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©NowMattersNow.org Dr.Ursula Whiteside Micro-Interventions for Suicidal Patients Ursula Whiteside, Ph.D., CEO, NowMattersNow.org Zero Suicide in Healthcare Summit Sydney Australia February 27, 2017

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Page 1: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org Dr.Ursula Whiteside

Micro-Interventions for Suicidal Patients

Ursula Whiteside, Ph.D.,CEO, NowMattersNow.org

Zero Suicide in Healthcare Summit Sydney Australia

February 27, 2017

Page 2: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Review - Language MattersDied of Suicide vs Committed SuicideSuicide Death vs Successful Attempt

Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide

Describe the Behavior vs ManipulativeWorking with vs Dealing with Suicidal Patients

Page 3: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

•Motto & Bostrom, 2001

•Carter et al., 2005

•Vaiva et al., 2006

•Fleischmann et al., 2008

Micro-interventions:Dialectical Behavior Therapy (DBT) Skills

Page 4: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Micro-InterventionsMost people don’t want to die, just that they don’t how to feel better

Page 5: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Micro-InterventionsMost people don’t want to die, just that they don’t how to feel better

“If you didn’t feel so (sad, depressed, hopeless) would you want to die?”

“If your divorce were resolved would you still be thinking about using a gun?”

Page 6: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Micro-InterventionsSuicidal thoughts by themselves are

not dangerous

Page 7: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Micro-InterventionsSuicidal thoughts by themselves are

not dangerous“What you do with the suicidal thought makes

all the difference”

Page 8: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Micro-InterventionsA way of looking at stress and

explaining stress to people

Page 9: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

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Explaining Stress

Page 10: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

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Explaining Stress

Page 11: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

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SELF-CARE

Explaining Stress

Page 12: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

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SELF-CARE

Explaining Stress

Page 13: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Opposite Action VideoDiana Yanez-Cortes

Video

http://www.nowmattersnow.org/skill/opposite-action
Page 14: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Opposite Action – Suicidal Thoughts

1. Feelings are strong when people are having suicidal thoughts - and they often have strong urges to do things that are harmful to themselves. Is this true for you?

2. Opposite Action is about getting outside of your head and doing the opposite of what your urges are telling you to do.

Page 15: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Opposite Action – Suicidal Thoughts (2/2)

3. Throw yourself entirely into doing something outside your head: cleaning, going for a walk, listening to music, playing a game online

4. Do this as if there were nothing else in the world to do

5. When you mind wanders back to worries and suicidal thoughts – acknowledge them and then throw yourself back into the moment (outside of your head)

Page 16: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

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SELF-CARE

Explaining Stress

SELF-VALIDATION

Page 17: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Validation Reduces Neg Emotions• Listening, reflecting, mind-reading • “It makes sense given what you’ve been

through”• “Anyone would feel that way in that situation”• Name patient’s emotion and related thoughts,

non-verbal expressions and ask about how it feels in their body

• Be radically genuine & real with the patient…

Page 18: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Validation when there are problematic Interpretations

• Practice Validation– “My sister is such a *^%!!**. I know she is trying

to take my kids away. She hates me and I’ll never win with her”

• Validate the emotion – Over the content when content is likely

misinterpretation or highly judgmental of self or others

Page 19: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

Page 20: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

What else?

Social justice IS teaching people how to harness their emotions

Page 21: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

• Treat my sleep problem

• Gently examine my paranoid thoughts with me

• I might feel like I’m bad or wrong for having these thoughts

• I might feel like I’m “in trouble” for reporting ideation

• Balance trusting me and my innate capabilities AND yourself as a clinician when what I reveal is potentially unsafe

• Ask, “Would you tell me if you did have [plans, a gun, pills etc]?” then PAUSE and watch my response and nonverbals

What Suicidal People Want -from Team Now Matters Now

Page 22: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

• Acknowledge that that this is a problem that researchers are still working on finding better cures for AND that you have great hope

• Give me feedback about the way I am asking you for help

• Know that I am telling you about my suicide ideation/plans because I want to live, I want help, and I want to work together

• I may be paying very close attention to how you respond to what I say, and telling you more or less based on how open I think you are to hearing it and how much I trust you

What Suicidal People Want -from Team Now Matters Now

Page 23: Micro-Interventions for Suicidal Patients · Suicide Death vs Successful Attempt Suicide Attempt vs Unsuccessful Attempt Suicide vs Completed Suicide Describe the Behavior vs Manipulative

©NowMattersNow.org 2016 Dr. Ursula Whiteside

CHRONICALLY SUICIDAL PATIENT: From Team SPR

•Be fully present with me•Help me hold my pain (feel less alone in my pain)• I feel helpless, broken, and scared•Please be aware if you are afraid and acknowledge it •Be transparent about what you are thinking and feeling (but

communicate in nonjudgmental and non-defensive way)• I may try to manage your emotions for you•Discuss with me my diagnosis, as it is in the charts and go

through the DSM criteria with me


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