September is Suicide Prevention Month, a time to make reliable information easier to find, reduce the stigma around asking for help, and remind people that support is available.
For anyone experiencing thoughts of suicide, a mental health crisis, or emotional distress that feels impossible to manage alone, the 988 Suicide & Crisis Lifeline is available 24 hours a day by call, text, or online chat. You do not have to be certain that your situation qualifies as an emergency before reaching out. Friends and family members who are worried about someone can also contact 988 for guidance as well.
If there is immediate danger or a life-threatening emergency, call 911 or go to the nearest emergency department.
Crisis support is one part of mental health care. Another part is the work that can happen before, after, or sometimes alongside a crisis: understanding what is contributing to a person’s distress, treating conditions such as depression or PTSD, building ways to manage periods of intense emotion, and helping the brain and body recover from what it has been carrying.
For families trying to understand what therapy might look like when someone has talked about suicide, begun harming themselves, or seems to be reaching a point where they no longer know how to keep going, it can help to know that support is available, and that treatment can be tailored to the person’s specific needs, circumstances, and level of risk.
Treatment Usually Starts With Understanding What Is Going On
A first therapy appointment is about much more than asking whether someone has had suicidal thoughts. A therapist wants to understand the larger picture. That can include mood, sleep, concentration, relationships, trauma, substance use, physical health, medications, previous treatment, major life changes, sources of stress and the support available at home or elsewhere. This broader assessment matters because suicide is rarely the result of one problem.
When there are concerns about suicide or self-harm, the therapist will also ask more direct questions about safety. These questions are not meant to be dramatic or alarming. They help determine how urgent the situation is and what kind of care is appropriate.
The CDC describes suicide as involving a combination of individual, relationship, community and societal factors. Depression and other mental illnesses can contribute to risk, but so can previous suicide attempts, substance use, chronic pain or serious illness, relationship problems, financial stress, isolation and other difficult circumstances. A risk factor is not a prediction. Most people living with depression, PTSD or other conditions associated with suicide risk do not attempt suicide.
The goal of assessment is therefore not simply to attach a label to someone’s distress. It is to understand what is happening well enough to decide what kind of help makes sense.
Sometimes Safety Comes First. Sometimes Treatment Can Begin Alongside It.
The next step depends on what the assessment shows. Someone in immediate danger may need emergency or more intensive care before ordinary outpatient therapy can continue. Another person may have thoughts about death or giving up without being in immediate danger and may be able to continue outpatient treatment with careful monitoring and a plan for what to do if those thoughts become more serious.
For some people, thoughts of suicide become a direct focus of therapy. For others, treatment centers primarily on depression, PTSD, substance use, emotional dysregulation or another problem that is contributing to the distress. Research supports both approaches. A large 2024 review published in JAMA Psychiatry examined psychotherapy that directly addressed suicidal thoughts and behaviors as well as therapy aimed at other mental health conditions. Both types of treatment were associated with improvements in suicide-related outcomes.
That distinction is useful for families because it answers a question that often comes up: Does therapy have to be specifically called “suicide prevention therapy” to be relevant? Not necessarily. Sometimes the work is directly about staying safe. Sometimes it is about treating the illness or experience that has made life feel increasingly difficult. Often, those pieces overlap.
When Depression Is Driving Much of the Struggle
Depression is one of the mental health conditions most strongly associated with suicide, but depression itself can look very different from person to person.
Treatment may be addressing persistent sadness, but it may also involve loss of interest, isolation, disrupted sleep, exhaustion, difficulty concentrating, changes in appetite, irritability, hopelessness or the sense that ordinary life has become too difficult to manage. For a parent watching a son or daughter go through depression, therapy may initially seem surprisingly practical.
At Worth It Therapy Services, depression treatment can include approaches such as Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy, Interpersonal Therapy, Behavioral Activation and supportive therapy.
Behavioral Activation, for example, looks at the way depression can gradually shrink someone’s life. Activities fall away. Contact with other people decreases. Things that once provided meaning or accomplishment stop happening. That withdrawal can deepen the depression. Treatment may begin with very small, intentional steps toward rebuilding routine, activity and connection.
Interpersonal Therapy looks more closely at relationships, loss, conflict and major changes in life roles.
