Emergency interventions: how to switch off suicidal thinking

It’s been an unsettling week.

Throughout Lockdown I’ve continued to supervise remotely and so am getting continuous feedback about the issues clients are bringing to the therapeutic coaching process. It’s becoming clear the emotional temperature of the nation is rising. Those who have been teetering on the edge are being tipped over by months of enforced isolation and many have now lost hope of a better future for themselves.

When we cannot imagine a future we want to buy in to, thoughts of suicide are common and something the therapeutic practitioner needs to be constantly aware of. For this reason I recommend using client feedback forms every session, like CORE 10 which has a specific suicide question. So often it’s easier to tick a box rather than talk about how you are really feeling.

My story

It's no secret that my own career in mental health began with a near-death experience of post natal depression. 

It was a petrifying period of my life and, what was even more frightening, was the lack of appropriate help and information available to me at that time. Rather than a diagnosis and medication, what I really needed was an explanation for what had happened to me and what I could start to do to help myself get better. Pills were offered but actually made things so much worse.

Thirty years on and we do not seem to have moved forward significantly. There is certainly a lot of media coverage highlighting the growing suicide problem but very little identifying the solution. There is plenty of research out there about the epidemic of people on addictive medications like specific serotonin reuptake inhibitors (SSRIs) for depression. It's enough to make anyone depressed!

My client

I remember sitting with a new client in my office several years ago. He told me he was afraid he was having a nervous breakdown; something he had experienced ten years earlier when he had found himself suicidal, medicated and in a secure mental health unit. Not surprisingly, it was a road he did not want to travel down again.

After he had given me an outline of how he was feeling and his fears for his future, I asked him to sit back and listen for a while. I told him there was some important information he needed to have; information that would clearly explain his current mind set and, more importantly, what he could do to feel better quickly....without the pills.

And, as I spoke, he began to cry.

But he wasn't upset... they were tears of relief.

'Why did no one ever tell me tall his me before?' he asked. 'All those years ago, why did no one explein what was happening to me?'

I've given information about emotional hijacking to thousands of practtioners and to many distressed clients over the years. I'm including it in my article below because people need to know about it right now. In the unique circumstances in which we all find ourselves, it's more urgent than ever that we bypass a system which is still offering labels, pills and waiting lists instead of the education and practical mind management tools to empower people to take back control of their own mental health.

Understanding emotional hijacking became a core underpinning theoretical principle of the coach-counsellor integrated Fusion Model I brought together to replicate my own working methods and train the volunteers of the mental health charity I co founded with Dr Kate Smith ten years ago.

I'm pleased to say it's now also been adopted by other organisations including the Foundation for Ribble Valley Families and by the many practitioners I've trained over the years, some of which I still supervise, albeit remotely at the moment :)

I hope it helps you and helps your clients too...

How to switch off suicidal thinking

Peter looked to me like a broken man. His eyes were shadowed. He was pale and gaunt, like he hadn’t been eating properly. He sat and stared at the ground, seeming to have too little energy to raise his head and meet my gaze.

‘I feel like ending it all.’ he finally said. Paul spoke in an unnerving, detached voice. Although he was physically present in my office, he seemed emotionally absent. ‘What’s the point in going on?’ he whispered ‘I simply don’t see a future worth living.’

I sat quietly for a while. The silence hung heavily in the air. Whatever I responded to Peter’s statement needed to reflect the gravity of what he was saying.

‘Peter,’ I said ‘Do you really want to be dead forever, or do you just want the pain you’re going through to go away?’

Life was good

Last year, Peter was flying high. As a top executive for a large PR company, he travelled the world, flew business class, stayed in the best hotels and was respected by his peers. Then, unexpectedly, he got made redundant.

He was devastated. His life began to unravel. He couldn’t sleep, concentrate or function at home. His GP gave him antidepressants and he began to drink heavily. He felt he had lost the thing most important to him in the whole world and simply couldn’t imagine a life without the job he had enjoyed so much. He began to experience thoughts of suicide.

I recognized immediately that Peter had been emotionally hijacked by the trauma of losing his role at work and the status that went with it. He was now in a dangerous mindset. I would have to act quickly to help him understand why he was feeling suicidal right now; what he could do to stop thinking this way, and how he could begin to take back control of his mental health.

Danger: Why suicide can seem like the only option

More men die in the UK every day as a result of suicide than road accidents and assaults combined. In 2017 there were approximately 5,821 registered deaths by suicide in the United Kingdom. That’s an average of 16 suicides per day and suicide is now acknowledged as the single biggest killer of men under the age of 45 in this country.

If you feel suicidal like Peter, you need some critical information about emotional high-jacking and, even more crucially, you need an effective tool for switching it off.

Knowledge is power and puts us back in control. To begin to understand the dangerous mechanism of emotional hijacking, we need to look at how the human brain developed.

