Suicidality

Improve Borderline Personality Disorder with Mindfulness

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Improve Borderline Personality Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“DBT . . . is considered one of the best treatments for [Borderline Personality Disorder] in terms of documented success rates. . . [Borderline Personality Disorder] is effective in reducing psychiatric hospitalization, substance use, and suicidal behavior. . .  self-injurious behaviors, and the severity of borderline symptoms.” – Kristalyn Salters-Pedneault

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. About ¾ of BPD patients engage in self-injurious behaviors.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. 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. The research regarding the effectiveness of DBT reduces for BPD patients has been accumulating. So, it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Psychological therapies for people with borderline personality disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199382/ ) Storebø and colleagues review and summarize the published randomized controlled trials on the effectiveness of Dialectical Behavior Therapy (DBT). for the treatment of Borderline Personality Disorder (BPD). They found 25 randomized controlled trials.

 

They report that the published research found that Dialectical Behavior Therapy (DBT) compared to treatment as usual, wait-list controls, and no-treatment produced significantly greater reductions in Borderline Personality Disorder (BPD) severity, self-harm, anger, impulsivity, dissociation, psychotic-like symptoms, and emotional instability and significantly greater increases in psychological functioning. There were no significant differences in adverse events between DBT and controls.

 

The published research clearly demonstrates that Dialectical Behavior Therapy (DBT) is a safe and effective treatment for Borderline Personality Disorder (BPD).

 

“‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it’s possible for you to achieve both these goals together.” – Mind

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews, 5(5), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2

 

Abstract

Background

Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers‐Winterling 2012).

Objectives

To assess the beneficial and harmful effects of psychological therapies for people with BPD.

Search methods

In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication.

Selection criteria

Randomised controlled trials comparing different psychotherapeutic interventions with treatment‐as‐usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self‐harm, suicide‐related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects.

Data collection and analysis

At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane’s ‘Risk of bias’ tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis.

Main results

We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation‐based treatment (MBT). The comparator interventions included treatment‐as‐usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months.

Psychotherapy versus TAU

Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) −0.52, 95% confidence interval (CI) −0.70 to −0.33; 22 trials, 1244 participants; moderate‐quality evidence. This corresponds to a mean difference (MD) of −3.6 (95% CI −4.4 to −2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is −3.0 points).

Psychotherapy may be more effective at reducing self‐harm compared to TAU (SMD −0.32, 95% CI −0.49 to −0.14; 13 trials, 616 participants; low‐quality evidence), corresponding to a MD of −0.82 (95% CI −1.25 to 0.35) on the Deliberate Self‐Harm Inventory Scale (range 0 to 34). The MIREDIF of −1.25 points was not reached.

Suicide‐related outcomes improved compared to TAU (SMD −0.34, 95% CI −0.57 to −0.11; 13 trials, 666 participants; low‐quality evidence), corresponding to a MD of −0.11 (95% CI −0.19 to −0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of −0.17 points was not reached.

Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD −0.45, 95% CI −0.68 to −0.22; 22 trials, 1314 participants; low‐quality evidence), corresponding to a MD of −2.8 (95% CI −4.25 to −1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of −4.0 points was not reached.

Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases.

A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning.

Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD −0.39, 95% CI −0.61 to −0.17; 22 trials, 1568 participants; very low‐quality evidence), corresponding to a MD of −2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of −3.0 points was not reached.

BPD‐specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data.

Psychotherapy versus waiting list or no treatment

Greater improvements in BPD symptom severity (SMD −0.49, 95% CI −0.93 to −0.05; 3 trials, 161 participants), psychosocial functioning (SMD −0.56, 95% CI −1.01 to −0.11; 5 trials, 219 participants), and depression (SMD −1.28, 95% CI −2.21 to −0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low‐quality evidence). No evidence of a difference was found for self‐harm and suicide‐related outcomes.

Individual treatment approaches

DBT and MBT have the highest numbers of primary trials, with DBT as subject of one‐third of all included trials, followed by MBT with seven RCTs.

Compared to TAU, DBT was more effective at reducing BPD severity (SMD −0.60, 95% CI −1.05 to −0.14; 3 trials, 149 participants), self‐harm (SMD −0.28, 95% CI −0.48 to −0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD −0.36, 95% CI −0.69 to −0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self‐harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD −0.58, 95% CI −1.22 to 0.05, 4 trials, 333 participants). All findings are based on low‐quality evidence. For secondary outcomes see review text.

