 Hello, everybody. This is episode number 215 of the Anxious Truth, and I am joined today by my friend, Kimberly Quinlan, next to you. Hey, Kim. I did a little jazz hand there. It was, it was a jazz hand. So this episode is a little bit different. I'm not going to, there's no intro, there's no music. I'm going to try and be as respectful to this topic as I think we need to be. Because I know this is a really crippling fear for so many people. Today we're going to talk about the fear of suicidal thoughts or the fear that you might become suicidal against your will, right? It's an incredibly common fear in our community. Yeah. So before we do that, and before we come in again to the conversation, I'm just going to have an informal chat about it, and hopefully it will help you guys. Just a quick reminder that while I am not a therapist working on it, and Kim is, this is not therapy, it can't be a replacement for therapy. So always consult your mental health provider. And of course, of course, always please, for our sake, we beg you, if you ever feel that you are truly a danger to yourself or anybody else, please immediate in-person help. It's don't rely on a podcast for that sort of thing. So if you have anything you want to add to that, Kimberly? No, I go straight to your emergency room or call 991. They're the best people to call. You can always call a suicide hotline as well, but we can talk about that later. That's true. If you go to the anxioustruth.com.com. That'll be the show notes for this episode. I'll make sure to have all those numbers and stuff. And the countries that I can find them for, I will put them in. So anyway, for those of you who do not know Kim, Kim, introduce yourself. I know you all know Kim. Go ahead. Hi, my name is Kimberly Quinlan. I am a marriage and family therapist. I live in California, USA. I specialize in anxiety disorders and eating disorders. And I have a podcast called your anxiety toolkit. It's a good one. If you're not following that podcast, you should. So I asked Kim on to talk about this today because it seemed like a topic that I want a seasoned clinician to weigh in on. You've been at this for over 10 years now. So, you know, well respected in the field. One of the most kind and compassionate people I know. So you're a perfect addition for this conversation. One of the questions that comes up in my community, we share so much of our community, which is great is this fear. I'm terrified that I might. I don't want to hurt myself. I have no intentions of doing that. And I think I'm describing it accurately for most people because I was that person at one point. I don't want to kill myself. I do not want to die. I don't want to hurt myself. But I'm afraid that one day I will make a decision that I have no intention to make. It will be completely out of my control. I won't be able to control my thoughts or my actions and I will do and I will harm myself. I can tell you from my own experience when I was at my worst, my doctor would prescribe Xanax for me. He would give me a 90 pills, right? And I would throw away 89 of them a year later. I was too stubborn to take them. But I was so afraid of this that I would ask people to hide them. I didn't want to take them. I had no business idea. I wasn't interested in them. But I was so afraid that I might do something that I really had no intentions of doing that I would ask to have those hidden. And I know other people get to the point where they're afraid of having sharp objects in the house and things of that nature, even though they have absolutely no intention of using them. I'm guessing you've seen this all the time. Yeah, all the time. Yeah. So just sort of let's just break it down into categories, right? So we know there are people who have suicidal ideation, like thoughts of suicide that line up with where they are in their mind, right? So we call it egocentonic, meaning like, yes, I'm having thoughts of suicide and I do want to die, right? So we call that active suicidal ideation. We also then have another category, which is called passive suicidal ideation. Lots of people have this, which is where it's not that you want to die. It's that you just don't want to get up today and do the day. You just kind of want to crawl under a rock and disappear into a dark place, right? And so it's not that you are in the plan and making a plan to die by suicide. It's that you're just, you're done, life is too hard kind of thing. And that's really common. And then the final category, which is what we're here to talk about. And the reason I want to be really clear with these classifications is the people who have the fear of one of those two things. Yeah, they don't have either, but they're afraid that they might. What can happen is you may have, there are times when some people have some suicidal ideation, whether it be passive or active and the fear, right? And so they can exist together. But the important thing to remember here is how we approach all of them in terms of how do we respond. And the cool thing is we respond in a very similar way, right? The first thing to recognize is if someone is in that final category of having