My strategies for dealing with suicidal thoughts

This article was kindly written by a good friend of the Your.MD team. We are incredibly grateful to them for sharing their story, and hope that you, or someone you know, finds it useful.

"I am worthless. I am nothing. I feel nothing. I’m a burden. I want to die. I deserve to die."

I’ve had these thoughts hundreds of times. I know that I will have them many more times. If you haven’t had these thoughts at some point in your life yourself, chances are you know someone who has. Worse still, you may have attempted to kill yourself or know others that have tried, or succeeded in doing so.

I’ve suffered from recurrent depression since my late teens. I’m now in my mid-thirties. I’ve had very low moments in my life. I didn’t tell anyone at first. I thought I was just weak. I thought I would be judged. I thought I didn’t have a ‘real illness’.

None of those things were true. The most important thing I did was to seek support from friends, families, colleagues, doctors and therapists. Without this support, I would not have learnt the strategies that now help me when I’m struggling. Without their help, I might not be alive today.

I do still struggle at times. But I now know that I am not powerless to the negative thoughts in my head. When the suicidal thoughts come, I know that they will eventually pass and I will want to live.

I’ve written down some of my strategies. I hope that they help you or someone you know who is going through a difficult time.

Speak to someone

Two people sitting on a beach looking at the ocean

If you are feeling suicidal then you need to reach out to someone. Speak to a friend or a family member. Speak to your doctor, therapist, teacher or colleague.

If your thoughts of harming yourself keep coming back, add their phone number to your favourite contacts so that you can access them easily, whenever you need them.

This can be incredibly daunting but it is the best thing you could possibly do.

If the idea of talking to someone you know feels too difficult, then speak to someone you don’t know. Befrienders have crisis helplines globally where you can talk to people who will understand what you are going through, and can give you the help that you need.

Know yourself

Open jouranl

Depression can take many forms. You might feel persistently low, or you could feel completely helpless or worthless. You might experience feelings of guilt, or simply not derive pleasure from the things that that other people do. In the midst of all these feelings, it can be hard to remember what ‘normal you’ feels like anymore.

To help deal with these moments, I carry the following three lists with me at all times. When I’m struggling or feeling low, I take them out of my pocket and read them to myself. I’m going to show you how you can create these lists for yourself now. Try to set aside at least thirty minutes to do this, but the longer you can spend the better.

You can use your phone for this if you like, but I prefer to use separate pieces of paper. You can use whichever you prefer, so long as you can keep them with you all the time. So grab some paper and a pen, or your phone, and let’s get started.

Reasons you’re worthwhile

Think back to all of things you have done in your life that you are proud of and write these down. Try thinking about:

  • Things you completed that you found challenging
  • Times you took responsibility for a failure, or admitted you could have done better
  • Situations where you stood up for yourself, or for someone else
  • Work, school or personal projects for which you received recognition
  • The times you have supported or helped other people
  • Any time you took a risk, or did something that scared you

Also think about what your family and friends are proud of you for. This could be things like:

  • Being a fantastic friend, daughter, son, sibling, partner, mother or father
  • Doing well at school or work
  • Starting a new job
  • Moving into a new place
  • Getting through a difficult time
  • Being brave enough to do something you believed in

If you’re not sure what they’re proud of you for, ask them.

Finally, think about all the small things you are proud of too, like:

  • Giving your seat to someone on the bus or train
  • Smiling at a stranger
  • Getting up in the morning when you really didn’t want to
  • Cleaning the house even when you were tired
  • Not losing your temper at work or home

Write all of these things down as you think of them on a list labelled ‘Why I’m Worthwhile’.

Keep this on you in your back pocket, in your bag, or on your phone. Make sure it is easily accessible.

Look at this list when you are feeling low and remind yourself of all the great things about yourself.

Things that make you happy

Feet of a woman running

Next, reflect on all of the small, everyday things that make you happy like:

  • Drinking a cup of tea or coffee exactly how you like it
  • Eating a great meal
  • Reading a book
  • Watching a TV series
  • Going to the cinema
  • Taking a walk
  • Going for a run
  • Listening to your favourite song
  • Having a relaxing bath
  • Making your bed
  • Speaking to a friend
  • Spending time with family or your partner
  • Seeing or learning something new, like going to an exhibition

If you find it really difficult to remember things that make you happy then ask a friend or family member.

Write all of these things that make you happy in a list labelled ‘What To Do When I Feel Low’.

Again, keep this list on you so you can easily find it.

Refer to this list whenever you are feeling low. Read the ‘Why I’m Worthwhile List’ first. Then read the ‘What To Do When I Feel Low’ list. Pick a few of those things from the list to do that day that will make you feel better.

Things you want to do in the future

Couple standing on the far end of a swimming pool

Finally, think about the things that you want do in the future; the things that you are really excited about and have planned or would like to do someday. This might include:

  • Spending time with your family or friends
  • Going travelling
  • Studying or learning something new
  • Meeting new people
  • Furthering your career
  • Having a family
  • Seeing your children grow up

Write all of these things down on your ‘Reasons To Be Alive’ list.

