relation between facets of mindfulness and suicide ideation among psychiatric inpatients. Participants were 118 psychiatric inpatients who completed self-report assessments of mindfulness, thwarted belongingness, perceived burdensomeness, and suicide ideation. Results indicated that the additive effect of thwarted belongingness and perceived burdensomeness mediated the relation between the act with awareness, non-judging, and non-reactivity mindfulness facets, and suicide ideation. Facets of mindfulness appear to be differentially related to thwarted interpersonal needs and subsequent suicide ideation. Continued examination of specific facets of mindfulness, as they relate to suicide ideation, may highlight potentially important distinctions and better inform suicide risk assessment and treatment.

Contributions of Cognitions, Psychological Flexibility, and Therapeutic Alliance to Suicidal Ideation in Psychiatric Inpatients

Although suicide treatment is an expanding area of research, there is relatively less in the literature with respect to how specific vulnerabilities to suicide are addressed by treatment. Utilizing measures of suicide cognitions, therapeutic alliance, and psychological flexibility, we compared their relative contributions to suicidal ideation during and posttreatment among a group of adult psychiatric inpatients (N = 434). Results revealed that cognitions contributed considerably more unique variance to suicidal ideation than alliance and flexibility at discharge and at 2 weeks postdischarge, and to change in suicidal ideation over the course of treatment. Psychological flexibility explained a small amount of variance at the 6-month time point. Factor level analyses also were conducted, with the unsolvability factor within suicide cognitions accounting for the largest portion of variance at both discharge and 2 weeks postdischarge. Study limitations, implications, and future directions are discussed.

Functional Coping Dynamics and Experiential Avoidance in a Community Sample with No Self-Injury vs. Non-Suicidal Self-Injury Only vs. Those with Both Non-Suicidal Self-Injury and Suicidal Behaviour

Although emotional avoidance may be a critical factor in the pathway from psychological distress to self-injury and/or suicidality, little is known about the relative importance of differing functional coping dynamics and experiential avoidance between people with self-injury histories of differing intent (e.g., Non-Suicidal Self-Injury only vs. Non-Suicidal Self-Injury plus Suicidal Behaviour; NSSI vs. NSSI + SB). A community-based survey (N = 313; female, 81%; ages 16-49 years, M = 19.78, SD = 3.48) explored self-reported experiential avoidance and functional coping dynamics in individuals with (i) no self-injury history (controls); (ii) a history of NSSI only; and (iii) a history of NSSI + SB. Jonckheere-Terpstra trend tests indicated that avoidance coping was higher in the NSSI and NSSI + SB groups than in controls. Emotion regulation was higher in controls than those with a history of self-injury (NSSI and NSSI + SB). Approach and reappraisal coping demonstrated significant ordered effects such that control participants were higher in these coping dynamics than those with a history of NSSI only, who, in turn, were higher than those with a history of NSSI + SB (Control > NSSI > NSSI + SB). Endorsement of the reappraisal/denial facet of experiential avoidance was most pronounced in those with a history of NSSI + SB (Control < NSSI < NSSI + SB). No significant ordered effects were observed for other dimensions of experiential avoidance. Understanding how the endorsement of functional coping dynamics and which components of experiential avoidance vary between groups with differing self-injury intent histories has important implications for treatment planning.

Recognizing and addressing unique vulnerabilities of suicidal patients: Suicide research at The Menninger Clinic

Suicide risk is an inescapable presence in the treatment of people with psychiatric disorders, a fact that applies especially in inpatient psychiatric settings. This article summarizes a several-year research initiative at The Menninger Clinic aimed at better understanding psychological contributors to suicidality and developing more effective clinical interventions. Two areas of research are described, an outcomes arm focused on assessing the feasibility and effectiveness of a suicide-specific intervention (The Collaborative Assessment and Management of Suicidality) and an exploratory arm whose objective is to learn about psychological vulnerabilities that distinguish suicidal from nonsuicidal patients, with an eye toward developing interventions that address such vulnerabilities. The author concludes that, combined with other developments in the field, this body of work strongly supports the view that suicidal patients should be treated with interventions that specifically target vulnerabilities that seem to set the stage for suicidal episodes.

Treating Suicidality in College Counseling Centers: A Response to Polychronis

This is a commentary on the article by Paul D. Polychronis, "Changes Across Three Editions of The Suicidal Patient: Clinical and Legal Standards of Care: Relevance to Counseling Centers," published in this issue of the Journal of College Student Psychotherapy.

Exploring the Relationship between Experiential Avoidance, Coping Functions and the Recency and Frequency of Self-Harm

This study investigated the relationship between experiential avoidance, coping and the recency and frequency of self-harm, in a community sample (N = 1332, aged 16–69 years). Participants completed online, self-report measures assessing self-harm, momentary affect, experiential avoidance and coping in response to a recent stressor. Participants who had self-harmed reported significantly higher levels of experiential avoidance and avoidance coping, as well as lower levels of approach, reappraisal and emotional regulation coping, than those with no self-harm history. Moreover, more recent self-harm was associated with lower endorsement of approach, reappraisal and emotion regulation coping, and also higher levels of both avoidance coping and experiential avoidance. Higher experiential avoidance and avoidance coping also predicted increased lifetime frequency of self-harm. Conversely, increased approach and reappraisal coping were associated with a decreased likelihood of high frequency self-harm. Although some of the effects were small, particularly in relation to lifetime frequency of self-harm, overall our results suggest that experiential avoidance tendency may be an important psychological factor underpinning self-harm, regardless of suicidal intent (e.g. including mixed intent, suicidal intent, ambivalence), which is not accounted for in existing models of self-harm.