210. why you’re feeling suicidal + a therapist’s advice on how to cope feat. kathryn gordon

Jan 31

listen to this episode:

Today's guest is Kathryn Gordon— a licensed clinical psychologist, speaker, and author. She specializes in cognitive-behavioral therapy (CBT) and has written several books on using CBT skills to prevent suicide.

In this episode, we discuss:

+ Why people have suicidal thoughts

+ The "mismatched" nature of feeling suicidal

+ How suicidal thoughts progress into behaviors

+ Having healthy conversations about suicide

+ Co-ruminating about suicide & setting boundaries

+ What to expect when in therapy for suicidal thoughts

+ CBT skills that are most effective for suicidal thoughts

+ Resources for when someone is in a crisis

+ so much more!

Mentioned In The Episode…

+ Kathryn's Website

+ The Suicidal Thoughts Workbook

+ The Suicidal Thoughts Guided Journal

+ ABCT

+ The interpersonal theory of suicide

+ The three-step theory of suicide

+ Heartstopper

+ She Persisted episode on anxiety

+ Aaron Beck & CBT

+ Feeling Good

+ Man's Search for Meaning

+ She Persisted episode on calling 988

+ She Persisted episode on Crisis Text Line

+ 988 safety template

+ Virtual Hope Box

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

Episode Sponsors

⚡ This week's episode is sponsored by Magic Mind. You can get 45% off the Magic Mind Bundle by using this link: https://magicmind.com/SHEPERSISTEDJAN.

About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: , Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

Katherine: we know that connecting with people when we're depressed that's really helpful.

And yet the nature of those mental health struggles is that you want to avoid those things. They seem like they're too much to even take on. And so I think about that a lot with suicidal thoughts that That hopelessness feels like there isn't any point in doing anything.

And when someone says to someone who's hopeless, well why don't you just do these things and you'll feel better. Unfortunately, that can make things worse because the person can feel ashamed for not being able to do those things that might help them.

Sadie: Hello, hello, and welcome to She Persisted. We're starting off with a little trigger warning. We are talking about suicidal thoughts and behaviors today, which can be a heavier topic. We came at this from a really intentional and evidence based approach. We have a clinical psychologist on the podcast today who's been involved in a lot of research on suicidal thoughts and behavior.

So we definitely come at this from a lens that is clinically supported and not intentionally Triggering or graphic or anything like that, but this is a heavier topic and I know personally in my journey There was a long time where anything that related to suicidal ideations or behaviors I steered clear from intentionally because it was a trigger that brought up those thoughts and Engaging in those in any capacity wasn't effective and was in some cases maladaptive.

be mindful, decide if this is for you, if it's not for you, if you're someone who's listening to this episode to support someone else, definitely recommend. We talk a lot about how you can actually support someone, what they're going through, why they're having these thoughts and feelings, and I think from that perspective, this episode is incredible, so if you're also listening and you're like, this isn't something I've struggled with, but like I have a friend or a family member, you're gonna love this, but wanted to give that initial warning, Before we get into the episode, because it is a heavier topic, and Set your own boundaries. But, with that, we have Katherine Gordon on the podcast today. She's a licensed psychologist, speaker, and author. She specializes in cognitive behavioral therapy, also known as CBT, and she's written several books on using CBT skills to prevent suicide.

So we talk about a lot of different things in this episode. We talk about why people have suicidal thoughts, which is something which is really misunderstood and not widely understood. known.

We talk about how suicidal ideations and thoughts progresses to behaviors. We talk about healthy conversations about suicide and what you can do to promote those healthy convos. We talk about co ruminating and setting boundaries. What to expect when you are in therapy for suicidal thoughts or behaviors, which is another huge point of anxiety for a lot of people, so I hope that's helpful to kind of shed some light on.

We touch on CBT skills that are most effective for suicidal thoughts, which I was really excited to touch on, because that's not something that's widely known or accessible or available in the mental health space, you kind of have to dig for it, so I'm really excited for you guys to hear that perspective.

