Attention and suicidality: A review of attentional biases in suicide and an investigation into the Broad Minded Affective Coping technique

Abstract

The aim of this thesis was to understand more about the cognitive processes underlying suicidal ideation and behaviour and to explore the acceptability and feasibility of delivering and evaluating a brief, positive imagery cognitive therapy technique to adults at high risk of suicide. The thesis is presented as three separate papers: 1) a systematic review, 2) an empirical paper and 3) a critical reflection paper. In Paper One we present a systematic review of the relationship between attentional biases and suicide. Sixteen studies utilising a range of designs and attentional bias tasks met the inclusion criteria. All studies were assessed for methodological quality and findings were presented using narrative synthesis. Overall, the review provided weak evidence for attentional biases in suicide, with some indication that biases may be related to the extent to which an individual is in a suicidal crisis. A small number of studies investigated attentional bias as a treatment target or predictor of suicide-related outcomes, with findings discussed. Implications for future research and clinical practice are considered. Paper Two presents a feasibility and acceptability case series investigation of the Broad Minded Affective Coping technique, a brief positive imagery therapy technique, in suicidal adults. Suicidal adults recruited from mental health wards and home-based treatment teams (n=14) received a one-session imagery intervention and were followed up after seven days of independent positive imagery. Nine participants completed post-intervention measures of depression and suicidal ideation and eleven participants provided qualitative feedback. Findings suggest that the BMAC is a feasible and acceptable intervention to evaluate in adults at risk of suicide, with strategies highlighted to improve rates of recruitment and mitigate against missing data. We propose areas for future research and discuss implications for clinical practice. Paper Three presents a critical appraisal of the methodology and decision-making processes which took place within both pieces of research. Strengths, limitations, and future directions are considered, alongside clinical and theoretical implications of the work. Finally, personal reflections on the research process are offered.

Date of Award	31 Dec 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	James Lea (Supervisor) & Daniel Pratt (Supervisor)