Evidence

Based on Cognitive Behavioural Therapy for Suicide Prevention (CBT-SP), safety planning helps individuals manage suicidal crises by identifying warning signs, coping strategies, and support contacts.

Stay Alive's Safety Plan plays an essential role in addressing safety concerns and empowers individuals with tools for coping with distress, helping to prevent escalation into suicidal behaviour.

Key studies:

• Marshall et al. (2022) – This systematic review of 22 studies concluded that suicide safety planning interventions significantly reduce suicidal behavior and ideation, and improve coping resources.
• Stanley et al. (2018) – This study showed those who received a structured safety planning intervention plus follow-up calls were half as likely to attempt suicide and more than twice as likely to attend outpatient care over 6 months compared to usual care.
• Gamarra et al. (2015) - This study found higher quality safety plans (more complete steps) were associated with fewer subsequent psychiatric hospitalisations.
• Stanley & Brown. (2012) - The Stanley-Brown safety plan is a 6-step tool that helps people at risk of suicide identify (1) the warning signs of a suicidal crisis, (2) the internal coping strategies they can use, (3) the people and social settings that provide distraction, (4) the people whom to ask for help, (5) the professional or agencies to contact during a crisis, and (6) the ways of making their environment safer.

The Reasons for Living inventory is a tool that identifies and reinforces protective factors, such as personal beliefs, values, and aspirations, that reduce suicidal behaviour. In Cognitive Behavioural Therapy for Suicide Prevention (CBT-SP), the RFL inventory is used to strengthen the individual’s sense of purpose and resilience, helping to counter suicidal thoughts with positive, life-affirming beliefs. This tool encourages a shift from hopelessness to hopefulness, emphasising future goals and social connections as protective factors.

Key studies:

• Tsypes et al. (2022) – This study found that daily increases in reasons for living were linked to reductions in suicidal ideation, indicating RFL are dynamic protective factors.
• Bakhiyi et al. (2016) – This systematic review found that higher endorsement of reasons for living is protective against suicidal ideation and attempts. The role of two specific reasons for living (Moral Objections to Suicide and Survival and Coping Beliefs) was particularly emphasised.
• Linehan et al. (1983) - This study outlines the Reasons for Living Inventory (RFL). The research showed six primary reasons for living: (1) Survival and Coping Beliefs, (2) Responsibility to Family, (3) Child-Related Concerns, (4) Fear of Suicide, (5) Fear of Social Disapproval, and (6) Moral Objections

Quick access to suicide prevention support is critical in reducing the risk of suicide and improving outcomes for individuals in crisis. Immediate interventions, whether through brief psychological treatments, follow-up contact, or person-centred crisis services, can provide essential support when individuals are most vulnerable. Timely access helps alleviate distress and lowers the likelihood of future suicide attempts, making it an essential component of effective suicide prevention strategies.

Key studies:

• Pauwels et al. (2024) – This study showed that callers showed significant improvement in their level of crisis, hopelessness, entrapment, suicide intent and social support after their call to the helpline.
• Cohen et al. (2022) – A mixed-methods review of web-based support services for young people and students identified that clarity, brevity, and immediacy are crucial for engaging individuals in crisis, supporting the need for quick access to support.
• Saini et al. (2020) - Fast access to brief psychological treatments for self-harm and suicidal crisis is crucial in reducing the risk of suicide. Immediate interventions can effectively reduce distress and improve outcomes.

The wellness plan encourages behavioural activation (BA), a key CBT principle, by motivating users to engage in rewarding activities that improve mood and mental health. BA interrupts the cycle of withdrawal, isolation, and despair common in suicidality. Engaging in meaningful activities boosts protective factors like self-efficacy, social connection, and pleasure or accomplishment.

Key studies:

• Hemanny et al. (2022) – In a post-hoc analysis of patients on antidepressants, adding behavioral activation (BA) (alongside cognitive therapy) significantly reduced suicidal ideation compared to antidepressants alone.
• Malik et al. (2021) – This systematic review collated evidence on the characteristics, effectiveness, and acceptability of behavioral activation (BA) interventions for young people aged 14 to 24 years. The study found that BA is a promising intervention for alleviating depression in this age group.
• Khosravani et al. (2020) - Higher behavioral activation activity was linked to lower suicidal ideation, mediated by reduced rumination and increased self-reflection, highlighting how BA strategies can support suicide prevention.

Suicidal crises can often involve overwhelming emotions like panic, rage, or despair. Breathing exercises (like slow, diaphragmatic breathing) activate the parasympathetic nervous system, which slows heart rate, reduces anxiety, and promotes calm. This makes them a vital distress tolerance tool during moments of crisis.

Key studies:

• Fincham et al. (2023) – A meta-analysis of 12 studies showed that breathwork may be effective for improving stress and mental health. Slow, paced breathing interventions significantly reduced self-reported stress and anxiety. This supports using breathing exercises to calm acute distress.
• Bentley et al. (2023) – In this systematic review of 58 studies, 75% of isolated breathing-training interventions reduced stress or anxiety. Interventions that avoided rapid breathing and used guided, ≥5-minute sessions were most effective.
• Zaccaro et al. (2018) - This systematic review of 15 studies found slow diaphragmatic breathing increased comfort, relaxation, pleasantness, vigor and alertness, and reduced symptoms of arousal, anxiety, depression, anger, and confusion.

Grounding techniques are a key component of Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP). They help individuals manage overwhelming emotions and thoughts during times of distress. Grounding exercises aid in emotion regulation, provide distraction from suicidal thoughts, and build resilience, helping individuals stay present and reduce the intensity of negative feelings.

Key studies:

• Stanley et al. (2021) – Distraction/positive activity based strategies are helpful in decreasing suicidal ideation in the short-term. These findings can help clinicians advise patients about strategies to use to cope with suicidal thoughts to prevent acting on them in a crisis.
• Toussaint et al. (2021) – Results from this study showed that progressive muscle relaxation, deep breathing, and guided imagery all increased the state of relaxation for participants in those groups, compared to participants in the control group.
• Tucker et al. (2017) - In this study of adult students, they found that distraction from suicidal thoughts was negatively related to suicide risk.