Exploring the pathway from anxiety sensitivity intervention to suicide risk reduction: Chained mediation through anxiety and depressive symptoms

Background: The suicide rate in the Unites States continues to increase suggesting novel intervention strategies are needed. Anxiety sensitivity (AS), or a fear of anxiety-related sensations, is a suicide risk factor that can be ameliorated via a single-session, computerized intervention called the Cognitive Anxiety Sensitivity Treatment (CAST). Results from randomized controlled trials have demonstrated that reductions in suicidal ideation (SI) due to CAST were mediated by AS reductions. However, a more detailed analysis of the mechanisms of SI reduction due to AS interventions is needed to further our understanding of theoretical models of AS and suicide, and to refine AS treatments. Methods: Participants (N = 74) with co-occurring anxiety pathology and SI were randomized to a single-session computerized treatment (CAST + cognitive bias modification) or a control intervention. Assessments were conducted immediately post treatment, and at 1 month and 4 month follow-ups. Results: Chained mediation models revealed significant reductions in SI (month 4 follow-up) through AS (post-treatment) and subsequently anxiety symptoms (month 1 follow-up), but not depressive symptoms. There were no direct mediation effects through either AS or anxiety or depressive symptoms. Limitations: Limitations include self-report assessment of symptoms, a sample of only individuals with a diagnosed anxiety pathology, and exploratory nature of anxiety/depression dimension analyses. Conclusions: Results of the current study help clarify the mechanistic pathways of SI reduction due to an AS intervention, and suggest future work attempting to increase the efficacy of AS interventions should consider the potentially important role of downstream mechanisms that follow AS reduction.