Introduction
The Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ) was developed to measure attentional fixation on suicide, a cognitive process characterized by a preoccupation with suicide as a solution. This study investigated a revised version (AFSEQ‐R) and examined differences between those who made a recent suicide attempt and those with suicidal ideation (SI).
Method
Participants were 57 inpatients who attempted suicide within 14 days of study participation and 57 inpatients who presented with SI but no suicidal behavior within the past year. Analyses examined the internal reliability, multidimensionality, and construct validity of the AFSEQ‐R, and whether attentional fixation moderated the correlation between SI and attempt status.
Results
Exploratory factor analysis revealed a two‐factor structure, and subscale and total scores demonstrated excellent internal consistency. Cognitive Stuckness (and total score) correlated with SI, anxiety, impulsivity, and specific problem‐solving deficits, while Cognitive Dysfunction correlated with anxiety and acted as a moderator of the correlation between Stuckness and SI. AFSEQ‐R scores did not moderate the relationship between SI and attempt status.
Conclusion
AFSEQ‐R is a psychometrically sound and valid measure of attentional fixation. Attentional fixation on suicide is correlated with SI, and prospective studies are needed to uncover its directional effect on suicidal crises.
Cognitive Therapy or Cognitive Behavioral Therapy (CBT) for depression is a well-studied, research-supported treatment. Contrary to common misconceptions about manual-based treatments, CBT can be provided with considerable flexibility. As the first manual-based treatment to be developed, it is remarkable that it is so principle-based and flexible. There is flexibility in focusing on the goals and topics of importance to clients. Therapists have discretion in determining how much to use various CBT strategies and determining how they might be used to meet the diverse needs of clients with depression. Because of the flexibility of CBT, therapists also have many options for determining what approach to use when a client does not initially respond well to an intervention. To ensure that CBT offers the therapeutic benefits that have been identified and supported in clinical trials, the treatment also needs to be provided with fidelity to the manual. Despite their limitations, observer ratings of competence remain the standard for ensuring that CBT is provided with fidelity.
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