Periodic Reporting for period 1 - ERDS (Emotion Regulation Deficits among People at Risk for Suicide)
Periodo di rendicontazione: 2021-11-01 al 2023-10-31
Suicide is a leading cause of death worldwide. One factor contributing to suicide risk is difficulties to regulate negative emotions. There is evidence linking suicide risk with self-reported difficulties in emotion regulation. However, the nature of such difficulties remains largely unknown. Existing research has mainly relied on self-reports collected at a single time point, and did not clearly distinguish between deficits experienced at different stages of the regulatory process. ERDS addresses this gap by assessing whether people at risk for suicide experience deficits in three individual stages of the emotion regulation process. Specifically, ERDS tests whether people at risk for suicide differ from psychiatric and non-psychiatric controls in their (1) attempts to decrease negative emotions, (2) in their access to emotion regulation strategies, and (3) in their ability to implement effective strategies. To do so, ERDS goes beyond self reports and utilizes carefully controlled behavioral tasks. ERDS also utilizes Experience Sampling Methods to track emotion regulation and suicidal ideation in daily life, in more ecologically valid settings. Finally, ERDS uses an experimental design to test whether providing assistance in emotion regulation improves emotion regulation efficacy among people at risk for suicide. To conclude, ERDS provides invaluable information on whether and how emotion regulation is impaired among people at risk for suicide. Gaining such knowledge could potentially help people at risk for suicide to better regulate emotions, hopefully reducing their need to resort to more extreme solutions for their suffering. Therefore, ERDS could potentially inform theory as well as treatment and suicide prevention.
To achieve ERDS objectives, two studies have been conducted. Study 1 (N=195) included three groups. Participants with current suicidal thoughts (suicidal thoughts in the past week; N=64), participants with equivalent psychiatric symptoms but no history of suicidal thoughts (psychiatric controls; N=64), and people with low levels of psychiatric symptoms and no history of suicidal thoughts (healthy controls; N=67). To target the first stage of the regulatory process, emotion regulation attempts, participants completed a behavioral decision-making task. Participants chose whether to decrease or not to decrease their emotional reactions to negative images. The percent of choices to decrease the emotional reaction was assessed, as well as the intensity of participants’ emotional reaction before and after they implemented their choice. Next, to assess all three regulatory stages in daily life, participants completed an ESM period of 7 days. During this period, they reported 6 times per day on their smartphones about their emotion regulation attempts, their use of 8 emotion regulation strategies, and their success and effort in implementing these strategies.
People with suicidal thoughts did not differ from the other two groups in their choices to decrease negative emotions in the behavioral task. This suggests that suicidal thoughts are not necessarily associated with deficits in attempting to regulate emotions. People with suicidal thoughts also did not differ from the other two groups in their ability to decrease negative emotions when they chose to do so. In fact, they were as effective in decreasing their negative emotions as the control groups. However, people with suicidal thoughts differed in how their negative emotions unfolded over time when they did not try to regulate their emotions. When healthy controls did not try to regulate, their emotional reaction naturally decreased, reflecting habituation. In contrast, when people with suicidal thoughts did not regulate, their emotional reactions increased over time. This suggests that people with suicidal thoughts might be less able to rely on automatic processes like habituation to reduce negative feelings. Unless they actively regulate their emotions, their negative feelings naturally intensify. This finding could encourage focusing on automatic processes of emotion regulation among people at risk for suicide, rather than focusing on effortful emotion regulation, a process that seems to be largely intact when assessed in controlled settings.
Mirroring the behavioral results, in the ESM period, people with suicidal thoughts did not differ from the other two groups in their regulation attempts in daily life. They did differ, however, in the strategies they used to decrease negative emotions. Specifically, they were more likely than healthy controls to use rumination, distraction, substances, and self-injury to regulate emotions. They differed from psychiatric controls only in their use of substances like alcohol or drugs to decrease negative emotions, suggesting that using substances to cope with negative feelings might particularly increase risk for suicidal thoughts. Finally, people with suicidal thoughts experienced significantly less success and more effort in regulation compared to the other two groups.
