The Truth About Suicidal Ideation – Part One

At age 13, I tried to take my own life. Overwhelmed by suicidal ideation and emotions I couldn’t understand or express, I attempted suicide by overdose and almost died. I spent several weeks in a psychiatric hospital, feeling lost and ashamed.

However, that experience became a turning point for me. Like 9 out of 10 people who survive a suicide attempt, I didn’t go on to commit suicide. That chapter in my life wasn’t the end of my story but the beginning of a journey toward healing and understanding. I now work with clients who are deemed high risk because of their suicidal ideation, history of attempts, or suicidal behaviors.

September is Suicide Prevention Month, so let’s do a deep dive into a topic that understandably scares people.

The Function of Suicidal Thoughts

Suicidal ideation is not always about the desire to die but can serve a different function—problem-solving pain. When a person feels overwhelmed by emotional pain, suicidal thoughts can seem like a solution to escape that suffering. It’s a way of saying, “I don’t want to feel like this anymore.” This doesn’t mean that the pain isn’t real; it’s a response to emotional distress that feels insurmountable.

Suicidal thoughts often arise when a person perceives their problems as unsolvable.

The idea of death can begin to look like the only option when they can’t see a way out. This is why addressing suicidal ideation is so crucial in therapy—it’s about helping someone find better ways to solve their problems and alleviate their pain without turning to thoughts of death.

DBT’s Approach to Suicidal Ideation

Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan, a psychologist who has publicly shared her own experiences with suicidal ideation. DBT is especially effective for people with Borderline Personality Disorder (BPD), but its techniques are used widely for managing suicidal thoughts.

In DBT, suicidal ideation is addressed early on—it’s a Stage 1 target behavior, meaning it’s one of the first things that is tackled in treatment.

Therapists working from a DBT framework will focus on the immediate triggers (or “prompting events”) for suicidal thoughts. What happened just before those thoughts appeared? By examining these events, clients can develop an understanding of what sparks their suicidal ideation and work on strategies to cope in healthier ways. Skills training, such as distress tolerance and emotion regulation, plays a key role here. Clients learn how to survive a crisis without resorting to self-harm or suicide.

Working Toward a Life Worth Living

The ultimate goal of DBT is to help people build what Linehan calls a “life worth living.” But what does that mean? A life worth living is one that aligns with your values, where you experience meaning and purpose even amidst life’s challenges. This doesn’t mean a life without pain, but rather a life where the good outweighs the bad, and you’re able to cope with stress in ways that don’t harm you.

A life worth living looks different for everyone. It might mean having meaningful relationships, pursuing fulfilling work, or even just experiencing peace.

The core of this concept is hope—the belief that life can get better and that there’s something worth sticking around for.

DBT helps clients connect with this vision of life by teaching them to tolerate their pain in the moment while building toward a future that feels fulfilling.

Statistics on Suicide and Mental Health

The prevalence of suicidal thoughts and behaviors is deeply connected to mental health conditions. According to the CDC, in 2022 alone, over 40,000 people died by suicide in the United States, and suicide remains the 11th leading cause of death. That is one suicide every 11 minutes. For individuals struggling with disorders like depression, anxiety, PTSD, and BPD, the risk of suicide is significantly elevated. Studies show that more than 90% of people who die by suicide have a diagnosable mental health condition at the time of their death.

Despite these statistics, most people who have mental health disorders do not die by suicide.

This reinforces the importance of addressing suicidal ideation through therapeutic interventions, proper diagnosis, and support. Research also highlights that early intervention, access to mental health care, and support systems can significantly reduce the risk of suicide.

Coping Skills for Suicidal Ideation

Coping with suicidal ideation can feel like an uphill battle, but there are strategies that can help. One of the first steps is learning to recognize the warning signs—both in yourself and in others. These may include feelings of hopelessness, withdrawal from friends and family, and increased talk about death or dying.

Here are some coping strategies that can be helpful for managing suicidal ideation:

Distress Tolerance Skills

Learning ways to survive intense emotional pain is crucial. Techniques like ice diving (holding your face in cold water to calm your nervous system), paired muscle relaxation, and paced breathing can help reduce the intensity of suicidal urges in the moment.

Mindfulness

Mindful awareness helps people notice their thoughts without judgment. When suicidal thoughts arise, acknowledging them without acting on them can be a powerful skill.

Self-Compassion

It’s important to be kind to yourself when you’re struggling. Suicidal ideation is a sign that something is deeply wrong, but it doesn’t mean you’re weak or broken. Self-invalidation is a common prompting event suicidal ideation by turning everyday pain into suffering. Practice talking to yourself like you would to a close friend.

Safety Planning

Creating a safety plan for when suicidal thoughts feel overwhelming can save lives. This includes identifying safe people to reach out to, listing distractions or activities to help pass the time, and removing access to lethal means like firearms or medications.

Seeking Support

Reach out to friends, family, or mental health professionals. You don’t have to face this alone. Support systems can help provide a sense of hope and remind you of reasons to keep going.

Reasons for Living to Help Those With Suicidal Ideation

Marsha Linehan developed the Reasons for Living Inventory, a tool to help individuals identify what is keeping them anchored in life. It encourages people to reflect on the things that matter to them, whether it’s relationships, personal accomplishments, or spiritual beliefs. This inventory can help someone struggling with suicidal ideation to focus on the reasons they have to live, no matter how small or distant they may feel.

By working through this inventory, individuals may find that even though they’re in deep pain, there are still things in life that matter to them. These reasons can serve as protective factors, offering moments of clarity when suicide feels like the only option.

A Personal Reflection

My personal experience with suicidal ideation as a teenager could have easily ended in tragedy. Through years of therapy, self-reflection, and the support of others, I learned how to navigate those difficult thoughts without acting on them. I found meaning in life, even in its hardest moments. If you’re reading this and struggling with suicidal thoughts, I want you to know that you’re not alone, and that things can get better.

It’s important to remember that thoughts of suicide are not a failure—they are often a symptom of something else, whether it’s depression, trauma, or other forms of emotional pain. By addressing the underlying issues, whether through therapy, medication, or other forms of treatment, it’s possible to find a way through.

Conclusion

Suicidal ideation is complex, but with the right tools, people can find ways to manage their pain and build lives worth living. DBT provides a framework to help individuals work through their pain, understand their thoughts, and develop coping mechanisms. While the journey may be difficult, it’s important to remember that 9 out of 10 people who attempt suicide go on to live their lives. Healing is possible, and support is out there. If you or someone you know is struggling with suicidal thoughts, reach out—there is hope.

If you’re experiencing suicidal thoughts, please reach out for help. You can contact the Suicide & Crisis Lifeline at 988 for immediate support, otherwise you can schedule an appointment with me. I would be happy to support you on the path to a better life.