A cognitive model of suicidal behavior: Theory and treatment

https://doi.org/10.1016/j.appsy.2008.05.001Get rights and content

Abstract

With some prominent exceptions, much of the research designed to elucidate the nature, prevalence, and correlates of suicidal behavior has been conducted from an atheoretical perspective. Conversely, psychological theories to explain suicidal behavior are largely untested by rigorous experimental designs. We propose a cognitive model of suicidal behavior that is grounded in the empirical literature on cognitive and behavioral correlates of and risk factors for suicidal behavior. In addition, we demonstrate the manner in which the theoretical components are targeted in cognitive therapy for suicidal patients. We highlight aspects of the model with less empirical support, and we propose ways those constructs can be tested in future research.

Section snippets

A Cognitive model of suicidal behavior: theory and treatment

The public health significance of research into the causes and treatment of suicidal behavior is profound—suicide is the 11th leading cause of death among all age groups and the second leading cause of death among adults between ages 25 and 34 (Centers for Disease Control, 2007). Surviving family members and friends struggle to understand why their loved one resorted to suicide and what they could have done to prevent it, often experiencing complicated bereavement for an extended period of time

A cognitive model of suicidal behavior

Our cognitive model of suicidal behavior (Wenzel, Brown, et al., 2008) is presented in Fig. 1. The large ovals represent the three main constructs that underlie suicidal behavior from a cognitive perspective. The ovals become darker as the constructs become more directly relevant to understanding suicidal behavior, rather than abnormal behavior in general. We propose that dispositional vulnerability factors are long-standing, trait-like variables that confer non-specific risk for psychiatric

Cognitive therapy for suicidal patients

Cognitive therapy for suicidal patients is an active, targeted psychosocial intervention that aims to provide patients skills to (a) modify suicide schemas, (b) interrupt cognitive processes associated with suicidal crises, and (c) modify dispositional vulnerability factors that played a central role in the recent suicidal crisis that brought them into treatment. By developing strategies to achieve these aims, it is hoped that patients will be less likely to engage in future suicidal behavior

Conclusion and future directions

Our cognitive model of suicidal behavior was designed to (a) incorporate relevant constructs that have been demonstrated in the empirical literature to be associated with suicide ideation, attempts, and completions, and (b) differentiate between distal and proximal factors associated with suicidal crises, such that it provides a template for understanding long-standing vulnerabilities as well as the cognitive phenomena experienced by suicidal patients in crisis. This model should be viewed as a

Acknowledgements

Completion of this manuscript was facilitated by support from the National Institute of Mental Health (P20-MH072905915, R01-MH067805), awarded to Dr. Aaron T. Beck, the American Foundation for Suicide Prevention, awarded to Dr. Amy Wenzel, and the National Alliance for Research in Schizophrenia and Depression, awarded to Dr. Amy Wenzel.

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