Differences in Guilt, Shame, Self-Anger, and Suicide Cognitions Based on Recent Suicide Ideation and Lifetime Suicide Attempt History.

ABSTRACT: Suicide risk factors such as hopelessness and psychiatric disorders can predict suicide ideation (SI) but cannot distinguish between those with SI and those who attempt suicide (SA). The fluid vulnerability theory of suicide posits that a person's activation of the suicidal mode is predicated on one's predisposition, triggers, and baseline/acute risks. This study compared guilt, shame, self-anger, and suicidal beliefs based on recent SI and lifetime SA. In a total of 2222 primary care patients in this cross-sectional, observational study reported no recent SI or lifetime SA (SI-SA-), 161 reported recent SI only (SI-SA+), 145 reported lifetime SA only (SI+SA-), and 56 reported both recent SI and lifetime SA (SI+SA+). Kruskal-Wallis test showed that the four risk factors were the highest for SI+SA+, followed by SI+SA-, then SI-SA+, and lastly SI-SA-. The study shows that risk factors may be worse in those with recent SI than those with SA history.

Affect, motivation, temptation, and drinking among alcohol-dependent outpatients trying to maintain abstinence: An Ecological Momentary Assessment study.

OBJECTIVES: Using Ecological Momentary Assessment we aimed to describe the time course of temptation episodes in alcohol-dependent outpatients in a real-life setting. We also examined whether affective and motivational variables were cross-sectionally and prospectively associated with temptation episodes. Additionally, we tested whether outpatients who drank against treatment goals (i.e., "lapsers") differed in craving, affect, and motivation from abstainers. METHODS: Participants were 43 alcohol-dependent outpatients (13 female). Using personal digital assistants (PDAs), patients were signaled to complete three random assessments per day for 4 weeks. They were also instructed to complete a temptation assessment whenever they experienced the temptation to drink alcohol. RESULTS: The number of temptation assessments declined over time and did not differ between lapsers and abstainers. Overall, craving was generally higher in lapsers (n = 14) than abstainers (n = 27). In lapsers, but not abstainers, abstinence motivation was lower at temptation assessments vs. random assessments. Across all patients, negative affect was prospectively associated with entry of temptation assessments later the same day. There were no significant effects for positive affect. CONCLUSIONS: In alcohol-dependent outpatients attempting to remain abstinent, negative affect is cross-sectionally associated with entry of temptation assessments. There is more evidence that negative affect precipitates temptations than vice versa. Professionals should be watchful of outpatients who report generally high levels of craving, and who report more negative affect and lower abstinence motivation, when tempted.

Associations between dispositional mindfulness, craving, and drinking in alcohol-dependent patients: An ecological momentary assessment study.

Hazardous alcohol use remains a significant global public health problem. A better understanding of relapse may assist the development of new interventions. Low levels of dispositional mindfulness may be a risk factor for craving and alcohol use, but few studies have examined these associations prospectively in an alcohol-dependent sample. In an ecological momentary assessment (EMA) study, Dutch alcohol dependent patients (N = 43) carried around a personal digital assistant for 4 weeks while trying to maintain abstinence. Participants completed assessments at random times 3 times per day, and when they felt a strong urge to drink or came to the brink of drinking without doing so. At each assessment, stress, negative affect, craving, recent drinking, and attentional or approach bias were assessed. Dispositional mindfulness was assessed at baseline with the Mindful Attention Awareness Scale (MAAS). More mindful individuals (higher MAAS scores) reported lower craving than less mindful individuals. There was no evidence that stress, negative affect, attentional bias, or approach bias mediated the association between MAAS and craving. However, there was evidence for an indirect path from MAAS to drinking such that higher mindfulness was associated with lower craving ratings that in turn were associated with less drinking. There was no evidence that MAAS significantly moderated associations between stress/negative affect/cognitive biases and craving, or between craving and drinking. In sum, more mindful recovering alcohol dependent patients reported lower craving ratings than less mindful patients, and this association appeared to be independent of stress/negative affect and cognitive biases. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Pro-tobacco advertisement exposure among African American smokers: An ecological momentary assessment study.

