Abstract
Human beings are the only living organisms that consciously and deliberately kill themselves. Moreover, suicide is present in all societies, and internationally nearly one in ten humans will consider suicide at some point during their lives. This has left many of us asking, “What is it about being human that causes so many people to consider killing themselves?” On the surface, the answer is not a simple one. There is not one clear pathway that leads to suicide. Suicide is associated with a broad array of stressors, mental illnesses, and demographic characteristics. Acceptance and Commitment Therapy (ACT) is a transdiagnostic psychosocial treatment approach grounded in a model of psychological (in)flexibility. ACT offers a compelling explanation for why suicide is uniquely human and heterogeneous in etiology, but has been understudied in regard to its applicability to suicide prevention. In the proposed chapter, we delineate the etiology of suicidal thoughts and behaviours according to the ACT model of psychological (in)flexibility. Further, we review and synthesize the extant literature relevant to this etiological model. Topics of focus include inflexible attention, experiential avoidance, cognitive fusion, attachment to a conceptualized self, and disruption of valued living. We discuss implications for suicide risk assessment and key considerations for using ACT to manage suicide risk (e.g. how to promote the acceptance of suicidal ideation, without encouraging suicidal behaviour and ways to identify new valued directions for taking action that strengthen protective factors). Case material is presented to illustrate how ACT can be used with suicidal individuals to help them build a life they deem worth living.
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Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., … Williams, J. M. G. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and non-meditating samples. Assessment, 15(3), 329–342.
Bahraini, N. H., Devore, M. D., Monteith, L. L., Forster, J. E., Bensen, S., & Brenner, L. A. (2013). The role of value importance and success in understanding suicidal ideation among Veterans. Journal of Contextual Behavioral Science, 2(1), 31–38.
Bahraini, N. H., Gerber, H. R., Monteith, L. L., Forster, J. E., Hostetter, T. A., & Brenner, L. A. (2016). Experiential avoidance and suicidal ideation among veterans exposed to combat Trauma. Manuscript in preparation.
Bardeen, J. R., & Fergus, T. A. (2016). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, and posttraumatic stress symptoms. Journal of Contextual Behavioral Science, 5(1), 1–6.
Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The scale for suicide ideation. Journal of Consulting and Clinical Psychology, 47(2), 343–352.
Beck, A. T., Steer, R. A., Kovacs, M., & Garrison, B. (1985). Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. American Journal of Psychiatry, 142(5), 559–563.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S. … Devins, G. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.
Blackledge, J. T., & Ciarocchi, J. (2006). Personal values questionnaire. Wollongong, Australia: Department of Psychology, University of Wollongong, Australia.
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., … Zettle, R.D. (2011). Preliminary psychometric properties of the acceptance and action questionniare-II: A revised measure of psychological flexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688.
Branstetter-Rost, A., Cushing, C., & Douleh, T. (2009). Personal values and pain tolerance: Does a values intervention add to acceptance? The Journal of Pain, 10(8), 887–892.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
Bryan, C. J., Ray-Sannerud, B. R., & Heron, E. A. (2015). Psychological flexibility as a dimension of resilience for posttraumatic stress disorder, depression, and risk for suicidal ideation among Air Force personnel. Journal of Contextual Behavioral Science, 4(4), 263–268.
Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance: The Philadelphia mindfulness scale. Assessment, 15(2), 204–223.
Chesin, M. S., Interian, A., Kline, A., Benjamin-Phillips, C., Latorre, M., & Stanley, B. (2016). Reviewing mindfulness-based interventions for suicidal behaviour. Archives of Suicide Research, 20(4), 507–527.
Chesin, M. S., & Jeglic, E. L. (2016). Factors associated with recurrent suicidal ideation among racially and ethnically diverse college students with a history of suicide attempt: The role of mindfulness. Archives of Suicide Research, 20(1), 29–44.
Chesin, M. S., Sonmez, C. C., Benjamin-Phillips, C. A., Beeler, B., Brodsky, B. S., & Stanley, B. (2015). Preliminary effectiveness of adjunct mindfulness-based cognitive therapy to prevent suicidal behaviour in outpatients who are at elevated suicide risk. Mindfulness, 6(6), 1345–1355.
Chiles, J. A., & Strosahl, K. D. (2005). Clinical manual for assessment and treatment of suicidal patients. Arlington, VA: American Psychiatric Publishing.
Chioqueta, A. P., & Stiles, T. C. (2007). Dimensions of the dysfunctional attitude scale (DAS-A) and the automatic thoughts questionnaire (ATQ-30) as cognitive vulnerability factors in the development of suicide ideation. Behavioural and Cognitive Psychotherapy, 35(05), 579–589.
Ciarrochi, J., & Bailey, A. (2008). A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance and commitment therapy. Oakland, CA: New Harbinger Publications Inc.
