1 00:00:00,440 --> 00:00:03,960 Welcome to Sheeper Assisted. I'm your host Sadie Sutton, a 19 2 00:00:03,960 --> 00:00:06,440 year old from the Bay Area studying psychology at the 3 00:00:06,440 --> 00:00:10,000 University of Pennsylvania. Sheeper Assisted is the teen 4 00:00:10,000 --> 00:00:12,880 mental health podcast made for teenagers by a teen. 5 00:00:13,360 --> 00:00:16,120 In each episode I'll bring you authentic, accessible and 6 00:00:16,120 --> 00:00:19,440 relatable conversations about every aspect of mental Wellness 7 00:00:19,960 --> 00:00:22,000 you can expect. Evidence based teen approved 8 00:00:22,000 --> 00:00:26,040 resources, coping skills including lots of DBT insights 9 00:00:26,040 --> 00:00:28,680 and education, and each piece of content you consume. 10 00:00:29,360 --> 00:00:32,439 She Persisted offers you a safe space to feel validated and 11 00:00:32,439 --> 00:00:35,160 understood in your struggle while encouraging you to take 12 00:00:35,160 --> 00:00:37,440 ownership of your journey and build your life worth living. 13 00:00:37,840 --> 00:00:41,720 So let's dive in. This week on She Persisted. 14 00:00:42,320 --> 00:00:45,880 We know that connecting with people when we're depressed, 15 00:00:45,880 --> 00:00:47,960 that's really helpful. And yet the nature of those 16 00:00:47,960 --> 00:00:51,440 mental health struggles is that you want to avoid those things. 17 00:00:51,440 --> 00:00:54,600 They seem like they're too much to even take on. 18 00:00:54,800 --> 00:00:58,040 And so I think about that a lot with suicidal thoughts that that 19 00:00:58,040 --> 00:01:00,600 hopelessness feels like there isn't any point in doing 20 00:01:00,600 --> 00:01:03,880 anything. And when someone says to someone 21 00:01:03,880 --> 00:01:06,080 who's hopeless, well, why don't you just do these things and 22 00:01:06,080 --> 00:01:08,600 you'll feel better? Unfortunately, that can make 23 00:01:08,600 --> 00:01:11,880 things worse because the person would feel ashamed for not being 24 00:01:11,880 --> 00:01:13,960 able to do those things that might help them. 25 00:01:14,560 --> 00:01:17,440 Hello, hello and welcome to She Persisted. 26 00:01:17,960 --> 00:01:19,640 We're starting off with little trigger warning. 27 00:01:19,640 --> 00:01:22,240 We are talking about suicidal thoughts and behaviors today, 28 00:01:22,240 --> 00:01:25,600 which can be a heavier topic. We came at this from a really 29 00:01:25,600 --> 00:01:27,720 intentional and evidence based approach. 30 00:01:27,720 --> 00:01:30,200 We have a clinical psychologist on the podcast today who's been 31 00:01:30,200 --> 00:01:33,720 involved in a lot of research on suicidal thoughts and behavior. 32 00:01:33,720 --> 00:01:37,080 So we definitely come at this from a lens that is clinically 33 00:01:37,080 --> 00:01:42,320 supported and not intentionally triggering or graphic or 34 00:01:42,320 --> 00:01:44,240 anything like that. But this is the heavier topic. 35 00:01:44,240 --> 00:01:47,080 And I know personally in my journey, there was a long time 36 00:01:47,080 --> 00:01:51,160 where anything that related to suicidal ideations or behaviors, 37 00:01:51,160 --> 00:01:53,800 I steered clear from intentionally because it was a 38 00:01:53,800 --> 00:01:56,600 trigger that brought up those thoughts and engaging in those 39 00:01:56,600 --> 00:01:59,920 in any capacity wasn't effective and was in some cases 40 00:01:59,920 --> 00:02:02,440 maladaptive. So be mindful, decide if this is 41 00:02:02,440 --> 00:02:04,160 for you. If it's not for you, if you're 42 00:02:04,160 --> 00:02:06,640 someone who's listening to this episode to support someone else, 43 00:02:06,640 --> 00:02:09,919 definitely recommend we talk a lot about how you can actually 44 00:02:10,120 --> 00:02:12,080 support someone, what they're are going through, why they're 45 00:02:12,080 --> 00:02:13,600 having these thoughts and feelings. 46 00:02:13,600 --> 00:02:15,960 And I think from that perspective, this episode is 47 00:02:15,960 --> 00:02:17,520 incredible. So if you're also listening and 48 00:02:17,520 --> 00:02:18,360 you're like. This isn't. 49 00:02:18,360 --> 00:02:20,920 Something I'm struggled with but like I have a friend or a family 50 00:02:20,920 --> 00:02:23,280 member. You're going to love this, but 51 00:02:23,560 --> 00:02:27,520 wanted to give that initial warning before we get into the 52 00:02:27,520 --> 00:02:31,160 episode because it is a heavier topic and set your own 53 00:02:31,160 --> 00:02:33,840 boundaries. But with that, we have Katherine 54 00:02:33,840 --> 00:02:36,680 Gordon on the podcast today. She's a licensed psychologist, 55 00:02:36,680 --> 00:02:39,600 speaker, and author. She specializes in cognitive 56 00:02:39,600 --> 00:02:42,880 behavioral therapy, also known as CBT, and she's written 57 00:02:42,880 --> 00:02:46,040 several books on using CBT skills to prevent suicide. 58 00:02:46,040 --> 00:02:47,880 So we talk about a lot of different things in this 59 00:02:47,880 --> 00:02:50,080 episode. We talk about why people have 60 00:02:50,080 --> 00:02:51,880 suicidal thoughts, which is something which is really 61 00:02:51,880 --> 00:02:55,240 misunderstood and not widely known. 62 00:02:55,440 --> 00:02:58,160 We talk about how suicidal ideations and thoughts 63 00:02:58,160 --> 00:03:01,000 progresses to behaviors. We talk about healthy 64 00:03:01,000 --> 00:03:04,480 conversations about suicide and what you can do to promote those 65 00:03:04,480 --> 00:03:07,200 healthy convos. We talk about Co ruminating and 66 00:03:07,200 --> 00:03:10,520 setting boundaries, what to expect when you are in therapy 67 00:03:10,520 --> 00:03:13,000 for suicidal thoughts or behaviors, which is another huge 68 00:03:13,000 --> 00:03:14,960 point of anxiety for a lot of people. 69 00:03:14,960 --> 00:03:17,320 So I hope that's helpful to kind of shed some light on. 70 00:03:17,400 --> 00:03:20,680 We touch on CBT skills that are most effective for suicidal 71 00:03:20,680 --> 00:03:22,760 thoughts, which I was really excited to touch on because 72 00:03:22,800 --> 00:03:25,560 that's not not something that's widely known or accessible or 73 00:03:25,560 --> 00:03:27,080 available in the mental health space. 74 00:03:27,080 --> 00:03:29,160 You kind of have to dig for it. So I'm really excited for you 75 00:03:29,160 --> 00:03:32,760 guys to hear that perspective. And lastly, resources for 76 00:03:32,760 --> 00:03:36,040 someone when they are in a crisis or navigating really 77 00:03:36,040 --> 00:03:38,200 intense suicidal ideation or behaviors. 78 00:03:38,440 --> 00:03:41,760 So I hope you guys find value from this episode. 79 00:03:41,760 --> 00:03:44,600 It's information that I wish I would have had access to earlier 80 00:03:44,600 --> 00:03:49,280 on in my journey and provide so much insight and perspective. 81 00:03:49,280 --> 00:03:51,400 If you know someone in your life who's struggling with these 82 00:03:51,400 --> 00:03:54,920 thoughts and behaviors and again, listen at your own risk. 83 00:03:54,960 --> 00:03:58,080 We again tried to be really, really intentional and come at 84 00:03:58,080 --> 00:04:00,280 this from an evidence based perspective where we're not 85 00:04:00,280 --> 00:04:02,600 doing anything that's known to trigger these thoughts and 86 00:04:02,600 --> 00:04:04,920 behaviors. But be mindful and you know 87 00:04:04,920 --> 00:04:07,200 yourself best. And if you guys do find this 88 00:04:07,200 --> 00:04:10,000 episode, make sure to share with a friend or family member, post 89 00:04:10,000 --> 00:04:12,320 about it on social media. This is information that can 90 00:04:12,320 --> 00:04:15,680 really help and save lives. And so if you find it valuable, 91 00:04:15,680 --> 00:04:18,920 if you find it relevant to your journey or others, make sure to 92 00:04:18,920 --> 00:04:22,520 share and leave a review. So with that, let's dive into 93 00:04:22,520 --> 00:04:24,600 the episode. Well, thank you so much for 94 00:04:24,600 --> 00:04:27,040 joining me today, Catherine. I'm so excited to have you on 95 00:04:27,040 --> 00:04:28,560 the podcast. This is. 96 00:04:29,080 --> 00:04:33,200 An episode and conversation I don't think is had on a lot of 97 00:04:33,200 --> 00:04:35,920 podcasts even in the mental health niche, but I think it's 98 00:04:35,920 --> 00:04:38,600 something that's really important for people to be aware 99 00:04:38,600 --> 00:04:41,920 of, especially from an evidence based perspective and getting 100 00:04:41,920 --> 00:04:44,600 that expert opinion. So I'm really excited to have 101 00:04:44,600 --> 00:04:49,000 you on today and talk about your work and your workbook and all 102 00:04:49,000 --> 00:04:52,600 things suicidal thoughts, ways to cope with that, different 103 00:04:52,600 --> 00:04:54,800 interventions, how to prevent suicide. 