Reduce the Risk of Suicide in Adolescents with Mindfulness

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-conceptimprove 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

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

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

 

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/

 

Reduce Suicide with Mindfulness

Reduce Suicide 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.

 

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 further study the ability of DBT to reduce suicides in adolescents.

 

In today’s Research News article “Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584278/), McCauley and colleagues recruited adolescents (12-18 years of age) with at least one suicide attempt, elevated suicide ideation, a history of self-harm, and symptoms of Borderline Personality Disorder (BPD). They were randomly assigned to receive 6 months of individualized group therapy either of Dialectical Behavior Therapy (DBT) or individual and group non-directive supportive therapy. They were measured before, midway and after treatment and 3 and 6 months later for suicides, suicide ideation, self-harm, mood, anxiety, psychosis, eating disorders, Borderline Personality Disorder (BPD), substance abuse, and externalizing symptoms.

 

They found that in comparison to individual and group non-directive supportive therapy, the participants in Dialectical Behavior Therapy (DBT) attended more sessions, remained in treatment longer, and had higher completing rates. Importantly, after treatment, the group receiving Dialectical Behavior Therapy (DBT) had significantly fewer suicide attempts, less self-harm, and significantly higher rates of clinical change.

 

These are important results that suggests that Dialectical Behavior Therapy (DBT) is an effective treatment for adolescents with a history of suicide attempts and self-harm. Since compliance and completion rates were high, it suggests that the treatment was acceptable to the youths. The fact that DBT was compared to another therapy is important as it demonstrates that participant expectancy effects or placebo effects cannot account for the findings. They are also important as they suggest that DBT may help save adolescent lives in a very vulnerable population or at the very least help to relieve their suffering.

 

So, reduce suicide with mindfulness.

 

“In general, the practice of mindfulness involves observing your thoughts without buying into them. You label your thoughts as just that – thoughts. Not necessarily truth. Not necessarily a call to action. If you have the thought, “I should kill myself,” you can then observe, “I just had the thought that I should kill myself.” – Stephanie 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

 

McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., … Linehan, M. M. (2018). Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA psychiatry, 75(8), 777–785. doi:10.1001/jamapsychiatry.2018.1109

 

Key Points

Question

Is dialectical behavior therapy more effective than individual and group supportive therapy in reducing suicide attempts and nonsuicidal self-injury in suicidal adolescents?

Findings

This multisite randomized clinical trial of 173 adolescents indicated a significant advantage for dialectical behavior therapy compared with individual and group supportive therapy for reducing repeat suicide attempts, nonsuicidal self-injury, and total self-harm after treatment. Although the dialectical behavior therapy advantage weakened over time, secondary analyses indicated that youths receiving dialectical behavior therapy were more likely to respond to treatment, indexed by the absence of any self-harm, after treatment and at 12-month follow-up.

Meaning

Dialectical behavior therapy is effective for reducing repeat suicide attempts among highly suicidal adolescents, underscoring the value of dialectical behavior therapy in suicide prevention initiatives.

Abstract

Importance

Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited.

Objective

To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths.

Design, Setting, and Participants

This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers. A total of 173 participants (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were studied. Adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use. Participants were followed up for 1 year.

Interventions

Study participants were randomly assigned to DBT or IGST. Treatment duration was 6 months. Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed.

Main Outcomes and Measures

A priori planned outcomes were suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview.

Results

A total of 173 adolescents (163 [94.8%] female and 97 [56.4%] white; mean [SD] age, 14.89 [1.47] years) were studied. Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 [78.9%] of 65 receiving IGST with no suicide attempts; odds ratio [OR], 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 [56.9%] of 72 receiving DBT vs 26 [40.0%] of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 [54.2%] of 72 receiving DBT vs 24 [36.9%] of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78). Rates of self-harm decreased through 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P = .61). Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes.

Conclusions and Relevance

The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584278/Importance

 

Lower PTSD Symptoms and Risk of Suicide in Firefighters are Associated with Mindfulness

Lower PTSD Symptoms and Risk of Suicide in Firefighters are Associated with Mindfulness

 

By John M. de Castro, Ph.D.

 

“I’m convinced [mindfulness] could be a powerful antidote to what I see happening to my peers, both as retirees and active personnel. We have high rates of suicide and PTSD. It can lead you to some pretty dark places.” – Gary Gonzalez

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime with 7%-8% of the population developing Post-Traumatic Stress Disorder (PTSD). It involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience negative changes in beliefs and feelings including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise.

