(Gillham and Reivich, 1999). No study to date, however, has investigated how changing attributional style affects suicidality.

Coping Style and Affect Regulation

Coping and emotion regulation styles refer to how individuals manage stressful conditions or events (actively or passively) and how they regulate their own emotional, physiological, behavioral, and cognitive reactions to stress (Lazarus and Folkman, 1984). Coping styles contribute to physical (see IOM, 2001) and mental health following stressors or trauma (e.g., Beaton et al., 1999; Benight et al., 1999a; Boeschen et al., 2001; Sandler et al., 1994; Schnyder et al., 2001). Specifically, active coping styles such as planning, engaging problems, and seeking social support, and cognitive reinterpretation coping (finding meaning and benefit from adverse events) appear to decrease symptoms of psychological disorder and attenuate hypothalamic-pituitary-adrenal responses to stress (e.g., Antoni et al., 2001; Benight et al., 1999a; Cruess et al., 2000b; Taylor et al., 2000). Likewise, religious coping positively influences physical and mental health (see Chapter 6). Maladaptive coping styles, however, generally correlate with negative outcomes and are such a cardinal feature of suicidal individuals that some have suggested including measures for these variables in assessment tools for suicidality (Shneidman, 1992; Yufit and Bongar, 1992).

Suicidologists consistently find ineffective coping styles for mood and impulse regulation and interpersonal problem-solving among suicidal individuals (for reviews, see Catanzaro, 2000; Weishaar and Beck, 1990). Suicidal individuals use fewer active coping strategies and more avoidant (passive) coping styles such as suppression and blame (Amir et al., 1999; Asarnow et al., 1987; Horesh et al., 1996; Josepho and Plutchik, 1994). Compared to other psychiatric patients, suicidal patients are also less likely to use cognitive coping strategies to de-emphasize the importance of a negative outcome or stressor (Horesh et al., 1996; Kotler et al., 1993). Impulsive problem-solving style and difficulty regulating mood is related to increased rates of suicide attempts (Brent and Kolko, 1990; Catanzaro, 2000). For some suicidal individuals, these inadequate coping styles appear during depressive episodes (are state-dependent); for others, especially those with personality disorders or alcoholism, these skills deficits are characteristics or traits of the individual (Linehan et al., 1987; Weishaar and Beck, 1990).

Many psychotherapeutic interventions target coping and emotion regulation skills (see Chapter 7). Coping skills are also relatively easy to target in school-based primary prevention, with many such programs



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