Why do we worry?

In some ways, the answer to this question could be: because we are human. Our powerful brains are problem-solving machines, always working away at the difficulties we face and trying to help us resolve them. This is a good thing, helping us find our path through life's many challenges; making us protective, thoughtful parents; solving problems at work, with our finances or in our love life. When thinking about why we worry, this is an important place to start – worry, per se, is not a bad thing.

What is less helpful is when we worry to excess, spending hours a day fretting about every aspect of our life. Or when that worry comes at 3am, keeping us from precious sleep while we chew over problems best left till the morning. And worry is especially unhelpful when it makes daily life unbearable, because we are so caught up in anxious, obsessional thinking about everything we do or say – and particularly about the myriad ways in which things that are important to us might go wrong.

In cognitive therapy, this is known as 'catastrophising' – when we constantly jump to the worst-case scenario, assuming that things will always turn out badly. Catastrophising is an unhelpful thinking style associated with every kind of anxiety problem (which makes sense when you understand the anxiety formula, explained in this post). It is also a feature of depression, as depressive thinking is overwhelmingly negative, so we always assume things will go badly for us.

Chronic worry is particularly associated with generalised anxiety disorder, which can make life very upsetting and difficult for people – but is treatable with cognitive therapy. One of the first things I do with my worried clients is to explain the difference between productive and unproductive worry. Unproductive worry is when we 'ruminate' about our problems, anxious thoughts going round and round in our head without finding any helpful answers or solutions. Productive worry is when we engage in focused problem-solving that leads to constructive solutions.

If you have a problem with worry, try this simple CBT technique today:

Take a worry break

If you are engaging in unproductive worry – for example lying awake fretting about your daughter's disappointing GCSE results at 3am – tell yourself firmly that you will take a 'worry break' the next day when you can think about this problem as much as you want.

Then get up (briefly – you are already awake!), find a half-hour slot in the following day and write Worry Break in your diary. Then follow these two simple rules:

1) In order to reward yourself with this break, you're not allowed to worry about your daughter until then. If your mind wanders to that subject (as it probably will), tell yourself firmly 'I am not going to think about this now, because I will focus on the problem tomorrow.'

2) During the worry break, your worrying must be productive. That means you have to come up with some solutions to your daughter's problems, not just fret about them. If you are struggling to come up with solutions, try talking it over with a trusted friend or family member – it's often easier for other people to think rationally about our problems, as they are not so emotionally charged for them.

If you stick to this regularly, you will find your upsetting, unproductive worrying reduces significantly. And if you would like to book a session with me please call 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

How self-criticism affects your mental health

It's common sense that being overly harsh or self-critical in your thinking will have a negative impact on your mood, confidence and overall wellbeing. But I think it's important to understand exactly why this is the case. Because of the miracle of magnetic resonance imaging (MRI) scans, we now have an intimate knowledge of how the brain operates under stress. We can see which parts of the brain 'light up' when we are feeling stressed or attacked – this is known as the 'threat system', a powerful self-protective network in the brain that detects and responds to any kind of danger or threat.

When you engage in self-critical thinking, calling yourself an idiot, or saying you are stupid or useless – especially if your internal dialogue has an harsh or hostile tone – MRI scans show the same threat system lights up in your brain as if someone else was shouting at or scolding you. It's no surprise that this kind of thinking is closely linked with depression, problems with anger and anxiety, as well as a lack of confidence or low self-esteem.

When you speak to yourself harshly, it's as if there is a bully in your head judging everything you say or do and putting you down at every turn. Not helpful. If you do tend to engage in self-critical thinking, try the following exercise to start being kinder to yourself:

The best friend test

When you make a mistake, have a setback or feel like you have failed at something important to you, you might find yourself slipping into a well-worn groove of negative, self-critical thinking: 'I am such a loser – why do I always screw things up?', or 'God, that was pathetic, I really am a failure.'

Unsurprisingly, these words will hurt and you will find your mood dipping and confidence ebbing away.

Instead, try to start noticing when you talk to yourself like that and take a step back. Imagine your best friend had just made the same mistake, had a setback or failed at something they valued. What would you say to them? Would you be harsh, mocking or critical? Probably not. I'm guessing you would try to be supportive, encouraging and help them see that it wasn't the end of the world.

You might say things like, 'Don't worry, it seems bad right now but you will feel better about it soon,' or 'Everybody makes mistakes sometimes – that doesn't make you stupid or a bad person, just human.'

Now try and start talking to yourself in the same way. If you notice that self-critical thinking kicking in, use the Best Friend Test to be a bit more kind and compassionate to yourself. Over time, it will help you feel calmer, stronger and more at peace. After all, life is hard enough, so why make it harder by being unkind to yourself?

If you would like to book a session call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

Should you take antidepressants?

If you are struggling with anxiety, or have been depressed for a few weeks and visit your GP, they are likely to prescribe antidepressants. But should you take them? And is medication really what you need? In a large number of cases, I think not. Before I explain why, let me be really clear – if you are severely depressed, your mood may be so low that some of the alternatives I'm about to suggest just won't work. In that case, you may need a course of antidepressants to lift your mood enough for talking therapy, for example, to work.

If you have bipolar disorder, you will probably need to take a combination of different medications, such as a mood stabiliser and possibly antidepressants. And, crucially, if you are currently taking antidepressants you should never stop taking them without consulting your psychiatrist or GP. This can be extremely risky, so please don't do it.

That said, I do worry that many hard-pressed GPs now dole out antidepressants far too easily. I don't blame them for this – they have so little time with patients now that they are often forced into the simple solution that medication represents. They may also want to refer a patient for a talking therapy such as cognitive-behavioural therapy (CBT), but know the waiting list is so long it would not be helpful for someone who was struggling (some of my clients say they faced a 12-month wait for CBT on the NHS – an impossibly long time to wait if you're in a bad way).

One of the biggest problems with antidepressants, though, is that they only help with the symptoms of depression as long as you're taking them. When you stop, unless you have addressed the issues that made you depressed in the first place (like negative or overly self-critical thinking, or low self-esteem) you are likely to get depressed again. That's why all the evidence shows that combining antidepressants with psychotherapy is far more effective than the meds alone.