Authors’ conclusions

Our assessments showed beneficial effects on all primary outcomes in favour of BPD‐tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF‐defined cut‐off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) .

The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low‐quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self‐harm and suicide‐related outcomes.

However, compared to TAU, we observed effects in favour of DBT for BPD severity, self‐harm and psychosocial functioning and, for MBT, on self‐harm and suicidality at end of treatment, but these were all based on low‐quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.

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Plain language summary

Psychological therapies for people with borderline personality disorder

Background

People affected by borderline personality disorder (BPD) often have difficulties with controlling their impulses and emotions. They may have a poor self‐image, experience rapid changes in mood, harm themselves and find it hard to engage in harmonious interpersonal relationships. Different types of psychological treatments (‘talking treatments’) have been developed to help people with BPD. The effects of these treatments must be investigated to decide how well they work and if they can be harmful.

Objective

This review summarises what we currently know about the effect of psychotherapy in people with BPD.

Methods

We compared the effects of psychological treatments on people affected by BPD who did not receive treatment or who continued their usual treatment, were on a waiting list or received active treatment.

Findings

We searched for relevant research articles, and found 75 trials (4507 participants, mostly female, mean age ranging from 14.8 to 45.7 years). The trials examined a wide variety of psychological treatments (over 16 different types). They were mostly conducted in outpatient settings, and lasted between one and 36 months. Dialectical behaviour Therapy (DBT) and Mentalisation‐Based Treatment (MBT) were the therapies most studied.

Psychotherapy compared with usual treatment

Psychotherapy reduced the severity of BPD symptoms and suicidality and may reduce self‐harm and depression whilst also improving psychological functioning compared to usual treatment. DBT may be better than usual treatment at reducing BPD severity, self‐harm and improving psychosocial functioning. Similarly, MBT appears to be more effective than usual treatment at reducing self‐harm, suicidality and depression. However, these findings were all based on low‐quality evidence and therefore we are uncertain whether or not these results would change if we added more trials. Most trials did not report adverse effects, and those that did, found no obvious unwanted reactions following psychological treatment. The majority of trials (64 out of 75) were funded by grants from universities, authorities or research foundations. Four trials reported that no funding was received. For the remaining trials (7), funding was not specified.

Psychotherapy versus waiting list or no treatment

Psychotherapy was more effective than waiting list at improving BPD symptoms, psychosocial functioning, and depression, but there was no clear difference between psychotherapy, and waiting list for outcomes of self‐harm, and suicide‐related outcomes.

Conclusions

In general, psychotherapy may be more effective than usual treatment in reducing BPD symptom severity, self‐harm, suicide‐related outcomes and depression, whilst also improving psychosocial functioning. However, only the decrease in BPD symptom severity was found to be at a clinically important level. DBT appears to be better at reducing BPD severity, self‐harm, and improving psychosocial functioning compared to usual treatment and MBT appears more effective than usual treatment at reducing self‐harm and suicidality. However, we are still uncertain about these findings as the quality of the evidence is low.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199382/

 

Spirituality is Related to Reduced Depression but Negative Religiosity is Associated with Suicidality

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Spirituality is Related to Reduced Depression but Negative Religiosity is Associated with Suicidality

 

By John M. de Castro, Ph.D.

 

“The trouble is that just as it is hard to feel connected to other people while depressed, it is difficult to feel connected to God. A leap of trust and faith is frequently needed to be spiritual while depressed.” – Healthtalk.org

 

Depression and other mood disorders are the number-one risk factor for suicide. More than 90% of people who kill themselves have a mental disorder, whether depression, bipolar disorder or some other diagnosis. So, the best way to prevent suicide may be to treat the underlying cause. For many this means treating depression.

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health. Spirituality may help to provide meaning and prevent suicide. But there is scant research on the relationship of spirituality and religiosity and suicide.

 

In today’s Research News article “Comparison of religiosity and spirituality in patients of depression with and without suicidal attempts.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221206/ ) Dua and colleagues

CMCS – Center for Mindfulness and Contemplative Studies recruited 2 groups of patients both with depression and suicidal ideation and one with an additional suicide attempt. They also recruited age and gender matched healthy control participants. They completed measures of the depression, impulsivity, hopelessness, anxiety, irritability, mania, suicide severity, centrality of religion and spiritual attitudes.

