The role of suicidal mental imagery and experiential avoidance in suicidality: an exploratory study

Background: Although research has highlighted that suicidal imagery (SuiMI) and experiential avoidance (EA) are important in understanding suicidality, there is a need to understand how they potentially interact. Previous research has highlighted that EA potentially leads to increased cognitive intrusions, but it not known whether EA leads to increased SuiMI.

Aims: The purpose of this study was to explore the influence of SuiMI and EA on suicidality (i.e. encompassing thoughts, behaviour and suicide attempts). It was hypothesised that greater frequency of SuiMI would be associated with greater EA. It was also hypothesised that greater SuiMI would be associated with greater suicidality, and that EA would moderate this relationship.

Method: Hypotheses were tested by surveying 197 general university students who completed self-report measures that assessed suicide-related mental imagery (i.e. Suicidal Imagery Questionnaire, SIQ), experiential avoidance (i.e. Multi-dimensional Experiential Avoidance Questionnaire, MEAQ) and suicidality (i.e. Suicidal Behaviours Questionnaire-Revised, SBQ-R).

Results: Frequency of SuiMI was positively correlated with the tendency to engage in EA. SuiMI was a significant predictor of both suicidality and EA. Exploratory analysis found that voluntary SuiMI explained greater variance in suicidality than intrusive, involuntary SuiMI, and that SuiMI only predicted EA in low-risk participants and not for those at high risk of suicide. EA did not predict suicidality and it also did not show any moderating effect on the relationship between SuiMI and suicidality.

Conclusion: There is evidence to suggest that suicide-related mental imagery may play an important role in suicide risk and more specifically imagery that is voluntarily engaged with. Future research is needed to explore the different types of imagery in relation to suicidal ideation in populations at higher risk of suicide.