Research also shows that regular cardiovascular exercise is just as effective as antidepressants for mild to moderate depression. As is mindfulness-based cognitive therapy (MBCT), which is especially good at preventing relapses. Both are completely free, once you've learned how to do them, have no nasty side effects and work straight away, unlike the 2-6 week wait for the meds to take effect.

So I'm not saying you should never take antidepressants – far from it. Just that they are powerful drugs that don't help everyone, have strong side effects and should not be taken lightly. And – especially for milder forms of anxiety or mild to moderate depression – other approaches work just as well.

If you would like to book a session with me call on 07766 704210 or dan@danroberts.com

Best wishes,

Dan

Overcoming public speaking anxiety

Public speaking anxiety is extremely common – in fact, I would say that more of us are anxious about speaking in public than not. You can think about it as a hierarchy of anxiety: speaking to one person you don't know can make you a little nervous; two, three, four, more anxious still; addressing a group of people you haven't met, a bit more difficult; giving a presentation to a small room-full of strangers, just that bit worse; then finally, way up there on the anxiety scale, giving a speech to a conference, or appearing on live TV – too hard to even contemplate for some people.

The first thing to remember is that anxiety is a perfectly normal human response to situations we find scary or threatening. It's not bad or wrong, any more than joy or sadness are. In fact, anxiety is very important – if we didn't feel anxious when, say, we walked down a dark alley at 3am, or our toddler opened up a toolbox full of sharp objects, we would fail to prevent potentially bad things from happening.

But when we get super-anxious about giving a 10-minute speech to a small room of friendly, interested people, we are clearly feeling anxiety that is disproportionate to the situation. When we get this anxious we are likely to experience a racing heartbeat, get sweaty and dry-mouthed, possibly go blank or have trouble concentrating, think lots of worrying, worst-case-scenario thoughts... no fun at all.

The good news is that this form of anxiety is treatable, either with cognitive-behaviour therapy (CBT), which is very effective for anxiety-related problems, or using self-help techniques like this one, which I often teach my clients:

Change the movie

When we get anxious about something in the future, we usually play a movie (let's call it the Scary Movie) in our heads about all the things that might go wrong – we imagine ourselves drying up and having nothing to say; forgetting our speech notes, so we have to wing it for 10 horrible minutes; other people seeing how nervous we are and judging us for it; or our audience looking bored, yawning, fidgeting and talking among themselves because our speech is so dull. Play this movie in your head enough times and, guess what? You will succeed in making yourself extremely anxious and, ironically, causing the exact problems you are worried about on the day.

So let's change the movie to... let's call it the Problem-Solving Movie. First, write down all the things you think might go wrong and find solutions for them. Worried about being dry-mouthed? Take a bottle of water with you. Worried your speech is dull? Read it to a colleague and ask for constructive criticism. Worried about appearing worried? Practice deep breathing to calm yourself down before and during the speech.

Then play this new movie every day in your head, in which everything goes well – you solve any little problems that come up, imagine everyone looking interested and engaged, giving you a big round of applause at the end, then see yourself looking proud and happy after the speech. The more detail you can include the better, especially about how things look/feel/sound, because then your brain will believe it's actually real and has already happened (our brains have exactly the same response to imagery like this and real-life experiences). This will help you feel less anxious on the day. Incidentally, this technique also works really well for driving tests, first dates, meeting in-laws, job interviews...

If you would like some help with your public speaking problems call 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

Five common myths about cognitive therapy

In some ways, cognitive therapy is the victim of its own success. Since it was developed by Aaron Beck in the 60s, cognitive therapy (also known as cognitive behaviour therapy, or CBT) has become the dominant form of 'talking therapy' in numerous countries around the world, including the US and UK. This is mainly because it works so well – research consistently shows CBT to be the most effective form of therapy we currently have. But it's also about economics – the NHS has embraced it partly because it's cost-effective too. Many problems can be resolved in under 20 sessions, some (such as phobias) in five or six.

However, as I explain below, this is not how Beck intended cognitive therapy to be practised. His initial therapy model was a 20-session treatment for depression, which I think is about right for most people. I strongly disagree with the (financially-driven) short-term treatments many people receive on the NHS for anxiety, depression and other serious psychological problems. This is just one of the myths I try to bust with my clients, and when I am teaching cognitive therapy to students. Here are some more:

1. CBT is all about filling in forms

Not true. Although some CBT techniques do involve written work for clients (such as daily thought records), good cognitive therapy is based on the relationship between therapist and client. This should be warm, trusting and supportive, as with other approaches to counselling and psychotherapy. And many of the techniques I and other cognitive therapists use involve stories, metaphors, working with imagery, role-playing, mindfulness-based techniques, drawing, Gestalt-style 'empty-chair' work... none of which involve forms!

2. CBT is a short-term, quick-fix approach

Nope. In my own practice, I always tell people that there is no such thing as a quick fix for complex, highly sensitive problems; so our work will be slow and incremental. A few problems – especially 'specific phobias' – can be resolved quickly. Most others take time – somewhere between 10 and 20 sessions, in my experience; while deep-rooted, hard-to-shift problems might take a year or more.

3. Feelings are not important in cognitive therapy

Ironically, cognitive therapy is all about emotions. Despite the name (cognitions being all of the thoughts, values, beliefs, memories, etc that make up our minds) we only focus on changing unhelpful thinking because that has a powerful impact on feelings and moods. Nobody comes to therapy saying 'I want to think more rationally'! They come because they are hurting in some way; my job is to help them feel better on a consistent, long-lasting basis.

4. Cognitive therapy is all about positive thinking

A common myth, this one. In fact, cognitive therapy is all about rational, realistic, balanced thinking, which is not necessarily positive. If you are in a horrible job or relationship, thinking positively about it would be both impossible and unrealistic. Someone once said that cognitive therapy is all about seeing things as they really are. Life is full of pain, hardship, loss, struggle... as well as joy, wonder, love, delight. The key is to give both equal weight, rather than focusing purely on the negative (common to both anxiety and depression, in different ways).

