If life must be lived, I think it's worth living well. Many are giving up with life and are contemplating suicide as an option. Sometimes those who hear them run away in fear of being co-joined. In all, suicide is preventable and anyone privy to a supposed victim's ordeals could help with a community-friendly therapy.
The World Health Organization's Factsheet on suicide records that death toll related to suicide gains reaches towards 800,000 yearly and has caused pain, grief and other related negative impacts on families, friends, colleagues, communities and societies where victims emerge.
During the 2019 World Summit on Suicide prevention, the World Health Organization’s (WHO) Director-General, Dr. Tedros Adhanom Ghebreyesus lamented that “despite progress in national prevention strategies, one person dies by suicide every 40 seconds”.source This was emphasized while highlighting key findings of the agency’s latest report on global suicide estimates.
What is Suicide?
According to the Stedman's Medical Dictionary for the Health Professions and Nursing (2005), suicide is the act of intentionally causing one's own death. The Suicide Fact sheet (2016) elucidates that suicide can be factored by mental disorders, including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, as well as substance abuse—including alcoholism and the use of drugs. Moreover, some suicides are impulsive acts due to stress, such as from financial difficulties, relationship problems such as breakups, or bullying. Other factors could be psychological states, cultural, family and social situations, genetics, and experiences of trauma or loss.(Hawton and van Heeringen, 2009; Dodds, 2017).
Suicide Ideation and methods
Suicide is never acted upon abruptly, it is planned by the victim over a process called Suicide ideation. Sicidal ideation, also known as suicidal thoughts is thinking about, considering, or planning suicide (Klonsky et al., 2016). The range of suicidal ideation varies from fleeting thoughts, to extensive thoughts, to detailed planning.
Suicide methods vary between countries, and is partly related to the availability of effective means. However, common methods include hanging, pesticide self-poisoning, and firearms. Records also has it that the suicide victims make several attempts numbering over 20 on the average before the finally take their lives. This shows that there are 1/19 chances where a supposed suicide victim can be saved. This therefore forms the onus of this write which focuses on the "Cognitive Behavioural Therapy" as a model for suicide prevention.
Simply put, suicides are preventable. This is possible though concerted efforts by an individual or at the family, community and national level. When timely, evidence-based and often low-cost interventions strategies are rightly engaged, then suicides can be handled.
Some strategic interventions that have shown success in reducing suicides include, early identification, restricting access to means of suicide; educating the media on responsible reporting of suicide; implementing programmes among young people to build life skills that enable them to cope with life stresses; and management and follow-up of people at risk of suicide.
Overview of Cognitive Behavioural Therapy (CBT)
The Cognitive Behavioural Therapy (CBT) founded by Dr. Aaron Beck for Suicide Prevention is an evidence-based, time-limited, manual cognitive-behavioral treatment for adults with suicidal ideation and behaviors and is directed to thoughts and behaviours and is considered transdiagnostic in nature.
All of human's actions start from the mind. The mind id the first brooding place for every act, whether good or bad. As such, ill behavious must be tackled from the instance of its conception in the mind. This is what makes CBT an awesome approach to preventing suicide ideation. Aaron Beck’s CBT model asserts that an individual’s biopsychosocial vulnerabilities can interact with suicidal thoughts and behaviors to produce a “suicide mode (Beck et al., 2001).
According to Wikipedia, the Cognitive behavioral therapy is a psycho-social intervention that has been widely applied to improve mental health. The focus of this model as a suicide prevention strategy is that it focuses on challenging and changing unhelpful cognitive distortions and behaviours, improves emotional regulation, and the develops personal coping strategies that target solving current problems.
Although a short-term approach, Cognitive behavioral therapy (CBT) and it involves the prescription of hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behaviour that are behind people's difficulties, and so change the way they feel. This helps the supposed victims to see that taking's one's life isn't the best option.
Applying CBT in Suicide Prevention
I remember visiting the General Hospital at Etinan and seeing a therapist attending to one of the Psychiatric patient for several minutes and I happened to identify the same patient with the Therapist in subsequent visits which led to my questioning on the activity and was told it was a therapy for suicide prevention. That is when I knew that some Psychiatric patients are not just those who went "mental", but also include those who think they are fed up with life and begin to exhibit some life threatening behaviours.
Suicide prevention with Cognitive Based Therpy involves three basic phases classified as:
- Telling the suicide story
- Building skills
- The Final Phase
The completion of three phases of the therapy is what assures that a supposed suicide victim have been rehablitated. An understanding of these phases helps one to become familiar with CBT strategies that can be adapted for suicidal treatment setting and used to intervene with vulnerable patients who are at risk for suicidal self-directed violence.
