Death by suicide in the US is currently at its highest rate in 15 years. Emerging evidence indicates that one component of anxiety sensitivity (AS), specifically cognitive concerns (ASCC) is a risk factor for elevated suicidality. ASCC refers to fear of arousal leading to mental incapacitation. ASCC is associated with suicidal ideation (SI) in a wide variety of populations including patients with post-traumatic stress disorder, air force cadets, and cigarette smokers. A separate line of study has revealed that AS is malleable through cognitive-behavioral interventions. Moreover, these effects can be achieved through brief computerized interventions and the benefits appear to be maintained over several years. However, current AS reduction protocols focus almost exclusively on the physical concerns facet of AS (i.e., arousal leading to physical catastrophe). There are several reasons why ASCC may represent a distinct construct from physical AS and thus warrant a specific intervention. First, ASCC are most closely associated with depression, whereas, AS physical concerns are more associated with anxiety conditions such as panic disorder. Second, individuals with elevated ASCC show elevated SI, whereas individuals with elevated AS physical concerns show reduced SI. Therefore, the effects of previous AS interventions may not be relevant to reducing SI and a targeted ASCC intervention is needed. The proposed study was designed to provide incremental training to the PI in psychophysiological assessment [specifically electroencephalogram/event related potential (EEG/ERP)], suicidology, and designing/executing a clinical trial. Learning EEG will allow for multilevel assessment in line with NIMH's Research Domain Criteria (RDoC) initiative and suicide is an urgent major public health burden. In the proposed study, approximately 60 individuals with elevated ASCC and SI will be randomized to receive either a recently developed one-session active ASCC intervention or a healthy living control intervention. The first specific aim of the project is to determine if ASCC can be reduced among a sample with elevated SI via this brief ASCC intervention. The next specific aim is to examine if high and low ASCC individuals show differential fear-specific event related potentials (ERP) to an emotional stroop task featuring ASCC threatening phrases using EEG measurement. To address this specific aim we will also recruit 15 individuals with absent/minimal ASCC. A related aim is to assess if the computerized intervention leads to reduced AN380 and P1 ERPs post-intervention (which have shown to differentiate high versus low AS individuals in previous work).
The third aim i s to determine whether this intervention leads to reduction in SI over time (one and four month follow ups).
The final aim i s to determine if reductions in ASCC mediate reductions in SI. By examining a brief treatment for ASCC in a sample with elevated SI, this study will provide critical knowledge regarding how to quickly and effectively reduce ASCC and potentially prevent/ameliorate SI.
This project is relevant to public health because it represents a novel approach to reducing suicide, a major public health concern that has been steadily increasing in recent years. Anxiety sensitivity cognitive concerns (ASCC) have been found to be associated with suicidality in a number of populations at elevated risk for death by suicide including: the military, cigarette smokers, individuals with post-traumatic stress disorder and individuals with HIV. This study proposes a one-session computerized ASCC intervention among individuals with elevated suicidal ideation [with post treatment change assessed by self-report and electroencephalogram/event related potential (EEG/ERP) methodology in line with NIMH's RDoC initiative] that could be a low-cost, highly portable solution to the growing problem of suicide.