 

They found that the depressed groups did not differ in purpose, hope, and organized, nonorganized religious activities and intrinsic religiosity. On the other hand, patients with suicidal ideation generally had a family history of suicide. Patients who had attempted suicide were significantly higher in hopelessness and suicide ideation and lower on social support than patients who had nor attempted suicide. They also had significantly higher levels of negative religious coping. Compared to the healthy controls the depressed groups were significantly lower in religiosity. They also found that the lower the levels of religiosity the greater the levels of suicidal ideation and the higher the number of suicide attempts. But, in the suicide attempters higher levels of ideological religiosity was associated with greater severity of suicide ideation.

 

These are interesting but correlative findings and as such causation cannot be determined. Nevertheless, the results suggest that spirituality, although associated with lower depression, is not significantly related to suicide ideation or attempts. On the other hand, negative religious coping, ideological religiosity, and low religiosity were. In other words, being religious, in general is not a problem. But adhering to the ideology or using negative religious coping are associated with suicidality.

 

Negative religious coping involves struggling with religion, questioning, guilt, and perceived distance from and negative views of god. This type of coping does not provide support in times of psychological distress and in fact may exacerbate feelings of hopelessness. Regardless, it appears that non-spiritual uses and ideas about religion and god my be associated with more thoughts about suicide and an increased likelihood of attempting suicide.

 

So, spirituality is related to reduced depression but negative religiosity is associated with suicidality.

 

“Whether your depression manifests itself as a loss of appetite, decreased sense of self-worth, lost productivity, feelings of helplessness, prolonged worry or any other symptom, spirituality can absolutely help an individual along their journey toward purpose.” – Pyramid Healthcare

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Dua, D., Padhy, S., & Grover, S. (2021). Comparison of religiosity and spirituality in patients of depression with and without suicidal attempts. Indian journal of psychiatry, 63(3), 258–269. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_246_20

 

Abstract

Aim:

This study is aimed to compare the religiosity and spirituality of patients with first-episode depression with suicidal ideation and those with recent suicidal attempts. Additional aim was compare the religiosity and spirituality of patients with first-episode depression with healthy controls.

Methods:

Patients of first episode depression with suicidal ideation and healthy controls were assessed by Centrality of Religiosity Scale (CRS), Duke University Religion Index (DUREL), Brief Religious coping scale (R-COPE), and Spiritual Attitude Inventory (SAI).

Results:

Patients with depression were divided into two groups based on the presence (n = 53) or absence (n = 62) of suicidal attempts in the previous 14 days. Both the patients with and without suicide attempts were matched for depression severity. Both the patient groups did not differ in terms of religiosity and spirituality as assessed using CRS and SAI. Both depression groups had lower scores on religiosity as compared to healthy controls as assessed on CRS. The two groups also had a lower score on the “sense of hope” which is a part of SAI, when compared to healthy controls. Compared to patients without suicide attempts (i.e., ideators group) and healthy controls, subjects with suicide attempts more often used negative religious coping. Total numbers of lifetime suicide attempts in the attempt group were associated with the ideology domain of the CRS.

Conclusion:

Compared with healthy controls, patients with depression have lower levels of religiosity and spirituality. In the presence of comparable severity of depression, higher use of negative religious coping is associated with suicide attempts.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221206/

Reduce Self-Harm and Suicidality in Adolescents with Mindfulness

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Reduce Self-Harm and Suicidality in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

“growing evidence supports DBT-A as a likely viable treatment intervention for adolescents who self-harm.” – Kimberly R. Freeman

 

Around 43,000 people take their own lives each year in the US. 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. Indeed, suicide is the second leading cause of death in adolescents.

 

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years.

 

One of the few treatments that appears to be Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic including self-injury. 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. DBT has been found to reduce self-injurious behaviors. The data is accumulating so there is a need to review and summarize what has been found.

 

In today’s Research News article “Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188531/ ) Kothgassner and colleagues review, summarize, and perform a meta-analysis of the published research literature on the effectiveness of Dialectical Behavior Therapy (DBT) for the treatment of self-harm and suicidality in adolescents.

 

They identified 21 published research studies encompassing 1673 adolescents. They report that the published research found that Dialectical Behavior Therapy (DBT) resulted in significant reductions in self-harm and suicide ideation in the adolescents. They further found that the longer the duration of DBT treatment the greater the reductions in suicidal ideation.

