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Nam RJ, Lowry NJ, Lawrence OC, Novotny LJ, Cha CB. Episodic future thinking and psychopathology: A focus on depression and suicide risk. Curr Opin Psychol 2024; 59:101853. [PMID: 39128387 DOI: 10.1016/j.copsyc.2024.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024]
Abstract
Episodic future thinking (EFT), the ability to imagine future autobiographical events, is both an everyday and clinically significant cognitive process. With a focus on depression and suicidality, here we discuss evidence connecting EFT with psychopathology. Emotional valence of imagined future events has emerged as the most widely established feature of EFT detected to date, with less positive EFT being associated with depressive symptoms and suicidal thoughts and behaviors. This pattern may not be merely a byproduct of sadness or anhedonia. Promising directions for future research include clarifying the temporal association between EFT and clinical outcomes, investigating the potential benefits and drawbacks of positive EFT, and refining assessments for youth to measure EFT either preceding or soon after onset of psychopathology.
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Affiliation(s)
- Rachel J Nam
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA
| | - Nathan J Lowry
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA
| | - Olivia C Lawrence
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA
| | - Layne J Novotny
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA.
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2
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Aupperle RL, Kuplicki R, Tsuchiyagaito A, Akeman E, Sturycz-Taylor CA, DeVille D, Lasswell T, Misaki M, Berg H, McDermott TJ, Touthang J, Ballard ED, Cha C, Schacter DL, Paulus MP. Ventromedial prefrontal cortex activation and neurofeedback modulation during episodic future thinking for individuals with suicidal thoughts and behaviors. Behav Res Ther 2024; 176:104522. [PMID: 38547724 PMCID: PMC11103812 DOI: 10.1016/j.brat.2024.104522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/30/2024] [Accepted: 03/14/2024] [Indexed: 04/08/2024]
Abstract
Individuals experiencing suicidal thoughts and behaviors (STBs) show less specificity and positivity during episodic future thinking (EFT). Here, we present findings from two studies aiming to (1) further our understanding of how STBs may relate to neural responsivity during EFT and (2) examine the feasibility of modulating EFT-related activation using real-time fMRI neurofeedback (rtfMRI-nf). Study 1 involved 30 individuals with major depressive disorder (MDD; half with STBs) who performed an EFT task during fMRI, for which they imagined personally-relevant future positive, negative, or neutral events. Positive EFT elicited greater ventromedial prefrontal cortex (vmPFC) activation compared to negative EFT. Importantly, the MDD + STB group exhibited reduced vmPFC activation across all EFT conditions compared to MDD-STB; although EFT fluency and subjective experience remained consistent across groups. Study 2 included rtfMRI-nf focused on vmPFC modulation during positive EFT for six participants with MDD + STBs. Results support the feasibility and acceptability of the rtfMRI-nf protocol and quantitative and qualitative observations are provided to help inform future, larger studies aiming to examine similar neurofeedback protocols. Results implicate vmPFC blunting as a promising treatment target for MDD + STBs and suggest rtfMRI-nf as one potential technique to explore for enhancing vmPFC engagement.
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Affiliation(s)
- R L Aupperle
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA; School of Community Medicine, 1215 South Boulder Ave W., The University of Tulsa, Tulsa, OK, 74119, USA.
| | - R Kuplicki
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - A Tsuchiyagaito
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - E Akeman
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - C A Sturycz-Taylor
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - D DeVille
- Department of Psychiatry, University of California San Diego, 4510 Executive Drive, San Diego, CA, 92121, USA
| | - T Lasswell
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - M Misaki
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - H Berg
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - T J McDermott
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - J Touthang
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - E D Ballard
- Experimental Therapeutics and Pathophysiological Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - C Cha
- Department of Psychology, Columbia University, 428 Horace Mann, New York, NY, 10027, USA
| | - D L Schacter
- Department of Psychology, Harvard University, 33 Kirkland St., William James Hall, Cambridge, MA, 02138, USA
| | - M P Paulus
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA; School of Community Medicine, 1215 South Boulder Ave W., The University of Tulsa, Tulsa, OK, 74119, USA
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3
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Pollak OH, Shin KE, Baroni A, Gerson RS, Bell KA, Tezanos KM, Fernandes SN, Robinaugh DJ, Schacter DL, Spirito A, Cha CB. An examination of episodic future thinking in the emergency department among youth experiencing suicidal thoughts and behaviors. Eur Child Adolesc Psychiatry 2024; 33:923-933. [PMID: 37162586 DOI: 10.1007/s00787-023-02219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
Youth experiencing suicidal thoughts and/or behaviors (STBs) frequently present to emergency departments for acute psychiatric care. These settings offer a transitory yet pivotal opportunity to assess, intervene on, and plan continued care for STBs. This study examined a clinically relevant, understudied aspect of psychological functioning among youth experiencing STBs in the emergency department: episodic future thinking, or the ability to imagine discrete autobiographical future events. A sample of 167 youths (10-17 years) presenting to a pediatric psychiatric emergency department for STBs completed a performance-based measure of episodic future thinking assessing richness in detail and subjective characteristics of imagined future events. STB recurrence was assessed 6 months later. Immediately following a suicide-related crisis, youth demonstrated mixed abilities to imagine their future: they generated some concrete future event details but did not subjectively perceive these events as being very detailed or likely to occur. Older adolescents (i.e., 15-17) generated more episodic details than pre-/younger adolescents (i.e., 10-14), particularly those pertaining to actions or sensory perceptions. There was no evidence linking less detailed episodic future thinking and greater likelihood of STBs following the emergency department visit; instead, hopelessness was a more robust risk factor. Findings underscore the importance and clinical utility of better understanding the psychological state of youth during or immediately following a suicide-related crisis. In particular, assessing youths' future thinking abilities in the emergency department may directly inform approaches to acute care delivery.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA.
| | - Ki Eun Shin
- Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ruth S Gerson
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Kerri-Anne Bell
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Katherine M Tezanos
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
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Verfaellie M, Patt V, Lafleche G, Strang C, Vasterling JJ. Future thinking in PTSD: Preliminary evidence for altered event construction. Psychiatry Res 2024; 333:115768. [PMID: 38325161 PMCID: PMC10901291 DOI: 10.1016/j.psychres.2024.115768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/04/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
Using a future event fluency task, the current study sought to examine future event construction in PTSD and to identify clinical profiles associated with altered event construction. Thirty-eight trauma exposed war-zone veterans with (n=25) and without (n=13) PTSD generated within one minute as many positive and negative future events as possible in the near and distant future. The PTSD group generated fewer specific, but not generic, events than the no-PTSD group, a difference that was amplified for positive events as a result of comorbid depression. Clinical correlates of event construction varied as a function of event valence.
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Affiliation(s)
- Mieke Verfaellie
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA; Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston MA, USA.
| | - Virginie Patt
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA
| | - Ginette Lafleche
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA
| | - Caroline Strang
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA
| | - Jennifer J Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston MA, USA; Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston MA, USA
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Matuza T, Shikh A, Sullivan SR, Wheeler A, Miranda R. Induced optimism to lessen hopelessness-related cognitions among young adults at risk for suicidal thoughts and behavior. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 14:100670. [PMID: 38125966 PMCID: PMC10732345 DOI: 10.1016/j.jadr.2023.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Hopelessness is one of the best-studied cognitive predictors of depression and suicide. Previous research suggests that hopelessness may develop through repetitive thinking about the occurrence of positive and negative future outcomes. The present study sought to investigate whether mental rehearsal in making optimistic future-event predictions, or induced optimism, would lead to reductions in hopelessness, particularly among individuals with a history of suicide ideation or suicide attempts. Methods Participants with (n = 58) and without (n = 76) a history of suicide ideation or attempts were randomly assigned to either practice making optimistic future-event predictions or to a control condition in which they practiced making a lexical decision (using the same stimuli) over three study sessions, each separated by one week. Results Findings offered modest support for the hypothesis that induced optimism would decrease hopelessness but not improve mood; this was regardless of history of suicide ideation or attempts. Limitations The sample was predominantly female, and assessment of suicide ideation and attempt history was not confirmed by clinical interview, which may limit generalizability. Conclusion Practice in making optimistic future-event predictions over time may be one way to reduce the hopelessness-related cognitions that confer vulnerability to suicide ideation and behavior.
