This study will collect 24-30 month followup to a clinical trial of a computerized protocol to improve thwarted belongingness, perceived burdensomeness, and anxiety sensitivity. The study will also examine the relationship between suicide risk and underlying brain mechanisms via neurophysiological assessments.

Three years ago a group of researchers at Florida State University found that they could reduce risk factors for suicide with a brief—lasting less than an hour—computer-based intervention designed to improve mood and reduce anxiety. However, one limitation of that promising study was its limited duration. The researchers had followed the subjects in the study for just six months, leaving open the question of whether the benefits would remain over the long term. Now that group of researchers is returning to their original subjects to see if that brief intervention can indeed reduce risk factors related to suicide for years afterward.

As FSU psychologist Brad Schmidt, the principal investigator on both the earlier study and the current one, explains, the previous study focused on two types of risk factors for suicide. One was anxiety sensitivity, or a tendency to overreact to stress or anxiety. A person with anxiety sensitivity becomes concerned that the symptoms of anxiety—a rapidly beating heart, say, or racing thoughts—are indications that some serious is wrong. The rapid heartbeat might be interpreted as a sign of an impending heart attack, and the racing thoughts might be seen as a sign that a mental breakdown is imminent. Anxiety sensitivity has been linked with an increased risk of suicide and other mental issues.

The second type of risk factor addressed in Schmidt’s work is interpersonal, related to how an individual perceives his or her relationships with others. Schmidt actually addressed two different interpersonal risk factors, both of which have been shown to be linked with an increased likelihood of suicide. The first is perceived burdensomeness, or an individual’s perception that he or she is a burden on loved ones or society. The second is thwarted belongingness, which is a sense of not really being an accepted member of any group despite a desire to belong.

Schmidt developed brief computer-based interventions to address both of these types of risk factors. His Cognitive Anxiety Sensitivity Treatment, or CAST, can be completed in about 45 minutes and is designed to teach an individual that symptoms of anxiety—rapidly beating heart or racing thoughts—are normal and not necessarily an indication that something bad is about to happen. His computer-based treatment Building-Stronger Allies, or BSA, was designed to lessen feelings of perceived burdensomeness and thwarted belongingness.

Three years ago Schmidt and his colleagues recruited about 300 subjects to test the two treatments and divided them into four groups. One group was treated with CAST, one with BSA, one with both, and one served as the control group, receiving a computer-based lesson on the importance of a healthy lifestyle but no treatment to reduce the risk factors for suicide. 

Schmidt found both treatments to be effective. The CAST treatment led to a reduction in anxiety sensitivity and also in suicidal thoughts. The BSA treatment reduced the levels of perceived burdensomeness (although not of thwarted belongingness) and lessened the likelihood of suicidal thoughts. Both effects were apparent through the six months that the subjects were followed.

Now Schmidt and his colleagues are getting back in touch with the subjects in the original study to see how they are doing three years after the initial treatment. Once again the researchers will perform comprehensive psychological and emotional assessments of those individuals using questionnaires, self-reports, and neurophysiological testing. With this information the researchers will be able to assemble a detailed understanding of the long-term effects of the treatments that Schmidt and colleagues developed, and determine whether these promising techniques can provide extended protection against the risk of suicide.