And then lastly, resources for someone when they are in a crisis or navigating really intense suicidal ideation or behaviors. So I hope you guys find value from this episode. It's information that I wish I would have had access to earlier on in my journey and provide so much insight and perspective if you know someone in your life who's struggling with these thoughts and behaviors.

And again, Listen at your own risk. We, again, tried to be really, really intentional and come at this from an evidence based perspective where we're not doing anything that's known to trigger these thoughts and behaviors, but be mindful and you know yourself best. And if you guys do find this episode, make sure to share with a friend or family member. Post about it on social media. This is information that can really help and save lives. And so if you find it valuable, if you find it relevant to your journey, or others, make sure to share and leave a review. So with that, let's dive into the episode.

well thank you so much for joining me today, Catherine. I'm so excited to have you on the podcast. This is. An episode and conversation that I don't think is had on a lot of podcasts, even in the mental health niche, but I think it's something that's really important for people to be aware of, especially from an evidence based perspective and getting that expert opinion.

So I'm really excited to have you on today and talk about your work and your work, workbook, and all things suicidal thoughts, ways to cope with that, different interventions, how to prevent suicide. , but to get started, can you tell me a little bit about your background and why you decided to go into psychology and then specialize in this specific area?

Katherine: Thank you so much for having me on. I just think it's wonderful to create more space for these types of conversations. We know that they're really important and that also there is a lot of. fear and shame around suicidal thoughts. So making it accessible like this is really important. So thank you for inviting me on, , to focus on the background of how I got into it.

Basically, my father is a therapist. And so I had kind of just grew up with some awareness of mental health issues. And also just over time, maybe especially as a teenager, knew a lot of people who are struggling with different mental health problems. And I was always really interested in psychology. And so when I was an undergraduate student, I was able to work with Dr.

Thomas Joiner and learn about eating disorders and suicide prevention. And what I learned is that those two areas were really understudied at the time that there was such a for more research about What causes suicidal thoughts and behaviors and how to help people with suicidal thoughts and behaviors.

So really That inspired and sparked passion to continue pursuing that area and in addition to how all of us know people in our lives or we ourselves have struggled with different things and so those pieces pulling together are what really led me down the path of focusing on suicide prevention and eating disorders.

Sadie: Yeah, , I really like that framework you presented of like, why people feel suicidal and then what we can do to support and help and I definitely want to touch on the, the piece of shame and kind of different responses when you go to someone and express that you're feeling suicidal. I was at ABCT this weekend and we're talking about digital resources and ethical concerns and that's obviously like a big concern.

layer there, especially when you're not interfacing with a therapist. And so, excited to get all your thoughts, but to back things up a bit, I think a lot of people either have never experienced suicidal thoughts or they have experienced them, but they don't understand why. Like, even though this is their own lived experience and the emotions are coming up for them, there's kind of that disconnect of like, why am I responding?

Bonding to situations with these thoughts or why is this the way that I'm coping with this? So to kind of give some increased understanding for, for both perspectives. Why do people have suicidal thoughts or suicidal ideation. , and then I'm sure will also get into, , behaviors as well.

Katherine: It's a great question.

I was at A BCT as well, so I wish I would've known. Oh my God. We could have out the person we shoulda connected.

Sadie: Yes. Oh my gosh. Maybe next year. Yes,

Katherine: You know, it's, it's, it's a really, really important question, and In terms of what causes suicidal thoughts, there are two scientific theories in particular that have helped me to understand what prompts suicidal thoughts. And I found that, one, it's important that they've been scientifically tested and have some empirical support for them, but also, two, in my work as a therapist, that they tend to resonate with people who struggle with suicidal thoughts.

The first is the Interpersonal Theory of Suicide by Thomas Joiner and colleagues and it really focuses on the idea that suicidal thoughts tend to arise when someone is feeling isolated and alone, like they don't belong. Simultaneously, they're feeling like they're a burden on others.

