Where is an emotion? Using body focus as a method of improving emotion regulation to inform suicide prevention initiatives

INTERVENTION: Visceroceptive awareness intervention. This involves directing attention to the physiological activity of a part of the body, where these parts differ across experimental groups. One group will focus attention on cardiac activity with another group focussing on gut activity in the lower abdomen. These groups undertake the intervention over an extended period of 8 weeks, 6 days per week, 20 minutes per day. Participants will be provided with written instructions online (developed by the Principal Investigator) for how to approach this daily task. These instructions will include the body posture to adopt during each session, the focal point for the task (being either cardiac or gastrointestinal, not skeletal), ensuring the set up in the room is comfortable (e.g. comfortable temperature, comfortable and stable chair), and common pitfalls when undertaking meditation (e.g. mind wandering). When beginning the task, participants in the cardiac focus group will be cued with an image highlighting the chest area, with those in the gut focus group being cued by an image highlighting the lower abdomen. They will be instructed to focus within the body at these locations. Further, there will be opportunities for participants to ask questions face to face and/or over email. The intervention (and knowledge of group allocation) will be introduced during an initial laboratory visit, which will be reinforced by the online materials. The first meditation session takes place after the initial laboratory visit. The Principal Investigator (PI) has based the intervention on instructions provided in journal articles using visceroception, in combination with a meditation framework taken from a traditional Zen Buddhist practice (the PI has 20 years' experience of this framework with the Zen Centre, London). This framework will be used to fix the bodily posture (upright position, curved lower back, chest out, ears in line with the shoulders, eyes lowered, one hand gripping the CONDITION: Mental Health ‐ Suicide Suicidality; ; Suicidality SECONDARY OUTCOME: Changes in emotion regulation ability, measured by a standard questionnaire: The Difficulties in Emotion Regulation Scale. [Baseline and 8‐week follow‐up] Changes in emotion regulation ability, measured by a standard questionnaire: The Emotion Reactivity Scale.[Baseline and 8‐week follow up] INCLUSION CRITERIA: (a) BMI equal to or lower than 30; 32 for Maori/PI; (b) Currently enrolled on a full time medical or nursing degree/diploma or allied health degree/diploma OR already qualified and working as a doctor/nurse/allied health professional; (c) Regular levels of physical activity: at least 150 minutes of moderate‐intensity aerobic physical activity throughout the week or least 75 minutes of vigorous‐intensity aerobic physical activity or an equivalent combination of moderate‐ and vigorous‐intensity activity (based on World Health Organisation guidelines); (d) Normal or corrected vision; (e) Normal or corrected hearing; (f) Right‐handed; (g) Aged 18‐35 years; (h) Availability for the entire study period. PRIMARY OUTCOME: Change in mean reaction time to the detection of a bodily change in response to emotional stimuli. This is a composite primary outcome. ; ; This will be assessed using emotional images from the International Affective Picture System (IAPS). Negative and neutral images will be presented on a computer screen using the presentation software package "Superlab'. Participants will have their ability to visually orient restricted by the use of a chin rest and a fixation cross onscreen. After each stimulus, reaction time for bodily reactions will be recorded using a mouse button, again recorded on 'Superlab". Heart rate will be recorded using ECG throughout to test for increased heart rate deceleration following negative stimuli (an established physiological reaction) and to control for known differences in cardiac response when an emotional stimulus is presented at systole compared with diastole.[Baseline and 8‐week follow‐up]