A preliminary assessment of the link between anxiety sensitivity cognitive concerns and suicidal thoughts through dissociative symptoms.

Anxiety sensitivity (AS) and AS subfactors (physical, cognitive, and social) have been found to have robust associations with suicide risk. While the direct association between AS subfactors and suicide risk have been explored, little is known about how specific mechanisms, such as dissociation, might explain this relationship. This study aimed to run three analyses to examine the direct and indirect effects of suicidal thoughts and AS via dissociative symptoms. We predicted that dissociation would be a pathway through which AS physical concerns (ASPC) and AS cognitive concerns (ASCC) predicts suicidal ideation. Participants included 84 undergraduate students from a Southeastern University who were elevated on ASCC. Participants completed measures examining dissociative experiences, anxiety sensitivity, and current suicidal ideation. Results revealed that dissociation had a significant indirect effect with ASPC but not ASCC. The current preliminary study showed that ASCC had direct associations with suicide risk; however, those with lower levels of ASPC and dissociation may also be more likely to develop suicide risk. Future research should explore the possibility that the dissociation/ASPC and ASCC pathways are separate, but related, paths to suicidality.

Expanding Fear of Loss of Vigilance: Intolerance of Uncertainty, Responsibility for Harm, and Fear of Sleep for Predicting Nocturnal Panic.

OBJECTIVE/BACKGROUND: Nocturnal panic involves experiencing panic attacks out of a sleeping state without obvious causes. Roughly half of patients with panic disorder will experience nocturnal panic in addition to panic attacks while awake, or daytime panic. Like daytime panic, nocturnal panic also occurs in other disorders such as PTSD. The Fear of Loss of Vigilance theory is currently the only model available to explain nocturnal panic. It suggests nocturnal panickers fear states in which they cannot easily react to or protect themselves from danger. The current study sought to expand upon the existing theory by including constructs from the broader anxiety literature. Nocturnal panickers were expected to report higher scores on these measures when compared to daytime panickers and non-panickers. PARTICIPANTS: A sample of 166 participants were screened for panic history. METHODS: Participants completed self-report measures regarding panic attacks, fear of sleep, intolerance of uncertainty, responsibility for harm, and fear of loss of vigilance. RESULTS: Measures of fear of sleep and responsibility for harm successfully differentiated nocturnal from daytime panickers, whereas measures of intolerance of uncertainty and fear of loss of vigilance did not. CONCLUSIONS: These results provide partial support for the Fear of Loss of Vigilance theory. Modifications to the theory to incorporate additional constructs are suggested.

Comparing symptom networks of daytime and nocturnal panic attacks in a community-based sample.

Nocturnal panic refers to waking in a state of panic without obvious triggers, experiencing the same symptoms as panic attacks that occur while awake. Interrelationships between daytime and nocturnal panic symptoms have not been examined despite theories suggesting panic symptoms perpetuate one another in a forward feedback loop. The current study compared associations between symptoms in daytime and nocturnal panic using network analysis. Network theory conceptualizes symptoms as causing one another, rather than originating from a latent variable (i.e., a disorder). Given that nocturnal panic originates from sleep stages without cognitive activity, cognitive symptoms were expected to be more central in daytime panic networks than nocturnal panic networks. Prior literature indicates similar nocturnal and daytime panic severity; thus, we expected that panic groups would report equivalent panic symptom severity. An online community sample (N = 215) provided panic symptom history. Panic network structures did not differ, although the daytime panic network produced stronger and more numerous connections between physical and cognitive symptoms. The nocturnal panic group, however, reported more severe cognitive symptoms than the daytime panic group. These results challenge biologically-focused nocturnal panic theories and suggest a more significant role of cognitive symptoms in perpetuating nocturnal panic attacks once the individual awakens.

Anxiety Sensitivity Index-3 Suicidal Cognition Concerns: A New Measure Examining Negative Reactions to Suicidal Ideation.

