From emotion regulation to suicide-specific coping: a qualitative study of self-regulatory processes in suicidal crises

IntroductionNegative affect is strongly associated with suicidal thoughts and behaviors (STBs). Accordingly, the ability to regulate intense negative affective states may be central to understanding the emergence and maintenance of STBs. However, very little is known about how individuals with lived experience regulate negative affect and cope with suicidal thoughts and urges. This study aimed to explore emotion-regulation strategies (ERS) and suicide-specific coping strategies (SCS) used during suicidal crises, their perceived effectiveness, and the situational and contextual factors influencing their selection.MethodsSemi-structured interviews were conducted with 12 individuals admitted to a psychiatric hospital due to an acute suicidal crisis. Data were analyzed using qualitative content analysis.ResultsBefore and during suicidal crises, participants predominantly used avoidance-oriented ERS that contributed to the maintenance of negative affect. With increasing distress, suicidal thoughts emerged as an additional ERS, providing short-term relief while contributing to the intensification of the suicidal crisis over time. A broad range of SCS was identified, differing in their motivational orientation toward suicidal behavior. Suicide-approach strategies (e.g., suppression, substance use, preparatory behaviors) often facilitated the escalation of the suicidal crisis, whereas suicide-avoidant strategies (e.g., seeking support, safety strategies) were context-dependent and not consistently effective. Strategy selection and effectiveness were shaped by situational and contextual factors.ConclusionSuicidal crises can be understood as dynamic, context-dependent self-regulatory processes characterized by escalating emotional distress, changes in strategy use, and dynamic regulatory resources. Interventions should focus on strengthening flexible coping repertoires and preserving self-regulatory capacity. Future research should further investigate these processes to improve prevention and intervention efforts.