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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.

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Suicidal Worrying : Online and Telephone

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  1. Suicidal Worrying:Online and Telephone IFOTES Göteborg July 11th 2013 Ad Kerkhof VU Vrije Universiteit Amsterdam

  2. suicidal worries Repetitive suicidal thinking Rehearsing suicidal thoughts Manyhours a day Loosing control over thinking

  3. Chaos in myhead

  4. Suicidal Worries Nobodyloves me I cannot live alone I have nofuture I amunlovable I cannot stand myfeelings I have to stop thinking

  5. Continuously

  6. Motives for attempted suicide Major influence (males-females in %): The situation was sounbearablethat I couldnotthink of anyotheralternative (71-76%) My thoughtsweresounbearable, I couldnotendurethemanylonger (64-68%) I wanted to die (65-59%) Hjelmeland et al, SLTB, 2002, 32, 380-393

  7. Suicidal Worries I will never benormalagainWhenwillthis stop? I am a total failure People are better off when I am dead, nobodywill miss me I cannot stand the pain I cannot live without partner

  8. Unbearable

  9. Clinicalobservations: • The continuousrepetition of these statements in the end becomesanobsessionthatcannotbecontrolledanymore

  10. Clinical observations: The repetitive thinking aboutdying, about stopping consciousness, and about the motives to die, show characteristics of worrying

  11. 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

  12. 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

  13. Worry and Rumination: rumination, worry, anxiety, depression are allsignificantlycorrelated Watkins et al, Behaviour Research and Therapy, 2005, 43, 1577-1585.

  14. Worry and suicidal ideation: Similar characteristics: • Repetitive • Uncontrollable • Without immediate cause • Future oriented • Threats to personal concerns • No solution

  15. Worry and suicidal ideation: Similar consequences: • No problem solving • Obssessive attention • Stress and sleeplessness • Vital exhaustion • Wish to stop consciousness • hopelessness

  16. Worriers and suicidalpatients: • Perceive personal threats • Overpredictnegativeoutcomes • Underestimatetheirabilities to cope • Maintaindemandingstandards • Repeatfutileattempts to solve • Suffer because of this

  17. Worry as determinant of suicidal behaviour In suicidal behaviour people want to escape theirownrepetitive and tantalizingthoughts and feelings Escape fromself (Baumeister, 1990)

  18. Warning: Worryingcanbe lethal

  19. Suicidal induction With yourpermission: I am going to make yousomewhat suicidal now. Ifyou are suicidal yourself, youwillrecognise the mechanism I willtry to get you out of this state again, at the end of the exercise

  20. Suicidal induction You have a song in yourhead This song willnot go away Whateveryou do, youwillhearit May be a nice song, maybe a boring Choose for yourself a song Or take ABBA: Waterloo………

  21. Suicidal induction TonightyouwillhearAbbasinging Waterloo, Waterloo, Waterloo, etc Youcannot stop it The more youtry to stop it, the loudertheysing

  22. Suicidal induction Whenyou go to sleep youhear ABBA Youcannot sleep because of ABBA Allnight long youhear ABBA Waterloo, Waterloo, Waterloo

  23. Suicidal induction Tomorrowmorningyouhear ABBA Tomorrow, allday long youcannot stop ABBA Tomorrow evening youhear ABBA Waterloo, Waterloo, Waterloo

  24. Suicidal induction Tomorrownightagainyoucannot sleep because of ABBA Second sleeplessnightyoucannot stop ABBA Waterloo, Waterloo, Waterloo

  25. Suicidal induction FromSaturday to Sundayagainyoucannot sleep because of ABBA Thirdsleeplessnightyoucannot stop ABBA On Sundayyouwillhearnothing but ABBA

  26. Suicidal induction Sunday evening you take more precautions: sleepingpills / alcohol Fourthsleeplessnightyoucannot stop ABBA Waterloo, Waterloo, Waterloo

  27. Suicidal induction Mondayyou have to work, and youfearyourexhaustionwillbenoticed In yourcar, to yourwork, suddenly ABBA has gone, silence in yourhead Out of relief, you put on the radio……

  28. ABBA Waterloo Waterloo Waterloo

  29. Suicidal induction Monday evening you take even more precautions: sleepingpills / alcohol Fifthsleeplessnightyoucannot stop ABBA You are exhausted

  30. Suicidal induction Later that week you take even more precautions: sleepingpills / alcohol You even don’tknowhowmanynightsyoucouldnot stop ABBA Youcannotendure ABBA anylonger You are exhausted

  31. Suicidal induction Finallyafterhaving taken manypills / alcohol, youfallasleep You wake up in a brightlylit environment Turns out to beanEmergency Ward

  32. Question? Didyouattempt suicide? Or didyoujustwanted to escape ABBA

  33. Change ABBA into worries Imaginehowit is to have other suicidal thingsinstead of ABBA: Memories of beingraped Thoughtslikebeing a failure Thoughts of loneliness Thoughts of killingyourself

  34. Warning: Youmight want to escape Worryingcanbe lethal

  35. Remember This was onlyanexercise Youwillnothear ABBA for the rest of your life You have notbecome suicidal Think of thisexerxise as a metaphore Imaginethis to be important whenyou help the next suicidal caller

  36. Volunteers: There is nobodywholoves me 1. How manytimes a day is thisthoughtgoingthroughyour mind? 2. How manyhours a day are youcontemplatingthisthought?

  37. Volunteers: I willthrowmyself in front of a train 1. How manytimes a day is thisthoughtgoingthroughyour mind? 2. How manyhours a day are youcontemplatingthisthought?

  38. Volunteers: My life has no meaning 1. How manytimes a day is thisthoughtgoingthroughyour mind? 2. How manyhours a day are youcontemplatingthisthought?

  39. Volunteers: I have no future 1. How manytimes a day is thisthoughtgoingthroughyour mind? 2. How manyhours a day are youcontemplatingthisthought?

  40. Experience: Mostlyonly a few suchthoughts are rehearsedveryfrequently These thoughts are prototypical They start as self-protection But in the end they are self-torturing Massive sufferingbecause of thisrepetition Try to understand the torturing mind

  41. Treatment of suicidal worry CBT approachesforworrying are applicableforsuicidalworry (Tallis, Leahy) • Worrypostponement • Positiveworrying • Distraction • Selffulfillingproperties • Mindfulness • Overgeneralization • Tolerance of uncertainty over the future

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