5. CBT only offers superficial symptom-relief

A common criticism from my non-cognitive counselling/therapy peers. It's true that CBT can help people feel better much more quickly than other approaches. That's one of the reasons it's so popular and successful. But this is only the start. If you suffer from depression, say – which has a high chance of relapse – as well as helping you feel better in the short-term, my aim is to teach you new ways of thinking and behaving which protect you from depression in the long-term. Again, we have very good evidence to back this up, as well as my own experience of staying in touch with clients after therapy ends to see how they're doing.

So, hopefully you now have a clearer idea of what cognitive therapy is and is not. If you would like to book a session call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

Learning to love yourself

Derek Walcott

Derek Walcott

I was reminded of this Derek Walcott poem at a recent talk by Jon Kabat-Zinn, founder of the Western mindfulness movement (and one of my heroes). It seems to embody not just a self-compassionate, mindful attitude, but also the key idea in schema therapy – that to heal our past hurts we must learn to love ourselves, even if we have long held negative, self-limiting/critical beliefs.

Also, it's a beautiful poem – I hope you enjoy it...

Love After Love
The time will come when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other's welcome,
and say, sit here. Eat. 

You will love again the stranger who was yourself.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you
all your life, whom you ignored
for another, who knows you by heart. 

Take down the love letters from the bookshelf, 
the photographs, the desperate notes, 
peel your own image from the mirror. 
Sit. Feast on your life.

Best wishes,

Dan

How to combat your inner critic

Many of us are self-critical, on a spectrum ranging from mild at one end to severe at the other. If we are mildly- self-critical, we might rebuke ourselves if something goes wrong, but not be too upset about it. If that criticism is harsh, we might be extremely sharp, even angry with ourselves – jumping on every mistake we make, however small, and beating ourselves up severely. Most, if not all, of my clients criticise themselves in this way.

One of the many things I love about schema therapy is that it's extremely effective at combatting this inner critic. We even have a name for this 'mode', or side of you – the Punitive Parent. This may simply be the internalised voice of one of your parents, especially if they were consistently harsh or judgemental with you when you were growing up.

Or it may be a way you learned to speak to yourself, perhaps if you felt unloved or flawed as a child, so assumed there must be something wrong with you that needed constant correction. For example, if you have a Defectiveness schema, you may have a frequent nagging sense that you're not good enough or a failure in some way. You might think that other people judge you harshly for these (supposed) defects, so you should judge yourself harshly too – either to make sure you don't repeat a mistake, or to try and pre-empt saying or doing things you will later regret and feel bad about. 

Battling the Punitive Parent

When I see people beating themselves up in this way, it always makes me sad. Nobody deserves to feel this bad about themselves – and, in schema therapy terms, the part of you that feels bad is your Vulnerable Child, who feels attacked and victimised by the Punitive Parent's constant belittling and criticism. There is a famous quote attributed to the Buddha. These are not exactly his words (most of the Buddha's 'quotes' we see on Facebook or floating around the Web are modern interpretations of what he actually said) but they carry the gist of what he wrote – and I love the sentiment behind them:

You, as much as anyone in the universe, deserve your love and respect.
— Buddha

You are worthy of love, kindness, respect. Whatever your flaws, real or imagined. However many things you have done in your life that you regret, or wish had turned out differently. That scared, vulnerable child inside you craves love and affection, not shaming and harsh rebukes. And all of the research shows that talking to yourself in that way is one of the things that makes you vulnerable to depression, chronic stress, problems with anxiety and anger. So it's very important that you learn to battle the Punitive Parent, to get it to shut up and leave you alone.

For many people, this is a central component of our work in schema therapy. You can also explore other avenues to defeat that critical voice, such as compassion-focused therapy (like schema therapy, a proven approach to increasing self-compassion, wellbeing and contentment), learning mindfulness meditation, or exploring Buddhism, which for 2,500 years has been helping people be kinder and more compassionate to themselves. See my Resources page to find out more about these and other routes to better mental health.

And if you would like my help with becoming less self-critical, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

Do you have trouble managing your anger?

Anger is a tricky emotion. In pure evolutionary terms, anger is our signal to fight a threat, as part of the fight, flight or freeze response (anxiety is the emotion that tells us to freeze or flee). This is all well and good if you are facing a hungry lion, but not so helpful if your boss has just criticised you, or another driver cuts you off in traffic. But this primitive, self-protective threat response explains why we can react so strongly, violently even, if we feel threatened – in a very crude way, that's what anger is for.

Most of my clients have some kind of problem with anger, roughly falling into two camps. The first group is scared of or uncomfortable with anger – theirs and other people's. If this describes you, it may be because one of your parents was given to angry outbursts, which as a child were very frightening. That vulnerable child inside you learns to be scared of anger, even when you are – on the outside at least – now an adult. It's also possible that your family were rather buttoned-up, viewing any expression of anger as rude and uncivilised (a very British way to deal with anger!), so you learned to keep your angry feelings stuffed deep down inside you. As an adult, it's now hard to access and express them, even when it's appropriate to do so.

The other problematic form of anger is expressing it too often and too volcanically. This is the cause of domestic violence, bar brawls, violent crime, road/air/trolley rage and aggressive bullying. It's just as harmful as repressed anger, both to those around you and ultimately yourself – you will probably end up in serious trouble, perhaps even prison, if you cannot contain your anger and explode at the smallest provocation. People with this 'anger style' may come from very angry, combustible families in which everyone was always shouting at/being aggressive to each other. They may also have been hurt, neglected or abused as children, so that child inside is absolutely furious at the world and can't help but express it, even when it's dangerous or destructive to do so.

The angry modes

In schema therapy, when people are expressing anger in a problematic way, we see this showing up as one of three angry modes. If you find yourself blowing up all the time, perhaps shouting or swearing at other people, being threatening or even physically violent, you are in Bully/Attack mode. This is the most problematic angry mode, so a major part of your therapy would involve learning how to respond to triggering situations in a calmer, more rational manner. Anger-management strategies can be helpful here, as well as longer-term healing of schemas such as Abandonment, Mistrust/Abuse or Vulnerability that can trigger this attack-is-the-best-form-of-defence style of responding to threats or challenges.