The evolution of the human brain

Millions of years ago, at the dawn of our evolution, we had simple reptilian brains that controlled basic instincts to breath, eat and reproduce.

As we evolved into mammals, we developed another layer of brain material known as the limbic system or emotional brain and from here emerged the emotions that became important drivers for our survival. Some of the most powerful human emotions are love, hate, anger and fear.

We developed the ability to feel love which became useful in forming social bonds. If we felt love and connection, we would not abandon our offspring but would rather nurture and feed them, ensuring the survival of the next generation of the group.

We experienced hate and anger; so that we would have the instinct to fight or kill if our own survival depended on it, or the survival of our offspring.

And we developed a sense of fear so that we knew when to run away!

As the human species continued to evolve, the neo cortex developed as another layer of brain. This is the rational, logical, thinking part of the brain and the part that truly separates us from the animals. It’s the brain area associated with our higher intelligence and problem solving which gives us the ability to take a psychological step back, 'play the film forward' and see context with all the options and the areas of grey.

Simply put, most of the connections from the emotional brain to the neo cortex are on the right side of the head and most of the connections to the rational brain are on the left. Essentially, we have a brain of two halves; emotional on the right and rational on the left.

The real reason why we often act in an irrational way is that our two brain hemispheres; the emotional and the rational, are always locked in a battle for control, yet they experience the world in two very different ways.

But here’s the key information I needed Peter to understand:

#1: Big emotions switch off rational thought

High emotion is able to switch off the rational brain very quickly. This has to be so to allow you to react quickly to preserve life, if necessary. If faced with a wild animal ten times larger than us, or perhaps more likely these days, a bus speeding towards you in the road, you will automatically run or jump out of the way without thinking. There is simply no time to make a list of all the options in a fight or flight situation.

#2: Big emotions make us stupid

The emotional brain can only see the world in very black or white terms. It’s ‘stay or go’, ‘fight or flight’, everything’s 'ok' or everything’s not 'ok’. It should not be surprising then that, the more emotional we become, the more stupid we become. However, for our survival, the emotional brain has to retain the ability to switch off the rational brain. 

So when we become caught up in our emotions, we actually become very stupid because we have lost the ability to step back and see the all the options or grey areas. Either everything is alright…. or everything is all wrong.

This explains why extreme emotional hijack leads to suicidal thinking. We can think ‘I can’t live like this……. so the only solution is to end it.’

In that moment, the neo cortex; that part of the brain which would say ‘hang on; there must be other solutions if you think about this or talk it over with someone,’ is suppressed.

Turns out the old-fashioned term used in the coroner’s courts of the past ‘the balance of the mind was disturbed,’ was surprisingly accurate and the rational-emotional scales can be easily tipped.

Our short term fight or flight mechanism must stay in place for our survival but it is not an appropriate response to the loss of a job or a relationship.

Emotional hijack

It is clear then, that we need to be able to switch off extreme emotional hijacking and stop this dangerous mindset in its tracks. The answer is found in a simple parasympathetic breathing technique generally referred to as 7-11. I would have to teach it to Peter straight away… but Peter was resistant.

At least I had his attention. He was more animated now and more engaged with what I was trying to explain to him.

‘Breathing? He said ‘I do it all the time! What’s so different about 7-11?

And this, word for word, was my response:

‘The reason 7-11 is so effective is based in how the autonomic nervous system works. When you breathe in, you activate the body’s sympathetic nervous system known as ‘fight or flight’. It is more of an effort to breathe in so, when you breathe in, you tense.

When you breathe out, you engage the parasympathetic nervous system known as ‘rest and digest’, so you have a feeling of letting go.

If you continue for five or ten minutes and engage a breathing pattern of a longer out breath than in breath, you cannot help but start to relax and you tap into the body’s innate ‘relaxation response’.

If you also count while breathing the effect is even stronger as the rational brain is engaged by the numbers. This quickly has the effect of lowering emotional arousal and switching off that dangerous all-or-nothing thinking style.Try breathing in to the count of seven and out to the count of eleven or engage whatever count feels comfortable for you. As long as the out breath is longer it will work.

Regular practice of this simple breathing technique establishes the ability to relax whenever you choose so that you can take back control whenyou need to. It really works well but, like any technique, it improves with practise, strengthening the muscles of the mind just like going down the gym strengthens the muscles of the body.

For you, Peter, I recommend five minutes first thing in the morning to help you start the day calmly, five minutes last thing at night to help you enjoy deeper sleep and five minutes at any point during the day whenever the emotional temperature starts to rise. Simply stop, count and breathe whenever you need to.’

Peter got it. He could now see how the real him had been hijacked by his emotional brain.

We worked on learning the breathing together and, by the time he left my office, he was a lot calmer and thinking more clearly. He started practising the 7-11 breathing technique several times a day. More importantly, he was relieved to have been given a powerful mind management tool that he could work on himself.

