# Future oriented group training for suicidal patients



## Daniel (Jan 9, 2012)

Future oriented group training for suicidal patients: a randomized clinical trial
2009 October 7

​*Background*

In routine psychiatric treatment most clinicians inquire about indicators of suicide risk, but once the risk is assessed not many clinicians systematically focus on suicidal thoughts. This may reflect a commonly held opinion that once the depressive or anxious symptoms are effectively treated the suicidal symptoms will wane. Consequently, many clients with suicidal thoughts do not receive systematic treatment of their suicidal thinking. There are many indications that specific attention to suicidal thinking is necessary to effectively decrease the intensity and recurrence of suicidal thinking. We therefore developed a group training for patients with suicidal thoughts that is easy to apply in clinical settings as an addition to regular treatment and that explicitly focuses on suicidal thinking. We hypothesize that such an additional training will decrease the frequency and intensity of suicidal thinking. We based the training on* cognitive behavioural approaches of hopelessness, worrying, and future perspectives*, given the theories of Beck, McLeod and others,concerning the lack of positive expectations characteristic for many suicidal patients. In collaboration with each participant in the training individual positive future possibilities and goals were challenged.​*
Discussion
*
We have developed our Future Oriented Group Training based on the* presumption that suicide ideation is characterized by diminished positive future thinking*. Our intervention intends to stimulate realistic future perspectives. When suicidal individuals are able to envision a worthwhile future, their hopelessness and suicidal thinking and behavior are expected to decrease.

Extensive research the last twenty years has provided information about the different aspects and dynamics of suicidal thinking and behavior, but only a few interventions for suicidal patients have been evaluated in randomized clinical trials. The ones we know of (for instance Brown et al. [52]) have been developed for patients coming into care after a suicide attempt. Our training aims to help patients early on in the suicidal process, and we include both patients with suicidal ideation and after a suicide attempt in our study.

Future Oriented Group Training combines different elements that have proven to be effective in the treatment of suicidal thinking and behavior, like cognitive therapy and problem solving. Relatively new is the emphasis in the training on* future thinking and goal oriented behavior.* The intervention is designed to be easy to implement and is suitable for a broad range of comorbid psychiatric disorders.

Treatment programs like our training encompass several potentially effective elements. In the RCT we cannot distinguish which specific factor contributes to what extend to the overall treatment effect. This is also a characteristic of well established treatments, like Dialectical Behavioral Therapy [53]. We obtain an indication of changes in specific areas by gathering data on explanatory factors, like coping, problem solving, and future orientation, but we cannot tell which element of the training is responsible for these changes. Further research might be helpful to discriminate the efficacy of the separate elements.

Stimulating future thinking is a way of helping suicidal individuals to recreate a meaningful life, by working on purposeful goals and overcoming inefficient behavioral and cognitive patterns. The goal of our Future Oriented Group Training is to help our patients to make life livable and maybe even enjoyable again by realistically focusing on what the future might have to offer.

Full article

Practical information about the intervention, and a case example (Word Document)​


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## Daniel (Jan 13, 2012)

Time perspective, personality and psychopathology
                                             November 2011

Time perspective theory assumes that behaviour is influenced by how individuals link their behaviour to their past, present,                      and future. This paper explores the concept of time perspective (Zimbardo and Boyd, 1999) within a psychiatric context. We compared 76 individuals, in treatment (_n_ = 32) or not in treatment (_n_  = 44). The participants completed the time perspective questionnaire  ZTPI, the NEO-PI-R (personality traits), an instrument                      to measure personality problems SIPP-118, and the  BDI-II (depression). We found correlations between measures of  psychopathology                      and Past Positive, Past Negative and Present  Fatalistic time perspectives. Particularly Past Negative appeared to be  indicative                      for psychiatric problems...

Our most notable finding is probably the strong relation between Past Negative time perspective and the measure of the severity of personality problems that we used. A tendency to keep focusing on *Past Negative is closely related to depression* (Boyd and Zimbardo, 2005; Lyubomirsky and Nolen-Hoeksema, 1995), and we found a similar relationship. People who are focused on their negative past are more depressed, and report more suicidal ideations...

*Present Fatalistic people, who tend to think their present life is dictated by fate and feel helpless report more psychopathology.* Zimbardo and Boyd (1999) demonstrate that Past Negative and Present Fatalistic perspectives are associated with strong feelings of depression, anxiety, anger and aggression. We found higher Present Fatalistic scores to be associated with less extraversion, consciousness, and higher neuroticism. In line with the findings by Laghi et al. (2009), a high Present Fatalistic is related to an increased risk of suicide ideation...

Suicidal patients lack the ability to envision a positive future and a high tendency to positive future thinking seems to be protective against suicide. These people are less future oriented, but the relationship between suicidality and the Future scale of the ZTPI is unclear, because the ZTPI does not differentiate between a positive and a negative orientation towards the Future. More research is needed on the difference between future positive and future negative time perspective in order to increase the usability of such perspectives in clinical settings. The dominant role of Past Negative also influences the relation between Future and suicidality. When we partial out Past Negative, we no longer find a significant correlation...

The role of the ZTPI in clinical psychology and psychopathology is interesting. Especially high Past Negative orientation appears to be a strong indicator of more psychopathology, while *Past Positive might be protective against psychopathology*. A preoccupation with negative experiences might be a bad indication for psychotherapy or treatment in general (Beiser and Hyman, 1997). On the other hand, a stronger ability and tendency to focus on past positive experiences appears to be correlated with less psychopathology. Consequently, it might be helpful to stimulate patients to stop focusing on their negative memories, and aid them to search for positive experiences in their pasts...


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