Adolescent Suicide and Self-Injury by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030428754
Publisher: Springer International Publishing

General Health and Social Factors

Insomnia

Persistent insomnia is frequent in youth and increases the risk of suicide, independent of co-morbid psychiatric illness ([62, 63]; see McCall and Black [64] for a review). Not surprisingly, people whose insomnia is co-morbid with BPD or chronic pain are at particularly high risk [65]. Investigations of suicidality in insomnia have been framed using the interpersonal theory of suicide [13]. This theory posits that suicide results from a combination of three factors: thwarted belongingness, perceived burdensomeness, and capability. In this model, insomnia may indirectly lead to thwarted belongingness via its impact on daytime function [66].

Insomnia’s many detrimental effects—impaired judgment, irritability, and hopelessness—may cause and result in mentalizing failures that underlie poor daytime function. Youth with insomnia and hopelessness may be less motivated to socialize; those with irritability may socialize less effectively. Notably, insomnia in youth is often caused by anxiety, compounded by dysfunctional (e.g., pessimistic or passive) beliefs about sleep [65]. This combination of factors suggests a role for mentalizing interventions in treating insomnia to reduce suicide risk.

Youth may talk about insomnia in pretend mode, making comments such as “I know this is a problem, I can fix it if I just….” (As noted in earlier chapters, the phrases “I know…” and “just” indicate pretend mode.) When encountering pretend mode, focus on emotion: “Does the insomnia bother you? How?” is a simple inquiry. Alternatively, one can ask, “When bedtime comes, what keeps you from doing [simple solution] or [adaptive behavior]?” and “How does it feel to do [sleep-interfering behavior]?” Questions about emotion tend to highlight competing or inconsistent priorities, since youth may acknowledge strong emotions related to insomnia, yet avoid confronting them, and describe insomnia as a low priority.

Psychic equivalence and teleological mode can perpetuate insomnia in the moment, even if they are absent in a therapy session. Youth will say they “need to” do whatever bedtime-interfering behavior they do (e.g., browsing social media or using cannabidiol). Here, as usual, therapists will want to elicit and empathize with whatever feeling(s) drive non-mentalizing . If that fails, asking youth to keep a journal or to try a mindfulness exercise at bedtime may create an opportunity for them to notice their emotions clearly enough to then describe them. When empathy does land effectively, therapists may be able to explore and clarify which daytime stressors (short- or long-term) lead to the feelings at bedtime. This process of linking emotions to events eventually helps youth tolerate emotions. With time, they can choose healthier coping behaviors or even regulate their bedtime emotions on their own.

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