Mindfulness-Based Cognitive Therapy helps people notice thoughts and emotional states without automatically getting pulled into them.
These approaches are different, but they share an important idea: treatment can work on the processes keeping depression going rather than simply asking someone to “cheer up” or think more positively.
What CBT Can Look Like
Cognitive Behavioral Therapy, or CBT, is one of the therapies Worth It uses for depression, anxiety, PTSD and other mental health concerns.
CBT looks at the relationships among thoughts, emotions and behavior. A therapist may notice, for example, that a person who is depressed has begun withdrawing from friends, work, hobbies and ordinary responsibilities. That withdrawal may provide temporary relief from things that feel difficult, but it can also remove experiences of connection and accomplishment. Negative beliefs become stronger, and withdrawing begins to feel even more necessary. CBT can work at several points in that cycle.
Sessions may involve identifying patterns, examining whether certain conclusions are accurate or helpful, experimenting with different behaviors, and practicing skills outside the therapy room. There are also specialized forms of CBT developed specifically for people at risk of suicide. Research on approaches such as Brief Cognitive Behavioral Therapy for Suicide Prevention has found reductions in subsequent suicide attempts in several clinical populations.
It is important to keep those findings in context. Standard CBT for depression or anxiety is not automatically the same as a specialized suicide-prevention program. Still, the research helps explain why cognitive and behavioral therapy has an important place in treatment when hopelessness, rigid thinking, withdrawal and difficulty coping are part of the clinical picture.
When the Problem Is Getting Through an Overwhelming Moment
Sometimes the question in therapy is less about whether a thought is reasonable and more about what happens when distress becomes extremely intense. This is an area where Dialectical Behavior Therapy, or DBT, has been particularly influential. Comprehensive DBT has a strong research history in the treatment of suicidal and self-harming behaviors, especially among people who struggle with severe emotional dysregulation. Research has found reductions in self-directed violence and use of psychiatric crisis services.
Worth It therapists use techniques drawn from DBT, rather than operating a comprehensive DBT program. That distinction matters, because the research on full DBT should not be attributed automatically to individual skills taken from the approach. Those skills can still play an important role in therapy.
DBT-based work may involve learning how to recognize distress as it is building, tolerate a powerful emotional state without immediately acting on it, regulate emotion more effectively, stay present in the moment, and navigate difficult relationships. This can be particularly helpful for understanding something families sometimes find confusing: a person may know intellectually that a crisis will pass and still have tremendous difficulty accessing that knowledge while emotionally overwhelmed. Therapy can help make useful responses more available during those moments, not just afterward.
And because self-harm does not always involve an intent to die, a therapist will generally want to understand what function the behavior is serving rather than making assumptions. For some people, self-injury is used in an attempt to manage unbearable emotion, numbness or physiological distress. For others, suicidal intent may also be present. The clinical response depends on understanding the difference.
When Trauma Is Part of the Story
For some people, severe distress is closely connected to trauma. PTSD has a well-established association with suicidal behavior, and it is also a condition for which effective treatments exist.
One of those treatments is Eye Movement Desensitization and Reprocessing, or EMDR, which Worth It offers for trauma and distressing experiences. EMDR is one of the trauma-focused psychotherapies strongly recommended for PTSD in current VA/DoD clinical guidelines.
EMDR is structured treatment. It is not simply asking someone to tell a painful story over and over. Treatment begins with assessment and preparation. The therapist and client identify relevant experiences, current symptoms and treatment goals. They also establish strategies that can help with regulation before trauma processing begins.
During processing, the person brings aspects of a traumatic memory to mind, including associated thoughts, emotions and physical sensations, while also attending to alternating visual, auditory or tactile stimulation. The therapist regularly checks what is changing and guides the process.
There is some early research examining EMDR specifically among people experiencing suicidal ideation, with promising findings. The evidence is still far smaller than the extensive research supporting EMDR for PTSD, so it would be premature to describe EMDR as an established treatment for suicide itself. The clearer connection is this: PTSD is associated with increased suicide risk, and EMDR is an evidence-based treatment for PTSD.
For a family member trying to picture what trauma therapy might mean, another point is important. The presence of a trauma history does not mean the therapist immediately begins processing the most painful memory. Safety, stability and readiness matter. If someone is in an acute suicidal crisis, that crisis needs attention. When suicidal thoughts are present but manageable, trauma treatment may still be appropriate depending on the clinical circumstances. That decision is part of therapy, too.