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Affiliation(s)
| | - Allan Shikh
- Hunter College, City University of New York, USA
- University of Rochester Medical Center, USA
| | - Sarah R. Sullivan
- Hunter College, City University of New York, USA
- The Graduate Center, City University of New York, USA
| | | | - Regina Miranda
- Hunter College, City University of New York, USA
- The Graduate Center, City University of New York, USA
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Amano M, Katayama N, Umeda S, Terasawa Y, Tabuchi H, Kikuchi T, Abe T, Mimura M, Nakagawa A. The effect of cognitive behavioral therapy on future thinking in patients with major depressive disorder: A randomized controlled trial. Front Psychiatry 2023; 14:997154. [PMID: 36761867 PMCID: PMC9905738 DOI: 10.3389/fpsyt.2023.997154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Pessimistic thinking about the future is one of the cardinal symptoms of major depression. Few studies have assessed changes in pessimistic thinking after undergoing cognitive behavioral therapy (CBT). A randomized clinical trial (RCT) was conducted with patients diagnosed with major depressive disorder (MDD) to determine whether receiving a course of CBT affects pessimistic future thinking using a future thinking task. METHODS Thirty-one patients with MDD were randomly assigned to either CBT (n = 16) or a talking control (TC) (n = 15) for a 16-week intervention. The main outcomes were the change in response time (RT) and the ratio of the responses for positive valence, measured by the future thinking task. Secondary outcomes included the GRID-Hamilton Depression Rating Scale, the Beck Depression Inventory-Second Edition (BDI-II), the Dysfunctional Attitude Scale (DAS), and the word fluency test (WFT). RESULTS Regarding the main outcomes, the CBT group showed reduced RT for the positive valence (within-group Cohen's d = 0.7, p = 0.012) and negative valence (within-group Cohen's d = 0.6, p = 0.03) in the distant future condition. The ratio of positive valence responses in both groups for all temporal conditions except for the distant past condition increased within group (distant future: CBT: Cohen's d = 0.5, p = 0.04; TC: Cohen's d = 0.8, p = 0.008; near future: CBT: Cohen's d = 1.0, p < 0.001; TC: Cohen's d = 1.1, p = 0.001; near past: CBT: Cohen's d = 0.8, p = 0.005; TC: Cohen's d = 1.0, p = 0.002). As for secondary outcomes, the CBT group showed greater improvement than the TC group regarding the need for social approval as measured by the DAS (p = 0.012). CONCLUSION Patients with MDD who received CBT showed a reduced RT for the positive and negative valence in the distant future condition. RT in the future thinking task for depressed patients may be a potential objective measure for the CBT treatment process. Because the present RCT is positioned as a pilot RCT, a confirmatory trial with a larger number of patients is warranted to elucidate the CBT treatment process that influences future thinking. CLINICAL TRIAL REGISTRATION https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000021028, identifier UMIN000018155.
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Affiliation(s)
- Mizuki Amano
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Nariko Katayama
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Umeda
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
| | - Yuri Terasawa
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan
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The Mediating Role of Time Perspective in the Relationship between Chronotype and Suicide in Bipolar Disorder. Behav Sci (Basel) 2022; 12:bs12120492. [PMID: 36546975 PMCID: PMC9774133 DOI: 10.3390/bs12120492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/09/2022] Open
Abstract
(1) Background: Suicide in patients with bipolar disorder (BD) is related to the chronotype of the person from a biological perspective. However, it is not known whether there is a relationship between suicide and psychological time in BD. The aim of our study was to evaluate the relationship between time perspective (TP) and suicide and the effect of TP on the relationship between suicide and chronotype in euthymic patients with BD. (2) Methods: We included 150 BD patients and 84 healthy controls in this cross-sectional study. We administered the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Beck Scale for Suicidal Ideation (BSSI), Zimbardo Time Perspective Inventory (ZTPI), and Morning−Evening Questionnaire (MEQ). (3) Results: There was a statistically significant difference between the median scores of past negative TP, present fatalistic TP, future TP, and MEQ total score (p < 0.001, p < 0.001, p = 0.010, and p = 0.020, respectively). There was a significant correlation between past negative TP, future TP, MEQ scores, and BSSI scores in the patient group (p < 0.001, p = 0.018, and p = 0.028, respectively). An inverse and significant relationship between the MEQ total score and BSSI score and TP types had a mediator role in this relationship. (4) Conclusions: Our study shows that TP, which evaluates time from a psychological perspective, has a direct relationship with suicidal ideation and a mediating role in the relationship between chronotype and suicide. According to our results, we can conclude that ZTPI can also be used to evaluate the risk of suicidality in patients with BD. Appropriate therapy methods for TP may help to prevent some suicide attempts.
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Enhancing future-directed thinking in people with first-episode psychosis using a guided imagery intervention. J Behav Ther Exp Psychiatry 2022; 76:101738. [PMID: 35738685 DOI: 10.1016/j.jbtep.2022.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 01/03/2022] [Accepted: 02/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Future-directed thinking (FDT) is associated with goal directed behaviour and may differ in people with psychosis compared to non-clinical controls. This study investigated whether guided imagery could enhance positive FDT in people with psychosis. METHOD Participants were 44 people experiencing a first episode of psychosis. They were assessed for negative and positive symptoms, FDT on the Future Thinking Task (FTT), depression, anxiety, autobiographical memory, verbal fluency and spontaneous use of imagery. They were randomised to either a positive or neutral imagery condition, before being retested on the FTT. Outcomes on the FTT were number of events generated, anticipated likelihood, anticipated affect and a composite score. RESULTS Participants in the positive imagery condition generated significantly more positive events on the FTT compared with those in the neutral (F (1, 42) = 19.916, p < .001, ηp2 = 0.322). In both imagery conditions, likelihood ratings of positive events increased post-intervention. Positive and negative events were both perceived as less likely to occur the further into the future they were, and positive events were anticipated to be more positive and negative events more negative, the further into the future they were. LIMITATIONS The participants in this study experienced relatively low levels of symptoms, and therefore caution should be used when applying these results to people with greater symptomatology. CONCLUSIONS Positive guided imagery shows promise for enhancing positive FDT in people with first-episode psychosis. This intervention may offer a simple and effective method of enhancing engagement with the future, with potential implications for goal-directed behaviour.
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Cha CB, Robinaugh DJ, Schacter DL, Altheimer G, Marx BP, Keane TM, Kearns JC, Nock MK. Examining multiple features of episodic future thinking and episodic memory among suicidal adults. Suicide Life Threat Behav 2022; 52:356-372. [PMID: 34978101 PMCID: PMC9233069 DOI: 10.1111/sltb.12826] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/29/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
BCKGROUND Theories of suicide suggest that suicidal ideation (SI) results in part from difficulty imagining the future, which itself relies on the ability to remember the past. The present study examines multiple components of episodic future thinking and memory including event richness, which is commonly measured within the cognitive literature but has not previously been assessed with suicidal individuals. METHODS Here, we tested the associations between SI and episodic future thinking and episodic memory across two studies (Study 1, n = 25; Study 2, n = 141): the first with a healthy comparison group and the second with a psychiatric comparison group. RESULTS Future event richness yielded large but statistically non-significant deficits in the SI group relative to healthy controls in Study 1 after controling the false discovery rate. The most robust effects for future thinking emerged in the case of perceived duration of future events, such that the SI group (vs. psychiatric comparison) imagined future events as longer-lasting in Study 2. Across both studies, episodic memory was unrelated to SI, and neither episodic future thinking nor memory predicted future SI. CONCLUSION Episodic future thinking may better distinguish individuals with SI history from psychiatric controls when compared with episodic memory, but that this effect is limited to select components of future thinking.
