New Research Reveals a Surprising Link Between Emotion Regulation and Suicidal Thoughts

When Coping Backfires

Suicide rates have been alarmingly on the rise. To reverse this devastating trend, scientists are urgently seeking a deeper understanding of the factors that contribute to suicidal ideation, particularly in the context of depression. A groundbreaking new study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging reveals a surprising and counterintuitive finding: for some depressed individuals, the reflexive use of emotion regulation strategies may actually worsen suicidal thoughts in response to daily stress.  

The Stress-Suicide Connection: A Daily Struggle:

While retrospective accounts often point to stressful life events as immediate triggers for suicidal acts, studying this connection prospectively—as it unfolds in real-time—has been a significant challenge. This new research tackles this challenge head-on, offering valuable insights into the complex interplay between emotion regulation, daily stress, and suicidal thoughts in individuals with major depressive disorder.

"Suicide rates in the United States have increased about 37% since the year 2000," says senior investigator J. John Mann, MD, of the New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons. "To reverse this trend, we need to understand how suicide risk emerges in daily life, and specifically the biopsychosocial factors that may influence the ebb and flow of suicide risk."  

A Two-Pronged Approach: Peeking Inside the Brain and into Daily Life:

The study employed two innovative methods to investigate this complex relationship:

1. fMRI Neural Signature: Researchers used functional MRI (fMRI) to measure brain activity while participants recalled personal negative memories. This allowed them to identify a specific neural signature associated with cognitive reappraisal, a common emotion regulation strategy that involves reinterpreting a situation to change its emotional impact. This provided a quantifiable measure of how readily individuals engage in emotion regulation at a neural level.

2. Ecological Momentary Assessment (EMA): Participants also used ecological momentary assessment (EMA), a method that involves repeated, real-time assessments of thoughts and emotions in everyday settings. This provided a window into how individuals respond to daily stressors with fluctuations in mood and suicidal thoughts.  

By combining these two methods, the researchers were able to link a laboratory-based measure of emotion regulation with real-world responses to stress.

The Surprising Finding: When Regulation Fuels Distress:

The study's most striking finding was that depressed individuals who spontaneously engaged the neural signature of emotion regulation when recalling negative memories actually experienced greater increases in suicidal thoughts when faced with daily stressors over the course of a week. This suggests that for some individuals, reflexively attempting to suppress or dampen initial emotional responses to negative stimuli may be a maladaptive strategy that exacerbates distress in the face of real-world challenges.

However, when participants were directed to use reappraisal (rather than doing it spontaneously), they showed more adaptive responses to stress. This difference highlights the importance of context and intention in emotion regulation.

The Importance of Flexibility:

"Flexibility in emotion regulation is generally understood to be a marker of psychological health," comments Cameron S. Carter, MD, Editor-in-Chief of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. "However, in the current study, researchers found that reflexively engaging emotion regulation in the face of unexpected stressors may not be helpful or effective in all circumstances. These findings, which leverage functional imaging combined with real-world in-the-moment assessments, are important to further our understanding of how to effectively deal with stress in daily life."

Unlocking the Mysteries of the Mind:

This research opens up exciting new avenues for understanding and intervening in suicidal ideation. As co-first author Noam Schneck, PhD, explains, "The use of neural decoding allows us to identify mental processes that were previously elusive to capture, such as spontaneous emotion regulation. In future work, the decoder approach can be employed to better understand how emotion regulation is engaged spontaneously to modulate hour-to-hour, day-to-day experience, thereby influencing suicide risk in a fluctuating manner."

This study was conceived by Barbara H. Stanley, MD, who sadly passed away in 2023. Dr. Mann acknowledges her invaluable contribution: "It was Dr. Stanley's idea that we employ ecological momentary assessment in the same depressed patients who completed the fMRI negative autobiographical memories task. It was that combination of research procedures that led to these remarkable findings."

This research underscores the complex nature of emotion regulation and its role in mental health. It suggests that simply trying to suppress negative emotions isn't always the most effective strategy, especially for individuals struggling with depression. Further research is needed to explore these findings and develop more targeted and effective interventions for preventing suicide.