104 00:04:55,120 --> 00:04:58,080 But to get started, can you tell me a little bit about your 105 00:04:58,080 --> 00:05:01,960 background and why you decided to go into psychology and then 106 00:05:01,960 --> 00:05:03,800 specialize in this specific area? 107 00:05:04,440 --> 00:05:06,120 Sure. Thank you so much for having me 108 00:05:06,120 --> 00:05:07,720 on. I just think it's wonderful to 109 00:05:07,720 --> 00:05:10,800 create more space for these types of conversations. 110 00:05:11,080 --> 00:05:14,400 We know that they're really important and that also there is 111 00:05:14,400 --> 00:05:18,000 a lot of fear and shame around suicidal thoughts. 112 00:05:18,000 --> 00:05:20,520 So making it accessible like this is really important. 113 00:05:20,520 --> 00:05:26,160 So thank you for inviting me on to focus on the background of 114 00:05:26,160 --> 00:05:29,640 how I got into it. Basically, my father is a 115 00:05:29,640 --> 00:05:32,000 therapist. And so I had kind of just grew 116 00:05:32,000 --> 00:05:37,040 up with some awareness of mental health issues and also just 117 00:05:37,480 --> 00:05:41,760 overtime, maybe especially as a teenager, knew a lot of people 118 00:05:41,760 --> 00:05:43,720 who are struggling with different mental health 119 00:05:43,720 --> 00:05:45,040 problems. And I was always really 120 00:05:45,040 --> 00:05:47,760 interested in psychology. And so when I was an 121 00:05:47,760 --> 00:05:51,920 undergraduate student, I was able to work with Doctor Thomas 122 00:05:51,920 --> 00:05:55,600 Joyner and learn about eating disorders and suicide 123 00:05:55,600 --> 00:05:57,960 prevention. And what I learned is that that 124 00:05:57,960 --> 00:06:01,880 those two areas were really understudied at the time that 125 00:06:02,200 --> 00:06:07,120 there was such a need for more research about what causes 126 00:06:07,120 --> 00:06:10,840 suicidal thoughts and behaviors and how to help people with 127 00:06:10,840 --> 00:06:15,120 suicidal thoughts and behaviors. So really that inspired and 128 00:06:15,120 --> 00:06:19,040 sparked passion to continue pursuing that area. 129 00:06:19,320 --> 00:06:22,880 And in addition to all of us know people in our lives or we 130 00:06:22,880 --> 00:06:24,720 ourselves have struggled with different things. 131 00:06:24,720 --> 00:06:28,480 And so those pieces pulling together are what really led me 132 00:06:28,480 --> 00:06:32,120 down the path of focusing on suicide prevention and eating 133 00:06:32,120 --> 00:06:34,840 disorders. Yeah, I really like that 134 00:06:34,840 --> 00:06:39,280 framework you presented of like why people feel suicidal and 135 00:06:39,280 --> 00:06:41,440 then what we can do to support and help. 136 00:06:41,440 --> 00:06:45,160 And I definitely want to touch on the the piece of shame and 137 00:06:45,160 --> 00:06:49,240 kind of different responses when you go to someone and express 138 00:06:49,240 --> 00:06:52,480 that you're feeling suicidal. I was at ABCT this weekend and 139 00:06:52,720 --> 00:06:57,200 we're talking about digital resources and ethical concerns. 140 00:06:57,200 --> 00:07:00,680 And that's obviously like a big layer there, especially when 141 00:07:00,680 --> 00:07:04,080 you're not interfacing with a therapist and so excited to get 142 00:07:04,080 --> 00:07:07,040 all your thoughts. But to back things up a bit, I 143 00:07:07,040 --> 00:07:10,680 think a lot of people either have never experienced suicidal 144 00:07:10,680 --> 00:07:13,320 thoughts or they have experienced them, but they don't 145 00:07:13,320 --> 00:07:16,240 understand why. Like even though this is their 146 00:07:16,240 --> 00:07:19,040 only of experience and the emotions are coming up for them, 147 00:07:19,040 --> 00:07:21,960 there's kind of that disconnect of like, why am I responding to 148 00:07:21,960 --> 00:07:25,480 situations with these thoughts or why is this the way that I'm 149 00:07:25,480 --> 00:07:28,040 coping with this? So to kind of give some 150 00:07:28,040 --> 00:07:32,120 increased understanding for for both perspectives, why do people 151 00:07:32,120 --> 00:07:34,800 have suicidal thoughts or suicidal ideation? 152 00:07:34,800 --> 00:07:37,560 And then I'm sure we'll also get into behaviors as well. 153 00:07:38,440 --> 00:07:41,280 It's a great question. I was at ABCT as well, so I wish 154 00:07:41,280 --> 00:07:42,760 I would have had we could have we. 155 00:07:42,760 --> 00:07:44,760 Should have connected, yes. Oh. 156 00:07:44,840 --> 00:07:49,520 My gosh, yes. You know, it's a really, really 157 00:07:49,520 --> 00:07:53,120 important question. And in terms of what causes 158 00:07:53,120 --> 00:07:56,440 suicidal thoughts, there are two scientific theories in 159 00:07:56,440 --> 00:08:01,760 particular that have helped me to understand what prompts 160 00:08:01,760 --> 00:08:05,800 suicidal thoughts. And I found that one, it's 161 00:08:05,800 --> 00:08:08,320 important that they've been scientifically tested and have 162 00:08:08,320 --> 00:08:11,280 some empirical support for them, but also too, in my work as a 163 00:08:11,440 --> 00:08:14,720 therapist, that they tend to resonate with people struggle 164 00:08:14,720 --> 00:08:17,520 with suicidal thoughts. The 1st is the interpersonal 165 00:08:17,520 --> 00:08:22,240 theory of suicide by Thomas Joyner and colleagues, and it 166 00:08:22,240 --> 00:08:25,720 really focuses on the idea that suicidal thoughts tend to rise 167 00:08:25,920 --> 00:08:29,560 when someone is feeling isolated and alone, like they don't 168 00:08:29,560 --> 00:08:33,440 belong simultaneously, they're feeling like they're a burden on 169 00:08:33,440 --> 00:08:35,799 others. And importantly, it's the 170 00:08:35,799 --> 00:08:38,280 perception that they're a burden, that the people in their 171 00:08:38,280 --> 00:08:42,039 lives are negatively impacted by them continuing living. 172 00:08:42,039 --> 00:08:47,800 And so the idea is if you feel alone and like your existence is 173 00:08:47,800 --> 00:08:51,640 a burden on others and you're hopeless about those being able 174 00:08:51,640 --> 00:08:58,120 to change that, the idea of escaping that pain and finding a 175 00:08:58,120 --> 00:09:02,360 way out makes sense. It's it's really hard to think 176 00:09:02,360 --> 00:09:05,080 about, but it also makes sense when someone is in that much 177 00:09:05,080 --> 00:09:09,120 pain, that suicide would come up as a way to think about escaping 178 00:09:09,120 --> 00:09:11,400 that pain. So that's that's one framework. 179 00:09:11,400 --> 00:09:13,760 The other framework, the three-step theory by David 180 00:09:13,760 --> 00:09:16,880 Klonsky and colleagues, the three-step theory of suicide, 181 00:09:16,880 --> 00:09:21,400 talks about that suicidal thoughts arise when someone is 182 00:09:21,400 --> 00:09:23,160 in pain and they're hopeless about it. 183 00:09:23,160 --> 00:09:26,560 And the pain can be emotional pain, physical pain, different 184 00:09:26,560 --> 00:09:29,160 types of pain. But the idea is that the pain is 185 00:09:29,160 --> 00:09:33,600 so strong and again, that belief that it's never going to change. 186 00:09:33,600 --> 00:09:38,520 And so suicide arises as a way to think about escaping that 187 00:09:38,520 --> 00:09:39,840 pain. And it's not something that 188 00:09:39,840 --> 00:09:43,320 people are doing intentionally. It's something that our minds 189 00:09:43,320 --> 00:09:48,160 and brains do in reaction to feeling that horrible. 