The second mode, Angry Protector, is less destructive but still problematic. This is when you express anger in more subtle ways, perhaps non-verbally by scowling or with a closed-off body posture; with sarcasm or cutting humour; angrily complaining about or being harshly critical of other people. This mode is all about keeping a distance between yourself and others, perhaps because deep down your vulnerable child is scared of attack or rejection. You may also be uncomfortable with any kind of criticism or challenge, so respond with subtle but unmistakeable shows of anger to shut that down.

Anybody can become angry – that is easy. But to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy.
— Aristotle

The third mode is the most helpful, even if it doesn't at first appear that way! This is the Angry Child mode, and is evident in the way a person expresses their anger – often disproportionately to the perceived insult or infraction. You may have a tantrum, smashing or throwing objects (not to hurt others, just to release your anger). You might also get very tearful or upset. And beneath the anger is always hurt, fear or sadness, so if we were working together I would help you express your anger in a non-attacking, non-destructive way, so we could contact and soothe the hurt, upset or fearful vulnerable child lying just beneath the angry surface. 

When we get people into Angry Child mode, teach them how to express their anger verbally or by doing something safe but physical, like twisting a towel or punching a cushion, they experience a tremendous sense of relief – all the anger literally drains out of their bodies. It can then be deeply healing and soothing to deal with the hurt that lies beneath – over time, your anger subsides as you feel happier, safer, stronger and calmer.

If you have a problem with anger and would like my help, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

 

Do you struggle with romantic relationships?

Many people have difficulties with relationships, for all sorts of reasons. Finding a suitable person to be with and then maintaining a reasonably happy, stable relationship is not easy, for any of us. But if you avoid romantic relationships altogether; if you find yourself repeating the same pattern over and over again in every relationship you have; or if you are in a long-term relationship but feel consistently unhappy, perhaps feeling disproportionately angry with or jealous of your partner, it's possible that unhelpful schemas are the root of your problems. As I explain in this article about schemas, they are unconscious, deeply-rooted ways of thinking and feeling that get triggered by certain situations – and romantic relationships are among the most common triggers.

If you avoid relationships, perhaps for fear of getting hurt or rejected, you may have an Abandonment schema. This is often linked to the death of a parent, or a significant member of the family leaving in a sudden and upsetting way. The love and care you received as a child may also have been unstable and unpredictable, perhaps because one of your parents had mental-health problems, or was just not cut out to for the complex business of parenting. So avoiding relationships altogether is one way to make sure that this painful schema never gets triggered – sadly though, that means your life will be lonely and unfulfilling (if you actually want a relationship, which most of us do), so this is clearly not the most helpful strategy. 

Watch out for schema chemistry

If you find yourself playing out similar patterns in relationships again and again, or perhaps choosing a certain type of man or woman in one relationship after the next, 'schema chemistry' may be to blame. This describes the unconscious, schema-driven forces that make a certain kind of person irresistibly attractive. When you feel very strong physical chemistry with someone, as if you can't get enough of them and feel like they are perfect for you in every way, tread with caution. It may just be healthy sexual attraction, of course, in which case there is nothing to worry about. But if you have a history of falling in love with unsuitable people, that lightning bolt of chemistry – though exciting and seductive – is not to be trusted.

If you are in a relationship but it's not a happy one, again that is not unusual – long-term relationships are hard work, requiring commitment, sacrifices and a huge amount of love and patience on both sides. But if you have the same kind of argument over and over – volcanically losing your temper about fairly minor domestic incidents, becoming very anxious or consumed with jealousy every time your partner speaks to a member of the opposite sex – then your schemas may be to blame again.

The good news is that the schemas which cause all of these problems can be healed. Although that's not easy, it's far from impossible. There are now a number of therapeutic approaches designed to help people with these deep-rooted, life-disturbing problems, such as schema therapy or compassion-focused therapy. When I am working with people who have these kinds of problems, one of our long-term goals is for them to find a happy, healthy, stable relationship – after all, what is life for but to love and be loved? And a healthy relationship as an adult is one of the best ways to heal the wounds of childhood, so a little work in this area goes a long way.  

If you would like some help from me in finding and maintaining a healthy relationship, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan 

 

 

Why is your 'attachment style' so important?

Humans, like all mammals, are hard-wired to attach to their parents from the moment they are born. When you are a tiny baby, the first person you usually attach to is your mother, followed by your father, grandparents, siblings, aunts and uncles, friends, teachers, colleagues, romantic partners, and so on, throughout your life. This 'attachment system' in your brain is very powerful, because when you are small and helpless it is literally a matter of life and death whether your parents – usually starting with your mother – love, feed and keep you safe. So attaching to them is absolutely vital.

The first person to really understand this was John Bowlby, a psychoanalyst who argued that all babies have this attachment system and, depending on their relationship with their mother, form either a secure on insecure attachment. A secure attachment means your mother has looked after you well enough, given you lots of love and hugs, changed you when you were wet, fed you when you were hungry, made plenty of eye contact, sung to you – and all the other things babies need to feel safe and secure.

Attachment and relationships

If your attachment was insecure, your mother – for all sorts of reasons, often because her own attachment with her mother was not secure – couldn't meet your needs as a baby, so you didn't feel 100% loved by or safe with her. One of Bowlby's  groundbreaking ideas was that the kind of attachment style you developed as a baby would stay with you into adult life. Why is this so important? Because people with an insecure attachment will struggle to form strong, lasting, happy relationships with friends, colleagues and especially romantic partners.

In schema therapy terms, these people may have an Abandonment schema, so constantly worry about being left or rejected by their partner. Understandably, this causes all sorts of problems and makes it very hard to have a stable, happy relationship with anyone. The good news is that, as Bowlby and later attachment researchers found, you can learn to have stronger attachments – and therefore better relationships – throughout your life. Schema therapy is one of the approaches that is very good at making these changes. If you do have an Abandonment schema, for example, we would work together on healing it so you felt happier, more confident, more trusting and relaxed in relationships.