thoughts about dying by suicide, meaning like they're having a fear about it, right? If you're having a fear of wanting to do this or fear that one day you will, your job is to remember that we don't treat that thought different than any other obsession. It's just that the content is different, right? Even what I'll say, and let's sort of go slow down here. Even at the beginning of the session, we talked about slowing down and being really respectful. And yes, we want to do that around suicide. We also don't want to treat these thoughts like they're important and special and to be particularly concerned about if they're just the fear of that happening. Yeah, I would agree with that 100%. Right. I think my desire to be respectful to this is the title alone is going to attract people to this. So yeah, but you're 100% right. But it is the most important thought a human can have. It seems like it is. Like it's a special thought. It's so important. I get that. Yeah, so your intro was perfect, right? We need to treat these topics like they're important because they are. But if you're having a fear, we don't treat fears like they're important and that's the classification difference, right? So yes, a lot of my patients report this, right? And it's usually a fear that comes on very intensely. There's a lot of urgency around it. There's the need to get certainty on it right away. And we know that when there is urgency and the need for certainty, that's usually a red flag for like this is an obsession and I'm getting caught up in it, right? And that can be a helpful way to identify how to respond. Yeah, which I think makes good sense because in general, and I'm going to defer to you on this, you're the experienced one, but there seems to be a difference. There's somebody who winds up in one of those first two categories, passive suicidal ideation, active suicide. That's a progression. Like they don't wake up one morning and decide and I think that's one of the, one of the sort of miscalculations that goes into this, that third category that we're addressing today, that somehow or other the decision to do something so extreme happens instantly for no reason, which doesn't appear to be the case in most situations. Well, usually when someone reports this kind of fear or obsession, we'll call it an obsession just for the sake of knowing that it's repetitive and it's unwanted and so forth. But it's basically a fear. It's a thought is when people have this thought, it is often triggered by reading something in the news, seeing something on social media, you know, watching something on YouTube or something, and you've seen someone who has died by suicide and your brain then sends a very direct message to your body like, what if I lose control and so much underlying of most fears or many fears is the fear that we'll lose control and just like snap, right? How many times I've heard a client say, what if I snap, right? It'll be too much. It's always too much. Yeah. And our job again is to zoom in and go, that's interesting. That sounds a lot like your fear of panicking, right? And that sounds a lot like your fear of snapping and doing, you know, making a big mistake or doing a behavior that doesn't line up with your values. And so our job here is to catch the trigger because there usually will be one and then to catch our response to need to get control over our bodies. Yeah, last time that I, excuse me, that I heard a big wave of this fear was after Naomi Judd, the country singer. Judd was only a few weeks ago. Unfortunately, she was in the news because she ended up taking her own life. And it triggered a big wave of discussion about this. People came up with it. Oh my God, this triggered me. This triggered me. Or maybe it's somebody that unfortunately, you know, personally who did that. And that will be the triggering event there. So what I'm hearing is that is, I know as hard as it is to believe and trust me when I was in that situation where I was asking to have the Xanax hid because I was so afraid that I would lose control and do this completely out of character thing. It seems like such an important thought. The content does seem so important, but it's just now I would tell you, in retrospect, I can tell you it was not important at all. I was also afraid that the orange juice was poisoned and that I had all kinds of stuff. So it's the same as all of that. Yeah, so I think that this is really important. The progression, if you're struggling with this, is if possible, go and get professional help. Sometimes we just need to sort of understand the assessment to figure out which category we belong in, get help in that area. Then we want to learn, and this is where I will say to you, as somebody who's had clients in all three categories, the tools are very similar for each one. Because even if you're having active suicidal ideation, we still practice a lot of metacognitive therapy. Observing that it's still just a thought. Just because you have the thought doesn't mean you have to act on your thoughts. It's the same if you have the fear, I'm having the thought just because I'm having the thought doesn't mean I have to act