Treatment: What do we know works? Treatment: What do we know works?

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Treatment: What do we know works?

Transcript of Treatment: What do we know works? Treatment: What do we know works?

Page 1: Treatment: What do we know works? Treatment: What do we know works?

Treatment:

What do we know works?

Treatment:

What do we know works?

Page 2: Treatment: What do we know works? Treatment: What do we know works?

We need to talk in simple and understandable terms about suicide Clearly articulated treatment model and

suicidality as targets Patients can understand and invest

When People drop out of treatment, action needs to be taken immediately to re-engage them Recognize that it is most likely a persistence of

hopelessness Frequently related to “simple things” that block

treatment participation Motivation, ambivalence, and intent to die

What Do Effective Treatments Have in Common?

What Do Effective Treatments Have in Common?

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What Do Effective Treatments Have in Common? People that are suicidal have poor skills

‣ Skills deficiencies targeted, not just symptoms

People need to take ownership of their treatment‣ Addressed self-reliance, self-awareness,

individual control‣ Commitment to treatment

People need to know what to do during a crisis‣ Crisis management/access to emergency

services‣ Limited access to method

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Provide an understandable model Explain why the suicide attempt(s)

happened The importance of shame, guilt

Contextualize/Normalize the problem Label and reinforce the presence of

ambivalence Reasons for living, reasons

for dying

Facilitating Hope During the First Contact

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•It is vital that clients deconstruct their suicidal cycle—explore it, move into it.

•Support clients identifying components; recognizing patterns or themes associated with their cycle Create a narrative of event Construct a timeline

Wenzel, Brown, Beck (2009). Cognitive Therapy for Suicidal Patients; Rudd, Joiner, & Rajab (2001). Treating Suicidal Behavior: An effective, time-limited approach

As long as suicidal clients are unable to understand their suicidal cycle, they remain

victims to it.

As long as suicidal clients are unable to understand their suicidal cycle, they remain

victims to it.

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Have patients describe the events and situations and their reactions to these events in as much detail as possible.

Beginning of the story: Major decision point associated

with increased suicide risk Strong emotional reaction to a

specific event External event such as a significant loss Internal event such as an automatic

thoughtsSource: Wenzel, Brown,& Beck (2009)

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1. Understand the function of suicidal behavior or thinking from the patient’s perspective; that the behavior “makes sense” to the patient in the context of his or her history, vulnerability, and circumstances.

2. Empathize with the patient’s strong feelings and desire to be reduce distress.

3. Refrain from trying to solve the patient’s problems before understanding the motivations for suicide.

4. Don’t rush the interview!Source: Wenzel, Brown,& Beck (2009)

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Criticism from Step-father and Mom

didn’t do anythingStormed off and

isolated self

“I can’t take it anymore. I can’t stand being so

upset so easily like this.”

Angry and Depressed

Anger

“That’s it. I’m doing it. I want to die. I want to end it. I want it to stop.”

Overdosed on 20 sleeping pills

Regrets that the attempt did not

succeed

ACTIVATING EVENTAFFECTIVE RESPONSE

KEY AUTOMATIC THOUGHTS

(MOTIVATION)

SUICIDE ATTEMPTREACTION TO THE

ATTEMPT

KEY AUTOMATIC THOUGHTS (SUICIDE

INTENT)

BEHAVIORAL RESPONSE

AFFECTIVE RESPONSE

Source: Wenzel, Brown, & Beck (2009)

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Treatment JournalCoping cardsHope KitDistraction techniquesRelaxation skillsSelf-soothing