190 00:09:49,640 --> 00:09:53,840 It's really interesting because especially if people listening, 191 00:09:53,840 --> 00:09:57,520 I've taken psychology classes or you like have some general idea 192 00:09:57,520 --> 00:10:01,000 of evolutionary theory. It's not an adaptive response to 193 00:10:01,000 --> 00:10:03,200 pain. Like it's not problem solving. 194 00:10:03,200 --> 00:10:07,360 It's not seeking out support. It's really counterintuitive. 195 00:10:07,360 --> 00:10:11,040 And I think that's what people struggle to empathize with when 196 00:10:11,040 --> 00:10:13,480 someone comes to them and says I'm feeling suicidal or I've 197 00:10:13,480 --> 00:10:16,560 been suicidal or this is something I've struggled with in 198 00:10:16,560 --> 00:10:18,360 the past. Do you have any thoughts there 199 00:10:18,360 --> 00:10:21,720 on kind of why there's this mismatch of how you would 200 00:10:21,720 --> 00:10:26,080 intuitively cope with and experience or think about it and 201 00:10:26,080 --> 00:10:29,680 then the way that people do, especially when they are feeling 202 00:10:29,680 --> 00:10:32,720 like a burden or grappling with that hopelessness? 203 00:10:33,960 --> 00:10:37,360 Thank you for asking that because I think you're exactly 204 00:10:37,360 --> 00:10:41,360 right about that mismatch. But what that speaks to is not 205 00:10:41,360 --> 00:10:45,440 that people who are struggling, not their unwillingness to do 206 00:10:45,440 --> 00:10:48,600 things that are helpful, but what it speaks to is the cruelty 207 00:10:48,600 --> 00:10:52,240 of mental health problems and the way that when we're 208 00:10:52,240 --> 00:10:55,640 suffering and struggling, it's actually hardest to do the 209 00:10:55,640 --> 00:10:59,800 things that would help us most. For example, we know that 210 00:10:59,960 --> 00:11:03,440 connecting with people when we're depressed or anxious, in a 211 00:11:03,440 --> 00:11:04,720 lot of ways that's really helpful. 212 00:11:04,720 --> 00:11:07,880 We know that when we fear things, the thing that helps the 213 00:11:07,880 --> 00:11:11,120 most is to face those fears. And yet the nature of those 214 00:11:11,120 --> 00:11:14,640 mental health struggles is that you want to avoid those things. 215 00:11:14,960 --> 00:11:18,360 They seem like they're too much to even take on. 216 00:11:18,600 --> 00:11:22,280 And so I think about that a lot with suicidal thoughts that that 217 00:11:22,280 --> 00:11:24,880 hopelessness feels like there isn't any point in doing 218 00:11:24,880 --> 00:11:28,160 anything. And when someone says to someone 219 00:11:28,160 --> 00:11:30,320 who's hopeless, well, why don't you just do these things and 220 00:11:30,320 --> 00:11:32,840 you'll feel better? Unfortunately, that can make 221 00:11:32,840 --> 00:11:36,600 things worse 'cause it can feel the person can feel ashamed for 222 00:11:36,600 --> 00:11:40,360 not thinking about it that way or not being able to do those 223 00:11:40,360 --> 00:11:43,800 things that might help them. And so I think that's a lot 224 00:11:43,800 --> 00:11:47,600 where therapy certainly, but also our support networks, our 225 00:11:47,600 --> 00:11:52,200 friends and family can help people to take those steps that 226 00:11:52,200 --> 00:11:56,200 feel they feel impossible sometimes to take those steps 227 00:11:56,200 --> 00:11:58,600 when you're in that level of agony and anguish. 228 00:12:00,520 --> 00:12:04,560 Another question that I want to ask you is we have like this 229 00:12:04,560 --> 00:12:07,560 idea of suicidal ideations with thinking about suicide. 230 00:12:07,560 --> 00:12:12,000 And then obviously some people engage in behaviors based on 231 00:12:12,000 --> 00:12:15,120 those ideations. And I would love to get your 232 00:12:15,120 --> 00:12:18,280 perspective there, especially for people listening that don't 233 00:12:18,760 --> 00:12:21,240 know how to support someone navigating that or they're not 234 00:12:21,240 --> 00:12:24,560 empathizing from experience and they're like, I don't understand 235 00:12:24,560 --> 00:12:27,160 why you're feeling this way. But also then why you would act 236 00:12:27,160 --> 00:12:29,760 on these feelings. What are what are your thoughts 237 00:12:29,760 --> 00:12:31,560 there? And kind of how that escalates, 238 00:12:31,560 --> 00:12:33,360 I guess would be the the correct term. 239 00:12:34,280 --> 00:12:37,640 I was actually watching a piece of a movie, a suicide 240 00:12:37,640 --> 00:12:41,080 documentary earlier today, and Thomas Joyner's interviewed and 241 00:12:41,080 --> 00:12:44,720 he says even if you haven't experienced suicidal thoughts, 242 00:12:44,720 --> 00:12:47,280 all of us have been through painful experiences. 243 00:12:47,280 --> 00:12:51,320 All of us have felt horrible. And so if you can imagine that 244 00:12:51,320 --> 00:12:55,240 and multiply it by 10100 times, whatever it is, you get some 245 00:12:55,240 --> 00:12:59,880 sense of how hard it is when you're feeling that bad to do 246 00:12:59,880 --> 00:13:02,840 things that might help you because you might just you're 247 00:13:03,080 --> 00:13:06,880 overwhelmed by it. And so I think that one of the 248 00:13:06,880 --> 00:13:11,480 things that is very hopeful overall is that little things 249 00:13:11,480 --> 00:13:16,560 that can support a person. So listening to them non judge 250 00:13:16,560 --> 00:13:20,280 mentally and allowing space for them to talk about the suicidal 251 00:13:20,280 --> 00:13:26,040 thoughts can actually make a huge impact because the opposite 252 00:13:26,040 --> 00:13:29,440 where it's saying something judgmental or you have so many 253 00:13:29,440 --> 00:13:31,680 good things in your life, why don't you look at the bright 254 00:13:31,680 --> 00:13:32,560 side? Why don't you have some 255 00:13:32,560 --> 00:13:35,200 perspective or why don't you just do this, this and this? 256 00:13:35,480 --> 00:13:38,960 If a person is already feeling so bad, like they're burdening 257 00:13:38,960 --> 00:13:41,400 others, there's something really wrong with them. 258 00:13:41,400 --> 00:13:45,120 They're isolated and alone. Having someone say you should 259 00:13:45,120 --> 00:13:49,520 just do this, that just prompts more and more shame because 260 00:13:49,520 --> 00:13:51,720 often the person is already thinking that they're already 261 00:13:51,720 --> 00:13:53,560 thinking, why can't I get myself out of this? 262 00:13:53,560 --> 00:13:56,520 They're trying to get themselves out of it, so to have someone 263 00:13:56,520 --> 00:14:00,120 respond that way, it kind of confirms that idea that they're 264 00:14:00,120 --> 00:14:03,120 wrong and that they're not doing the right things and that 265 00:14:03,120 --> 00:14:07,040 there's something that is unacceptable about what they're 266 00:14:07,040 --> 00:14:09,320 experiencing and how they're responding to it. 267 00:14:10,440 --> 00:14:12,720 You mentioned listening empathetically. 268 00:14:12,920 --> 00:14:14,280 I'm sure you get this question all the time. 269 00:14:14,280 --> 00:14:17,720 And it's also like a big general media question, which is how do 270 00:14:17,720 --> 00:14:20,520 we talk about suicide and suicidal ideation? 271 00:14:20,520 --> 00:14:23,600 Because it can be very triggering for for people. 272 00:14:23,600 --> 00:14:27,760 And if you've been in therapy contacts, maybe group therapy, 273 00:14:27,760 --> 00:14:29,960 DBT can sometimes be a little bit different. 