Before long, Peter felt he was back in the driver’s seat of his life and, once he was thinking clearly again, he re engaged his neo cortex to do what it does best…solve problems so we started to look at his choices and what he wanted to do with his life.

The 7-11 breathing technique certainly helped Peter stay focused when he went for his next interview.

He got the job! 

Stay safe and well... 

Frances Masters  MBACP accred GHGI 

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• When and how to use the Fusion Wheel of Life
• Present, future and super-future focusing
• How to use guided imagery to effect change fast
• integration of therapeutic story and metaphor
• How to successfully treat anxiety and depression, fears and phobias
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Module 1 

The Therapeutic Coaching Timeline

Professional evolution

The Therapeutic Coach: A new paradigm

The big experiment

What is therapeutic coaching? Is it different from counselling?  

About the NCFE accredited Therapeutic Coaching Diploma

Effective Therapy: Affordable training 

Module 2 

Work Book

Zen philosophy; an auspicious beginning

Setting SMART Goals

Self Reflection

Learning something new

Recognising emotions

Module 3 

Communication Micros Skills

S.O.L.E.R

Listen

Mirroring and reflection

Paraphrasing

Summarising

Open questions

Empathy

Carl Roger’s core conditions

About Carl Rogers

Look back, but don’t stare 

Module 4 

Human needs

Create a SAFE SPACE to get your emotional needs met:

The work life balance

Attunement and the therapeutic alliance

Accelerated rapport

Smile

Information Gathering: Using Clinical Measures and feedback

CORE 10

Taking an emotional needs ‘audit’

Actualising tendency versus learned helplessness

How to restoring hope 

Module 5 

A first session with a client

Placebo-nocebo

Confidentiality in therapeutic work

Positive expectation

SUDS scaling 

Module 6 

Dealing with anxiety and panic attacks

Fight or flight

Pattern matching

Thinking errors or cognitive distortions

Resilience and Base Stress

Diaphragmatic Breathing

The Observing Self and Meta awareness

Misuse of the Imagination

What else do I need to know? 

Module 7 

Setting therapeutic goals

The Magic Question

The Reticular Activating System (RAS)

RAS and focused attention

What are your Hobbies and Interests?

Developing metaphor therapeutically 

Module 8 

Psycho Education

Triune theory

Sleep

Pattern matching and neural pathways

Patterns of response 

Module 9 

Supervision and the helping professions

Referrals

Diversity: Celebrating Difference, Celebrating ‘Sameness’

Challenging the labels

HAPPINESSISNOWHERE 

Module 10 

STOP: GO Bridging the gap between counselling and coaching

Holistic Life Coaching

Ploughing new furrows: Counselling in a coaching context

Where are you on the wellbeing continuum?

React or respond?

Thought stopping

Neuroplasticity and the changing brain

Affirmations 

Module 11 

The STOP System

STOP and diaphragmatic breathing: How to test your own breathing

STOP and ‘Taking a Step Back’

STOP and the Observing Self

STOP and Emotional intelligence

STOP and interrupting old or habitual patterns 

Module 12 

The Wheel of Life

Case study: Geoff #1

Using the coaching wheel of life

Assessing and scaling life as it is

The life wheel protocol 

Module 13

 Case study: Geoff #2

Wheel of life doc 1

A holistic view of the client

The preferred future

Story: What a bird should look like

Write it down-make it happen 

Module 14 

Case study: Geoff #3

Wheel of life doc 2

SMART goals

Case study: Geoff #4

SMART goals doc 

Module 15 

Visualisation

Describing guided imagery

Visualisation: a history

Meditation and mindfulness

Metaphor in guided imagery 

Module 16 

Case study: Geoff #5

Therapeutic time travel

From problem focused to solution focused

A progressive relaxation and bespoke visualisation for Geoff 

Conclusion 

Intelligence plus intuition equals ‘whole brain’ learning

The Ebbinghaus Curve of Forgetting

A privilege 

Appendix 

TASK documents

Therapeutic stories 

Resources 

Therapeutic Coaching in practice

First session questionnaire

SAFE SPACE audit sheet

CORE 10 questions

Case study: Shelly

Case Study: David; coaching a client with M.E.

BACP ethical guidelines

Association for Coaching: coaching competencies

Articles Is the Therapeutic Coach a ‘brain mechanic?’

What do you do if you don't like your client?

Smile and the world smiles back.

The Top Five Regrets of the Dying

Swim towards the light.

A Nice Result

Better to do something imperfectly than nothing flawlessly

No need for my services?

The Super Organising Idea

All boxed up?

Working at the cutting edge

Epigenetics

Mapping the connectome

The gut microbiome

Polyvagal theory

The seven pillars of mindfulness

Mental health first aid 

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