Suicide Prevention – Barbara Rubel – Compassion Fatigue Keynote Speaker

Suicide Prevention in a Vicarious Trauma-Informed Workplace

Barbara Rubel — Wed, 14 Aug 2024 21:13:47 +0000

Promoting Self-Compassion and Suicide Prevention in a Vicarious Trauma-Informed Workplace

Suicide remains a critical global health concern, demanding accessible interventions to safeguard those working with those who are traumatized, grieving, or struggling with a crisis in their life. Exposure to vicarious trauma is a reality for police, firefighters, emergency personnel, mental health professionals, and social workers, potentially leading to symptoms mirroring those they assist.

First responders and helping professionals have the opportunity to develop internal resources that can help them manage suicidal thoughts. These professionals may have feelings of thwarted belongingness—where they feel disconnected and don’t belong—and perceived burdensomeness—feeling like a burden or liability—both of which are strongly linked to suicidality. The research underscores that low self-compassion exacerbates these factors, highlighting the potential for enhancing self-compassion to reduce the risk of suicide (Bianchini & Bodell, 2024).

Professionals can develop symptoms similar to those they help, such as anxiety, hopelessness, isolation, low self-esteem, and depressive symptoms, all of which are associated with suicidal thinking. However, individuals with high levels of anxiety and depression and who practice self-compassion are less likely to engage in suicidal behaviors (Kelliher-Rabon et al., 2018). Self-compassion mediates the link between negative affect and suicidal ideation (Hasking et al., 2019). A vicarious, trauma-informed workplace acknowledges these challenges and the need to support these professionals.

Can self-compassion be the difference between life and death?

Self-compassion involves directing kindness inwardly. It is a crucial aspect of addressing suicide risk among first responders and helping professionals. It can be nurtured through internal resources that empower them to navigate challenges with self-kindness and understanding. So, what are these internal resources? Alongside resilience, creativity, problem-solving skills, mindfulness, self-awareness, and a positive outlook, several other internal resources contribute to fostering self-compassion:

Coping Strategies: Techniques like relaxation, emotional regulation, and seeking social support can help manage difficult emotions.
Spirituality: beliefs and practices that foster self-acceptance during tough times.
Adaptability: Being open to change enhances perspective and supports self-compassion amidst challenges.
Sense of Purpose: Clarity in life’s meaning strengthens resilience and sustains self-compassion through setbacks.
Emotional Intelligence: Understanding and empathizing with difficult emotions aids in responding to challenges with self-compassion.
Appreciating Social Support: Strong relationships bolster feelings of connection and support.
Prioritizing Physical Health: Exercise, rest, and nutrition bolster mental well-being, facilitating self-compassionate responses to challenges.

Best Practices for Fostering a Self-Compassionate Workplace

Although there are various strategies to prevent suicide among professionals, agencies and organizations can implement these practices:

Cultural Shifts: Foster a workplace culture that prioritizes wellness and emotional well-being.
Leadership Responsibilities: Equip leaders with skills to model and support self-compassionate behaviors among supervisors and teams.
Peer Trust: Cultivate trust and collaboration among team members to create a supportive environment.
Holistic Approach: Embrace holistic self-care strategies encompassing mental, emotional, and physical well-being organization-wide.

Challenges in Vicarious Trauma Prevention Efforts

As a keynote speaker and trainer on compassion fatigue and vicarious trauma, I have learned much from the attendees of my programs. Here are the challenges that they bring up regarding their efforts to prevent vicarious trauma in the workplace:

Insufficient prioritization of vicarious trauma-informed practices in workplace culture.
Lack of clear guidelines on stress reduction strategies and protective factors.
Limited financial resources are allocated for vicarious trauma-informed training and support.
High turnover rates necessitate frequent vicarious trauma training.
Employees’ inadequate self-care skills and uncertainty about where to seek help.
The emotional strain is heightened by current events and societal issues.

In conclusion, creating a workplace that embraces self-compassion involves addressing challenges in vicarious trauma prevention and implementing comprehensive strategies that support employee well-being at every level of the organization.

Thwarted Belongingness, Perceived Burdensomeness, Hopelessness, and Cognitive Distortions for First Responders

Barbara Rubel — Mon, 25 Sep 2023 16:39:03 +0000

For all first responders whether law enforcement, emergency medical personnel or paramedics, or firefighters, there is a connection or link between thwarted belongingness, perceived burdensomeness, hopelessness, and cognitive distortions.

Thwarted Belongingness

According to Thomas Joiner’s interpersonal psychological theory of suicide, feeling like you don’t belong and that you are a burden can trigger suicidal thoughts. When a person lacks deep relationships with those around them, they are lonely and socially disconnected. If they feel that others are not reciprocating their feelings, they experience a sense of thwarted belongingness.

