Conference Agenda

Fluid vulnerability theory (FVT) is uniquely suited to understanding the cognitive-behavioral conceptualization of the suicidal mode and the temporal dynamics of suicidal thinking, suicidal ambivalence, and suicidal behavior. In particular, FVT offers a conceptual model for understanding, assessing and the clinical treatment of both discrete episodes of risk and enduring vulnerability to future episodes once an acute episode has resolved. Research over the past 20 years has offered strong support for FVT, with unique translation to specific clinical risk assessment strategies and targeted clinical interventions that are foundational to brief cognitive behavioral therapy for suicide prevention (BCBT-SP). In addition to reviewing the empirical support for FVT, clinical assessment strategies will be discussed, along with treatment modules included in BCBT+, a recent abbreviated and empirically-supported 4 hour-long adaptation of the full BCBT-SP treatment protocol.

Existing models for understanding suicidal ideation and behavior may not provide satisfactory orientation for clinical-therapeutic work with suicidal clients. Based on the observation that ambivalence accompanies the entire suicidal process and building on the empirical knowledge about suicidal ambivalence, the ambivalence model of suicidality (ABS model), a new clinical working model that aims to provide a framework for suicide risk assessment, case conceptualization and treatment planning, will be presented. The model divides the suicidal process into three phases (uncertainty phase, transition phase and action phase), describes the psychological state within the different phases, and identifies phase-specific therapeutic interventions. The ABS model is a descriptive model that can be used to structure and organize crisis intervention and psychotherapy with suicidal patients.

The result of a recent scoping review on suicidal ambivalence (k = 28) and of a qualitative study with Iranian inpatients (N = 10) will be used to illustrate the core assumptions of the ABS-Model.

Suicidal thoughts and behaviors (STB) emerge from highly dynamic and individually diverse processes that are not fully accounted for by most existing suicide theories. The Dual-System Model of Suicidality (DSMS) is a new process-based, transdiagnostic framework developed to address this gap. Grounded in dual-process theories, the DSMS proposes that suicidal crises unfold through the interaction of two functionally distinct systems: a reflective system, encompassing effortful, goal-directed, and cognitively demanding processes (e.g., effortful emotion regulation, problem solving, self-control), and an impulsive system, characterized by fast, associative, resource-independent processes (e.g., implicit biases, automatic behavior, suicidal urges). STB is conceptualized as the result of dysregulation within and between these systems, particularly under conditions of emotional distress, cognitive load, or depleted self-regulatory resources. Such depletion may arise from situational factors including sleep problems, substance use, heightened stress, or interpersonal conflict.

To illustrate the explanatory value of the DSMS, preliminary findings from two recent studies will be presented. A qualitative interview study with psychiatric inpatients after a suicidal crisis (N = 12) revealed a predominance of maladaptive emotion regulation strategies (ERS) and identified distinct suicide-specific coping strategies that either escalate or mitigate suicidal crises. These findings closely align with core DSMS assumptions regarding dysfunctional self-regulation processes, leading to depleted resources and suicide-facilitating processes. In addition, real-time data from a matched healthy–STB sample (N = 110) demonstrated that better sleep quality predicts higher state self-control, higher positive affect, and greater use of adaptive ERS at the within-person level. These results offer first support for the proposed mechanisms, highlighting sleep as a modifiable factor facilitating adaptive self-regulation.

Together, the DSMS and these initial findings underscore the importance of examining dynamic self-regulatory processes to better understand and ultimately prevent suicidal crises.

Building on the metacognitive model of depression, the metacognitive model of suicidality proposes that metacognitions about suicide play a crucial role in explaining the activation, intensification and prolongation of suicidal ideation and intent. The model proposes that thoughts about death and dying activate positive metacognitions about the need to engage in sustained mental processing or rumination about suicide and thereby activate a Cognitive Attentional Syndrome (CAS), consisting of suicide-specific rumination, attentional fixation on suicide and thought suppression. Once the CAS is activated and individuals experience a buildup of rumination, attentional fixation on suicide and failed attempts of thought suppression, negative metacognitions about the uncontrollability and harmfulness to the individual become activated. This activation of negative metacognitions might not only contribute to a further intensification of the CAS, but also to an aggravation of suicidality in the form of suicide planning, suicide intention formation and ultimately suicidal behavior.

The assumptions of the model will be outlined and self-report instruments measuring the central concept of the model will be introduced. In addition, results from recent cross-sectional and longitudinal studies that examined the model assumptions using data from the general population and from patients who were hospitalized after a suicide attempt or suicidal crisis (total N>600) are presented. Overall, the results support the suppositions of the metacognitive model of suicidality model and suggest that the model may be valid and helpful in conceptualizing and understanding the suicidal process. Especially suicide-specific rumination and positive metacognitions may be important drivers of intensification and prolongation of suicidal ideation and suicidal intent formation. Potential perspectives for future research will be discussed in light of the current findings.