To target the next two stages of the regulatory process (access to emotion regulation strategies and implementation of strategies), a second study was conducted. Study 2 (N=281) also included three groups. Participants with current suicidal thoughts (suicidal thoughts in the past week; N=91), participants with equivalent levels of psychiatric symptoms but no history of suicidal thoughts (psychiatric controls; N=89), and people with low levels of psychiatric symptoms and no history of suicidal thoughts (healthy controls; N=101). Participants completed a multi-stage behavioral task. First, participants watched negative images and rated how they felt to assess emotional reactivity. Next, to assess deficits in access to emotion regulation strategies, participants were asked to try to decrease their emotions in reaction to a different set of images, and report which strategies they used. Finally, participants underwent training in implementing cognitive reappraisal and were asked to use this strategy to regulate their emotions in reaction to a third set of images. Their success in implementing this strategy was assessed to identify deficits in strategy implementation. Participants also wrote how they implemented reappraisal to enable the use of language processing tools to identify any content or structural differences in how people with suicidal thoughts implement cognitive reappraisal. The analysis of Study 2’s results is still ongoing, and conclusions are forthcoming.
People with suicidal thoughts did not differ from the other two groups in their choices to decrease negative emotions in the behavioral task. This suggests that suicidal thoughts are not necessarily associated with deficits in attempting to regulate emotions. People with suicidal thoughts also did not differ from the other two groups in their ability to decrease negative emotions when they chose to do so. In fact, they were as effective in decreasing their negative emotions as the control groups. However, people with suicidal thoughts differed in how their negative emotions unfolded over time when they did not try to regulate their emotions. When healthy controls did not try to regulate, their emotional reaction naturally decreased, reflecting habituation. In contrast, when people with suicidal thoughts did not regulate, their emotional reactions increased over time. This suggests that people with suicidal thoughts might be less able to rely on automatic processes like habituation to reduce negative feelings. Unless they actively regulate their emotions, their negative feelings naturally intensify. This finding could encourage focusing on automatic processes of emotion regulation among people at risk for suicide, rather than focusing on effortful emotion regulation, a process that seems to be largely intact when assessed in controlled settings.
Mirroring the behavioral results, in the ESM period, people with suicidal thoughts did not differ from the other two groups in their regulation attempts in daily life. They did differ, however, in the strategies they used to decrease negative emotions. Specifically, they were more likely than healthy controls to use rumination, distraction, substances, and self-injury to regulate emotions. They differed from psychiatric controls only in their use of substances like alcohol or drugs to decrease negative emotions, suggesting that using substances to cope with negative feelings might particularly increase risk for suicidal thoughts. Finally, people with suicidal thoughts experienced significantly less success and more effort in regulation compared to the other two groups.
To target the next two stages of the regulatory process (access to emotion regulation strategies and implementation of strategies), a second study was conducted. Study 2 (N=281) also included three groups. Participants with current suicidal thoughts (suicidal thoughts in the past week; N=91), participants with equivalent levels of psychiatric symptoms but no history of suicidal thoughts (psychiatric controls; N=89), and people with low levels of psychiatric symptoms and no history of suicidal thoughts (healthy controls; N=101). Participants completed a multi-stage behavioral task. First, participants watched negative images and rated how they felt to assess emotional reactivity. Next, to assess deficits in access to emotion regulation strategies, participants were asked to try to decrease their emotions in reaction to a different set of images, and report which strategies they used. Finally, participants underwent training in implementing cognitive reappraisal and were asked to use this strategy to regulate their emotions in reaction to a third set of images. Their success in implementing this strategy was assessed to identify deficits in strategy implementation. Participants also wrote how they implemented reappraisal to enable the use of language processing tools to identify any content or structural differences in how people with suicidal thoughts implement cognitive reappraisal. The analysis of Study 2’s results is still ongoing, and conclusions are forthcoming.
Until the end of the project, ERDS is expected to clarify whether people with suicidal thoughts experience emotion regulation deficits in each of the three stages of the regulatory process. So far, the project has revealed that people with suicidal thoughts do not experience deficits in attempting emotion regulation. Instead, they seem to rely on less effective and even harmful emotion regulation strategies (e.g. substance use and self-injury). They also seem to be less able to rely on automatic processes of regulation, like habituation, to reduce negative feelings. These findings can direct future research to focus mainly on these forms and stages of regulation. They could also be exploited to promote better emotion regulation in people at risk for suicide. For instance, by assisting people to replace ineffective emotion regulation strategies with more adaptive ones.