Keep this list on you, along with your ‘Why I’m Worthwhile’ and ‘What To Do When I Feel Low’ lists.

If you’re struggling with suicidal thoughts, after seeking help, read your ‘Reasons To Be Alive’ list to remind yourself why you shouldn’t listen to those negative thoughts.

Challenge negative thoughts

It can be very difficult to silence negative thoughts. You may find you can never stop them altogether, but you can intervene when they occur and stop yourself from being weighed down by them.

Practise mindfulness

Beach waves and sunset

Mindfulness is the process of bringing your attention to the present moment. It can help make you more aware of destructive thoughts and remind you not to overreact to them in a negative way emotionally. Apps like Headspace, Calm and Smiling Mind can make this practice more convenient and accessible.

You can also try everyday Mindfulness exercises.

Next time you are washing a cup, pay attention to the temperature of the water, how it feels on your hands, the sounds that you can hear and what the cup looks like. Look for any chips or cracks in its surface, the way the handle attaches to it, or any writing you can see on the base.

You can do this with anything - the sound of your breath as you sit in a quiet room, or the noise of the birds and the leaves on the trees as you walk down the street. Try it for yourself now. Pick something to focus on and try doing nothing else for the next five minutes. Don’t get annoyed at yourself if you become distracted - just gently bring your attention back when you notice this happening.

With consistent practice, you can use Mindfulness to interrupt the negative chatter in your brain. This will take time, so it’s important to be patient. Forget about progress or ‘not doing it right’, and instead focus on the process itself.

Cognitive behavioural therapy

Going one step further you can try cognitive behavioural therapy (CBT). It’s becoming increasingly accessible through face-to-face therapists or online platforms such as BetterHelp, CCBT or Braive. Try searching for “online CBT” in your internet browser.

CBT teaches you to recognise triggers for your negative thoughts, your associated feelings and subsequent actions.

Once you begin to visualise how these are all related, you can start to challenge how true your negative thoughts are. Try this exercise for yourself the next time you notice a negative thought:

  • Write it down on a piece of paper or in a notes app on your phone
  • Rate how strongly you believe the negative thought - with 1 being not at all, and 5 being completely
  • Write down all the reasons that thought is true - stick to facts that you know someone else would agree with
  • Finally, write down all the reasons that thought is false - think about all the evidence against the thought
  • Now score how strongly you believe in that negative thought again

You’ll often find that breaking a thought down will reduce how strongly you believe in it.

You can print out this negative thought analysis sheet and fill it in whenever you notice negative thoughts.

Negative thought analysis sheet

I also find it helpful to ask myself ‘what would I say to my best friend if they thought the same thing about themselves?’.

Undoubtedly you would challenge them. Remember, be kind to yourself and challenge your own thoughts, because thoughts are not facts.

Create a daily check-in

Journal and mug on a bed

Having a daily check-in can help you to spot trends in the way you are feeling. This can be really important, not only because it allows you to track positive progress, but also because you can spot when things are getting worse and take action.

A daily check-in is best done in the evening, or right before you go to bed. To start your own, first write down three things that you are proud that you did that day. This could include:

  • I got out of bed today
  • I went to work when I really didn’t want to
  • I read to my daughter before she went to sleep
  • I ate my favourite meal

Next, write down a score out of 5 for each of the following - with 1 being ‘very bad’ and 5 being ‘good’:

  • Mood
  • Sleep
  • Appetite
  • Energy levels

Here is a daily check-in diary that you can print, put on your wall and fill in.

Daily check in diary

Look at the trend over the last few days.

If things are staying the same or getting better - then congratulate yourself for making progress. If things have got worse, then speak to a close family member, friend, or your doctor. Try to identify key triggers for low mood and negative thoughts. You could then start to think about ways to avoid those triggers or to manage them in a different way. For example:

I slept in so I was late for work. Because I was late I was distracted in my meeting. By the end of the day I’d been really unproductive because the day started badly. I start telling myself “I’m stupid”, “I’m bad at my job”, “I’m worthless”.

The trigger was being late because I haven’t been sleeping well. So in this case I can avoid the trigger by changing my sleep habits.

Another example:

My friend messaged me to say she can’t meet me today. She’s always cancelling on me. It must be because I don’t mean anything to her. I don’t mean anything to anyone. I should just disappear.

The trigger here was my friend cancelling. In this case I can try and manage it in a different way. I ask myself:

‘What thought distortions may I have applied in this situation?’

I’m personalising. She could have cancelled because she’s ill or busy or having her own difficulties. I guess it’s more likely that it has nothing to do with me.

I’m probably over generalising too - she doesn’t ‘always’ cancel and most of my other friends are reliable.

Perhaps I’m catastrophising too. Just because she cancelled doesn’t mean that she doesn’t care and doesn’t really have any bearing on the other relationships in my life.

Attributing your negative thoughts to specific thought distortions can be really helpful. You can say to yourself “I’ve had this thought. But I’m going to ignore it because I know that I’m over generalising”.