on that thought and fear. There will be some variations in how we treat it in terms of yes, if you are active in your ideation, yes, we would take away the means, right? The means in which that could happen. However, let me sort of give you a case study here, and hopefully this is helpful, is I once treated a client who had came to me with fear of suicidal, the fear that she would die by suicide. And she 10, 15 years before had attempted suicide. She was depressed. She'd gone through a very difficult time. She then had gone through full therapy, fully recovered from her major depressive episode. And now she's having this fear, right? So whether you've had that event or not doesn't change the way I treat it, and we treated it, which was we do an inventory on, okay, you're having this thought. How are you responding to it? Let's write every single response down. I hide the pills. I keep the knives locked in the blah, blah, blah, right? Like I ruminate on it for many hours a day. I avoid staying up late at night, or whatever they're being triggered by in the park. Being alone. That was one of the reasons I was so afraid to be alone. Yeah. Yeah. I won't take a bath because next to the bath is the hay drive. Right. So we do an inventory of all the behaviors, even the little nuanced behaviors, like avoiding the words, suicide, right? You know, unfollowing people who talk about it on social media and so forth. So we do an inventory and then we slowly return back to undoing those behaviors, right? So we will, and so an example would be, I had a client, similar to you, is my client's homework was to have the pills next to her in bed. Yeah. And she had to keep observing that thought, ping, ping, popping up in her head so that she could practice changing her response. Because if you don't change your response, the fear keeps being fueled. That's 100%. Yeah. Now, there have been times when I've had clients who would say, I'm doing, I'm trying to undo these responses. I'm trying to just let the thought be there. And sometimes I do have passive or active suicidal ideation. And we just do little shifts in the treatment, but we still have them showing up and living their life according to their values and not responding to that fear as if that fear or that thought is important. Yeah. Yeah. That makes perfect sense. And I can 100% verify that that was my experience, exactly what you said. I remember the first time that I did that knowing like, although I'm cheating a little bit here because what I discovered, a lot of people will ask me, and we can talk about this. Well, what would be my exposure for this? They asked me all the time, well, did you do exposure? What was your exposure for that? Really as my relationship with my thoughts and fears changed as I was doing all of the other work, because I'm guessing that this fear, although maybe, I don't know if this is a specific OCD subtype, maybe part of harm OCD, I don't know. But most of the people in my community do not have this fear that we're talking about by itself. This isn't a standalone thing. Yeah. It's part of the whole panic anxiety agoraphobia complex. So as I get better at the rest of that, I was able to relate to that thought in a much more reasoned way. And I remember the day that I said, give me the pills. And it was a little bit of a weird moment. Like, what do you mean, give me the pills? I'm like, no, no, no, not that. And they put them in the medicine cabinet up on the top shelf. My kids were in there. They could never get to them. And they had the crazy child group walk on them. But, okay, I'm going to have to let these sit here. Yeah. And I would throw them away at the end of the year when they would expire. But nonetheless, that was a big step for me, that. And, okay, yeah, fine. Go to the supermarket. I'll stay home alone for the hour. Yeah. The thing to remember with this fear is we could take a couple of approaches, but the way that I often train my staff and I treat my clients is being alive and is the exposure. Just going about your day is the exposure. Really what we're focusing on here, which is more important than anything is the response prevention, right? It's like 70% of the work, which is when you have the thought, how do you respond? Do you respond with urgency and with importance? And do you respond as if that is, absolutely, you cannot tolerate that? Or are you responding in a really mindful, open way? Now, again, I want to keep coming back to the intro, which is if you are having suicidal ideation, don't just ignore it. Absolutely go and see your medical professional. Go and see a mental health professional. I'm not in any way saying that, you know, let's just blow it off as no big deal. But what we're talking about, I want to just be clear here, we're talking about specifically the fear of suicidal ideation. Yeah, which is 100% true. And I think it's never a bit, again, understanding that not everybody has access to this, which is terrible. It is hard for people to go see a mental health professional sometimes, but even to just be evaluated, is this something I need to be worried about? And if you have somebody like Kimberly