The Suicidal Intrusions Attributes Scale (SINAS): a new tool measuring suicidal intrusions.

Introduction: Suicidal intrusions are uncontrollable, intrusive mental images (e. g., visualizing a future suicidal act). They may also be called suicidal "flash-forwards." Despite the importance of integrating the assessment of suicidal intrusions into a clinical routine assessment, quick self-report screening instruments are lacking. This study describes the development of a new instrument-Suicidal Intrusions Attributes Scale (SINAS)-to assess the severity and characteristics of suicidal intrusions and examines its psychometric properties. Method: The sample included currently suicidal outpatients with elevated levels of depression recruited across mental health institutions in the Netherlands (N = 168). Instruments administered were 10-item SINAS, the Suicidal Ideation Attributes Scale (SIDAS), the Prospective Imagery Task (PIT), four-item Suicidal Cognitions Interview (SCI), and the Beck Depression Inventory (BDI-II). Results: An exploratory factor analysis identified a one-factor structure. The resulting SINAS demonstrated good internal consistency (Cronbach's α = 0.91) and convergent validity, as expected. Discussion: Overall, this study demonstrated acceptable levels of reliability and validity of the measure in a depressed clinical population with suicidal ideation. The SINAS may be a useful screening tool for suicidal intrusions in both research and clinical settings.

Treatment of Intrusive Suicidal Imagery Using Eye Movements.

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.

Schema therapy for chronic depression: Results of a multiple single case series.

BACKGROUND AND OBJECTIVES: The aim of this study was to test the effects of individual schema therapy (ST) for patients with chronic depression. METHODS: Using a multiple-baseline single case series design, patients with chronic major depressive disorder (N = 25) first entered a 6-24 weeks baseline phase; this phase functioned as a no-treatment control condition. Then, patients started a 12 week exploration phase during which symptoms and underlying schemas were explored; this phase functioned as an attention control condition. Next, patients received up to 65 sessions of individual ST. The Beck Depression Inventory II (BDI-II) and the Quick Inventory of Depressive Symptomatology (QIDS) were the primary outcome measures. The BDI-II was assessed once a week during all phases of the study resulting in 100 repeated assessments per participant on average. Mixed regression analysis was used to contrast change in symptoms during the intervention with change in symptoms during the baseline and exploration control phases. RESULTS: When compared to the no-treatment control period, the intervention had a significant, large effect on depressive symptoms (Cohen's d BDI-II = 1.30; Cohen's d QIDS = 1.22). Effects on secondary continuous outcomes were moderate to large. LIMITATIONS: The small sample size and lack of a control group. CONCLUSIONS: These findings provide evidence that ST might be an effective treatment for patients with chronic depression.

Effects of a best-possible-self mental imagery exercise on mood and dysfunctional attitudes.

Dispositional optimism has been related to positive physical and mental health outcomes, increased positive mood ratings and cognitions about the future. In order to determine the causal relation between optimism and mood and cognitions optimism should be manipulated experimentally. The current study tested the effects of a best-possible-self mental imagery exercise on affect and mood ratings and dysfunctional cognitions following a sad mood induction in undergraduate students (N=40). Participants in the experimental condition wrote about their best possible self in the future for 15 min and engaged in a mental imagery task about their best possible self in the future for 5 min in order to experimentally induce optimism. Participants in the control condition wrote about a typical day for 15 min and engaged in mental imagery about a typical day for 5 min. We assessed affect, mood and dysfunctional cognitions before and after the experimental manipulation. Participants in the experimental condition had higher positive mood ratings and higher positive affect compared to participants in the control condition. Participants in the control condition reported decreased dysfunctional cognitions whereas dysfunctional cognitions in the experimental group remained unchanged. Future studies should replicate these findings in clinical groups with more profound levels of negative affect and dysfunctional cognitions.

Disrupting the rhythm of depression: design and protocol of a randomized controlled trial on preventing relapse using brief cognitive therapy with or without antidepressants.

BACKGROUND: Maintenance treatment with antidepressants is the leading strategy to prevent relapse and recurrence in patients with recurrent major depressive disorder (MDD) who have responded to acute treatment with antidepressants (AD). However, in clinical practice most patients (up to 70-80%) are not willing to take this medication after remission or take too low dosages. Moreover, as patients need to take medication for several years, it may not be the most cost-effective strategy. The best established effective and available alternative is brief cognitive therapy (CT). However, it is unclear whether brief CT while tapering antidepressants (AD) is an effective alternative for long term use of AD in recurrent depression. In addition, it is unclear whether the combination of AD to brief CT is beneficial. METHODS/DESIGN: Therefore, we will compare the effectiveness and cost-effectiveness of brief CT while tapering AD to maintenance AD and the combination of CT with maintenance AD. In addition, we examine whether the prophylactic effect of CT was due to CT tackling illness related risk factors for recurrence such as residual symptoms or to its efficacy to modify presumed vulnerability factors of recurrence (e.g. rigid explicit and/or implicit dysfunctional attitudes). This is a multicenter RCT comparing the above treatment scenarios. Remitted patients on AD with at least two previous depressive episodes in the past five years (n = 276) will be recruited. The primary outcome is time related proportion of depression relapse/recurrence during minimal 15 months using DSM-IV-R criteria as assessed by the Structural Clinical Interview for Depression. Secondary outcome: economic evaluation (using a societal perspective) and number, duration and severity of relapses/recurrences. DISCUSSION: This will be the first trial to investigate whether CT is effective in preventing relapse to depression in recurrent depression while tapering antidepressant treatment compared to antidepressant treatment alone and the combination of both. In addition, we explore explicit and implicit mediators of CT. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR1907.