Reduced social contact and attachment insecurity as predictors of loneliness during COVID-19: A two-month experience sampling study.

The impact of reduced social contact on mental health during the COVID-19 pandemic has been identified as a major public health concern. While personality factors such as attachment style have been associated with psychological distress during the pandemic, the longitudinal relevance of these factors and the role of daily social contact in mitigating distress remains poorly understood. This study evaluated the impact of social contact and attachment style on changes in loneliness over an 8-week experience sampling period during the COVID-19 pandemic. A general adult sample (n = 184) recruited online completed measures of psychological distress, attachment, and loneliness via smartphone. Loneliness and daily social contact were assessed twice per week for eight weeks, yielding 1124 unique observations. During the experience sampling period, proximal increases in loneliness were associated with decreased daily in-person contact. In contrast, participants who described themselves as having fewer interactions via text, phone, or videoconferencing, as well as those with higher anxious and avoidant attachment traits, reported greater experiences of loneliness over time. These findings suggest the relevance of both enduring personality characteristics and daily social behaviors as risk factors for loneliness during the pandemic, pointing to potential targets for clinical intervention and future empirical study.

The persistent shadow of suicide ideation and attempts in a high-risk group of psychiatric patients: A focus for intervention.

OBJECTIVE: Patients with a history of suicidal ideation or attempts, especially if they have serious psychopathology with repeated hospitalizations, are burdened by ongoing risk for suicide. We studied this high-risk group to assess their psychological status following their most recent suicide attempt, in contrast to equally ill patients without a suicide history. Further, among suicidal patients, we compared those with only ideation, with a non-medically serious suicide attempt and with medically serious suicide attempts. We also report on the development of a new measure of psychic pain. METHODS: Patients in residential treatment (n=131) completed self-report questionnaires about suicide history, impulsiveness, psychic pain, resilience, and reasons for living. A series of univariate ordinal logistic regressions identified variables to include in a multivariable logistic regression to examine the odds associated with increasing levels of suicidality. RESULTS: A history of suicidal ideation or suicide attempts is associated with proportionally more psychic pain and fewer current reasons for living. Prior history of abuse, impulsiveness, and general resilience were not significantly associated with suicidal severity. CONCLUSIONS: For patients who have suicidal ideation, or have attempted suicide, and also have additional risk factors including past hospitalization, treatments should include both understanding the sources of psychic pain and promoting individual discovery of reasons for living.

Attachment, loneliness, and social connection as prospective predictors of suicidal ideation during the COVID-19 pandemic: A relational diathesis-stress experience sampling study.

INTRODUCTION: Concerns about the impact of the COVID-19 pandemic on mental health have led to efforts to understand how pandemic-specific factors, such as decreased social contact during periods of social distancing, may relate to suicide risk. The present study evaluated personality-based risk factors and frequency of social contact as prospective predictors of suicidal ideation (SI) during the pandemic. METHODS: We tested a relational diathesis-stress model of suicide focusing on insecure attachment, trait loneliness, and social contact as predictors of SI, using twice-weekly survey data collected via smartphone from a community sample (n = 184) over 8 weeks. RESULTS: Multilevel modeling showed that both trait loneliness and anxious attachment predicted the prospective development of SI during the study period. Reduced in-person contact, but not remote contact, was proximally associated with increased SI. Participants with high attachment avoidance were more likely to develop SI in the context of reduced daily in-person contact compared to participants without these traits. CONCLUSION: Findings support a relational diathesis-stress model of suicide risk during the pandemic, showing that dispositional traits related to emotional connection with others predicted the relative salience of reduced social contact as a proximal risk factor for SI.

Intolerance of aloneness as a prospective predictor of suicidal ideation during COVID-19.

