According to recent research, in the United States each year, 34 thousand Americans commit suicide. Worldwide, every 40 seconds someone takes his or her own life. This problem is only getting worse. The rate of suicide has increased by 60% over the last 45 years. Not everyone who has suicidal thoughts will commit suicide, but learning to cope with suicidal thoughts is a important step toward managing depression.

A recent survey noted that 8.3 million Americans experienced suicidal thoughts last year, of whom only a small fraction acted on them. Many people that I have worked with throughout the years were able to cope with their negative thoughts, and their suicidal ideation dissipated as their depression and anxiety lifted. Suicide is an irreversible choice, but the negative emotions that give rise to suicidal thoughts change with time. The steps I outline below will provide some guidance on how to successfully navigate the difficult period you may be going through.

Assessment of Risk of Suicide

The first step in coping with suicidal thoughts is examining their frequency and content. Although many people might wish to be dead, fewer individuals have a clear plan and intent to follow through on such thoughts. Many factors, such as having access to lethal weapon, experiencing physical illnesses, having psychiatric disorders, and hopelessness may increase the risk of committing suicide. If you feel you are in imminent danger, you need to go to the nearest emergency room or seek professional help immediately.

If your suicidal thoughts are not strong or you do not have a clear plan and intent, make a crisis plan, in case your thoughts get stronger. In your crisis plan, identify the coping strategies that might help you take your mind off your suicidal thoughts in the moment. It is also important to write down the names and phone numbers of people and agencies that you need to contact for support in case of emergency. Take your crisis plan with you at all times, because sometimes emotions spiral quickly out of control, and it’s crucial for you to have access to that information when you need it the most.

Reducing Vulnerability

When people are feeling depressed, they tend to ignore their overall health. Unfortunately, neglecting your health will only make your mood worse. Often people in depression suffer from physical illnesses that they need to attend to or they do not take medication as prescribed. Make a conscious effort to address these issues and take steps to alleviate your pain.

Another area that people often neglect is their diet. They either engage in emotional eating or they starve themselves, which influences their body chemistry and worsens their overall mood. When you are depressed and anxious it is normal not to have an appetite, but think of food as a medicine and focus on eating at least three balanced meals each day. During this time, it is also crucial to stay away from alcohol and other mind-altering drugs. These substances impact executive functioning and make you more impulsive, increasing the chance of you acting on your negative thoughts.

Create a Life Worth Living

Although crisis management is an important part of protecting you from immediate danger, the most important step is to create a life worth living. I have worked with many people who had felt depressed and hopeless all their lives. They engaged in a tug of war with their negative thoughts and emotions. Often, the more they pushed their emotions down the harder these emotions pushed back. Instead of focusing on repressing and changing the emotions, I often find it is more effective to acknowledge them but focus energy on creating a life that is exciting and rewarding.

Not being afraid of death can encourage you to create a life full of adventure and take advantage of life’s excitement. I encourage you to close your eyes and think about the life that would be worth living for you. I want you to imagine that you are living the life that you always dreamed of, even if it seems unrealistic at this moment. Where would you be, who you would be, and what would you feel. Then reflect on what is getting in the way of living such a life. Ernest Hemingway, an American writer and a winner of the Nobel Prize in literature, lived an adventure-filled life that many people only dream of; he attributed this to his early exposure to death and suicide.

In my experience, when people focus on creating a thriving future, they have a better chance of changing a current negative state. I used to work with a 56-year-old woman who was struggling with chronic depression for years. She had been hospitalized twice because of her suicidal attempts. She felt hopeless and frustrated for the several months that we worked together. Although we worked on helping her to understand her past and working through unresolved conflicts, she still felt deeply sad and immobilized. One day, I adopted a solution-focused strategy and asked her what she would do if she knew for a certainty that she would die the next month. She paused for a while and then said she would go on a cruise to see Europe. She said she had always wanted to see Europe, since she was a child, but growing up with financial hardships had taught her that she should not spend money on things that are not essential parts of life. She added that she had always lived a frugal life, but knowing that she would die soon would help her to overcome her fear of spending money.

After exploring her thoughts and feelings for a few sessions, she decided to go on a cruise. She returned after several months and her mood and thought process were drastically different. She met a group of similarly minded people on the trip and the connections she made helped her to overcome her feelings of loneliness and despair. Although exploring past trauma and the factors that contribute to the formation of suicidal thoughts are important in therapy, sometimes people need to take action to get unstuck and become able to examine those elements.