Cloitre, M. (2013, August). Skills Training in Affect and Interpersonal Regulation (STAIR). Retrieved from https://www.ptsd.va.gov/professional/continuing_ed/STAIR_online_training.asp.
Coleman, D., & Casey, J. T. (2007). Therapeutic mechanisms of suicidal ideation: The influence of changes in automatic thoughts and immature defenses. Crisis, 28(4), 198–203.
Cougle, J. R., Keough, M. E., Riccardi, C. J., & Sachs-Ericsson, N. (2009). Anxiety disorders and suicidality in the national comorbidity survey-replication. Journal of Psychiatric Research, 43(9), 825–829.
Ducasse, D., René, E., Béziat, S., Guillaume, S., Courtet, P., & Olié, E. (2014). Acceptance and Commitment Therapy for management of suicidal patients: A pilot study. Psychotherapy and Psychosomatics, 83(6), 374–376.
Ellis, T. E., & Rufino, K. A. (2016). Change in experiential avoidance is associated with reduced suicidal ideation over the course of psychiatric hospitalization. Archives of Suicide Research, 20(3), 426–437.
Forkmann, T., Wichers, M., Geschwind, N., Peeters, F., van Os, J., Mainz, V., & Collip, D. (2014). Effects of mindfulness-based cognitive therapy on self-reported suicidal ideation: Results from a randomized controlled trial in patients with residual depressive symptoms. Comprehensive Psychiatry, 55(8), 1883–1890.
Fresco, D. M., Moore, M. T., van Delmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J.M.G. (2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38(3), 234–246.
Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., … Remingotn, B. (2014). The development and validation of the cognitive fusion questionnaire. Behavior Therapy, 45(1), 83–101.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.
Guerreiro, D. F., Cruz, D., Frasquilho, D., Santos, J. C., Figueira, M. L., & Sampaio, D. (2013). Association between deliberate self-harm and coping in adolescent: A critical review of the last 10 years’ literature. Archives of Suicide Research, 17(2), 91–105.
Gutierrez, P. M., Osman, A., Barrios, F. X., & Kopper, B. A. (2001). Development and initial validation of the Self-Harm Behavior Questionnaire. Journal of Personality Assessment, 77(3), 475–490.
Harris, R. (2009). The house of ACT. In C. Honeychurch (Ed.), ACT made simple (pp. 33–39). Oakland, CA: New Harbinger Publications Inc.
Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., … Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35(4), 821–835.
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and Commitment Therapy and contextual behavioural science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180–198.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behavior Research and Therapy, 44(1), 1–25.
Hayes, S. C., Pistorello, J., & Biglan, A. (2008). Acceptance and commitment therapy: Model, data, and extension to the prevention of suicide. Brazilian Journal of Behavioral and Cognitive Therapy, 10(1), 81–102.
Hayes, S. C., Pistorello, J., & Levin, M. E. (2012a). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976–1002.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012b). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: The Guilford Press.
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioural disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.
Herzberg, K. N., Sheppard, S. C., Forsyth, J. P., Credé, M., Earleywine, M., & Eifert, G. H. (2012). The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment, 24(4), 877–891.
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11–21.
Josepho, S. A., & Plutchik, R. (1994). Stress, coping, and suicide risk in psychiatric in patients. Suicide and Life Threatening Behavior, 24(1), 48–57.
Keilp, J. G., Sackheim, H. A., Brodsky, B. S., Oquendo, M. A., Malone, K. M., & Mann, J. J. (2001). Neuropsychological dysfunction in depressed suicide attempters. American Journal of Psychiatry, 158(5), 735–741.
Lamis, D. A., & Dvorak, R. D. (2014). Mindfulness, nonattachment, and suicide rumination in college students: The mediating role of depressive symptoms. Mindfulness, 5(5), 487–496.
Linehan, M. M., & Comtois, K. (1996). Lifetime parasuicide history. Seattle, WA: University of Washington. Unpublished work.
Lundgren, T., Luoma, J. B., Dahl, J., Strosahl, K., & Melin, L. (2012). The bull’s eye values survey: A psychometric evaluation. Cognitive and Behavioral Practice, 19(4), 518–526.
Luoma, J. B., & Vilatte, J. L. (2012). Mindfulness in the treatment of suicidal individuals. Cognitive and Behavioral Practice, 19(2), 265–276.
Marzuk, P. M., Hartwell, N., Leon, A. C., & Portera, L. (2005). Executive functioning in depressed patients with suicidal ideation. Acta Psychiatrica Scandinavica, 112(4), 294–301.
Miranda, R., Valderrama, J., Tsypes, A., Gadol, E., & Gallagher, M. (2013). Cognitive inflexibility and suicidal ideation: Mediating role of brooding and hopelessness. Psychiatry Research, 210(1), 174–181.