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Affiliation(s)
- Christine B. Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | | | | | | | - Brian P. Marx
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Terence M. Keane
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Jaclyn C. Kearns
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
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Katayama N, Nakagawa A, Umeda S, Terasawa Y, Abe T, Kurata C, Sasaki Y, Mitsuda D, Kikuchi T, Tabuchi H, Mimura M. Cognitive behavioral therapy effects on frontopolar cortex function during future thinking in major depressive disorder: A randomized clinical trial. J Affect Disord 2022; 298:644-655. [PMID: 34800568 DOI: 10.1016/j.jad.2021.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/25/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the importance of Beck's theoretical cognitive model of psychopathology, the neural mechanisms underlying future thinking in cognitive behavioral therapy (CBT) remain elusive. Recent neuroimaging studies have shown that the function of the frontopolar cortex (Brodmann area 10 [BA10]) is associated with future thinking. We hypothesized that, compared with unstructured psychotherapy (talking control: TC), CBT may involve different neural responses in BA10 associated with future thinking. METHODS This randomized clinical trial included 38 adult patients with moderate-to-severe major depressive disorder who underwent up to 16 weeks of CBT or TC with a 6-month follow-up period. We evaluated changes in BA10 activation during distant future thinking using functional magnetic resonance imaging with a future-thinking task. We assessed frontal neurocognitive function and clinical symptoms at baseline and post-treatment. Depression severity and automatic thoughts were assessed at the 6-month follow-up. RESULTS We found decreased activation in the frontopolar cortex during distant future thinking after CBT (t = 3.00, df=15, p = 0.009) and no changes after TC. Further, the reduction in BA10 activity significantly correlated with changes in frontal cognitive function after the treatment (r = 0.48, p = 0.007), and in positive automatic thought after 6 months of treatments (r = 0.39; p = 0.03). LIMITATIONS Relatively small sample size and homogenous clinical profile could limit the generalizability. Patients received pharmacotherapy including antidepressant. CONCLUSIONS CBT appears to improve frontopolar cortex function during future thinking in a manner distinct from TC. Larger clinical trials are necessary to provide firm evidence whether BA10 activity may serve as a neuro-marker for monitoring successful depression treatment with CBT.
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Affiliation(s)
- Nariko Katayama
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan; Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Umeda
- Department of Psychology, Keio University Faculty of Letters, Tokyo, Japan
| | - Yuri Terasawa
- Department of Psychology, Keio University Faculty of Letters, Tokyo, Japan
| | - Takayuki Abe
- Yokohama City University School of Data Science, Yokohama, Japan
| | - Chika Kurata
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yohei Sasaki
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Dai Mitsuda
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
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Colin C, Martin A, Bonneviot F, Brangier E. Unravelling future thinking: a valuable concept for prospective ergonomics. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2021. [DOI: 10.1080/1463922x.2021.1943045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Clement Colin
- Université de Lorraine, PERSEUS EA7312, Metz, France
- Total S.E., Corporate R&D, F-92078 Paris, France
| | | | - Flavie Bonneviot
- Université de Lorraine, PERSEUS EA7312, Metz, France
- Vedecom Institute, Versailles, France
| | - Eric Brangier
- Université de Lorraine, PERSEUS EA7312, Metz, France
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12
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Pollak OH, Guzmán EM, Shin KE, Cha CB. Defeat, Entrapment, and Positive Future Thinking: Examining Key Theoretical Predictors of Suicidal Ideation Among Adolescents. Front Psychol 2021; 12:590388. [PMID: 33746823 PMCID: PMC7969632 DOI: 10.3389/fpsyg.2021.590388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/29/2021] [Indexed: 12/30/2022] Open
Abstract
Adult-based suicide theories have determined much of what we know about suicidal ideation. Here, we investigate the extent to which elements of the Integrated Motivational-Volitional (IMV) model generalize to adolescence, a period when rates of suicidal ideation increase dramatically. In a sample of community-based adolescents (n = 74), we tested whether defeat and entrapment related to suicidal ideation, and whether poor positive future thinking abilities exacerbated this association. Consistent with the IMV model, we found that defeat/entrapment was associated specifically with history of suicidal ideation, and not with history of suicide attempt. Defeat/entrapment was related to baseline suicidal ideation severity above and beyond depressive symptoms. While defeat/entrapment predicted future suicidal ideation controlling for history of ideation, it did not do so controlling for depressive symptoms. Counter to the IMV model, we initially found that the association between defeat/entrapment and suicidal ideation was strongest among adolescents with greater positive future thinking abilities. This was driven by the tendency to imagine more positive future events, particularly those that are less realistic and achievable. These findings call for a more nuanced understanding of defeat/entrapment and positive future thinking among adolescents, particularly in how they interact to predict recurrent suicidal ideation.
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Affiliation(s)
- Olivia H Pollak
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Eleonora M Guzmán
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Ki Eun Shin
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Christine B Cha
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, United States
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Mostowik J, Mielimąka M, Rutkowski K, Ostrowski T. Time in the Mental Health Context: Neurotic Symptomatology, Defense Mechanisms and the Perception of Time Perspective Among Patients Diagnosed With Neurotic and Personality Disorders - A Clinical Study. Psychol Rep 2020; 125:232-255. [PMID: 33349168 DOI: 10.1177/0033294120978164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The main objective of the study is to explore relations between the time perspective, neurotic symptoms, anxiety, and defense mechanisms in the group of patients diagnosed with neurotic and personality disorders (ICD-10 groups: F4x, F60.x and F61) treated with group psychotherapy. The research is conducted on the theoretical basis of the Zimbardo and Boyd's Time Perspective Theory. METHODS The study included 49 patients treated in the day ward for the Treatment of Neurotic Disorders and Behavioral Syndromes at the University Hospital. The measurement of the TP was performed with the Zimbardo Time Perspective Inventory. Patients also completed the State-Trait Anxiety Inventory and the Defense Style Questionnaire 40. The diagnosis was done by licensed psychiatrists and supported with the measures: Symptom Checklist KO"O", Neurotic Personality Questionnaire KON-2006. RESULTS Multiple regression analysis models showed that the four time perspectives (past negative, present fatalistic, present hedonistic, and future) are predicted in different variations by the level of anxiety state or trait and repertoire of used defense mechanisms (immature or mature). CONCLUSIONS Considering the established bilateral correlations, change in the time perspective may constitute an important factor in the reduction of neurotic symptoms, possibly through changes in the repertoire of utilized defense mechanisms. However, there is also possible that altering neurotic symptomatology would alter time perspective. The assessment of the time perspective in patients with neurotic and personality disorders may provide useful data for the diagnosis and the monitoring of psychotherapy effectiveness. Based on the results of this study conducting further research on the role of the changes in the time perspective in the course of psychotherapy is recommended and necessary to expand the understanding of the relations observed in this study.
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Affiliation(s)
- Joanna Mostowik
- Institute of Applied Psychology, Jagiellonian University, Krakow, Poland; Department of Psychotherapy, University Hospital in Krakow, Krakow, Poland
| | | | - Krzysztof Rutkowski
- Department of Psychotherapy, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Ostrowski
- Faculty of Psychology and Humanities, Andrzej Frycz-Modrzewski Cracow University, Krakow, Poland
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Katayama N, Nakagawa A, Kurata C, Sasaki Y, Mitsuda D, Nakao S, Mizuno S, Ozawa M, Nakagawa Y, Ishikawa N, Umeda S, Terasawa Y, Tabuchi H, Kikuchi T, Abe T, Mimura M. Neural and clinical changes of cognitive behavioural therapy versus talking control in patients with major depression: a study protocol for a randomised clinical trial. BMJ Open 2020; 10:e029735. [PMID: 32102803 PMCID: PMC7045124 DOI: 10.1136/bmjopen-2019-029735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION While major depression causes substantial distress and impairment for affected individuals and society, the effectiveness of cognitive behavioural therapy (CBT) in treating the condition has been established. However, the therapeutic mechanism underlying the efficacy of CBT remains unknown. This study aimed to describe a protocol for a randomised controlled trial that will measure the CBT-induced clinical and neural changes in patients with non-psychotic major depression. METHODS AND ANALYSIS The current study is a 16-week assessor-blinded, randomised, parallel-group trial with a 12-month follow-up as part of usual depression care at an outpatient clinic. Patients aged 20-69 years with major depressive disorder will be randomly assigned to receive either CBT in addition to their usual treatment or talking control in addition to their usual treatment for 16 weeks. The primary outcome is the functional changes in the brain areas that have been associated with future-oriented thinking at 16 weeks; secondary outcomes include changes in functional brain connectivity, severity and changes in the scores of objective and subjective clinical depression symptoms, proportion of responders and remitters and quality of life. The intention-to-treat analysis will be used. ETHICS AND DISSEMINATION All protocols and the informed consent form are compliant with the Ethics Guideline for Clinical Research (Japanese Ministry of Health, Labour and Welfare). Ethical Review Committees at the Keio University School of Medicine have approved the study protocol (version 3, 11 September 2017). We will disseminate research findings to scientific and general audiences through national and international conference presentations as well as lay summaries to the general public, including mental health consumer and publications in international peer-reviewed psychiatry and brain imaging journals. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000018155); Pre-results.
