نگرش ضمنی و صریح نسبت به خودآسیبی: پشتیبانی برای یک مدل کاربردی

Abstract Background and objectives Self harm is a serious public health problem worldwide. Implicit attitude measures offer a novel method of exploring associations with self harm (SH). Here we used implicit measures in order to (i) examine implicit evaluative and arousal associations with SH (ii) compare the discriminatory power of implicit and explicit attitude measures in a non-clinical sample at high risk of SH. Methods Two experiments using Go No-Go Association (GNAT) tasks designed to tap implicit attitudes toward SH in an undergraduate sample.

.

4. Conclusions The existence of associations with social and automatic reinforcement at the implicit level suggests that interventions which consider only the deliberative level of processing may be ineffective as this may not address the problems at the associative level. Cognitive Behaviour Therapy, which could be argued to focus on deliberative, thinking, has nevertheless been shown to affect disorder relevant implicit associations but few studies to date have examined the effect of treatments on such associations (Roefs et al., 2011). Understanding the impact of such associations on treatment attempts, for example determining whether individuals are consciously aware of such automatic thoughts or not, and whether they are able to suppress them, is necessary as these problems could pose a significant challenge to efforts to reduce SH. It may be necessary to modify both deliberative (explicit) and automatic (implicit) beliefs about SH in order to help individuals whose first thoughts in times of crisis may be of self harm. Study Two replicated the finding from Study One that explicit attitude scales can successfully discriminate SH cases from controls. This suggests that explicit self report should not be considered inferior to more objective measures such as performance based tasks (Haeffel et al., 2007). In Study Two, however, only the implicit attitude measure was correlated with different reported functions. The present studies demonstrate that using explicit self report and implicit tasks together can help in better understanding the nature of SH across both important levels of processing. The small sample size should be borne in mind when considering the study’s implications. In particular, the failure of the GNAT tasks to discriminate between groups requires replication in larger samples. While the present studies were concerned with addressing functions of self harm, other within-group differences could also affect implicit associations in SH cases and should be addressed within larger samples of SH participants. In particular, recency of self harm and frequency of self harm may impact on the strength of associations. It is also recognised that those who SH may endorse different motivations at different times (in Study Two, cases only responded ‘yes/no’ to motivations). It may be that SH cases who report experiencing both interpersonal and intrapersonal functions at different times may have different associations. The samples were also predominantly female and it is possible that functional associations may differ between males and females this requires investigation. The study was furthermore limited to addressing retrospective self harm in a cross sectional design. Although this exposed unique functional associations, demonstrating the need to consider the implicit level of processing when addressing how SH is reinforced, future research should address whether the tasks are associated with future instances of SH. The GNATs in the present study addressed the core affect dimensions specifically, but the potential of GNATs to tap other discrete associations should also be explored. The study also did not control for current mood, which as suggested may impact on strength of associations, and future studies should also control for other variables which may impact on responding in the GNAT task, such as impulsivity, or which may account for differences between the samples, such as occurrence of psychopathology which would be expected to be higher in SH cases. Nevertheless, the study demonstrates the utility of GNAT tasks for exploring specific associations between SH and attitudinal or affective dimensions.