And importantly, it's the perception that they're a burden, that the people in their negatively impacted by them continuing living. And so the idea is, if you feel alone, And, like, your existence is a burden on others, and you're hopeless about those being able to change, that the idea of escaping that pain and finding a way out makes sense.

It's really hard to think about, but it also makes sense. When someone is in that much pain, that suicide would come up as a way to think about. that pain. So that's, that's one framework. The other framework, the three step theory by David Kalonsky and colleagues, The three step theory of suicide talks about That suicidal thoughts arise when someone is in pain, and they're hopeless about it. And the pain can be emotional pain, physical pain, different types of pain. But the idea is that the pain is so strong, and again, that belief that it's never going to change.

And so, suicide arises as a way to think about escaping that pain. And it's not something that people are doing intentionally. It's something that, you know,

Sadie: It's really interesting because especially if people listening have taken psychology classes or you like have some general idea of evolutionary theory, it's not an adaptive response to pain. Like it's not problem solving. It's not seeking out support. It's really. counterintuitive and I think that's what people struggle to empathize with when someone comes to them and says I'm feeling suicidal or I've been suicidal or this is something I've struggled with in the past.

Do you have any thoughts there on kind of why there's this mismatch of how you would intuitively cope with an experience or think about it and then the way that people do especially when they are feeling like a burden or grappling with that hopelessness?

Katherine: Thank you for asking that because I think you're exactly right about that mismatch.

But what that speaks to is not that people who are struggling, not their unwillingness to do things that are helpful, but what it speaks to is the cruelty of mental health problems and the way that when we're suffering and struggling, it's actually hardest to do the things that would help us most. For example, we know that connecting with people when we're depressed or anxious in a lot of ways, that's really helpful.

We know that when we fear things. The thing that helps the most is to face those fears. And yet the nature of those mental health struggles is that you want to avoid those things. They seem like they're too much to even take on. And so I think about that a lot with suicidal thoughts that That hopelessness feels like there isn't any point in doing anything.

And when someone says to someone who's hopeless, well why don't you just do these things and you'll feel better. Unfortunately, that can make things worse because it can feel, the person can feel ashamed for not thinking about it that way or not being able to do those things that might help them.

And so I think that's a lot where therapy certainly, but also our support networks, our friends and family can help people to take those steps. That feel, they feel impossible sometimes to take those steps when you're in that level of agony and anguish.

Sadie: Another question, , that I want to ask you is we have like this idea of suicidal ideations with thinking about suicide and then, Obviously, some people engage in behaviors based on those ideations, and I would love to get your perspective there, especially for people listening that don't know how to support someone navigating that or they're not empathizing from experience and they're like, I don't understand why you're feeling this way, but also then why you would act on these feelings.

, what are, what are your thoughts there and kind of how that escalates, I guess, would be the, the correct term?

Katherine: I was actually watching a piece of a movie, a suicide documentary earlier today, and Thomas Doerner is interviewed, and he says, even if you haven't experienced suicidal thoughts, all of us have been through painful experiences.

All of us have felt horrible. And so if you can imagine that and multiply it by 10, 100 times, whatever it is, you get some sense of how hard it is when you're feeling that pain. I'm not bad to do things that might help you because you might just, you're overwhelmed by it. And so I think that one of the things And what I find very hopeful overall is that little things that can support a person, so listening to them non judgmentally and allowing space for them to talk about the suicidal thoughts can actually make a huge impact because the opposite where it's saying something judgmental or you have so many good things in your life, why don't you look at the bright side, why don't you have some perspective, or why don't you just do this, this, and this, if a person is already feeling And So bad like they're burdening others.

There's something really wrong with them. They're isolated and alone Having someone say, you should just do this, that just prompts more and more shame. Because often the person is already thinking that they're already thinking, why can't I get myself out of this? They're trying to get themselves out of it.

So to have someone respond that way, it kind of confirms that idea. that they're wrong and that they're not doing the right things and that there's something that is unacceptable about what they're experiencing and how they're responding to it.