274 00:14:29,960 --> 00:14:33,520 But like you were saying, it can sometimes be discouraged to talk 275 00:14:33,520 --> 00:14:35,640 about these things. And there is of course 276 00:14:35,640 --> 00:14:39,000 literature supporting reasons why maybe certain settings 277 00:14:39,000 --> 00:14:40,400 aren't the best place to bring these up. 278 00:14:40,400 --> 00:14:43,560 But what are the best practices with having these conversations, 279 00:14:43,560 --> 00:14:45,760 both from the perspective of someone that's looking to ask 280 00:14:45,760 --> 00:14:49,240 for help or or be vulnerable, and then also people that are 281 00:14:49,240 --> 00:14:53,000 wanting to offer support and not wanting to to trigger someone's 282 00:14:53,000 --> 00:14:57,760 experience or bring attention to something if the person is like 283 00:14:57,760 --> 00:14:59,520 moved through it or coped past it. 284 00:15:00,160 --> 00:15:04,880 I think that this is something that is on a lot of people's 285 00:15:04,880 --> 00:15:07,640 minds when they're feeling the complications of helping and 286 00:15:07,640 --> 00:15:09,760 supporting others. So I'm glad for the opportunity 287 00:15:09,760 --> 00:15:14,640 to talk about it in general. And it's there are individual 288 00:15:14,640 --> 00:15:17,720 differences depending on and what people need and how they 289 00:15:17,720 --> 00:15:21,960 feel supported. But in general, I'm in favor of 290 00:15:22,120 --> 00:15:27,480 being direct, open and honest because anything else just 291 00:15:27,480 --> 00:15:30,880 confirms that idea that it's unspeakable and that the person 292 00:15:30,880 --> 00:15:34,480 can't talk about it. And so I think just starting 293 00:15:34,480 --> 00:15:37,720 with open-ended questions, how do you feel? 294 00:15:38,160 --> 00:15:40,080 What do you think LED you to feel that way? 295 00:15:40,600 --> 00:15:44,080 That sounds really hard. Simple, empathic, non judgmental 296 00:15:44,080 --> 00:15:46,600 statements like that are helpful. 297 00:15:46,600 --> 00:15:50,920 I think that's really hard to do because it's uncomfortable and 298 00:15:50,920 --> 00:15:54,040 painful to hear that people are in those situations where 299 00:15:54,040 --> 00:15:56,920 they're feeling suicidal. So often the urge, which is 300 00:15:56,920 --> 00:16:02,320 totally understandable, is to jump in and problem solve or to 301 00:16:02,320 --> 00:16:04,280 kind of push away the conversation. 302 00:16:04,280 --> 00:16:06,120 So being direct is really helpful. 303 00:16:06,560 --> 00:16:11,480 To your point about not wanting to make the suicidal ideation 304 00:16:11,480 --> 00:16:15,480 worse by talking about it, in the vast majority of cases, what 305 00:16:15,480 --> 00:16:18,520 research we have that exists suggests that if someone is not 306 00:16:18,520 --> 00:16:22,200 thinking about suicide and you ask them about it or they listen 307 00:16:22,200 --> 00:16:25,000 to music about it or whatever it is, that they aren't going to 308 00:16:25,000 --> 00:16:28,440 start becoming suicidal. And so that's something we can 309 00:16:28,440 --> 00:16:32,400 kind of rest assured about. On the other, there is evidence 310 00:16:32,400 --> 00:16:35,280 that if you talk to someone about suicide and they are 311 00:16:35,280 --> 00:16:38,160 struggling with suicidal thoughts that even talking about 312 00:16:38,160 --> 00:16:42,000 can reduce some of the distress and intensity surrounding it. 313 00:16:43,480 --> 00:16:47,360 And I think that one area, you know, you mentioned DBT that it 314 00:16:47,360 --> 00:16:51,760 that is worth mentioning and group settings there are rules 315 00:16:51,760 --> 00:16:54,680 about. I'm not going into details 316 00:16:54,680 --> 00:16:57,120 surrounding methods. I think that's a controversial 317 00:16:57,120 --> 00:16:59,920 area about how much that matters, but I think it makes 318 00:16:59,920 --> 00:17:02,320 sense. And I don't think it's necessary 319 00:17:02,320 --> 00:17:07,040 to go into details about methods if you're trying to understand 320 00:17:07,680 --> 00:17:11,920 why someone's experiencing that. I do think it is important to 321 00:17:11,920 --> 00:17:15,520 understand what people are thinking about in terms of 322 00:17:15,520 --> 00:17:18,599 methods for the next piece, which is making sure they're 323 00:17:18,599 --> 00:17:20,280 safe. So if someone has specific 324 00:17:20,280 --> 00:17:26,040 methods in mind or past methods they've used to try to end their 325 00:17:26,040 --> 00:17:29,440 lives or kill themselves, then actually it is important and 326 00:17:29,440 --> 00:17:32,160 helpful to know what those are so that you can help create a 327 00:17:32,160 --> 00:17:34,760 safer environment. Because the research really 328 00:17:35,160 --> 00:17:39,640 strongly points to the fact that if you, if someone has firearms 329 00:17:39,640 --> 00:17:43,440 in their home or they plan an overdose, or they plan whatever 330 00:17:43,440 --> 00:17:47,400 their plan is, that if you can restrict that, that can be life 331 00:17:47,400 --> 00:17:50,280 saving. And so there's a, there's some 332 00:17:50,280 --> 00:17:53,760 nuance to it, but the general rule is it's better to talk 333 00:17:53,760 --> 00:17:56,840 about suicide than not. And keeping it open and non 334 00:17:56,840 --> 00:18:01,240 judge mental and expressing compassion tend to be helpful. 335 00:18:02,200 --> 00:18:05,320 What about peers and Co ruminating? 336 00:18:05,320 --> 00:18:07,760 Because we have a lot of young adults that listen to the 337 00:18:07,760 --> 00:18:12,280 podcast and often times with young adulthood comes your peers 338 00:18:12,280 --> 00:18:14,320 being the people you're leaning on the most. 339 00:18:14,320 --> 00:18:18,400 Maybe there's more fear and shame about going to parents or 340 00:18:18,400 --> 00:18:21,160 counselor, a trusted adult to try and be vulnerable. 341 00:18:21,160 --> 00:18:25,360 And especially with mental health challenges, that can be a 342 00:18:25,360 --> 00:18:29,200 double edged sword because you just don't have the training and 343 00:18:29,200 --> 00:18:32,480 expertise and emotional bandwidth and all the things at 344 00:18:32,520 --> 00:18:35,200 at that point in life. And it's also not in like a 345 00:18:35,200 --> 00:18:37,560 negative connotation, but it's not your responsibility. 346 00:18:37,560 --> 00:18:42,000 Like you're not their caretaker or guardian or parents or school 347 00:18:42,000 --> 00:18:44,800 counselor and all the things. So especially with young adults 348 00:18:44,800 --> 00:18:47,520 and and Co ruminating or if there's multiple people that are 349 00:18:47,520 --> 00:18:50,720 struggling, is that kind of like an outlier to the the rule of 350 00:18:50,720 --> 00:18:54,480 thumb? Have you seen the Netflix series 351 00:18:54,480 --> 00:18:56,240 Heart Stopper? No. 352 00:18:56,920 --> 00:19:00,800 The recent series, the main star, the main character of it 353 00:19:00,800 --> 00:19:05,080 has eating disorder symptoms and also some self harm issues. 354 00:19:05,080 --> 00:19:10,120 And it's actually really nice depiction of it because one, 355 00:19:10,120 --> 00:19:16,400 it's realistic, it's and two, it shows the friends and the 356 00:19:16,400 --> 00:19:19,760 character's boyfriend both feeling like they don't know 357 00:19:19,760 --> 00:19:23,360 what to do to help him. And so there's a nice scene 358 00:19:23,360 --> 00:19:27,480 where the the boyfriend happens to have a psychiatrist who's an 359 00:19:27,480 --> 00:19:31,840 aunt, which is handy. And she says your job is to ask 360 00:19:31,840 --> 00:19:34,920 him how he's feeling, be willing to spend time with him. 361 00:19:35,400 --> 00:19:40,800 And then you gently urge him to seek help, to talk to his 362 00:19:40,800 --> 00:19:44,760 parents, to talk to a therapist. But your job is not to intervene 363 00:19:44,760 --> 00:19:46,600 and, and change it. You can't do that. 364 00:19:46,800 --> 00:19:50,280 And also your mental health could deteriorate if you think 365 00:19:50,280 --> 00:19:52,160 you can and you're unable to change that. 366 00:19:52,160 --> 00:19:55,080 And so I was impressed by that because you don't see that a 367 00:19:55,080 --> 00:19:57,560 lot, but there are much better mental health depictions than 368 00:19:57,560 --> 00:20:01,040 there used to be. But that really shapes, to 369 00:20:01,040 --> 00:20:03,760 answer your question, the boundaries around what we can do 370 00:20:03,760 --> 00:20:07,480 as as peers. Even I'm, I'm a psychologist and 371 00:20:07,480 --> 00:20:10,680 I'm psychologist friends and even though I have the training 372 00:20:10,680 --> 00:20:14,680 as a therapist and the capacity as a friend, I don't approach it 373 00:20:14,680 --> 00:20:18,600 the same way at all. It's very much listening support 374 00:20:18,880 --> 00:20:22,680 and also knowing my own limits. So are there things that are 375 00:20:22,800 --> 00:20:25,200 that I don't have the bandwidth for that you mentioned? 