Cognitive Therapy and Research

, Volume 32, Issue 1, pp 83–104 | Cite as

Cognitive Reactivity, Suicidal Ideation and Future Fluency: Preliminary Investigation of a Differential Activation Theory of Hopelessness/Suicidality

  • J. M. G. Williams
  • A. J. W. Van der Does
  • T. Barnhofer
  • C. Crane
  • Z. S. Segal
Original Article

Abstract

The authors investigated whether the re-emergence of hopeless/suicidal cognitions over time can be explained within a differential activation framework. Studies 1 (N = 146) and 2 (N = 136) showed that individuals who reported suicidal ideation when depressed in the past had higher scores on the hopelessness/suicidality subscale of a measure assessing cognitive reactivity to low mood, the LEIDS. Study 3 (N = 32) demonstrated that self-reports on this subscale predicted changes in generativity for positive future events, an experimental measure of processes underlying hopelessness/suicidality, following sad mood induction. The results provide preliminary evidence that history of suicidal ideation is related to a specific cognitive response pattern, which may be reactivated by mild fluctuations in mood.

Keywords

Depression Suicide Recurrence Cognitive reactivity Rumination Hopelessness Future thinking Vulnerability Differential activation theory 

References

  1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th Ed) (DSM-IV). Washington, DC: Author.Google Scholar
  2. Beautrais, A. L. (2004). Further suicidal behavior among medically serious suicide attempters. Suicide and Life-Threatening Behavior, 34, 1–11.PubMedCrossRefGoogle Scholar
  3. Beautrais, A. L., Joyce, P. R., Mulder, R. T., Fergusson, D. M., Deavoll, B. J., & Nightingale, S. K. (1996). Prevalence and co-morbidity of mental disorders in persons making serious suicide attempts: A case-control study. American Journal of Psychiatry, 153, 1009–1014.PubMedGoogle Scholar
  4. Beck, A. T., Brown, G., Berchick, R. J., Stewart, B. L., & Steer, R. A. (1990). Relationship between hopelessness and ultimate suicide—A replication with psychiatric outpatients. American Journal of Psychiatry, 147, 190–195.PubMedGoogle Scholar
  5. Beck, A. T., & Steer, R. A. (1989). Clinical predictors of eventual suicide: A 5- to 10-year prospective study of suicide attempters. Journal of Affective Disorders, 17, 203–209.PubMedCrossRefGoogle Scholar
  6. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). The Beck Depression Inventory—2nd edition (BDI-II). San Antonio, TX: The Psychological Corporation.Google Scholar
  7. Bouton, M. E. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52, 976–986.PubMedCrossRefGoogle Scholar
  8. Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. JAMA, 294, 563–570.PubMedCrossRefGoogle Scholar
  9. Clark, D. M., & Teasdale, J. D. (1985). Constraints on the effects of mood on memory. Journal of Personality and Social Psychology, 48, 1595–1608.CrossRefGoogle Scholar
  10. Cox, B. J., Enns, M. W., Borger, S. C., & Parker, J. D. A (1999) The nature of the depressive experience in analogue and clinically depressed samples. Behaviour Research and Therapy, 37, 15–24.PubMedCrossRefGoogle Scholar
  11. Dykman, B. M. (1997). A test of whether negative emotional priming facilitates access to latent dysfunctional attitudes. Cognition & Emotion, 11, 197–222.CrossRefGoogle Scholar
  12. Fawcett, J., Scheftner, W. A., Fogg, L., Clark, D. C., Young, M. A., Hedeker, D. et al. (1990). Time-related predictors of suicide in Major Affective-Disorder. American Journal of Psychiatry, 147, 1189–1194.PubMedGoogle Scholar
  13. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1996). User’s guide for the Structured Clinical Interview for DSM-IV Axis I Disorders. Washington, DC: American Psychiatric Press.Google Scholar
  14. Goldney, R. D., Wilson, D., Del Grande, E., Fisher, L. J., McFarlane, A. C. (2000). Suicidal ideation in a random community sample: Attributable risk due to depression and psychosocial and traumatic events. Australian and New Zealand Journal of Psychiatry, 34, 98–106.PubMedCrossRefGoogle Scholar
