Brief Survey –Personal Experiences with Suicide bit.ly ... · Slide 24 DBT Skills with support work too! (without all the other stuff) DBT SKILLS Linehan, M. M., et al. (2015)

Making it Matter with Micro-Interventions:Brief Interventions for Clinical Care

Copyright © 2019 by Ursula Whiteside (ursulawhiteside.com) DO NOT DISTRIBUTE beyond your organization without permission, public version forthcomingCopyright © 2018 by EDC/SPRC for ZeroSuicide.com All Rights Reserved

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Ursula Whiteside ©2018 All Rights Reserved

Making it Matter with Micro-Interventions:Brief Interventions for Clinical Care Using the Zero Suicide Framework

Dr. Ursula WhitesideFacebook, Twitter, Website:

@ursulawhiteside @nowmattersnow

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Ursula Whiteside ©2018 All Rights ReservedFree Evidence-Based Resource’’

Videos, Safety P

lan, Crisi

s Lines

NowMattersNow.org

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Brief Survey – Personal Experiences with Suicide

bit.ly/SuicideExp

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Ursula Whiteside ©2019 All Rights ReservedSlide 18

Dialectical Behavior Therapy

DBT Therapy includes DBT skills

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Dialectical Behavior Therapy Works

What Works?

Also have support: Collaborative Assessment and Management of Suicidality (CAMS), Cognitive Therapy for Suicide Prevention (CBT-SP). There is little to no support for medication-only or hospitalization

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1. Weekly individual (one-to-one) therapy

2. Weekly skills-training group

3. As-needed coaching with client outside of sessions

4. Weekly therapist consultation meeting (therapists meet to discuss their DBT cases)

DBT Components

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1. Weekly individual (one-to-one) therapy

2. Weekly skills-training group

3. As-needed coaching with client outside of sessions

4. Weekly therapist consultation meeting (therapists meet to discuss their DBT cases)

DBT Components

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DBT Skills with support work too!

(without all the other stuff)

DBT SKILLS

Linehan, M. M., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis.JAMA Psychiatry, 72(5), 475-482.

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Emotion RegulationMindfulness

Interpersonal Effectiveness

Mindfulness

Distress Tolerance

Mindfulness

DBT SkillsGroup

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Linehan’s Theory of Emotion Dysregulation

Stress Model

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Time

Linehan’s Theory of Emotion Dysregulation (Stress Model)

Micro-Intervention


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Time

Linehan’s Theory of Emotion DysregulationLinehan’s Theory of Emotion Dysregulation

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Some of us have biology, history, or current life circumstances that makes

us more responsive to stressful events.

What to Say


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Makes things memorable

Is “social modeling” a powerful way to learn

Reduces stigma

Anyone can benefit from skills

Storytelling

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What is strategic vulnerability?

Storytelling

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Micro-Interventions support doing what

works in your setting

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Do It NowLinking Statements

DBT SkillsCaring Contacts

Micro-Interventions

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Do It NowGOAL: Increase the likelihood that the safety

plan and DBT skills will be used once they leave.

Micro-Interventions

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Use mobile phones•Crisis lines, photos of Safety Plan, calling from session

Do DBT skill together•Using resources, doing a DBT Skill together, sharing an example

Caring message•Write one for the future, schedule one together

Linking Statements•Discuss linking statements and how they relate to patient’s life

‘Do It Now’

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National Suicide Prevention Lifeline1-800-273-8255 (TALK)

Crisis Text Line741741 “START”

‘Do It Now’

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Micro-Interventions

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Linking StrategiesGOAL: Link things like risk assessments and

general conversations with patient to the Safety Plan and DBT skills

GOAL: Create opportunity for “Ah-Hah!” moments

Micro-Interventions

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Linking Statement“Ah-Hah” Statements

Micro-Interventions

Validate/Accept: A statement that shows that you are listening and that you empathize with their experience.

Hope/Change: Always orienting in the direction of emotional management (Safety Plan and DBT Skills).

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Linking StatementHere you begin always linking to safety planning, from assessments, from patient statements, from

other programming.

Micro-Interventions

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Linking StatementSuicidal thoughts are not uncommon, but they are a

good measure of how much someone is suffering.

