Rachel Bresnahan

April 20, 2026

In many real-world settings, suicide risk is often assessed using a single question such as item 9 on the Patient Health Questionnaire (PHQ-9). However, people do not always report suicidal thoughts directly, even when they are having them. This can make it harder to identify who may need more support. People living with bipolar disorder are particularly at risk; about 20 to 60% of people with bipolar disorder will attempt suicide at least once in their lifetime.

To address this gap, researchers from the Heinz C. Prechter Bipolar Research Program developed a new approach called the Network-Augmented Machine Learning Utility, or NAMU. NAMU is a computer model that uses a person's answers to routine depression questions collected on intake forms, such as the PHQ-9, to estimate an additional warning signal for suicidal thoughts.

Instead of looking only at how severe depression symptoms are overall, NAMU also examines which symptoms tend to appear together and how strongly they linked, creating what researchers call a symptom network. Looking at symptoms this way may help uncover risk signals that are missed by standard screening methods. 

Key findings

The research team behind NAMU, led by Hanjoo Kim, Ph.D., found that models combining symptom networks with machine learning outperformed traditional approaches that determine depression severity by summing scores across the PHQ-9 questions. The team also found that the NAMU performed well enough to be useful in real-world care, while still showing which symptoms and symptom patterns were most important in estimating risk.

Importantly, the NAMU model was successfully tested across multiple independent and diverse datasets totaling more than 800,000 people, showing that it can work across many different populations. NAMU also performed well in the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD), supporting its potential use in bipolar populations.

Why this matters

NAMU provides an added clinical warning signal that helps identify people who could be at risk, even when they do not report suicidal thoughts. 

Rather than relying on how severe symptoms are, this model also captures how symptoms relate to one another, offering a fuller picture of risk. 

What's next?

Building on the findings from “Predicting Suicidal Ideation from Depression Screening Data: A Network-Augmented Machine Learning Approach,” the Prechter Program is now working toward developing bipolar disorder-specific, personalized suicide risk prediction models using 20 years of data from the PLS-BD. The team is also exploring ways to extend the NAMU framework to better capture within-person dynamics, or how an individual changes and develops within their own contexts, over time. 

This work is part of a broader effort to create prediction tools that are more understandable, more scalable and more useful in real clinical settings, with the long-term goals of improving early detection and intervention for suicide risk, especially in complex populations such as bipolar disorder.

Open science: Introducing PNUT

To support broader use of this approach, the research team also developed PNUT (Personalized Network Utility Toolkit), an open-source tool that helps researchers to easily prepare data for NAMU analysis.

PNUT is now publicly available via GitHub, helping bridge the gap between symptom data, network analysis and machine learning applications.

Read the full publication here. 

New research from the Prechter Program shows that people living with bipolar disorder may strategically maintain negative feelings as a way of stabilizing mood.

Rachel Bresnahan

March 27, 2024

The Contrast Avoidance Model suggests that people who are sensitive to negative emotional shifts deliberately charge themselves with negative feelings to protect themselves from feeling worse when things go wrong. On the other hand, the model explains that heightened negative feelings can help them feel better when unexpectedly good things happen. This theory could be particularly relevant for people with bipolar disorder, a condition characterized by significant mood swings from feeling very up and excited (manic) to feeling very down (depressed).

According to this theory, when someone with bipolar disorder transitions from a depressive state to a (hypo)manic state, it is like moving from a low point to a high point. This shift can make the (hypo)manic phase feel even more exciting. Conversely, when they transition from a (hypo)manic state to a depressive state, it is like falling from a high point to a low point, which can intensify feelings of depression. Because people with bipolar disorder experience these mood swings repeatedly, they might use strategies to maintain their negative feelings to prevent their mood from worsening and to enhance their mood when they are up.

Researchers at the Prechter Program tested this theory by comparing people with bipolar disorder, people with depression, and people without these conditions. They found that people with bipolar disorder were more likely to use these strategies compared to the other two groups. This suggests that the strategy of avoiding emotional lows and enhancing emotional highs through maintaining negative feelings could be a key aspect of bipolar disorder.

For people with generalized anxiety disorder, relaxation exercises might have the opposite of the intended effect.

Relaxation-induced anxiety was first described in 1983, but the specific cause hasn’t been known, according to a recently published study in the Journal of Affective Disorders.

The authors, from Penn State University, tested their hypothesis that relaxation induces anxiety in people with generalized anxiety disorder (GAD), and possibly major depressive disorder (MDD), because they fear a sharp spike in negative emotion. To avoid that sharp spike, they prefer to worry nonstop instead of trying to relax.

For their study, the authors enrolled 96 college students, ranging in age from 18 to 34 years. Of the 96, there were 32 with GAD, 30 with MDD, and 30 controls with neither disorder.

Researchers first led participants in relaxation exercises, then showed them movie clips to elicit negative affect, measured how sensitive they were to changes in their emotional state, led them through the relaxation exercises again, and finally measured their anxiety levels.

Participants learned how to perform both progressive muscle relaxation and diaphragmatic breathing. Because the 2 techniques enhance relaxation in different ways, they might not equally elicit relaxation-induced anxiety, the authors noted, adding that future studies might want to administer them separately in the same people.

