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

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Presentation on theme: "Suicidal Worrying: Online and Telephone IFOTES Göteborg July 11th 2013 Ad Kerkhof VU Vrije Universiteit Amsterdam."— Presentation transcript:

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

2 suicidal worries Repetitive suicidal thinking Repetitive suicidal thinking Rehearsing suicidal thoughts Rehearsing suicidal thoughts Many hours a day Many hours a day Loosing control over thinking Loosing control over thinking

3 Chaos in my head

4 Suicidal Worries Nobody loves me I cannot live alone I have no future I am unlovable I cannot stand my feelings I have to stop thinking

5 Continuously

6 Motives for attempted suicide Major influence (males-females in %): The situation was so unbearable that I could not think of any other alternative (71-76%) My thoughts were so unbearable, I could not endure them any longer (64-68%) I wanted to die (65-59%) Hjelmeland et al, SLTB, 2002, 32,

7 Suicidal Worries I will never be normal again When will this stop? I am a total failure People are better off when I am dead, nobody will miss me I cannot stand the pain I cannot live without partner

8 Unbearable

9 Clinical observations: The continuous repetition of these statements in the end becomes an obsession that cannot be controlled anymore The continuous repetition of these statements in the end becomes an obsession that cannot be controlled anymore

10 Clinical observations: The repetitive thinking about dying, 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,

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 all significantly correlated Watkins et al, Behaviour Research and Therapy, 2005, 43,

14 Worry and suicidal ideation: Similar characteristics: RepetitiveRepetitive UncontrollableUncontrollable Without immediate causeWithout immediate cause Future orientedFuture oriented Threats to personal concernsThreats to personal concerns No solutionNo solution

15 Worry and suicidal ideation: Similar consequences: No problem solvingNo problem solving Obssessive attentionObssessive attention Stress and sleeplessnessStress and sleeplessness Vital exhaustionVital exhaustion Wish to stop consciousnessWish to stop consciousness hopelessnesshopelessness

16 Worriers and suicidal patients: Perceive personal threats Perceive personal threats Overpredict negative outcomes Overpredict negative outcomes Underestimate their abilities to cope Underestimate their abilities to cope Maintain demanding standards Maintain demanding standards Repeat futile attempts to solve Repeat futile attempts to solve Suffer because of this Suffer because of this

17 Worry as determinant of suicidal behaviour In suicidal behaviour people want to escape their own repetitive and tantalizing thoughts and feelings In suicidal behaviour people want to escape their own repetitive and tantalizing thoughts and feelings Escape from self (Baumeister, 1990) Escape from self (Baumeister, 1990)

18 Warning: Worrying can be lethal

19 Suicidal induction With your permission: I am going to make you somewhat suicidal now. With your permission: I am going to make you somewhat suicidal now. If you are suicidal yourself, you will recognise the mechanism If you are suicidal yourself, you will recognise the mechanism I will try to get you out of this state again, at the end of the exercise I will try to get you out of this state again, at the end of the exercise

20 Suicidal induction You have a song in your head You have a song in your head This song will not go away This song will not go away Whatever you do, you will hear it Whatever you do, you will hear it May be a nice song, may be a boring May be a nice song, may be a boring Choose for yourself a song Choose for yourself a song Or take ABBA: Waterloo……… Or take ABBA: Waterloo………

21 Suicidal induction Tonight you will hear Abba singing Waterloo, Waterloo, Waterloo, etc Tonight you will hear Abba singing Waterloo, Waterloo, Waterloo, etc You cannot stop it You cannot stop it The more you try to stop it, the louder they sing The more you try to stop it, the louder they sing

22 Suicidal induction When you go to sleep you hear ABBA When you go to sleep you hear ABBA You cannot sleep because of ABBA You cannot sleep because of ABBA All night long you hear ABBA All night long you hear ABBA Waterloo, Waterloo, Waterloo Waterloo, Waterloo, Waterloo

23 Suicidal induction Tomorrow morning you hear ABBA Tomorrow morning you hear ABBA Tomorrow, all day long you cannot stop ABBA Tomorrow, all day long you cannot stop ABBA Tomorrow evening you hear ABBA Tomorrow evening you hear ABBA Waterloo, Waterloo, Waterloo Waterloo, Waterloo, Waterloo

