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A Distress-Processing Model for Clients in Suicidal Crisis

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Crisis: the Journal of Crisis Intervention and Suicide Prevention
Authors:
Johanna M. Mickelson
Johanna M. Mickelson
Johanna M. Mickelson
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Daniel W Cox at University of British Columbia
Daniel W Cox
Richard A. Young
Richard A. Young
Richard A. Young
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David Kealy at University of British Columbia
David Kealy
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Background: While crisis intervention frameworks have indicated the importance of clients in suicidal crisis better understanding their distress to decrease suicidality, it is unclear how clients in suicidal crisis process their distress. Aims: To develop (Study 1) and validate (Study 2) a sequential distress-processing model for clients in suicidal crisis. Methods: Applying task analysis, Study 1 consisted of three phases, which resulted in a theoretically and empirically informed model. In Study 2, we examined the distress-processing model’s validity using a longitudinal design. In both studies, data were online crisis chats with adults in suicidal crisis. Results: In Study 1, we developed a sequential five-stage distress-processing model: (Stage 1) unengaged with distress, (Stage 2) distress awareness, (Stage 3) distress clarity, (Stage 4) distress insight, and (Stage 5) applying distress insight. In Study 2, the model’s validity was supported via evidence that (H1) progression through the processing stages was sequential and (H2) clients with good outcomes had greater progression in their processing than clients with poor outcomes. Limitation: Clients who were suicidal but did not disclose their suicidality were not included. Conclusion: Our findings provide a framework for conceptualizing and operationalizing how clients move through suicidal crises, which can facilitate intervention and research developments.
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Research Trends
A Distress-Processing Model for
Clients in Suicidal Crisis
Development and Initial Validation
Johanna M. Mickelson
1
, Daniel W. Cox
1
, Richard A. Young
1
, and David Kealy
2
1
Counselling Psychology, University of British Columbia, Vancouver, BC, Canada
2
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
Abstract: Background: While crisis intervention frameworks have indicated the importance of clients in suicidal crisis better understanding their
distress to decrease suicidality, it is unclear how clients in suicidal crisis process their distress. Aims: To develop (Study 1) and validate (Study 2) a
sequential distress-processing model for clients in suicidal crisis. Methods: Applying task analysis, Study 1 consisted of three phases, which
resulted in a theoretically and empirically informed model. In Study 2, we examined the distress-processing model’s validity using a longitudinal
design. In both studies, data were online crisis chats with adults in suicidal crisis. Results: In Study 1, we developed a sequential five-stage
distress-processing model: (Stage 1) unengaged with distress, (Stage 2) distress awareness, (Stage 3) distress clarity, (Stage 4) distress insight,
and (Stage 5) applying distress insight. In Study 2, the model’s validity was supported via evidence that (H1) progression through the processing
stages was sequential and (H2) clients with good outcomes had greater progression in their processing than clients with poor outcomes.
Limitation: Clients who were suicidal but did not disclose their suicidality were not included. Conclusion: Our findings provide a framework for
conceptualizing and operationalizing how clients move through suicidal crises, which can facilitate intervention and research developments.
Keywords: client change, crisis intervention, suicidal crisis
Crisis counselors apply crisis theory to help clients in
suicidal crisis move from a crisis state back to their
baseline. Within crisis theory, crisis occurs when people’s
perceptions of experiences create psychological distress
and the distress exceeds their ability to cope (Yeager &
Roberts, 2015). As those in crisis increasingly understand
their distress, distress decreases and they are more able to
adaptively cope (Mishara et al., 2007).
While crisis theorists have indicated the importance of
clients better understanding their experience to reduce
their psychological distress (e.g., Roberts & Ottens, 2005),
how clients make sense of their distress is unclear.
Therefore, the aim of our two studies was to develop a
model of how clients in suicidal crisis process their dis-
tress. By understanding the distress-processing stages,
suicide intervention practices can be tailored to address
clients’stage-specific needs.
Crisis Theory
Within crisis theory, suicidal crises occur when an expe-
rience is perceived as intolerable and inescapable
(Granello, 2010; Yeager & Roberts, 2015). When in crisis
states, people often feel overwhelmed by their emotions,
are unable to cope, and see suicide as an escape (Granello,
2010; Yeager & Roberts, 2015). As clients better under-
stand their distress, their agency and hopefulness increase
and their distress decreases. Once clients are less dis-
tressed, they are more able to adaptively cope and reduce
their suicidality (Granello, 2010; Roberts & Ottens, 2005).
Several studies have found that crisis theory-based in-
terventions have been linked with distress reductions
among those in crisis (Gould et al., 2007; Mishara et al.,
2007). In the following section, we consider relevant
distress-processing theory as a framework for this client-
change process.
Distress Processing
Within distress-processing theories, psychological distress
occurs when the perception of an experience conflicts with
existing beliefs (Stiles, 2001). Processing is making sense
of distress by bringing the perceptions of experiences in-
line with existing beliefs. Processing occurs via (a) ad-
justing perceptions of experiences to be consistent with
existing beliefs or (b) altering beliefs to be consistent with
perceptions of experiences. As the conflict between per-
ceptions of experiences and beliefs abate, so does distress.
Crisis (2024), 45(1), 18–25
https://doi.org/10.1027/0227-5910/a000907
© 2023 Hogrefe Publishing
... Suicide crisis is used to describe the psychological state preceding a suicide behavior, characterized by cognitive and affective dysregulation. It occurs when individuals experience intolerable emotions and they think only to be able to escape through one's death [19][20][21]. Acute behavioral, emotional, and cognitive changes characterizing the "suicide crisis" could develop during days, hours, and minutes before a suicide behavior, and suicide can occur suddenly in the suicidal process [22,23]. ...
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