Background: Social distancing has been essential in mitigating the spread of the SARS-CoV-2 virus. Evidence regarding the impact of reduced social contact on mental health during the pandemic has been mixed, however, with studies suggesting that enduring personality traits and affect regulation impairments may together increase risk for suicidal distress during periods of lockdown. The present study utilized experience sampling and longitudinal follow-up methods to evaluate intolerance of aloneness (IA) as a predictor of suicidal ideation (SI) during the pandemic. Methods: A general adult sample (n = 184) recruited online completed an 8-week experience sampling protocol via smartphone between April and September 2020. A subset of n = 69 participants completed a follow-up assessment of SI six months after the initial study period. Results: IA was associated with suicidal ideation both at baseline and prospectively during the experience sampling period. Individuals with greater IA were more likely to report SI in the short-term context of reduced daily in-person social contact. Higher IA at baseline furthermore prospectively predicted the occurrence of SI during the 6-month follow-up period. Limitations: The sample was relatively homogenous in terms of demographic characteristics and excluded individuals with limited access to communication technology. While statistical models accounted for current mental health treatment status, other factors that were not assessed (such as adverse events or psychiatric symptoms in non-treatment-seeking subjects) may have contributed to the development of SI. Conclusions: Findings enhance understanding of how personality-based factors may contribute to suicide risk during periods of social distancing, informing both clinical treatment, risk assessment, and public health intervention approaches.

Assessment of Psychological Pain in Clinical and Non-Clinical Samples: A Preliminary Investigation Using the Psychic Pain Scale.

Psychological pain is an important contributing factor to suicide risk. The present study examined the psychometric properties of the Psychic Pain Scale (PPS), a new measure assessing unbearable negative affect as described in Maltsberger's theory of suicidality. The PPS was administered to n = 131 adult psychiatric patients as well as n = 953 undergraduate students. An initial factor analysis which replicated across both clinical and undergraduate samples identified two factors, affective deluge, and loss of control. These subscales were associated with risk factors including trauma history, severity of psychopathology, and decreased resilience, as well as a range of pathological personality traits. Findings support the utility of the PPS as a measure of psychological pain and point to future directions of empirical evaluation.

Quality of Internalized Object Representations and Suicidality in Individuals With Anaclitic and Introjective Personality Styles.

Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in the context of poorer quality of object relations. The treatment implications of these findings are discussed, and areas for future research are considered.

A view from Riggs: treatment resistance and patient authority-IX. Integrative psychodynamic treatment of psychotic disorders.

Psychotic spectrum disorders present treatment challenges for patients, families, and clinicians. This article addresses the history of the dualism in the field between biological and psychological approaches to mental disorders, and surveys the contemporary literature about the etiology and treatment of psychotic spectrum disorders. An integrative approach to treatment derived from work at Austen Riggs with previously treatment refractory patients with psychotic spectrum disorders is described that combines individual psycho- dynamic psychotherapy, psychopharmacology, family systems approaches, and intensive psychosocial engagement. Helping patients develop their own authority to join the treatment, use relationships for learning, and understand the meaning of their symptoms is central to the treatment at Austen Riggs. An extended case vignette of a patient diagnosed with a schizoaffective disorder is presented illustrating this integrative psychodynamic treatment approach.

Disillusionment and Suicidality: When a Developmental Necessity Becomes a Clinical Challenge.

Both illusion and disillusion play an important role in development, fostering processes of going-on-being and separation (Winnicott 1960). The capacity to bear disillusionment is both a developmental necessity and an ongoing challenge. Disillusionment penetrates the sphere of illusion and invites the individual into an expanded encounter with shared realities. But when disillusionment becomes chronic and pervasive or is accompanied by severe psychic pain, then suicide is felt by some to be an urgent option for refusing or escaping this pain. Contextualized within a review of psychoanalytic developmental theories of disillusion, vignettes from a research study of participants who have survived a near lethal suicide attempt illuminate the phenomenon of suicide as an illusory solution to what feels like unbearable disillusionment.

Unrepresented states and the challenge of historicization.

Bernd Nissen has been developing a metapsychology of hypochondria and 'autistoid' states for 20 years, working within the Kleinian object relations tradition to formulate the earliest events of psychic life. His imaginative work shows careful thinking about early catastrophic developmental experiences which may lead to various forms of psychopathology. In the current paper, Hypochondria as an actual neurosis, Nissen extends his progressive work on hypochondria and joins his evolving theory of autistoid encapsulation to a revival of interest in Freud's concept of actual neurosis, the experience of unrepresentable early trauma, the problems of historicization, and to Winnicott's description of the fear of breakdown. I first summarize Nissen's theoretical work in the area of hypochondria and autistoid encapsulation, and then comment on his current paper including the challenge of historicization in unrepresented states. Finally I consider the question of parsimony in Nissen's metapsychology.

Suicidality in High-Risk Psychiatric Patients: The Contribution of Protective Factors.

