Trigger warning: This article addresses the topic of suicidal thoughts. No methods are described. If you are personally affected, please reach out immediately to someone you trust or to professional help (e.g. Telefonseelsorge Austria: 142, Telefonseelsorge Germany: 0800 111 0 111).

1. Introduction – Why we need to talk about suicidal thoughts

Suicidal thoughts are among the most severe psychological strains a person can endure. Many affected individuals feel alone and misunderstood with these thoughts. Yet suicidal thoughts are not rare – and they almost always arise from a combination of emotional suffering, mental illness, and social stress factors.

Therapy for Suicidal Thoughts: such thoughts do not automatically mean that someone truly wants to die. Often, they reflect the desire for peace, relief from pain, or an end to what feels like a hopeless situation. In psychology, we often speak of this as a cry for help from the soul.

2. The origins of suicidal thoughts – how they develop

The development of suicidal thoughts is complex. They rarely stem from a single cause, but are usually the result of multiple factors.

• Mental disorders: Depression, anxiety disorders, bipolar disorder, borderline personality disorder, or post-traumatic stress disorder are frequently linked with suicidal thoughts.
• Crises and stressors: The loss of a loved one, separation, occupational overload, or financial difficulties can trigger the feeling of “not being able to go on.”
• Sense of hopelessness: A central pattern is the belief that one’s situation will never improve.
• Inner exhaustion: Many report feeling emotionally and physically drained. Suicidal thoughts can then appear like a final “escape route.”

3. Mental health conditions that increase suicidal thoughts

Suicidal thoughts do not always occur within a diagnosis, but certain conditions increase the likelihood:

• Depression: Characterized by feelings of worthlessness, guilt, and profound hopelessness.
• Anxiety disorders: Chronic fear and panic attacks can be so overwhelming that thoughts of an “end” emerge.
• Borderline personality disorder: Intense emotions, impulsivity, and tendencies toward self-harming behavior can increase suicidal crises.
• Substance use disorders: Alcohol and drugs can both intensify suicidal thoughts and lower inhibitions that normally prevent action.

4. How suicidal thoughts manifest

Suicidal thoughts often develop in phases. There are warning signs that family members and professionals should take seriously:

• Withdrawal from friends and family
• Increased expressions of hopelessness or worthlessness
• Loss of interest in activities that were once important
• Irritability
• Statements like “Nothing makes sense anymore” or “You’d be better off without me”
• Sudden calmness or apparent improvement after a period of inner turmoil (sometimes a warning sign!)

Not every signal indicates acute danger – but every signal deserves attention and conversation.

5. Normal thoughts vs. red flag – where is the line?

There is a difference between fleeting, abstract thoughts (“Sometimes it would be easier not to be here”) and concrete suicidal intentions.

• Abstract thoughts: They can occur during periods of high stress. They must be taken seriously, but do not necessarily mean immediate danger.
• Increasing concretization: If someone begins thinking about it frequently, mentally rehearsing scenarios, or fixating on the idea, the risk rises.
• Acute danger: When concrete plans emerge, when people show farewell gestures, or begin to “get their affairs in order,” immediate help is necessary.

6. Psychological therapy – the central approach

Therapy for Suicidal Thoughts: Therapy plays a central role in dealing with suicidal thoughts. The goal is to rebuild hope and perspective.

• Talk therapy: Simply voicing thoughts can bring relief. Silence often deepens the feeling of loneliness.
• Cognitive behavioral therapy: Helps to question negative thought patterns and develop alternative perspectives.
• Stabilizing methods: Breathing techniques, mindfulness, and relaxation training can reduce acute tension.
• Relational work: Many patients experience, sometimes for the first time, that their suffering is truly seen and taken seriously.

As a psychologist, I offer a safe space where people can openly talk about their thoughts without being judged.

7. When is psychiatric hospitalization useful or necessary?

Not every person needs immediate inpatient care. But in some situations, it is the safest option:

• When acute suicidal intentions are present
• When someone can no longer keep themselves safe
• When severe mental illness is in an acute phase
• When relatives are overwhelmed and cannot ensure safety

In a psychiatric clinic, the focus is first on crisis intervention: safety, stabilization, medical and therapeutic support. Often, inpatient treatment is only temporary before outpatient therapy continues.

8. How relatives can help

Family and friends are important protective factors. Helpful actions include:

• Listening without judgment or quick advice
• Taking every statement seriously
• Offering support
• Encouraging professional help
• In acute situations: immediately contacting emergency services or psychiatric crisis hotlines (see numbers below)

9. Hope and outlook

Suicidal thoughts are a serious warning sign – but they are not an inevitable destiny. With the right support, psychological treatment, and, if needed, medical care, affected individuals can regain joy in life.

Therapy is not just about “surviving a crisis” – it is about discovering new paths, finding meaning, and experiencing life as something that can be shaped again.

10. Conclusion

Suicidal thoughts are an expression of deep emotional suffering, not weakness. They often arise in the context of mental illness or severe crises. The key is to recognize them early, take them seriously, and seek professional help.

Therapy for Suicidal Thoughts: As a psychologist, I see my role as opening new perspectives together with clients and working step by step out of the darkness. If you are affected by suicidal thoughts, or someone close to you is struggling, let’t talk about it in a free initial session.

Helplines:

• Telefonseelsorge Austria: available 24/7, anonymous & free; Tel.: 142; Web: https://www.telefonseelsorge.at
• Rat auf Draht (for children, young people & their caregivers): Tel.: 147 (24/7, free, anonymous); Web: https://www.rataufdraht.at
• Crisis Intervention Center Vienna: Counseling in acute psychological crises; Tel.: +43 (0)1 406 95 95; Web: https://www.kriseninterventionszentrum.at
• Psychosocial Emergency Service (Vienna): Tel.: 01 31330 (daily, 24/7)
• Police & Ambulance: 112 or 133 / 144
• European emergency number: 112 (EU-wide)
• Telefonseelsorge Germany: 0800 111 0 111 (free, 24/7)
• Medical on-call service (Germany): 116117
• Emergency: 112 (in acute danger)
• International hotlines: https://findahelpline.com

Quellen:

• Hegerl, U. & Zaudig, M. (2019). Depression und Suizidalität: Ursachen, Prävention, Therapie. München: Elsevier Urban & Fischer.
• Pöldinger, W. (2015). Suizid: Theorie, Klinik und Therapie. Stuttgart: Thieme.
• Wolfersdorf, M. (2013). Suizidalität: Vorbeugen – Erkennen – Behandeln. Göttingen: Hogrefe.
• Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN). (2017). S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression. AWMF-Registernr.: 038-013. Verfügbar unter: https://www.awmf.org/leitlinien/detail/ll/038-013.html
• Deutsche Gesellschaft für Suizidprävention (DGS). (2020). Suizidprävention in Deutschland. Verfügbar unter: https://www.suizidprophylaxe.de