BITES: Framework for Safety Planning: Understanding Mental Health Warning Signs
- Ron Henson
- Jun 19
- 4 min read
Understanding the Patterns Before a Crisis
As therapists, we are trained to look for patterns.
A significant part of therapy involves helping clients notice the themes that show up repeatedly in their lives: the thoughts they return to, the emotions they struggle with, the situations that overwhelm them, and the behaviors they use to cope.
This awareness is often where meaningful change begins.
When working with clients who experience thoughts of suicide, self-harm, or harm toward others, identifying patterns becomes even more important. Safety planning is a critical part of clinical work because it helps individuals recognize warning signs, identify supports, and develop steps they can take before reaching a crisis point.
However, one part of safety planning that can sometimes receive less attention is identifying the specific triggers and early warning signs that happen before the crisis develops. The moments leading up to a crisis often contain valuable information.
Why Identifying Warning Signs Matters and BITES Framework for Safety Planning
A crisis rarely appears without context.
For many people, there is a buildup that happens over days, weeks, or even months. Stress accumulates. Coping strategies become less effective. Certain thoughts become more frequent. Emotions become harder to manage.
The challenge is that these patterns are often easier to see in hindsight.
Someone may say: “I don’t know what happened. I just reached a breaking point.”
But when we slow the process down and explore what happened beforehand, we can often identify important clues.
This is where the BITES framework can be helpful.
Introducing BITES: A Framework for Exploring Patterns
In my clinical work with safety planning and behavioral change, I developed the acronym BITES as a way to help clients and myself explore what typically happens before a crisis or significant emotional shift.
BITES focuses on five areas:
B – Behaviors I – Images T – Thoughts E – Emotions S – Sensations
This framework helps break down a complex internal experience into specific pieces that can be examined and understood.
B: Behaviors
The first area is behavior.
Before a crisis, many people notice changes in what they do.
These behaviors may include:
withdrawing from others
stopping activities that normally provide support
increased substance use
changes in sleep or daily routines
avoiding responsibilities
seeking reassurance repeatedly
engaging in impulsive actions
Behaviors are often the most visible warning signs because they are what others may notice first.
However, behaviors are only one piece of the picture.
Understanding what is happening internally alongside these behaviors provides a clearer understanding of the full experience.
I: Images
The second area is mental images.
This is an area that can sometimes be missed when exploring emotional experiences.
People often assume distress is mainly about thoughts, but many individuals experience vivid mental images or scenarios.
Examples may include:
imagining future situations going badly
replaying painful memories
visualizing conflict or rejection
experiencing intrusive images
imagining what a crisis moment might look like
Mental imagery can influence emotions and behaviors in powerful ways.
A person may feel overwhelmed by something they are imagining, even if the event has not happened.
Exploring these images can reveal important information about what the person is experiencing internally.
T: Thoughts
The third area is thoughts.
This includes the internal dialogue and beliefs that appear during periods of distress.
Examples may include:
“I can’t handle this.”
“Nothing will change.”
“I am a burden.”
“There is no way forward.”
“I have failed.”
Thoughts often reinforce emotional experiences and influence the choices someone makes.
Identifying these thoughts allows clients to recognize when their thinking patterns are shifting and when additional support may be needed.
E: Emotions
The fourth area is emotions.
Emotions are often the most obvious part of distress, but they can also be difficult to identify.
Someone may describe feeling:
hopeless
angry
ashamed
disconnected
trapped
overwhelmed
numb
Sometimes the emotion that appears on the surface is not the primary experience.
For example, anger may be connected to hurt. Irritability may be connected to exhaustion. Numbness may be connected to emotional overload.
Naming emotions helps create awareness and gives people a clearer understanding of what they are responding to.
S: Sensations
The final area is physical sensations.
The body often responds before a person fully recognizes what is happening emotionally.
Sensations may include:
tightness in the chest
restlessness
feeling heavy or exhausted
racing heart
difficulty breathing
feeling detached or disconnected
changes in appetite or sleep
Physical sensations can become important warning signs.
Learning to notice these signals can help someone identify that their stress level is increasing before reaching a crisis point.
Using BITES Beyond Safety Planning
Although BITES was developed as a way to support safety planning, the framework can also be useful for broader self-awareness and behavior change.
Many therapeutic approaches focus on understanding the relationship between thoughts, emotions, and behaviors. BITES expands this process by also intentionally exploring mental imagery and physical sensations.
This creates a more complete picture of someone’s experience.
A person is not just their thoughts.
They are also their emotions, their body responses, their memories, their behaviors, and the meaning they assign to what is happening.
Awareness Creates Opportunity for Change
The purpose of identifying patterns is to create awareness to allow space for change.
When people recognize their personal warning signs, they have more opportunities to respond differently.
They can reach out sooner.
They can use coping strategies sooner.
They can reconnect with support before distress becomes overwhelming.
Sometimes change begins with something simple: Noticing.
Disclaimer
BITES is an educational framework designed to support reflection and clinical conversations. It is not a replacement for professional crisis intervention or emergency services. If you or someone you know is experiencing an immediate risk of harm, seek emergency support or contact a crisis resource such as the Suicide & Crisis Lifeline by calling or texting 988 in the United States.
In Situ Counseling & Coaching provides virtual therapy for adults in Illinois, offering support for anxiety, stress, life transitions, emotional regulation, and personal growth. Learn more at https://www.insitucounseling.com/
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