The therapy must ensure to make a thorough assessment of the patient’s psychiatric diagnosis and history, presenting problems, and risk and protective factors for suicide must be completed before treatment begins if necessary.
Lets take a look at the different phases of CBT and its application in suicide prevention.
Phase I: Telling the suicide story
This is the early phase of suicide prevention which focuses on treatment engagement, risk assessment, and crisis management. This treatment phase begins with the therapist completing a thorough suicide risk assessment, in addition to gathering other relevant information from the patient. This is swiftly followed by the therapist's guide to the patient to obtain a detailed narrative timeline of the most recent suicidal ideation (Stanley et al., 2009).
The Therapist is expected to establish a strong, early therapeutic alliance with the patient to avoid drop-out. He is exected to show genuine empathy and providing a safe, supportive, and nonjudgmental environment are instrumental for engaging patients in treatment.
The therapist is expected to listens carefully to the patient’s narrative, provide periodic summaries to check on accurate understanding, and keeps interruptions to a minimum. This narrative serves asa foundation for planning treatment and a model for understanding how best to deactivate the wish to die through the process of psychotherapy.
Phase II: Building skills
This is the intermediate phase of treatment. First, behavioral strategies are implemented to help the patient develop cognitive, behavioral, and affective copings skills. Examples of this include relaxation training, activity monitoring, and increasing social resources.
It is also important to not that cognitive strategies are implemented to help modify unhelpful beliefs associated with the risk of triggering a suicidal crisis. Patients must be educated about the cognitive model and are taught ways to evaluate their thoughts and beliefs. These strategies could include modifying core beliefs and identifying reasons for living (Stanley et al., 2009).
Specifically, a patient with underdeveloped skills in regulating anger and hatred toward himself during the intermediate or building stage is taught to modulate these problematic emotions more effectively. In addition, effective problem-solving strategies are reviewed and practiced.
The overall goal is to determine skill-based problem areas that are associated with the most recent episode of suicidal self-directed violence.
Phase III: The Final Phase
The final phase is modeled to accommodate several relapse prevention exercises. This is to consolidate skills learned during therapy. The main component of the relapse prevention exercises is a guided imagery task, in which the patient is directed to implement skills learned during therapy in response to imaginal exposure of past and potential future suicidal crises.
The purpose of this exercise is to highlight skills learned during therapy, and allow the patient to practice effective problem-solving strategies that are aimed at minimizing the recurrence of suicidal self-directed violence.
Once the patient is able to demonstrate generalization of skills learned, a debriefing and summary of skills learned is conducted. At this time, the provider will conduct a thorough risk assessment and offer additional treatment session or referrals as clinically indicated (Stanley et al., 2009).
In conclusion, this write showed that Cognitive Behavioural Therapy programme is an effective and acceptable intervention for suicidal idealists. Using the CBT framework, psychiatric diagnoses are conceptualized in terms of how the associated symptoms contribute to the activation, maintenance, and exacerbation of the suicide mode.
Next time you see a person trying out self-harm, lend a helping hand by contacting the nearby CBT Therapist who are always available in Psychiatric hospitals.
Thanks for the read!
- World Health Organization (2019). One person dies by suicide every 40 seconds: new UN health agency report. World Health Organization, Geneva.
- World Health Organisatin Summit on Suicide
- Suicide Fact sheet (2016). N°398". WHO. April 2016. Archived from the original on 4 March 2016. Retrieved 3 March 2016.
- Stedman's Medical Dictionary for the Health Professions and Nursing (2005)
- Hawton K, van Heeringen K (2009). Suicide. Lancet. 373 (9672): 1372–81.
- Dodds, (2017) https://www.psychiatrist.com/PCC/article/Pages/2017/v19n02/16r02037.aspx
- Klonsky, E. David; May, Alexis M.; Saffer, and Boaz Y. (2016). "Suicide, Suicide Attempts, and Suicidal Ideation". Annual Review of Clinical Psychology. 12 (1): 307–330.
- Beck, A.T., Wright, F.D. Newman, C.F., Liese, B.S. (2001). Cognitive Therapy of Substance Abuse. New York, London. Guilford Press.
- Stanley, B., Brown, G., Brent, D., Wells, K., Poling, K., Curry, J. Kennard, B. D., Wagner, A., Cwik, M., Klomek, A. B., Goldstein, T., Vitiello, B., Barnett, S., Daniel, S. and Hughes, J. (2009). Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility and Acceptability. J Am Acad Child Adolesc Psychiatry. 48(10): 1005–1013.