Information provided below is NOT most appropriate for active suicidal ideation or long-term symptoms of depression or suicidality.
The topic of mental health in humans is just as complex as the people affected. So when attempting to define a depressive or passive suicidal thought accurately, the outcome can be subjective because no presentation is the same in one person as in their neighbor. As a generality, we know that patterns of intrusive, ruminating thinking are often at the root of developing depression or anxiety disorder. Most of us experience intrusive thoughts periodically, but when these thoughts interfere with day-to-day life and functioning or cause significant distress, this can be a signal that you may benefit from having professional support.
A depressive thought is just another way of saying an intrusive thought, though the term may be more specific to those who experience depression or have received a formal diagnosis. An intrusive idea originating in depression may contain overwhelming guilt and shame, sadness, and hopelessness, and making decisions may feel harder than usual. Passive suicidal thoughts are less defined and specific and may be fleeting compared to active suicidal thoughts. People with passive suicidal thoughts may think about death and dying personally, believe they don’t deserve to live or wish they could stop living. Generally, there is no plan to carry out suicide with passive thinking. Suicidal thoughts, whether passive or active, can happen to anyone and are common. You do not have to have a mental health diagnosis or be clinically depressed. Often, suicidal thoughts signal you are overwhelmed with emotions or situations you struggle to manage. Many people find that they occur during times of very high stress, like facing physical/mental health challenges, grief, or living through a global pandemic.
Why interrupt a depressive or passive suicidal thought?
Now that we are thinking about and defining moments of crisis (moments that are highly stressful or distressing in nature, shorter term, create feelings of intense pressure to resolve the emotions or events immediately, and feels challenging to access regular coping tools), the question is not if we will experience them but how will we experience them? Intrusive thinking can lead to a full-blown crisis if the pattern is continuous, escalates, puts the person at risk of harming themselves, or interferes with daily functioning or tasks. The goal, always, is for our pain not to transform into suffering. In Dialectical Behavioral Therapy (DBT), the belief exists that pain in life is inevitable, but that suffering is not. We want to find within ourselves the ability to survive a crisis without making it any worse. If that crisis involves intrusive or suicidal thoughts, finding ways to interrupt them is crucial. Distraction techniques can be highly effective when used correctly.
Why are distraction techniques helpful? Are they ever unhelpful?
There are many myths floating around the depths of the internet about why distraction techniques are harmful, but I’m here to clear all of that up. It is entirely against human nature to be uncomfortable in any capacity, let alone to sit in painful and overwhelming emotions. It’s a universal human trait to seek comfort, and often the quickest ways to receive the benefits are not healthiest for us (think: overuse of alcohol, drugs and other substances, risky sex, socially isolating, etc.). Distraction techniques help keep you safe in the moment by preventing some of these unhealthy behaviors while also widening your tolerance for discomfort. Scientifically, purposeful distraction techniques ease amygdala activation, the part of the brain responsible for processing emotional responses and threat detection. Distraction helps reduce emotional intensity so that it’s easier to manage later. Hint: distraction isn’t about avoiding or escaping a feeling – after all, would a therapist encourage you to do that? Distractions aren’t a long-term solution. Distractions are temporary, so the hope would be that distraction helps reduce the emotional intensity enough to return to the feeling shortly.
4 tools to add to your toolbox:
Below you’ll find five tools to add to your toolbox for coping with and managing difficult emotions. The first three of these skills are specifically for distress tolerance and are based in the DBT model. The fourth tool borrows from ACT (Acceptance and commitment therapy), and the fifth is often used in treatment. I try to communicate this to my clients: I don’t recommend tools I don’t use or haven’t tried before.
