Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 20 1 2025 01 31 12 21 Ahmad Alipour Department of Psychology, Payame Noor University, Tehran, Iran. Afsaneh Rahimi Department of Psychology, Payame Noor University, Tehran, Iran. Shahin Shadnia Department of Clinical Toxicology, Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mitra Rahimi Department of Clinical Toxicology, Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Peyman Erfan Talab Evini Department of Clinical Toxicology, Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sayed Masoud Hosseini Department of Clinical Toxicology, Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Babak Mostafazadeh Department of Clinical Toxicology, Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 07 28 2024 10 20 Objective: Automatic negative thoughts have an important role in development of a persistent negative cognitive bias, which may ultimately result in suicidal ideation. The primary objective of the present study was to examine the relationship between automatic negative thoughts and experiential avoidance in relation to psychological distress. Method: The study sample comprised 441 individuals who had attempted suicide. Participants underwent interviews utilizing standardized questionnaires including Automatic Thoughts Questionnaire, Kessler Psychological Distress Scale, Acceptance and Action Questionnaire–II, and Cognitive Emotion Regulation Questionnaire along with its nine subscales. After internal relationships assessment among the research variables, outlier detection was done using the boxplot analysis and standard deviation distance metrics. To analyze the direct and indirect associations between the input and output variables, Structural Equation Modeling (SEM) was employed. In addition, SPSS-28 and Amos 29 software were used to analyzed the data. Results: The final model showed that automatic negative thoughts were significantly inversely associated with adaptive cognitive emotion regulation (β = -0.42, P ≤ 0.01) and significantly positively related to both maladaptive cognitive emotion regulation (β = 0.49, P ≤ 0.01) and psychological distress (β = 0.53, P < 0.01). Additionally, experiential avoidance showed a significant positive relationship with maladaptive cognitive emotion regulation (β = 0.22, P < 0.01). Conclusion: This research demonstrated that automatic negative thoughts could worsen psychological distress through the regulation of cognitive emotion in those who had a history of suicide. By the clinical management of automatic negative thoughts and shifting individuals’ cognitive emotion regulation toward adaptive strategies, there is potential for a substantial reduction in suicidal ideation and attempts which can be evaluated in future clinical trials. https://ijps.tums.ac.ir/index.php/ijps/article/view/3977