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23-05-2022 | Original Article

Measuring Psychological Inflexibility of Suicidal Thoughts: The Acceptance and Action Questionnaire for Suicidal Ideation (AAQ-SI)

Auteurs: Joseph W. Boffa, Jamie L. Tock, Danielle M. Morabito, Norman B. Schmidt

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 5/2022

Abstract

Background

Despite interest in psychological inflexibility as a marker of suicide risk, no measure of psychological inflexibility specific to SI exists.

Methods

The present study utilized data from two internet- and one lab-based sample to establish and evaluate such a measure, the Acceptance and Action Questionnaire for Suicidal Ideation (AAQ-SI). Reliability analysis of seven initial items identified four items in Sample 1 that measured this construct.

Results

Confirmatory factor analysis demonstrated a one-factor solution fit these data in Samples 1 and 2. AAQ-SI scores demonstrated convergent validity (i.e., bivariate correlations) in all samples with another measure of general psychological inflexibility and measures of SI intrusiveness, avoidance, and comfort. AAQ-SI scores demonstrated a statistically significantly weaker correlation with depression symptoms compared to a measure of general psychological inflexibility in Sample 2. AAQ-SI scores were uniquely statistically significantly associated with SI severity in separate regression models within each sample, while an existing measure of general psychological inflexibility was not.

Conclusions

The AAQ-SI appears to be an appropriate measure of psychological inflexibility specific to the experience of suicidal thoughts. Clinicians and researchers interested in this construct among suicidal individuals may opt for the AAQ-SI over other alternatives.

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American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA

Baca-Garcia, E., Perez-Rodriguez, M. M., Keyes, K. M., Oquendo, M. A., Hasin, D. S., Grant, B. F., & Blanco, C. (2010). Suicidal ideation and suicide attempts in the United States: 1991–1992 and 2001–2002. Molecular Psychiatry, 15(3), 250. https://doi.org/10.1038/mp.2008.98CrossRefPubMed

Barnes, S. M., Borges, L. M., Smith, G. P., Walser, R. D., Forster, J. E., & Bahraini, N. H. (2021). Acceptance and Commitment Therapy to Promote Recovery from suicidal crises: A Randomized Controlled Acceptability and Feasibility Trial of ACT for life. Journal of Contextual Behavioral Science, 20, 35–45. https://doi.org/10.1016/j.jcbs.2021.02.003CrossRef

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. Handbook of Suicidal Behaviour (pp. 485–504). Singapore: Springer. https://doi.org/10.1007/978-981-10-4816-6_26CrossRef

Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97(1), 90CrossRef

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), 343CrossRef

Beck, A. T., Steer, R. A., & Ranieri, W. F. (1988). Scale for suicide ideation: Psychometric properties of a self-report version. Journal of Clinical Psychology, 44(4), 499–505CrossRef

Bendayan, R., Esteve, R., & Blanca, M. J. (2012). New empirical evidence of the validity of the Chronic Pain Acceptance Questionnaire: The differential influence of activity engagement and pain willingness on adjustment to chronic pain. British Journal of Health Psychology, 17(2), 314–326. doi: https://doi.org/10.1111/j.2044-8287.2011.02039.xCrossRefPubMed

Bentley, K. H., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Fox, K. R., & Nock, M. K. (2016). Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clinical Psychology Review, 43, 30–46. https://doi.org/10.1016/j.cpr.2015.11.008CrossRefPubMed

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 Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007CrossRefPubMed

Borkovec, T., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics. Journal of Behavior Therapy and Experimental Psychiatry, 26(1), 25–30. https://doi.org/10.1016/0005-7916(94)00064-sCrossRefPubMed

Bryan, C. J., Ray-Sannerud, B., & Heron, E. A. (2015). Psychological flexibility as a dimension of resilience for posttraumatic stress, depression, and risk for suicidal ideation among Air Force personnel. Journal of Contextual Behavioral Science, 4(4), 263–268. doi: https://doi.org/10.1016/j.jcbs.2015.10.002CrossRef