 

First responders such as firefighters and police experience traumatic events as part of their jobs and many develop symptoms of PTSD. This is responsible for the fact that wore firefighters and police officers die by suicide than all line-of-duty deaths combined. 103 firefighters and 140 police officers died by suicide in 2017, compared to 93 firefighter and 129 officer line-of-duty deaths. Obviously, this is a troubling problem that needs to be addressed. There are a number of therapies that have been developed to treat PTSD. One of which, mindfulness training has been found to be particularly effective.  Indeed, mindfulness has been shown to has been shown to reduce suicidality and to reduce the impact of trauma on the individual.

 

In today’s Research News article “Posttraumatic stress disorder symptoms and mindfulness facets in relation to suicide risk among firefighters.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434694/), Stanley and colleagues examine the relationship of mindfulness to PTSD symptoms and suicide risk in firefighters. They recruited firefighters (94% male) and had them complete an online survey measuring mindfulness, lifetime exposure to trauma, PTSD symptoms, and suicide risk severity.

 

They found that the higher the levels of mindfulness the lower the levels of PTSD symptoms and suicide risk. They also found that the higher the levels of PTSD symptoms the higher the levels of suicide risk. A moderation analysis indicated that the effect of PTSD symptoms on suicide risk severity was lowered by mindfulness, particularly the mindfulness facets of acting with awareness and non-judging of inner experience.

 

It should be noted that these findings are correlations and thus there cannot be definitive conclusions about causation. Nevertheless, the results suggest that mindfulness is associated with lower Post-Traumatic Stress Disorder (PTSD) and lower risk of suicide among firefighters. In addition, being able to act with awareness and to experience feelings without judgement may be particularly strongly associated with a lower association between the symptoms of PTSD and the risk of suicide. These results suggest that a randomized clinical trial of the ability of mindfulness training to lower PTSD symptoms and suicide risk is warranted.

 

First responders have a tough job. They are not only exposed to immediate risks to their safety but also long-term risks associated with the trauma experienced in the course of their jobs. Mindfulness may be very helpful for firefighters. It may have the ability to help them withstand the long-term consequences of the trauma they experience. Perhaps mindfulness may make a tough, but important, job less costly for the firefighters mental health.

 

“Firefighters are more likely to die by suicide than to die on the job. We heavily invest in protective equipment to keep them physically safe – special masks, boots, jackets, pants. So why don’t we spend any money to protect their minds?” – Rich Landward

 

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

 

Stanley, I. H., Boffa, J. W., Tran, J. K., Schmidt, N. B., Joiner, T. E., & Vujanovic, A. A. (2019). Posttraumatic stress disorder symptoms and mindfulness facets in relation to suicide risk among firefighters. Journal of clinical psychology, 75(4), 696–709. doi:10.1002/jclp.22748

 

Abstract

Objective:

Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk among firefighters. Few studies have examined modifiable factors, such as mindfulness facets, that might attenuate this association. This study examined the interactive effects of PTSD symptoms and mindfulness facets in relation to suicide risk among firefighters.

Method:

Overall, 831 career firefighters were assessed for PTSD symptoms, mindfulness facets, and suicide risk via the PTSD Checklist for DSM‐5, Five Facet Mindfulness Questionnaire, and Suicidal Behaviors Questionnaire—Revised, respectively.

Results:

Greater PTSD symptoms were associated with more severe suicide risk; however, higher levels of two specific mindfulness facets, acting with awareness and nonjudging of inner experience, attenuated this association. By contrast, higher levels of the observing facet of mindfulness potentiated the association between PTSD symptoms and suicide risk.

Conclusions:

Suicide prevention initiatives among firefighters, particularly those experiencing trauma‐related sequelae, might benefit from the inclusion of mindfulness‐based practices alongside frontline empirically‐supported approaches.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434694/

 

Students and Military who are High in All Facets of Mindfulness Have Better Psychological Health

Students and Military who are High in All Facets of Mindfulness Have Better Psychological Health

 

By John M. de Castro, Ph.D.

