Suicide Warning Signs & How Exposure Therapy Can Help

September 15, 2025
By Phoebe Long, PhD. Each day in the United States, around 130 people die by suicide. Behind every number is a real person and a community left grieving. While no single approach can erase every risk, recognizing warning signs and understanding how evidence-based and effective treatments like exposure therapy can be life-saving to some.

Recognizing the Warning Signs

Suicidal crises rarely appear without warning. Ideation around suicide often builds toward planning over time, shaped by depression, trauma, or substance use. Common warning signs include:
  • Talking or writing about death or expressing hopelessness (“I can’t take this anymore”).
  • Withdrawing from friends, family, or once-enjoyed activities.
  • Major shifts in sleep or appetite lasting weeks.
  • A sudden sense of calm after distress—sometimes a sign of resolved intent.
  • Preparing for death by gathering pills, researching methods, or giving away prized possessions.
These are urgent red flags that should be taken seriously. If someone you know demonstrates these behaviors, ask directly about suicidal thoughts and connect them with professional help or a crisis line (dial 988 in the U.S.).

Understanding Risk Factors

Certain circumstances heighten vulnerability:
  • Previous suicide attempts
  • Family history of suicide
  • Untreated conditions such as bipolar disorder or PTSD
  • Access to firearms or large amounts of medication
  • Major life changes (breakups, job loss, academic setbacks)
  • Chronic pain or serious medical illness
None of these “cause” suicide, but when combined with feelings of hopelessness, risk increases. Compassionate, early support is essential to effective suicide prevention.

How Exposure Therapy Can Help

When you think of exposure therapy, you may think of treatment for phobias and panic. However, a growing body of research shows it can also reduce the distress driving suicidal and self-harm urges. In exposure therapy, clients gradually face avoided thoughts, sensations, and situations, with closely monitored professional support.
  1. Confronting Painful Memories Traumatic memories—bullying, assault, sudden loss—often lurk beneath suicidal despair. Imaginal exposure invites clients to revisit these events gradually, in detail, with a trained therapist. Over time, the brain learns the memory is painful but survivable, shrinking the urge to escape through self-harm.
  2. Facing Intense Emotions Through interoceptive exposure, clients practice tolerating difficult sensations—like a racing heart or dizziness—learning they are temporary and manageable.
  3. Reclaiming Avoided Situations Situational exposure helps clients return to places or activities linked with shame or grief, gradually restoring confidence and reducing avoidance cycles.
Exposure therapy is always combined with safety planning and close monitoring to ensure clients are supported every step of the way.

A Comprehensive Approach

Exposure is most effective within a broader care plan that includes:
  1. A thorough evaluation tailored to individual risk by licensed clinicians
  2. A collaborative safety plan with warning signs, coping strategies, and emergency contacts
  3. Skills training (mindfulness, distress tolerance) to manage urges between sessions
  4. Medication when appropriate for severe mood or anxiety disorders
  5. Coordination with primary care and hospital teams for acute crises

What You Can Do Right Now

  • Ask directly. Studies show that asking “Are you thinking about suicide?” does not plant the idea; it opens a life-saving conversation.
  • Listen with empathy. Validating responses like “that sounds unbearably painful” reduce shame.
  • Reduce access to lethal means. Secure firearms, medications, or car keys if needed.
  • Stay until help arrives. If risk is imminent, call 988 or go to the nearest ER.
  • Encourage professional care. Evidence-based therapies, including exposure therapy, CBT, and DBT, can significantly reduce suicidal thinking and behaviors.

The Ross Center Is Here to Help

Our multidisciplinary team of psychiatrists, psychologists, and social workers provides personalized care for suicide prevention. We integrate exposure-based therapies, cognitive restructuring, and medication management to reduce distress and restore hope. Contact Us We also offer secure telehealth in DC, Virginia, New York, Maryland, and additional PSYPACT states—so help is within reach. If you or someone you love is in crisis, call 988 or go to your nearest emergency department. You are not alone, and help is available.