As I always tell my clients, however difficult things were in your childhood, and however much you are still affected by those experiences as an adult, it's never too late to change. Heal your schemas and you heal the most painful and vulnerable parts of you – this really can be life-changing, as I have seen time after time with the people I work with.

If you would like to find out more about schema therapy, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

 

 

Cognitive therapy and chronic pain

If you suffer from a medical condition that causes you chronic pain, life can be gruelling. Nobody likes being in pain, so over time it can really grind you down. Musculoskeletal problems like hip, knee or lower-back pain, arthritis and other ongoing, hard-to-treat conditions can sap your strength and energy over time, making it hard to stay positive or hopeful that a solution will eventually be found. Dealing with pain can make you stressed or depressed, as the ongoing struggle – unsurprisingly – causes sadness and low mood.

But if you or someone you care about is struggling with a painful condition, it's important to know that there is very good evidence for the impact that psychological treatments can have – in particular, cognitive therapy and mindfulness meditation. Of course, thinking differently about your problem, the core strategy in cognitive therapy, will not take away the pain (although it can significantly decrease the amount of pain you are in). Instead, it will help you stop thinking so negatively about the problem, which will boost your mood and stave off the risk of depression. 

The mindful approach to stress

Since the 1970s, mindfulness – in particular, mindfulness-based stress reduction, or MBSR – has been used to help people with a wide range of psychological and physical ailments. MBSR's founder, Jon Kabat-Zinn, developed his revolutionary approach to help people who had been failed by traditional Western medicine. He worked with patients suffering from treatment-resistant spinal problems and even terminal illness – and had a remarkable success rate at lowering their stress levels and improving the quality of their daily lives.

As with all forms of suffering, whether emotional or physical, the mindful approach is to change our relationship to the thoughts, feelings and physical sensations, enabling us to stop fighting or resisting them and – counterintuitively – accept them, even if we do not want them to be there. Over time, we find that this stance of acceptance is an extremely powerful one, allowing the 'aversive' experiences to come and go, so they don't get stuck or morph into other forms of suffering like self-criticism or anger.

I want to be clear: I am not minimising how hard or upsetting it can be to live with chronic pain (as someone with ongoing back, hip and other musculoskeletal problems, I know that only too well). But being human inevitably means dealing with stressors, large or small; and, if we cannot free ourselves from them, we must find the best possible way to live with them.

If you would like help with chronic pain, call me on 07766 704210 or email dan@danroberts.com.

Best wishes,

Dan

How to look after your vulnerable child

One of the most important ideas in schema therapy is that we all have different 'modes' – aspects of our personality that get triggered in different situations. For example, many of us have a Demanding Parent mode, which is the part of us that pushes us hard to achieve and be successful. Because this mode pushes us too hard, it can lead to stress, exhaustion or burnout, because our drive to achieve exceeds our internal resources and so we struggle to cope with the relentless demands. 

Another part – the most important one in schema therapy – is the Vulnerable Child mode. We call this Little Dave, or Sue, or Steven, and so on (mine is called Little Dan) and it's the part that holds all of our vulnerability, anxiety, unhappiness, loneliness, feelings of rejection or being bullied, depending on our experiences as a child. For example, if your parents were harshly critical of you throughout your childhood, this part will feel defective and incompetent – as if nothing you ever do is good enough. If one of your parents died or left the family when you were young, your Vulnerable Child will feel abandoned and, as an adult, you will be hypersensitive to being left or rejected by those you love. 

In schema therapy, we work hard to look after this part of you – to help him or her feel protected, safe, cared for. In fact, we try to meet those core needs that were not met when you were a child. So if your parents were flaky or untrustworthy, as your therapist I would work very hard to be a solid, dependable, trustworthy person for you. If one or both of your parents was cold and unloving, I would try to be extra-warm, friendly and kind. In this way (as well as using all of the schema therapy techniques, especially imagery) we would, over time, heal your Vulnerable Child – and help you feel calmer, stronger, more confident and secure. It's quite magical to watch this transformation take place – even with the deepest, most sensitive wounds.

Caring for yourself

Of course, you don't need schema therapy to start this healing process yourself. Learning to be kinder and more compassionate to yourself is a good start – take a course in mindfulness, visit a Buddhist centre near you or check out Dr Kristin Neff's website, where there are many free resources on self-compassion training. Yoga is another great way to heal your mind and body, as is reading one of the many wonderful self-help books available – try Loving-Kindness: The Revolutionary Art of Happiness, by Sharon Salzberg; or Get Your Life Back: The Most Effective Therapies for a Better You, by Fiona Kennedy and David Pearson, for starters. If you are using alcohol, drugs or food to deal with painful emotions, you may need help to tackle your compulsive behaviour. Visit my Resources page to find a whole range of useful organisations working in this area.

It is my strong belief that, whatever has happened to us in our past, it is never too difficult or too late to change. You may not be able to do this on your own – if so, seek help from me, another schema therapist or any psychotherapist sufficiently well trained and competent to tackle deep-rooted problems. Ultimately, healing yourself begins with a decision – that you are worthy of love and happiness; that you do not want to spend the rest of your life suffering because of painful experiences that were not your choice, not your fault in any way. We only have one life, so it's up to all of us to make the most of it, however hard it has been up to now.

If you would like help from me, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan 

 

 

Strengthening your Healthy Adult

One of the key ideas in schema therapy is that we all have different 'modes', or parts of our personality, which are more or less helpful for us in our lives. One of the most important of these modes is the Healthy Adult, which is the part of you that does all the important day-to-day stuff like going to work, being a caring parent and partner, paying the bills, going to the gym, not drinking too much, and so on. 

So the Healthy Adult does all the important, healthy stuff that you often take for granted, but without which life would quickly grind to a halt. This part is also very protective, again in terms of the outside world, being assertive when you need to stand up to an aggressive boss, say, or dealing with the teenage neighbour who loves blasting their favourite house music at 2am.

