Suicide has been a significant part of my research and a major element in my clinical practice treating people for the last 23 years. It is a tricky subject because there are so many variables and having been at this point myself and lost far too many friends to suicide, this is something I am extremely passionate about. I spend a large amount of my time reading and researching suicide treatments, new research and suicide prevention programmes around the world. It is also the main thrust behind my research and development of the “Immediate care Process.”
In an attempt to turn the tide, suicide researchers have increasingly been looking for more targeted ways to understand suicide. Emerging research drills into the details around who is at risk, the different routes suicidal ideation can take, and the common features of treatments that seem to work. Recognising that suicidal behaviour comes and goes, this approach aims to meet people at the period of highest risk and provide options and potentially solutions.
One of the most persistent problems in suicide prevention is assessing who will make an attempt. Research in the US led by Gregory Simon, MD, MPH, of the Group Health Research Institute in Seattle, found that of patients who admitted to suicidal ideation on the Patient Health Questionnaire Depression Scale, a commonly used outpatient measure, less than 10% engaged in suicidal behaviour in the following year (Psychiatric Services, Vol. 64, No. 12, 2013). Meanwhile, around half of people who attempt or die by suicide deny suicidal ideation beforehand (McHugh, C. M., et al., BJPsych Open, Vol. 5, No. 2, 2019).
To complicate matters further, suicidal ideation is not constant, and even the best-monitored patients typically assess their suicidal thoughts with a clinician only once a week. This can be extremely misleading. Imagine two patients with roughly the same time spent feeling suicidal each week. If one reported their level of suicidal thoughts during an ebb in ideation, they might appear to be at low risk. The other who fills out an assessment at a high point might seem at higher risk than they actually are. Clinicians should thus be looking for patterns, not single points in time. Research has shown that an acceleration in the ups and downs in ideation—the emotional roller coaster of suicidal thinking—might be an indicator of a period of increased risk (New Ideas in Psychology, Vol. 57, 2020).
Researchers are also working on posing better questions to adults at risk for suicide. Some patients may not want to admit suicidal thoughts because they’re afraid of involuntary hospitalisation, while others might experience suicidal ideation differently than what questionnaires ask. “This is where we put all of our eggs into one basket, where everything in screening hinges on this one concept: Asking, ‘Are you thinking about killing yourself?’”
Researchers in the US are working on alternative screeners that may get at the thoughts underlying a suicide attempt. Their Suicide Cognitions Scale asks patients how much they agree with statements such as “I don’t deserve to be forgiven” or “I can’t imagine anyone tolerating this pain.”
What these researchers have discovered in multiple studies is it actually predicts and identifies the patients who attempt suicide better than asking them directly if they are thinking of killing themselves,” Bryan said (Military Psychology, online first publication, 2021).
At times, helping those who are at risk has seemed an uphill battle. However, in a study led by University of Memphis president and clinical psychologist M. David Rudd, PhD, military members randomised to receive a brief cognitive behavioural therapy intervention were 60% less likely to make a suicide attempt in the following 2 years than those randomised to treatment as usual (The American Journal of Psychiatry, Vol. 172, No. 5, 2015). The intervention consisted of 12 individual psychotherapy sessions during which the clinician and the patient developed a crisis response plan, practiced basic emotion-regulation skills, and imagined using those skills to prevent their original suicidal crisis (1). A follow-up study on the crisis response plan—a living document in which patients strategize coping techniques, support networks, and reducing access to lethal means—found that crisis planning alone reduced suicide attempts by 76% over the next 6 months versus filling out a basic safety contract, which simply asked the patient to promise not to harm themselves (Journal of Affective Disorders, Vol. 212, 2017). Researchers are also looking at ways to help patients cope with suicidal thoughts that may intrude on their daily lives (2). A recent study led by Columbia University clinical psychologist Barbara Stanley, PhD, which used ecological momentary assessment to track how suicidal individuals coped with suicidal thoughts, found that distraction-based techniques (3), such as keeping busy or socialising, were best at lowering the intensity of suicidal thoughts (Journal of Psychiatric Research, Vol. 133, 2021).
