Attempted suicide as an operant behavior

Professional Problems in Treating Suicidal Persons

Because physicians, psychiatrists and other clinicians must constantly deal with suicidal people, it is important to examine the problems and limitations of actual practice. This is made difficult by the paucity of research. What few clinical studies we do have manifest strong patterns which this article identifies as important hypotheses for further investigation. This is the third in a series of articles designed to shift sociological research away from the futile, Durkheimian study of causes for suicide and towards the analysis of how people cope with suicidal behavior.

Behavioral Contracting for Repeated Suicide Attempts

A behavioral contract was used to decrease the frequency of repeated suicide attempts and to increase adaptive behavior of a chronic schizophrenic patient hospitalized on a locked psychiatric ward. The behavior therapist left the patient's unit a few months after the contract ended. A follow-up at one year after termination of the contract showed no suicide attempts, suicidal ideas only once, and good adjustment on an unlocked psychiatric ward for the previous nine months. Just before completion of this article, 18 months after the contract, the patient committed suicide. A psychological autopsy showed the patient had continued without suicidal behavior for 14 months after the contract ended. When faced with possible discharge from the hospital and a return to the interpersonal conditions the contract had corrected earlier, the patient increased self-injurious and suicidal behavior and finally killed himself. This temporary success, followed by longer-term failure, is presented to illustrate certain clinical and methodological issues in the behavioral treatment of suicidal patients.

Changes in mental health policy and their influence on self-injurious behaviours in the Israeli military prison system

OBJECTIVE

Self-injurious behaviours (SIBs) are widespread among prisoners and are sometimes classified as potentially calculated acts intended to control others. Access to a psychiatrist may be valued by imprisoned soldiers seeking immediate release from service. The main goal of the study was to assess the effects of a new mental health regulation in the Israel Defense Forces (IDF) prison system, which requires ordering an immediate interview with a psychiatrist for inmates performing SIBs.

METHOD

Frequency of SIBs in 2 military prisons was examined and compared for 11 months before and 10 months after the implementation of the regulation. Severity of injuries and rates of release from service were examined for 4 months.

RESULTS

The frequency of SIBs significantly increased after the implementation of the regulation in one prison, but not in the other. No effect was found for rate of release from service or for severity of injuries.

CONCLUSIONS

Increased accessibility to a psychiatrist for military prisoners may have resulted in increased motivation for inmates to perform SIBs. These effects are limited to the prison that serves a higher proportion of highly stressed soldiers.

Classification of suicidal behavior: a review and step toward integration

The many forms of suicidal phenomena, including contemplated, attempted, and completed suicide, present significant problems to both researchers and practitioners. Although many attempts have been made to develop categories, agreement among the proposed systems has been more the exception than the rule. This article reviews theoretical and empirical efforts to define types of suicidal individuals and attempts to integrate them by means of higher-order categories of variables. These categories or "dimensions" are as follows: (1) descriptive, (2) situational, (3) psychological/behavioral, and (4) teleological. Implications for research and practice are discussed.

A reciprocal control approach to the treatment of repeated parasuicide

Patterson and Reid's formulation of coercive versus reciprocal control offers a theoretical model for understanding both parasuicide and nontherapeutic exchanges between treatment staff and repeat suicide attempters. An interpersonal treatment program, derived from the Patterson and Reid formulation, which has been consistently associated with positive changes in the course of hospitalization for moderate-risk inpatients, is outlined, followed by a case illustration and discussion of the treatment strategy. The article stresses the importance of targeting the interpersonal environment as well as parasuicidal acts in the treatment program for repeat suicide attempters.

Psychological models of self-mutilation

The descriptive models of self-mutilation fall into three broad categories. The psychodynamic formulation; the second category includes the anxiety reduction model, the hostility model, the behavioral learning model and the appeal model; the third social learning category includes the group-epidemic model and aspects of the violence and punishment model. The three models support the view that there is no single cause or motive responsible for self-mutilating behavior. Having a number of factors in mind allows for flexibility and enables clinicians to test particular hypotheses during management and gives them the opportunity to alter intervention accordingly. The problems faced by self-mutilating patients are so varied that no single form of treatment is likely to be universally appropriate.

