How to Treat Suicidal Thoughts the suicidal thoughts are undoubtedly the most serious psychopathological disturbance exists, since the risk of seriously put the life of the person who suffers.
In addition, dealing with this type of aspect is often very complex and should always be emphasized with great delicacy, professionalism and rigor, since a poor approach to suicidal thoughts can bring devastating and irreversible consequences.
How to Treat Suicidal Thoughts
In this article we will explain how these types of thoughts should be treated and what aspects should be taken into special consideration.
Evaluation of suicidal thinking
Knowing how to identify a suicide risk is a requirement that all mental health professionals must know.
As we have seen, the motivations, intentions and attitudes of a suicidal thinking can be very diverse; therefore it is important to evaluate the patient adequately to be able to detect its presence.
The objective of the evaluation is to estimate the risk of suicide in order to immediately implement the intervention plan that guarantees the safety of the patient’s life.
This evaluation should be performed through a clinical interview, which will allow identifying specific factors, signs and symptoms that may increase or decrease the risk of suicide. It must have four sections:
- Psychopathological exploration
The appearance and general behavior of the patient (appearance, hygiene, clothing, expression, etc.), level of contact, level of consciousness, alterations of attention and alterations of memory should be collected.
Likewise, speech and language should be explored, the speed of motor movements, the expressions of mood and affectivity, suicidal impulses and the level of tolerance to frustrations.
In this way, one should not be afraid to ask directly for ideas of suicide if one connotes indications that they can exist, and the answers given by the patient must be evaluated taking into account the form and the content of his thought.
In the case of suicidal thoughts, the role of the patient should be explored (active or passive), their motives, their idea of suicide, their suicide plans, and their degree of development.
- Assessment of risk factors
Those factors that may indicate an increased risk of suicidal thoughts and behaviors should be evaluated.
These are: chronic medical illnesses, advanced age, male sex, existence of a mental illness (especially major depression, alcoholism, schizophrenia, and borderline personality disorder), previous suicide attempts and difficulties sleeping.
Other aspects such as being single, having no job, having recently been discharged, impulsive traits, chronic stress, body wounds, death or loss of loved ones increase the risk of suicide.
- Protection Factors
However, other factors can reduce the likelihood of suicidal thoughts and behaviors, these are:
The feeling of personal value and self-esteem , having meaningful relationships and activities, being religious, being a woman and being pregnant, having a social support network , having a good social integration, having a flexible style of thinking, having children and having control skills .
- High Suicide Profile
The people most likely to commit suicide have the following characteristics:
They are depressed or have a major psychiatric disorder, are over 45 years old, are separated, divorced or widowed, are retired or unemployed, have chronic medical illnesses, personality disorder, have previously attempted suicide, have suffered from alcoholism and have poor support psychosocial.
Treatment of suicidal thoughts
Firstly, it must be taken into account that in those cases that the patient’s safety cannot be guaranteed, the patient should be admitted to a hospital to start treatment under control.
Subsequently, most serious suicidal thoughts require pharmacological treatment.
When choosing the drug should take into account the mental disorder underlying the idea of suicide.
Most are usually diagnosed with major depression, so they are usually treated with antidepressants.
In cases where suicidal thoughts are accompanied by large impulsive features or psychotic symptoms, atypical antipsychotics should be given.
The remaining patients are usually treated with benzodiazepines. Also, in very severe depressions or with psychotic symptoms, electroconvulsive therapy is usually an effective technique.
As far as psychological therapy is concerned, the role that the therapist acquires is fundamental for the proper approach to suicidal thoughts.
The main foundations that the therapist must have are:
- Activity: The therapist must be active so that the patient feels that something is happening. This aspect is fundamental to reestablish in the patient the feeling that he is important.
- Authority: The therapist must assume authority and lead the patient on a temporary basis. A patient with suicidal thoughts will find himself in a situation where he is not able to find solutions, so the therapist must guide him empathically.
- Involvement of others: people close to the patient will be keys to help you rebuild your feelings of self-esteem and self-confidence.
Likewise, to treat suicidal thoughts the following objectives must be achieved:
- Reduce the unbearable psychological pain experienced by the patient through understanding and empathic listening.
- Take into account the frustration of psychological needs and accept them as real.
- Give the subject an opportunity to manifest his situation and understand that for him the solution is suicide.
- Provide emotional support.
- Recognize the symptoms of hopelessness and not combat them with pessimistic expressions.
- Look for positive alternatives to the patient’s possible ambivalence.
- Always be alert to the messages of intent to commit suicide.
To achieve these goals, the therapist can perform the following psychological interventions:
- Work the “tunnel vision”
The patient has a narrow and rigid vision of reality on all its negative aspects, fact that causes that only sees a solution, the suicide.