This skill is a personal favorite of mine because you have so many choices, so there is a greater likelihood of finding a distraction that works. Helpful and healthy distractions are classified into seven categories with the acronym ACCEPTS (Activities, Contributions, Comparisons, different Emotions, Pushing away, other Thoughts, other Sensations). The link in the previous sentence will give examples of what these various distractions could look like from their respective categories. Distracting with another activity could be one that you’ve found to be helpful in the past when you’re stressed out or overwhelmed, like cleaning, replying to emails, or doing a puzzle. Other sensations to distract yourself could be taking a hot or cold shower, running an ice cube down the inside of your arm, or squeezing a stress ball – these sorts of techniques are proven to help quickly bring your body back down to its baseline. Another category that I find helpful is distracting with other thoughts, like reciting the alphabet backward or trying to learn the lyrics to a new song. Pro tip: I keep a small piece of paper in my wallet with at least three of these techniques that I can use anywhere, and I mean anywhere, like walking down the street or on the train. That isn’t going to be all these distractions, so choose wisely. When we are emotionally overwhelmed enough, the logical side of our brain goes to sleep like a computer, while the emotional part of our brain stays highly activated. This is why our memory becomes foggier, and it can be challenging to remember necessary information. If you have a few skills on hand that you can use as needed, you’ll thank yourself later.
TIP your body chemistry
In the same realm of “other sensations” from ACCEPTS, changing your body’s chemistry quickly forces your brain to focus on that new feeling instead of the old one. TIP is another acronym:
- Tip your body’s temperature with cold water to calm down quickly by holding your breath and putting your face into a bowl of ice-cold water for thirty seconds (or having a cold pack on your eyes and cheeks).
- Intense exercise will calm your body when it’s highly emotionally activated, even for a short time. You can run, jump, play an aerobic sport, or lift weights, for example.
- Paced breathing and Paired muscle relaxation will help slow your breathing and relax your muscles simultaneously. To pace your breathing, slow your inhaling and exhaling way down and breathe out more slowly than you breathe in (the good ole 5 seconds in and 7 seconds out rule is reliable). You want these breaths to be felt deeply into your belly. Once you find a rhythm, taut your muscles on your in-breath while noticing the tension in your body. On your exhale, say “relax” to yourself and let go of the strain while noticing the difference.
Use your 5 senses to re-ground
Self-soothing with the five senses is excellent because you use your senses to observe where you are in the present moment. With your vision, you can observe the colors around you, count how many chairs are in the room, read the poster on the wall, look up at the sky and count the stars if it’s nighttime. With your hearing, you may listen to a soothing music playlist, pay attention to the city’s sounds, or turn on the radio. With your smell, you could burn incense, light a scented candle, bake cookies or cake, or open a window to inhale fresh air. With your taste, you can treat yourself to a dessert, drink your favorite soothing drink, or suck on a peppermint candy. Take a long shower or bath with your touch, pet your fur baby, put a cold compress on your forehead, or rub lotion on your body. The more you can bring yourself to the present moment, the less your emotional brain is stimulated.
Practice cognitive defusion
Within the ACT framework, the content of a thought is not viewed as the problem but rather how we relate to the thought that then creates a problem. When we become fused or attached to our thoughts, we begin to perceive them as facts and absolute truths instead of the fleeting pictures or words they are. Facts and feelings are just that: fleeting, limited, and non-permanent. Cognitive defusion allows us to put space between ourselves and our thoughts to remain present and ultimately focus on our broader life experience instead of little moments. There are many ways to practice defusion, but I’ll share a way that I like to practice (and clients have given feedback that this has been useful in distress). One way to practice is to notice your thoughts as you put more and more distance between the thought and yourself. If, for example, you struggle with body image and think, “I look really fat in these pants today,” you would instead say to yourself, “I notice that I’m having a fatphobic and unkind thought about myself.” Then you could say, “I notice that I’m noticing that I’m having a fatphobic and unkind thought about myself.” You would repeat this process using as many ‘notices’ as it takes for you to feel less attached to that thought. Labels are how we sometimes describe our experience; however, they are not always the most accurate, productive, or reliable.
Remember, we sometimes struggle to manage our emotional pain, yet we often have what it takes to prevent that from turning into suffering. I will never forget learning that our brains have not yet evolved into who we are now as a human race; it’s still what’s called our “lizard brain” in many ways. That is, it’s not responsible for creating joy and happiness but solely for keeping us alive. We have to create intentional pleasure and satisfaction in our lives, which begins with how we govern our thoughts.