3 Strategies for Reducing Risk of Suicide

Emotional intelligence has been defined as a key protective factor against suicidal ideation and behaviour. This concept refers to the ability to understand, appraise, and express emotions accurately and appropriately. Additionally, it refers to the capability to use emotions to guide one’s thinking, to use emotional knowledge effectively, and to regulate emotions to promote both emotional and intellectual growth. Emotional intelligence has been described as an element of resilience, as those who can understand and express their needs tend to have an internal locus of control and the capacity to get their needs met.

Individuals who experience thoughts of suicide tend to have a very difficult relationship with their emotions. Attachment theory and bio-social theory explain how early experiences with caregivers teach individuals whether or not to trust and express their emotions. From this perspective, suicidality can be seen as a skills deficit issue, as individuals need to learn skills to label, tolerate and regulate emotions that were not learned in childhood.

Case Application – Sarah

Sarah, age 15, was referred to me after she was seen by the local mobile crisis service due to suicidal ideation. Her mother had called the crisis line after the school guidance counsellor contacted her to let her know that Sarah had dropped a class and shared that she “can’t take it anymore, and what’s the point of living anyway”. Sarah had admitted to the crisis team that she has been having suicidal thoughts increasingly over the past year due to pressures to excel in school and on her school sports teams.

When I meet with Sarah, she shares that despite typically high grades, she never feels her performance is good enough. She also shares that her parents have been unsupportive of her recent disclosure that she is a lesbian. Sarah has a history of anxiety and has been on an antidepressant for about a year. She has recently begun to lose weight, she is getting lower grades than usual, and she has demonstrated low energy on the basketball court. Sarah shares feelings of inadequacy and hopelessness. Although she is very hesitant to talk to a therapist, she has agreed to attend sessions and has shared that she still has some will to live.

Sarah displays the general ability to communicate her thoughts and feelings with adults who provide validation. However, she is not able to express her emotions very readily to her parents or her peers. Sarah has some ability to express herself, but really struggles with managing and coping with strong emotions.

Dialectical behavioural therapy (DBT) is a highly effective form of cognitive behavioural therapy that can be effective in developing emotional intelligence, or emotional regulation, for individuals with suicidality. Although DBT in its entirety is an intense and multi-faceted treatment model that will neither be appropriate or available to all individuals who experience thoughts of suicide, the behavioural skills emphasized by this model include an emphasis on emotional experiencing.

Counselling Strategies

In order to promote the development of greater emotional intelligence, we can focus on assisting individuals to identify, tolerate, and regulate their emotions more effectively. This can be done through an emphasis on behavioural skills like emotional regulation, distress tolerance, and mindfulness strategies:

1. Model regulated states as a helper with your clients and their families if possible.

• Notice your own body and whether you are in a calm state. Speak at a relaxed pace, relax your body, breathe slowly, and keep your environment quiet and peaceful.
• Model a healthy relationship with emotions. Find opportunities to talk about different emotions, share your own emotions as appropriate, and provide healthy messages about emotions, including that all emotions are acceptable to feel and share.

2. Help clients learn to manage their emotions when they feel suicidal through the development of emotional regulation strategies.

• Teach your clients that suicidality is largely a state of physiological over-arousal and that their nervous system sends out false alarms that signal danger when there is none. Often suicidal thoughts start when the body becomes activated due to early negative experiences and predispositions to anxiety and depression.
• Emphasize that suicidality often occurs due to difficulty with experiencing various levels of emotion. When individuals are used to being stuck in intense emotions it can be difficult not to over-respond to typically less upsetting types of situations. Do scaling exercises on various levels of emotions (e.g. annoyed, irritated, disappointed, upset, angry, enraged, etc.) and then practice various case scenarios that tend to elicit certain levels of response (e.g. a friend needing to cancel tends to be a disappointing experience rather than an experience that leads to anger).
• Various emotional regulation exercises can be used such as engaging in opposite actions to one’s typical response. For example, if your client identifies that they tend to isolate themselves when they are sad, encourage them to reach out to a support instead.

3. Help clients learn to ride the wave of emotions when they feel suicidal through the development of distress tolerance and mindfulness.

• Help individuals understand the value in connecting with their five senses to learn to self soothe. An example for using one’s hearing, smell, and tactile senses may be attending a yoga class where one is soothed by gentle music, essential oils, and comforting positioning of their body.
• Explore distraction techniques that can assist your clients to engage in activities until their intense emotions subside. This may include concentrating on enjoyable activities, invoking a competing emotion or using thought stopping techniques.
• Help individuals learn to manage problems through developing an understanding of radical acceptance. An individual who lost their job can be encouraged to move from “That’s not fair” to “It’s frustrating and I don’t agree with their decision, but I accept that I must now move forward”.
• Incorporate breathing exercises or other body-regulating activities into your work to teach clients how to regulate their bodies as well as mindfulness exercises that promote stillness and silence, presence in the moment, self acceptance, compassion, and non-judgement.
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Sarah

Sarah greatly benefits from understanding how her early experiences of feeling invalidated have resulted in a tendency to ignore and hold in her emotions. Through these discussions she is also able to shift her perception somewhat from believing that her parents do not care about her feelings to an understanding that her parents care very deeply for her but struggle with emotional expression. Sarah begins to learn how her body experiences emotion, and is able to learn how to notice signs of stress and use various strategies to move into more regulated states. She is also able to learn how to level her emotions more appropriately, becoming aware that even though her body tends to give her signals of threat, often her initial intense reactions are not appropriate to the situation. Sarah also notices that when she begins to express her emotions rather than hold them in, they don’t become so intense and she has fewer suicidal thoughts.

Assisting clients to increase their ability to perceive, appraise, and express emotions accurately and appropriately as well as building stronger emotion regulation skills can help strengthen emotional intelligence. This is one way that helpers can assist individuals who experience suicidality to develop greater resilience.

This blog is a sample from our book, Counselling Insights.

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