Advances in behavioral approaches to adolescent health care

Behavior change professionals have developed treatment programs for a wide variety of health care problems affecting adolescents. Although a substantial data base of experimentally tested techniques exists for obesity, smoking prevention, and dysmenorrhea, much work remains in other areas. For example, the case studies reported on neurodermatitis and the survey work in teenage alcohol abuse must give way to systematic interventions employing group experimental designs. In addition, behavioral procedures should be compared to other treatments. Also, component analysis should be performed when multiple treatment strategies are used. Finally, strategies aimed at increasing the generalization of treatment, such as from classrooms to different community settings in substance abuse prevention programs and maintenance of treatment effects over long follow-up periods, are necessary. Only in this way will the efficacy of behavioral interventions for specific health problems be established. The leading causes of mortality among adolescents are due to accidents. Of the total number of deaths due to accidents, approximately 50% are attributed to motor vehicle accidents (National Safety Council, 1977). Many of these accidents are due to negligence, substance abuse, and, in general, immature behavior (Bakwin & Bakwin, 1972). In spite of a slow but consistent trend toward lower accidental deaths over time (National Safety Council, 1977), there still is a need for interventions designed to decrease risk-taking behavior, substance abuse, and carelessness in adolescents. Again, behavior change professionals might follow the example set by researchers who have begun to develop successful strategies for decreasing onset of cigarette smoking. These interventions and research methods, designed for use in schools, may provide a promising approach for addressing other kinds of prevention problems. It also seems appropriate to categorize cigarette smoking not only as a risk factor in the development of cardiovascular disease (Kuller, 1976), but also as a member of the risk-taking behaviors. Thus, procedures used to prevent cigarette smoking might also be adapted to prevent other kinds of risk-taking behaviors among adolescents. The work of McAlister et al. (1980), in preventing alcohol abuse as well as cigarette smoking by use of the same or similar procedures, is a case in point. Use of a procedure designed to train competency in refusing peer pressure has clear implications for reducing other risk-taking behaviors, such as reckless driving, drug abuse, and swimming and boating accidents.(ABSTRACT TRUNCATED AT 400 WORDS)

Family interaction and adolescent suicidal behaviour: a preliminary investigation

While investigators have emphasized the importance of familial relations in the production of suicidal behaviour in adolescence, experimental evaluation of specific family interaction processes has, thus far, been neglected. The aim of the present study was to investigate possible relationships between adolescent suicidal behaviour and total on-going family functioning. Hypotheses were advanced to evaluate the communication, interaction and reinforcement patterns in families. A modified revealed differences technique was employed to elicit standardized segments of interaction which were video-taped and later studied by two independent raters. The sample consisted of twelve individually matched, intact family tetrads, six normal (N) and six containing an adolescent female who had exhibited suicidal behaviour (SM). Results suggest that SM families constitute a malfunctioning system which can be differentiated from that of normal samples. As compared with the N group, SM family interaction evidenced less effective productivity, specificity, and adaptive interaction, and higher rates of conflict and negative reinforcement. Overall findings were discussed in terms of current family theory and their possible relationship to the genesis, maintenance and management of some classes of suicidal behaviour.

Excessive use of psychiatric services by suicidal patients

The use of psychiatric services by patients with a suicidal history was examined to see if they placed a greater long-term burden on these services than other types of patient. Suicidal patients spent significantly more days in hospital and made more outpatient attendances; suicide attemptors in particular not only needed more emergency consultations but also spent more days in hospital. A more economical yet more effective treatment policy for the suicidal patient is needed.

Attempted suicide: an operant formulation

An alternative formulation of attempted suicide is offered, in which the phenomenon is considered within the context of social learning theory. The suicidal behaviour is viewed as an operant which is reinforced and maintained by the consequent interpersonal contingencies. The modification of the suicidal behaviour then involves alteration of the contingent consequences. This theoretical formulation is elaborated and the treatment principles and practice are outlined.

On the prevention of parasuicide

Parasuicide rates have shown a marked increase in recent years and now consume a substantial proportion of medical services. To reduce hospital admission rates for parasuicide is probably desirable. While there has been considerable research on parasuicide, it is apparent that many of the findings have limited application to prevention. It is argued that attempts at primary prevention should be directed at those factors in the population considered to have a substantial function in promoting this group of behaviours. The first step in such a program should be the empirical delineation of a typology of parasuicide, since it is not a unitary phenomenon and a single preventive measure is therefore unlikely to have widespread success. Following the recognition of different requirements for different population groups, an experiment in prevention might be attempted by monitoring the parasuicide rates in two closely similar populations, one of which has alterations made sequentially to variables such as the following: the availability of tablets and the form of their presentation; the availability of personal advisory services; and community attitudes to parasuicide. Possible dangers inherent in such experimental epidemiology are acknowledged but it is argued thai aspects of the current approach to the problem of parasuicide may be in need of revision.