Conference Agenda

Introduction:

The predictive performance of suicide risk factors remains limited, and there is growing recognition that underlying cognitive mechanisms may play a central role in suicidal processes. Suicide-specific rumination (SSR), the repetitive, intrusive preoccupation with one’s own suicidal thoughts, has been proposed as a potential driver of both the escalation and the persistence of suicidality. This presentation synthesizes findings from three empirical studies examining the role of SSR across acute and chronic manifestations of suicidality.

Methods:

The first study investigated whether SSR predicts suicide planning, suicidal intent, and suicide attempts in N = 637 adult outpatients, including a follow-up after twelve therapy sessions. A second study compared in- and outpatients with one (n = 101) versus multiple (n = 80) suicide attempts to test whether SSR contributes to chronic suicidal behavior beyond clinical covariates. Study 3 focused on analyzing cognitive mechanisms underlying persistent suicidal ideation (PSI) in N = 466 outpatients. Therefore, individuals with PSI versus non-PSI were compared with regard to SSR and comfort from suicidal thoughts (CST). It was further tested whether SSR and CST predict PSI beyond other known suicide-related correlates.

Results:

In Study 1, SSR significantly differentiated suicide attempters from ideators, and prospectively predicted both suicide planning and intent. In Study 2, multiple attempters showed higher SSR, but this difference disappeared after adjustment for demographic and clinical variables. Study 3 found that patients with PSI displayed higher levels of SSR and CST; both factors significantly determined the presence of PSI even when controlling for age, sex, depression, anxiety, and stress.

Conclusions:

Overall, the findings show that SSR plays a consistent role in the progression from suicidal ideation to severe and chronic forms of suicidality. As a potentially modifiable intrapersonal mechanism, SSR may represent a promising clinical target.

Abstract

Self-harm is a strong predictor of suicide, yet it remains unclear whether self-harm with and without suicidal intent represent distinct behaviors or points along a continuum. To clarify this, we examined how psychological risk factors, mainly from the motivational phase of the Integrated Motivational–Volitional (IMV) model, are organized following self-harm with or without suicidal intent. We applied network analysis to cross-sectional data from 474 participants recruited from two Scottish hospitals shortly after an episode of self-harm. Participants were categorized into suicide attempt (SA; n = 314) and non-suicidal self-injury (NSSI; n = 160) groups based on the presence of suicidal intent during their self-harm episode. Risk factors are analyzed at two levels: one that includes all risk factors and another that focuses solely on motivational-phase factors. At both levels, internal entrapment showed significantly more connections in the NSSI network than in the SA network. In the motivational-phase subgroup comparison, the overall pattern of associations among risk factors differed significantly between groups. Moreover, internal entrapment showed a significantly stronger association with perceived burdensomeness in the NSSI subgroup network than in the SA subgroup network. This suggests that internal entrapment may underlie unresolved distress following NSSI, potentially escalating into suicidal ideation over time.

This paper presents an innovative theoretical perspective on the mechanisms underlying suicide thought accessibility - the Cognitive Accessibility of Suicide (CAS) model. While the model was initially developed to better understand the levers of suicide thought accessibility in the general population, this talk will focus on its relevance for clinicians. Distinguishing suicide thought accessibility from suicidal ideation, the CAS model outlines the motivational mechanisms that increase the cognitive accessibility of suicide-related thoughts. Integrating the principles of social cognition to the study of suicide-related phenomena, it posits that experiences of failure motivate individuals to avoid self-awareness. This motivation, in turn, heightens the accessibility of suicide as a way to escape this aversive state. Several contextual and dispositional moderators, likely to strengthen the link between failure and the motivation to avoid self-awareness and backed by empirical findings, are considered. The potential functions of increased suicide thought accessibility are explored, such as emotion regulation and distress signaling that might trigger responses that often prevent suicide. It is suggested that future research should investigate the conditions that facilitate the progression from mere accessibility under specific conditions, which might be inoffensive in the general population, to chronic accessibility and more elaborate suicidal ideation, which is a serious risk factor for suicide attempts. Theoretical implications will be discussed, as well as practical implications for interventions that could reduce suicide-related thought accessibility, such as favoring challenge rather than threat appraisal, as well as possible interventions on the components of self-compassion. It is argued that clinical practice can benefit from the CAS model by acting on suicide thought accessibility even before the individual is at elevated risk of suicide.

Introduction: Restricting access to the physical means of suicide is the suicide prevention intervention supported by the strongest evidence. The concept of cognitive availability of suicide, and of specific suicide methods (also known as psychological distance from suicide methods), have been described as important influences on suicide risk. To clarify their meaning and application we conducted a conceptual review of the literature describing their definitions, mechanisms, measurement and implications for intervention development.