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Affiliation(s)
- Nariko Katayama
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
- Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Japan
| | - Chika Kurata
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Yohei Sasaki
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Dai Mitsuda
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Shigetsugu Nakao
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Sayuri Mizuno
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Mire Ozawa
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Yuko Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Natsumi Ishikawa
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Satoshi Umeda
- Department of Psychology, Keio University Faculty of Letters, Minato-ku, Japan
| | - Yuri Terasawa
- Department of Psychology, Keio University Faculty of Letters, Minato-ku, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Takayuki Abe
- Association of International Arts and Science, Yokohama City University School of Data Science, Yokohama, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
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The measurement of episodic foresight: A systematic review of assessment instruments. Cortex 2019; 117:351-370. [DOI: 10.1016/j.cortex.2018.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/05/2018] [Accepted: 08/20/2018] [Indexed: 01/07/2023]
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Bortolon C, Yazbek H, Norton J, Capdevielle D, Raffard S. The contribution of optimism and hallucinations to grandiose delusions in individuals with schizophrenia. Schizophr Res 2019; 210:203-206. [PMID: 30639163 DOI: 10.1016/j.schres.2018.12.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 01/08/2023]
Abstract
Grandiose delusions (GDs) are defined as false beliefs about having an inflated worth, power, or a special identity which are firmly sustained despite undeniable evidence to the contrary. Although it is the second most commonly encountered delusional beliefs, GDs have received little attention. Thus, in this study, we explored the role of future expectations and sensitivity to reward in GDs in schizophrenia (SZ) disorder. In total, 115 SZ patients completed measures of positive and negative symptoms, sensitivity to reward, depression, and a task in which individuals were asked to estimate the probability that positive, negative and neutral events will occur in the future. Correlation and Linear Regression analyses were performed in order to determine whether sensitivity to reward and future expectations are associated with GDs. Regressions showed that hallucinations and future positive expectations were significantly associated with GDs. In conclusion, the present study showed that higher optimism regarding the future might be important psychological processes associated with the maintenance of GDs in SZ patients. Moreover, it is possible that patients experiencing hallucinations may interpret this phenomenon as a kind of special ability or power, resulting in turn in GDs maintenance. Implications of these findings and directions for future research are discussed.
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Affiliation(s)
- Catherine Bortolon
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, France; Université Grenoble Alpes - Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Grenoble, France.
| | - Hanan Yazbek
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, France
| | - Joanna Norton
- INSERM U1061, Montpellier, France; University of Montpellier, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, France; INSERM U1061, Montpellier, France; University of Montpellier, Montpellier, France
| | - Stéphane Raffard
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, France; Univ. Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, F34000, Montpellier, France
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Katayama N, Nakagawa A, Umeda S, Terasawa Y, Kurata C, Tabuchi H, Kikuchi T, Mimura M. Frontopolar cortex activation associated with pessimistic future-thinking in adults with major depressive disorder. NEUROIMAGE-CLINICAL 2019; 23:101877. [PMID: 31170685 PMCID: PMC6551553 DOI: 10.1016/j.nicl.2019.101877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/27/2019] [Accepted: 05/25/2019] [Indexed: 01/19/2023]
Abstract
Background Pessimistic thinking about the future is one of the cardinal symptoms of major depressive disorder (MDD) and is an important domain of cognitive functioning associated with hopelessness. Neuroimaging studies have shown that the frontopolar cortex (Brodmann area [BA] 10) is involved in thinking about the future and demonstrated that patients with MDD have dysfunctions in BA10. However, the relationship between pessimistic thinking about the future and brain activity is unclear. Hence, we aimed to compare brain activity during future-thinking between patients with MDD and healthy individuals. Methods We assessed 23 patients with current MDD and 23 healthy individuals. Participants were instructed to imagine the future or to recall the past using the future-thinking paradigm with four distinct temporal conditions (distant future, near future, distant past, and near past) during functional MRI. Resting-state functional MRI was also performed to explore the functional connectivity of BA10. Results Compared with healthy individuals, patients with MDD had greater negative thinking about the distant future and exhibited increased activation in the medial BA10 when imagining the distant future, following small-volume correction focusing on the frontopolar a priori region of interest (family-wise error correction p < 0.05). Increased positive functional correlation between the right BA10 seed region and the posterior cingulate cortex was also observed. Conclusion Patients with MDD who show greater pessimistic thinking about the distant future demonstrate increased activation in the frontopolar cortex. These findings are consistent with the hypothesis that frontopolar cortical dysfunction plays a key role in the hopelessness that manifests in patients with MDD. Pessimistic thinking about the future is one of the cardinal symptoms of MDD. Patients with MDD showed greater negative thinking about the distant future. MDD who show greater pessimistic future-thinking demonstrate higher activation in the frontopolar cortex (BA10). Resting-functional connectivity from right BA10 to PCC was increased in MDD. Frontopolar cortical dysfunction may play a key role in the hopelessness that manifests in patients with MDD.
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Affiliation(s)
- Nariko Katayama
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan.
| | - Satoshi Umeda
- Department of Psychology, Keio University Faculty of Letters, Tokyo, Japan
| | - Yuri Terasawa
- Department of Psychology, Keio University Faculty of Letters, Tokyo, Japan
| | - Chika Kurata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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HU Z, CHEN J, WU H, Ge O. Future thinking in non-clinical depression: the relevance of personal goals. ACTA PSYCHOLOGICA SINICA 2019. [DOI: 10.3724/sp.j.1041.2019.00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gordon DE, Kenny DM, O’Reilly DA, Moore DGP. Being transformed: Delivering a psychotherapeutic group intervention targeting repeat suicide attempts. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2018. [DOI: 10.1080/13642537.2018.1495242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Dr Evelyn Gordon
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland
| | - Dr Maeve Kenny
- Psychology Department, St Vincent’s Hospital, Dublin 3, Fairview, Ireland
| | - Dr Aileen O’Reilly
- Jigsaw, The National Centre for Youth Mental Health, Dublin 2, Pearse St, Ireland
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Bergmans Y, Gordon E, Eynan R. Surviving moment to moment: The experience of living in a state of ambivalence for those with recurrent suicide attempts. Psychol Psychother 2017; 90:633-648. [PMID: 28497887 DOI: 10.1111/papt.12130] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 02/25/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This qualitative study aimed to capture the experience of living in the ambivalent space between life and death for adults with recurrent suicide attempts (RSA). It sought to expand upon an earlier study that explored the processes involved in transitioning away from RSA among adults, which revealed that occupying this ambivalent space is a crucial part of this process. DESIGN Interpretive phenomenological analysis (IPA) was used. This methodology was designed to explore the lived experiences and meaning making and enabled interpretation of the multidimensional subjective experiences of RSA participants. METHODS In-depth semi-structured interviews were conducted with eight adult women with a history of RSA who had participated in a therapeutic intervention at the research site (Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts [SfSL/PISA]). The six stages of IPA were followed to analyse the interview data. RESULTS Analysis revealed the superordinate theme, 'surviving moment to moment', which refers to a precarious state of making decisions about one's life and destiny on a moment-to-moment basis without clear commitment to either life or death. Two subordinate themes were identified: 'deciding not to die in the moment' when the participants were more invested in dying than living and 'deciding to live in the moment' when they were more invested in living than dying. CONCLUSION The study illuminated the complex process of making decisions about ones' destiny on a moment-to-moment basis. It revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA. Clinicians who recognize the subtle distinctions associated with this in-between state can tailor their interventions accordingly. PRACTITIONER POINTS Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.
