A Behavioral Conceptualization of Suicide and Suicide PreventionTaylor AvesMA Applied Behavior Analysis, School of Behavioral Sciences & EducationDr. Jonathan IvyPhD, BCBA-D

The Current Issue

• 800,000 people die by suicide globally every year (Fazeel & Runeson, 2020)

• Suicide is the 10th leading cause of death in North America and the leading cause of death worldwide amongst adults age 15-24 (Centers for Disease Control & Prevention, 2021)

• Suicide rates in the US have climbed 1.5% per year since 2000 (Fazeel & Runeson, 2020)

Centers for Disease Control & Prevention, 2021

What is Applied Behavior Analysis (ABA)?

• ABA identifies environmental variables and their influence on behavior while applying behavioral principles to produce socially meaningful behavior change

• Many precursors to suicide are behaviors (Duarte et al., 2020; Runcan, 2020)• Withdrawal from activities, drug use, self-harm, suicide attempts, etc.

• Despite this, very little behavior-analytic research has been done to address this situation

Objectives

• Examine some of the existing approaches to suicide and suicide prevention

• Examine those approaches through a behavior-analytic lens

• Discuss potential behavior-analytic solutions and areas for future research for behavior analysts

Some Current Approaches

• Cognitive Behavior Therapy: Focuses on redirecting thought patterns and replacing negative thoughts with positive ones (Geschwind et al., 2019; (Tarrier et al., 2008)

• Dialectical Behavior Therapy: A branch of CBT that focuses on teaching emotional regulation, which is believed to help with harmful behaviors; initially developed to combat suicidal behaviors (Katz & Korslund, 2020)

• Acceptance & Commitment Therapy: Based in ABA, assumes behaviors serve particular functions in one's environment (Murrell et al., 2014)

Cognitive Behavior Therapy (CBT)

Dialectical Behavior Therapy (DBT)

Acceptance & Commitment Therapy (ACT)

• Focuses on thoughts causingbehavior, whereas ABA believes that thoughts are behavior known as "private events"

• Reducing or redirecting negative thoughts leads to decreases in likelihood of suicidal ideation and behaviors, which in turn decreases likelihood of suicide (Tarrier et al., 2008)

• ABA focuses on environmental variables to change behavior rather than unobservable thoughts

• Relies on behavioral chain analyses to examine relevant precursors and consequences to behavior (DiGiorgio et al., 2010)

• Uses behavioral skills training and exposure-based strategies (Katz & Korslund, 2020)

• Conceptualizes suicidal behaviors as maladaptive problem solving, where the goal is to solve unbearable emotional distress (Rathus & Miller, 2002)

• Suicidal behaviors are considered a learned method of problem solving to escape or avoid intense negative emotions/stimuli (Chiles & Strosahl, 2005)

• Experience Avoidance: suicidal behaviors serve to provide escape or avoidance of aversive events (negative reinforcement) (Murrell et al., 2014)

• Teach individuals how to respond to unpleasant events appropriately (Murrell et al., 2014)

Behavioral Accounts & Approaches to Suicide

Current Gaps in the Literature

• Despite increases in research on interventions addressing self-injurious thoughts & behaviors (SITBs), there are currently no well-established treatments for suicidal or non-suicidal SITBs in youth (Glenn et al., 2015)

• Effect sizes tend to be smaller for studies involving children or adolescents (Fox et al., 2020)

• Intervention effects have not improved over time despite exponential increases in in randomized controlled studies examining SITBs (Fox et al., 2020)

Current Gaps in the Literature

• We largely attribute suicide and suicidal tendencies to mental illness, 54% of people who committed suicide had no known mental illnesses (Yampolsky & Kushner, 2020)

• There are increases in suicide rates despite increased intervention and awareness (Yampolsky & Kushner, 2020)

ABA Could Help

• Small shifts in the anticipated probability of rewarding vs punishing consequences of engaging in VR suicide caused significant decrease in VR suicide rates (Linthicum et al., 2019)

• Most approaches to suicide are theoretical; targeted, experimentally informed assessments to determine specific causes of SITBs may be helpful (Fox et al., 2020)• Similar to ABA's "functional analyses," which experimentally

determine environmental variables maintaining behavior

ABA Could Help

• Many precursors to suicide are behavioral (substance abuse, social withdrawal, self-harm) (Duarte et al., 2020; Runcan, 2020)

• Despite this, very little behavior analytic research has been done to combat this issue

• Behavior analysts may provide a new set of expertise and solutions through ABA and should consider exploring this area further

ReferencesCenters for Disease Control & Prevention. (2021, January 21). Preventing Suicide. Centers for Disease Control & Prevention. https://www.cdc.gov/suicide/facts/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Fsuicide%2Ffastfact.html

Chiles, J. A., & Strosahl, K. D. (2005). Clinical manual for assessment and treatment of suicidal patients. American Psychiatric Publishing, Inc.

DiGiorgio, K. E., Glass, C. R., & Arnkoff, D. B. (2010). Therapist’ use of DBT: A survey study of clinical practice. Cognitive and Behavioral Practice, 17(2), 213-221.

Duarte, T. A., Paulino, S., Almeida, C., Gomes, H. S., Santos, N., & Gouveia-Pereira, M. (2020). Self-harm as a predisposition for suicide attempts: A study of adolescents’ deliberate self-harm, suicidal ideation, and suicide attempts. Journal of Psychiatry Research, 287,112553.

Fazeel, S., & Runeson, B. (2020). Suicide. The New England Journal of Medicine, 382(3), 266-274.

Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide and self-injury meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological Bulletin. http://dx.doi.org.ezaccess.libraries.psu.edu/10.1037/bul0000305

Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy. Behaviour Research and Therapy, 116, 119-130. DOI:10.1016/j.brat.2019.03.005

ReferencesGlenn, C. R., Franklin, J. C., & Nock, M. K. (2015). Evidence-based psychosocial treatments for self-injurious thoughts and behaviors in youth. Journal of Clinical Child and Adolescent Psychology, 44, 1–29. https://doi.org/10.1080/15374416.2014.945211

Katz, L. Y., & Korslund, K. E. (2020). Principles of behavioral assessment and management of “life-threatening behavior” in dialectical behavior therapy. Cognitive and Behavioral Practice, 27(1), 30-38.

Linthicum, K. P., Harris, L., & Ribeiro, J. D. (2019). An experimental investigation of the effects of uncertainty on virtual suicidal behavior. 53rd Annual Conference for the Association for Behavioral and Cognitive Therapies, Atlanta, GA. Retrieved from https://eventscribe.com/ 2019/ABCT/fsPopup.asp?ModepresInfo&PresentationID603434

Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32(2), 146-157.

Runcan, R. (2020). Suicide in adolescence: A review of literature. Revista de Asistenta Sociala, (3), 109-120.

Tarrier, N., Taylor, K., & Gooding, P. (2008). Cognitive-behavioral interventions to reduce suicide behavior. Behavior Modification, 32(1), 77-108.

Yampolsky, E., & Kushner, H. I. (2020). Morality, mental illness, and the prevention of suicide. Social Epistemology, 34(6), 533-543.