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An investigation of aspects of the cry of pain model of suicide risk: The role of defeat in impairing memory

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Abstract

Aim

Feelings of defeat and deficits in autobiographical memory are thought to be central to the formation of suicidal thoughts and behaviours. However, no work has established the role of defeat, specifically, in directly leading to memory problems. This study sought to assess whether a defeating event and associated defeated mood impaired memory for a story.

Method

Participants were from a student population. Those in the experimental condition (n=37) experienced an event which was designed to induce defeat prior to both the encoding and verbal retrieval of a story. Participants in control condition (n=37) experienced no such defeating event. Visual analogue scales of five mood states were taken at baseline, prior to encoding and prior to retrieval.

Results

Participants in the experimental condition reported increased feelings of defeat following baseline, and recalled fewer story units relative to the control condition.

Discussion

These results show that appraising an event as defeating increased subsequent defeated mood and led to impaired episodic memory, independently of low mood in general, thus suggesting a causal role of a specific negative mood state on impaired memory. Implications for clinical research are discussed.

Introduction

The ‘Cry of Pain’ (CoP) model of suicide (Williams, 1997; Williams, Crane, Barnhofer, & Duggan, 2005) provides a biopsychosocial framework with which to understand suicidal behaviour. It endeavours to describe, explore, and understand, numerous socio-cognitive factors which lead to suicidal behaviour (Bolton, Gooding, Kapur, Barrowclough, & Tarrier, 2007). Explaining perceptions of entrapment or lack of escape (Baumeister, 1990; Dean & Range, 1999; Hunter & O’Connor, 2003) is a core theme of the model in which arrested flight (Williams et al., 2005), hopelessness (Beck, Brown, Berchick, Stewart, & Steer, 1990) and defeat (Brown, Harris, & Hepworth, 1995; Gilbert & Allan, 1998) are central. Defeat is particularly important because it has been associated with several psychopathological states, and may be trans-diagnostic in nature. For example, it has been identified as a factor in post-traumatic stress disorder (Ehlers, Maercker, & Boos, 2000), depression (Gilbert & Allan, 1998; Rooke & Birchwood, 1998) and hopelessness (Gilbert & Allan, 1998), as well as suicidality (O’Connor, 2003).

Work expanding on the CoP model proposes that one key process concerns the appraisal of stressors and their consequences from which feelings of defeat emerge (Johnson, Gooding, & Tarrier, 2008). This may occur in response to perceived social messages concerning self-worth, social belonging, rejection, failure to achieve and irreversible loss of valued roles or significant others (Sloman, Gilbert, & Hasey, 2003). It may also involve self-evaluation and the evaluation of social support in terms of the current situation and the future (Johnson et al., 2008). In accord with the CoP model, information processing biases are thought to underpin the appraisal of stressors as negative, and to contribute to the formation of negative, memory schema (Lau, Segal, & Williams, 2004; Tarrier, Gooding, Gregg, Johnson, & Drake, 2007; Teasdale, 1988; Williams et al., 2005). It has been further suggested that impoverished problem solving in social or intra-personal situations is, at least in part, a result of dysfunctional memory schema because such deficits in memory processes lead to poor access to successful problem solving in past situations (e.g. Williams et al., 2005). Although there is a large body of research demonstrating that a range of psychological disorders are associated with poor autobiographical memory (e.g. Evans Williams, O’Loughlin, & Howells, 1992; Iqbal, Birchwood, Hemsley, Jackson, & Morris, 2004; Riutort, Cuervo, Danion, Peretti, & Salame, 2003; Sidley, Whitaker, Calam, & Wells, 1997; Williams, 1997; Williams & Broadbent, 1986; see Williams, 2006 for a review), this work has not established whether specific feelings of defeat, as opposed to more general negative or depressive feelings, are associated with poor memory. Nor has it determined whether there is a causal link between defeat and dysfunctional memories.

Hence, the first stage in establishing the causal pathways between defeat, deficits in memory which may underlie impoverished social problem solving, and ensuing feelings of entrapment and hopelessness, is to determine whether feelings of defeat result in poor memory performance in ‘healthy’ samples. As evidence suggests that symptoms of psychopathology may lie on a continuum within the general population (Tarrier, Liversidge, & Gregg, 2006), such research could potentially inform the clinical literature. This was the principal aim of the research reported in this paper and fundamental to one of the basic tenets of the CoP model.

An experimental design was used in which undergraduate student participants were exposed to a defeating event prior to the encoding and recall of a story, and their memory performance was compared to a control group who experienced no such defeat. Subjective ratings of sadness, fear, calmness and energy were also collected in order to ascertain whether effects were attributable to defeat rather than negative ratings across a range of emotional states. A defeating event was used prior to both encoding and recall tasks to maximise the effects of the defeating event, and because it is as yet unknown whether negative emotions differentially affect encoding relative to retrieval or vice-versa. The story was constructed from idea units (Wechsler, 1997) and had both negative and neutral content. The key prediction of the current study was that participants experiencing a defeating event would demonstrate increased perceptions of defeat and concomitant impaired recall of a story relative to controls. A corollary of this prediction was that based on the mood congruency literature (Clark & Teasdale, 1982; Lloyd & Lishman, 1975; Teasdale & Fogarty, 1979) it was expected that those in the defeat condition would recall proportionally more negative idea units than neutral idea units.

Section snippets

Design

There was one between-subjects (BS) factor of condition (defeat versus no defeat), and three within-subjects (WS) factors of story content (neutral versus negative), time (baseline, pre-encoding and pre-retrieval), and experienced emotion (defeat, sadness, fear, calmness and energy). The dependent variable was the number/proportion of story units recalled.

Participants

A total of 74 participants attending the University of Manchester took part in the experiment: 36 females (M age=18.58, SD=0.90) and 1 male

Rating of subjective defeat

In order for the experiment to be valid, it was important to show, first, that baseline levels of defeat were similar for the defeat (experimental) and the no defeat (control) groups, and second, that the defeat manipulation successfully induced defeated mood in the experimental group alone. As can be seen from Fig. 1 and Table 1, this was indeed the case. A 2×3 way mixed ANOVA, with a BS factor of defeat manipulation (defeat versus no defeat) and a WS factor of time of defeat measure

Discussion

The main aim of the study was to test one of the key aspects of the Cry of Pain (CoP) model of suicide (Williams, 1997; Williams et al., 2005) which suggests that appraising a situation as defeating affects memory processes detrimentally, and in a causative manner. It was predicted that ‘healthy’ participants experiencing a defeating event prior to encoding and retrieval of a story would show impaired memory relative to controls who experienced no such defeat. As expected, participants in the

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