376 00:20:25,200 --> 00:20:27,760 Am I having a really hard week and I need all the resources I 377 00:20:27,760 --> 00:20:30,320 can? Well, then I you can tell the 378 00:20:30,320 --> 00:20:32,960 friend, is there anyone else who can call or can you call the 379 00:20:32,960 --> 00:20:36,560 crisis hotline 988? Have you tried to talk to your 380 00:20:36,560 --> 00:20:39,600 therapist? Can I help you by identifying a 381 00:20:39,600 --> 00:20:42,240 therapist? So finding something to do while 382 00:20:42,240 --> 00:20:45,720 not taking on the full responsibility for it because 383 00:20:45,720 --> 00:20:47,800 you want to check in with yourself and your own mental 384 00:20:47,800 --> 00:20:51,680 health and understand really what you can do is very 385 00:20:51,680 --> 00:20:53,520 powerful, which is to show that you care. 386 00:20:53,520 --> 00:20:58,000 But what you can't do is control someone else's behavior or 387 00:20:58,000 --> 00:21:00,880 something like that. And if it helps at all to think 388 00:21:00,880 --> 00:21:05,200 about it this way, by you modeling that you have certain 389 00:21:05,200 --> 00:21:08,920 boundaries around mental health and that you're taking care of 390 00:21:08,920 --> 00:21:11,880 yourself, that can be helpful for your friend too. 391 00:21:11,880 --> 00:21:15,560 It might not immediately feel good to them, but they're 392 00:21:15,560 --> 00:21:19,840 getting the message that OK, my friend, when they're struggling 393 00:21:19,880 --> 00:21:23,840 or want to prevent struggling, they are doing things to take 394 00:21:23,840 --> 00:21:26,280 care of themselves. And so they're observing that as 395 00:21:26,280 --> 00:21:28,120 well. And I do think that model can be 396 00:21:28,120 --> 00:21:30,560 helpful. Yeah, I, I think that was one of 397 00:21:30,560 --> 00:21:35,160 my biggest learnings and I think it caused me a lot more struggle 398 00:21:35,160 --> 00:21:39,240 than I needed to experience was by surrounding myself with 399 00:21:39,240 --> 00:21:41,040 people that were feeling the same way. 400 00:21:41,040 --> 00:21:44,600 And it's instinctive, like we attract the energy we put out 401 00:21:44,600 --> 00:21:47,520 and getting our feelings validated is is really 402 00:21:47,520 --> 00:21:50,080 important. And also like an innate need. 403 00:21:50,200 --> 00:21:52,320 We look for that from people around us. 404 00:21:52,360 --> 00:21:56,440 And in this situation it just adds a whole nother layer to the 405 00:21:56,440 --> 00:21:58,960 situation and it can hurt it rather than help it. 406 00:21:58,960 --> 00:22:02,400 And I think even now, same thing where like when I think about 407 00:22:02,400 --> 00:22:06,360 how I could help and support my peers, it wouldn't be like 408 00:22:06,360 --> 00:22:09,680 listen to this podcast or like, this is how we're going to walk 409 00:22:09,680 --> 00:22:14,200 through this and even like making a situation more safe 410 00:22:14,200 --> 00:22:16,800 because that's not my role in their life. 411 00:22:16,800 --> 00:22:21,200 But being someone that they know they can have a fun night with 412 00:22:21,200 --> 00:22:24,600 and watch a show together or laugh and just call when they're 413 00:22:24,600 --> 00:22:27,160 not doing well. I think that you're adding like 414 00:22:27,360 --> 00:22:30,720 a great deal of positivity and support their life that they can 415 00:22:30,720 --> 00:22:34,000 count on. And I think people underestimate 416 00:22:34,000 --> 00:22:37,520 how much that's valued. And even if they feel like they 417 00:22:37,520 --> 00:22:41,120 could do more, I think that is an incredible position to be in 418 00:22:41,240 --> 00:22:44,320 as a friend if you know that they can count on you and you 419 00:22:44,320 --> 00:22:48,000 know that you can be an outlet for them to feel better and get 420 00:22:48,000 --> 00:22:49,680 out of their head and just connect. 421 00:22:50,440 --> 00:22:54,280 That's exactly right. It can mean the world to someone 422 00:22:54,280 --> 00:22:57,800 who thinks that they're a burden and they're alone to be with 423 00:22:57,800 --> 00:23:00,680 someone who likes being around them and it will do things with 424 00:23:00,680 --> 00:23:02,760 them. And the other part that you 425 00:23:02,760 --> 00:23:05,640 said, which I think is really important is that often in 426 00:23:05,640 --> 00:23:10,200 therapy, we're trying to not avoid things, we're trying to 427 00:23:10,200 --> 00:23:13,480 really not distract, we're trying to process things. 428 00:23:13,880 --> 00:23:17,440 But as you know, with suicidal thoughts, actually it's it's 429 00:23:17,440 --> 00:23:22,560 very important, especially during a crisis to have that 430 00:23:22,560 --> 00:23:26,840 skill and tool of distracting and tool that intensity 431 00:23:26,840 --> 00:23:29,360 decreases. And the research supports that. 432 00:23:29,360 --> 00:23:32,640 And that's certainly present in a lot of therapies that we do 433 00:23:32,640 --> 00:23:36,320 that that actually is not a good time to just keep. 434 00:23:37,000 --> 00:23:38,920 You want to eventually get back to the causes. 435 00:23:38,920 --> 00:23:42,400 But while you're in a crisis, distraction may be the best 436 00:23:42,400 --> 00:23:44,880 thing to do. Yeah, I just recorded an episode 437 00:23:44,880 --> 00:23:48,440 on anxiety and I was like, let's not distract too much, let's go 438 00:23:48,440 --> 00:23:50,600 towards that thing. This time we're like distract, 439 00:23:50,600 --> 00:23:53,320 distract, distract. Watch as much office as you 440 00:23:53,320 --> 00:23:55,400 want. Listen to like do whatever you 441 00:23:55,400 --> 00:23:58,320 need to do. And I, I think that's very true. 442 00:23:58,400 --> 00:24:03,360 Shifting gears a little bit and kind of expanding on how you can 443 00:24:03,360 --> 00:24:06,280 work through these thoughts. Well, I'm sure we'll get into 444 00:24:06,280 --> 00:24:08,960 identifying the the core issues. You have a workbook which we'll 445 00:24:08,960 --> 00:24:11,680 put in the show notes about how people can work through suicidal 446 00:24:11,680 --> 00:24:13,840 thoughts, especially from the CBT framework. 447 00:24:13,840 --> 00:24:17,960 But can you give us like a 30,000 foot view of kind of what 448 00:24:17,960 --> 00:24:20,080 this process looks like? Because that's the other thing. 449 00:24:20,120 --> 00:24:24,360 If you haven't been to therapy for navigating suicidal ideation 450 00:24:24,360 --> 00:24:26,800 before, you really have no idea what to expect because it's not 451 00:24:26,800 --> 00:24:29,040 a natural skill in life to be like, oh, I intentionally 452 00:24:29,040 --> 00:24:31,840 changed the way I think about things because it has really 453 00:24:31,840 --> 00:24:35,800 detrimental impacts on my life. So overview, what can people 454 00:24:35,800 --> 00:24:37,400 expect? And I think it's also helpful 455 00:24:37,400 --> 00:24:40,880 for parents and peers to understand the work that their 456 00:24:40,880 --> 00:24:42,240 friends and family might be doing. 457 00:24:43,200 --> 00:24:46,280 The, the kind of behavioral therapy model kind of zoomed out 458 00:24:46,280 --> 00:24:50,520 and at its basic level is that a thoughts, emotions and behaviors 459 00:24:50,560 --> 00:24:54,280 all influence each other. And when someone's in a suicidal 460 00:24:54,880 --> 00:24:58,560 mind state, often the thoughts are about being alone, about 461 00:24:58,560 --> 00:25:01,360 being a burden, that nothing in life matters, not feeling 462 00:25:01,360 --> 00:25:05,680 connected to it and their perception, even though it's not 463 00:25:05,680 --> 00:25:08,360 their fault. Often it has some flaws to it 464 00:25:08,440 --> 00:25:12,240 because the, again, the cruelty of struggling with suicidal 465 00:25:12,240 --> 00:25:16,880 thoughts is that you're so can be so hypercritical of yourself 466 00:25:17,200 --> 00:25:23,920 and you can be unable almost to see reasons to believe that 467 00:25:23,920 --> 00:25:27,440 things can change or that you can help to affect that. 468 00:25:27,440 --> 00:25:32,200 So with the cognitive behavioral therapy model, really the work 469 00:25:32,200 --> 00:25:37,600 that's being done is finding ways to be aware, first of all, 470 00:25:37,640 --> 00:25:42,920 of suicidal thinking patterns and how they tend to increase 471 00:25:42,920 --> 00:25:46,240 pain, increase hopelessness, and look for evidence that prove 472 00:25:46,240 --> 00:25:48,680 you're not worthy, things like that. 473 00:25:48,880 --> 00:25:54,680 And then exploring evidence that suggests you are worthy and that 474 00:25:54,680 --> 00:25:57,640 things can change and you've been through hard things before 475 00:25:57,640 --> 00:26:01,040 and you can get through them and there are ways to cope. 476 00:26:01,960 --> 00:26:05,880 So that's a big piece of it at a, at a zoomed out level. 