Lower Suicide Risk in College Students with Mindfulness
By John M. de Castro, Ph.D.
“Zhongyong thinking still plays an important role in regulating mental distress and maintaining subjective well-being among contemporary Chinese young adults.” – Xeuling Yang
Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.
Mindfulness training has been shown to reduce suicidality. Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.
Zhong‐Yong thinking emphasizes pursuing the middle ground and never going to extremes and is characterized by acting appropriately and flexibly under different situations. It would seem to be compatible with the kinds of training occurring in Dialectical Behavior Therapy (DBT) and would tend to be an antidote for suicidal thinking. Although it would seem reasonable combining Zhong‐Yong thinking with DBT would improve its effectiveness in lowering the risk of suicide, there have been no systematic studies.
In today’s Research News article “Effectiveness of Zhong-Yong thinking based dialectical behavior therapy group skills training versus supportive group therapy for lowering suicidal risks in Chinese young adults: A randomized controlled trial with a 6-month follow-up.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303376/) Yang and colleagues recruited high suicide risk college students and randomly assigned them to either a wait-list control condition or to receive a 2-hour once a week for 12 weeks program of either Dialectical Behavior Therapy (DBT) modified for inclusion of Zhong‐Yong thinking or a supportive group therapy program based upon interpersonal psychology focusing on emotional regulation and interpersonal effectiveness. They were measured before and after training and 6 months later for suicide behaviors and ideation, hopelessness, psychological distress, and psychopathological symptoms.
They found that in comparison to baseline and the wait-list control group, the groups that received either treatment has significant reductions in suicide behaviors and ideation, hopelessness, psychological distress, and psychopathological symptoms. But at the 6-month follow up the treatment groups differed with the Zhong-Yong thinking based Dialectical Behavior Therapy (DBT) group producing significantly greater improvements of obsessive compulsive, anxiety, hostility, phobic, and psychotic symptoms in comparison to supportive group therapy.
The results are promising that Zhong-Yong thinking based Dialectical Behavior Therapy (DBT) can reduce suicidality and risk factors for suicide in college students and maintain the benefits for 6 months after the end of active treatment. Although supportive therapy was equally beneficial on the short-term, it was less effective on the long-term. So, Zhong-Yong thinking based DBT would appear to be the superior treatment. It would be important in future research to compare Zhong-Yong thinking based DBT to traditional DBT to determine if the addition of training in Zhong-Yong thinking increases the benefits.
So, lower suicide risk in college students with mindfulness.
“those who scored high on the Zhongyong Thinking Scale had substantially lower scores on anxiety and depressive symptoms, and had higher scores on self-esteem and life satisfaction.” – Xeuling Yang
CMCS – Center for Mindfulness and Contemplative Studies
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Yang, X., Liu, D., Wang, Y., Chen, Y., Chen, W., Yang, C., Zhang, P., Ding, S., & Zhang, X. (2020). Effectiveness of Zhong-Yong thinking based dialectical behavior therapy group skills training versus supportive group therapy for lowering suicidal risks in Chinese young adults: A randomized controlled trial with a 6-month follow-up. Brain and behavior, 10(6), e01621. https://doi.org/10.1002/brb3.1621
Dialectical behavior therapy (DBT) is a first‐line treatment for the prevention of suicide. Zhong‐Yong thinking could be viewed as a Chinese way of dialectical thinking, has long been a culturally dictating thinking style in China. To enhance cultural adaptability, we integrated Zhong‐Yong thinking into DBT group skills training and examined its efficacy in suicidal prevention compared with a supportive group therapy and a wait‐list group in high‐risk suicidal Chinese college students.
A total of 97 suicidal participants were randomized to either Zhong‐Yong thinking based DBT group skills training (DBTZYT, n = 33), or supportive group therapy (SGT; n = 32), or wait‐list group (WL; n = 32). DBTZYT was a 12‐week program based on Zhong‐Yong thinking instead of dialectical thinking, coaching participants mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Supportive group therapy was a 12‐week program aiming at improving interpersonal effectiveness and emotion regulation skills. Outcome measures were assessed at pre‐ and post‐treatment and 6‐month follow‐up.
At post‐treatment measures, the levels of suicidal ideation, hopelessness, psychache symptoms, and general psychopathology had significantly decreased in both intervention groups; at the 6‐month follow‐up measures, the intervention effects were better maintained in the DBTZYT group rather than in the SGT group. Specifically, DBTZYT was more effective in relieving participants’ long‐term obsessive‐compulsive, anxiety, hostility, phobic, psychotic, and additional symptoms.
Zhong‐Yong thinking not only could integrate with DBT skills training in Chinese young adult population, but also has special strength in enhancing DBT’s efficacy.