or, you know, qualified professional who says, no, no, no, you fall into this category that we're talking about. At least you know how to deal with that. Yeah. The other thing that I want to talk about a little bit is I want to talk about the difference. How do I know? How do I know which thoughts are the ones that I should? What puts me in the passive and then active category? Because I guarantee that people watching and listening are going, that's going to be the next question. Yeah. Well, how will I know when I'm having passive ideation? How will I know when I'm having active ideation? Yeah. Well, again, I think that that's true for health anxiety. That's true for, you know, so many obsessions, right? Like they have a fear. How do I know what won't happen? And if you get too caught up in trying to identify, like I talked about those three categories. If you find that you're listening to this on repeat, trying to define which category it is, you might find that you want to step back a little bit because really all you're doing is you're just, again, trying to get certainty. And I think that the thing with, again, we treat health anxiety in this exact way is we're actually going to use your tools and sit back and just wait a little bit and not know. And then practice not knowing. Again, because again, you'll, you'll, this is annoying to say, but you'll know. Yeah, I knew you were going to say that. You'll know. You'll know. But if your thought is how do I know? Well, then you probably should defer to using some of your mindfulness and response prevention skills. Right. You'll know. And the same thing with health anxiety. People who are, who are ill know that they're ill. Yeah. They're not worried that they might be ill. Exactly. Yeah. And I would think and correct me if I'm wrong in any of this, but if you're, if you're fixated now on, oh my God, which of those three categories in my end is really a good chance during the third one that we're talking about now. Yeah. Yeah. And at the end of the day, like I said, I may have some people who, you know, there's no shame in being in the first two categories, right? Like there's nothing to be ashamed of. But even then, we're still going to be responding in this really wise, skillful way, right? Yeah. In that when you have the, this is true for any thought, any thought, even if it's about your lovely little baby, right? That you're having terrible thoughts about or your grandma or whatever is any thought we're going to always slow down and just be like, okay, how can I be really skillful in my response to this? Right. That's so important. And yes, if you may find that you are, you know, particularly in these times when the world is so divided and there's a lot of passive suicidal ideation right now. That's very common. Again, no reason that we need to like run to the ER. If you are struggling and you really think you're in danger, go to. But I had a follower a few months ago talk about, I thought was really cool. She said, she had such strong fear of, of harming herself that she drove to, it was like two in the morning. She drove down to the ER. She sat in her car. She was in treatment and she said, I just sat there. And I thought, what is the most skilled way to respond to this? Right? Like, am I responding from fear or am I responding from a place of really feeling like this is true for me? And she turned around and she drove home because she knew she was able to identify. I'm only here to make my fear go away, not to keep me safe. That story actually makes me a little emotional. I did that. I did that twice, like three and four o'clock in the morning. And I remember sitting there and it was interesting to me because my experience there was once I was there in the parking lot, I did not go in the building. I just wanted to be close enough so I could run in case I really did snap. It started to dawn on me that like, oh, wait a minute. I clearly don't need to run into this building. So it was a desperate act in a way, but in a way that desperation made a little bit of space for me, you know, to be able to respond a little bit differently. So that was a, I remember those two nights very, very, very good. Yeah. Just scary nights. Yeah. But in the end, inconsequential. So the last version of this before we sort of wrap it up because we don't go too long. And I so appreciate it. I learned something every time I talked to you. It's just so great. But there's the other category of people that are listening right now. I know we're going to say, yeah, but I'm not worried that I'm going to snap today and like instantly somehow go into this suicidal mode and kill myself. The fear for other people is really tied to that, the fear of depression. Well, now I'm worried that I might become depressed and then the depression will progress all the way down the road and it will end with this act. So it's not so much the fear of a suicidal thought or a fear that they might have one today. It's really the fear. Well, what if I become depressed or what if I am depressed and they don't know it? That's a different topic, but it ties together. Yeah. It's a fear of depression. Yeah. I