  15. Hawton, K., Arensman, E., Townsend, E., Bremner, S., Feldman, E., Goldney, R., Gunnell, D., Hazell, P., van Heeringen, C., House, A., Owens, D., Sakinowsky, I., & Traskman-Bendz, L. (1998). Deliberate self-harm: A systematic review of the efficacy of psychosocial and pharmacological treatments in preventing depression. British Medical Journal, 317, 441–447.PubMedGoogle Scholar
  16. Hawton, K., Fagg, J., Simkin, S., Bale, E., & Bond, A. (1997). Trends in deliberate self-harm in Oxford, 1985–1995—Implications for clinical services and the prevention of suicide. British Journal of Psychiatry, 171, 556–560.PubMedCrossRefGoogle Scholar
  17. Hawton, K., & James A. 2005 Suicide and deliberate self harm in young people. British Medical Journal, 330, 891–894.PubMedCrossRefGoogle Scholar
  18. Hawton, K., & van Heeringen, K. (Eds.) (2000). The international handbook of suicide and attempted suicide. New York, NY: John Wiley.Google Scholar
  19. Ingram, R. E., Miranda, J., & Segal, Z. V. (1998) Cognitive vulnerability to depression. New York: Guilford Press.Google Scholar
  20. Ingram, R. E., & Ritter, J. (2000). Vulnerability to depression: Cognitive reactivity and parental bonding in high-risk individuals. Journal of Abnormal Psychology, 109, 588–596.PubMedCrossRefGoogle Scholar
  21. Joiner, T. E. (2002). The trajectory of suicidal behavior over time. Suicide and Life-Threatening Behavior, 32, 33–41.PubMedCrossRefGoogle Scholar
  22. Joiner, T. E., & Rudd, M. D. (Eds.) (2000a). Suicide science: Expanding the boundaries. New York, NY: Kluwer Academic/Plenum Publishers.Google Scholar
  23. Joiner, T. E., & Rudd, M. D. (2000b) Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. Journal of Consulting and Clinical Psychology, 68, 909–916.CrossRefGoogle Scholar
  24. Kendler K. S., Thornton L. M., Gardner C. O. (2000). Stressful life events and previous episodes in the etiology of major depression in women: An evaluation of the ‘kindling’ hypothesis. American Journal of Psychiatry, 157, 1243–1251.PubMedCrossRefGoogle Scholar
  25. Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Archives of General Psychiatry, 56, 617–626.PubMedCrossRefGoogle Scholar
  26. Korszun, A., Moskvina, V., Brewster, S., Craddock, N., Ferrero, F., Gill, M. et al. (2004). Familiality of symptom dimensions in depression. Archives of General Psychiatry, 61, 468–474.PubMedCrossRefGoogle Scholar
  27. Lau, M. A., Segal, S. Z., & Williams, J. M. G. (2004). Teasdale’s differential activation hypothesis: Implications for mechanisms of depressive relapse and suicidal behaviour. Behaviour Research and Therapy, 42, 1001–1004.PubMedCrossRefGoogle Scholar
  28. Lewinsohn, P. M., Hops, H., Roberts, R. E., Seeley, J. R., & Andrews, J. A. (1993) Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology, 102, 133–144.PubMedCrossRefGoogle Scholar
  29. Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking of killing yourself. Journal of Consulting and Clinical Psychology, 51, 276–286.PubMedCrossRefGoogle Scholar
  30. MacLeod, A. K. (1999). Prospective cognition. In T. Dalgleish, & M. J. Power (Eds.), Handbook of cognition and emotion. New York, NY: John Wiley & Sons Ltd.Google Scholar
  31. MacLeod, A. K., & Byrne, A. (1996). Anxiety, depression, and the anticipation of future positive and negative experiences. Journal of Abnormal Psychology, 105, 286–289.PubMedCrossRefGoogle Scholar
  32. MacLeod, A. K., & Cropley, M. L. (1995). Depressive future-thinking—the role of valence and specificity. Cognitive Therapy and Research, 19, 35–50.CrossRefGoogle Scholar
  33. MacLeod, A. K., Pankhania, B., Lee, M., & Mitchell, D. (1997). Parasuicide, depression and the anticipation of positive and negative future experiences. Psychological Medicine, 27, 973–977.PubMedCrossRefGoogle Scholar