Silencing your inner critic

The Healthy Adult also protects you from yourself. In schema therapy, we also work with two 'maladaptive parent' modes, the Demanding Parent and Punitive Parent. The first drives you way too hard, often leading to stress or burnout – nothing is ever good enough. And the second is your inner critic, telling you that you are stupid, or fat, or useless. Both modes need to be disempowered, told to shut up and leave you alone. It's the Healthy Adult's job to do that. 

Finally, and perhaps most importantly, the Healthy Adult looks after the most vulnerable, wounded part of you, the Vulnerable Child. This part holds a lot of your most difficult schemas, so is the mode that is triggered when you feel anxious, upset, threatened or ashamed. All of our work in schema therapy is about healing this part of you, at first with my help but later through your Healthy Adult.

Working together, we will build this healthy, protective part of you like an inner muscle, until it is strong enough to calm you down when you're upset, or help you through a challenging job interview or parent's evening at school. You will feel yourself getting stronger and stronger; making increasingly healthy choices in your life; letting go of self-soothing strategies like excessive drinking or spending... And you will find yourself becoming more like the person you always wanted to be, but never knew how.

If you would like to find out more about how schema therapy can help you, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

 

Are you an orchid or a dandelion?

One of the key ideas I always share with my clients is that we all have a certain temperament, which we are born with and which has a profound impact on the way that life experiences, good or bad, affect us. Many of my clients have a sensitive, emotional temperament, which means that they are much more affected by problems in the family than someone with a robust, more intellectual temperament. It's important to emphasise that having a certain kind of temperament is neither good nor bad – it's just like being born with brown or blonde hair, blue or green eyes, not your choice or fault in any way but simply how you arrived on this planet.

I also tell my clients that I have a sensitive, emotional temperament too. This can make life difficult at times, as I am affected deeply by negative experiences and my childhood was pretty bumpy, to say the least. But it also bestows on me particular talents and gifts – I could not be a therapist without this kind of temperament. After all, you wouldn't want a therapist who was insensitive, unempathic or unkind! 

'Dandelion children'

Psychologists have, in recent years, been investigating the theory that we are all either orchids or dandelions. This is based on the Swedish idea that 'dandelion children' are pretty robust and do well in any environment, even if the parenting and family dynamic are less than perfect. US psychologists Bruce Ellis and W. Thomas Boyce extended this idea to include 'orchid children', who were especially sensitive and so needed just the right conditions to thrive. In practice, that means loving, nurturing parents; a relatively calm and stable family environment; and no traumatic experiences during childhood.

If orchids have a difficult family dynamic, they will struggle – developing a number of schemas which will affect them throughout their life and very likely experiencing depression or anxiety, among other problems, when these schemas are triggered by stressful events. But, if these sensitive children are well-nurtured, they will bloom into beautiful young people and later adults – just like the orchids above.

If you are a dandelion, you may be lucky enough not to need my help. But if you're an orchid whose childhood was not what you needed, life may be a struggle. If you would like some help from me, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

 

Schema therapy or CBT – which is right for you?

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If you are struggling with psychological problems, you may be thinking about having some therapy – but which kind of therapy should you choose? I offer both cognitive behaviour therapy (CBT) and schema therapy – two of the most effective forms of 'talking therapy' currently available – at my North London practice. Here is a guide to which therapy is the best fit for different kinds of problems...

CBT is widely recognised to be the most effective, evidence-based form of therapy ever created. Founded by Dr Aaron Beck in the 1960s (originally as just 'cognitive therapy' – the B was added later on), CBT has been proven to be effective at treating depression, anxiety disorders such as OCD or health anxiety, panic attacks and agoraphobia, eating disorders, anger management problems, addiction... the list goes on.

If your problem is relatively short-term (for example, one episode of depression rather than many); if you are functioning fairly well in most aspects of your life, but struggling with a specific problem like anxiety or depression; if you would prefer a short-term treatment; and if, perhaps, you have had CBT before and found it helpful, or have been recommended CBT by your GP or another medical professional, then CBT is probably the right choice for you. It is always possible to have CBT to reduce upsetting symptoms, such as panic attacks, and then move on to schema therapy afterwards to address more deep-rooted problems.

When schema therapy is the best option

In general, it's best to opt for schema therapy (ST) if your problems are longstanding – for example, if you have been struggling with recurrent episodes of depression for much of your life. Problems related to a difficult childhood, to extremely critical parents, say, or if you experienced abuse, neglect or traumatic incidents as a child, are best treated with schema therapy. CBT will be helpful up to a point, but schema therapy is designed to heal painful/unhelpful ways of thinking, feeling and behaving at a deep level – otherwise you may find problems coming back after therapy when you experience a period of stress, say, or a relationship breakup.

Schema therapy was developed by Dr Jeffrey Young in the 1990s to treat people with personality problems – especially Borderline Personality Disorder, which can have a profound effect on someone's life and was poorly treated before approaches like schema therapy and dialectical behaviour therapy (DBT) came along. Because it's intended to help with deep-rooted problems, schema therapy is a slower, longer-term approach than CBT. Generally, I tell my clients that 20 sessions are the minimum – and therapy can last for a year or more for really hard-to-treat problems. It's important to note that schema therapy is not just for personality problems – it is now used to treat all of the difficulties people seek therapy for.

In terms of how it feels to have ST versus CBT,  I would say that schema therapy is a warmer, more compassionate, more nurturing approach than CBT. It's much more focused on the relationship between therapist and client, rather than specific techniques to change thinking or behaviour, which form the bulk of treatment in CBT. But of course because schema therapy is just a newer form of cognitive therapy, all of the CBT techniques are still available, if I think they will be helpful for you.

I hope that helps – but if you would like to know more about which form of therapy might be best for you, call me on 07766 704210 or email dan@danroberts.com

Best wishes,

Dan 

 

How does 'exposure' work in CBT for anxiety?

If you feel anxious about something, the most understandable reaction is to avoid it. If you're scared of heights, you will avoid tall buildings; if it's spiders, rooms that look cobwebby will be a no-no; if you're scared of dogs, you may avoid parks, and so on. The problem is that, although this is understandable, it's not helpful. Every time you avoid, you are giving yourself the message that the 'phobic object' (a high place, spider or dog) is a scary, dangerous thing to be avoided at all costs. In fact, it's only because you avoided that you didn't fall off the edge or get bitten.

