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

 

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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/

Decreased Suicidality in Veterans with Spirituality

“there are certain moral reactions to war and the experience of combat training that indicate a violation of moral conscience in war can have devastating inner consequences in soldiers.” – Rita Nakashima Brock

 

It has been widely reported that there are extremely high levels of suicides among veterans. But these reports are based upon the entire veteran population which includes large numbers of elderly veterans. Looking only at veterans discharged since 2001, the rates suicide rates observed were much lower consisting of about one suicide per day. The actual annual suicide rate these veterans was 29.5 per 100,000 veterans. This is roughly 50% higher than the rate among similar civilians. Interestingly, the rates of suicide are lower in veterans who were deployed to combat than those who were not. Deployed Veterans had a 41% higher suicide risk compared to the general U.S. population while Non-Deployed Veterans had a 61% higher suicide risk.

 

These figures are still alarming, although less so than common reports of veteran suicides. It also suggests that the transition back to civilian life may be as difficult as dealing with combat produced Post Traumatic Stress Disorder (PTSD). Regardless, it is important to investigate the causes of these suicides and discover methods that might prevent them. Mindfulness training is one important potentially helpful method to lower suicidal thoughts and prevent suicide. Mindfulness has been shown to has been shown to reduce suicidality (see http://contemplative-studies.org/wp/index.php/category/research-news/suicidality/) and to reduce the impact of trauma on the individual (see http://contemplative-studies.org/wp/index.php/category/research-news/trauma/). Another potentially important factor is spirituality. Indeed, spirituality has been shown to reduce suicide tendencies in the elderly (see http://contemplative-studies.org/wp/index.php/2015/07/17/spirituality-improves-end-of-life/). Unfortunately, there has been very little systematic research on spirituality relationships to suicide in either the general population or in veterans.

 

In today’s Research News article “Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1169673129723278/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729329/

Kopacz and colleagues studied the relationships between spirituality and suicidality in a veteran sample undergoing residential treatment for PTSD. They compared three groups, a no suicide group who had not even thought about suicide, an Ideation group who had contemplated suicide, and an Attempt group who had attempted suicide. They found that the Ideation and Attempt group had greater amounts of spiritual struggle and lower level of forgiveness. They also found that low levels of thoughts about suicide (ideations) were associated with involvement in a spiritual community and high levels of spiritual experiences.

 

It should be noted that these results were correlative and thereby do not demonstrated a causal connection between spirituality and lower levels of suicidality. In fact, less suicidal ideation may prompt veterans to seek out spiritual experiences of some third factor such as religious upbringing is associated with both. In order to demonstrate causation, it will be necessary to actively increase spirituality and observe its effects on suicidality.

 

With these caveats in mind, the results may signal that being spiritual protects the individual from suicidal thoughts. It may do so by providing other higher ideas about the meaning of life and its sacredness. Higher levels of spirituality may also provide a community that is supportive of the individual and thus helps them cope with difficult thoughts and experiences. It is also possible that a key factor may be spiritual struggles, where the inability to find higher meaning makes suicide more likely. It is also possible that inability to forgive is the key, where the individual cannot forgive, particularly themselves, making destroying the self are seemingly reasonable solution.

 

Regardless, it is clear that spirituality is an important factor influencing suicidality in veterans. This clearly suggests that further research is warranted and that spirituality may be an important factor in suicide prevention in veterans.

 

“The Army’s “spiritual fitness” encourages soldiers to see events in a neutral light, rather than labeling them as good or bad, and to create a nightly list of positive things that happened that day. The lack of awareness is startling regarding what it might mean to ask someone to think of killing a child, losing a close friend or torturing detainees as neutral or positive.”Rita Nakashima Brock

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Disrupt Suicidal Thoughts with Mindfulness  

“Did you really want to die?”
“No one commits suicide because they want to die.”
“Then why do they do it?”
“Because they want to stop the pain.”
  ― Tiffanie DeBartolo

 

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.