Bryan, C. J., & Rozek, D. C. (2018). Suicide prevention in the military: A mechanistic perspective. Current Opinion in Psychology, 22, 27–32. https://doi.org/10.1016/j.copsyc.2017.07.022CrossRefPubMed

Centers for Disease Control and Prevention [CDC] (2019). WISQARS: Web-Based Injury Statistics Query and Reporting System. Retrieved from http://www.cdc.gov/ncipc/wisqars/default.htm

Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871–890. https://doi.org/10.1002/jclp.20400CrossRefPubMed

Chiles, J. A., & Strosahl, K. D. (2005). Clinical manual for assessment and treatment of suicidal patients. Washington, DC: American Psychiatric Publishing

Coxe, S., West, S. G., & Aiken, L. S. (2009). The analysis of count data: A gentle introduction to Poisson regression and its alternatives. Journal of Personality Assessment, 91(2), 121–136. https://doi.org/10.1080/00223890802634175CrossRefPubMed

Cramer, R. J., Holaday, T. C., & Brausch, A. M. (2015). Suicidal imagery, history of suicidality, and acquired capability in young adults. Journal of Aggression, Conflict, and Peace Research, 7(3), 127-138. doi: 10.1108/JACPR-10-2014-0146

Cukrowicz, K. C., Ekblad, A. G., Cheavens, J. S., Rosenthal, M. Z., & Lynch, T. R. (2008). Coping and thought suppression as predictors of suicidal ideation in depressed older adults with personality disorders. Aging & Mental Health, 12(1), 149–157. https://doi.org/10.1080/13607860801936714CrossRef

Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Increase in suicide in the United States, 1999–2014. NCHS Data Brief, 241, 1–8

DeBeer, B. B., Meyer, E. C., Kimbrel, N. A., Kittel, J. A., Gulliver, S. B., & Morissette, S. B. (2018). Psychological inflexibility predicts of suicidal ideation over time in veterans of the conflicts in Iraq and Afghanistan. Suicide and Life-Threatening Behavior, 48(6), 627–641. https://doi.org/10.1111/sltb.12388CrossRefPubMed

Drapeau, C. W., & McIntosh, J. L. (2020). USA suicide 2018: Official final data. Accessed April 11, 2020. https://suicidology.org/wp-content/uploads/2020/02/2018datapgsv2_Final.pdf

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. https://doi.org/10.1159/000365974CrossRefPubMed

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345CrossRef

Ellis, T. E., & Rufino, K. A. (2015). A psychometric study of the Suicide Cognitions Scale with psychiatric inpatients. Psychological Assessment, 27(1), 82. https://doi.org/10.1037/pas0000028CrossRefPubMed

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. https://doi.org/10.1080/13811118.2015.1093983CrossRefPubMed

Franklin, J. C., Huang, X., Fox, K. R., & Ribeiro, J. D. (2018). What suicide interventions should target. Current Opinion in Psychology, 22, 50–53. https://doi.org/10.1016/j.copsyc.2017.08.002CrossRefPubMed

Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187. https://doi.org/10.1037/bul0000084CrossRefPubMed

Gardner, W., Mulvey, E. P., & Shaw, E. C. (1995). Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychological Bulletin, 118(3), 392CrossRef

Golding, S., Nadorff, M. R., Winer, E. S., & Ward, K. C. (2015). Unpacking sleep and suicide in older adults in a combined online sample. Journal of Clinical Sleep Medicine, 11(12), 1385–1392. https://doi.org/10.5664/jcsm.5270CrossRefPubMedPubMedCentral

Hales, S. A., Deeprose, C., Goodwin, G. M., & Holmes, E. A. (2011). Cognitions in bipolar affective disorder and unipolar depression: imagining suicide. Bipolar Disorders, 13(7-8), 651–661. https://doi.org/10.1111/j.1399-5618.2011.00954.xCrossRefPubMedPubMedCentral

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006CrossRefPubMed

Hayes, S. C., Pistorello, J., & Biglan, A. (2008). Acceptance and Commitment Therapy: model, data, and extension to the prevention of suicide. Revista Brasileira de Terapia Comportamental e Cognitiva, 10(1), 81–102

