Symposia
Suicide and Self-Injury
Peter J. Franz, Ph.D.
Montefiore Medical Center
New York, New York
Rebecca G Fortgang, Ph.D.
Postdoctoral Fellow
Harvard University
Cambridge, Massachusetts
Alexander Millner, Ph.D.
Director of Mental Health Research
Franciscan Children's Hospital
Brighton, Massachusetts
Adam Jaroszewski, Ph.D.
Postdoctoral Fellow
Massachusetts General Hospital
Boston, Massachusetts
Ellen Wittler, PhD
Research Coordinator
Butler Hospital
Providence, Rhode Island
Vilma Gabbay, M.D.
Associate Professor
Albert Einstein College of Medicine
The Bronx, New York
Jonathan Alpert, M.D., Ph.D.
Silverman University Chair
Montefiore Medical Center
The Bronx, New York
Joshua Buckholtz, Ph.D.
Assistant Professor
Harvard University
Cambridge, Massachusetts
Matthew Nock, Ph.D.
Professor
Harvard University
Cambridge, Massachusetts
Nonsuicidal self-injury (NSSI), a top risk factor for suicide, is most often used as a strategy to gain relief from negative affect, but why people would choose to harm themselves instead of using healthier strategies remains unexplained. Prior research demonstrates convincingly that cognitive effort influences decisions about attaining rewards, such that people will choose lower rewards if doing so allows them to expend less cognitive effort, a decision-making bias known as effort discounting. No study, however, has ever tested whether cognitive effort similarly influences decisions about relief, the primary goal of self-injurious behavior, including both NSSI and suicide. The aim of this study was to test the hypotheses that (1) effort discounting occurs in the context of choices about relief, (2) people use self-injurious behavior as a means of achieving relief because their decisions are more sensitive to cognitive demands while experiencing affective distress, and (3) these individuals perceive self-injury to be a less-effortful means of achieving the goal of relief.
In experiment one, 43 adults completed a novel behavioral task designed to index effort discounting in the context of choices about relief. In experiment two, one hundred forty-nine adults, 52% with a history of NSSI, completed our task both while experiencing negative affect and while experiencing more neutral affect.
Experiment one revealed that people prefer to accept less relief if this allows them to expend less effort, i.e. effort discounting occurs in the context of decisions about relief (interaction between available relief and required effort OR = 1.42, 95% CI [1.16, 1.74], p = .001). Experiment two provided evidence that effort discounting is more pronounced in those who engage in NSSI (b = 0.49, CI: [0.01, 0.96], p = .042), but effort discounting did not differ during the experience of negative affect (b = -.21, CI: [-0.21, 0.49], p = .434). Finally, we found that for those who had engaged in NSSI, effort discounting was associated with perceptions of healthier affect regulation strategies as requiring more effort than self-injurious behavior (b = 0.41, CI: [0.11, 0.71] , p = .008).
This study is the first to utilize a relief-based effort discounting task and also the first to demonstrate that preferences about exerting cognitive effort may be a barrier to using healthier affect regulation strategies among people who engage in self-injurious behavior. As such, this study paves the way to future investigations of relief-seeking behavior, including suicide.