INTRODUCTION: Many African Americans live in communities with a disproportionately high density of tobacco advertisements compared to Whites. Some research indicates that point-of-sale advertising is associated with impulse purchases of cigarettes and smoking. Ecological Momentary Assessment (EMA) can be used to examine associations between tobacco advertisement exposure and smoking variables in the natural environment. METHODS: Non-treatment seeking African American smokers were given a mobile device for 2weeks (N=56). They were prompted four times per day and responded to questions about recent exposure to tobacco advertisements. Participants were also asked to indicate the number of cigarettes smoked, and if they made any purchase, or an impulse purchase, since the last assessment. Linear mixed models (LMMs) analyzed between- and within-subject associations between exposure and outcomes. RESULTS: Participants reported seeing at least one advertisement on 33% of assessments. Of those assessments, they reported seeing menthol advertisements on 87% of assessments. Between-subject analyses revealed that participants who on average saw more advertisements were generally more likely to report purchasing cigarettes and to purchase cigarettes on impulse. Within-subject analyses revealed that when an individual participant reported seeing more advertisements than usual they were more likely to have reported purchasing cigarettes, making an impulse purchase and smoking more cigarettes during the same period, but not the subsequent time period. CONCLUSIONS: Many African American smokers are frequently exposed to pro-tobacco marketing. Advertisement exposure is cross-sectionally associated with impulse purchases and smoking. Future research should assess prospective associations in more detail.

Effect of attentional retraining on cognition, craving, and smoking in African American smokers.

African American cigarette smokers have lower rates of cessation than Whites and live in communities with a higher number of tobacco advertisements. Exposure to smoking cues may promote smoking and undermine cessation. It may be possible to reduce attention to smoking cues ("attentional bias"). In this study, we investigated the effect of attentional retraining (AR) on attentional bias and smoking in African American smokers. Nontreatment- seeking African American smokers (N = 64) were randomly assigned to an AR or control condition. Participants were given a mobile device for 2 weeks and prompted to complete up to 3 AR (or control) trainings per day. Participants completed assessments of attentional bias, craving, and smoking both in the lab and in the field. Participants in the AR and control conditions completed an average of 29.07 AR (SD = 12.48) and 30.61 control training tasks (SD = 13.07), respectively. AR reduced attentional bias assessed in the laboratory, F(1, 126) = 9.20, p = .003, and field, F(1, 374) = 6.18, p = .01. This effect generalized to new stimuli, but not to new tasks. AR did not significantly reduce craving or biological measures of smoking. Smoking assessed on the mobile device declined over days in the AR group, F(1, 26) = 10.95, p = .003, but not in the control group, F(1, 27) = 0.02, p = .89. Two weeks of AR administered on a mobile device reduced attentional bias in African American smokers and had mixed effects on smoking. (PsycINFO Database Record

Cognition and craving during smoking cessation: an ecological momentary assessment study.

INTRODUCTION: Some studies using ecological momentary assessment (EMA) have revealed an association between craving for cigarettes and relapse. It is therefore important to understand the correlates of craving during smoking cessation. Attentional bias to smoking cues is a potential correlate of craving, but it has not previously been assessed using EMA during smoking cessation. METHODS: Smokers enrolled in a research smoking cessation study were offered the opportunity to take part in an EMA study. Volunteers carried around a personal digital assistant (PDA) for the first week of their quit attempt. They completed up to 4 random assessments (RAs) per day as well as assessments when they experienced a temptation to smoke and when they relapsed. Craving for cigarettes was assessed with a single item (1-7 scale). Attentional bias was assessed with a smoking Stroop task (a reaction time task) at every other assessment, as was self-reported attention to cigarettes. RESULTS: Data were available from 119 participants. Across 882 assessments, participants exhibited a significant smoking Stroop effect. Linear mixed models revealed a significant between-subject association between craving and the smoking Stroop effect. Individuals with higher levels of craving exhibited greater attentional bias. The within-subject association was not significant. Similar results were obtained for the relationship between self-reported attention to cigarettes and attentional bias. CONCLUSIONS: Attentional bias can be assessed in the natural environment using EMA during smoking cessation, and attentional bias is a correlate of craving during the early stages of a quit attempt.

Gender differences on documented trauma histories: inpatients admitted to a military psychiatric unit for suicide-related thoughts or behaviors.

Suicide is a leading cause of death among men and women in the United States Military. Using a retrospective chart review design, the current study investigated gender differences on documented traumas for people admitted to a military inpatient psychiatric unit for suicide-related thoughts or behaviors (N = 656). Men more often had no documented lifetime traumas and women more often had 2 or more trauma types. Women had significantly more documented incidences of childhood sexual abuse, adulthood sexual assault, adulthood physical assault, and pregnancy loss. The gender gap in documented trauma types for childhood and adulthood traumas persisted even after adjusting for demographic variables, psychiatric diagnoses, and comorbid trauma types (i.e., trauma types other than the one being used as the dependent variable). Given the observed gender differences in documented traumas, professionals working with military women admitted for suicide-related thoughts or behaviors need to consider trauma in the context of treatment.