Micro-Interventions

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Linking StatementSuicidal thoughts are not uncommon, but they are

a good measure of how much someone is suffering.

Micro-Interventions

Validate/Accept: You’ve been through so much. I think that anyone in your position would be in a great deal of pain.

Hope/Change: I can help direct you to some ways that will help reduce your mental pain in a crisis, but also do so over time.

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Linking StatementOften don’t want to die, per say.

It is that they don’t know how to feel better.

Micro-Interventions

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Linking StatementIf I could magically remove your pain/problems,

do you think you would you still want to die?

Micro-Interventions

Validate/Accept: It is natural to want to escape pain. I wish I could stop it for you.

Hope/Change: Focusing on death makes it hard to change things. Can we focus on helping the pain be more manageable?

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Linking StatementSuicidal thoughts by themselves are not dangerous.

What you do with them is what matters.

Micro-Interventions

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Linking StatementSuicidal thoughts by themselves are not dangerous.

What you do with them is what matters.

Micro-Interventions

Validate/Accept: It can be scary (or relieving) to have suicidal thoughts. Even when you are working on the future, they still ariseHope/Change: One thing you can do is choose how you respond to

them. Do not “get in bed” with your suicidal thoughts.

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Micro-Interventions

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DBT SkillsGOAL: Support their strengths and also teach

additional ways to manage their painful emotions and suicidal thoughts.

Micro-Interventions

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DBT SkillsGOAL: Build new neural networks.

This is uncomfortable!

Micro-Interventions

Strong Negative Emotions

SUICIDE ATTEMPTXDBT SKILLS

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Ice-WaterPaced Breathing

DBT Skills

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See NowMattersNow.org• Paced Breathing• Crisis Help

DBT- Skills

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Micro-Interventions

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Caring ContactsGOAL: Have the patient understand that there is someone who has hope for them and who cares

and does not judge them.

Micro-Interventions

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Caring Contacts

Henry, It was good to meet you. I don’t know you well yet, but I am glad that you told me a little more about your life. I have lots of hope for you. I see you’ve been through a lot. Thank you for watching the Opposite Action of Diana (on this website).

With care, Nurse Matt

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https://www.nowmattersnow.org/skill/paced-breathing

https://www.nowmattersnow.org/help-line



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See NowMattersNow.org• Free Training and Resources• Caring Contact Card

Caring Contacts

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Care without judgment/condescensionDo not say “I’m worried about you.” Do not ask for something

Imagine being in their shoes and what you would want to hear-Write on on back of NowMattersNow.org card

Caring Contacts

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•Write a Caring Contact, even on the first visit•Link to the future, Safety Plan, and DBT skills•Give something personalized and tangible•Provide hope as if their life depended on it

Caring Contacts

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Bonus Material

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https://www.nowmattersnow.org/get-involved

https://www.nowmattersnow.org/wp-content/uploads/2018/10/nmn_cards.pdf



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See NowMattersNow.org• Free Training and Resources• Plan (Google Doc, PDF)• Guide (Google Doc, PDF)

Safety Plan

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NowMatters

Now.org

Safety

Plan

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NowMattersNow.org Safety Plan

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Patient Guide and Documentation Template

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https://www.nowmattersnow.org/get-involved

https://docs.google.com/document/d/1hes0aAT7E_qQ7MGq9G4PVRaDpSkyoMI23MzWllRgHgI/edit%3Fusp=sharing

https://www.nowmattersnow.org/wp-content/uploads/2018/10/0.-NowMattersNow.org-Safety-Plan-Website-Version.pdf

https://docs.google.com/document/d/1HXZeE-2KaNo60RykCxiGT917pAC2muPhRiOfBLZih3E/edit%3Fusp=sharing

https://www.nowmattersnow.org/wp-content/uploads/2018/10/1.-NowMattersNow.org-Safety-Plan-Guide-Website-Version.pdf

Documents

Brief Survey –Personal Experiences with Suicide bit.ly ... · Slide 24 DBT Skills with support work too! (without all the other stuff) DBT SKILLS Linehan, M. M., et al. (2015)