Stressed out teen with suicidal thoughts

Dear Dazed,

You’re not alone in having thoughts of suicide, and reaching out for help is a major step forward. If you haven’t already, you might consider making an appointment to speak with a mental health professional about your concerns. A first step may be your school’s counseling center, but if that service isn’t available or you’re not comfortable with that option, try calling the National Suicide Prevention Lifeline (1-800-273-8255). This resource offers free, confidential support at any time of day. You can also check out Feeling suicidal…Help! in the Go Ask Alice! archives for tips on what to do if you’re feeling suicidal. If you’re currently in crisis, it's critical to seek support right away. Once you've been able to reach out for support, you can also work on incorporating stress management strategies into your routine. 

Based on your description, it’s possible you’re experiencing suicidal ideation (another term for suicide-related thoughts) along with suicidal imagery (also referred to as suicidal intrusions or flash-forwards). Common instances of suicidal imagery include envisioning what would happen to you during or right after a suicide attempt or completion, or imagining the responses of people you know in the aftermath. Although the frequency and intensity of suicidal ideation and imagery vary from person to person, suicidal thoughts and associated images may cause great distress and put a person at risk of attempting suicide. The good news is that there are interventions available to address suicidal ideation and imagery. Experts generally recommend psychotherapy (more commonly called talk therapy) and getting evaluated for medication. Research shows the combination of both tends to be the most effective at reducing suicidal thoughts. Some of these forms of treatment include: 

• Cognitive behavioral therapy: This is an evidence-based form of psychotherapy shown to reduce rumination, which is the persistent repetition of depressive or maladaptive thoughts (such as suicidal ideation) and the repetition of associated images (such as suicidal imagery). In CBT, a therapist helps to identify and change negative thinking patterns while also providing tools such as relaxation, coping, or stress management strategies to manage negative thoughts, beliefs, and emotions as they arise.
• Mindfulness-based cognitive therapy: Research indicates this may also help decrease depressive rumination and associated stress. This type of cognitive therapy emphasizes the acceptance and management of maladaptive thoughts, rather than trying to change thinking patterns. Proponents of this type of therapy believe in accepting maladaptive thinking as outside of a person’s control. However, it does emphasize that how a person responds is within their control — for example, they have the ability to not act on maladaptive thoughts or emotions, and to replace maladaptive behaviors with more helpful behaviors.
• Eye movement dual task: This process may help reduce suicidal imagery as well. This treatment typically spans over three weeks, where, in six hour-long sessions, a person engages in a task (such as playing a game or working out a math problem) that activates their working memory while also being asked to recollect suicidal thoughts and images. The eye movement dual task isn’t designed to be a stand-alone treatment and instead is recommended as a complement to other treatment approaches.  

You also mentioned wanting to learn more about stress management strategies. Stress can sometimes manifest itself in tense muscles and other bodily symptoms. In addition to considering professional help, there are a number of strategies you can try at home. These include:

• Deep breathing: While sitting or lying down, place one hand on your abdomen and one on your heart. Inhale and exhale slowly, feeling the sensation of your stomach rising and falling.
• Meditation: The goal of meditation is to focus your attention as a way to become more relaxed. Try to find a quiet place, and focus your attention on your breath, something in the room, or to words in your mind. If you notice your mind wandering, gently bring your attention back.
• Progressive muscle relaxation: In this strategy, you tense one muscle group at a time for a few seconds, and then release. Start with your toes and feet, and work your way up the body, or start with your face and work your way down.
• Yoga: Yoga integrates specific poses and movements with a focus on mindful breathing and meditation. If you’re new to yoga, you might start by going to a class or working with an instructor who can ensure your safety.
• Tai chi: This ancient Chinese practice involves slow movements and postures. Similar to yoga, participants are encouraged to focus on their breath.

Adapted from MedlinePlus.

In addition to these strategies, you may also find it helpful to read some of the Q&As in the Stress and Anxiety section of the Go Ask Alice! Emotional Health archives. These can provide some additional strategies as well as share some thoughts of those who are also learning to cope with stress. 

It's admirable that you're so intuitive and ready to seek help. There is hope and you deserve to feel better. Here’s to taking care and seeking support soon.