Catastrophic thoughts about the future linked to suicidal patients

Suicide has been on the increase recently in the United States, currently accounting for almost 40,000 deaths a year. A new study shows that one successful effort to avoid suicide attempts would be to focus on correcting the distorted, catastrophic thoughts about the future that are held by many who try to kill themselves. Such thoughts are unique and characteristic to those who attempt suicide, says Shari Jager-Hyman of the University of Pennsylvania Perelman School of Medicine in the US. Jager-Hyman led a study, published in Springer’s journal Cognitive Therapy and Research, about how distorted thoughts influence suicidal behaviors in patients who seek emergency psychiatric treatment.

The research team recruited a relatively large and ethnically diverse group of 168 participants from emergency departments or psychiatric inpatient units in Philadelphia. Of these, 111 people had attempted suicide in the 30 days prior to the study. The other 57 participants were receiving emergency psychiatric treatment, but had not tried to commit suicide in the two years prior to the study. The research study is the first to use the Inventory of Cognitive Distortions, a 69-item self-report questionnaire designed to be used among various clinical populations, to measure cognitive distortions in people who have recently tried to commit suicide.

The study found that people who attempt suicide are more likely to have distorted thoughts than others. These include the way in which they think about their own self-worth, how they negatively compare themselves to others, and how they generally slap derogatory labels on themselves. This is true even when the effects of depression and feelings of hopelessness are taken into account. The findings add weight to the many theories presented over decades that suicidal people have unique cognitive styles by which they misinterpret or wrongly process experiences or stimuli.

Uniquely, people who made suicide attempts were found to be especially prone to so-called “fortune telling,” through which they predict and firmly believe that bad things will happen in the future. Fortune telling is akin to catastrophizing, and does not consider other, more probable outcomes. Importantly, when the researchers took thoughts of hopelessness into account, fortune telling was no longer strongly linked to suicidal attempts. Jager-Hyman and her colleagues believe this is because fortune telling and hopelessness may be overlapping constructs or ideas which share the fear of negative future events.

“To prevent suicides, therapists would benefit from directly targeting patients’ thoughts of hopelessness in clinical interventions,” says Jager-Hyman. “A cognitive approach can help patients evaluate their beliefs that negative outcomes will inevitably occur, and show them how to entertain other possible options. This can help to minimize patients’ thoughts of hopelessness, help them to cope better, and ideally decrease their suicidal ideation and behaviors.”