Suicidal Worrying : Online and Telephone
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Transcript of Suicidal Worrying : Online and Telephone
Suicidal Worrying:Online and Telephone
IFOTES Göteborg July 11th 2013
Ad Kerkhof
VU Vrije Universiteit Amsterdam
suicidal worries
Repetitive suicidal thinking
Rehearsing suicidal thoughts
Many hours a day
Loosing control over thinking
Chaos in my head
Suicidal Worries
Nobody loves meI cannot live aloneI have no futureI am unlovableI cannot stand my feelingsI have to stop thinking
Continuously
Motives for attempted suicide
Major influence (males-females in %):
The situation was so unbearable that I could not think of any other alternative (71-76%)
My thoughts were so unbearable, I could not endure them any longer (64-68%)
I wanted to die (65-59%)
Hjelmeland et al, SLTB, 2002, 32, 380-393
Suicidal Worries
I will never be normal againWhen will this stop?I am a total failurePeople are better off when I am dead, nobody will miss meI cannot stand the painI cannot live without partner
Unbearable
Clinical observations:
The continuous repetition of these statements in the end becomes an obsession that cannot be controlled anymore
Clinical observations:
The repetitive thinking about dying, about stopping consciousness, and about the motives to die, show characteristics of worrying
Worry:
“A chain of thoughts and images negatively affect-laden and relatively uncontrollable, as an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes”.
Borkovec, et al, Cognitive Therapy and Research, 1983, 22, 561-567
Rumination:
“Behaviors and thoughts that focus one’s attention on one’s depressive symptoms and on the implications of these symptoms, … passively and repetitively focusing on one’s symptoms of distress and the circumstances surrounding these symptoms”
Nolen-Hoeksema, 1991, 1997
Worry and Rumination:
rumination, worry, anxiety, depressionare all significantly correlated
Watkins et al, Behaviour Research and Therapy, 2005, 43, 1577-1585.
Worry and suicidal ideation:
Similar characteristics:
• Repetitive• Uncontrollable• Without immediate cause• Future oriented• Threats to personal concerns• No solution
Worry and suicidal ideation:
Similar consequences:
• No problem solving• Obssessive attention• Stress and sleeplessness• Vital exhaustion• Wish to stop consciousness• hopelessness
Worriers and suicidal patients:
Perceive personal threats Overpredict negative outcomes Underestimate their abilities to cope Maintain demanding standards Repeat futile attempts to solve Suffer because of this
Worry as determinant of suicidal behaviour
In suicidal behaviour people want to escape their own repetitive and tantalizing thoughts and feelings
Escape from self (Baumeister, 1990)
Warning:
Worrying can be lethal
Suicidal induction
With your permission: I am going to make you somewhat suicidal now.
If you are suicidal yourself, you will recognise the mechanism
I will try to get you out of this state again, at the end of the exercise
Suicidal induction
You have a song in your head This song will not go away Whatever you do, you will hear it May be a nice song, may be a boring
Choose for yourself a song
Or take ABBA: Waterloo………
Suicidal induction
Tonight you will hear Abba singing Waterloo, Waterloo, Waterloo, etc
You cannot stop it
The more you try to stop it, the louder they sing
Suicidal induction
When you go to sleep you hear ABBA
You cannot sleep because of ABBA
All night long you hear ABBA
Waterloo, Waterloo, Waterloo
Suicidal induction
Tomorrow morning you hear ABBA
Tomorrow, all day long you cannot stop ABBA
Tomorrow evening you hear ABBA
Waterloo, Waterloo, Waterloo
Suicidal induction
Tomorrow night again you cannot sleep because of ABBA
Second sleepless night you cannot stop ABBA
Waterloo, Waterloo, Waterloo
Suicidal induction
From Saturday to Sunday again you cannot sleep because of ABBA
Third sleepless night you cannot stop ABBA
On Sunday you will hear nothing but ABBA
Suicidal induction
Sunday evening you take more precautions: sleeping pills / alcohol
Fourth sleepless night you cannot stop ABBA
Waterloo, Waterloo, Waterloo
Suicidal induction
Monday you have to work, and you fear your exhaustion will be noticed
In your car, to your work, suddenly ABBA has gone, silence in your head
Out of relief, you put on the radio……
ABBA
Waterloo
Waterloo
Waterloo
Suicidal induction
Monday evening you take even more precautions: sleeping pills / alcohol
Fifth sleepless night you cannot stop ABBA
You are exhausted
Suicidal induction
Later that week you take even more precautions: sleeping pills / alcohol
You even don’t know how many nights you could not stop ABBA
You cannot endure ABBA any longer You are exhausted
Suicidal induction
Finally after having taken many pills / alcohol, you fall asleep
You wake up in a brightly lit environment
Turns out to be an Emergency Ward
Question?
Did you attempt suicide?
Or did you just wanted to escape ABBA
Change ABBA into worries
Imagine how it is to have other suicidal things instead of ABBA:
Memories of being raped Thoughts like being a failure Thoughts of loneliness Thoughts of killing yourself
Warning:
You might want to escape
Worrying can be lethal
Remember
This was only an exercise You will not hear ABBA for the rest of
your life You have not become suicidal Think of this exerxise as a metaphore Imagine this to be important when
you help the next suicidal caller
Volunteers:
There is nobody who loves me
1. How many times a day is this thought going through your mind?
2. How many hours a day are you contemplating this thought?
Volunteers:
I will throw myself in front of a train
1. How many times a day is this thought going through your mind?
2. How many hours a day are you contemplating this thought?
Volunteers:
My life has no meaning
1. How many times a day is this thought going through your mind?
2. How many hours a day are you contemplating this thought?
Volunteers:
I have no future
1. How many times a day is this thought going through your mind?
2. How many hours a day are you contemplating this thought?
Experience:
Mostly only a few such thoughts are rehearsed very frequently
These thoughts are prototypical They start as self-protection But in the end they are self-torturing Massive suffering because of this
repetition Try to understand the torturing mind
Treatment of suicidal worry
CBT approaches for worrying are applicable for suicidal worry (Tallis, Leahy)
1. Worry postponement2. Positive worrying3. Distraction4. Self fulfilling properties5. Mindfulness6. Overgeneralization7. Tolerance of uncertainty over the future