Methods: We pre-registered our search strategy and searched three databases (PsycINFO, EMBASE, MEDLINE) from inception to January 2025, screened 100% of references independently and charted data setting out definitions, mechanisms, and interventional implications, presenting a narrative review.

Results: We identified 21 eligible publications (8 non-empirical; 13 empirical). Cognitive availability of suicide was defined as “the awareness of suicide as an option and knowledge of possible means of suicide” including “knowledge of technical aspects of the method”. Mechanisms were described at three levels: population (e.g. media influences; social-cultural norms), interpersonal (e.g. exposure to peer suicidal behaviour; interpersonal communications about suicide) and individual (e.g. past suicide attempts; imagery of past attempts). We identified one validated measure of the psychological distance from suicide methods. We described the relationship of the cognitive availability of suicide to three models of suicidal behaviour, and summarised interventional approaches at three levels: population (e.g. media guidelines), interpersonal (e.g. modified lethal means counselling) and individual (e.g. imagery rescripting).

Conclusion: The cognitive availability of suicide, and of specific methods, are valuable concepts, offering explanations for the development and progression of suicidal ideation. Their application to the design of cognitive restriction interventions offers potential to operate upstream of (and complement) physical restriction interventions, balancing safety and acceptability issues. Further development of such approaches at the population and individual levels is indicated.

Intro: Narrative Crisis Model (NCM) is a recently developed stepwise multi-stage stress-diathesis model to explain suicide behaviour. Recent studies suggest that this model demonstrates promise in predicting suicidal behaviour and has led to the introduction of a suicide-specific diagnosis, the Suicide Crisis Syndrome (SCS).
Method: A scoping review was conducted using the Prisma - ScR guidelines to systematically review and outline the extant evidence on NCM. Electronic databases and supplementary sources were systematically searched, yielding a total of 12 studies for inclusion in the review. All included studies employed quantitative designs. The screening and extraction process was conducted by two reviewers independently. The quality of the articles was assessed using the JBI Quality Appraisal Tools.

Results: The review showed that only one study had tested the entire model while five studies have tested parts of the model. The included studies indicate that the NCM shows utility in predicting prospective suicidal behaviour, with the SCS receiving the strongest and most consistent empirical support across the reviewed literature.

Conclusion: The review highlights opportunities to further develop the model. Some differences remain between the model’s conceptual definition and how it has been tested in research. Clearer definition and measurement of the model’s components would help address this gap. In addition, further research is needed to clarify the activating role of stressful life events. Given the model’s focus on personal narrative, qualitative research approaches may be especially useful for improving understanding of how the model operates in practice. Overall, this review suggests that the NCM offers a detailed and potentially useful framework with emerging empirical support; however, further research is needed to clarify its conceptual boundaries and to strengthen and refine the evidence base.

Background

Mechanisms of repetitive self-harm remain poorly understood, hindering the development of targeted interventions. Recent evidence highlights similarities between self-harm and addiction at a phenomenological level (Witcher et al., 2025) and biases in reward processing (Carenys & Adan, 2025).

Our experimental project “IMAGINE” investigates if differences in cognitive-motivational processes relevant to addictive behaviours are also present in young people with repetitive self-harm. We have shown that young people with self-harm tend to avoid self-harm cues compared to controls, and suggested this may represent ambivalence towards engaging in the behaviour (Rodrigues et al., 2023). In a series of follow-up studies we tested a motivational paradigm, the approach/avoidance task (AAT, Rinck and Becker, 2007), and if the above attention biases are also present under conditions of social exclusion.

 

Methods: Young people (age 16-25) with >1 lifetime SH episode and healthy controls completed an approach/avoidance task (AAT, Rinck and Becker, 2007) modified to include self-harm cues (N=40/group); and a Self-Harm Dot Probe task (Rodrigues et al., 2023) after an ostracism manipulation (Cyberball game) (N=70/group). Self-report measures of affect, emotion regulation, impulsivity and mental imagery were also collected.

 Results: We found no significant between-group differences in approach/avoidance tendencies towards self-harm cues (p>.1). We found that unlike in our previous study, after a social exclusion game there were no differences in attention towards self-harm stimuli between young people with self-harm and controls (p>.1). Recency of self-harm was correlated with difficulty to disengage from self-harm cues at 2 seconds (p=.039). This suggests that individuals who self-harm may lose the automatic tendency to avoid self-harm stimuli under conditions of interpersonal distress.

Conclusions: It remains unclear if cognitive-motivational processes similar to those characterising addiction (such as attentional biases) may also underpin self-harm. Larger studies are needed taking into account individual differences in self-harm motives and affective states.