know what you're going to say. What am I going to say? Yeah. It's the same thought. Thinking that you might become depressed is just a thought like any other thought. Just because you think it doesn't mean it's going to happen. Yeah. Yeah. See, not exactly. You know me so well. Obviously I've bored you to tears with my theories. Hardly. But the other thing I would add to that is really in treatment for anxiety, do I spend a lot of time correcting distorted thoughts, right? Because often that can become compulsive in and of itself. When I will correct distorted thoughts is when people say statements about their coping, right? I won't be able to cope. And then I love to get in there and like really work on them having again skillful thoughts about how they cope with life, right? So in this case, what I would also encourage them to do is they're really saying that there's another feeling and there's another sensation that I can't tolerate just like panic. Well, I can't handle panic. So I don't want panic and I can't now I can't handle depression. And a lot of recovery requires a really flexible mindset where you remind people, okay, if and when that happens, we'll find a solution then. But until then there's three words I always hold up my three fingers to my clients, not happening now, right? Yeah. Not happening now. And so we we don't need to solve whether that will happen or not. But we can, there's one thing we can do which is remind ourselves of our ability to cope with emotions. And so you're saying. We always do. I mean, in the end I see I people are tired of hearing me saying that you've always coped with all of your emotions. It didn't feel good. No, not feeling good doesn't mean you didn't cope. Yeah. And those three words not happening today for me and I was so I mean, there was a lot of death themes for me for sure 100%. It was this fear of death and this fixation of death dying in existence. And it was one day we'll die today is not that day. So today is not that day was five words for me that was incredibly powerful. It's not that day. And if it turns out to be, I guess I'll have to deal with it. Yeah. Same rules apply. And you will. And I will one day I will like everybody. Yeah. Yeah. So I mean, it's a hard thing. It's a hard thing. Again, often people are having this fear when they're already in so much pain. So of course they don't want more pain. Right. That's human. Right. But again, this is about stopping for a second and and really asking yourself, you know, how, how I respond to this thought is the beginning of me training my brain and molding my brain into the way that I want to be. So I'm going to change how I respond, which is an exercise in resiliency and psychological flexibility. And the bad news is not bad news. It's just, we should acknowledge that the struggle partially comes from when you are in that suffering or pain state, our ability to be resilient and flexible tends to drop a little bit naturally when you're struggling. It's the same sort of thing, you know. Exactly. It doesn't mean that you can't just because you're struggling doesn't mean you're not capable or that this is an overwhelm. Yeah. Yeah. Yeah. Just one thought at a time is all you have to focus on. Very good. Thank you so much. This has been incredibly helpful for those of you who want to, where can you comment on this? YouTube, my Facebook group, wherever. I don't post these on Instagram, but if you have questions, ask them where you can. Just answer them. But I hope that this has at least put this not assured you, which is wasn't the job to argue with that thought, but to at least make you understand the context they exist in and why it's not as big an emergency as you are sure that it is right now, even though you're so scared of the thought. Yeah. Anything else you want to add to that to wrap it up, Kim? No, just a nice dose of compassion. This isn't easy stuff. This is hard. It's a heavy weight to carry. So if you can just give yourself a little dose of compassion as you handle it, I think that will sometimes loosen the load a little. Yeah. I would agree. All right, guys. Well, thanks for taking the time to hang out with us, Kimberly. Thank you, Kimberly. Thank you so much for coming on. As always, I love when we get to work together. And again, if you have, or if you're watching on YouTube, it's on the screen right now. TheAnxiousTreat.com, so there's 215. I'll have all Kim's links to her courses and her podcast, which is excellent. Your thoughts series? So good. The mental compulsions. Yeah. I listen to everyone. I'm like, I literally take notes. I know. It was so good. It's like one of my career highlights. It was so fun. And you had some real heavy weights way in there. Yeah. That says something about who you are. Thank you. All right, guys. If you're watching on YouTube, by all means, subscribe and comment and all that stuff. If you're listening on iTunes or Spotify, leave a five-star rating, write a little review of the podcast if you think this is helping you. And then I will be back next week with another topic even though I don't know what that's going to be. We'll see you now. Thanks, Kim.