OBJECTIVE: This study's objective was determine the incremental association of reasons for living to the lifetime number of suicide attempts in relation to other known risk and protective factors in a sample of psychiatric patients with extensive psychopathology in residential treatment. METHODS: Participants (n = 131) completed a demographic questionnaire that also asked for information about lifetime suicide history, psychiatric history, trauma, and abuse history. Additional measures of resilience, reasons for living (RFL), and impulsiveness were completed. RESULTS: A history of sexual abuse was associated with an increasing lifetime number of suicide attempts, while a history of physical abuse and trait impulsiveness were not associated with the lifetime number of suicide attempts. Survival and coping beliefs, a subscale of the Reasons for Living Inventory (RFLI), was found to add incremental predictive validity to the number of lifetime suicide attempts. A composite fear variable, combining fear of suicide and fear of social consequences of suicide, was negatively correlated with lifetime number of attempts but did not add incremental validity to the prediction of lifetime number of suicide attempts. CONCLUSION: In a sample of participants with significant psychiatric impairment, the protective factor of survival and coping beliefs may be an important barrier to repeated suicide attempts and may be considered a suicide-specific resilience measure. Understanding the psychological processes contributing to the development of such protective factors as resilience, meaning in life, and coping resources is an important area of study and a potential avenue for targeted therapeutic intervention in high-risk populations.

When a patient commits suicide: an empirical study of psychoanalytic clinicians.

Twelve psychoanalysts/psychoanalytic psychotherapists who had a patient commit suicide while in treatment, or shortly after leaving treatment, were interviewed to gain a deeper understanding of the effects of patient suicide on the clinician. A phenomenological research interview was used to gather data, and a psychoanalytic lens was used to interpret the data, generating a descriptive account of the experience of having a patient commit suicide. Thematic analysis of the transcripts yielded eight common themes associated with the clinician's subjective experience of having a patient suicide. The eight themes may be broadly grouped into three general structures: I. Traumatic loss and grief; II. Interpersonal relationships; and III. Professional identity concerns.

The Intergenerational Transmission of Suicide: Moral Injury and the Mysterious Object in the Work of Walker Percy.

The intrapsychic mechanisms for the intergenerational transmission of suicide are not adequately theorized, though it is well known that a family history of suicide places survivors at increased risk for suicide. The suicide of a family member, particularly a parent, it is hypothesized, marks some survivors with a type of trauma associated with moral injury, which may produce an alteration in object relations with the emergence of what may be called a mysterious object. Under the press of these conditions, survivors may embark on what Apprey (2014) has termed an "urgent errand" in an effort to solve a problem in the anterior generation. Analysands with a history of familial suicide may bring symptoms of moral injury, a mysterious object relation, and a risk for suicide into the transference. The family history, life history, and literary work of the novelist Walker Percy, who had an extensive family history of suicide, provides evidence for the hypothesis linking moral injury, a mysterious object, and an urgent errand in such patients.

Impairments in Object Relations and Chronicity of Suicidal Behavior in Individuals With Borderline Personality Disorder.

While studies have demonstrated connections between impairments in object relations and self-destructive behaviors in individuals with borderline personality disorder (BPD), few have investigated whether these impairments relate to actual suicidal behaviors. The current study utilized the Social Cognition and Object Relations Scale-Global Method to investigate object relational functioning and suicidal behaviors in 131 residential treatment patients. Cognitive but not affective aspects of internalized representations predicted past suicidal behavior in BPD subjects; no relationships were found between quality of object representations and suicide in other-PD subjects. Implications of these findings for research, theory, and treatment of suicidal individuals are discussed.

Mixed methods research design for pragmatic psychoanalytic studies.

Calls for more rigorous psychoanalytic studies have increased over the past decade. The field has been divided by those who assert that psychoanalysis is properly a hermeneutic endeavor and those who see it as a science. A comparable debate is found in research methodology, where qualitative and quantitative methods have often been seen as occupying orthogonal positions. Recently, Mixed Methods Research (MMR) has emerged as a viable "third community" of research, pursuing a pragmatic approach to research endeavors through integrating qualitative and quantitative procedures in a single study design. Mixed Methods Research designs and the terminology associated with this emerging approach are explained, after which the methodology is explored as a potential integrative approach to a psychoanalytic human science. Both qualitative and quantitative research methods are reviewed, as well as how they may be used in Mixed Methods Research to study complex human phenomena.