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8. Improved prediction of dynamic self-injurious thoughts using multidimensional, ambulatory assessment
Self-injurious thoughts (SIT) fluctuate considerably from moment to moment rendering hallmark static predictors (e.g., demographic variables, prior history, laboratory questionnaire and clinical interview derived negative affect such as hopelessness, distress, pain, and cognitive abilities related to inhibitory and executive control) less useful in the imminent prediction of SIT. Advances in ambulatory recording capabilities allow for the measurement of potential predictors with a relatively high degree of temporal resolution and can be used to improve the prediction of imminent SIT. The current study examined two candidate predictors of SIT: state negative affect and “online” cognition. State NA and SIT was measured using self-report sliders, while cognitive performance was measured using a modified Trail Making Test. Data were collected using a specially designed mobile application (administered 4x/week up to 28 days) in dually diagnosed inpatients (N = 111). State SIT was significantly related to both increased state NA and poorer online cognitive performance. Moreover, an interaction showed that those with poorer online cognitive performance were more vulnerable to SIT with increased state NA. Our findings highlight the potential importance of employing multidimensional state risk markers to predict SIT. Ambulatory recording reflects an efficient, sensitive, and ecological valid methodology of accomplishing this endeavor.