  34. MacLeod, A. K., Rose, G. S., & Williams, J. M. G. (1993). Components of hopelessness about the future in parasuicide. Cognitive Therapy & Research, 17, 441–455.CrossRefGoogle Scholar
  35. Malone, K. M., Oquendo, M. A., Haas, G. L., Ellis, S. P., Li, S. H., & Mann, J. J. (2000). Protective factors against suicidal acts in major depression: Reasons for living. American Journal of Psychiatry, 157, 1084–1088.PubMedCrossRefGoogle Scholar
  36. Mann, J. J., Waternaux, C., Haas, G. L., & Malone, K. M. (1999) Towards a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry, 156, 181–189.PubMedGoogle Scholar
  37. Miranda, J., Gross, J. J., Persons, J. B., & Hahn, J. (1998). Mood matters: Negative mood induction activates dysfunctional attitudes in women vulnerable to depression. Cognitive Therapy and Research, 22, 363–376.CrossRefGoogle Scholar
  38. Mitchell, P. B., Parker, G. B., Gladstone, G. L., Wilhelm, K., & Austin, M. P. V. (2003). Severity of stressful life events in first and subsequent episodes of depression: The relevance of depressive subtype. Journal of Affective Disorders, 73, 245–252.PubMedCrossRefGoogle Scholar
  39. Mueller, T. I., Leon, A. C., Keller, M. B., Solomon, D. A., Endicott, J., Coryell, W., Warshaw, M., & Maser, J. D. (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. American Journal of Psychiatry, 156, 1000–1006.PubMedGoogle Scholar
  40. O’Connor, R. C. (2003). Suicidal behaviour as a cry of pain: Test of a psychological model. Archives of Suicide Research, 7, 1–12.CrossRefGoogle Scholar
  41. Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schechtman, E. (2003) Mental Pain: a multidimensiopanl operationalization and definition. Suicide and Life-Threatening Behavior, 33, 219–230.PubMedCrossRefGoogle Scholar
  42. Paykel, E. S., Prusoff, B. A., & Myers, J. K. (1975). Suicide attempts and recent life events: A controlled comparison. Archives of General Psychiatry, 32, 327–333.PubMedGoogle Scholar
  43. Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index Manual, 2 nd edn. Worthington, OH: IDS Publishing Corporation.Google Scholar
  44. Petrie, K., Chamberlain, K., & Clarke, D. (1988). Psychological predictors of future suicidal behaviour in hospitalized suicide attempters. British Journal of Clinical Psychology, 27, 247–257.PubMedGoogle Scholar
  45. Pokorny, A. D. (1993). Prediction of suicide in psychiatric patients: Report of a prospective study. In R. W. Maris, A. L. Berman, J. T. Maltsberger, & R. I. Yufit (Eds.), Assessment and prediction of suicide. New York: Guilford Press.Google Scholar
  46. Post, R. M. (1992). Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. American Journal of Psychiatry, 149, 999–1010.PubMedGoogle Scholar
  47. Rudd, M. D., Joiner, T. E., & Rajab, M. H. (1996). Relationship among suicide ideators, attempters and multiple attempters in a young adult sample. Journal of Abnormal Psychology, 105, 541–550.PubMedCrossRefGoogle Scholar
  48. Salter, D., & Platt, S. (1990). Suicidal intent, hopelessness and depression in a parasuicide population: The influence of social desirability and elapsed time. British Journal of Clinical Psychology, 29, 361–371.PubMedGoogle Scholar
  49. Schotte, D. E., Cools, J., & Payvar, S. (1990). Problem-solving deficits in suicidal patients—trait vulnerability or state phenomenon. Journal of Consulting and Clinical Psychology, 58, 562–564.PubMedCrossRefGoogle Scholar
  50. Scott, J., House, R., Yates, M., & Harrington, J. (1997). Individual risk factors for early repetition of deliberate self-harm. British Journal of Medical Psychology, 70, 387–393.PubMedGoogle Scholar
  51. Segal, Z. V., Gemar, M., & Williams, S. (1999). Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression. Journal of Abnormal Psychology, 108, 3–10.PubMedCrossRefGoogle Scholar
  52. Segal, Z. V., & Ingram, R. E. (1994) Mood priming and construct activation in tests of cognitive vulnerability to unipolar depression. Clinical Psychology Review, 14, 663–695.CrossRefGoogle Scholar
