Suicidal Behavior And Treatment


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evidence based understanding of suicide and treatment for suicidal patients. Gives a look into why people attempt suicide and some solutions clinicians can do to help.

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Suicidal Behavior And Treatment

  1. 1. Liz Wolf<br />Suicidal Behavior and Treatment<br />“Death is sometimes chosen as the only alternative by people who feel deeply alone and ashamed, yet are profoundly loved and respected” (McKeon, 53).<br />Research on suicide and suicidal behavior is scarce and according to McKeon, “we do not have research that inpatient treatment is effective, let alone under what circumstances hospitalization might be effective” (McKeon, 1). But one thing has been seen as a constant; very closely after inpatient discharge, for acute care of suicide, the patient is at high risk for suicidal behavior. “Most suicides occur within the first month of discharge” (McKeon, 36). Clinicians who treat suicidal individuals have to have various expertise and aptitudes in; assessment, treatment planning, crisis management, and knowing state law and regulations. <br />I am going to use an analogy to make suicide comparable to something that more people know and talk about, once you go from thinking about killing yourself to taking the action you have crossed the imaginary line and there is no going back you have desensitized yourself to death, it is like once you have crossed that imaginary line of being a social drinker to an alcoholic there is no going back you will always be an alcoholic. <br />In my opinion suicide is a trifold disorder biological, psychological, and environment. The neuropsychiatric theory on suicide has strong evidence, from identical twin studies, that genetics have a strong influence in suicide behavior. This theory also states that along with genetics playing a role that psychological and environmental components play in as well, “the genetic contribution to suicide presumably acts by creating a biological vulnerability, which then interacts with environmental factors to intensify risk” (McKeon, 26). There are a few psychological theories one of which is by Edwin Shneidman who states that suicidal individuals have a reason for their actions its to escape the intolerable psychological pain. “Cognitive constriction was a common characteristic of all suicidal individuals. Suicidal people have “tunnel vision” and don’t see alternatives to suicide as solutions for ending their pain” (McKeon, 28). Beck points out that suicidal people have an over general memory, a type of autobiographical memory that emphases that persons life history, and leans to remember their life in a general way and the events are distorted to be depressing and hopeless. Linehan’s model says, <br />“Suicidal persons frequently experience strong emotions; they respond emotionally to a wide variety of cues and their responses are intense. They have difficulty tolerating this emotional distress without resorting to behaviors that help them escape or moderate these intense and painful emotions” (McKeon, 29).<br />Joiner points out a very important fact, before the suicidal act is to ensue two things must exist before; desire to die and capacity to follow through. Then Joiner points out why people want to kill themselves. There are seven common reasons besides mental illness; the feelings of hopelessness, helplessness, being a burden, psychological pain, despair, don’t want to be conscious anymore. If people didn’t feel these emotions they probably wouldn’t want to die, they just want the unbearable pain to go away. With every attempt there is always ambivalence, “no matter how high the risk for an individual, no matter how deep and realistic the clinicians level of concerns, there is always hope” (McKeon, 15).<br />As sad as it is the number one mistake made by clinicians is not doing a thorough evaluation at intake with a solid suicide risk assessment, Suicide Assessment (C-CASA) and the Suicide Severity Rating Scale (CSSRS).<br />Most clinicians don’t even do a suicide risk assessment due to the fact that it is uncomfortable. And even when clinicians do a suicide risk assessment and the patient is seeing them because of a suicide attempt clinicians often make the error of treating them for the underlying condition, when the attention should be placed on how suicide risk will be assessed, managed, and treated. “It is important for therapists to treat the suicidal behaviors, thoughts, or desires directly” (McKeon, 31). Treating the underlying conditions doesn’t prevent suicidal behavior from occurring again; it doesn’t give the patient any tools to use in defense against the urges to engage in the behavior. <br />Treating suicidal patients is a multimodal treatment plan; there have been no studies that show that one form of treatment is more effective than another because every study has used a variety of treatment models. The three most common combinations of treatments are; medication management, short-term CBT focused on suicidal thoughts, and DBT long term. The most effective medication in preventing suicide according to scientific evidence is Lithium; this medication is usually used for Bipolar patients or Major Depression patients that are treatment resistant. Another medication that has had good results in preventing suicide in patients with Schizophrenia and Schizoaffective Disorder is Clozapine, these patients were “less likely to attempt suicide or be hospitalized for suicide risk” (McKeon, 39). Before starting DBT doing a short-term 12 week cognitive behavioral therapy sessions will help symptoms of depressions, anxiety, problem solve, distress tolerance, and distorted burdensome. After the 12-week therapy attending a long term DBT sessions will help in preventing suicide. To this day the best noted treatment for suicidal behavior is Dialectal Behavior Therapy and it is for people who have attempted suicide multiple times. Clinicians will want to examine the patient’s social withdrawal, isolation, and why the patient feels that they are a burden. The goal is to instill an awareness of belonging and presence of meaningful social connections.<br />The goal in therapy for suicidal behavior is to ease pain, make the intolerable a little more tolerable and maybe one day tolerable, and problem solve. In DBT one of the skills they teach is mindfulness, it is the core of the theory, “cultivation of mindfulness stands in direct opposition to the desire to die by suicide" (McKeon, 60). The reason being that suicidal people want to end consciousness/ attentiveness, mindfulness is a skill that requires you to perceive everything you experience in life “enhances conscious awareness” (McKeon, 60). Distress tolerance skills can help a suicidal person in a crisis to stay alive with the use of distraction tools long enough to solve the problems that are causing the pain. The second part of distress tolerance is radical acceptance. Emotional regulation skills can help the patient alter their actions based on emotions through behavior adjustment. The last DBT skill is interpersonal effectiveness where the patient integrates all parts of the therapy and uses assertiveness and does what is efficient for them. <br />In both CBT and DBT homework assignments are useful and effective. Diary cards help the suicidal person have knowledge of what leads up to their suicidal behavior, what their triggers are for acting out. The diary cards are done everyday and have on them suicidal ideation and if they acted in suicidal behaviors. <br />References<br />McKeon, R. (2009). Suicidal behavior. Ashland, OH: Hogrefe.<br />