477 00:26:06,160 --> 00:26:08,480 And then there's a lot more details in between. 478 00:26:08,480 --> 00:26:11,840 But that's the main idea is looking at those what thoughts, 479 00:26:11,840 --> 00:26:15,560 behaviors and emotions, what can we do to impact those to 480 00:26:15,560 --> 00:26:19,400 basically disrupt the suicidal crisis and system? 481 00:28:45,760 --> 00:28:48,400 If we can like kind of go through the cycle and get 482 00:28:48,480 --> 00:28:50,880 detailed on thoughts and then the behaviors and then the 483 00:28:50,880 --> 00:28:53,640 emotion shift as well. And I'm sure there's, we talked 484 00:28:53,640 --> 00:28:56,440 about shame earlier, sometimes guilt, like these emotions that 485 00:28:56,440 --> 00:28:58,840 can really 'cause this cycle to continue. 486 00:28:59,160 --> 00:29:00,960 The thoughts piece of it, I think is really interesting. 487 00:29:00,960 --> 00:29:04,880 And like you said, the the data doesn't support that engaging in 488 00:29:04,880 --> 00:29:07,880 these thoughts or going down that that line of thinking, it 489 00:29:07,880 --> 00:29:10,560 doesn't have a positive impact on your mood, even though people 490 00:29:10,560 --> 00:29:13,120 sometimes do, like you said, use this to cope with feeling 491 00:29:13,120 --> 00:29:16,280 hopeless or like a burden or these other emotion. 492 00:29:16,280 --> 00:29:19,280 So in the thought piece of thing, what's arising? 493 00:29:19,280 --> 00:29:21,640 How can people rewire that? All the things? 494 00:29:22,680 --> 00:29:26,360 So one piece that I want to mention is that I think it's 495 00:29:26,360 --> 00:29:29,280 part of the complexity. It's not helpful to, for 496 00:29:29,280 --> 00:29:32,800 example, continue to think about suicide as an escape and that it 497 00:29:32,800 --> 00:29:36,360 can increase suicide risk. However, it's really important 498 00:29:36,360 --> 00:29:39,680 to be compassionate with yourself and recognize one that 499 00:29:39,680 --> 00:29:41,240 that's not completely in your control. 500 00:29:41,240 --> 00:29:44,760 Your thoughts can kind of do all kinds of things and, and just 501 00:29:44,920 --> 00:29:46,920 approaching yourself, yourself with warmth. 502 00:29:47,240 --> 00:29:51,800 And So what a thought might look like is something like, I'm not 503 00:29:51,800 --> 00:29:53,920 going to get through this. I'm going to be in this pain 504 00:29:53,920 --> 00:29:57,280 forever. And a way that you might address 505 00:29:57,280 --> 00:30:00,720 that with kind of behavioral therapy is dig a little bit 506 00:30:00,720 --> 00:30:02,080 deeper. Well, why is that? 507 00:30:02,440 --> 00:30:06,000 Well, it's because I'm incapable and it's because the world is 508 00:30:06,000 --> 00:30:10,240 cruel and nobody wants me around and all of those thoughts. 509 00:30:10,440 --> 00:30:13,360 And so then once you've identified what those thoughts 510 00:30:13,360 --> 00:30:16,560 are, you can look and see, do they fit certain patterns? 511 00:30:16,560 --> 00:30:21,040 Often the patterns that we tend to see are all or nothing 512 00:30:21,040 --> 00:30:24,520 thinking. So the person is thinking about 513 00:30:24,520 --> 00:30:28,040 all the things, the mistakes they've made and they don't 514 00:30:28,040 --> 00:30:32,920 they're, they can't think without some help about the 515 00:30:32,920 --> 00:30:35,040 things that they have contributed and how they've 516 00:30:35,040 --> 00:30:37,920 connected. They can't think about building 517 00:30:37,920 --> 00:30:41,520 confidence by looking at what they've done in the past. 518 00:30:42,280 --> 00:30:45,200 They can't think about, well, I feel like a burden. 519 00:30:45,400 --> 00:30:49,000 So maybe if I change the behavior and start intentionally 520 00:30:49,000 --> 00:30:52,720 contributing more, that might reduce the emotions. 521 00:30:52,960 --> 00:30:55,960 And so the the process is identifying the thought, 522 00:30:55,960 --> 00:30:59,080 identifying what the pattern is. Is it all or nothing? 523 00:30:59,280 --> 00:31:02,360 Is it disqualifying the positive things that are coming up? 524 00:31:02,600 --> 00:31:06,240 And these are all from Aaron Beck's kind of behavioral 525 00:31:06,240 --> 00:31:10,040 therapy and David Burns also his Feeling Good book has a lot of 526 00:31:10,040 --> 00:31:13,960 these common patterns in them. And so I I found in therapy that 527 00:31:13,960 --> 00:31:17,600 even introducing those patterns helps people so much because 528 00:31:17,880 --> 00:31:21,280 they relate to them and they realize it's not just them. 529 00:31:21,280 --> 00:31:24,160 If someone's written a book and there's a list of them that's 530 00:31:24,160 --> 00:31:26,720 really helpful. And then the next piece is 531 00:31:26,920 --> 00:31:30,560 helping go through evidence against those thoughts and then 532 00:31:30,560 --> 00:31:34,640 coming up with a new reframed thought that's more accurate. 533 00:31:34,640 --> 00:31:38,480 And it's totally different than positive thinking because you, 534 00:31:38,600 --> 00:31:42,320 you aren't just saying, OK, you think you're a bad person, just 535 00:31:42,320 --> 00:31:45,080 think you're a good person. That's that's, that doesn't work 536 00:31:45,080 --> 00:31:47,000 that way, right? That would be nice if it did. 537 00:31:47,280 --> 00:31:49,360 It doesn't, though. So rather what you're doing is 538 00:31:49,360 --> 00:31:54,080 you're building a case by examining evidence that supports 539 00:31:54,480 --> 00:31:58,040 that they're not a bad person and then coming up with a 540 00:31:58,040 --> 00:32:01,440 reframed thought that's more accurate and then acting as if 541 00:32:01,440 --> 00:32:04,760 that's the truth. And so that's part, a big part 542 00:32:04,760 --> 00:32:07,560 of what it is. And then the behavioral piece is 543 00:32:07,560 --> 00:32:11,440 very much adding in those things that connect to person, that 544 00:32:11,440 --> 00:32:14,120 tether them to life. What's meaningful to them, What 545 00:32:14,120 --> 00:32:17,200 are their values? How can they amplify those? 546 00:32:17,200 --> 00:32:20,920 Because under the crushing weight of suicidal thoughts, not 547 00:32:20,920 --> 00:32:24,600 everyone, but a lot of people withdraw, give up, and all of 548 00:32:24,600 --> 00:32:27,200 that. And so it's also finding things 549 00:32:27,200 --> 00:32:31,520 that feel doable with that energy level or whatever it is 550 00:32:31,800 --> 00:32:35,320 for creating a little more joy and connection in the person's 551 00:32:35,320 --> 00:32:37,960 life. So that's the main gist of how 552 00:32:37,960 --> 00:32:41,800 to build a hopelessness and to soothe some of the pain that's 553 00:32:41,800 --> 00:32:45,480 driving the suicidal thoughts. I really like what you mentioned 554 00:32:45,480 --> 00:32:47,680 there where you have to have that self compassion with the 555 00:32:47,680 --> 00:32:51,560 first thought because it's you can't necessarily control that, 556 00:32:51,560 --> 00:32:55,280 just like you can't control like an emotion as it rises or if 557 00:32:55,280 --> 00:32:57,600 you've coped with something behaviorally a certain way for 558 00:32:57,600 --> 00:33:00,520 years, it's not immediately going to shift even if you set 559 00:33:00,520 --> 00:33:02,880 that intention. But the next thought or how you 560 00:33:02,880 --> 00:33:06,000 respond to it or the evidence you collect against that initial 561 00:33:06,000 --> 00:33:08,840 thought, you do have that autonomy and choice and power 562 00:33:08,840 --> 00:33:10,520 there, which I think is really important. 