The sections of text in the above paragraph are in bold and numbered because this directly reflects what the Immediate care Process is and does. It teaches 3 simple and highly effective emotional regulation tools and uses visualisation and revivification of past experiences to test that the intervention is having the desired effect. The three self-regulation techniques are:
- Negative Thought Pattern Interrupt – this does precisely what it says. It is a short, very simple mental exercise that interrupts the thought pattern and reduces the intensity of the negative emotions and feelings that a person is experiencing through their problematic thoughts. The person is in complete control of this technique and can use it at any time, in any situation, with any number of people around them and no one will know that they are using this method. This builds confidence, a sense of agency and hope that things can change. This technique can be used in as many rounds as is necessary for the person to reduce their emotional response to a 3 or less on the SUDS Scale.
- Whole Brain State – This is a breathing technique that incorporates a small amount of physical movement and a word, phrase, image or sound that the person identifies with that captures how they want to feel rather than how the currently feel. It is self induced and slows the frequency that their brain is operating in down into Alpha or Theta and thereby induces a trance state from which they can then redirect themselves into a positive, empowered high performance state.
- Anchoring – This is a very basic anchor conducted over 5 breaths that anchors the end state of the Whole Brain State to a physical action of their choice. This is tested 3 times through past and future experiences and finally in the present. This enables a person to access this calm, empowered state at will.
- There is a fourth step that goes further to reprocess problematic/traumatic memories.
“More is not better,” Rudd said. “The interventions that have demonstrated efficacy are brief, and the idea that the only way to have meaningful enduring impact and behavior change is with long-term care doesn’t appear to be supported scientifically.”
Treatments that work tend to be easy to understand, grounded in theory, and focused on treating patients as partners, Rudd said. They target identifiable skills such as emotion regulation and problem-solving, emphasise patient-driven management of care, and improve access to treatment and crisis services.
The Immediate Care Process is exactly that. It is easy to teach and learn, it is grounded in solid, reliable, well researched theory, it is easy to apply in practice and real time by a medical or mental health professional as well as by a person using it for themselves, thereby embedding patient-driven management of their own care. It speeds up access to treatment at crisis point because family members can learn these techniques to support mental health services and reduce the necessity and/or frequency of specialist mental health services and ultimately cutting costs.
Access is crucial because more than half of adults who have serious thoughts of suicide do not see a mental health professional and as such researchers are also looking for ways to expand access to the treatments with the most promise. The pandemic forced the expansion of telehealth for suicide prevention, which is still underresearched, wrote Simon Fraser University psychologist Alexander Chapman, PhD, and Philippa Hood in a recent commentary (The Behavior Therapist, Vol. 43, No. 8, 2020). Telehealth has the exciting ability to expand the geographic reach of suicide interventions and The Immediate Care Process has been delivered via video calls for the last 15 years very successfully.
A large proportion of people with suicidal ideation across socioeconomic lines initially seek treatment at Accident & Emergency departments, implementation science will be crucial to figuring out how best to support A&E staff in screening and then connecting patients with services that they can access and will find useful. This is a particularly pressing issue for teenagers, as DBT is the only well-validated, effective treatment for youth suicide prevention, but most paediatric patients can’t receive DBT because it is difficult to access and expensive, in fact this is much the same across all age groups.
Researchers are looking into options for self-administered treatment such as apps and tele-health and this is where the Immediate Care Process fits seamlessly because it is simple to teach, easy to learn and can be slotted into the existing infrastructure as a plug and play program. Training can be delivered online further reducing costs and speeding up delivery time.
If you would like further information please get in touch to arrange an initial call and to discuss how this can fit into your organisation, or of this is something that would be useful for you and your family.
In the meantime be well.
Source: Original article by Stephanie Pappas
Date created: August 25, 2021