So if you see a cognitive therapist like me for help with a phobia, a central plank of the treatment is 'exposure' – doing the thing you are scared of, even though it's scary. This may just seem mean, but in fact it's extremely effective and is backed up by decades of research. We know that every time you do something scary, your brain gets more and more used to the scary thing, learning that it's not in fact dangerous and nothing bad really happens. This is called 'habituation'.

If you are phobic of spiders, as well as working on your anxiety-provoking thoughts about arachnids, I will get you to look at pictures of spiders in magazines or on the internet. We will work up to having a spider in a glass jar in the room, then you holding the jar and, ultimately, touching or holding the spider. And if you go through this exposure process, your phobia will be completely cured – something that may have completely blighted your life will be gone forever.

The only way out is through 

That's why, even though it can be tough, it's so important to use some form of exposure in a CBT treatment of any anxiety 'disorder' (what psychologists call the different kinds of anxiety-related problem people commonly experience). This applies to panic disorder, agoraphobia, health anxiety, obsessive-compulsive disorder (OCD), phobias, post-traumatic stress disorder (PTSD), body dysmorphic disorder (BDD), and generalised anxiety disorder (GAD).

As I often tell my clients, when you're treating anxiety the only way out is through. So if you're scared of the Tube, you have to end up taking the Tube. If it's pigeons, we'll need to look at lots of pictures of birds and maybe send you to Trafalgar Square. With OCD, you will need to actively imagine – and probably do – the things you try so hard to avoid thinking about and doing. With PTSD, you will need to run through the traumatic experience again as an imagery exercise with me, and visit the place where the trauma happened.

Exposure really works

As I also tell my clients, if I had a magic pill that would solve their problem, I would give it to them in an instant. But until that day, exposure is the closest thing we have to a magic cure, because I have seen it work miracles with people – if you stick at it, this treatment can literally change your life. And I will be with you every step of the way, encouraging, supporting, explaining the science behind it and problem-solving any difficulties you may encounter.

So if you or someone you care about has problems with anxiety, I strongly recommend you give CBT, and exposure, a try – remember that CBT is the only talking therapy recommended by the NHS for all anxiety disorders. That's because it works, while I'm afraid most other forms of counselling or therapy – while they might help with bereavement, say, or depression – really don't help with anxiety disorders.

If you would like some help with anxiety, call me on 07766 704210 or email dan@danroberts.com.

Best wishes,

Dan

How mindfulness meditation helps with anxiety & depression

Mindfulness is a real buzzword at the moment. It's hard to pick up a newspaper without coming across an article extolling its virtues. Mindfulness meditation programmes have been introduced into corporations like Google and Facebook, as well as schools, government departments and a whole host of other settings – it feels like everyone has suddenly switched on to the power of meditation.

But what exactly is mindfulness and how can it help with psychological problems like depression or anxiety? The first thing to say is that, although we in the West are only learning about mindfulness now, in the East people have been using mindfulness techniques for 2,500 years. Mindfulness is a cornerstone of Buddhist practice, used to calm and focus the 'monkey mind' (which normally just jumps around from one thing to the next).

Mindfulness was first introduced into the medical mainstream by Jon Kabat-Zinn in the 1970s – he developed an eight week mindfulness-based stress reduction (MBSR) programme, to help people with chronic pain and other serious medical problems. This proved so successful that a team of psychologists adapted it to help people with psychological problems, especially recurrent episodes of depression. They called this new programme mindfulness-based cognitive therapy (MBCT) and it proved equally effective.

The key idea in mindfulness practice is learning to focus on your moment-to-moment experience, rather than being swept away by the storms of anxious or depressive thinking that drive psychological problems. As with both cognitive and schema therapy, we have a large body of evidence showing that mindfulness works. On a personal note, I have had a daily meditation practice for years, and absolutely vouch for its power to calm and centre me for the day ahead. I have also taught many clients to meditate and seen the huge impact it has had on their problems with anxiety and depression.

Here is a simple sitting meditation you can try right now:

    •    Switch your phone off, then set a timer for 10 minutes, so you don't have to worry about how long you’ve been meditating.
    •    Sit in a straight-backed chair, cross-legged on the floor or lie down. Try to relax your body, letting your shoulders drop and face muscles soften.
    •    Close your eyes and become aware of your breathing – the flow of air over your lips and nostrils, in and out. Don’t try to change your breathing in any way, just breathe naturally.
    •    If your mind gets bored and gets distracted (as it probably will), don't give up or get frustrated. Every time you notice your mind has wandered gently turn your attention back to your breathing until the timer goes off.
    •    Once you feel able to meditate for 10 minutes, extend the time to 15 minutes, then 20 minutes, and so on. And remember that, like anything, the more you practicemeditation the easier it gets.

If you would like to book a session with me call 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

When someone you love is depressed

It seems to me that we don't give enough help and support to the loved ones of people with mental health problems. If your partner, child, sibling or parent has a mental health problem like an anxiety disorder, depression or an eating disorder, it can place a huge strain on you. They may be the one who is struggling – and, hopefully, receiving the right help to resolve their problems – but it's easy to overlook the impact that can have on the people around them.

If someone close to you is depressed, you may feel out of your depth as you try to help them. Your normal strategies, like being encouraging or trying to look on the bright side, might not actually be helpful for your depressed loved one – and may even make them feel worse. Coming up with solutions for the many problems they perceive in their lives might also be unwelcome right now. And we know that depression can be 'contagious', meaning that you might also feel low, or become influenced by their negative and hopeless view of events.

Here are three ways you can help your loved one as they struggle with depression:

1. Understand what they are going through

If you have never experienced depression yourself, it can be bewildering when someone close to you is depressed. But it's incredibly common – one in four people will experience some kind of mental health problem in the course of a year, with the most common form being mixed anxiety and depression. Understanding what depression feels like, what causes it and especially what can help is key.

