Table 4: Safety Planning Intervention (Continued) Step 5. Professionals or Agencies that can be Contacted During a Crisis: • Write down the names and phone numbers for all contacts. ○ Therapist/Clinician (Include any pager numbers or after-hours numbers).
○ Local crisis centers/urgent care centers. ○ National Suicide Prevention Lifeline (1-800-273-TALK/1-800-273-8255. ○ Local emergency department (Write down address). ○ 911.
Note : Adapted from Safety Plan Treatment Manual to Reduce Suicide Risk: Veteran Version, by B. Stanley and G. K. Brown, 2008, New York, NY: New York Suicide Prevention Center, Department of Psychiatry: Columbia University & New York State Psychiatric Institute; and “Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk,” by B. Stanley and G. K. Brown, 2012, Cognitive and Behavioral Practice, 19 (2), pp. 256- 264. Crisis cards
Crisis cards are another form of intervention available to clinicians when patients are determined to be at a moderate level of risk or lower. They must, however, provide more than just emergency numbers. Like safety planning intervention, crisis cards highlight mood regulation techniques, pleasant activities, and emergency numbers in the event that other techniques fail to reduce suicidal symptoms. Using this technique, clinicians assist patients to match protective behaviors with feelings, thoughts, or nonprotective behaviors that might activate a suicidal crisis. For example, agitation may be met with relaxation
and/or exercise. Loneliness may be addressed with behavioral activation with an interpersonal focus, such as calling a friend. Each suicidal crisis trigger is then written on a card with an identified protective symptom-matching technique to be used when the trigger occurs. Thorough assessment aids in the creation of symptom-matching hierarchies (Pauwels et al., 2017). Patients can keep these cards handy to consult as needed, and in recent years digital crisis coping card smartphone apps have been created (Bush et al., 2017; Pauwels et al., 2017). Box 3 outlines the steps for creating a crisis card.
Box 3: Steps for Creating a Crisis Card 1. Explain the rationale to the client : I’d like us to come up with some steps you can take if you become upset or start thinking about suicide. It can be hard to think clearly when you are having this kind of crisis, so I’d like us to write the steps on this index card (or keep them as a note in your smart phone), and you can pull out these steps when you realize you are thinking about suicide. 2. Brainstorm with the client things that make him or her feel better : Clinicians can ask: What have you found helps you when you feel badly? How have you taken the edge off intense feelings? How do you distract yourself from suicidal thoughts? What helps you feel even a little better? Helpful activities are ones that have worked in the past or require at least one of the following: ○ Attention (e.g., working on a puzzle requires attention; watching television does not require attention). ○ Physical activity. ○ Increased belongingness (e.g., calling a friend, going to a place with people, such as a restaurant or mall). See Appendix A and Resources for other ideas on pleasant events for adults. ○ Step 1: [pleasurable activity or therapy skill]. ○ Step 2: [pleasurable activity or therapy skill]. ○ Step 3: [pleasurable activity or therapy skill]. ○ Step 4: Repeat all of the above. ○ Step 5: If the thoughts continue, get specific, and I find myself preparing to do something, I’ll call (insert number of emergency call person) or 1-800-273-TALK. ○ Step 6: If I still feel suicidal and don’t feel like I can control my behavior, I’ll call 911 or go to the emergency department. Cognitive behavioral therapy 3. List the helpful activities on the card in a step format . Example: When I’m upset and thinking about suicide, I’ll take the following steps:
Cognitive and behavioral therapies (CBT) usually are short- term treatments (i.e., often between six and 20 sessions) that focus on teaching patients specific skills. CBT is different from many other therapeutic approaches because it focuses on how a person's cognitions (i.e., thoughts), emotions, and behaviors are connected and affect one another. Behavior therapists and cognitive-behavior therapists usually focus more on the current situation and its solution, rather than the past. They concentrate on a person’s views and beliefs about their life, not on personality traits. CBT trials with suicidal adults typically find encouraging results and several models share key features, some of which are described below (e.g., Asarnow et al., 2017; Bryan, 2019; Lee, Bryan, & Rudd, 2020; Singer, O’Brien, & LeCloux, 2017). The central premise of cognitive theory is that the meaning people assign to environmental stimuli significantly shapes subsequent affect, and affect is in turn associated with their behavioral responses (Asarnow et al., 2017). Several
empirically-based suicide cognitive constructs are identified through assessment, including hopelessness, heightened impulsivity, information-processing biases, problem-solving deficits, and dysfunctional attitudes. Behavioral approaches vary; however, they focus mostly on how some thoughts or behaviors may accidentally be "rewarded" within one's environment, contributing to an increase in the frequency of these thoughts and behaviors. Behavior therapies can be applied to a wide range of psychological symptoms to adults, adolescents, and children. Although behavioral therapies are different from disorder to disorder, a common thread is that behavioral therapists encourage patients to try new behaviors and not to allow negative "rewards" to dictate the ways in which they act. Once cognitive constructs are identified, a comprehensive behavioral chain analysis is conducted to specify antecedents and consequences of suicidal thoughts and behaviors. CBT includes several strategies to reduce
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Book Code: SWUS1524B
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