 

This summary of the published research studies suggests that Dialectical Behavior Therapy (DBT) is a safe and effective treatment for the reduction of self-harm and suicidal thoughts in adolescents. Since, suicide is the second leading cause of death in adolescents and has increased substantially over the last decade, a treatment that can help reduce these rates is needed. The present results suggest that DBT with its associated training in mindfulness may be able to address this need.

 

So, reduce self-harm and suicidality in adolescents with mindfulness.

 

“the DBT-A group experienced fewer episodes of self-harm. . . as well as statistically significant reductions in suicidal ideation and depression (both of which are risk factors for suicide).” – Suicide Prevention Resource Center

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological medicine, 51(7), 1057–1067. https://doi.org/10.1017/S0033291721001355

 

Abstract

Background

Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.

Methods

We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.

Results

Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63).

Conclusions

DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188531/

 

Spirituality is Associated with Fewer Suicide Attempts

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Spirituality is Associated with Fewer Suicide Attempts

 

By John M. de Castro, Ph.D.

 

“spirituality can engender the perspective that things happen for some reason and serve a greater purpose. This, in turn, deploys our attention toward the potential for a brighter future, which can create a sense of optimism even when one’s situation seems dire.” – David Rosmarin

 

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.

 

Depression and other mood disorders are the number-one risk factor for suicide. More than 90% of people who kill themselves have a mental disorder, whether depression, bipolar disorder or some other diagnosis. So, the best way to prevent suicide may be to treat the underlying cause. For many this means treating depression. Spirituality may help to provide meaning and prevent suicide. But there is scant research on the relationship of spirituality and religiosity and suicide.

 

In today’s Research News article “Factors Related to Suicide Attempts: The Roles of Childhood Abuse and Spirituality.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044867/ ) Tae and Chae recruited patients with anxiety or depressive disorders and had them complete measures of suicide attempts, anxiety, depression, childhood trauma, spiritual well-being, and social support. 25% of the participants indicated that they had attempted suicide.

 

They found that in comparison to non-suicide attempters, the participants who had attempted suicide had significantly higher levels of anxiety, depression, emotional, physical, and sexual abuse, and emotional and physical neglect and significantly lower levels of spirituality and social support. A hierarchal regression revealed that a high level of emotional abuse and a high level of sexual abuse as well as low spirituality predicted suicide attempts. A mediation analysis revealed that childhood emotional, sexual abuse, and low spirituality were all significant direct predictors of suicide attempts and also significant indirect predictors such that abuse and low spirituality were associated with higher levels of depression which, in turn was associated with suicide attempts.

 

These results are correlational. So, no conclusions concerning causation can be reached. But the associations are clear. Depression, childhood emotional and sexual abuse, and low spirituality are all associated with suicide attempts. It is also clear that in addition to being directly associated with suicide attempts, childhood emotional and sexual abuse, and low spirituality also are associated with higher levels of depression which, in turn, is associated with suicide attempts.

 

Childhood emotional and sexual abuse are clearly risk factors for suicide and should be viewed as red flags in evaluating a patient. But these abuses occurred in the past and cannot be changed. Spirituality on the other hand can change. There are many religious and contemplative practices that can improve spirituality. The present results suggest that this may be helpful and lowering depression and preventing suicide. Future research is needed to investigate this idea, that increasing spirituality can decrease suicide risk.

 

So, spirituality is associated with fewer suicide attempts.

 

“I personally think spirituality is a part of each of our beings. It has been the difference in my life and has walked me back from the place where I thought suicide was my only option.” – Kelli Evans

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Tae, H., & Chae, J. H. (2021). Factors Related to Suicide Attempts: The Roles of Childhood Abuse and Spirituality. Frontiers in psychiatry, 12, 565358. https://doi.org/10.3389/fpsyt.2021.565358

 

Abstract

Objectives: The purpose of this article was to identify independent factors associated with suicide attempts in patients with depression and/or anxiety.

Background and Aims: This study was conducted in order to examine whether risk and protective psychological factors influence the risk of suicide attempts among outpatients with anxiety and/or depressive disorders. In this regard, explanatory models have been reported to detect high-risk groups for suicide attempt. We also examined whether identified factors serve as mediators on suicide attempts.