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: Guilford Press

Holmes, E. A., Crane, C., Fennell, M. J., & Williams, J. M. G. (2007). Imagery about suicide in depression—“Flash-forwards”? Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 423–434CrossRef

Jacoby, R. J., Abramowitz, J. S., Buchholz, J., Reuman, L., & Blakey, S. M. (2018). Experiential avoidance in the context of obsessions: Development and validation of the Acceptance and Action Questionnaire for Obsessions and Compulsions. Journal of Obsessive-Compulsive and Related Disorders, 19, 34–43. https://doi.org/10.1016/j.jocrd.2018.07.003CrossRef

Joiner, T. E., Pfaff, J. J., & Acres, J. G. (2002). A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project. Behaviour Research and Therapy, 40(4), 471–481. https://doi.org/10.1016/S0005-7967(01)00017-1CrossRefPubMed

Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA, 293(20), 2487–2495. https://doi.org/10.1001/jama.293.20.2487CrossRefPubMed

Kline, R. B. (2005). Principles and Practice of Structural Equation Modeling (2nd Edition ed.). The Guilford Press, New York, NY

Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173. https://doi.org/10.1016/j.jad.2008.06.026CrossRefPubMed

Kumpula, M. J., Wagner, H. R., Dedert, E. A., Crowe, C. M., Day, K. T., Powell, K. … Kimbrel, N. A. (2019). An evaluation of the effectiveness of evidence-based psychotherapies for depression to reduce suicidal ideation among male and female veterans. Women’s Health Issues, 29, S103–S111. https://doi.org/10.1016/j.whi.2019.04.013CrossRefPubMed

Lee, I. A., & Preacher, K. J. (2013). Calculation for the test of the difference between two dependent correlations with one variable in common [Computer software]. Available from http://quantpsy.org

Litman, L., Robinson, J., & Abberbock, T. (2017). TurkPrime. com: A versatile crowdsourcing data acquisition platform for the behavioral sciences. Behavior Research Methods, 49(2), 433–442. https://doi.org/10.3758/s13428-016-0727-zCrossRefPubMed

Long, J. S. (1997). Regression models for categorical and limited dependent variables. Thousand Oaks, CA: Sage

Lund, E. M., Nadorff, M. R., Winer, E. S., & Seader, K. (2016). Is suicide an option?: The impact of disability on suicide acceptability in the context of depression, suicidality, and demographic factors. Journal of Affective Disorders, 189, 25–35. https://doi.org/10.1016/j.jad.2015.08.028CrossRefPubMed

Lynch, T. R., Cheavens, J., Morse, J. Q., & Rosenthal, M. Z. (2004). A model predicting suicidal ideation and hopelessness in depressed older adults: The impact of emotion inhibition and affect intensity. Aging & Mental Health, 8(6), 486–497. https://doi.org/10.1080/13607860412331303775CrossRef

Martell, A., & Addis, M. (2001). Jacobson (2001) Depression in Context: Strategies for Guided Action. New York, NY: Norton

May, A. M., & Klonsky, E. D. (2016). What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors. Clinical Psychology: Science and Practice, 23(1), 5–20. https://doi.org/10.1111/cpsp.12136CrossRef

Metalsky, G. I., & Joiner, T. E. (1997). The hopelessness depression symptom questionnaire. Cognitive Therapy and Research, 21(3), 359–384CrossRef

Najmi, S., Wegner, D. M., & Nock, M. K. (2007). Thought suppression and self-injurious thoughts and behaviors. Behaviour Research and Therapy, 45(8), 1957–1965. https://doi.org/10.1016/j.brat.2006.09.014CrossRefPubMed

Ng, R. M., Di Simplicio, M., McManus, F., Kennerley, H., & Holmes, E. A. (2016). ‘Flash-forwards’ and suicidal ideation: A prospective investigation of mental imagery, entrapment and defeat in a cohort from the Hong Kong Mental Morbidity Survey. Psychiatry Research, 246, 453–460. https://doi.org/10.1016/j.psychres.2016.10.018CrossRefPubMed