Furthermore, after retirement, a first responder no longer has many of the stable interpersonal relationships that they had while they were working. They can experience loneliness due to having fewer social connections. Although those individuals still working do care, the retiree may feel as though no one cares about them anymore. Being that thwarted belongingness is a risk factor for suicide ideation, it is important to talk about.

Perceived Burdensomeness

It’s possible that my father, a retired police officer, may have killed himself because he felt that his health issues made him a burden to his wife and children. Because I was due to give birth to triplets, he may have felt that his medical issues would be too much of a burden to his family.

When someone perceives themselves as being useless or a burden to others because of the work involved in taking care of them, that is perceived burdensomeness. They may also think that they make no contribution to the lives of those around them, making them more of a liability than an asset to the total well-being of the group. Research demonstrates that perceived burdensomeness is one factor in determining suicidality in Veterans.

Hopelessness

Gradus and Associates discovered in 2010 that individuals who have depression and PTSD have a much higher suicide mortality rate. Many first responder departments put most of their focus on PTSD, but they should also be concentrating on depression, insomnia, hopelessness, and stress caused by trauma. They must be cognizant of how a first responder’s personal accomplishments outside of work act as a protectant, and they can help increase self-confidence and belief in themselves in the face of challenges at work by offering specialized psychological care to reduce feelings of hopelessness and educational support to lower stress. This can easily be done through classes on wellness. Also, departments should focus on the importance of getting check-ups.

Hopelessness is strongly predicted by burnout and depression. Financial difficulties, health issues, and negative life events that have lowered one’s self-esteem can all contribute to feelings of hopelessness. Hopelessness can cause one to be unable to think about the future, and to feel a sense of desperation and loss of hope. When working with a first responder dealing with hopelessness, it is just as important to hear what they are not saying, as much as what they are saying.

Cognitive Distortions

Suicidal thoughts can be triggered by different things, but a first responder who is thinking about killing themself may be experiencing cognitive distortions. These are incorrect, irrational, or excessive ways of thinking, and it is believed that they play a significant role in the development and persistence of a number of mental disorders.

Finding some middle ground can be challenging for first responders who suffer from cognitive distortions. They could isolate themselves because they believe they are a bad person, a failure, that they don’t belong, or that they are a burden to others.

Questions to Ask First Responders

If a first responder is thinking things that are not necessarily true, they need support. Here are 10 questions to pose to a first responder on the judgments they make about themselves as a result of cognitive mistakes:

Are they putting unnecessary blame on themself?
Are they assuming the worst of the situation?
Are they thinking in an extreme way about what happened?
Do they focus more on what they perceive to be their failures instead of their successes?
Do they describe themself with negative language?
Are they personalizing what happened, even though it wasn’t their fault?
Do they focus more on negative thoughts rather than positive thoughts?
Are they drawing conclusions without any evidence to back them up?
Are the conclusions that they draw from what happened not telling the whole story?
Have they told anyone what they are thinking or are they too embarrassed?

These questions are meant to make a first responder aware of the possibility that occasionally their perceptions may not be accurate. Cognitive distortions are flawed thought patterns that can adversely affect behavior. Whether they jump to conclusions, over-generalize, or blame themselves, they are not alone. If you are a peer, help them or get them the professional help that they need. Don’t allow shame, stigma, or first responder culture to get in the way of their wellness.

National Suicide Prevention Month

Barbara Rubel — Fri, 17 Sep 2021 18:18:14 +0000

What would you say if I asked you if you have the tools that could prevent a suicide? While I was in the hospital waiting for my triplets to be born, my father died by suicide. I was among the 135 persons impacted by every suicide death. As the survivor of a suicide loss, my focus is now on suicide postvention and strategies to provide support after a suicide. I’ve come to know that postvention is the same as prevention.

September is National Suicide Prevention Month, and I have watched a lot of suicide prevention webinars. The problem of opioids and suicide, I believe, is the most unexpected element throughout the webinars. According to recent studies, a substantial percentage of overdoses are suicides. One out of every five suicide deaths is caused by opioids. In addition, the incidence of opioid overdose is twice as high among veterans as it is among non-veterans.

I was listening to the media during the pandemic as they talked about how suicide is on the rise. Research and webinars on suicide prevention, on the other hand, show that this is not the case. In fact, a research study of 21 nations, including Italy, that was published in the Lancet journal found no increase in suicide rates in 2020. In addition, for the first time in two years, new data from JAMA (Journal of the American Medical Association) reveals a 2% reduction. I recently watched Thomas Joiner’s webinar, Why People Die by Suicide: What the Last 20 Years of Research Has Shown Us. He pointed out that suicide rates are not rising among whites, but among African Americans.

