The role of mental imagery in understanding, assessing and treating suicidal behaviours

Recent surveys have shown an alarming increase in suicidal behaviours in adolescents and young adults, a population known to be associated with high levels of stress, anxiety, and depression. Despite the great improvements made over the years in the way we understand and address suicidality in the clinic, it remains extremely challenging and complex for the clinicians to assess risk and help patients alleviate their suicidal thoughts. In this context, recent studies have shown that a particular form of intrusive mental imagery of suicide, called "flashforwards" in analogy with the flashbacks in PTSD, could play a pivotal role in suicidal behaviour. More specifically, suicidal flashforwards have been shown to be associated with greater severity of suicidal symptoms and a greater likelihood of engaging in actual suicidal behaviour. This in line with the broader evidence of a powerful impact of mental imagery on emotion and behaviour, while in the specific of context of suicidality these flashforwards could be seen as real marker of suicidal risk and severity. Frequent exposure to suicidal scenarios through repeated experience of intrusive imagery may induce habituation to this outcome and thus increase the person's acquired ability to do so. Beyond assessment of suicidal risk, exploring suicidal images offers privileged access to the emotional states, cognitions, and behavioural responses that patients experience when they feel at their most depressed and despairing. Further, recently developed intervention methods designed to specifically target these suicidal images could hold promise in helping patients to deal with their suicidality. These are the subjects that Arnaud Pictet evokes in this interview with Jean-Pierre Bouchard.(c) 2023 Published by Elsevier Masson SAS.