A long-standing challenge for scientific and clinical work on suicidal behavior is that people often are motivated to deny or conceal suicidal thoughts. We proposed that people considering suicide would possess an objectively measurable attentional bias toward suicide-related stimuli, and that this bias would predict future suicidal behavior. Participants were 124 adults presenting to a psychiatric emergency department who were administered a modified emotional Stroop task and followed for six months. Suicide attempters showed an attentional bias toward suicide-related words relative to neutral words, and this bias was strongest among those who had made a more recent attempt. Importantly, this suicide-specific attentional bias predicted which people made a suicide attempt over the next six months, above and beyond other clinical predictors. Attentional bias toward more general negatively-valenced words did not predict any suicide-related outcomes, supporting the specificity of the observed effect. These results suggest that suicide-specific attentional bias can serve as a behavioral marker for suicidal risk, and ultimately improve scientific and clinical work on suicide-related outcomes. Keywords suicide; attentional bias; Stroop task; predictionSuicide is a leading cause of death in the United States and worldwide (Nock et al., 2008). Mortality data indicate that one person dies by suicide somewhere around the world every 40 seconds (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). The high rate of suicide results in part from the fact that assessment primarily depends on people's explicit self-report, Correspondence to Matthew K. Nock, Ph.D., Department of Psychology, Harvard University, 33 Kirkland Street, 1280, Cambridge, MA 02138, nock@wjh.harvard.edu.. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/ABN NIH Public Access which is unreliable because people often are motivated to deny their suicidal thoughts (Busch, Fawcett, & Jacobs, 2003). Developing more objective and scientifically rigorous ways of determining who is at risk for suicidal behavior is essential for both scientific and clinical work addressing this devastating behavior problem.The National Institute of Mental Health (NIMH) Strategic Plan lists as one of its primary objectives the identification of biological and behavioral markers associated with mental disorders and clinical behavior problems (NIMH, 2009). Behavioral markers are objectively observable, behavior-based factors that indicate some underlying disease process and can aid in c...

This study proposes and tests a theoretical model suggesting that the propensity to suppress unwanted thoughts is associated with an increased presence and frequency of self-injurious thoughts and behaviors (SITB). In the model, propensity to suppress unwanted thoughts is hypothesized to be a cognitive mediator of the relationship between emotional reactivity and SITB, and is expected to be related to the extent to which SITB is initiated to escape from aversive emotions. Results of this cross-sectional study of adolescents (N=87) revealed that the self-reported propensity to suppress unwanted thoughts is associated with the presence and frequency of non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts. Furthermore, thought suppression partially mediates the relationship between emotional reactivity and the frequency of NSSI and suicidal ideation. Finally, adolescents with a higher tendency to suppress unwanted thoughts report engaging in NSSI in order to reduce aversive emotions rather than for social communication. Results are discussed within the framework of the negative reinforcement function of SITB.

In the current study, we evaluated the effectiveness of attention training in individuals with subclinical obsessive-compulsive symptoms. We hypothesized that after completing attention training, participants would be more likely to complete steps in a hierarchy approaching their feared contaminant compared to participants in the control condition. Participants completed a probe detection task by identifying letters replacing one member of a pair of words (neutral or contamination-related). We trained attention by building a contingency between the location of the contamination-related word in the active condition and not in the control condition. Participants in the active group showed a significant reduction in attention bias for threat and completed significantly more steps approaching their feared objects compared to participants in the control group. Our results suggest that attention disengagement training may facilitate approaching feared objects in individuals with obsessive-compulsive symptoms. KeywordsObsessive Compulsive Disorder; Attention Training; Attention; Behavioral Approach Test Obsessive-compulsive disorder (OCD) is a severe mental disorder that has a chronic course unless treated. Although cognitive models of OCD emphasize the role of dysfunctional beliefs (Rachman, 1997;Salkovskis, 1985Salkovskis, , 1989 in the etiology and maintenance of the disorder, others have proposed that OCD symptoms may be the result of aberrant processing of threatrelevant information (e.g., Tallis, 1997; for reviews see Muller & Roberts, 2005;Summerfeldt & Endler, 1998). According to this model, selective attention to threatening information heightens anxiety and anxiety-related avoidance of the perceived threat, and the avoidance behaviors, in turn, prevent disconfirmation of fear-related beliefs and serve to maintain anxiety. Thus, attention bias towards threat may be causally related to behavioral avoidance of perceived threat and the anxiety experienced in the context of the approach behavior.Several researchers have reported that individuals with subclinical or clinical OCD show an attention bias for OCD-relevant material

Suppression is one of various mental control techniques that people may use to manage unwanted thoughts. Evidence suggests that it is at best unsustainable and at worst counterproductive. This leads to the question: If suppression is a futile way to respond to unwanted, intrusive, thoughts, what is a more effective alternative? In the current study, we evaluated the relative effectiveness of suppression and two alternative mental control techniques-focused distraction and acceptance-on the frequency of intrusions and distress associated with them. Results support the claim that suppression is a counterproductive technique for dealing with unwanted, intrusive thoughts in OCD.However, the harmfulness of suppression was reflected primarily in the magnitude of distress and not in intrusion frequency. Focused distraction and acceptance were the more effective techniques for managing clinically significant intrusive thoughts. We discuss implications for the cognitive treatment for OCD.