To elicit negative affect, the scientists used 2 video clips that had previously been validated for that purpose. The sad clip was a scene from “The Champ” in which a boy cries after seeing his father die in a brutal boxing match. The scary clip was a scene from “The Shining” in which a boy plays with toys in an ominous hallway. After viewing the clips, the participants answered questions designed to measure how sensitive they were to changes in their emotional state.

Sensitivity to changes in emotional state predicted relaxation-induced anxiety in participants with GAD and, to a lesser extent, in participants with MDD, the study found. “Our study found that AR [applied relaxation] may not be a panacea for everyone [with] anxiety and depression,” the authors concluded.

People with anxiety may actively resist relaxation and continue worrying to avoid a large jump in anxiety if something bad does happen, according to researchers.

Katie Bohn

September 30, 2019

UNIVERSITY PARK, Pa. — Relaxing is supposed to be good for the body and soul, but people with anxiety may actively resist relaxation and continue worrying to avoid a large jump in anxiety if something bad does happen, according to Penn State research.

In a new study, the researchers found that people who were more sensitive to shifts in negative emotion — quickly moving from a relaxed state to one of fear, for example — were more likely to feel anxious while being led through relaxation exercises.

Michelle Newman, professor of psychology, said the results could help benefit people who experience “relaxation-induced anxiety,” a phenomenon that occurs when people actually become more anxious during relaxation training.

“People may be staying anxious to prevent a large shift in anxiety, but it’s actually healthier to let yourself experience those shifts,” Newman said. “The more you do it, the more you realize you can do it and it’s better to allow yourself to be relaxed at times. Mindfulness training and other interventions can help people let go and live in the moment.”

Hanjoo Kim, a graduate student in psychology, said the study also sheds light on why relaxation treatments designed to help people feel better can potentially cause more anxiety.

“People who are more vulnerable to relaxation-induced anxiety are often the ones with anxiety disorders who may need relaxation more than others,” Kim said. “And of course, these relaxation techniques were meant to help, not make someone more anxious. Our findings will hopefully serve as a cornerstone for providing better care for these populations.”

Newman said that while researchers have known about relaxation-induced anxiety since the 1980s, the specific cause of this phenomenon has remained unknown. When Newman developed the contrast avoidance theory in 2011, she thought the two concepts might be connected.

“The theory revolves around the idea that people may make themselves anxious intentionally as a way to avoid the letdown they might get if something bad were to happen,” Newman said. “This isn’t actually helpful and just makes you more miserable. But, because most of the things we worry about don’t end up happening, what’s reinforced in the brain is, ‘I worried and it didn’t happen so I should continue worrying.’”

For this study, the researchers recruited 96 college students. Participants included 32 people with generalized anxiety disorder, 34 people with major depressive disorder and 30 controls with neither disorder.

When the participants arrived at the lab, the researchers led them through relaxation exercises before having them watch videos that may elicit fear or sadness. The participants then answered a list of questions designed to measure how sensitive they were to changes in their emotional state. For example, some people may be uncomfortable with the negative emotions incited by the videos right after relaxing, while others might find the relaxation session helpful in dealing with those emotions.

Next, the researchers led the participants through a relaxation session once more before having them fill out a second survey. These questions were designed to measure the participants’ anxiety during the second relaxation session.

After analyzing the data, the researchers found that people with generalized anxiety disorder were more likely to be sensitive to sharp spikes in emotion, like going from feeling relaxed to feeling scared or stressed. Additionally, this sensitivity was linked to feeling anxious during sessions intended to induce relaxation.

The researchers found similar results in people with major depressive disorder, although the effect wasn’t as strong.

Kim said he hopes the results — recently published in the Journal of Affective Disorders — may help clinicians provide better care for people with anxiety.

“Measuring relaxation-induced anxiety and implementing exposure techniques targeting the desensitization of negative contrast sensitivity may help patients reduce this anxiety,” Kim said. “Also, it would be important to examine relaxation-induced anxiety in other disorders, such as panic disorder and persistent mild depression.”

Leon Windscheid

April 21, 2021

"Hanjoo Kim von der Pennsylvania State University hat mir von einer neuen Untersuchung berichtet, in der dieser Zusammenhang gezeigt werden konnte.23 Menschen, die sich oft und viele Sorgen machen, durchliefen 2019 ein Entspannungstraining, wobei sich fand, dass die Entspannung – also ein kurzzeitiges Befreien von Sorgen – zu einem starken Anstieg der Angst führte. Entspannung löste bei diesen Menschen Angst aus. Das klingt merkwürdig und ergibt aus psychologischer Sicht doch Sinn. Mit Sorgen betäuben wir uns gegen Angst. In einem leicht angespannten Dauerzustand, in dem wir nie ganz zur Ruhe kommen, fühlen wir uns vorbereitet und halten so die eigentliche Angst, die den Sorgen zugrunde liegt, auf Abstand."

"Hanjoo Kim from Pennsylvania State University told me about a new study where this connection was demonstrated. People who worry a lot and frequently went through relaxation training in 2019, and it was found that relaxation – a temporary relief from worries – led to a significant increase in anxiety. Relaxation triggered anxiety in these individuals. This may sound odd but makes psychological sense. We numb ourselves against anxiety with worries. In a slightly tense, constant state where we never fully relax, we feel prepared and keep the actual anxiety underlying the worries at a distance."

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