Sadie: You mentioned listening empathetically. I'm sure you get this question all the time and it's also like a big general media question which is how do we, talk about suicide and suicidal ideation because it can be very triggering for, for people and if you've been in.

therapy context, maybe group therapy, DBT can sometimes be a little bit different. But like you were saying, it can sometimes be discouraged to talk about these things and there is, of course, literature supporting reasons why maybe certain settings aren't the best place to bring these up. But what are the best practices with having these conversations, both from the perspective of someone that's looking to ask for help or be vulnerable, and then also, , people that are wanting to offer support and not wanting to, to trigger someone's experience or, , , bring attention, , to something if the person has, like, moved through it or coped past it.

Katherine: I think that this is something that is on a lot of people's minds when they're feeling the complications of helping and supporting others. So I'm glad for the opportunity to talk about it. In general, I, and it's, there are individual differences depending on what people need and how they feel supported, but in general, I'm in favor of being direct, open, and honest, because anything else just confirms that idea that it's unspeakable and that the person can't talk about it.

And so I think just, Starting with open ended questions. How do you feel? What do you think led you to feel that way? That sounds really hard. Simple, empathic, non judgmental statements like that. are helpful. I think that's really hard to do because it's uncomfortable and painful to hear that people are in those situations where they're feeling suicidal.

So often the urge, which is totally understandable, is to jump in and problem solve or to kind of push away the conversation. So being direct is really helpful. To your point about not wanting to make the suicidal ideation worse by talking about it. In the vast majority of cases, what research we have that exists suggests that if someone is not thinking about suicide and you ask them about it or they listen to music about it or whatever it is, that they aren't going to start becoming suicidal. And so that's something we can kind of.

Rest assured about. On the other hand, there is evidence that if you talk to someone about suicide and they are struggling with suicidal thoughts, that even talking about it can reduce some of the distress and intensity surrounding it.

Sadie: Mm hmm.

Katherine: And I think that one area, you know, you mentioned DBT, that is worth mentioning.

In group settings, there are rules about not going into details surrounding methods. I think that's a controversial area about how much that matters, but I think it makes sense, and I don't think it's necessary to go into details about methods if you're trying to understand why someone's experiencing that.

I do think it is important to understand what people are thinking about in terms of methods for the next piece, which is making sure they're safe. So if someone has specific methods in mind or past methods they've used to try to end their lives or kill themselves, then actually it is important and helpful to know what those are so that you can help create a safer environment.

Because the research really strongly points to the fact that if you if someone has firearms in their home or they plan to overdose or they plan whatever their plan is that if you can restrict that that can be life saving and so there's a there's some nuance to it, but the general rule is it's better to talk about suicide than not, and keeping it open and non judgmental and expressing compassion tend to be helpful.

Sadie: What about peers and co ruminating? Because we have a lot of young adults that listen to the podcast, and oftentimes with young adulthood comes your peers being the people you're leaning on the most. Maybe there's more fear and shame about going to parents or a counselor or a trusted adult to try and be vulnerable.

And especially with mental health challenges, that can be a double edged sword because you just, don't have the training and expertise and emotional bandwidth and all the things, , at, at that point in life. And it's also Not in like a negative connotation, but it's not your responsibility.

Like, you're not their caretaker or guardian or parent or school counselor and all the things. So, especially with young adults and co ruminating, or if there's multiple people that are struggling, is that kind of like an outlier to the rule of thumb?

Katherine: Have you seen the Netflix series Heartstopper?

Sadie: No.

Katherine: The recent series, the main star, the main character of it has eating disorder symptoms and also some self harm issues.

And it's actually a really nice depiction of it because one, it's realistic, it's, and two, it shows the friends and the character's boyfriend both feeling like they don't know what to do to help him. And so there's a nice scene where, The, the boyfriend happens to have a psychiatrist who's an aunt, which is handy.

And she says your job is to ask him how he's feeling, be willing to spend time with him, and then gently urge him to seek help, to talk to his parents, to talk to a therapist. But your job is not to intervene and, and change it. You can't do that. And also your mental health could deteriorate if you think you can and you're unable to change that.