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Affiliation(s)
- Yvonne Bergmans
- Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | | | - Rahel Eynan
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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22
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Goodby E, MacLeod AK. Future-directed thinking in first-episode psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 55:93-106. [PMID: 26514944 DOI: 10.1111/bjc.12096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 09/15/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study employed the Future Thinking Task (MacLeod et al., 2005, Br. J. Clin. Psychol., 44, 495) to investigate whether future-directed thinking in first-episode psychosis is significantly different from that of matched controls, and to identify its correlates in this patient group. DESIGN Cross-sectional, mixed-model, case-control design. METHOD Participants were 30 patients with first-episode psychosis and 27 matched controls. The Future Thinking Task was used to assess future-directed thinking in both groups. Anxiety and depression were also measured as well as self-report measures of hopelessness, suicide ideation and a measure of negative symptoms. RESULTS Individuals with psychosis were impaired in future-directed thinking in both positive and negative domains, particularly with respect to the coming year. Increased self-reported hopelessness was associated with reduced positive future thinking and increased negative future thinking. Increased positive future thinking was also associated with reduced severity of negative symptoms, whilst negative future thinking was associated with suicide ideation. CONCLUSIONS Individuals with first-episode psychosis show a reduction in positive future thinking in line with that seen in other clinical groups, but this is accompanied by an unexpected reduction in negative future thinking. The findings suggest a general disengagement with the future in this group that may affect recovery and functioning. PRACTITIONER POINTS Individuals with first-episode psychosis may benefit from interventions to help them engage with their future, in particular in the mid-range, up to 1 year. The Future Thinking Task may be a helpful addition to the assessment of suicide risk in those with first-episode psychosis. Decreased positive future thinking was associated with increased severity of negative symptoms, indicating a potential new treatment angle for this resistant aspect of psychosis. The cross-sectional design of this study does not allow for conclusions about the causal relationship between psychosis and future-directed thinking. This study investigated future-directed thinking in individuals with a range of psychotic illnesses employing a trans-diagnostic approach; therefore, conclusions cannot be drawn about the nature of future-directed thinking in individual psychotic disorders.
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Affiliation(s)
- Emmeline Goodby
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Andrew K MacLeod
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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Hawton K, Townsend E, Arensman E, Gunnell D, Hazell P, House A, van Heeringen K. WITHDRAWN: Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Database Syst Rev 2015; 2015:CD001764. [PMID: 26436718 PMCID: PMC10759787 DOI: 10.1002/14651858.cd001764.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This review has been withdrawn because the topic has been split into three separate reviews, one on psychosocial interventions for self‐harm in adults; another on interventions for self‐harm in children and adolescents; and a third on pharmacological interventions for self‐harm in adults. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Keith Hawton
- Warneford HospitalCentre for Suicide Research, University Department of PsychiatryOxfordUKOX3 7JX
| | - Ellen Townsend
- University of NottinghamSelf‐Harm Research Group, School of PsychologyUniversity ParkNottinghamUKNG7 2RD
| | - Ella Arensman
- University College CorkNational Suicide Research Foundation and Department of Epidemiology and Public HealthCorkIreland
| | - David Gunnell
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PR
| | - Philip Hazell
- Sydney Medical SchoolDiscipline of PsychiatryG03 ‐ Thomas Walker HospitalHospital RdConcord WestNew South WalesAustralia2138
| | - Allan House
- University of LeedsLeeds Institute of Health SciencesCharles Thackrah Building101 Clarendon RoadLeedsUKLS2 9LJ
| | - Kees van Heeringen
- Ghent UniversityUnit for Suicide Research, Department of Psychiatry and Medical PsychologyGhentBelgium9000
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Roepke AM, Seligman MEP. Depression and prospection. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 55:23-48. [PMID: 26096347 DOI: 10.1111/bjc.12087] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 04/17/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Prospection, the mental representation of possible futures, is usually adaptive. When it goes awry, however, it disrupts emotion and motivation. A negative view of the future is typically seen as one symptom of depression, but we suggest that such negative prospection is the core causal element of depression. Here, we describe the empirical evidence supporting this framework, and we explore the implications for clinical interventions. METHODS We integrate several literatures: Using the database PsycInfo, we retrieved empirical studies with the keywords prospection, prediction, expectation, pessimism, mental simulation, future-thinking, future-directed thinking, foresight, and/or mental time travel, in conjunction with depression, depressed, or depressive. RESULTS Three kinds of faulty prospection, taken together, could drive depression: Poor generation of possible futures, poor evaluation of possible futures, and negative beliefs about the future. Depressed mood and poor functioning, in turn, may maintain faulty prospection and feed a vicious cycle. Future-oriented treatment strategies drawn from cognitive-behavioural therapy help to fix poor prospection, and they deserve to be developed further. CONCLUSIONS Prospection-based techniques may lead to transdiagnostic treatment strategies for depression and other disorders.
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Affiliation(s)
- Ann Marie Roepke
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin E P Seligman
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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O'Connor RC, Smyth R, Williams JMG. Intrapersonal positive future thinking predicts repeat suicide attempts in hospital-treated suicide attempters. J Consult Clin Psychol 2014; 83:169-76. [PMID: 25181026 PMCID: PMC4321534 DOI: 10.1037/a0037846] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Although there is clear evidence that low levels of positive future thinking (anticipation of positive experiences in the future) and hopelessness are associated with suicide risk, the relationship between the content of positive future thinking and suicidal behavior has yet to be investigated. This is the first study to determine whether the positive future thinking–suicide attempt relationship varies as a function of the content of the thoughts and whether positive future thinking predicts suicide attempts over time. Method: A total of 388 patients hospitalized following a suicide attempt completed a range of clinical and psychological measures (depression, hopelessness, suicidal ideation, suicidal intent and positive future thinking). Fifteen months later, a nationally linked database was used to determine who had been hospitalized again after a suicide attempt. Results: During follow-up, 25.6% of linked participants were readmitted to hospital following a suicide attempt. In univariate logistic regression analyses, previous suicide attempts, suicidal ideation, hopelessness, and depression—as well as low levels of achievement, low levels of financial positive future thoughts, and high levels of intrapersonal (thoughts about the individual and no one else) positive future thoughts predicted repeat suicide attempts. However, only previous suicide attempts, suicidal ideation, and high levels of intrapersonal positive future thinking were significant predictors in multivariate analyses. Discussion: Positive future thinking has predictive utility over time; however, the content of the thinking affects the direction and strength of the positive future thinking–suicidal behavior relationship. Future research is required to understand the mechanisms that link high levels of intrapersonal positive future thinking to suicide risk and how intrapersonal thinking should be targeted in treatment interventions. This study highlights the importance of positive future thinking as a predictor of future suicidal behavior. Clinicians ought to consider the content of positive future thinking, as not all types of positive future thinking are protective over time.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behavior Research Laboratory, Institute of Health & Wellbeing, University of Glasgow
| | - Roger Smyth
- Department of Psychological Medicine, Royal Infirmary of Edinburgh
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Kosnes L, Whelan R, O’Donovan A, McHugh LA. Implicit measurement of positive and negative future thinking as a predictor of depressive symptoms and hopelessness. Conscious Cogn 2013; 22:898-912. [DOI: 10.1016/j.concog.2013.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/27/2013] [Accepted: 06/01/2013] [Indexed: 01/17/2023]
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Effects of Two Forms of Internet-Delivered Cognitive Behaviour Therapy for Depression on Future Thinking. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stirman SW, Brown GK, Ghahramanlou-Holloway M, Fox AJ, Chohan MZ, Beck AT. Participation bias among suicidal adults in a randomized controlled trial. Suicide Life Threat Behav 2011; 41:203-9. [PMID: 21470296 PMCID: PMC3367501 DOI: 10.1111/j.1943-278x.2010.00011.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although individuals who attempt suicide have poor compliance rates with treatment recommendations, the nature and degree of participation bias in clinical treatment research among these individuals is virtually unknown. The purpose of this study was to examine participation bias by comparing the demographic and diagnostic characteristics of adult suicide attempters who participated in a randomized controlled trial to a sample of nonparticipants. Results indicated that males and individuals with a diagnosis of substance abuse or dependence were more likely to be participants in the randomized controlled trial. The implications of these findings for suicide intervention research are discussed.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Women's Health Sciences Division, National Center for PTSD, Boston University, Boston, MA 02130, USA.