 

“The research is strong for mindfulness’ positive impact in certain areas of mental health, including stress reduction, emotion and attention regulation, reduced rumination, for reducing mild to moderate depression and anxiety, and preventing depressive relapse.“ – Kelle Walsh

 

Mindfulness training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. As a result, mindfulness training has been called the third wave of therapies.

 

One of the premiere measurement tools for mindfulness is the Five Factors of Mindfulness Questionnaire. It measures overall mindfulness and also five facets; observing, describing, acting with awareness, non-judgement, and non-reactivity. People differ and an individual can be high or low on any of these facets and any combination of facets. It is not known what pattern of mindfulness facets are most predictive of good mental health.

 

In today’s Research News article “Mindfulness and Psychological Health Outcomes: A Latent Profile Analysis among Military Personnel and College Students.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800780/ ), Bravo and colleagues recruited active and retired military personnel and college students. They were measured online for mindfulness, depression, anxiety, rumination, suicidality, post-traumatic stress disorder, alcohol and drug abuse symptoms.

 

They found that overall, the greater the levels of mindfulness, the better the mental health of the participants including lower depression, anxiety, rumination, suicidality, post-traumatic stress disorder, alcohol and drug abuse symptoms. The military personnel were higher on all measures except rumination than the college students.

 

For the college students latent profile analysis revealed 4 mindfulness profiles ““high mindfulness” group (i.e., moderately high on all facets of mindfulness), a “low mindfulness” group (i.e., relatively low-to-average on all facets of mindfulness), a “judgmentally observing” group (i.e., high on observing facet, low on non-judging of inner experience and acting with awareness) and a “non-judgmentally aware” group (i.e., low on observing, high on non-judging of inner experience and acting with awareness).” For the military personnel latent profile analysis revealed 3 mindfulness profiles “high mindfulness” group (i.e., moderately high on all facets of mindfulness), a “low mindfulness/ judgmentally observing” group (i.e., relatively low-to-average on describing, and non-reacting facets of mindfulness and  high on observing facet, low on non-judging of inner experience and acting with awareness) and a “non-judgmentally aware” group (i.e., low on observing, high on non-judging of inner experience and acting with awareness).

 

For both the military personnel and the students, the participants with the “high mindfulness” profile had significantly better mental health than those with the other profiles including lower depression, anxiety, rumination, suicidality, post-traumatic stress disorder, alcohol and drug abuse symptoms. It is important to note that the results were similar in very different participant populations, suggesting that the results are generalizable.

 

The results further suggest that with mindfulness there are very different types of people, expressing mindfulness in different ways and this makes a difference in the relationship of mindfulness to mental health. The results suggest that overall being mindful is associated with good mental health. They further suggest that being generally high on all facets of mindfulness is an even better predictor of good mental health. It may make sense in future research to pay more attention to these different mindfulness profile groups in investigating mindfulness relationships with mental and physical well-being.

 

It is clear that mindfulness is associated with better mental health.

 

“We’ve seen this in the clinical domain for many years. People, in concert with their physicians… actually going off their medications for pain, for anxiety, for depression, as they begin to learn the self-regulatory elements of mindfulness. They discover that the things that used to be symptomatically problematic for them are no longer arising at the same level.” – Jon Kabat-Zinn

 

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

 

Bravo, A. J., Pearson, M. R., & Kelley, M. L. (2017). Mindfulness and Psychological Health Outcomes: A Latent Profile Analysis among Military Personnel and College Students. Mindfulness, 9(1), 258-270.

 

Abstract

Previous research on trait mindfulness facets using person-centered analyses (e.g., latent profile analysis [LPA]) has identified four distinct mindfulness profiles among college students: a high mindfulness group (high on all facets of the Five-Factor Mindfulness Questionnaire [FFMQ]), a judgmentally observing group (highest on observing, but low on non-judging of inner experience and acting with awareness), a non-judgmentally aware group (high on non-judging of inner experience and acting with awareness, but very low on observing), and a low mindfulness group (low on all facets of the FFMQ). In the present study, we used LPA to identify distinct mindfulness profiles in a community based sample of U.S. military personnel (majority veterans; n = 407) and non-military college students (n = 310) and compare these profiles on symptoms of psychological health outcomes (e.g., suicidality, PTSD, anxiety, rumination) and percentage of participants exceeding clinically significant cut-offs for depressive symptoms, substance use, and alcohol use. In the subsample of college students, we replicated previous research and found four distinct mindfulness profiles; however, in the military subsample we found three distinct mindfulness profiles (a combined low mindfulness/judgmentally observing class). In both subsamples, we found that the most adaptive profile was the “high mindfulness” profile (i.e., demonstrated the lowest scores on all psychological symptoms and the lowest probability of exceeding clinical cut-offs). Based on these findings, we purport that the comprehensive examination of an individual’s mindfulness profile could help clinicians tailor interventions/treatments that capitalize on individual’s specific strengths and work to address their specific deficits.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800780/