563 00:33:11,120 --> 00:33:14,200 I'm curious, are there any behaviors or coping skills or 564 00:33:14,200 --> 00:33:17,840 activities that clients have found really helpful across the 565 00:33:17,840 --> 00:33:20,080 board? A few that you consistently 566 00:33:20,080 --> 00:33:23,440 recommend that people can try out if they're like OK, I like 567 00:33:23,440 --> 00:33:26,360 the idea of increasing meeting but I don't know where to start. 568 00:33:27,000 --> 00:33:29,440 Sure. So I think about a couple of 569 00:33:29,560 --> 00:33:34,400 different types of behaviors and one one thing that my workbook 570 00:33:34,400 --> 00:33:38,080 really focuses on as a framework and then I use as a therapist is 571 00:33:38,080 --> 00:33:40,560 the idea that there have to be a menu of options because 572 00:33:40,560 --> 00:33:42,200 different things work for different people. 573 00:33:42,400 --> 00:33:45,560 So if one thing doesn't work, OK, well we have nine other 574 00:33:45,560 --> 00:33:48,120 things or 10 other things. And that in itself can build 575 00:33:48,120 --> 00:33:51,360 hope getting through it. So one category I would say is 576 00:33:51,360 --> 00:33:53,360 self soothing. And when someone's struggling 577 00:33:53,360 --> 00:33:57,720 with a mental health problem and feeling suicidal, they often are 578 00:33:57,720 --> 00:34:00,320 punishing themselves. They don't even think, oh, now's 579 00:34:00,320 --> 00:34:02,160 the time to actually soothe myself. 580 00:34:02,480 --> 00:34:06,720 So I think about if you have the flu or you're sick, at least 581 00:34:06,720 --> 00:34:09,560 some part of you knows that it's not your fault. 582 00:34:09,560 --> 00:34:13,639 It's just something that happens and you kind of have to go easy 583 00:34:13,639 --> 00:34:16,360 on yourself. You have to have comfort foods, 584 00:34:16,360 --> 00:34:18,480 you you can't do the things you normally do. 585 00:34:18,480 --> 00:34:19,880 Hopefully you can call out of work. 586 00:34:20,239 --> 00:34:23,199 And so I try to make that analogy that when you're 587 00:34:23,199 --> 00:34:27,520 struggling in a lot of pain, that is the last time for more 588 00:34:27,520 --> 00:34:29,880 punishment and self criticism. So things that tend to soothe 589 00:34:29,880 --> 00:34:32,400 people. I think a lot of it, a lot of 590 00:34:32,400 --> 00:34:36,199 people go to music. A lot of people go to, I like 591 00:34:36,199 --> 00:34:39,520 stand up comedy because it's kind of the opposite of feeling 592 00:34:39,520 --> 00:34:42,719 bad when you're laughing. And I think the other part of it 593 00:34:42,719 --> 00:34:46,400 is that actually there's so much comedy now about mental health 594 00:34:46,400 --> 00:34:51,560 stuff, so kind of have like a 2 functions where it's funny and 595 00:34:51,560 --> 00:34:54,000 you can resonate with it. So those are a lot of them. 596 00:34:54,000 --> 00:34:58,000 Getting outside, like just changing the perspective and 597 00:34:58,000 --> 00:35:00,360 going for a walk, taking a hot shower. 598 00:35:00,360 --> 00:35:03,680 Anything that captures your attention and feels positive can 599 00:35:03,680 --> 00:35:06,680 be helpful. So watch a horror movie that was 600 00:35:06,680 --> 00:35:09,720 one of the big go to ones that I heard a lot because you cannot 601 00:35:09,720 --> 00:35:12,760 feel like deeply sad and hopeless and jump scare at the 602 00:35:12,760 --> 00:35:15,400 same time. So any of those where it's like 603 00:35:15,400 --> 00:35:18,400 it's just that all-encompassing emotion being evoked. 604 00:35:18,400 --> 00:35:20,480 It's really effective as an intervention. 605 00:35:21,080 --> 00:35:24,560 Exactly because what you're doing is your mind is kind of 606 00:35:24,560 --> 00:35:26,200 like a magnet when you're suicidal. 607 00:35:26,200 --> 00:35:30,000 And it's it's everything that confirms your negative views 608 00:35:30,000 --> 00:35:32,400 kind of sticks. And so it takes something to 609 00:35:32,400 --> 00:35:35,240 jolt out of that. So that's, that's exactly right. 610 00:35:35,240 --> 00:35:36,920 And you it's trial and error too. 611 00:35:36,920 --> 00:35:39,840 So you see what works for you and you try other things. 612 00:35:40,200 --> 00:35:42,960 And then the other piece I would say with the behavior, just 613 00:35:42,960 --> 00:35:47,000 trying not to isolate. And one way to do that is to 614 00:35:47,000 --> 00:35:51,000 reflect on your values. And my workbook, I talk about 615 00:35:51,200 --> 00:35:55,560 Viktor Frankel's Man's search for Meaning that he wrote, he's 616 00:35:55,560 --> 00:36:00,080 a Holocaust survivor and as a psychiatrist and talked about 617 00:36:00,080 --> 00:36:04,200 how even in the worst situations, I mean, he was doing 618 00:36:04,200 --> 00:36:07,200 suicide prevention and a concentration Campbell, he was 619 00:36:07,200 --> 00:36:10,440 held captive there. There is still a way to find 620 00:36:10,440 --> 00:36:12,960 meaning. And so a lot of it, boiling down 621 00:36:12,960 --> 00:36:17,000 the basics is spending some time to reflect what are my values 622 00:36:17,000 --> 00:36:20,360 and what am I doing in my life that connects me with those 623 00:36:20,360 --> 00:36:23,240 values. And the other theme I've 624 00:36:23,240 --> 00:36:26,400 mentioned a few times, they don't have to be huge things. 625 00:36:26,400 --> 00:36:32,720 If you value being compassionate or charitable or educated or 626 00:36:32,880 --> 00:36:36,360 whatever it is, you can find something, something to do that 627 00:36:36,360 --> 00:36:38,520 just kind of connects you with that value. 628 00:36:38,800 --> 00:36:41,000 And then life doesn't feel so empty. 629 00:36:41,280 --> 00:36:45,000 And so it's worth thinking about those types of things and making 630 00:36:45,000 --> 00:36:48,640 action plans for what something I might do to enhance that 631 00:36:48,640 --> 00:36:51,120 meaningful feeling. For sure. 632 00:36:51,600 --> 00:36:54,680 The last thing I want to touch on is what people can do in a 633 00:36:54,680 --> 00:36:59,000 crisis because I know people are like, we know 988. 634 00:36:59,000 --> 00:37:01,560 We did an episode a while ago and I'll put it in the show 635 00:37:01,560 --> 00:37:04,920 notes with Adia Fedai and she is a 988 operator. 636 00:37:04,920 --> 00:37:08,400 So we like went through exactly what happens when you call and 637 00:37:08,400 --> 00:37:12,160 what they'll say and how you can still be anonymous and all the 638 00:37:12,160 --> 00:37:14,280 things. We did a similar one with Crisis 639 00:37:14,280 --> 00:37:17,280 Text line and what people are commonly talking about. 640 00:37:17,280 --> 00:37:20,400 And we had a a young adult volunteer on the podcast and she 641 00:37:20,400 --> 00:37:22,760 went through kind of like how she typically responds and what 642 00:37:22,760 --> 00:37:26,640 people can expect. So generally those are our 643 00:37:26,640 --> 00:37:29,240 resources, but there's still anxiety and apprehension about 644 00:37:29,240 --> 00:37:31,760 utilizing those. We talked about distraction. 645 00:37:31,760 --> 00:37:34,680 Is there anything else that you would recommend in crisis that 646 00:37:34,680 --> 00:37:37,680 people can utilize? I am almost positive people are 647 00:37:37,680 --> 00:37:40,560 listening to this not in crisis. They can write it down, maybe 648 00:37:41,160 --> 00:37:43,920 take a photo of a sticky note, whatever it is to come back to 649 00:37:43,920 --> 00:37:46,760 this as a crisis survival plan. But what other tips do you have 650 00:37:46,760 --> 00:37:50,680 for crisis? Or 988, I would go to their 651 00:37:50,680 --> 00:37:53,960 website and they have safety plan templates and I would look 652 00:37:53,960 --> 00:37:58,560 there and and fill out one. It's worth having a safety plan 653 00:37:58,640 --> 00:38:00,960 like you said, when you're not in crisis, but the main things 654 00:38:00,960 --> 00:38:03,720 that it has on there are one. What is your main reason for 655 00:38:03,720 --> 00:38:05,880 living? Because when you're suicidal, 656 00:38:05,880 --> 00:38:08,160 it's hard to remember. Wait, why do I want to hang on 657 00:38:08,160 --> 00:38:11,080 anyway? And that that can make it more 658 00:38:11,080 --> 00:38:14,440 salient again, that idea that you're kind of shining your 659 00:38:14,440 --> 00:38:16,400 attention and spotlight on something else. 660 00:38:16,640 --> 00:38:18,960 And also the idea that it doesn't have to be something 661 00:38:18,960 --> 00:38:20,400 huge. Some people say their family and 662 00:38:20,400 --> 00:38:23,960 members are what keep them going or their pets or whatever it is. 663 00:38:24,080 --> 00:38:26,760 But it whatever it is that's acceptable. 