Abstract
Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions.
Highlights
Suicidal ideation and behaviors are major public health problems and have been estimated to affect 3–9% of the population worldwide [1]
We suggest that the pathway from suicidal ideation to suicidal behavior simulates obsessive-compulsive symptomatology in that an increased presence of intrusive suicidal imagery leads to increased distress, which in turn leads to suicidal ideation and suicidal behavior
The Eye Movement Dual Task (EMDT) protocol has been developed in co-creation with patients and mental health professionals involved in mental health care for depressed patients with suicidal ideation, currently in treatment for depression or suicidality, or both
Summary
Prior to the dual task, the patient needs to understand the concept of suicidal intrusions and how to identify their associated intrusive images. The patient and therapist have discussed the negative, emotional experience and content of the targeted suicidal intrusion in great detail. Once both therapist and patient feel confident about the established target suicidal intrusion, an introduction about EMDT will be provided. The therapist tries to get the patient to be in the heavily emotionally charged state as they feel when experiencing the suicidal intrusions. This is essential, as the fear-network needs to be highly activated in order to generate any changes to the stimulus-aspects, meaning-aspects, and response-aspects associated to the memory representation of the intrusive suicidal image. The target image is selected and portrays the part of the suicidal intrusion that invokes maximum emotional tension
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