 

Decrease Suicide Ideation with Skills Learned in Dialectical Behavior Therapy

Decrease Suicide Ideation with Skills Learned in Dialectical Behavior Therapy

 

By John M. de Castro, Ph.D.

 

“DBT provided me with a rubric for figuring out what was causing my anxiety, anger or sadness, and new options for how to behave in light of it. Once a week, for the last two-and-a-half years, I’ve attended a DBT group and learned a set of skills that have been nothing short of transformative.” – Will Lippincott

 

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. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

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. How important it is for the patients to be successful in the development and employment of these skills is unknown.

 

In today’s Research News article “Suicidal Ideation and Skill Use During In-patient Dialectical Behavior Therapy for Borderline Personality Disorder. A Diary Card Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920639/ ), Probst and colleagues recruited patients diagnosed with Borderline Personality Disorder (BPD) and provided them with a 5-week program of Dialectical Behavior Therapy (DBT). The patients completed diary entries after each treatment day with ratings of their levels of suicide ideation and their use of the five core skills of DBT.

 

They found that the patients used skills and found them useful on 80% of treatment days. They found that the patients who had successful skill use on most days had greater reductions in suicide ideation than less successful patients. In addition, on days where skill use was successful there were lower levels of suicide ideation. Hence, successful employment of the five core skills of DBT appears to be very important for progress in therapy.

 

During the course of therapy, the BPD patient is encouraged to practice and use the five core skills; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. If they are successful in using these skills, suicidal thoughts appear to diminish. This emphasizes the importance of stressing skill development and use during Dialectical Behavior Therapy (DBT) treatment for Borderline Personality Disorder (BPD) as it can influence the effectiveness of treatment.

 

So, decrease suicide ideation with skills learned in Dialectical Behavior Therapy.

 

“A variety of dialectical behavioral therapy (DBT) interventions can reduce suicidal behavior in women with borderline personality disorder (BPD), but skills training is a “necessary component” of any intervention.” – Megan Brooks

 

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

Probst, T., Decker, V., Kießling, E., Meyer, S., Bofinger, C., Niklewski, G., Mühlberger, A., … Pieh, C. (2018). Suicidal Ideation and Skill Use During In-patient Dialectical Behavior Therapy for Borderline Personality Disorder. A Diary Card Study. Frontiers in psychiatry, 9, 152. doi:10.3389/fpsyt.2018.00152

 

Abstract

Associations between suicidal ideation and skill use were investigated during in-patient dialectical behavior therapy (DBT) for borderline personality disorder (BPD). Participants were N = 44 patients with BPD undergoing a 5-week in-patient DBT program in a psychiatric clinic. They filled in a diary card each treatment day resulting in 1,334 skill use ratings and 1,364 suicidal ideation ratings. Treatment days were categorized as days with successful skill use (using skills and perceiving them as effective), days with no skill use, days with unsuccessful skill use (using skills but perceiving them as ineffective). Multilevel models were performed to account for the nested data structure. The results showed that suicidal ideation improved more for patients who applied skills successfully more often during treatment (p < 0.05). Moreover, suicidal ideation was lower on treatment days with successful skill use compared to treatment days with no skill use and compared to treatment days with unsuccessful skill use (p < 0.05). When treatment days with no skill use were compared to treatment days with unsuccessful skill use, suicidal ideation was higher on treatment days with unsuccessful skill use (p < 0.05). To conclude, using skills successfully on as many treatment days as possible is associated with lower suicidal ideation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920639/

 

Protect Against Mental Illness and Suicide in Gay Men with Mindfulness

Protect Against Mental Illness and Suicide in Gay Men with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness enables you to recognize just how transitory thoughts are. They come and they go, like clouds before the sun. . . Watch your suicidal thoughts as they float by. You don’t need to grab one and hold on to it. More thoughts will come. More thoughts will go.” – Stacey Freedenthal

 

The word gay connotes happy and fun loving. This descriptor of homosexual men as gay, however is inaccurate. In fact, the risk of a mental health condition, like depression, anxiety disorders, or post-traumatic stress disorder, is almost three times as high for youths and adults who identify as gay, It is troubling that suicide is attempted four times more often by gay youth. In addition, gay youth are almost twice as likely as their heterosexual peers to abuse drugs and alcohol.

