A common approach used to treat people who are depressed and thinking about suicide is to help them identify and remember several reasons for hope and to keep living. One specific intervention often used in cognitive-behavioral therapy (CBT) to cultivate hope is to create a “hope box” (also known as a “crisis kit”), a collection of various items that remind the depressed person that their life is meaningful and worth living.
A hope box is made by getting a box, envelope, bag or any type of container and filling it with reminders of things that give you hope, or that have given you hope in the past. Some people choose to creatively decorate their box, while others keep them plain and simple.
Items in a hope box may include:
- Cards, notes or emails with special meaning
- Photos of special times and places in the past or desired destinations for the future
- Photos of loved ones
- Spiritual verses, prayers or objects, if you are religious
- Recordings of relaxing or uplifting music
- Letters or recordings from loved ones offering positive, caring messages
- Inspiring articles, affirmations, quotes or poems
- Jokes or stories that make you laugh
- Lists of goals, dreams and aspirations
- Coping cards with skills or activities used to cope with stressful situations
- Anything else that reminds you of reasons to stay alive
The person is asked to keep their hope box nearby and use its contents when they feel distressed, depressed or suicidal. The technique helps to address and combat irrational beliefs (e.g., “I am worthless ,” “life isn’t worth living anymore”) that are often associated with depression and suicidal thinking.
By looking at the items in the hope box, the individual can learn to directly challenge and modify these distressing and negative thoughts by being reminded of previous successes, positive experiences, and reasons for living.
It’s often suggested to also put a copy of one’s safety plan in the hope box. The safety plan lists things to do to feel better when depressed or thinking of suicide, people to contact to talk to for support, and contact information for places to call for professional help in a crisis.
It is also recommended to put things in the hope box that can serve as a distraction to negative thoughts. These might include puzzles, playing cards, drawing materials, or other similar items.
The “Virtual Hope Box”
Although the hope box is a helpful tool, it’s sometimes difficult to keep it close at hand. It may be inconvenient to have on a trip or in certain work environments, such as those involving extreme weather or in military or public safety settings.
To address these limitations, the Virtual Hope Box, a free smart phone application (Apple, Android) has been developed which allows someone to keep a virtual collection of their reasons for living close by at all times.
The Virtual Hope Box is designed to be used as an accessory to mental health treatment, with simple tools to help with coping, relaxation, distraction, and positive thinking. It has the same types of items (although in digital form) as the traditional hope box (photos, videos, music, messages from loved ones), plus several more features.
The current version of the Virtual Hope Box app is organized into the following sections:
- “Remind Me” – Various media including pictures, videos, music and recordings of personal significance can be uploaded and kept here.
- “Distract Me” – Contains several games and puzzles for distraction from negative thoughts, such as Sudoku, word search and solitaire.
- “Inspire Me” – Several dozen inspirational quotes are pre-loaded and additional quotes may be added.
- “Relax Me” – Includes several guided exercises (with written scripts and accompanying audio commentary) for meditation, breathing and relaxation.
- “Coping Tools” – Two sections: 1) Coping Cards – Allows for creation of individualized coping cards which include an identified problem area, related negative emotions and symptoms, and a specific positive coping skill; 2) Activity Planner – Schedule specific enjoyable activities on a calendar, add invitees, and text or email an invitation to them.
- “Support Contacts” – Create a customized list of key support persons or agencies along with their contact information.
The app also has an accompanying Clinician’s Guide, which contains a detailed User’s Guide with specific instructions for how to use each section of the app as part of a course of treatment.
In a small initial study of the effectiveness of the Virtual Hope Box, 18 veterans deemed a high risk for suicidal thoughts were provided with the app in addition to their regular treatment regimen. Feedback about the app from both the veterans and their care providers was consistently positive. The veterans used the app frequently and found it to be helpful.
A second study is planned to see how well the Virtual Hope Box helps veterans cope with negative or suicidal thoughts, depression and stress compared to a similar group who don’t have access to the app.
The Virtual Hope Box mobile app was the recipient of the 2014 Department of Defense Innovation Award for its unique application of technology to support improved behavioral health in service members and their families.
Whether you make a traditional hope box or use the Virtual Hope Box app, the techniques can be very helpful for managing depression and negative or suicidal thoughts. Give them a try and see.
Here’s a question: What would you put in your hope box or a loved one’s hope box? Please leave a comment. Also, please consider subscribing to my blog, and feel free to follow me on Twitter, like my Facebook page, or connect on LinkedIn. Thanks!