| | - Gregory K. Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Allison J. Fox
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Aaron T. Beck
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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MacLeod AK, Tata P, Tyrer P, Schmidt U, Davidson K, Thompson S. Hopelessness and positive and negative future thinking in parasuicide. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 44:495-504. [PMID: 16368029 DOI: 10.1348/014466505x35704] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Hopelessness about the future is a key element in suicidal behaviour. The aim of the present study was to examine possible components of hopelessness, in particular, to contrast positive and negative future thinking and to examine separately number, expectancy, and value of anticipated positive and negative future experiences. DESIGN A correlational design. METHOD Repeat parasuicide patients (N = 441) were administered the Beck Hopelessness Scale, the Hospital Anxiety and Depression Scale and the future thinking task, a measure of future positive and negative thinking that assesses number, perceived likelihood, and perceived value of anticipated future positive and negative events. RESULTS Consistent with predictions, hopelessness correlated more strongly with lack of positive thoughts about the future than it did with presence of negative thoughts. Both positive and negative future thinking showed a relationship to hopelessness over and above their relationships to depression (positive future thinking) and anxiety (negative future thinking). Number and likelihood of positive events and likelihood and value of negative events showed both simple and partial relationships to hopelessness. Number of negative events related to hopelessness but only after the other future thinking variables had been controlled for and value of positive events no longer related to hopelessness after controlling for the other variables. CONCLUSIONS Hopelessness about the future in suicidal individuals is a multi-faceted construct but lack of positive future thinking is more important than presence of negative future thinking.
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Rasmussen SA, Fraser L, Gotz M, MacHale S, Mackie R, Masterton G, McConachie S, O'Connor RC. Elaborating the cry of pain model of suicidality: Testing a psychological model in a sample of first-time and repeat self-harm patients. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 49:15-30. [DOI: 10.1348/014466509x415735] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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31
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Suicide schemas in non-affective psychosis: An empirical investigation. Behav Res Ther 2010; 48:1211-20. [PMID: 20869042 DOI: 10.1016/j.brat.2010.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 08/16/2010] [Accepted: 08/20/2010] [Indexed: 11/22/2022]
Abstract
Suicide is the leading cause of premature death among individuals experiencing psychosis. The risk of suicide is proposed to increase with a greater potential for activation of suicide related schemas. Empirical representations of suicide schemas were compared between individuals experiencing non-affective psychosis, with and without a history of suicidal behaviour. Employing a cross-sectional between-groups comparison design, 84 participants, previously diagnosed with a non-affective psychotic disorder, were recruited from community mental health services. Participants completed a demographic questionnaire and clinical measures of psychopathology. To assess participants' suicide schemas, a series of direct and indirect cognitive tasks were designed and administered. Pathfinder analysis enabled the construction of empirically derived representations of the groups' suicide schemas based on responses to the cognitive tasks. The suicide group achieved significantly greater scores on measures of anxiety, depression, hopelessness and suicidality than the non-suicide group, but not on measures indicative of the severity of psychosis. The suicide schema for the suicide group was more elaborate and extensive than for the non-suicide group, even when clinical measures were taken into account. Clinical and theoretical implications are discussed.
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32
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Danchin CL, MacLeod AK, Tata P. Painful engagement in deliberate self-harm: The role of conditional goal setting. Behav Res Ther 2010; 48:915-20. [DOI: 10.1016/j.brat.2010.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 05/15/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
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Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez C. The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatr Clin North Am 2010; 33:657-85. [PMID: 20599139 PMCID: PMC3138327 DOI: 10.1016/j.psc.2010.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article provides a comprehensive review of cognitive behavioral therapy (CBT) treatments for personality disorders (PDs), including a description of the available treatments and empirical support, drawing on research published between 1980 and 2009. Research generally supports the conclusion that CBT is an effective treatment modality for reducing symptoms and enhancing functional outcomes among patients with PDs, thereby making it a useful framework for clinicians working with patients with PD symptomatology. There is a clear need, however, to develop and evaluate CBT in order to provide specific and more unambiguous treatment recommendations with particular relevance for understudied PDs.
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Affiliation(s)
- Alexis K. Matusiewicz
- Center Addictions, Personality and Emotion Research, University of Maryland, College Park, Maryland
- Department of Psychology, University of Maryland, College Park, Maryland
| | | | - Annie N. Banducci
- Center Addictions, Personality and Emotion Research, University of Maryland, College Park, Maryland
- Department of Psychology, University of Maryland, College Park, Maryland
| | - C.W. Lejuez
- Center Addictions, Personality and Emotion Research, University of Maryland, College Park, Maryland
- Department of Psychology, University of Maryland, College Park, Maryland
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34
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A pilot study of Manual-Assisted Cognitive Therapy with a Therapeutic Assessment augmentation for Borderline Personality Disorder. Psychiatry Res 2010; 178:531-5. [PMID: 20537722 DOI: 10.1016/j.psychres.2010.04.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 04/20/2010] [Accepted: 04/29/2010] [Indexed: 11/23/2022]
Abstract
This study examined the efficacy of Manual Assisted Cognitive Therapy (MACT) as a stand-alone treatment for Borderline Personality Disorder (BPD) with suicidal ideation, and piloted a Therapeutic Assessment (TA) intervention among 16 patients randomly assigned to MACT or MACT+TA. Although MACT was associated with significant reductions in BPD features and suicidal ideation, less than half of the sample completed the treatment. The TA augmentation did not improve treatment retention but it was associated with somewhat greater clinical improvement. Although findings associate MACT with symptom reduction among persisting patients, attrition rate was problematically high in the overall sample.
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35
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Bjärehed J, Sarkohi A, Andersson G. Less positive or more negative? Future-directed thinking in mild to moderate depression. Cogn Behav Ther 2010; 39:37-45. [PMID: 19714541 DOI: 10.1080/16506070902966926] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Depressed patients have been found to generate fewer anticipated positive future events, but most previous studies have included patients who have either been severely depressed or expressed suicidal thoughts and intents or both. The aim of this study was to compare positive and negative future-directed thinking in persons with mild to moderate depression who did not express suicidal thoughts or intents (n = 20) with a matched group of nondepressed persons (n = 20). The two groups completed the Future-Thinking Task (FTT), in which they were asked to generate positive and negative anticipated future events for three upcoming time periods (1 week, 1 year, and 5-10 years). In the present version of the FTT, both quantitative and qualitative aspects were included (i.e. subjective likelihood and emotional valence). Results showed that depressed persons reported lower scores regarding anticipated future positive events but they did not differ in terms of future negative events. The results are consistent with previous research and further strengthen the notion that reduced anticipation of future positive events is a defining characteristic of depression, even in the absence of suicidal ideation.