 

Hence, it is important to develop resources that can reduce mental illness and suicidality in gay men. Mindfulness has been found to be associated with psychological well-being in gay men. It makes sense, then to further explore the ability of mindfulness to improve mental health and reduce suicidality in gay men.

 

In today’s Research News article “Mindfulness and Other Psycho-Social Resources Protective Against Mental Illness and Suicidality Among Gay Men.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095030/ ), Wang and colleagues recruited gay men and had them complete measures of self-efficacy, internalized homophobia, self-acceptance, purpose in life, hedonism, altruism, religion, spirituality, mindfulness, positive affect, life satisfaction, vitality, positive relations with others, mental illness, suicidality, and victimization. These data were analyzed with sophisticated modelling and regression analyses.

 

They found that the higher the levels of mindfulness, the higher the levels of self-efficacy, purpose in life, positive emotions, life satisfaction, vitality, and positive relations with others, and the lower the levels of internalized homophobia, emotional reactivity, and rumination. They also found that gay men with higher levels of mindfulness had lower incidences of mental illness, depression, and suicidality, and less medical/ psychological disability.

 

Hence, dispositional mindfulness appears to be associated with better psychological and mental health including reduced tendency for depression and suicide. These results are encouraging but are correlational, so causation cannot be determined. But other research has shown that mindfulness causes improvements in the mental and physical states of a wide variety of individuals. And there is no reason to believe that this would also not be the case with gay men. Future research should manipulate mindfulness levels with training and assess the impact of the increased mindfulness on the psychological and mental health of the gay men.

 

So, protect against mental illness and suicide in gay men with mindfulness.

 

“Mindfulness can be a powerful tool in dealing with various mental health challenges and symptoms. Beyond breathing exercises, mindfulness means being fully aware of the facets of the body and mind. This helps in assessing intrusive thoughts and emotional reactions.” – Faith Onimiya

 

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

 

Wang, J., Häusermann, M., & Ambresin, A. E. (2018). Mindfulness and Other Psycho-Social Resources Protective Against Mental Illness and Suicidality Among Gay Men. Frontiers in psychiatry, 9, 361. doi:10.3389/fpsyt.2018.00361

 

Abstract

Background: There is considerable evidence of health disparities among gay men characterized by higher levels of stress and distress. Psycho-social resources have been linked to numerous positive health outcomes and shown to act as buffers in the stress-distress pathway.

Methods: With data from the 3rd Geneva Gay Men’s Health Survey carried out in 2011 using time-space sampling (n = 428), a relatively elaborate profile of 14 psycho-social resources—including mindfulness—is presented. Using their original scores, latent class analysis created an index variable dividing the respondents into meaningful groups. Psycho-social resources—the index variable as well as each resource individually—were then compared to two recent outcomes—i.e., serious mental illness in the past 4 weeks and short-term disability in the past 2 weeks—using a series of logistic regression models, controlling for all other psycho-social resources and socio-demographic confounders. To assess their potential role as buffers, a similar series of logistic regression models were erected using victimization and three outcomes—i.e., major depression, suicidal ideation, and suicide attempt—in the past 12 months.

Results: According to the latent class analyses, (1) 5.1% of this sample had a low level of psycho-social resources (i.e., one standard deviation (SD) below the group means), (2) 25.2% a medium-low level, (3) 47.4% a medium level (i.e., at the group means), and (4) 22.2% a high level of psycho-social resources (i.e., one SD above the group means). Psycho-social resources appeared to strongly protect against recent mental morbidity and buffer against the impact of victimization on major depression and suicidality in the past 12 months, reducing the adjusted odds ratios below statistical significance. The explained variance and the individual psycho- https://www.huffingtonpost.com/lodro-rinzler/meditation-isnt-enough-a-_b_5672580.htmlConclusions: There may be disparities in several psycho-social resources among gay men, and as strong compensatory and protective factors, they may explain in part the well-established disparities in stress and distress in this population. While multiple psycho-social resources should be promoted in this population, gay men under 25 years should receive particular attention as all three disparities are most pronounced in this age group.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095030/