 

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, according to the National Alliance on Mental Illness (NAMI). So, the best way to prevent suicide may be to treat the underlying cause. For many this means treating depression. Mindfulness training has been shown to reduce suicidality in substance abusers (see http://contemplative-studies.org/wp/index.php/2015/11/30/decrease-suicidality-with-mindfulness/). Mindfulness training has also been shown to be effective for treating depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to treat depression and prevent relapse. So, it would seem reasonable to expect that MBCT would be effective in suicide prevention.

 

In today’s Research News article “Mindfulness-Based Cognitive Therapy (MBCT) Reduces the Association Between Depressive Symptoms and Suicidal Cognitions in Patients with a History of Suicidal Depression”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1158656587491599/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655869/

Barnhofer and colleagues treated patients with a history of suicidal depression with eight weeks of either MBCT, Cognitive Psychoeducation (CE), or Treatment as Usual (TAU). They found that at the end of treatment the participants treated with MBCT had a significant reduction in suicidal thoughts while the other groups did not. For the CE and TAU groups there were strong and significant correlations between depression and suicidal thoughts. That is, for these groups, the higher the level of depression the higher the levels of suicidal thought. In contrast for the MBCT group the correlations were significantly weaker That is, there was a much weaker relationship between depression and suicidal thoughts after Mindfulness-Based Cognitive Therapy (MBCT) than Cognitive Psychoeducation (CE), or Treatment as Usual (TAU).

 

These are interesting and potentially important findings that MBCT can reduce suicidal thoughts and that it weakens the link between depression and suicidal thoughts. This makes sense as MBCT is designed to reprogram depressive thought processes, helping the patient to see that their typical ways of thinking about and assessing their experiences are faulty and tend to heighten depression and that looking at and interpreting their experiences in a more rational way can reduce depression. This, in turn, appears to reduce suicidal thinking.

 

These results clearly suggest that Mindfulness-Based Cognitive Therapy (MBCT) may be an effective program to prevent suicide in people with high levels of suicidal thinking. Since mindfulness training has been shown to reduce suicidality in drug abusers, the second most likely group to commit suicide, it would appear that mindfulness training is potentially an important method to prevent suicide.

 

So, disrupt suicidal thoughts with mindfulness.

 

“The thought of suicide is a great consolation: by means of it one gets through many a dark night.” 
― Friedrich Nietzsche
CMCS – Center for Mindfulness and Contemplative Studies

 

Decrease Suicidality with Mindfulness

 

Killing yourself is a major commitment, it takes a kind of courage. Most people just lead lives of cowardly desperation. It’s kinda half suicide where you just dull yourself with substances.” – Robert Crumb

 

Suicide is the 10th leading cause of death in the US for all ages. It is much more prevalent with males who account for 79% of suicides. Every day, approximately 105 Americans die by suicide. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). Yet compared with other life threatening conditions there has been scant research on how to identify potential suicide attempters and reduce suicidality.

 

Depression and other mood disorders are the number-one risk factor for suicide, but alcohol and drug abuse – even without depression – are a close second. In fact, research has shown that the strongest predictor of suicide is alcoholism, not a psychiatric diagnosis. People with substance use disorders are about six times more likely to commit suicide than the general population. To make matter worse people with substance abuse are often incarcerated. In prison suicidality is even higher than outside. It is not the primary effects of the substances that promote suicide as the likelihood of suicide does not decline after complete withdrawal from the drugs or alcohol.

 

So there is a great need to study suicidality especially in conjunction with substance use disorders to identify predictors and potential methods to prevent actual suicide attempts. In today’s Research News article “Trait Mindfulness, Reasons for Living and General Symptom Severity as Predictors of Suicide Probability in Males with Substance Abuse or Dependence”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1123964037627521/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434430/

Mohammadkhani and colleagues studied incarcerated and outpatient substance abusers and measured mindfulness, psychiatric symptoms, reasons for living, and suicide probability. These groups were indeed high risk as 36% of the outpatients and 42% of the incarcerated participants had attempted suicide. They found that the strongest single predictor of suicide probability was the severity of the individuals’ psychiatric symptoms and the second was fear of social disapproval. Importantly, they found that the higher the level of mindfulness, the lower the probability of suicide.

