Therapeutic mechanisms of suicidal ideation: the influence of changes in automatic thoughts and immature defenses

The treatment processes associated with reduced suicidal ideation have received little research attention. This study evaluates the influence on suicidal ideation of theory-based intrapsychic processes: maladaptive cognition and defensive style. Thirty-three community mental health patients completed questionnaires at two time points. Decreases in automatic thoughts were a strong correlate of decreased suicidal ideation, and decreases in immature defenses were a moderate strength correlate. These relationships remained significant even when controlling for initial level of depression. The theorized mechanisms of cognitive-behavioral and psychodynamic therapy had the expected effects on suicidal ideation. The strong association of decreased maladaptive cognitions with decreased suicidal ideation supports further development of cognitive-behavioral suicide interventions and clinical use of cognitive interventions. Psychodynamic processes in suicidal ideation and behavior warrant further exploration.