Promoting Clinical Knowledge,Skills, and Empathy via a Creative Self-Suicide Assignment

Abstract

Suicide is a leading cause of American deaths. Given suicide's overall frequency and negative effects, specialized suicide training is warranted. This article describes a creative self-suicide assignment designed to enhance doctoral students? suicide assessment and intervention knowledge and clinical skills, and promote greater counselor empathy for clients presenting with suicidal ideation. Doctoral students who participated in the assignment reported increased suicide assessment and intervention knowledge and skills, and enhanced empathy toward clients presenting with suicide-related issues. Student summarizations related to their assignment experiences are included.     

Differential Reinforcement of Other Behavior in the Treatment of Inappropriate Behavior and Aggression in an Adult with Mental Retardation at a Vocational Center

Differential reinforcement of other behavior (DRO) was used to reduce aggression and other inappropriate actions in a 26-year-old man with moderate mental retardation employed at a vocational center. Initially high baseline levels of inappropriate behavior were reduced by implementing contingent praise and a sticker system used to earn points needed to gain access to social activities. The procedure was low cost, required minimal time and effort on the part of center staff, and made it possible for the client to remain employed at the vocational center.     

Purpose in Life, Satisfaction with Life, and Suicide Ideation in a Clinical Sample

This study examined the role of purpose in life and satisfaction with life in protecting against suicide ideation in a clinical psychiatric sample. Forty-nine psychiatric patients completed self-report measures of suicide ideation, purpose in life, satisfaction with life, neuroticism, depression, and social hopelessness. Zero-order correlations indicated significant associations between suicide ideation and the various predictors, in the hypothesized directions. Regression analyses illustrated that purpose in life and satisfaction with life accounted for significant additional variability in suicide ideation scores above and beyond that accounted for by the negative psychological factors alone. Purpose in life also mediated the relation between satisfaction with life and suicide ideation and moderated the relation between depression and suicide ideation. These findings demonstrate the potential value of attending to both resilience and pathology when building predictive models of suicide ideation and of attending to key existential themes when assessing and treating suicidal individuals.     

Discerning the Behavior of the Suicide Bomber: The Role of Vengeance

Deliberate suicide used to achieve some end in group conflict is a relatively rare but always dramatic behavior. Motivation for such behavior is complex occurs usually at both the group and individual levels, and can have multiple meanings. The author examines suicide bombing as it has occurred recently in both the 9/11 event and in the Israeli-Palestinian conflict, notes that it appears to be a behavior motivated mainly by the singular intent to destroy a particular people, and concludes that it is a 'depressive equivalent' behavior rooted in the desire for vengeance. He identifies such behavior, given this motivation, as a crime by the leaders of the groups planning such acts against those they send on suicide bombing missions. He exhorts civilized society to bring these criminals to justice in order to prevent such acts.     

A Cultural Adaptation of Dialectical Behavior Therapy in Nepal

Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia.     

Posttraumatic Stress Disorder Symptom Severity and Emotion Regulation in Acute-Care Psychiatric Inpatients: Associations With Suicidality

Posttraumatic stress disorder (PTSD) symptomatology has been positively associated with suicidality (suicidal ideation and attempts), but less is known about factors that might exacerbate that association. The present study examined the main and interactive effects of PTSD symptom severity and difficulties in emotion regulation in association with four suicidality outcomes. Participants included 128 adults in an acute-care psychiatric inpatient setting. Results revealed that PTSD symptom severity was significantly incrementally associated with self-reported suicidal ideation (ß = .30, p = .02). Difficulties in emotion regulation were significantly associated with suicide as the reason for current admission (p = .01). The interactive effect of PTSD symptom severity and difficulties in emotion regulation was significant only for self-reported suicidal ideation (ß = .24, p < .001). Participants with high levels of PTSD symptom severity and difficulties in emotion regulation exhibited the highest level of suicidal ideation. Clinical implications and future directions are discussed.     

Child Abuse—Suicide Resilience Link in African American Women: Interpersonal Psychological Mediators

The interpersonal-psychological theory of suicidal behavior (IPTS) is an exemplary model for understanding the desire for suicidal behavior. As such, it is important to explore its applicability in ethnoracial minority groups at increasing risk for suicidal behavior, such as low-income, African American women. Guided by the IPTS, the current study used 5 parallel mediation models to examine if there are links between individual types of childhood abuse (physical, sexual, emotional) and suicide resilience, and between cumulative abuse (higher levels of abuse inclusive of all three types, more types of severe levels of abuse) and suicide resilience, and whether the three components of the model (thwarted belongingness, perceived burdensomeness, acquired capability for suicide) mediate these associations. In a sample of low-income, African American women (n = 179), higher levels of each of the 3 types of childhood abuse and cumulative abuse correlated with lower levels of suicide resilience. Parallel mediation analyses using bootstrapping techniques revealed that increased acquired capability for suicide mediated all 5 associations and perceived burdensomeness mediated 3 of the links (emotional abuse, cumulative abuse, and cumulative abuse–severe with suicide resilience). Attention is paid to the clinical implications of the findings in terms of attending to the acquired capability for suicide and suicide resilience in the assessment and treatment of low-income, suicidal, African American women.     

An Evolutionary Account of Suicide Attacks: The Kamikaze Case

Explanations for suicide attacks abound. Yet the literature remains conceptually fragmented, with different authors focusing on different attitudes, incentive structures, values, psychological processes, strategic imperatives, and cultural, historical, and personal circumstances. Curiously, however, there have been few efforts to cast suicide bombing within the extensive evolutionary literature on human altruism—in which it clearly belongs. Neither have there been more than occasional efforts to mobilize the distinction between “proximate” and “ultimate” explanations, with most proposed explanations being proximate. Here we draw on content analyses from materials written by Japanese Kamikaze pilots to propose an evolvable cognitive algorithm—by hypothesis, species typical—that (1) specifies environmental circumstances under which such “heroic” behavior is likely; (2) is consistent at the proximate level with the Japanese data; and (3) that is not inconsistent with many of the diverse proximate attitudes, values, and psychological mechanisms that dominate discussions of contemporary suicide campaigns. The evolutionary perspective is not an alternative to most of the proximate explanations offered in discussions of contemporary cases but is, rather, a paradigm around which diverse proximate explanations can be organized.     

Factor Structure of the Reasons for Attempting Suicide Questionnaire (RASQ) with Suicide Attempters

A sample of 134 suicide attempters completed the Reasons for Attempting Suicide Questionnaire (RASQ). Maximum likelihood factor and principal components analyses confirmed the multidimensionality of the RASQ, with two-component and three-factor models each receiving support. Scales from these competing multidimensional RASQ models demonstrated adequate internal consistency reliability. For the two-component model, two previously developed scales demonstrated differential validity with suicide indices. It is concluded that the RASQ has at least two dimensions, and it is recommended that the RASQ be scored for two scales: Internal Perturbation-Based Reasons and Extrapunitive/Manipulative Motivations.