And so. , I was impressed by that because you don't see that a lot. , there are much better mental health depictions than there used to be, but that really shapes, to answer your question, the boundaries around what we can do as, as peers. Even I'm, I'm a psychologist and I have psychologist friends, and even though I have the training as a therapist and the capacity as a friend, I don't approach it the same way at all.

It's very much. listening, support, and also knowing my own limits. So are there things that are, that I don't have the bandwidth for that you mentioned? Am I having a really hard week and I need all the resources I can? Well, then I can tell the friend, is there anyone else who can call or can you call the crisis hotline 988?

Have you tried to talk to your therapist? Can I help you by identifying a therapist? So finding something to do while not taking on the full responsibility for it, because you want to check in with yourself and your own mental health and understand really what you can do is very powerful, which is to show that you care, but what you can't do is control someone else's behavior or something like that.

And if it helps at all to think about it this way, by you modeling that you have certain boundaries mental health and that you're taking care of yourself, that can be helpful for your friend too. It might not immediately feel good to them, but they're getting the message that, okay, my friend, when they're struggling or want to prevent struggling, they are doing things to take care of themselves.

And so they're observing that as well. And I do think that model can be helpful.

Sadie: Yeah. I think that was one of my biggest learnings and I think it caused me a lot more. , struggle than I needed to experience was by surrounding myself with people that were feeling the same way and it's instinctive like we attract the energy we put out and getting our feelings validated is really important and also like an innate need.

We look for that from people around us and in this situation. it just adds a whole nother layer to the situation and it can hurt it rather than help it and I think even now same thing we're like when I think about how I could help and support my peers it wouldn't be like listen to this podcast or like this is how we're going to walk through this and even like making a a situation more safe because that's not my role in their life, but being someone that they know they can have a fun night with and watch a show together or laugh and , just call when they're not doing well.

I think that you're adding like a great deal of positivity and support to their life that they can count on. , and I think people underestimate how much that's valued, , and even if they feel like they could do more, I think that is an incredible, , position to be in as a friend if you know that they can count on you and you know that , you can be an outlet for them to feel better and get out of their head and just connect.

Katherine: That's exactly right. It can mean the world to someone who thinks that they're a burden and they're alone to be with someone who likes being around them and it will do things with them. And the other part that you said, which I think is really important is that often in therapy, we're trying to not avoid things.

We're trying to really not distract. We're trying to process things, but As you know, with suicidal thoughts, actually, it's, it's very important, especially during a crisis, to have that skill and tool of distracting until the intensity decreases. And the research supports that, and that's certainly present in a lot of therapies that we do, that that actually is not a good time to just keep.

You want to eventually get back to the causes, but while you're in a crisis, Distraction may be the best thing to do.

Sadie: Yeah, I just recorded an episode on anxiety and I was like, Let's not distract too much. Let's go towards that thing. This time we're like, distract, distract, distract. Watch as much Office as you want.

Listen to, like, do whatever you need to do. , and I, I think that's very true. , shifting gears a little bit and kind of expanding on How you can work through these thoughts, well I'm sure we'll get into identifying the core issues, , you have a workbook which we'll put in the show notes about how people can work through suicidal thoughts, especially from the CBT framework, but can you give us like a 30, 000 foot view of kind of what this process looks like because that's the other thing.

If you haven't been to therapy, , for navigating suicidal ideation before, you really have no idea what to expect because it's not a natural skill in life to be like, oh, I intentionally changed the way I think about things because it has really detrimental impacts on my life. So overview, what can people expect?

And I think it's also helpful for parents and peers to understand the work that their, , friends and family might be doing.

Katherine: Yeah, the, the cognitive behavioral therapy model kind of zoomed out and at its best. basic level is that a thoughts, emotions and behaviors all influence each other. And when someone's in a suicidal mind state, often the thoughts are about being alone, about being a burden that nothing in life matters, not feeling connected to it and their perception, even though.