OBJECTIVE: Anxiety sensitivity cognitive concerns (ASCC), the fear of the consequences of mental dyscontrol, has been established as a risk factor for suicidal ideation (SI). Treatments targeted at reducing ASCC have been shown to reduce suicide risk. In this study, a new self-report measure, the Anxiety Sensitivity Index-3 Suicidal Cognition Concerns (ASI-3-SCC), was developed to assess sensitivity specifically to thoughts of suicide and wanting to die. METHOD: Participants completed the new measure as well as measures of anxiety sensitivity, depressive symptoms, SI, and worst point SI. We hypothesized that the ASI-3-SCC would be associated with SI and worst point SI. Additionally, we hypothesized that the ASI-3-SCC would moderate the relationship between ASCC and SI. RESULTS: As predicted, the ASI-3-SCC was significantly associated with SI in the past two weeks and lifetime worst point SI after accounting for ASCC and depression. The ASI-3-SCC also moderated the relationship between ASCC and SI such that ASCC was related to SI at high levels of ASI-3-SCC. CONCLUSIONS: We suggest that the interpretation of SI and feelings of wanting to die as dangerous may lead to more attention to those thoughts when they occur and increased psychological distress associated with those thoughts. This measure will allow researchers to measure a novel construct in the literature and further examine the impact of catastrophic interpretations of suicidal thoughts.HighlightsCreated a new measure for sensitivity to thoughts of suicide and wanting to die.Suicidal cognition concerns associated with suicidal ideation in the past two weeks.Suicidal cognition concerns associated with lifetime worst point suicidal ideation.Suicidal cognition concerns moderated AS cognitive concerns and ideation relation.

Aggressive Worriers: How Aggression Moderates the Association between Intolerance of Uncertainty and Suicidal Desire Constructs.

Suicide is a public health concern and has been the tenth leading cause of death in the United States since 2008. The Interpersonal-Psychological Theory of Suicidal Behavior is an empirically supported model of suicide. The theory posits that thwarted belongingness and perceived burdensomeness examine the individual's perceived connectedness to others around them and together create suicidal desire. Anxiety is another widespread public health concern, associated with suicidal ideation and suicide attempts above and beyond the effects of socio-demographic factors and other mental disorders. A key factor in anxiety disorders is intolerance of uncertainty, or the individual's tendency to perceive ambiguous situations and events as being aversive to emotional and behavioral well-being. Additionally, different facets of aggression have been associated with both intolerance of uncertainty and suicidal desire. The current study sought to examine how facets of aggression moderated the associations between intolerance of uncertainty (both prospective and inhibitory) and thwarted belongingness/perceived burdensomeness. Participants were 440 adults recruited online. The hypotheses of aggression facets moderating the association between intolerance of uncertainty and perceived burdensomeness were largely supported with statistical significance for six out of eight models. Similarly, the hypotheses of aggression facets moderating thwarted belongingness were largely supported with significant moderations for seven out of eight models. The results were upheld when using Benjamini-Hochberg test of significance to account for Type I error. Overall, results indicate that aggressive facets can amplify the associations between intolerance of uncertainty and thwarted belongingness/perceived burdensomeness; however, results differed based on the intolerance of uncertainty dimensions.

The Pathways of Aggression - Differential Indirect Associations Between Anxiety Sensitivity Cognitive Concerns and Suicidality.

Background: Suicide prevention efforts have focused on risk factors that help identify people with an increased risk for suicide. One risk factor related to suicide risk is anxiety sensitivity cognitive concerns (ASCC), which is the "fear of going crazy." The association between ASCC and suicidal ideation is hypothesized to result from the depression-distress amplification model, which postulates that ASCC exacerbates feelings of depression and concurrent distress. Furthermore, there is evidence for associations between ASCC/dysregulated anger and dysregulated anger/suicidal ideation. We hypothesized that aggression may provide pathways from ASCC to suicidality. The current study examined how facets of aggression (described as elevated agitation) meditated the association between ASCC and suicidality. Aims: The current study aimed to extend prior research by examining how different facets of aggression mediate the association between ASCC and suicidality. Method: Participants were 440 adults recruited online, 32.7% of whom endorsed experiencing lifetime suicidal ideation. Results: Our hypotheses were partially supported with two significant indirect effects. Results indicated that physical aggression and hostility provided significant indirect effects; however, verbal aggression and anger did not. Limitations: The study was cross-sectional in nature, limiting causal interpretations about the indirect effects. The sample included primarily White participants. Conclusion: Specific facets of aggression provide pathways through which ASCC is associated with suicidality. Aggression may be a catalyst for individuals to progress to suicidality. The current study provides foundational research for continued examination of physical aggression as a catalyst for suicide attempts.

The association between nocturnal panic attacks and suicidal ideation, plans, and attempts.

Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk factors. Only one study to date has examined this relationship, but measured suicidality as a unitary construct. This represents a significant gap in the literature, considering most individuals who think about suicide do not make a plan and most who make a plan never make an attempt. We sought to expand upon existing research by examining how nocturnal panic relates to suicidal ideation, plans, and attempts separately. We predicted nocturnal panic would be associated with more suicidal ideation, plan, and attempt history than daytime only panic and no panic. Participants recruited from an online community sample were thoroughly screened for nocturnal and daytime panic history and completed questionnaires about past suicidal ideation, plans, and attempts. Nocturnal and daytime panic groups did not differ in past suicidal ideation or plans, but both groups exceeded the non-panic group. The nocturnal panic group reported more suicide attempts than the daytime and non-panic groups and judged themselves as more likely to make an attempt in the future. These results indicate a promising avenue for future research and suicide prevention efforts.

Internal Battles: Examining How Anger/Hostility Moderate the Association Between Negative Urgency and Suicidal Desire Variables in Military and Civilian Samples.

OBJECTIVE: Suicide is consistently within the top ten leading causes of death in the United States. The suicide rate of National Guard personnel is elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. We examined whether negative urgency moderated the relationships between anger/hostility and perceived burdensomeness/thwarted belongingness in both a military and civilian samples. METHOD: There were two samples in the current study: (1) military personnel (majority national guard) and (2) community members oversampled for suicide attempt history. RESULTS: Our hypotheses were partially supported with the interaction of hostility and negative urgency predicting perceived burdensomeness in the military sample. Within civilians, anger interacted with negative urgency to predict perceived burdensomeness. There were nonsignificant findings for analyses predicting thwarted belongingness. Exploratory analyses indicated that in both samples, anger and hostility interacted with negative urgency to predict suicidal ideation. CONCLUSIONS: Results suggest that aggressive attributes may contribute to individuals feeling as though they are a burden on others when moderate to high levels of negative urgency are present. Additionally, this study provides foundational support for the differences between suicidal desire and ideation.

Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks.

Nocturnal panic involves waking suddenly from sleep in a state of panic, with no apparent cause, and affects more than half of patients with panic disorder. The Fear of Loss of Vigilance theory is the only proposed model for nocturnal panic, suggesting nocturnal panickers fear states in which they are unable to react to danger or protect themselves from threats. Prior work using a self-report questionnaire designed to test the theory (i.e., Fear of Loss of Vigilance Questionnaire; FLOVQ) was unsuccessful at differentiating nocturnal from daytime panickers. This study tested the theory using alternative measures to the FLOVQ. We predicted nocturnal panickers would show elevated responses to measures assessing fears of being unable to respond to or protect themselves from threats. A diverse community sample (N = 218) completed self-report measures related to panic attacks, intolerance of uncertainty, responsibility for harm, and anxiety sensitivity dimensions. Nocturnal panickers endorsed greater inhibitory intolerance of uncertainty and responsibility for harm, but not prospective intolerance of uncertainty, or anxiety sensitivity physical or cognitive concerns. This study provides support for the fear of loss of vigilance theory and suggests intolerance of uncertainty and responsibility for harm reduction be targeted in treatment for nocturnal panic attacks.

Fear reactivity to head-mounted display perceptual illusion challenges is associated with suicidality.

Suicide remains a public health concern with suicide rates showing a consistent increase over the last 20 years. Recent studies have found a relationship between anxiety sensitivity (i.e., the fear of anxiety related symptoms) and suicidality. Specifically, a relationship has been found between anxiety sensitivity cognitive concerns (ASCC) and suicidality. The knowledge around this relationship, however, has relied mostly on self-report measures. This study seeks to expand on the current literature by exploring the association between ASCC and suicidality, through the use of head-mounted display perceptual illusion challenges (e.g., using tactile sensations and mannequins to create illusions that the participant has switched bodies). A head-mounted display was used to elicit symptoms (e.g., depersonalization, derealization) related to ASCC in a sample of undergraduate students (N = 54). Suicidality and depression were measured by the Inventory of Depression and Anxiety Symptoms-2 (IDAS-II), anxiety sensitivity cognitive concerns by the Anxiety Sensitivity Index-3 (ASI-3), and distress by the Subjective Units of Distress Scale (SUDS). Findings indicated that suicidality was associated with self-reported ASCC as well as the fear generated from the challenges. Furthermore, our results found that challenge-induced fear predicted suicidality scores above and beyond the traditional self-report measures of ASCC. The small sample size and low suicide risk of the current sample limits generalizations to more severe populations.