 

Improve Borderline Personality Disorder and Reduce Suicidal Thoughts with Mindfulness

Improve Borderline Personality Disorder and Reduce Suicidal Thoughts with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation encourages recognition of the wide palate of human emotions, but also keenly encourages one not to fixate on these temporary feelings. Work in mindfulness meditation includes labeling these emotions in a non-judgmental manner and allowing them to pass just as freely as they came. The misery and the suffering those with BPD experience in life often come from our denial of some of these emotions.” – Blaise Aguirre

 

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. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. BPD is dangerous as it can propel the sufferer, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives.

 

BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DBT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder (BPD). Mindfulness training has been found to be helpful intreating substance abuse and decreasing suicidal thoughts. Hence, there appears to be a relationship between mindfulness and Borderline Personality Disorder (BPD), substance abuse and suicidal thoughts.

 

In today’s Research News article “The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834542/, Shorey and colleagues recruited adult women with Borderline Personality Disorder (BPD) who were also undergoing treatment for substance abuse. The women completed measures of mindfulness, BPD features, including affective, identity problems, negative relationships, and self-harm, suicidal thoughts, alcohol abuse, drug use, and impression management. They then conducted regression analyses to investigate the relationship between mindfulness and BPD, suicidality, and drug use.

 

They found that in these patients the higher the levels of mindfulness the lower the levels of BPD features, including affective, identity problems, negative relationships, and self-harm, the lower the levels of suicidal thoughts, and the higher the levels of impression management. Hence, mindfulness was significantly negatively associated with BPD symptoms and suicidality. These relationships, with the exception of self-harm, remained significant even after statistically accounting for alcohol use, drug use, age, and impression management.

 

These results suggest that mindfulness may be an antidote to Borderline Personality Disorder (BPD) symptoms and suicidal thoughts. It is possible that this results from the ability of mindfulness to improve emotion regulation. Mindful people to experience their emotions deeply but are able to respond to them rationally and adaptively. Characteristically, patients with BPD avoid experiencing negative emotions. So, mindfulness, by promoting the experience of these emotions may counteract one of the core features of BPD.

 

It should be recognized that these results are correlational. So, causality cannot be determined. But, since Dialectical Behavior Therapy (DBT) which contains mindfulness training is the only known therapy that has been shown to be effective for BPD. It would seem reasonable to suggest that mindfulness causes changes in BPD symptoms. A randomized clinical trial of mindfulness training for BPD symptoms and suicidality should be conducted in the future to test these ideas. The potential for mindfulness training to improve the symptoms of this devastating and dangerous mental illness mandates that such a trial be conducted.

 

So, improve borderline personality disorder and reduce suicidal thoughts with mindfulness.

 

“Mindfulness meditation training can help people with BPD to feel less “stuck” in their emotions, and less judgmental of the emotions and themselves. Mindfulness meditation training may also help individuals with BPD be more effective in applying healthy coping skills in the midst of emotional pain, because mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.” – Line Goguen-Hughes

 

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

 

Shorey, R. C., Elmquist, J., Wolford-Clevenger, C., Gawrysiak, M. J., Anderson, S., & Stuart, G. L. (2016). The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment. Psychiatry Research, 238, 122–128. http://doi.org/10.1016/j.psychres.2016.02.040

 

Highlights

  • Theory suggests mindfulness is inversely related to BPD/suicidal ideation
  • We investigated this in a sample of women in treatment for substance use
  • Dispositional mindfulness was negatively associated with BPD
  • Dispositional mindfulness was negatively associated with suicidal ideation

Abstract

Borderline personality disorder (BPD), which is characterized by unstable moods, behavior, and relationships, is also associated with heightened suicidal ideation. Prior research has demonstrated that BPD and suicidal ideation are prevalent among women in substance use treatment. Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation among women in treatment for substance use to support their associations, which was the purpose of the present study. Pre-existing medical records were reviewed from a residential substance use treatment center. A total of 81 female patients were included in the current study. Patients completed self-report measures of mindfulness, BPD, suicidal ideation, substance use, and impression management at treatment intake. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. Future research should examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834542/