Tomás Santa Cecilia: "Suicidal behavior is a problem of social scale".

Tomás Santa Cecilia talks to us about cognitive-behavioral therapy in the face of suicidal ideation.

Suicidal thoughts are one of the warning signs to which most attention is paid in the field of mental health. This type of ideas and mental images often serve as rehearsals before making an attempt to end one's own life, and that is why for decades work has been done to offer tools to people who feel that way.

In this interview we speak with the psychologist Tomás Santa Cecilia, expert in one of the most effective models of intervention with the people who suffer suicidal ideation: the cognitive-behavioral one..

Interview to Tomás Santa Cecilia: the therapy before the suicidal thoughts

Tomás Santa Cecilia is a psychologist specializing in the cognitive-behavioral model; he offers his services as an expert in psychological intervention to individuals and companies, both in his office in Madrid and also online.

What is the limit between what is considered a simple macabre exercise of imagination and suicidal thoughts?

In relation to suicidal behaviors I have to say that the limit is in carrying out the suicidal thought, in moving from thought to action, to behavior. It is fundamental to make this distinction; what determines the limit is the intentionality of the action.

It is important to emphasize that suicidal thought is one thing and suicidal behavior is another. In the world more than 1 million people commit suicide every year. In Spain more than 3,500 people decide to take their own lives every year, or in other words, 9 people take their own lives every day.

These are the data of people who take their own lives, other data are the people who have attempted suicide and the number can be multiplied by 10.

Do people who develop suicidal ideation usually warn some of their friends or relatives to try to ask for help?

This is a point of vital importance and one that still remains to be achieved, I sincerely believe that it is the great Achilles heel of suicidal behavior. Most of the people who go through this do not ask for help, and this must be one of the alarms that must make us put ourselves in the hands of a professional "I have been thinking about it for a long time, I am going to put myself in the hands of a professional".

On the one hand, it is necessary to educate the population so that this behavior does not become "the behavior" the only option in the face of certain problems or situations such as, for example: economic, labor, love, social, family or other problems. For this, it is necessary to convey to society that the difficulties can be addressed from many different levels and that there is not a single solution to a problem, this is the key, we have to show that there are several options from here things change.

In another line, it is necessary to promote plans for the prevention of suicidal behavior in the population aimed at detecting signs or identifying risk factors for possible suicidal behavior such as: presence of mental disorders, social isolation, alcoholism, drug addiction, abandonment of medication, depression or in the case of some young people, academic stress.

Because of the stigma around the concept of suicide, do people who present with suicidal thoughts usually recognize it from the first therapy session?

Normally yes, not clearly, but as the session progresses they manifest it. As health professionals we detect if there are risk factors and we guide the person so that they do not express it with peace of mind and confidence.

What can a psychologist do in these cases?

We can work on many fronts, at a preventive level, teaching people to ask for help, not to wait for it to be the only option in the face of life's difficulties. At the institutional level, from education, from the media, from the institutions, the important thing is to start from the premise that suicidal behavior is a problem of social, not individual, magnitude that every year claims more than 3,500 lives.

On a more individual level, once mental illness is ruled out, the person is made to see that suicidal behavior can be a definitive and irreversible solution to a temporary problem; this is one of the keys that we must convey to people, to teach them not to engage in self-injurious behaviors that are irreversible.

As a psychology professional, would you say that it is complex to help people with suicidal ideation to transform the beliefs from which they interpret reality and what happens to them?

It is important to create a good bond with the professional that allows the person to gain confidence and thus build a program of coping with situations, self-confidence and acquisition of strategies and tools before conflicts and difficulties.

We have to teach that there are a series of predisposing but not conditioning factors such as: sexual abuse, school, academic or work maladjustment, parental-filial conflicts or romantic breakups, among others.

And as for the change of ways of relating to the environment and to others, it is certainly not easy, considering that depression goes hand in hand with a lack of energy and motivation to try new things. How is this achieved through the cognitive-behavioral model?

In the specific case of depression and suicidal behavior it must be said that not everyone who has depression is going to have suicidal behavior and conversely not all suicidal behavior is followed by a depressive state, there are cases and it is another factor to be assessed by health professionals.

In this case the complementation of therapies such as psychopharmacological or cognitive behavioral therapy have good results in the remission of this suicidal ideation.

How do changes for the better occur after several weeks of therapy?

The important and decisive step is for the person to regain self-confidence, to see that there are options, that he or she is not alone. This allows the professional to start working efficiently and, above all, to move towards healthy coping styles. As the person faces situations that were previously assumed to be unattainable or insurmountable, the rest comes as a matter of course. It must be said that each person has his or her own process, his or her own time.