664 00:38:26,960 --> 00:38:30,400 So it's a reminder of that. The other piece is of course, 665 00:38:30,400 --> 00:38:33,040 the emergency numbers, but people don't always want to call 666 00:38:33,040 --> 00:38:36,200 that, you know, I encourage it, but if you don't want to, you 667 00:38:36,200 --> 00:38:39,320 don't want to the distraction and coping strategies. 668 00:38:39,320 --> 00:38:42,800 And then the thing and I'll add is a piece about making your 669 00:38:42,800 --> 00:38:45,720 environment safe, as we were talking about earlier, that's 670 00:38:45,720 --> 00:38:49,800 super important when you're in a high risk situation that you put 671 00:38:49,800 --> 00:38:53,720 distance and time between yourself and the lethal methods, 672 00:38:53,720 --> 00:38:55,840 whatever they are, that is life saving. 673 00:38:55,840 --> 00:39:00,240 There is there is research looking at how long the typical 674 00:39:00,280 --> 00:39:05,800 intensity like very intense suicidal thoughts can last and 675 00:39:06,040 --> 00:39:10,480 at their highest peak, often they diminish within hours. 676 00:39:10,520 --> 00:39:13,520 And so if you can get through that without having access to 677 00:39:13,520 --> 00:39:17,160 the lethal methods, having some support people that you can 678 00:39:17,160 --> 00:39:20,960 contact, having some coping skills and remember your reason 679 00:39:20,960 --> 00:39:23,680 for a living, that can be really life saving. 680 00:39:24,160 --> 00:39:28,520 And I'll mention an app called the Virtual Hope Box, which has 681 00:39:28,520 --> 00:39:34,200 a lot of these ideas in them and includes distraction things in 682 00:39:34,200 --> 00:39:37,040 there like games that you can play and inspirational quotes 683 00:39:37,040 --> 00:39:41,160 and emergency numbers. And so the goal is to have this 684 00:39:41,160 --> 00:39:45,200 plan in place so that when you can't think clearly about it, 685 00:39:45,760 --> 00:39:49,120 you can access that and that gives you the steps to take. 686 00:39:49,120 --> 00:39:51,440 And so those are those are the main pieces. 687 00:39:51,440 --> 00:39:55,560 Separation from lethal means support people, emergency 688 00:39:55,560 --> 00:39:57,240 numbers, and your reason for a living. 689 00:39:57,600 --> 00:40:00,320 Yeah, there's like you mentioned, there's so many. 690 00:40:00,520 --> 00:40:02,760 Different ways that we apply double standards to mental 691 00:40:02,760 --> 00:40:06,240 health and I think the like giving yourself an environment 692 00:40:06,240 --> 00:40:09,120 that you can be successful in is a great example of that. 693 00:40:09,120 --> 00:40:14,040 Like if you have celiac, you don't buy 12 loaves of sourdough 694 00:40:14,040 --> 00:40:17,400 when you go to Trader Joe's because no one has that level of 695 00:40:17,400 --> 00:40:19,320 self restraint. Even if you know there's going 696 00:40:19,320 --> 00:40:21,600 to be a negative consequence, if you're struggling with 697 00:40:21,600 --> 00:40:24,840 addiction, you don't spend 3 hours at the bar after your work 698 00:40:24,840 --> 00:40:26,720 day. Hopefully these are things you 699 00:40:26,720 --> 00:40:29,400 don't do because you know, you're just setting yourself up 700 00:40:29,400 --> 00:40:32,720 to be in a situation you have to use willpower and humans don't 701 00:40:32,720 --> 00:40:34,960 have a lot of willpower, whether you're looking at them taking 702 00:40:34,960 --> 00:40:36,320 grit lab right now. And so we're talking about 703 00:40:36,320 --> 00:40:38,920 achieving your goals and like deliberate practice with 704 00:40:38,920 --> 00:40:41,120 instruments like willpower doesn't get you there. 705 00:40:41,120 --> 00:40:42,720 It's these contacts you put yourself in. 706 00:40:42,720 --> 00:40:46,440 And that's absolutely true for mental health and, and suicidal 707 00:40:46,440 --> 00:40:48,720 ideation. And I, I think that's really 708 00:40:48,720 --> 00:40:51,040 important to remember because I think again, it could, it comes 709 00:40:51,040 --> 00:40:53,800 back to the shame piece of like, why can't I just get through 710 00:40:53,800 --> 00:40:55,520 this thought? Like, why would I have to adjust 711 00:40:55,520 --> 00:40:57,200 the environment? But we adjust our environments 712 00:40:57,200 --> 00:41:01,000 for everything, and it's really, really key in allowing us to be 713 00:41:01,000 --> 00:41:02,840 successful. It's simple things like putting 714 00:41:02,840 --> 00:41:05,320 your alarm across the room so you can't get back in bed. 715 00:41:05,320 --> 00:41:08,560 Like all these things we do, because as humans, we're very 716 00:41:08,560 --> 00:41:11,760 susceptible to our environments. We don't have a lot of willpower 717 00:41:12,000 --> 00:41:15,000 and unfortunately that works against us in this context. 718 00:41:15,760 --> 00:41:19,320 You're absolutely right, and I think the analogy of other types 719 00:41:19,320 --> 00:41:22,560 of medical emergencies is correct too, in that if 720 00:41:22,560 --> 00:41:26,120 someone's having a heart attack, you don't expect them to figure 721 00:41:26,120 --> 00:41:28,880 it all out on their own. You people that can support you, 722 00:41:29,120 --> 00:41:32,880 you contact emergency services, you have someone else drive you 723 00:41:32,880 --> 00:41:35,200 to the hospital. So when you're in a suicidal 724 00:41:35,200 --> 00:41:40,480 crisis, you why in that emergency situation, would you 725 00:41:40,480 --> 00:41:44,120 not want to reach out except, as we mentioned, knowing the shame 726 00:41:44,120 --> 00:41:46,400 that comes with it and feeling like no one cares. 727 00:41:46,400 --> 00:41:49,080 So it can be helpful, just like you're saying, to think about it 728 00:41:49,120 --> 00:41:52,400 when you're not in crisis, so that when you're in crisis you 729 00:41:52,400 --> 00:41:55,120 already have the plan laid out and don't even have to think too 730 00:41:55,120 --> 00:42:00,880 deeply about what you need to do A. 100% Well, if people want to 731 00:42:00,960 --> 00:42:04,200 get your workbook or I know you have another book coming out as 732 00:42:04,200 --> 00:42:08,840 well, where can they do that? My book is available on Amazon 733 00:42:08,840 --> 00:42:11,840 and a bookshop and basically most places where books are 734 00:42:11,840 --> 00:42:14,880 available, it's usually at least a copy or two at Barnes and 735 00:42:14,880 --> 00:42:18,080 Noble. So it's it's not too hard to 736 00:42:18,080 --> 00:42:21,280 find if you're looking for it. And I think the other, the 737 00:42:21,280 --> 00:42:25,080 guided journal I'll mention, which is just another format it 738 00:42:25,080 --> 00:42:29,440 it's much shorter, but I found that journaling people find 739 00:42:29,440 --> 00:42:31,920 really beneficial for a variety of things. 740 00:42:31,920 --> 00:42:35,400 And so the guided journal for Suicidal thoughts workbook kind 741 00:42:35,400 --> 00:42:38,640 of to your point, it's not ruminative, it's guided and it 742 00:42:38,640 --> 00:42:41,600 has a lot of these cognitive behavioral therapy practices 743 00:42:41,840 --> 00:42:46,000 that will be out in July 2025. And that'll be available Amazon 744 00:42:46,000 --> 00:42:48,560 Bookshop, Barnes and Noble, all, all of the same types of 745 00:42:48,560 --> 00:42:50,040 websites. Amazing. 746 00:42:50,040 --> 00:42:52,400 Well, I'll put that in the show notes and thank you so much for 747 00:42:52,400 --> 00:42:55,040 joining me. Oh, thanks so much for having me 748 00:42:55,040 --> 00:42:55,920 on. It was my pleasure. 749 00:42:55,920 --> 00:42:58,480 Thank you for having me on the talk about this important topic.