It's not their fault. Often it has some flaws to it, because the, again, the cruelty of struggling with suicidal thoughts is that you're so, can be so hypercritical of yourself, and you can be unable, almost, to see reasons to believe that That things can change or that you can help to affect that. So, with the Cognitive Behavioral Therapy model, really, the work that's being done is finding ways to be aware, first of all, of suicidal thinking patterns and how they tend to increase pain, increase hopelessness, and look for evidence that prove you're not worthy.

things like that, and then exploring evidence that suggests you are worthy and that things can change and you've been through hard things before and you can get through them and there are ways to cope. So that's a big piece of it at a, at a zoomed out level. And then there's a lot more details in between, but that's the main idea is looking at those, what thoughts, behaviors, and emotions, what can we do to impact those to basically disrupt the suicidal crisis and system.

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If we can like kind of go through the cycle and get Detailed on thoughts and then the behaviors and then the emotion shift as well. And I'm sure there's we talked about shame earlier sometimes guilt like these emotions that can really cause this cycle to continue The thoughts piece of it I think is really interesting and like you said the the data doesn't support that engaging in these thoughts or Going down that that line of thinking it doesn't have a positive impact on your mood Even though people sometimes do like you said use this to cope with feeling hopeless or like a burden or these Other emotions.

So in the thought piece of thing, what's arising? How can people rewire that? All the things?

Katherine: So one piece that I want to mention is that, I think it's part of the complexity. It's not helpful to, for example, continue to think about suicide as an escape and that it can increase suicide risk.

However, it's really important to be compassionate with yourself and recognize one that that's not completely in your control. Your thoughts can kind of do all kinds of things and, and just approaching yourself with warmth. And so what a thought might look like is something like, I'm not going to get through this.

I'm going to be in this pain forever. And a way that you might address that with cognitive behavioral therapy is dig a little bit deeper. Well, why is that? Well, it's because I'm incapable and it's because the world is cruel and nobody wants me around and all of those thoughts. And so then once you've identified what those thoughts are, you can look and see, do they fit certain patterns?

Often the patterns that we tend to see, Are all or nothing thinking. So the person is thinking about all the things, the mistakes they've made and they don't, they can't think without some help about the things that they have contributed and how they've connected. They can't think about building confidence by looking at what they've done in the past.

They can't think about, well, I feel like a burden. So maybe if I change the behavior and start intentionally contributing more, that might reduce the emotions. And so the process is identifying the thought, identifying what the pattern is. Is it all or nothing? Is it disqualifying the positive things that are coming up?

And these are all from Aaron Beck's Cognitive Behavioral Therapy. And David Byrne's also, his Feeling Good book has a lot of these common patterns in them and so I, I found in therapy that even introducing those patterns helps people so much because they relate to them and they realize it's not just them.

If someone's written a book and there's a list of them, that's really helpful. And then the next piece is helping go through. evidence against those thoughts and then coming up with a new reframed thought that's more accurate. And it's totally different than positive thinking because you, you aren't just saying, okay, you think you're a bad person, just think you're a good person.

That's, that's, that doesn't work that way. Right. That would be nice if it did. It doesn't though. So rather what you're doing is you're building a case by examining evidence that supports, you know, That they're not a bad person and then coming up with a reframe thought that's more accurate and then acting as if that's the truth and so that's part a big part of what it is.

And then the behavioral piece is very much. Adding in those things that connect a person that tether them to life. What's meaningful to them? What are their values? How can they amplify those because under the crushing weight of suicidal thoughts? It's not everyone, but a lot of people withdraw, give up and all of that.

And so it's also finding things that feel doable with that energy level or whatever it is for creating a little more joy and connection in the person's life. So that's the main gist of how to build a hopelessness and to soothe some of the pain that's driving the suicidal thought.

Sadie: I really like what you mentioned there where you have to have that self compassion with the first thought because it's, you can't necessarily control that just like you can't control like an emotion as it arises or if you've coped with something behaviorally a certain way for years, it's not immediately going to shift even if you set that intention.

