Suicidal thoughts can look very different from person to person and from time to time. For some people, they appear during a specific crisis and fade as circumstances improve. For others, suicidal thoughts can become persistent or recurring, showing up over months or even years. This is sometimes referred to as chronic suicidality or chronic suicidal ideation.
Living with chronic suicidal thoughts can be exhausting. The thoughts may become stronger during periods of stress, rejection, conflict, burnout, or hopelessness, and quieter at other times. Someone may still go to work, spend time with friends, make future plans, and experience moments of happiness while also struggling with thoughts of not wanting to be alive. These experiences can exist at the same time.
Dialectical Behavior Therapy, or DBT, was developed specifically for people experiencing severe emotional distress, recurrent suicidal behavior, and self-harm. Rather than treating suicidality as a separate issue, DBT places life-threatening behaviors at the highest priority in treatment while also helping people develop skills to manage the emotions and circumstances that contribute to crises.[1]
Understanding Chronic Suicidality
Chronic suicidality does not mean suicidal thoughts should be ignored or assumed to be harmless. Suicidal thoughts can change in intensity, and increases in intent, planning, or difficulty staying safe should always be taken seriously.
At the same time, chronic suicidal thoughts can be more complicated than a constant intention to die. For some people, thoughts of suicide can become a familiar response to intense emotional pain—a way the mind imagines escaping circumstances or emotions that feel impossible to tolerate.
This is one reason DBT focuses on understanding what happens before, during, and after a suicidal crisis. Instead of only asking, “How do we stop this thought?” DBT also examines what triggered the crisis, what emotions and thoughts followed, what behaviors made things better or worse, and where a different response might be possible next time.
How DBT Can Help
At its core, DBT balances two ideas: acceptance and change. A person can acknowledge that their suffering is real while also working toward behaviors, relationships, and circumstances that make life more manageable.
Distress tolerance skills help people move through intense moments without making the situation worse. Emotion regulation skills help identify emotional patterns and reduce vulnerability to overwhelm. Mindfulness can create space between experiencing a painful thought and acting on it, while interpersonal effectiveness skills support clearer communication, healthier boundaries, and asking for help when it is needed.
DBT also uses tools such as behavior chain analysis to understand how crises develop. Looking closely at triggers, vulnerabilities, thoughts, emotions, urges, and behaviors can make experiences that once felt completely unpredictable easier to recognize and interrupt.
What the Research Says
DBT has been studied extensively in populations at elevated risk for suicide and self-harm. In a landmark randomized controlled trial, adults receiving DBT were less likely to attempt suicide and had fewer psychiatric hospitalizations and emergency visits related to suicidality than those receiving treatment from expert community therapists.[1]
Later research found that DBT interventions containing skills training were effective in reducing suicide attempts and nonsuicidal self-injury among adults at high suicide risk.[2] DBT has also shown promising results among adolescents. In a multisite randomized clinical trial of 173 highly suicidal adolescents, those receiving DBT had fewer repeat suicide attempts, episodes of nonsuicidal self-injury, and overall self-harm after treatment than adolescents receiving supportive therapy.[3]
The research is also important to describe accurately. DBT does not necessarily make suicidal thoughts disappear immediately. A meta-analysis of DBT for borderline personality disorder found reductions in self-harming behavior and depression but a much smaller effect on suicidal ideation itself.[4] Research in adolescents has similarly found meaningful reductions in self-harm, with evidence for reductions in suicidal ideation varying across studies.[5]
That distinction matters. Progress does not always mean never having another suicidal thought. Sometimes it means recognizing the thought sooner, understanding what triggered it, using skills instead of acting on an urge, reaching out for support, and gradually experiencing fewer or less severe crises.
Supporting Someone With Chronic Suicidality
Chronic suicidality can also be difficult for loved ones. Friends and family may feel frightened, helpless, or unsure of what to say, particularly when suicidal thoughts have been present for a long time.
One of the central ideas in DBT is validation. Validation does not mean agreeing that suicide is the answer. It means recognizing that the person's emotional pain is real and trying to understand why they feel the way they do.
Loved ones can listen without judgment, take changes in risk seriously, and help someone connect with professional support. At the same time, caring for someone does not mean becoming their entire treatment system. Friends and family members need boundaries and support of their own.
Building a Life Worth Living
One of DBT's broader goals is helping people build what is often called a life worth living.
That does not mean life suddenly becomes easy or that painful thoughts never return. It means gradually building more ways to cope, healthier relationships, greater stability, meaningful experiences, and a stronger ability to survive painful moments without suicide feeling like the only available escape.
For someone experiencing chronic suicidality, progress can happen through very small steps: getting through one difficult night, practicing one skill, telling someone what is happening, understanding one trigger, or changing one part of life that has become unbearable.
Over time, those small changes can add up.
At Rooted DBT, we believe DBT skills can provide practical tools for understanding emotions, surviving difficult moments, and building a more sustainable life. Rooted provides education and self-guided DBT practice, but it is not a replacement for therapy, medical care, crisis services, or comprehensive DBT treatment.
Safety note: If suicidal thoughts become more intense, you begin developing a plan or intent to act, or you do not feel able to stay safe, seek immediate support from a mental health professional, emergency service, or crisis resource in your area.
References
- Linehan MM, Comtois KA, Murray AM, et al. Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry. 2006;63(7):757–766. doi:10.1001/archpsyc.63.7.757.
- Linehan MM, Korslund KE, Harned MS, et al. Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder: A Randomized Clinical Trial and Component Analysis. JAMA Psychiatry. 2015;72(5):475–482. doi:10.1001/jamapsychiatry.2014.3039.
- McCauley E, Berk MS, Asarnow JR, et al. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(8):777–785. doi:10.1001/jamapsychiatry.2018.1109.
- Chen SY, Cheng Y, Zhao WW, Zhang YH. Effects of dialectical behaviour therapy on reducing self-harming behaviours and negative emotions in patients with borderline personality disorder: A meta-analysis. Journal of Psychiatric and Mental Health Nursing. 2021;28(6):1128–1139. doi:10.1111/jpm.12797.
- Kothgassner OD, Goreis A, Robinson K, et al. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological Medicine. 2021;51(7):1057–1067. doi:10.1017/S0033291721001355.