Therefore, it is important to show them that there are other options. To do this, self-registrations will be made and work will be done:
Test the veracity of your thoughts in order to value your certainty and not automatically accept them.
Provide a system of beliefs or alternative schemes that offers explanations and visions different from yours.
Educate the patient to understand the emotional and situational nature of their cognitive distortions and their thoughts of suicide.
- Negotiate for a delay
The therapist must have built a good relationship with the patient to allow him to delay suicidal behavior. In this way, the stress of suicide will decrease without the need for it to be carried out, and the therapist will gain time to work with the patient in a calmer environment.
- Working with cognitive factors
People with suicidal thoughts have a negative view of themselves, the world and the future, so these three spheres must be worked out to get more neutral thoughts.
For this you can use:
- Cognitive techniques: detection of thinking, problem solving, understating, advantages and disadvantages, and exaggeration or paradox of thoughts.
- Behavioral techniques: activity programming, domain and pleasure assessment, task assignment, social skills training and assertiveness, role play therapy and behavioral testing.
What is suicide?
The word suicide proceeds etymologically from Latin and means, literally, killing itself.
For its part, the Dictionary of the Royal Spanish Academy defines suicide as “the act or conduct that damages or destroys the agent himself” and commits suicide as “the act of voluntarily taking life.”
With these three definitions we are not learning anything that we do not know to commit suicide means to take the life voluntarily, intentionally and planned.
Currently, both the ICD-10 diagnostic manual and the DSM-IV do not include suicide as a mental disorder; however, suicidal thoughts are included in different psychopathologies such as depression, personality disorders or schizophrenia.
However, it would be a mistake to think that all suicidal thoughts are identical and respond to the same situation.
Obviously, a person who thinks of death or the idea of suicide will not be the same as a person who has reflected on his own suicide, has designed a plan to carry it out and is totally focused on ending his life.
In the eyes of all, the first suicidal thought will seem less light and less likely to commit suicide, and the second will alarm us much more and we will interpret it as more dangerous and alarming.
However, the complexity of this type of thinking is not based on a simple specificity of its seriousness, reason why many authors have tried to organize them in different groups.
It is not the purpose of this article to review all the literature on the different classifications of suicidal thoughts since there have been many authors who have made their proposals and theories of categorization.
However, in order to clarify the complexity of these types of thoughts and to obtain a broader view of them, I find it interesting to comment on the different classifications made by León Fuentes in 1996.
This author very aptly indicated that thoughts and suicidal behaviors could be classified as follows:
- According to its etiology
Not all suicidal thoughts are based on the same bases, depending on the origin can be divided into 4 different types:
- Psychotic: when the thought of death is constituted by delirium and psychotic cognitions.
- Neurotic: when they are caused by a mental illness that distorts rational thinking, without it becoming delusional.
- Psychodisplastics: when the person suffers a psychopathic personality alteration and attacks himself.
- Philosophical: when suicidal thinking is originated by a feeling of existential void or depressive states.
- According to his intentionality
It should be borne in mind that, although a suicidal thought holds the idea of dying, it can have a myriad of intentions.
- Intent to die: when thinking is based on doing a behavior that ends with life and gets death.
- Escape from an unsustainable situation: when suicidal thinking aims to get out of a situation that produces high levels of discomfort, through death.
- Risk behavior: When suicidal behavior is subject to risky thoughts and dangerous activities.
- Ordain intentionality: when what is desired is suicide in itself, not death.
- Suicide as a rematch: when the act of committing suicide is intended to emotionally harm someone.
- Existential balance suicide: when suicidal thinking appears after making an assessment of the advantages and disadvantages of doing so.
- According to the results obtained
A suicidal thought can have different effects.
- Consummate suicide: when you try and you succeed in carrying out the suicide.
- Frustrated suicide: when suicidal behavior is achieved but the goal of dying is not achieved.
- Suicide attempt: When attempting to carry out suicidal behavior but not achieved.
- Idea of suicide: when you think of suicide but it does not take place.
- Idea of death: when thinking about death but not on the act of committing suicide.
- According to severity
According to the seriousness of suicidal thinking, it can be classified as fatal if the suicide has been consummated, very serious if the suicide has not been consummated but has put (or can put) a high danger the life of the patient, and slight when suicidal thinking does not imply a self-political act.
- According to the attitude
Finally, the person with suicidal thinking can adopt an active attitude towards killing or a passive attitude.
So we see that suicidal thoughts can be of many types, they may have different origins, of different modalities, and with different intentions and attitudes.
That is why, although all suicidal thoughts have aspects in common, it is important to evaluate them in detail before intervening.