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36
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van Beek W, Kerkhof A, Beekman A. Future oriented group training for suicidal patients: a randomized clinical trial. BMC Psychiatry 2009; 9:65. [PMID: 19811638 PMCID: PMC2767345 DOI: 10.1186/1471-244x-9-65] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 10/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In routine psychiatric treatment most clinicians inquire about indicators of suicide risk, but once the risk is assessed not many clinicians systematically focus on suicidal thoughts. This may reflect a commonly held opinion that once the depressive or anxious symptoms are effectively treated the suicidal symptoms will wane. Consequently, many clients with suicidal thoughts do not receive systematic treatment of their suicidal thinking. There are many indications that specific attention to suicidal thinking is necessary to effectively decrease the intensity and recurrence of suicidal thinking. We therefore developed a group training for patients with suicidal thoughts that is easy to apply in clinical settings as an addition to regular treatment and that explicitly focuses on suicidal thinking. We hypothesize that such an additional training will decrease the frequency and intensity of suicidal thinking.We based the training on cognitive behavioural approaches of hopelessness, worrying, and future perspectives, given the theories of Beck, McLeod and others, concerning the lack of positive expectations characteristic for many suicidal patients. In collaboration with each participant in the training individual positive future possibilities and goals were challenged. METHODS/DESIGN We evaluate the effects of our program on suicide ideation (primary outcome measure). The study is conducted in a regular treatment setting with regular inpatients and outpatients representative for Dutch psychiatric treatment settings. The design is a RCT with two arms: TAU (Treatment as Usual) versus TAU plus the training. Follow up measurements are taken 12 months after the first assessment. DISCUSSION There is a need for research on the effectiveness of interventions in suicidology, especially RCT's. In our treatment program we combine aspects and interventions that have been proven to be useful in the treatment of suicidal thinking and behavior. TRIAL REGISTRATION ISRCTN56421759.
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Affiliation(s)
| | - Ad Kerkhof
- Vrije Universiteit, Dpt Clinical Psychology, Amsterdam; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Vrije Universiteit, Dpt Psychiatry, Amsterdam; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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37
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O'Connor RC, Fraser L, Whyte MC, MacHale S, Masterton G. Self-regulation of unattainable goals in suicide attempters: the relationship between goal disengagement, goal reengagement and suicidal ideation. Behav Res Ther 2008; 47:164-9. [PMID: 19103433 DOI: 10.1016/j.brat.2008.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 10/18/2008] [Accepted: 11/04/2008] [Indexed: 11/18/2022]
Abstract
There is growing interest in models of adaptive self-regulation. Recent research suggests that goal disengagement and goal reengagement (i.e., goal adjustment) are implicated in the self-regulation of emotion. This study extends the self-regulation research to investigate the utility of goal adjustment in understanding suicidal risk. To this end, two hundred adults hospitalised following a suicidal episode completed a range of clinical and psychological measures in hospital and were followed up approximately 2.5 months after discharge (Time 2). Hierarchical regression analyses showed that goal reengagement predicted suicidal ideation at Time 2. In addition, the lack of goal reengagement was especially pernicious when reported concomitantly with high disengagement. These predictive effects were independent of baseline mood, attempt status and suicidal intent. The theoretical and clinical implications are discussed.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Group, Department of Psychology, University of Stirling, Stirling FK9 4LA, UK.
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38
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O'Connor RC, Fraser L, Whyte MC, Machale S, Masterton G. A comparison of specific positive future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers. J Affect Disord 2008; 110:207-14. [PMID: 18262284 DOI: 10.1016/j.jad.2008.01.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/07/2008] [Accepted: 01/07/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hopelessness and the lack of positive future expectancies have been related to suicidality. This is the first study to compare the power of positive future expectancies and global hopelessness in the prediction of suicidal ideation. In short, are specific positive expectancies or global hopelessness attitudes more closely related to suicidality? METHOD One hundred and forty four adults hospitalized following a suicidal self-harm episode completed a range of clinical and psychological measures in hospital and were followed up approximately 2.5 months after discharge. All participants reported at least one other self-harm episode in addition to the index episode. RESULTS Hierarchical regression analyses confirmed that specific positive future expectancies were better predictors of Time 2 suicidal ideation than global hopelessness. In addition, as hypothesized, negative future thinking was not independently associated with suicidal ideation. LIMITATIONS Short-term follow-up. CONCLUSIONS Specific, idiographic expectancies for positive events (i.e., positive future thinking) are more important predictors of suicidal ideation than global attitudes of hopelessness. Unlike global hopelessness, they provide more options for intervention (e.g., identifying life goals and plans). These findings are particularly noteworthy given the widespread use of measures of global hopelessness. The theoretical and clinical implications are discussed.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Group, Department of Psychology, University of Stirling, Stirling, FK9 4LA, United Kingdom.
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39
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Schulz N, Kroker K, Mesker A, de Jong-Meyer R. Zugriff auf positive versus negative Zukunftsereignisse und Erinnerungen bei depressiven Probanden. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2007. [DOI: 10.1026/1616-3443.36.4.243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Depressive unterscheiden sich von gesunden Kontrollpersonen durch reduzierten Zugriff auf positive bei vergleichbarem Zugriff auf negative Zukunftsereignisse ( MacLeod, Tata, Kentish & Jacobson, 1997 ). Fragestellung: Ziel ist eine Replikation der Befunde zum valenzspezifischen Zugriff auf Zukunfts- und Vergangenheitsereignisse. Zudem werden Korrelationen zwischen den Häufigkeiten der Zukunftsvorstellungen und Ängstlichkeit bzw. Sorgenneigung (Worrying) untersucht. Methode: 24 depressive (BDI > 16) und 22 nicht-depressive Probanden (BDI < 9) bearbeiteten ein Wortflüssigkeitsparadigma, bei dem sie positive oder negative Zukunftsvorstellungen bzw. Erinnerungen nennen sollten. Ängstlichkeit und Worrying wurden mit Fragebögen erhoben. Ergebnisse: Die depressiven Probanden generierten signifikant weniger positive aber nicht mehr negative Zukunftsvorstellungen und Erinnerungen als die Kontrollprobanden. Das Verhältnis zwischen positiven und negativen Ereignissen war innerhalb der depressiven Gruppe ausgewogen, während die Kontrollprobanden mehr positive als negative Ereignisse nannten. Schlussfolgerungen: Es wird diskutiert, welche Faktoren den reduzierten Zugriff auf positive Ereignisse der Depressiven erklären könnten.
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40
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O'Connor RC, Cassidy C. Predicting hopelessness: The interaction between optimism/pessimism and specific future expectancies. Cogn Emot 2007. [DOI: 10.1080/02699930600813422] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Bergmans Y, Brown AL, Carruthers ASH. Advances in crisis management of the suicidal patient: perspectives from patients. Curr Psychiatry Rep 2007; 9:74-80. [PMID: 17257518 DOI: 10.1007/s11920-007-0013-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper discusses crisis intervention with the suicidal client from the perspective of two clients who discuss both the strengths and challenges they have encountered while in crisis. The paper then discusses a model for understanding a suicidal crisis and a template for intervention.
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Affiliation(s)
- Yvonne Bergmans
- University of Toronto-St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
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42
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O'Donovan A. Pragmatism rules: the intervention and prevention strategies used by psychiatric nurses working with non-suicidal self-harming individuals. J Psychiatr Ment Health Nurs 2007; 14:64-71. [PMID: 17244007 DOI: 10.1111/j.1365-2850.2007.01044.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Self harm in the absence of expressed suicidal intent is an under explored area in psychiatric nursing research. This paper reports on findings of a study undertaken in two acute psychiatric inpatient units in Ireland. The purpose of the study was to gain an understanding of the practices of psychiatric nurses in relation to people who self harm, but who are not considered suicidal. Semi structured interviews were held with eight psychiatric nurses. Content analysis revealed several themes. For the purpose of this paper the prevention and intervention strategies psychiatric nurses engage in when working with non-suicidal self harming individuals are presented. Recommendations for further research are offered.
