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Reducing Suicide: A National Imperative
Hopelessness appears to arise from multiple sources, including low self-esteem combined with interpersonal losses and the lack of confidence in one’s ability to regulate mood or solve personal problems (negative coping efficacy beliefs, e.g., Catanzaro, 2000; Dieserud et al., 2001). Cognitive behavioral therapy (CBT) is designed to reduce clinical symptoms by changing thoughts and behaviors (Weishaar and Beck, 1990). Numerous studies show CBT is effective in reducing depression and hopelessness in various populations including adolescents (Brent et al., 1999; Brent et al., 1998). Reductions in suicidal ideation and attempt have also been reported (see Chapter 7), but there are no published findings on the specific effect of reducing hopelessness on rates of suicidality.
Alternatively, positive expectations regarding the future (hope) and positive ways of assigning causality to events (optimistic attributional style) powerfully buffer the effects of life stress on mental, behavioral, and physical health (e.g., Beck et al., 1976; Linehan et al., 1983; Range and Penton, 1994; Scheier and Carver, 1992; Taylor et al., 2000; Werner, 1996; Wyman et al., 1993). Research suggests that optimism enables individuals to procure and engage potent protective factors such as adaptive coping skills and increased self-efficacy (described below), reinterpreting adverse experiences to find meaning and benefit, and seeking and perceiving social support (Antoni et al., 2001; Benight et al., 1999a; Brissette et al., 2002; Scheier et al., 1986). Chapter 6 discusses how religious beliefs and involvement can increase hope. Several research groups have designed cognitive–behavioral interventions that teach optimism, and results suggest that children and adults can learn positive, hopeful thinking patterns that attenuate psychological distress and depression and make subsequent episodes of depression less likely (Antoni et al., 2001; Brissette et al., 2002; Gillham and Reivich, 1999; Gillham et al., 1995; Jaycox et al., 1994). Although studies indicate that hope protects against suicidality (Linehan et al., 1983; Malone et al., 2000; Range and Penton, 1994), no published studies on the effect of optimism training on suicidality are currently available.
Self-efficacy beliefs, the assessment of one’s ability to manage or control external and internal threats, exert a primary influence on human emotion, cognition, and behavior (Bandura, 1982; 1991). Positive self-efficacy beliefs represent the opposite of hopelessness and appear to protect individuals from suicidality (Linehan et al., 1983; Malone et al., 2000; Range and Penton, 1994; Strosahl et al., 1992). Coping self-efficacy beliefs affect physiological stress responses involving the catecholamines, opioids, and the hypothalamic-pituitary-adrenal axis (see Chapter 4)