But the next thought or how you respond to it, , or the evidence you collect against that initial thought, you do have that autonomy and choice and power there, which I think is really important. I'm curious, are there any, , behaviors or coping skills or activities that clients have found really helpful across the board.

a few that you consistently recommend that people can try out if they're like, okay, I like the idea of increasing meeting, but I don't know where to start.

Katherine: Sure. so I think about a couple of different types of behaviors and one, one thing that my workbook really focuses on as a framework and that I use as a therapist is the idea that there have to be a menu of options because different things work for different people.

So if one thing doesn't work, okay, well, we have nine other things or 10 other things and that in itself can build hope. Getting through it. So one category I would say is self soothing. And when someone's struggling with a mental health problem and feeling suicidal, they often are punishing themselves.

They don't even think, Oh, now's the time to actually soothe myself. So I think about if you have the flu or you're sick, at least some part of you knows that it's, it's not your fault. It's just something that happens and you kind of have to go easy on yourself. You have to have. Comfort foods, you, you can't do the things you normally do.

Hopefully you can call out of work. And so I try to make that analogy that when you're struggling and in a lot of pain, that is the last time for more punishment and self criticism. So things that tend to soothe people, I think a lot of it, a lot of people go to music. A lot of people go to, I like stand up comedy because it's kind of the opposite of self criticism.

Feeling bad when you're laughing. And I think the other part of it is that actually there's so much comedy now about mental health stuff. So I kind of have like a. two functions where it's funny and you can resonate with it. So those are a lot of them getting outside, like just changing the perspective and, , going for a walk, taking a hot shower, anything that captures your attention and feels positive can be helpful.

Sadie: So

Katherine: that's a horror movie.

Sadie: That was one of the big go to ones that I heard a lot because you cannot feel like deeply sad and hopeless and jump scare at the same time. So any of those where it's like it's just that all encompassing emotion being evoked, it's really effective as an intervention.

Katherine: Exactly because what you're doing is your mind is kind of like a magnet when you're suicidal and it's, it's everything that confirms your negative views kind of sticks and so it takes something to jolt out of that. So that's, yeah. That's exactly right. And you, it's trial and error too. So you see what works for you and you try other things.

And then the other piece I would say with the behavior is trying not to isolate. And one way to do that is to reflect on your values. In my workbook, I talk about Viktor Frankl's Man's Search for Meaning that he wrote. It's a holocaust survivor and as a psychiatrist and talked about how even in the worst situations, I mean, he was doing suicide prevention and the concentration camp while he was held captive there.

Sadie: Yeah,

Katherine: there's still a way to find meaning. And so a lot of it boiling down to basics is Spending some time to reflect, what are my values and what am I doing in my life that connects me with those values and the other theme I've mentioned a few times, they don't have to be huge things. If you value being compassionate or charitable, Or educated or whatever it is, you can find something, something to do that just kind of connects you with that value.

And then life doesn't feel so empty. And so it's worth thinking about those types of things and making action plans for what something I might do to enhance that meaningful feeling.

Sadie: For sure. , the last thing I want to touch on is what people can do in a crisis, because I know people are like, we know 9 8 A, we did an episode, , a while ago, and I'll put it in the show notes with, , Adia Fadai, and she is a 9 8 A operator, so we like went through exactly what happens when you call and what they'll say and, you know, How you can still be anonymous and all the things we did a similar one with crisis text line and what people are commonly talking about.

And, , we had a young adult volunteer on the podcast and she went through kind of like how she typically responds and what people can expect. So we. Generally, those are, are resources, but there's still anxiety and apprehension about utilizing those. , we talked about distraction. Is there anything else that you would recommend in crisis that people can utilize?

I am almost positive people are listening to this, not in crisis. They can write it down, maybe take a photo of a sticky note, whatever it is to come back to this as a crisis survival plan. , what other tips do you have for a crisis?

Katherine: For, , 988, I would go to their website and they have safety. Plan templates and I would look there and and fill out one.

