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Managing suicidal thoughts

Updated: Sep 29

Operating a suicide prevention support service has given me the privilege to speak with numerous courageous individuals who have survived a suicide attempt. In particular, individuals looking for support after a suicide attempt. Of them, about 75% have continued to experience suicidal thoughts. Of those who do, around 40% are still experiencing thoughts of suicide more than 18 months after their attempt. The reasons for this are many and varied.


For some individuals, the feelings of hopelessness and helplessness linger after an attempt. Others experience suicidal ideation as part of the symptoms of an underlying mental illness. And for some, the desire to live doesn't return after their attempt. Regardless of the reason, the fact that thoughts can persist is something to be aware of, whether you're reading this as someone with lived experience, or you provide care and support to someone after a suicide attempt. Being aware gives space to better manage suicidal thinking.


Just as important as awareness of thoughts is the awareness that thoughts of suicide are in fact common. Many will experience a thought and assume it is a sign they need to end their life. Instead, suicidal thoughts are a sign that something in life needs to change. This is why, in managing the thoughts, one of the primary objectives is to minimise the risk of acting on the thoughts.


It's often the case that thoughts of suicide stem from overwhelming or severely intense emotions. Many individuals will speak of feelings of pain, unworthiness, rejection, helplessness, anger, or even emptiness. It's important to validate these feelings. They are present, they're trying to tell us something, they can feel unbearable. Just as important as validating such feelings is to remember that feelings are transient. It may feel like they hang around for days, but eventually they will pass. There's also ways in which we can tend to these feelings. This involves self-soothing. View our Self-Soothing Fact Sheet here.


Just like self-soothing, much of the work involved in minimising the impact of suicidal thoughts aims to reduce the intensity of the feelings and increase coping capacity. Increasing one's capacity to cope can include short-term crisis management strategies as well as long-term therapeutic approaches. An example of a short-term crisis management strategy is a safety plan. A safety plan details the steps an individual agrees to take to keep themselves safe when presented with a moment of crisis. You can view our example Safety Plan Template here.


Longer term therapeutic approaches can include CBT, which asks us to evaluate the factual components of our thinking and then challenge our thoughts. Additionally, DBT, which examines intense emotions and how we can use skills to recognise them and soothe them is another example. It's best to have the support of a Therapist when learning and practicing these strategies.


Much of the content so far, has revolved around change. One style of therapy, ACT encourages individuals to sit with the discomfort of emotions without judgement. ACT also inspires the ability to let thoughts come and go. To avoid believing them or getting caught up in them. This type of therapy can be demonstrated by the Pink Elephant analogy. When we're asked not to think of a pink elephant a pink elephant is the only thing we can think about. Yet if we had a thought of a pink elephant during any given day, we wouldn't pay too much attention and before long we would be onto the next thought.


Managing suicidal thoughts can seem challenging at the outset. Over time, practicing skills and implementing plans gets easier; particularly if you're supported. It's vital to remember that in the instance where you don't feel you can manage your thoughts yourself or you have a plan or intention to act on your thoughts that you talk with someone. Speaking with a friend, family member, crisis line, or therapist may not provide the ultimate solutions to the difficulties you are facing, but it will give you some time to lessen the impact of the thoughts or receive immediate assistance.


CBT - Cognitive Behaviour Therapy

DBT - Dialectical Behaviour Therapy

ACT - Acceptance and Commitment Therapy



 

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