Metacognitive Beliefs and Suicidal Ideation: An Experience Sampling Study.

Vikki Aadahl,Adrian Wells,Daniel Pratt,Robert Hallard

doi:10.3390/ijerph182312336

Abstract

The current study aimed to examine the relationship between metacognitive beliefs about suicidal ideation and the content and process of suicidal ideation. This was to examine the potential contribution of the Self-Regulatory Executive Function (S-REF) model (Wells and Matthew, 2015) to suicidal ideation. Twenty-seven participants completed both trait and state-level measures of suicidal ideation, negative affect, defeat, hopelessness, entrapment and metacognitive beliefs. Experience Sampling Methodology (ESM) was adopted to measure state-level measurements with participants invited to complete an online diary up to seven times a day for six days. Multi-level modelling enabled a detailed examination of the relationships between metacognitive beliefs and suicidal ideation. Positive (β = 0.241, p < 0.001) and negative (β = 0.167, p < 0.001) metacognitive beliefs about suicidal ideation were positively associated with concurrent suicidal ideation even when known cognitive correlates of suicide were controlled for. The results have important clinical implications for the assessment, formulation and treatment of suicidal ideation. Novel meta-cognitive treatments targeting beliefs about suicidal ideation are now indicated. A limited range of characteristics reported by participants affects the generalizability of findings. Future research is recommended to advance understanding of metacognition and suicide but results demonstrate an important contribution of the S-REF model.

Highlights

Over 700,000 people die each year by suicide [1], so improving our understanding of suicide is imperative [2]
In the Self-Regulatory Executive Function (S-REF) model, suicidal ideation is seen as a type of rumination that is principally a coping strategy, and this can be distinguished from beliefs about that process or worry about that process, which are higher level metacognitions
A multilevel model examined whether metacognitive beliefs about suicidal ideation were significantly associated with suicidal ideation when known cognitive correlates of suicide were accounted for

Summary

Introduction

Over 700,000 people die each year by suicide [1], so improving our understanding of suicide is imperative [2]. Klonsky and May (2015) argue that any model of suicide should explain the development of suicidal ideation and the progression to suicidal behavior [4]. Kerkhof and van Spijker (2011) argued that the process of suicidal ideation is similar to worry and rumination [5]. In the S-REF model, suicidal ideation is seen as a type of rumination that is principally a coping strategy, and this can be distinguished from beliefs about that process or worry about that process, which are higher level metacognitions (since they are cognitions about cognition). Worry and rumination have been conceptualised as cognitive coping strategies that can have paradoxical effects of maintaining emotional difficulties through affecting the processes required for effective self-regulation [6,7].

Objectives

Discussion

Conclusion