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Affiliation(s)
- A O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
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43
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Dahlberg LL, Butchart A. State of the science: violence prevention efforts in developing and developed countries. Int J Inj Contr Saf Promot 2005; 12:93-104. [PMID: 16156533 DOI: 10.1080/15660970500086239] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Violence is an important global public health problem that claims the lives of over 1.6 million people each year and results in numerous other health and social consequences. It is also a preventable health problem. This paper provides an overview of the current status of prevention efforts in developing and developed countries, describes what is known about the effectiveness of different approaches and highlights some of the important challenges in building the evidence-base for violence prevention programmes. Research conducted to date shows an imbalance in the emphasis of prevention programmes across the different types of violence. This imbalance is reflected in the timing of response, the nature and level of influence of interventions and programmes and the outcomes studied. Promising and effective approaches have been identified, but many more still require rigorous testing, particularly in developing countries. The current state of the science in violence prevention reveals both progress and a number of remaining challenges.
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Affiliation(s)
- Linda L Dahlberg
- The Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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44
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MacLeod AK, Tata P, Tyrer P, Schmidt U, Davidson K, Thompson S. Personality disorder and future-directed thinking in parasuicide. J Pers Disord 2004; 18:459-66. [PMID: 15519956 DOI: 10.1521/pedi.18.5.459.51329] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Parasuicide patients have been found to lack positive expectations for the future. The aim of the present study was to look at variations in this lack of positive future-thinking as a function of personality status. A sample (N = 442) of repeat parasuicide patients was assessed on positive and negative future-thinking and the presence of personality disorder or personality difficulty. Those with a Cluster B personality disorder (borderline or dissocial) were significantly lower in positive future-thinking than those with no Cluster B symptoms or those with Cluster B personality difficulty. Neither Cluster A nor Cluster C symptomatology was related to positive future-thinking. Negative future-thinking was not significantly related to any type of personality disorder or difficulty. The results are interpreted as evidence of the importance of personality status in influencing positive future-thinking and gives some indications of why those with Cluster B personality disorder have such high rates of recurrent self-harm.
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Affiliation(s)
- Andrew K MacLeod
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
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45
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Tyrer P, Jones V, Thompson S, Catalan J, Schmidt U, Davidson K, Knapp M, Ukoumunne OC. Service variation in baseline variables and prediction of risk in a randomised controlled trial of psychological treatment in repeated parasuicide: the POPMACT Study. Int J Soc Psychiatry 2003; 49:58-69. [PMID: 12793516 DOI: 10.1177/0020764003049001148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The treatment protocol and baseline characteristics of 480 subjects with a history of repeated parasuicide recruited in five centres to a randomised therapeutic trial of manual assisted cognitive-behaviour therapy (MACT) and treatment as usual (TAU) are described. Most patients had significant anxiety and depressive disturbance with 42% having a personality disorder. Variation in service policies influenced recruitment, with earlier assessment centres seeing people with more frequent episodes of self-harm and greater parasuicide risk than later ones. Parasuicide risk was also significantly greater in those with their first parasuicide episode at an earlier age and in those with a more recent latest episode.
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Affiliation(s)
- Peter Tyrer
- Department of Public Mental Health, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Paterson Centre, London, UK.
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46
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Sheehy N, O'Connor RC. Cognitive style and suicidal behaviour: Implications for therapeutic intervention, research lacunae and priorities. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2002. [DOI: 10.1080/0306988021000025574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Bergmans Y, Links PS. A Description of a Psychosocial/Psychoeducational Intervention for Persons with Recurrent Suicide Attempts. CRISIS 2002. [DOI: 10.1027//0227-5910.23.4.156] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Summary: This paper gives a description of a psychosocial/psychoeducational group intervention for individuals with a history of recurrent suicide attempts. The intervention was conceived to reduce the risk of future suicidal behavior and to modify the client's psychopathology. Three features are felt to make the intervention unique from others described in the literature. First, the intervention is targeted at both men and women from an inner-city population who are often underhoused, underemployed, and undereducated. 24 of 48 clients (50%) lived alone, and 24 of those (92%) were living in subsidized housing; 33% lived in supportive housing, and one lived on the street at the time of assessment. 48% had a high-school education or less. Second, the principles of our approach stressed client validation and participation in the development and delivery of the therapy. Our frame of reference was to name ourselves as professionals with a set of skills and access to some kinds of information and clients as the experts on the experience in their lives. Third, the group content incorporated a multimodal approach to meet the varied needs of the clients. Future reports will discuss the empirical evaluation of this intervention; however, the development of specific, targeted approaches for unique individuals with recurrent suicide attempts is clearly needed.
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Affiliation(s)
- Yvonne Bergmans
- St. Michael's Hospital—University of Toronto, Toronto, Canada
| | - Paul S. Links
- St. Michael's Hospital—University of Toronto, Toronto, Canada
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48
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Abstract
In some randomised controlled trials the nature of the therapy means that subjects cannot or should not be blinded. Such studies need careful design. Particular attention needs to be given to the choice of control group and the nature of the informed consent obtained from subjects, because these affect the precise research question being addressed. A survey of published studies was carried to investigate how these issues had been tackled. The paper summarizes key findings from the survey. If the research question is about the specific effect of a therapy sometimes a good case can be made for a second control group which is 'attention-controlled'. There is a need for more detailed justifications of such design decisions in published studies.
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Affiliation(s)
- A Hart
- Statistics Group, Faculty of Science, University of Central Lancashire, Preston, UK.
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Hawton K, Townsend E, Arensman E, Gunnell D, Hazell P, House A, van Heeringen K. Psychosocial versus pharmacological treatments for deliberate self harm. Cochrane Database Syst Rev 2000:CD001764. [PMID: 10796818 DOI: 10.1002/14651858.cd001764] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To identify and synthesise the findings from all randomised controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves. SEARCH STRATEGY Electronic databases screened: MEDLINE (from 1966-February 1999); PsycLit (from 1974-March 1999); Embase (from 1980-January 1999); The Cochrane Controlled Trials Register (CCTR) No.1 1999. Ten journals in the field of psychiatry and psychology were hand searched for the first version of this review. We have updated the hand search of three specialist journals in the field of suicidal research until the end of 1998. Reference lists of papers were checked and trialists contacted. SELECTION CRITERIA All RCTs of psychosocial and/or psychopharmacological treatment versus standard or less intensive types of aftercare for patients who shortly before entering a study engaged in any type of deliberately initiated self-poisoning or self-injury, both of which are generally subsumed under the term deliberate self-harm. DATA COLLECTION AND ANALYSIS Data were extracted from the original reports independently by two reviewers. Studies were categorized according to type of treatment. The outcome measure used to assess the efficacy of treatment interventions for deliberate self-harm was the rate of repeated suicidal behaviour. We have been unable to examine other outcome measures as originally planned (e.g. compliance with treatment, depression, hopelessness, suicidal ideation/thoughts, change in problems/problem resolution). MAIN RESULTS A total of 23 trials were identified in which repetition of deliberate self-harm was reported as an outcome variable. The trials were classified into 11 categories. The summary odds ratio indicated a trend towards reduced repetition of deliberate self-harm for problem-solving therapy compared with standard aftercare (0.70; 0.45 to 1.11) and for provision of an emergency contact card in addition to standard care compared with standard aftercare alone (0.45; 0.19 to 1.07). The summary odds ratio for trials of intensive aftercare plus outreach compared with standard aftercare was 0.83 (0.61 to 1.14), and for antidepressant treatment compared with placebo was 0.83 (0. 47 to 1.48). The remainder of the comparisons were in single small trials. Significantly reduced rates of further self-harm were observed for depot flupenthixol vs. placebo in multiple repeaters (0. 09; 0.02 to 0.50), and for dialectical behaviour therapy vs. standard aftercare (0.24; 0.06 to 0.93). REVIEWER'S CONCLUSIONS There still remains considerable uncertainty about which forms of psychosocial and physical treatments of self-harm patients are most effective, inclusion of insufficient numbers of patients in trials being the main limiting factor. There is a need for larger trials of treatments associated with trends towards reduced rates of repetition of deliberate self-harm. The results of small single trials which have been associated with statistically significant reductions in repetition must be interpreted with caution and it is desirable that such trials are also replicated.
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Affiliation(s)
- K Hawton
- University Department of Psychiatry, Warneford Hospital, Oxford, UK, OX3 7JX.
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