This month, there were a lot of webinars on suicide prevention, and I’d like to point out a few of the ones that stood out to me. First, I listened to a webinar by Eboni Webb, PsyD. Eboni explained how dealing with suicidality in clients with high-crisis DBT and being vulnerable emotionally can be caused by attachment disorders, trauma, and loss. Cortisol overproduction from stress suppresses the immune system and has an effect on neuron death. The webinar mainly dealt with the fight or flight response and the amygdala.

Techniques for Reducing Suicide Intentions

The webinar taught me that we all need to have a better understanding of what happens during the response to stress, emotional dysregulation, and techniques for reducing thoughts of suicide. Eboni gave some ways to increase oxytocin that include focused breathing, laughter, prayer, spending time with a baby, and other distractions without engaging in negative behaviors. Eboni’s webinar, like the others, touched on the fundamentals of safety assessment and developing a safety plan. Eboni’s email address is ewebb@thevillageofkairos.com. If you want more information about the Columbia Protocol, go to cssrs.columbia.edu

I also saw a presentation by Kelly Posner Gerstenhaber, PhD, who claims that the Columbia Protocol can minimize suicide, liability, and strain in healthcare and beyond. Because of prejudices and ignorance, people do not receive the life-saving care they deserve. Men are less apt to get treatment, according to Kelly, and up until 2010, pilots were prohibited from flying while taking antidepressant medication, so many pilots either did not disclose or just ignored the signs of depression. Kelly also talked about minimizing the stigma of depression for those in the US army and normalizing screening. You can contact Kelly at Kelly.posner@nyspi.columbia.edu. Visit cssrs.columbia.edu for additional information on the Columbia Protocol.

Kathryn Gordon, PhD’s presentation was full of information about dealing with thoughts of suicide that won’t go away. Kathryn believes that you should guide your patient in developing a safety plan and that they should be aware of the symptoms of a crisis (e.g., unable to sleep, agitation). They also require a purpose in life, a support system of people they can contact for help, and techniques to stay safe (e.g., getting rid of medicines or drugs they could overdose on).
Kathryn also mentioned the importance of knowing how to quickly alleviate painful feelings (e.g., hot tea, hugging, playing or listening to music, art, a hot shower) in order to elicit happy feelings. Numbers for emergency services and crisis centers should be close at hand for your patients. They must also nurture hope and create purpose by linking their activities with their values. Visit kathrynhgordon.com for more information on Kathryn and her work.

Encouraging Hope

My favorite webinar of all that I watched was the one by Stacey Freedental, Phd, LCSW, called Helping the Suicide Person: A Clinical Toolbox. In the webinar she focused on collaborating and connecting with a client that is suicidal, instilling hope and resolving problems. Stacey also explained the difference between challenging and altering suicidal thoughts, along with reinforcing successes (e.g., analyze a recent suicidal situation using new skills). Prepare for a narrative interview by knowing what to say. “Could you explain me how you came to the point where you intended to kill yourself?” for example. Pay attention to psychological pain, “Can you describe your mental suffering?”

Show your patient a grounding technique that incorporates all of their senses. Look for needs that are unmet, like autonomy, the feeling of belonging, and competence. Center on planning for safety. Discuss their motivations for living and go over the list of what they have unfinished and still want to do. Takeaway points are: Focus on the problems that would be solved by killing themselves, work on problem-solving skills, challenge their thoughts of suicide and thoughts that contribute to suicidal thinking, and employ CBT to help fight those thoughts. “Picture yourself getting suicidal in the future,” Stacey says. “What things would you want to say to your future self?”

Clinicians MUST Learn about Suicide Prevention

Taking everything into consideration, I believe that clinicians absolutely must learn about preventing suicide, intervention, and postvention. From my experience as a speaker who talks to professionals about vicarious trauma and compassion fatigue, I know that it is very stressful to work with patients that are suicidal. What is even more stressful, however, is when they decide to take their own life. That’s why all helping professionals must be trained in suicide prevention. Many years ago, I attended a breakout session at an American Association of Suicidology convention led by Ed Shneidman. Two questions he put forth are, “Where do you hurt?” and “How can I help you?” That, I believe, is an excellent place to begin.

Barbara Rubel’s Podcast and Videos on Suicide Awareness

Interview: https://www.youtube.com/
Hope4Med Podcast: https://www.youtube.com/
Elite Healthcare Interview: https://www.youtube.com/
Healing Place Podcast: https://www.youtube.com/
Bear Podcast: https://bearpsych.libsyn.com
Podcast: https://www.voiceamerica.com/
Videos: https://www.griefworkcenter.com/videos/