Handy apps such as iCBT help you to go through this process whenever you notice a negative thought.

Have an action plan

Person putting hood up

My last tip is to write your own action plan. If you have experienced depression and suicidal thoughts in the past then you’ll be able to reflect on how you feel at different stages. Writing this down and referring to it on a regular basis can help you to spot when things are getting worse and take action.

Your action plan is the thing that can help you realise what stage your depression is at currently, and what you need to do to either keep it there, or make things better. It can really help to write it with someone that knows you and make sure that they have a copy of it too.

Create your action plan

Grab a piece of paper (a piece of A4 paper flipped sideways works well) and a pen. Write the following headings:

  • My best self
  • Feeling low
  • Feeling very low, and
  • Crisis point

Next, under each heading, write down the following headings:

  • Mood
  • Sleep
  • Energy levels
  • Appetite
  • Concentration
  • Feelings about the future

The aim here is to record what each of these things looks like at each stage of your depression. For example, your ‘mood’ when you are your ‘best self’ might mean that you don’t get upset by things that happen throughout the day. When you’re ‘feeling low’ however, you might find that you cry for no reason at least twice per week. When you’re ‘feeling very low’ you might be crying almost every day, and at ‘crisis point’ you could be crying daily, or even multiple times throughout the day.

Equally, for ‘sleep’, your ‘best self might be awake in the morning by 6:30 having had between 7-9 hours of sleep. When you’re ‘feeling low’ you may have woken up several times in the night. ‘Feeling very low’ might correspond with only sleep 3-4 hours per night, and at ‘crisis point’ you might not be sleeping at all.

Continue this for each of the sections and headings, but leave some space because now we need to record what to do when you’re at each of these points.

Under the heading ‘best self’ write down the things that you should do because you know they help to maintain your mental wellbeing. This might include things like spending time with your family, exercising, eating well or taking prescribed antidepressant medications.

Under ‘feeling low’ and ‘feeling very low’ write down the action points you should take to help bring you back to your ‘best self’. This might include things like booking an appointment with your doctor, seeing a therapist or counsellor, or speaking to a friend or family member.

Finally, under ‘crisis point’, write down the immediate action points you must do right away, such as book an appointment to see a doctor today, call a helpline, or go stay with family or friends. Collate all the phone numbers and emails you require in the event that you have reached your crisis point. Write a draft email or text message explaining all the details that you need other people to know.

Here you can download and print an action plan template, and an example action plan to give you a better idea of how to fill yours in.

Example action plan

Using your action plan

Earlier you created your daily check-in. The scores you write down here will help you to spot when you’re starting to feel low or that things are getting worse. When you notice this happening, take out your action plan and refer to it. Look at where you are currently, and carry out the necessary actions.

You should also come back to this plan on a weekly basis even if you haven’t been feeling low. It’s important to do this because some signs can be more subtle than others, and you may not notice them until things get really bad.

Each week, score where you think you are in relation to these stages and review if there are any actions to take. If you struggle to do this for yourself then get a friend or family member to do it for you, or to work through it with you.

What to do if you reach crisis point

Two hands holding

The most important thing you can do if you reach crisis point is to reach out for help immediately. I know this can be really daunting, but it is the best thing you can do to help yourself. You should have drafted your email or text message in advance, because at crisis point you may find making one too difficult. This is my email that I keep in my inbox, ready to send to one of my best friends whenever I need to:

Dear Sarah,

I’ve spoken to you in the past a little bit about having depression, but it has got to the point where I am really struggling and feeling at times like I want to kill myself. If you could help me with doing the following things, I would be really grateful:

1) Ask me if I have been taking my antidepressant - sertraline 50 mg daily. If I have not, then ask me to take it then and there in front of you.

2) Call my doctor for an urgent appointment:

These are my doctor’s details:

Dr Jones

020 8712 9342

To book, you will probably need my date of birth. It is: 04/05/1982.

If the receptionist asks, then please tell them that the reason for my appointment is because I’m feeling suicidal.

3) Ask me if I have a place to stay that’s not on my own, where someone close to me can keep an eye on me.

4) Email my line manager, Leanne, that I’m ill and going to need to need to take the week off. This is her email address...

Thank you a lot, for everything.

If you ever think you’ve reached your crisis point, then please reach out to your family, friends, doctor or therapist immediately. If you find it too difficult to speak to them then call Befrienders, who have helplines, globally.

Try to be open-minded to what your family, friends or doctors suggest - ultimately, they want you to be healthy, well and happy. It may be that you need to make some immediate adjustments such as staying with a friend or family member who can look after you, or taking some sick leave from work.

The important message

The most important message here is that you need to get help and you need to let people help you. I am so thankful that I am alive. Perhaps I would not be if not for all the support I’ve received from others, and having these strategies in place has also really helped me in some of my darker moments. Having a system I can use has definitely made me stronger and happier, and I hope that it helps you too.

Resources to print:

Negative Thought Analysis Sheet

Daily Check-In Diary

Action Plan Template

Example Action Plan