I strongly recommend Overcoming Depression: A Self-help Guide Using Cognitive Behavioural Techniques, by Paul Gilbert – one of the world's leading experts on depression. You can also find a wealth of information online from charities such as Mind and the Mental Health Foundation.

2. Remember that it's not your job to fix them

When people we love are struggling, it's the most natural thing in the world to try and help them feel better. But when you are depressed it can be incredibly hard to lift your mood, or solve even minor problems that still seem utterly insurmountable because you lack energy, motivation and hope that things will get better. So rather than trying to fix them or gee them up just listen to them, keep showing them you love and care about them, and encourage them to see a mental-health professional, who does have the knowledge and skills to help them get better.

3. Help them take small steps to becoming more active

When you are depressed, you commonly stop doing the things you used to enjoy – partly because you have no energy, and partly because you don't take much pleasure in them any more. But if you stop doing things you enjoy, or that give you a sense of self-worth, your mood will clearly keep getting lower. So – gently – encourage them to do small things, such as going for a walk or to the park, doing some gardening, seeing close friends, going to the cinema, or if they feel up to it helping someone else, like an elderly neighbour (we know that this is especially helpful when you feel down).

If they are drinking heavily, encourage them to cut down or even stop for a while, as alcohol is a depressant. If their diet is really poor, try to get them eating more healthily – perhaps cooking healthy meals for their freezer. And if they aren't doing any exercise, see if you can help them start – regular cardiovascular exercise like swimming or brisk walking is as effective as antidepressants for mild to moderate depression.

Finally, if their depression does not lift after a few months, they may need talking therapy such as cognitive behaviour therapy (CBT), or schema therapy if they have had recuurent episodes of depression. You may need to encourage them to see a therapist – this is especially hard for men – but remind them that one in four people experience a mental health problem at some point in their life; and that therapy is now extremely effective, so it's definitely worth seeking help if their life is a real struggle.

I hope you find this helpful – please also remember to take care of yourself, as this will be a tough time for you too. 

Best wishes,

Dan

 

The difference between pressure and stress

People often tell me that they 'thrive on stress'. I respond that they might be confusing pressure – which can be energising and motivating, if we respond to it well – and stress, which always has a negative impact on us. Let me give you two examples:

James is a 30-year-old entrepreneur, who has recently launched a startup website selling his own brand of clothing. James is passionate about his new business and thrives on the pressure he puts himself under to make it successful. He works long hours, but knows this is necessary to get a new business up and running. James thoroughly enjoys every minute of his working day, so never feels stressed or overwhelmed – the fact that his business is doing well helps him stay positive and optimistic about the future. 

So for James, it's clear that the – self-imposed – pressure is a positive thing; it gives him the energy and drive he needs to make his new business a success.

Emma is a 26-year-old nurse working in a busy hospital in inner London. Over the last year, she has seen wave after wave of cuts in the number of nurses and support staff working on her ward. She and her colleagues work very long hours with no breaks – Emma wolfs a sandwich during her daily meeting with the other nurses. Sometimes she goes hours without even a drink of water or toilet break, as she is swamped with constant crises and demands from her patients. Emma's nerves are stretched and jangling, she feels exhausted and irritable all the time – recently she snapped at a difficult patient, which shocked and upset her. Emma is so stressed that she doesn't know how much longer she can take it and is seriously considering quitting nursing before she becomes seriously ill.

It's clear that Emma is suffering from chronic, debilitating stress, which is affecting her physically and psychologically. Like many people suffering from stress, she feels overwhelmed, under-supported and out of control of her working life. If she doesn't do something soon, she may will burn out or develop a more serious illness, as all the research shows that long-term stress is harmful to the body and mind.

In schema therapy terms, this kind of stress is generally caused by the Demanding Parent mode, which drives us on to work harder and harder, never feeling that what we do is good enough. This part can also make us feel under pressure – but it's not the kind of positive, motivating pressure James thrives on. Demanding Parent-induced pressure is unpleasant, debilitating and overwhelmingly negative. James's enjoyable pressure is probably coming from his Healthy Adult, which encourages and motivates us, rather than being critical or undermining of our best efforts.

If you are struggling with short-term stress, cognitive behaviour therapy (CBT) will be extremely helpful. If becoming stressed is a pattern for you, or it's affecting every area of your life, schema therapy may be more suitable. If you would like some help from me, call 07766 704210 or email dan@danroberts.com

Best wishes,

Dan

Why exercise is key for good mental health

Most psychological problems – such as chronic stress, anxiety or depression – will require some kind of psychological treatment, especially if they persist over time. But it's easy to underestimate the impact of direct physical interventions on psychological problems.

Partly, of course, this is because the whole separation of mind and body is an artificial one – your mind is the product of your brain; hormones play a key role in regulating your moods; psychological problems such as stress and anxiety have a whole range of physiological symptoms... In reality, your mind and body are inextricably linked, with an exquisitely complex feedback system between the two.

So it should come as no surprise that regular physical exercise is key to good mental health. Think of exercise in two main areas: cardiovascular and relaxing. Cardio exercise such as cycling, dancing, racquet sports, football, brisk walking or swimming, weight training or martial arts burns off hormones such as adrenaline and cortisol that are produced when we are anxious or stressed; just 20 minutes of moderate exercise gives you a shot of endorphins, which help you feel happy and calm; and regular cardio exercise is proven to be just as effective as antidepressants for mild to moderate depression (and with no nasty side effects).

Stress-relieving exercise

Relaxing exercise includes yoga, tai chi, gentle swimming or slow walking and is an excellent stress-reliever, especially if you do it in a green space, such as your local park. This kind of exercise activates the relaxation response, which balances out the stress response and helps you feel calmer and more relaxed. If you are suffering from depression, you may lack the energy to do more vigorous exercise, but it's really important to do something even if it's just a walk round the block.

So if you're stressed out, struggling with an anxiety problem or depressed, remember that exercise will really help – and if the problem is short-term, it may be all you need to regain your equilibrium and feel better, so why not give it a try?

If you would like to book a session with me, call 07766 704210 or email dan@danroberts.com

Best wishes,

Dan