Materials and Methods: Patients from 18 to 65 years old from an outpatient clinic at Seoul St. Mary’s Hospital were invited to join clinical studies. From September 2010 to November 2017, a total of 737 participants were included in the final sample. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Childhood Trauma Questionnaire (CTQ), Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12), and Functional Social Support Questionnaire (FSSQ) were used to assess psychiatric symptoms. An independent samples t-test, a chi-square test, hierarchical multiple regression analyses, and the Baron and Kenny’s procedures were performed in order to analyze data.

Results: Young age, childhood history of emotional and sexual abuse, depression, and a low level of spirituality were significant independent factors for increased suicide attempts. Depression was reported to mediate the relationship between childhood emotional and sexual abuse, spirituality, and suicide attempts.

Conclusions: Identifying the factors that significantly affect suicidality may be important for establishing effective plans of suicide prevention. Strategic assessments and interventions aimed at decreasing depression and supporting spirituality may be valuable for suicide prevention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044867/

 

Change Behavior for the Better with Mindfulness

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Change Behavior for the Better with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness practice supports and facilitates behavior change through training attention, emotion, and self-awareness.” – Yi-Yuan Tang

 

We tend to think that illness is produced by physical causes, disease, injury, viruses, bacteria, etc. But many health problems are behavioral problems or have their origins in maladaptive behavior. This is evident in car accident injuries that are frequently due to behaviors, such as texting while driving, driving too fast or aggressively, or driving drunk. Other problematic behaviors are cigarette smoking, alcoholism, drug use, or unprotected sex.

 

Problems can also be produced by lack of appropriate behavior such as sedentary lifestyle, not eating a healthy diet, not getting sufficient sleep or rest, or failing to take medications according to the physician’s orders. Additionally, behavioral issues can be subtle contributors to disease such as denying a problem and failing to see a physician timely or not washing hands. In fact, many modern health issues, costing the individual or society billions of dollars each year, and reducing longevity, are largely preventable.

 

Hence, promoting healthy behaviors and eliminating unhealthy ones has the potential to markedly improve health. Mindfulness training has been shown to promote health and improve illness. It is well established that mindfulness can improve healthy behaviors. The research has been accumulating. So, it is reasonable to stop and summarize what has been learned. In today’s Research News article “Mindfulness and Behavior Change.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647439/ )  Schuman-Olivier and colleagues review and summarize the published research on the ability of mindfulness training to promote healthy behaviors.

 

They report that the published studies found that mindfulness training reduces cravings and produces improvements in alcohol and substance abuse disorders, binge eating disorder, obesity, improves smoking cessation, reduces emotional eating and eating when not hungry and produces weight reduction. Mindfulness training has been shown to improve self-management of chronic diseases, including hypertension, COPD, and diabetes and results in improvements in quality of life and reductions in anxiety and depression. Mindfulness training also reduces impulsive behavior, risky sexual behavior, aggression, and violent behaviors. It also reduces self-injury, suicidal thinking, and suicidal behavior.

 

The authors go on to produce and discuss a model of how mindfulness training may be improving troubling behaviors. They speculate that mindfulness training produces a general improvement in self-regulation which results in improved control of behavior. This self-regulation is produced by improvements in attention and cognitive control, emotion regulation, and self-related processes, as well as motivation and learning ability. Regardless, it is clear that mindfulness training improves behaviors that can lead to or exacerbate illness. It’s actually amazing that such simple practices can have such profound and widespread effects in promoting health and well-being and treating diseases.

 

So, change behavior for the better with mindfulness.

 

“On your path to create change invite compassion and embrace and accept where you are. Only from a place of compassion will your efforts move into fruition. What is the next compassionate step you can make towards this change today?” – Carley Hauck

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020). Mindfulness and Behavior Change. Harvard review of psychiatry, 28(6), 371–394. https://doi.org/10.1097/HRP.0000000000000277

 

Abstract

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

CONCLUSION

A growing evidence base supports the benefits of mindfulness for behavior change. A mindful self-regulation model based on an integration of neuroscientific findings describes the complex and synergistic effects of attention/cognitive control, emotion regulation, and self-related processes, as well as motivation and learning mechanisms that may provide a unique pathway toward sustainable behavior change. While evidence supports the impact of mindfulness on behavior change for key health behaviors related to psychiatric practice, more high-quality research is needed, especially with objective measures, larger samples, replication studies, active controls, and formal monitoring of adverse events.474 The field will also benefit from additional research on the impact of integrating compassion practices and from a focus on trauma-sensitive adaptations for diverse populations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647439/

 

Lower Suicide Risk in College Students with Mindfulness

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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

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

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

 

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303376/

 

Reduce the Risk of Suicide in Adolescents with Mindfulness

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Reduce the Risk of Suicide in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

“results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.” — Christina Vogt

 

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.

