New insights into emotion regulation and suicide risk
Emotion regulation describes a person’s ability to effectively manage and respond to emotional experiences. Throughout a typical day, we use a variety of strategies to cope with difficult or challenging situations. “It is widely accepted that people at risk of suicide have difficulties in emotion regulation,” says ERDS project fellow Yael Millgram from Tel Aviv University in Israel. “Suicidal thoughts are sometimes an attempt to escape intensely negative emotions, because the person experiencing them feels they are not able to control them in any other way.”
Better understanding emotional difficulties
As an expert in emotion regulation and depression, Millgram noted that very little research focused on what these difficulties actually are among people struggling with suicidal thoughts. Furthermore, most previous data was gathered from questionnaires, which are retrospective, and fail to capture the lived daily experience of people at risk of suicide. The ERDS project, which was supported by the Marie Skłodowska-Curie Actions programme, took a fresh approach to better understanding the emotional difficulties associated with suicide risk. Millgram applied a three-stage theory of emotion regulation and sought to examine what happens at each of these stages. “The first stage involves identifying the need to regulate one’s emotions,” she explains. “The next stage involves selecting which emotion-regulation strategy to use. This could be distracting yourself or turning to someone else. The final stage involves implementation, which can result in different levels of success and effort.” Millgram was also interested in uncovering the mechanisms that lead to emotion regulation difficulties such as people’s ability to identify the cause of their emotions. “When you have negative feelings but don’t know why, it is much harder to change these emotions,” she adds.
Detecting emotional regulation deficits
Together with supervisors Matt Nock from Harvard University and Gal Sheppes from Tel Aviv University, Millgram ran two studies based on the three-stage theory. A group of people who had reported suicidal thoughts in the past week was recruited, along with two control groups – a cohort of healthy people with low symptoms and a psychiatric group reporting no suicidal thoughts. Each group downloaded an app onto their phones, which sent them six surveys a day for seven days, asking them about their emotion regulation in real time. These studies led to a number of insightful findings. For instance, Millgram found that participants with suicidal thoughts selected more harmful strategies such as alcohol and drugs to manage emotions, and experienced more effort in regulation, compared to both control groups. “This differentiates people with general psychopathologies from people with suicidal thoughts,” she explains.
Understanding the causes of emotions
Millgram also found that people at risk of suicide tend to be less knowledgeable about the causes of their emotions. “This group knew less about why they feel negative than both control groups,” she says. “Furthermore, people at risk of suicide were more likely to think about suicide when they were unable to identify the source of their emotions.” For Millgram, these insights underline the importance of finding out exactly why people are feeling negative emotions. This is an area of study she intends to focus on moving forward. “If we can help people to identify the source of negative emotions, we might be able to improve their emotional regulatory capabilities,” she adds. “We can then perhaps make adaptive strategies easier to apply.”
Keywords
ERDS, emotion, suicide, psychiatric, suicidal, symptoms