  53. Segal, Z. V., Kennedy, S., Gemar, M., Sagrati, S., Hood, K., & Pedersen, R. (2003). Using mood induction to activate depression relapse vulnerability following cognitive or pharmacological treatment. Presented at the Society for Research in Psychopathology, Toronto, ON.Google Scholar
  54. Segal, Z. V., Williams, J. M. G., Teasdale, J. D., & Gemar, M. (1996). A cognitive science perspective on kindling and episode sensitization in recurrent affective disorder. Psychological Medicine, 26, 371–380.PubMedCrossRefGoogle Scholar
  55. Segal, Z. V., Kennedy, S., Gemar, M., Hood, K., Pedersen, R., & Buis, T. (2006). Cognitive reactivity to sad mood provocation and the prediction of depressive relapse. Archives of General Psychiatry, 63, 749–755.PubMedCrossRefGoogle Scholar
  56. Sidley, G. L., Calam, R., Wells, A., Hughes, T., & Whitaker, K. (1999). The prediction of parasuicide repetition in a high-risk group. British Journal of Clinical Psychology, 38, 375–386.PubMedCrossRefGoogle Scholar
  57. Szanto, K., Reynolds, C. F., Conwell, Y., Begley, A. E., & Houck, P. (1998). High levels of hopelessness persist in geriatric patients with remitted depression and a history of attempted suicide. Journal of the American Geriatrics Society, 46, 1401–1406.PubMedGoogle Scholar
  58. Taylor, L., & Ingram, R. E. (1999). Cognitive reactivity and depressotypic information processing in children of depressed mothers. Journal of Abnormal Psychology, 108, 202–210.PubMedCrossRefGoogle Scholar
  59. Tversky, A., & Kahneman, D. (1973). Availability: A heuristic for judging frequency and probability. Cognitive Psychology, 5, 207–232.CrossRefGoogle Scholar
  60. Van der Does, A. J. W. (2002a). Cognitive reactivity to a sad mood: structure and validity of a new measure. Behaviour Research & Therapy, 40, 105–120.CrossRefGoogle Scholar
  61. Van der Does, A. J. W. (2002b). Manual of the Dutch version of the BDI-II [Handleiding bij de Nederlandse bewerking van de BDI-II]. San Antonio TX/Lisse NL: The Psychological Corporation/Swets Test Publishers.Google Scholar
  62. Van der Does, A. J. W. (2005). Thought suppression and cognitive vulnerability to depression. British Journal of Clinical Psychology, 44, 1–14.PubMedCrossRefGoogle Scholar
  63. Van der Does, A. J. W., Barnhofer, T., & Williams, J. M. G. (2003). The Major Depression Questionnaire (MDQ) www.dousa.nl/publications.Google Scholar
  64. Van der Does, A. J. W., & Williams, J. M. G. (2003). The Leiden Index of Depression Sensitivity (LEIDS). Revised version. Unpublished manuscript.Google Scholar
  65. Wetzel, R. D., Margulies, T., Davis, R., & Karam, E. (1980). Hopelessness, depression, and suicide intent. Journal of Clinical Psychiatry, 41, 159–160.PubMedGoogle Scholar
  66. Weissman, A. N. (1979). The dysfunctional attitude scale. Philadelphia PA: University of Pennsylvania (Dissertation Abstracts International: 40, 1389B–1390B).Google Scholar
  67. Williams, J. M. G., Barnhofer, T., Crane, C., & Beck, A. T. (2005). Problem solving deteriorates following mood challenge in formerly depressed patients with a history of suicidal ideation. Journal of Abnormal Psychology, 114(3), 421–431.PubMedCrossRefGoogle Scholar
  68. Young, M. A., Fogg, L. F., Scheftner, W., Fawcett, J., Akiskal, H., & Maser, J. (1996). Stable trait components of hopelessness: Baseline and sensitivity to depression. Journal of Abnormal Psychology, 105, 155–165.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • J. M. G. Williams
    • 1
  • A. J. W. Van der Does
    • 2
  • T. Barnhofer
    • 1
  • C. Crane
    • 1
  • Z. S. Segal
    • 3
  1. 1.Department of PsychiatryOxford University, Warneford HospitalOxfordUK
  2. 2.Department of PsychologyLeiden UniversityLeidenNetherlands
  3. 3.Department of PsychiatryUniversity of TorontoTorontoCanada

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