24 Suicidal induction Tomorrow night again you cannot sleep because of ABBA Tomorrow night again you cannot sleep because of ABBA Second sleepless night you cannot stop ABBA Second sleepless night you cannot stop ABBA Waterloo, Waterloo, Waterloo Waterloo, Waterloo, Waterloo

25 Suicidal induction From Saturday to Sunday again you cannot sleep because of ABBA From Saturday to Sunday again you cannot sleep because of ABBA Third sleepless night you cannot stop ABBA Third sleepless night you cannot stop ABBA On Sunday you will hear nothing but ABBA On Sunday you will hear nothing but ABBA

26 Suicidal induction Sunday evening you take more precautions: sleeping pills / alcohol Sunday evening you take more precautions: sleeping pills / alcohol Fourth sleepless night you cannot stop ABBA Fourth sleepless night you cannot stop ABBA Waterloo, Waterloo, Waterloo Waterloo, Waterloo, Waterloo

27 Suicidal induction Monday you have to work, and you fear your exhaustion will be noticed Monday you have to work, and you fear your exhaustion will be noticed In your car, to your work, suddenly ABBA has gone, silence in your head In your car, to your work, suddenly ABBA has gone, silence in your head Out of relief, you put on the radio…… Out of relief, you put on the radio……

28 ABBA WaterlooWaterlooWaterloo

29 Suicidal induction Monday evening you take even more precautions: sleeping pills / alcohol Monday evening you take even more precautions: sleeping pills / alcohol Fifth sleepless night you cannot stop ABBA Fifth sleepless night you cannot stop ABBA You are exhausted You are exhausted

30 Suicidal induction Later that week you take even more precautions: sleeping pills / alcohol Later that week you take even more precautions: sleeping pills / alcohol You even don’t know how many nights you could not stop ABBA You even don’t know how many nights you could not stop ABBA You cannot endure ABBA any longer You cannot endure ABBA any longer You are exhausted You are exhausted

31 Suicidal induction Finally after having taken many pills / alcohol, you fall asleep Finally after having taken many pills / alcohol, you fall asleep You wake up in a brightly lit environment You wake up in a brightly lit environment Turns out to be an Emergency Ward Turns out to be an Emergency Ward

32 Question? Did you attempt suicide? Did you attempt suicide? Or did you just wanted to escape ABBA Or did you just wanted to escape ABBA

33 Change ABBA into worries Imagine how it is to have other suicidal things instead of ABBA: Imagine how it is to have other suicidal things instead of ABBA: Memories of being raped Memories of being raped Thoughts like being a failure Thoughts like being a failure Thoughts of loneliness Thoughts of loneliness Thoughts of killing yourself Thoughts of killing yourself

34 Warning: You might want to escape Worrying can be lethal

35 Remember This was only an exercise This was only an exercise You will not hear ABBA for the rest of your life You will not hear ABBA for the rest of your life You have not become suicidal You have not become suicidal Think of this exerxise as a metaphore Think of this exerxise as a metaphore Imagine this to be important when you help the next suicidal caller Imagine this to be important when you help the next suicidal caller

36 Volunteers: There is nobody who loves me 1. How many times a day is this thought going through your mind? 2. How many hours a day are you contemplating this thought?

37 Volunteers: I will throw myself in front of a train 1. How many times a day is this thought going through your mind? 2. How many hours a day are you contemplating this thought?

38 Volunteers: My life has no meaning 1. How many times a day is this thought going through your mind? 2. How many hours a day are you contemplating this thought?

39 Volunteers: I have no future 1. How many times a day is this thought going through your mind? 2. How many hours a day are you contemplating this thought?

40 Experience: Mostly only a few such thoughts are rehearsed very frequently Mostly only a few such thoughts are rehearsed very frequently These thoughts are prototypical These thoughts are prototypical They start as self-protection They start as self-protection But in the end they are self-torturing But in the end they are self-torturing Massive suffering because of this repetition Massive suffering because of this repetition Try to understand the torturing mind Try to understand the torturing mind

41 Treatment of suicidal worry CBT approaches for worrying are applicable for suicidal worry (Tallis, Leahy) 1. Worry postponement 2. Positive worrying 3. Distraction 4. Self fulfilling properties 5. Mindfulness 6. Overgeneralization 7. Tolerance of uncertainty over the future


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