 

Adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the adolescent can feel overwhelmed and unable to cope with all that is required. This can produce despair leading to suicide. Indeed, suicide is the second leading cause of death in adolescents.

 

Mindfulness training for children and adolescents has been shown to have very positive effects. These include academic, cognitive, psychological, and social domains. Mindfulness training has been shown to improve emotion regulation and to benefit the psychological and emotional health of adolescents. Importantly, mindfulness training with children and adolescents appears to improve the self-concept, improve attentional ability and reduce stress. This suggests that mindfulness practices may be effective in reducing the risk of suicide in adolescents. Indeed, 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. Hence it makes sense to review the published research studies examining the effectiveness of DBT for the reduction of the risk of suicide in adolescents.

 

In today’s Research News article “Recent advances in understanding and managing self-harm in adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816451/), Clarke and colleagues review and summarize the published research studies on the use of various therapeutic techniques including Dialectical Behavior Therapy (DBT) for the reduction of the risk of suicide in adolescents. They report that the published research supports the ability of mindfulness-based interventions, especially DBT for the reduction of self-injurious behaviors in adolescents with a high risk of suicide. It appears that the most important components for the effectiveness of DBT are “family involvement, emotion regulation skills, communication skills, and problem-solving skills.” As a result, they deem DBT as “the first and only “well-established” treatment for suicidal and [self-injurious]  adolescents.”

 

So, reduce the risk of suicide in adolescents with mindfulness.

 

“One RCT of DBT with adolescents has been conducted in Norway demonstrating greater reductions in self-harm behaviors than enhanced usual care at 19 week and one year follow-up.” Michele Berk

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent advances in understanding and managing self-harm in adolescents. F1000Research, 8, F1000 Faculty Rev-1794. doi:10.12688/f1000research.19868.1

 

Abstract

Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816451/

 

Reduce Suicide Risk in Young Adults with Mindfulness

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Reduce Suicide Risk in Young Adults with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The pain of depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne. The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.”– William Styron

 

After cancer and heart disease, suicide accounts for more years of life lost than any other cause. 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. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. 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. A risk factor for suicide has been found to be an inability to describe and identify emotions, alexithymia. On the other hand, mindfulness training has been shown to reduce suicidality.  Hence, there is a need to further study the relationship of alexithymia and mindfulness in affecting the risk of suicide.

 

In today’s Research News article “Mindfulness and Suicide Risk in Undergraduates: Exploring the Mediating Effect of Alexithymia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753216/), Fang and colleagues recruited undergraduate students and measured them for mindfulness, suicide risk, difficulty in identifying feelings, difficulty in describing feelings and alexithymia. They then performed regression and mediation analysis of the data.

 

They found, pretty much as expected, that the higher the levels of mindfulness the lower the levels of suicide risk, difficulty in identifying feelings, difficulty in describing feelings and alexithymia, while the higher the levels of alexithymia the higher the levels of suicide risk, difficulty in identifying feelings, difficulty in describing feelings. In addition, they found that the negative relationship between mindfulness was in part direct but also strongly mediated by alexithymia, such that the higher the levels of mindfulness the lower the levels of alexithymia which, in turn, was associated with lower suicide risk. The mindfulness – suicide risk relationship also was mediated by the alexithymia components of difficulty in identifying feelings and difficulty in describing feelings.

 

It should be noted that the present study was correlational and as such causation cannot be determined. Hopefully future research with investigate the effects of mindfulness training on suicide risk and alexithymia. Nevertheless, the present study verified that being high in mindfulness is associated with being low in the risk of committing suicide. It also verified the that being high in alexithymia is a risk factor for suicide. The new finding here is that mindfulness is associated with reduced suicide risk, in large part, by its association with lower levels of alexithymia.

 

Ignoring the problems with determining causation it can be speculated that mindfulness makes an individual more sensitive to their internal state and emotions. This is the opposite to the lower sensitivity with alexithymia. This greater sensitivity to the individual’s emotional state produced by mindfulness reduces the likelihood that negative emotions can lead to suicide. Hence, mindfulness may be a protective factor for suicide.

