News

People who survive suicide attempts usually come to regret their choice of suicide attempt over constructive alternatives, suggesting that this choice is often an error of decision-making. In a crisis, decisions are often made during a complex sensorimotor interaction, with real or perceived time pressure, and a vast number of options that may become available and vanish dynamically. While there may be many choices available to an individual in a period of intense distress, it can be hard to consider which ones would work when experiencing a sense of crisis. 

Reinforcement learning frames option competition as a dilemma between exploiting options thought to be best and exploring potentially superior alternatives. 

A team of scientists including Aliona Tsypes, PhD (Assistant Professor of Psychiatry); Angela Ianni, MD, PhD (clinical fellow in geriatric psychiatry); and Alex Dombrovski, MD (Pittsburgh Foundation Endowed Professor in Brain and Mind Research and Professor of Psychiatry and Associate Professor Psychology), from Pitt Psychiatry, examined exploration/exploitation in people with borderline personality disorder (sample 1) and late-life depression (sample 2) who had made high-lethality vs low-lethality suicide attempts. Whereas borderline personality disorder is characterized by affective instability, rash decisions, and recurrent suicidal thoughts and behaviors, suicidal acts in individuals with late-life depression are less frequent but more determined and lethal. They additionally examined whether behavioral exploration/exploitation predicted incident suicidal thoughts assessed via ecological momentary assessment.

“Clinical theories have long highlighted the concept of cognitive constriction in suicidal crises—a rigid, tunnel-vision mindset that limits problem-solving. Yet, we have lacked precise, reliable models that explain how these thought processes unfold in real time during a crisis.  Reinforcement learning provides a powerful framework for understanding this by examining the dynamic interplay between sticking to familiar solutions and exploring new, potentially better alternatives. Within this framework, cognitive constriction reflects a restricted and overly narrow exploration of available options,” said Dr. Tsypes, first and corresponding author of the study, recently published in JAMA Psychiatry.

The investigators found associations between serious suicidal behavior in both borderline personality disorder and late-life depression and an inability to shift away from unrewarded choices resulting in the under-exploration of a continuous option space. This narrow, inflexible behavior prospectively predicted daily suicidal ideation. By contrast, low-lethality suicidal behavior in both individuals with borderline personality disorder and depression was associated with excessive shifts after rewarded as well as unrewarded actions.

“Our results hint at two distinct pathways to suicide, one rigid and one stress-reactive. People in the rigid group stick with one or a few options and persist even when they do not work, and they may be the ones who focus on suicide as the only solution to their problems, ignoring constructive alternatives. Stress-reactive people, on the other hand, abandon potentially useful options prematurely and may quit when running into obstacles in real life, favoring suicide as a quick escape,” said Dr. Dombrovski, senior author of the study. 

Exploration-Exploitation and Suicidal Behavior in Borderline Personality Disorder and Depression
Tsypes A, Hallquist MN, Ianni A, Kaurin A, Wright AGC, Dombrovski AY.
JAMA Psychiatry. Published online July 10, 2024. doi:10.1001/jamapsychiatry.2024.1796