 

These findings are interesting and suggest that mindfulness training might be an effective intervention to lower suicidality and the risk of attempting suicide in the high risk population of substance abusers. Of course, a randomized clinical trial is needed to establish effectiveness.

 

The findings also raise interesting questions as to why mindfulness might be an antidote to suicidality. There are a number of known effects of mindfulness that might account for its negative association with suicidality. Mindfulness has been shown to decrease psychiatric symptoms and depression, the leading causes of suicide attempts. Indeed, they found that high mindfulness was associated with lower levels of psychiatric symptoms. Mindfulness also improves emotion regulation allowing the individual to respond more adaptively to sometimes overwhelming emotions. In addition, it is known to reduce physiological and psychological responses to stress which might lower stress’ ability to prompt a suicide attempt. In addition, suicide is often associated with hopelessness about the future. Mindfulness by increasing focus on the present moment lowers worry and rumination about the future and may thereby reduce the likelihood of a suicide attempt. Finally, mindfulness is known to help prevent relapse after successful withdrawal from addiction and this may make the individual more hopeful about the future.

 

Regardless of the reasons, mindfulness appears to be able to buffer the individual against the forces that can promote and prompt suicide.

 

Suicide is a serious thing. And if you know anyone who is suicidal, you need to get them help. No one should be in pain. Everyone should love themselves. – Gerard Way

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Spirituality Improves End of Life

Death in inevitable, but that does not mean that it has to be awful. We don’t know how or when we will die, but we will die. It could be sudden or gradual or prolonged. We don’t know which it will be. But, regardless, how we approach it makes a huge difference.

Suzuki Roshi at the end of his life was in excruciating pain from cancer yet he told everyone around him “Don’t worry, It’s just Buddha suffering”. He passed with a smile on his face. Augustus Montague Toplady, the preacher author of the hymn “Rock of Ages” dying from tuberculosis said “”Oh, what delights! Who can fathom the joy of the third heaven? The sky is clear, there is no cloud; come Lord Jesus, come quickly!” These stories exemplify how our religiousness and spirituality can influence the quality of our passing.

In today’s Research News article “Religion, Senescence, and Mental Health: The End of Life Is Not the End of Hope”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1051111154912810/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357420/

Van Ness & Larson showed that individuals with high levels of religiousness/spirituality had significantly higher levels of well-being and were less likely to be depressed or suicidal at the end of life.

Americans 65+ portray themselves as more religious than do their younger counterparts. Hence it would appear that people understand that religiousness/spirituality can help in confronting end of life. But, how exactly does religiousness/spirituality help when dealing with eminent death?

Religiousness/spirituality can function by providing hope that helps the individual overcome increasing disease, disability, and emotional difficulties. Indeed, it has been shown that people high in religiousness/spirituality are significantly lower in hopelessness. This hope may take the form of belief in a life after death, reincarnation, or rebirth. Such a hope may be interpretable as a symbol of personal integrity that survives the indignities of illness, disability, and dissolution. This can be a great comfort to the dying person improving well-being and decreasing depression.

Religiousness/spirituality in older individuals is associated with a higher sense of well-being. This in turn can help the individual cope with the afflictions and challenges they face as death approaches. It can also help to bring families and communities to the dying process. It is often these connections that are the most important to the dying.

When approaching death, religiousness/spirituality can provide the structure to grapple with the basic questions of existence. Without it the person may experience spiritual distress. “When our bodies are under assault from disease or illness and our minds are reeling from the threat of disability or death, our spirit is there to hold it all together.” (Rev. Dr. Walter J. Smith).

So, practice religiousness/spirituality to be better prepared for death.

CMCS