 

So, reduce suicide risk in young adults with mindfulness.

 

“Mindful curiosity treats suicidal thoughts for what they are: a symptom, not a truth. They are a symptom that something in you needs healing. . . Mindfulness enables you to recognize just how transitory thoughts are. They come and they go, like clouds before the sun.” – Stacey Freedenthal

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Fang, Y., Zeng, B., Chen, P., Mai, Y., Teng, S., Zhang, M., … Zhao, J. (2019). Mindfulness and Suicide Risk in Undergraduates: Exploring the Mediating Effect of Alexithymia. Frontiers in psychology, 10, 2106. doi:10.3389/fpsyg.2019.02106

 

Abstract

The present study was designed to examine the relationship between dispositional mindfulness and suicide risk in undergraduates, and it further explored the potential mediating role of alexithymia in this relationship. A total of 2,633 undergraduates completed the Mindful Attention Awareness Scale (MAAS), the Suicidal Behaviors Questionnaire – Revised (SBQ-R), and the 20-item Toronto Alexithymia Scale (TAS-20). The results indicate that mindfulness and suicide risk were negatively correlated, and alexithymia partially mediated the relationship between mindfulness and suicide risk only in the female undergraduates. Moreover, only the difficulty in identifying feelings (DIF) factor of alexithymia mediated the relationship between mindfulness and suicide risk in the female undergraduates. These findings contribute to the potential mechanism that explains the relationship between mindfulness and suicide risk. Furthermore, it is possible to implement mindfulness in the suicide intervention of alexithymic individuals.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753216/

Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

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Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

 

By John M. de Castro, Ph.D.

 

“The pain of depression is quite unimaginable to those who have not suffered it,  and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

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. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. 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. It is important to identify the characteristics of adolescents who are most likely to benefit from DBT for the reduction of suicide.

 

In today’s Research News article “Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099), Adrian and colleagues recruited adolescents with previous lifetime suicide attempt, repetitive self‐harm in the past 12 weeks, borderline personality disorder (BPD) characteristics, and clinically significant suicidal ideation. They were randomly assigned to receive 6-months of either Dialectical Behavior Therapy (DBT) or individual/group supportive therapy. They were measured before and after treatment and at the midpoint of treatment for suicide attempts, non-suicidal self-injuries, self-harm, prior self-harm severity, externalizing symptoms, other psychiatric disorders, substance abuse, PTSD symptoms, borderline personality disorder (BPD) symptoms, adolescent-parent conflict, and emotional dysregulation. In addition, their parents were measured for emotional distress and adolescent-parent conflict.

 

They found that non-white adolescents had a greater response to treatment than white adolescents in the reduction in suicide ideation. The adolescent’s pre-treatment history also affected the response to treatment with adolescents with greater levels of family conflict, more extensive self‐harm histories, and more externalizing problems having a greater reduction in self-harm. They also found that Dialectical Behavior Therapy (DBT) was more effective for adolescents who were high in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation.

 

These results are interesting and suggest that certain adolescents are more responsive to treatment than others. Non-white (particularly Latino) youths, adolescents with greater levels of family conflict, more extensive self‐harm histories, more externalizing problems, higher in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation had more positive changes produced by therapy. These factors may be used to triage which youths would be most likely to benefit from different therapies and thus may potentiate therapeutic benefits.

 

Suicide is a major problem for adolescents and self-harm, self-injury, suicide ideation, and suicide attempts are all indicators of potential lethal outcomes. So, treatment is extremely important. Dialectical Behavior Therapy (DBT) appears to be effective but it is particularly effective for certain youths. Knowing this can help target and refine therapy to improve therapeutic effectiveness in reducing suicides in adolescents.

 

So, reduce suicidality in certain adolescents with mindfulness.