It's worth having a safety plan. Like you said when you're not in crisis, but the main things that it has on there are one. What is your main reason for living? Because when you're suicidal, it's hard to remember. Wait, why do I want to hang on anyway? And that can make it more salient again, that idea that you're kind of shining your attention and spotlight on something else.

And also the idea that it doesn't have to be something huge. Some people say their family members or what keep them going or their pets or whatever it is, but whatever it is, that's acceptable. So it's a reminder of that. The other piece is of course the emergency numbers, but people don't always want to call that.

You know, I encourage it, but if you don't want to, you don't want to. The distraction and coping strategies. And then the thing that I'll add is a piece about making your environment safe. As we were talking about earlier, that's super important. When you're in a high risk situation, that you put distance and time between yourself and the lethal methods, whatever they are, that is life saving.

There is, there is research looking at how long the typical intensity, like very intense suicidal thoughts can last. And, At their highest peak, often they diminish within hours. And so if you can get through that without having access to the lethal methods, having some support people that you can contact, having some coping skills, and remember your reason for living, that can be really life saving.

And I'll mention an app called the Virtual Hope Box, which has a lot of these ideas in them and There's distraction things in there like games that you can play and inspirational quotes and, , emergency numbers. And so the goal is to have this plan in place so that when you can't think clearly about it, you can access that and that gives you the steps to take.

And so those are, those are the main pieces, separation from lethal means, support people, emergency numbers, and your reason for living.

Sadie: Yeah, there's, like you mentioned, there's so many, , different ways that we apply double standards to mental health, and I think the, like, giving yourself an environment that you can be successful in is a great example of that.

Like, if you have celiac, you don't buy 12 loaves of sourdough when you go to Trader Joe's because no one has that level of self restraint. even if you know there's going to be a negative consequence. You're struggling with addiction. You don't spend three hours at the bar after your work day, hopefully.

these are things you don't do because you know you're just setting yourself up to be in a situation where you have to use willpower. And humans don't have a lot of willpower. Whether you're looking at, I'm taking Grit Lab right now, and so we're talking about achieving your goals and like, that's what we're talking about.

Deliberate practice with instruments like willpower doesn't get you there. It's these contexts you put yourself in and that's absolutely true for mental health and suicidal ideation and , I think that's really important to remember because I think again it comes back to the shame piece of like why can't I just get through this thought like why would I have to adjust the environment but we adjust our environments for everything and it's really, really difficult.

key in allowing us to be successful. It's simple things like putting your alarm across the room so you can't get back in bed, like all these things we do because as humans we're very susceptible to our environments. We don't have a lot of willpower and unfortunately that works against us in this context.

Katherine: You're absolutely right and I think the analogy of other types of medical emergencies is correct too in that if someone's having a heart attack, you don't expect them to figure it all out on their own. You have people that can support you, you contact emergency services, you have someone else drive you to the hospital.

So when you're in a suicidal crisis, you, why in that emergency situation would you not want to reach out, except as we mentioned, knowing the shame that comes with it and feeling like no one cares. So it can be helpful, just like you're saying, to think about it when you're not in crisis, so that when you're in crisis, you already have the plan laid out and don't even have to think too deeply about what you need to do.

Sadie: A hundred percent. Well, if people want to get your workbook or, , I know you have another book coming out as well, where can they do that?

Katherine: my book is available on Amazon and bookshop and basically most. places where books are available, it's usually at least a copy or two at Barnes and Noble. So it's, it's not too hard to find if you're looking for it.

And I think the other, , the guided journal I'll mention, which is just another format. It's much shorter, but still. I found that journaling people find really beneficial for a variety of things, and so the Guided Journal for Suicidal Thoughts Workbook, kind of to your point, it's not ruminative, it's guided, and it has a lot of these cognitive behavioral therapy practices, that will be out in July 2025, and that'll be available Amazon, Bookshop, Barnes Noble, all the same types of websites.

Sadie: Amazing. Well, I'll put that in the show notes and thank you so much for joining me.

Katherine: Oh, thanks so much for having me on. It was my pleasure. Thank you for having me on to talk about this important topic.

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