Why the Body May Be Part of Mental Health Treatment
The word “mental” can make psychological illness sound as though it exists only in someone’s thoughts. In practice, the boundaries are much less tidy.
Depression can affect sleep, appetite, energy, movement and concentration as well as mood. PTSD can involve memories and beliefs while also producing physical alarm responses: increased startle, muscle tension, disrupted sleep, racing heart or a persistent sense of being on guard. Chronic stress can change how readily someone becomes activated and how easily the system settles again. This is the basis of Worth It’s emphasis on the brain-body connection.
It does not mean that a distressed body inevitably progresses toward suicide, or that calming the nervous system prevents suicide. The relationship is more complicated than that. Instead, the brain-body perspective recognizes that thinking, emotion, physiology and behavior continually influence one another. A therapist might therefore spend part of treatment talking through an experience and another part helping someone recognize what is happening physically when distress begins to rise.
Grounding may help bring attention back to the present when a trauma response is pulling attention elsewhere. Breathing and other regulation strategies may help settle physiological arousal. Mindfulness can help someone notice an internal state before reacting automatically. Other coping strategies may be practiced repeatedly so that they are easier to access when life becomes harder. These aren’t substitutes for treating depression, trauma or suicide risk. They are tools used within a larger treatment plan.
Treatment Often Changes as More Becomes Clear
Therapy does not always follow a straight line. Someone may begin treatment for depression and gradually recognize that unresolved trauma is playing a larger role than anyone initially realized. Another person may need to spend time developing ways to tolerate distress before beginning trauma processing. Substance use may turn out to be complicating treatment. Medication may need to become part of the conversation with a physician or psychiatrist.
If thoughts of suicide become more frequent, more specific or more difficult to manage, the treatment plan may need to change as well. That can mean more frequent assessment, involving other healthcare providers, establishing additional supports, or moving temporarily to a higher level of care. None of that necessarily means therapy has failed. It means treatment is responding to the clinical picture as it changes. This is also why good mental health care sometimes involves several professionals rather than one therapist trying to address everything alone.
What Improvement May Actually Look Like
Families naturally hope that successful therapy will mean the person simply seems happier. Sometimes that happens. Often progress is more gradual and more specific. A person with depression may begin getting out of the house again, returning calls, completing ordinary tasks or reconnecting with people who matter. Someone with PTSD may still remember what happened but experience less fear, shame or physical activation when the memory surfaces.
A person who once moved rapidly from distress to self-harm may become better able to recognize what is happening, use a skill, contact someone, or allow the emotional intensity to fall before deciding what to do next. Someone who has talked about wanting to die may gradually begin talking about plans, relationships or parts of life that matter again.
Clinicians may also be tracking changes that are not immediately obvious from the outside: severity of depression, frequency of suicidal thoughts, ability to regulate emotions, trauma symptoms, substance use, sleep, functioning and the ability to use support when distress increases. Therapy is not simply a weekly conversation about whether the past seven days were good or bad. It is treatment with specific problems, patterns and goals in mind.
Mental Health Care Does Not Have to Begin With Crisis
Suicide Prevention Month necessarily draws attention to moments when someone urgently needs help. Those resources matter enormously. But crisis care is only one part of mental health care. Someone struggling with depression can receive treatment for depression. Someone carrying the effects of trauma can receive treatment for PTSD. Someone who has difficulty getting through powerful emotional states can learn skills for regulation and distress tolerance.
And when thoughts about death, self-harm or giving up become part of the picture, treatment can address those concerns directly while also asking an equally important question:
What is making life this difficult, and what can be treated?
There is no therapy that can promise that suicide will never occur. There is, however, substantial evidence that many of the conditions and difficulties associated with severe psychological distress can be treated—and that psychotherapy itself can improve suicide-related outcomes in appropriate clinical care. That is one reason mental health care does not need to wait until someone reaches a crisis.
At Worth It Therapy Services, assessment helps determine what is happening, what needs attention first, and which treatment approach may be appropriate. Contact Worth It Therapy Services to learn more about available treatment options and whether our practice may be a good fit.