Olfson, M., Blanco, C., Wall, M., Liu, S. M., Saha, T. D., Pickering, R. P., & Grant, B. F. (2017). National trends in suicide attempts among adults in the united states. JAMA Psychiatry, 74(11), 1095–1103. https://doi.org/10.1001/jamapsychiatry.2017.2582CrossRefPubMedPubMedCentral

Pettit, J. W., Temple, S. R., Norton, P. J., Yaroslavsky, I., 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. https://doi.org/10.1002/da.20512CrossRefPubMed

Razzaque, R. (2013). An acceptance and commitment therapy based protocol for the management of acute self-harm and violence in severe mental illness. Journal of Psychiatric Intensive Care, 9(2), 72–76. https://doi.org/10.1017/s1742646412000258CrossRef

Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. The British Journal of Psychiatry, 212(5), 279–286. https://doi.org/10.1192/bjp.2018.27CrossRefPubMed

Rogers, M. L., Gallyer, A. J., & Joiner, T. E. (2021). The relationship between suicide-specific rumination and suicidal intent above and beyond suicidal ideation and other suicide risk factors: A multilevel modeling approach. Journal of Psychiatric Research, 137, 506–513. https://doi.org/10.1016/j.jpsychires.2021.03.031CrossRefPubMed

Rogers, M. L., Law, K. C., Houtsma, C., Tucker, R. P., Anestis, M. D., & Joiner, T. E. (2021). Development and Initial Validation of a Scale Assessing Suicide-Specific Rumination: The Suicide Rumination Scale. Assessment, 107319112110338. https://doi.org/10.1177/10731911211033897

Schneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. New York, NY: Aronson

Smith, N. S., Bauer, B. W., Martin, R. L., Tucker, R. P., & Capron, D. W. (2020). Anxiety Sensitivity Index-3 Suicidal Cognition Concerns: A New Measure Examining Negative Reactions to Suicidal Ideation. Archives of Suicide Research, 26(1), 245–260. https://doi.org/10.1080/13811118.2020.1793042CrossRefPubMed

Stanley, B., & Brown, G. K. (2012). Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral Practice, 19(2), 256–264. doi: https://doi.org/10.1016/j.cbpra.2011.01.001CrossRef

Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251CrossRef

Tucker, R. P., Smith, C. E., Hollingsworth, D. W., Cole, A. B., & Wingate, L. R. (2017). Do thought control strategies applied to thoughts of suicide influence suicide ideation and suicide risk? Personality and Individual Differences, 112, 37–41. https://doi.org/10.1016/j.paid.2017.01.019CrossRef

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. doi: https://doi.org/10.1016/j.brat.2015.08.012CrossRefPubMed

Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62(4), 615–640CrossRef

Whiting, D. L., Deane, F. P., Ciarrochi, J., McLeod, H. J., & Simpson, G. K. (2015). Validating measures of psychological flexibility in a population with acquired brain injury. Psychological Assessment, 27(2), 415–423. https://doi.org/10.1037/pas0000050CrossRefPubMed

Williams, J. M. 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: WileyCrossRef

Wolgast, M. (2014). What does the Acceptance and Action Questionnaire (AAQ-II) really measure? Behavior Therapy, 45(6), 831–839. https://doi.org/10.1016/j.beth.2014.07.002CrossRefPubMed

Zettle, R. (2007). ACT for depression: A clinician’s guide to using Acceptance & Commitment Therapy in treating depression. Oakland, CA:New Harbinger Publications

Zeileis, A., Kleiber, C., & Jackman, S. (2008). Regression models for count data in R. Journal of Statistical Software, 27(8). 1–25

Titel: Measuring Psychological Inflexibility of Suicidal Thoughts: The Acceptance and Action Questionnaire for Suicidal Ideation (AAQ-SI)
Auteurs: Joseph W. Boffa
Jamie L. Tock
Danielle M. Morabito
Norman B. Schmidt
Publicatiedatum: 23-05-2022
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 5/2022
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-022-10309-w

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