Mohammadkhani, P., Khanipour, H., Azadmehr, H., Mobramm, A., & Naseri, E. (2015). Trait mindfulness, reasons for living, and general symptom severity as predictors of suicide probability in males with substance abuse or dependence. Iranian Journal of Psychiatry, 10(1), 56–63.
Monteith, L. L., Pease, J. L., Forster, J. E., Homaifar, B. Y., & Bahraini, N. H. (2015). Values as moderators of the association between interpersonal-psychological constructs and suicidal ideation among veterans. Archives of Suicide Research, 19(4), 122–134.
Morrison, R., & O’Connor, R. C. (2011). A systematic review of the relationship between rumination and suicidality. Suicide and Life Threatening Behavior, 38(5), 523–538.
Neuringer, C., & Lettieri, D. J. (1971). Cognition, attitude, and affect in suicidal individuals. Suicide and Life Threatening Behavior, 1(2), 106–124.
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., … Williams, D. (2008a). Cross-national prevalence and risk factor for suicidal ideation, plans, and attempts. British Journal of Psychiatry, 192(2), 98–105.
Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008b). Suicide and suicidal behaviour. Epidemiologic Reviews, 30(1), 133–154.
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviours interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317.
Norton, P. J., Temple, S. R., & Pettit, J. W. (2008). Suicidal ideation and anxiety disorders: Elevated risk or artifact of comorbid depression? Journal of Behavior Therapy and Experimental Psychiatry, 39(4), 515–525.
Perrah, M., & Wichman, H. (2010). Cognitive rigidity in suicide attempters. Suicide and Life Threatening Behavior, 17(3), 251–255.
Pettit, J. W., Temple, S. R., Norton, P. J., Yaroslavsky, B. S., Grover, K. E., Morgan, S. T., & Schatte, D.J. (2009). Thought suppression and suicidal ideation: Preliminary evidence in support of a robust association. Depression and Anxiety, 26(8), 758–763.
Plumb, J. C., Stewart, I., Dahl, J., & Lundgren, T. (2009). In search of meaning: Values in modern clinic behaviour analysis. The Behavior Analyst, 32(1), 85–103.
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The columbia-suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277.
Salters-Pedneault, K., Tull, M. T., & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders. Applied Preventive Psychology, 11(2), 95–114.
Sandoz, E. K., & Hebert, E. R. (2015). Meaningful, reminiscent, and evocative: An initial examination of four methods of selecting idiographic values-relevant stimuli. Journal of Contextual Behavioral Science, 4(4), 277–280.
Serpa, G. J., Taylor, S. L., & Tillisch, K. (2014). Mindfulness-based stress reduction (MBSR) reduces anxiety, depression, and suicidal ideation in veterans. Medical Care, 52(12), 19–24.
Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought action fusion in obsessive-compulsive disorder. Journal of Anxiety Disorders, 10(5), 379–391.
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264.
Strosahl, K., Robinson, P., & Gustavsson, T. (2012). Brief interventions for radical change: Principles and practice of focused acceptance and commitment therapy. Oakland, CA: New Harbinger Publications.
Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of acceptance and commitment therapy in treating depression and suicidal ideation in veterans. Behaviour Research and Therapy, 74, 25–31.
Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34–52.
Williams, M. J. G., & Broadbent, K. (1986). Distraction by emotional stimuli: Use of a stroop task with suicide attempters. British Journal of Clinical Psychology, 25(2), 101–110.
Williams, M. J. G., Duggan, D. S., Crane, C., & Hepburn, S. (2011). Modes of mind in suicidal processes: The potential role of mindfulness in changing minds. In R. C. O’Connor, S. Platt, & J. Gordon (Eds.), International handbook of suicide prevention: Research, policy, and practice (pp. 401–418). Oxford, UK: Wiley.
Wilson, K. G., Sandoz, E. K., Kitchens, J., & Roberts, M. E. (2010). The valued living questionnaire: Defining and measuring valued action within a behavioral framework. The Psychological Record, 60(2), 249–272.
Wilson, K. G., Stelzer, J., Bergman, J. N., Kral, M. J., Inayatullah, M., & Elliott, C. A. (1995). Problem solving, stress, and coping in adolescent suicide attempts. Suicide and Life Threatening Behavior, 25(2), 241–252.
World Health Organization (WHO). (2016). “Suicide Data”. Retrived June 22, 2016 from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/.
Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30–38.
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Barnes, S.M., Smith, G.P., Monteith, L.L., Gerber, H.R., Bahraini, N.H. (2017). ACT for Life: Using Acceptance and Commitment Therapy to Understand and Prevent Suicide. In: Kumar, U. (eds) Handbook of Suicidal Behaviour. Springer, Singapore. https://doi.org/10.1007/978-981-10-4816-6_26
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