Developing the Implicit Relational Assessment Procedure (IRAP) to Assess Evaluations of Death Within Suicidality Thesis submitted to the Department of Psychology, Faculty of Science, in part fulfillment of the requirements for the degree of Doctor of Philosophy, Maynooth University. Ian Hussey, B.A. (Hons.) July 2015 Research Supervisor: Professor Dermot Barnes-Holmes Head of Department: Dr Andrew Coogan Table of contents Acknowledgements iii Published sections iv Abstract vi Ethics statement viii Life of Tables ix List of Figures x List of Appendices xi Chapter 1: A review of the prediction of suicidality using self-report and 1 implicit measures 1.1 Definitions and theories of suicide 1 1.2 The prediction of suicidal behaviours 8 1.3 A systematic review of implicit measures and suicidal behaviours 10 1.4 A functional-analytic approach to language, suicide, and implicit attitudes 37 1.5 Overview of the current research program 49 Chapter 2: Comparing the IRAP and IAT as measures of death-identity and 52 death-evaluation in a normative population 2.1 Method 55 2.2 Results 68 2.3 Discussion 74 Chapter 3: An empirical investigation of the role of the contrast category within 78 the IRAP 3.1 Experiment 1 79 3.2 Method 80 3.3 Results 83 3.4 Discussion 86 3.5 Experiment 2 88 3.6 Method 91 3.7 Results 94 3.8 Discussion 97 Chapter 4: Exploring death evaluations on the IRAP using mortality salience 102 inductions and contrast category manipulations 4.1 Experiment 1 104 4.2 Method 105 4.3 Results and Discussion 110 4.4 Experiment 2 115 4.5 Method 115 4.6 Results and Discussion 117 4.7 Experiment 3 119 4.8 Method 120 4.9 Results and Discussion 121 4.10 Experiment 4 124 4.11 Method 125 4.12 Results and Discussion 127 4.13 Post Hoc Analyses and Discussion 129 i Chapter 5: Comparing death evaluations on the IRAP between normative and 135 suicidal individuals 5.1 Method 137 5.2 Results 142 5.4 Discussion 149 Chapter 6: General discussion 155 6.1 Summary of findings 155 6.2 Issues raised 163 6.3 Broader implications 174 6.4 Conclusions 177 References 179 Appendices 213 ii Acknowledgements Dermot My heartfelt thanks for affording me such academic freedom, for helping me exorcise my mentalistic assumptions, and for keeping me on track and productive when I was inclined to run amuck in the sweet shop. I am very grateful to call you my mentor. This was great fun. Yvonne Thank you for helping me get in touch with my values. You bring fiery compassion to a sometimes-indifferent world. Please save me a glass of Kool-Aid: I'm still thirsty. John & Martina Thank you for the genetic and developmental endowment of your combined sharp minds; the quiet encouragement to do something with my life I value and enjoy; and the loud financial support that allowed me to pursue it. Few are gifted with such freedom and privilege. Aoife, Francesca, Mary, Nicole, Sean, and everyone else Thank you for making a one-horse town livable. Our earnest time together as students will always be special to me. The undergraduate students I worked with while conducting this research Having people to work with made this research infinitely more interesting. Thanks in particular to Dearbhaile Ní Mhaoileoin, Emma Fawcett, June Dennehy, and Tarah Daly. The service users and staff at St Patrick’s Hospital Thank you for your patience, support, and for generously volunteering your time. Thanks in particular to Dr. Richard Booth, Rose Keane, Georgina Mullen, Aisling Ryan and all those who participated in this research. The participants at Maynooth University Thank you for volunteering your time. You deserved more than the chocolates you got. The staff at the department of psychology Anne, you hold the keys to the kingdom; thank you for using them to open doors for me whenever you could. Carol and Richard, thank you for you input and advice, I thoroughly enjoyed our collaborations. Derek, Victoria, and Caroline, thank you for your kind support whenever it was needed. iii Published sections of this thesis Sections of this thesis are currently published or under review. The references that correspond to each chapter are listed below. Note that some chapters contain sections from multiples papers, and material from some papers is distributed across multiple chapters. Chapter 1: A review of the prediction of suicidality using self-report and implicit measures1,2,4 Chapter 2: Comparing the IRAP and IAT as measures of death-identity and death-evaluation in a normative population5,8 Chapter 3: An empirical investigation of the role of the contrast category within the IRAP7 Chapter 4: Exploring death evaluations on the IRAP using mortality salience inductions and contrast category manipulations6 Chapter 5: Comparing death evaluations on the IRAP between normative and suicidal individuals3 Chapter 6: General discussion1,2,3,5,6,7 References 1Barnes-Holmes, D., Barnes-Holmes, Y., Hussey, I., & Luciano, C. (2015). Relational Frame Theory: Finding its historical and intellectual roots and reflecting upon its future development. In R. D. Zettle, S. C. Hayes, D. Barnes-Holmes, & A. Biglan (Eds.), The Wiley Handbook of Contextual Behavioral Science (pp. 115–128). John Wiley & Sons, Ltd. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/9781118489857.ch8/summary 2Hussey, I. & Barnes-Holmes, D. (under review). A systematic review of implicit measures and suicidal behaviors. iv 3Hussey, I., Barnes-Holmes, D., & Booth, R. (2016). Individuals with current suicidal ideation demonstrate implicit “fearlessness of death.” Journal of Behavior Therapy and Experimental Psychiatry, 51, 1–9. http://doi.org/10.1016/j.jbtep.2015.11.003 4Hussey, I., Barnes-Holmes, D., & Barnes-Holmes, Y. (2015). From Relational Frame Theory to implicit attitudes and back again: clarifying the link between RFT and IRAP research. Current Opinion in Psychology, 2, 11–15. http://doi.org/10.1016/j.copsyc.2014.12.009 5Hussey, I., Daly, T., & Barnes-Holmes, D. (2015). Life is Good, But Death Ain’t Bad Either: Counter-Intuitive Implicit Biases to Death in a Normative Population. The Psychological Record, 65(4), 731–742. http://doi.org/10.1007/s40732-015-0142-3 6Hussey, I., Dennehy, J., Fawcett, J., Barnes-Holmes, D., & Murphy, C. (under review). Negative evaluations of death on the IRAP are dependent on mortality salience and the context set by the other stimulus categories. 7Hussey, I., Mhaoileoin, D. N., Barnes-Holmes, D., Ohtsuki, T., Kishita, N., Hughes, S., & Murphy, C. (2016). The IRAP Is Nonrelative but not Acontextual: Changes to the Contrast Category Influence Men’s Dehumanization of Women. The Psychological Record, 66(2), 291–299. http://doi.org/10.1007/s40732-016-0171-6 8Hussey, I., Thompson, M., McEnteggart, C., Barnes-Holmes, D., & Barnes-Holmes, Y. (2015). Interpreting and inverting with less cursing: A guide to interpreting IRAP data. Journal of Contextual Behavioral Science, 4(3), 157–162. http://doi.org/10.1016/j.jcbs.2015.05.001 v Abstract Over the last fifty years, psychological science can be credited with persistent efforts to prevent and treat suicidal behaviours. However, the utility of such interventions is often moderated by the ability to identity individuals who are likely to engage in suicidal behaviors ahead of time. Less progress has been made on this front; the ability to accurately predict such behaviors at an individual level remains limited. Recent evidence suggests that this may be due in part to the field’s reliance on self-report measures. One promising avenue that has emerged in recent years is the objective behavioural tasks referred to as “implicit measures”, which have shown greater promising predictive validity relative to existing risk factors derived from self-report measures. The current body of research sought to expand on these findings and, specifically, to explore implicit evaluations of death in both normative and suicidal individuals using the Implicit Relational Assessment Procedure (IRAP). This thesis begins with a systematic review of the literature on implicit measures and suicide. Based on the conclusions of this review, five analogue studies were conducted exploring implicit studies to death in normative student populations. Two further experiments developed a novel experimental methodology (i.e., manipulations of the IRAP’s “contrast category”) in order to facilitate a more detailed understanding of what drives effects on the measure. A final experiment compared implicit death-evaluations on the IRAP between psychiatric patients with current suicidal ideation and normative controls. All studies presented participants with one or more implicit measures (IRAP and IAT) and a number of self-report measures. Generically, the IRAP presents participants with four category pairings (e.g., “life-positive”, “life-negative”, “death-positive”, and “death-negative”), and compares the relative ease with which they respond to these pairings with “true” relative to “false”. The difference in mean response-latency between the two response options is referred to as an implicit bias. vi Together, these studies allowed for a more detailed interrogation of how death is evaluated between individuals with and without a history of suicidal behaviours than was previously possible. Specifically, across studies, results demonstrated the IRAP’s ability to isolate specific implicit biases between categories, relative to other measures. The results from the analogue studies were used to development and assess a death-evaluation IRAP that is sensitive to mortality salience. A final experiment to conclude that suicidal ideation was found to be associated with a specific rejection of the negativity (i.e., fearlessness) of death. Results across studies indicate that differential patterns of implicit bias between normative individuals and suicidal ideators were attributable to suicidality specifically rather than the salience of mortality more generally, thereby providing a degree of construct validity for death-evaluations on the IRAP.