Examining decentering as a moderator in the relation between non‐suicidal self‐injury and suicide ideation via cognitive–affective factors

Abstract

Objective Given the high prevalence of self‐injury but low treatment‐seeking among young adults, brief, accessible interventions might help reduce risk of self‐injurious thoughts and behavior in this population. This cross‐sectional study examined the moderating effects of decentering—a cognitive–affective regulation strategy—in the relation between non‐suicidal self‐injury (NSSI) and suicide ideation via cognitive–affective factors that increase risk for both NSSI and suicide ideation. Methods College students (N = 125, 79% women), ages 18–27, pre‐screened for moderate levels of depression and anxiety, completed self‐report measures of NSSI, decentering, rumination, hopelessness, depressive symptoms, and suicide ideation. Results Young adults with past‐year non‐suicidal self‐injury scored lower on decentering than their peers without NSSI. Decentering was associated with lower levels of all cognitive–affective risk factors and moderated the relation between NSSI and rumination, but not the relation between NSSI and hopelessness and depressive symptoms. Decentering moderated the indirect effect of past‐year non‐suicidal self‐injury on past‐week suicide ideation via rumination, but not via hopelessness or depressive symptoms. Conclusions Decentering is a potential cognitive–affective regulation strategy for targeting factors that increase risk of self‐injurious thoughts and behaviors. Future studies should examine decentering as a buffer against risk using designs that allow for conclusions about temporal order of effects.

The association between nonsuicidal and suicidal self-injurious behaviors: A systematic review and expanded theoretical model

“…Authors demonstrated a significant moderated-mediation model for rumination, but not for hopelessness or depressive symptoms. At low and average levels of decentering, there was an indirect effect on the NSSI and SI relationship via rumination, but this association did not hold at high levels of decentering (Rosario-Williams et al, 2021).…”

“…Paralleling the lack of empirical literature evaluating the Interpersonal Theory of Suicide, few studies have examined the additional theorized associations outlined in Hamza and colleagues' (2012) Integrated Model, including the likely effect of intrapersonal distress on the NSSI -SSI association. The few studies identified in the review (i.e., Anestis et al, 2011;Anestis et al, 2013;Knorr et al, 2016;Rosario-Williams et al, 2021) suggest that, in line with the Integrated Model, several constructs related to intrapersonal distress serve to strengthen the role between NSSI and suicide-related outcomes. However, research has yet to replicate any given association (i.e., only one study examined the role of distress tolerance), limiting the generalizability of these findings.…”

Comparing Ruminative and Distracting Responses and Emotion Regulation Difficulties in Early Community Adolescents With and Without Self-Harm

“…Dialectical behavior therapy-skill training (DBT-ST), including mindfulness, emotion regulation, distress tolerance, and effective interpersonal relationships, can be effective in reducing self-harm and suicide [ 36 ]. The core mechanism of mindfulness therapy, decentering, involves perceiving situations from a distant “dispassionate observer” state instead of viewing the situation from self-immersed perspective [ 37 ]. This helps to alleviate the direct relationship between NSSI and rumination, thereby influencing the Emotional Cascade Mode.…”

“…This helps to alleviate the direct relationship between NSSI and rumination, thereby influencing the Emotional Cascade Mode. It may also reduce the vulnerability of adolescents with moderate to severe NSSI to the transition from rumination to suicidal thoughts and potential suicidal behaviors [ 37 ], potentially stopping the gateway from self-harm to suicide. Considering that the self-harming adolescents in this study showed a higher tendency for rumination, difficulty with distraction, and difficulties with emotion regulation than the control group, DBT-ST may be helpful.…”

Perceived discrimination and suicidal ideation among impoverished and nonimpoverished college students: Different mechanisms via social support, depressive symptoms, and nonsuicidal self‐injury

“…In addition, the interpersonal model of NSSI (Prinstein et al, 2009) posits that negative interpersonal experiences (e.g., rejection or exclusion) and related mental health problems can predict NSSI. Studies also indicated that perceived discrimination, social support, and depressive symptoms could predict NSSI among adolescents and young adults (Forrester et al, 2017; Rojas‐Velasquez et al, 2021; Wang, Zhang, et al, 2021), which could eventually result in suicidal ideation (Chu et al, 2018; Rosario‐Williams et al, 2021). However, few previous studies contrasted the specific pathways above between impoverished and nonimpoverished students.…”