 

“Being curious about your suicidal thoughts is another part of mindful observation. If you have the thought, “I should kill myself,” how does it affect the thought’s meaning to then tell yourself, “Hmm, I wonder why I just had the thought that I should kill myself?” – Stacey Freedenthal

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Molly Adrian, Elizabeth McCauley, Michele S. Berk, Joan R. Asarnow, Kathryn Korslund, Claudia Avina, Robert Gallop, Marsha M. Linehan. Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry, 30 July 2019, 60(10), 1123-1132, https://doi.org/10.1111/jcpp.13099

 

Key points

  • Adolescent prior self‐harm, externalizing problems, and reported family conflict were significant predictors of change in self‐harm, NSSI, and suicidal ideation, where adolescents with higher family conflict and less severe self‐harm history produced on average more reduction in SH from baseline to post‐treatment.
  • DBT produced better rate of improvement compared to IGST for adolescents who were emotionally dysregulation and whose parents had higher baseline emotion dysregulation and psychopathology.
  • Clinicians could consider either IGST or DBT for adolescents with self‐harm histories whose parents are well regulated and do not have impairing psychopathology. Adolescents with emotional dysregulation and parents with psychopathology and emotion dysregulation may benefit more from DBT than IGST.

Abstract

Background

In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST.

Methods

Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes.

Results

Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals.

Conclusions

These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099

 

Spirituality is Associated with Lower Suicidality in Adolescents

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Spirituality is Associated with Lower Suicidality in Adolescents

 

By John M. de Castro, Ph.D.

 

“suicide is never the right answer. The more we can nurture a sense of connectedness and purpose in our lives (of “spirituality”), the less likely people will be tempted to “end it all.” – Eben Alexander

 

After cancer and heart disease, suicide accounts for more years of life lost than any other cause. Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. It is estimated that worldwide about a million people die by suicide every year. It is much more prevalent with males who account for 79% of suicides. 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.

 

Depression and other mood disorders are the number-one risk factor for suicide. More than 90% of people who kill themselves have a mental disorder, whether depression, bipolar disorder or some other diagnosis. So, the best way to prevent suicide may be to treat the underlying cause. For many this means treating depression. Spirituality may help to provide meaning and prevent suicide. But there is scant research on the relationship of spirituality and religiosity and suicide.

 

In today’s Research News article “The role of social support and spiritual wellbeing in predicting suicidal ideation among marginalized adolescents in Malaysia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565529/), Ibrahim and colleagues recruited adolescents from low income families and measured them for suicide ideation, social support, and spiritual well-being.

 

They found that the higher the levels of social support, and spiritual well-being the lower the levels of suicide ideation. It should be recognized that this study was correlational and as such no conclusions regarding causation can be reached. The results suggest clear negative relationships between spirituality and social support and suicide ideation in adolescents from low income families. Being spiritual and having social support are related to having few, if any, thoughts regarding suicide. It remains for future research to establish whether improving spirituality and/or social support would result in fewer thoughts about suicide.

 

So, spirituality is associated with lower suicidality in adolescents.

 

“I personally think spirituality is a part of each of our beings. It has been the difference in my life and has walked me back from the place where I thought suicide was my only option. Maybe spirituality can be the difference in someone else’s life, too.” – Kelli Evans

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Ibrahim, N., Che Din, N., Ahmad, M., Amit, N., Ghazali, S. E., Wahab, S., … A Halim, M. (2019). The role of social support and spiritual wellbeing in predicting suicidal ideation among marginalized adolescents in Malaysia. BMC public health, 19(Suppl 4), 553. doi:10.1186/s12889-019-6861-7

 

Abstract

Background

The high number of adolescents and young adults harbouring suicidal ideation, as reported by the Ministry of Health Malaysia, is alarming. This cross-sectional study aims to examine the association between social support and spiritual wellbeing in predicting suicidal ideation among Malaysian adolescents.

Methods

A total of 176 adolescents in selected urban areas in the states of Wilayah Persekutuan and Selangor were selected. The Suicide Ideation Scale (SIS) was used to measure the level of severity or tendency of suicidal ideation. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the perceived social support received by the respondent while the Spiritual Wellbeing Scale (SWBS) was used to measure the religious wellbeing (RWB), the existential wellbeing (EWB) and the overall score of spiritual wellbeing (SWB).

Results

The study found that both RWB and EWB showed significant negative correlation with suicidal ideation. Similarly, support from family and friends also showed a negative correlation with suicidal ideation. Further analysis using multiple regressions showed that RWB and SWB, and family support predict suicidal ideation in adolescents.

Conclusion

Spiritual wellbeing in combination with family support plays a major role in predicting suicidal ideation. Therefore, intervention for encompassing spirituality and family support may contribute to a more positive outcome in suicidal adolescents.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565529/