Anxiety

What is dissociation?

Dissociation is a self-protective mechanism in the brain that we all experience from time to time. It’s what happens when you feel overwhelmed and your brain shuts parts of itself down so you can cope with the situation. For example, when people have a car crash, they often report strange things happening, like time slowing down, floating above the scene of the accident, or not feeling any pain despite being injured. These are symptoms of dissociation, as the brain has shut down a bit to help them deal with the overwhelming and upsetting situation.

Think of dissociation like a circuit breaker being triggered. If there’s an electrical surge, a circuit breaker gets tripped to switch circuits off, so no electrical devices get damaged. That’s what happens in your brain when you dissociate.

If you experienced traumatic events as a child, your brain will have shut down to protect you. This was a healthy, ‘adaptive’ response to overwhelming feelings and sensations that your little self could not handle. But over time, dissociation becomes a habitual response, so your brain shuts down even when you experience much milder feelings, like a little anxiety.

Symptoms of dissociation

Unfortunately, dissociation causes various problems for us – we may feel spacey, empty, numb or weird in some other way (this is called ‘depersonalisation’). We might go blank, or struggle to hear what someone’s saying to us. Some people say everything looks far away, or it’s as if they are looking through a thick glass wall at the world (known as ‘derealisation’). When we dissociate we struggle to concentrate or remember important information. Not helpful if you are in a meeting, or about to take an exam.

You might experience dissociation when your anxiety is high – it’s a common symptom of panic attacks, for example. Or when you feel threatened in some way, your schemas getting triggered by a stressful event or situation that reminds you of something threatening from your past. I recently wrote a post about the ‘Detached Protector’ mode which we work with in schema therapy – this is a dissociative mode.

The good news is that dissociation can be treated – I have helped many people with dissociative problems using schema therapy. If you would like some help with your dissociation, call me on 07766 704210, email dan@danroberts.com or use the Contact form to get in touch.

Warm 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 some help, call me on 07766 704210, email dan@danroberts.com or use the contact form to get in touch.

Warm wishes,

Dan 

 

 

Self-Care for the Highly Sensitive Person

Orchid flowers.jpg

I recently wrote a post about Elaine Aron's wonderful book, The Highly Sensitive Person: How to Thrive When the World Overwhelms You. I also admitted that it was a particular eye-opener for me because I realised she is writing about me – I am a highly sensitive person and proud of it. And probably at least 50% of my clients are HSPs too, so this concept has helped me immensely, both personally and professionally.

As a follow-up, here are three of the things I have realised about how we highly sensitive folk need to take care of ourselves day to day:

  • We need time to process. Sometimes, in my downtime between seeing clients, writing up session notes, and all the many other things I do as part of my (wonderful) job as a therapist, I notice that I am compulsively surfing the Web. Having recently given up social media (here's another post about that), I realised that looking at The Guardian's website and depressing myself with the latest scary thing happening in the world, or just reading football-related nonsense, was my new digital addiction. I also realised that it made me feel, well, just bad. HSPs need time to process stuff, because we are so attuned to every detail of what is happening that it's easy to get flooded (what Aron calls being over-aroused). So more mindfulness for me, less scary news and screen time.

  • Slow is (generally) good. Linked to the first point, because being an HSP means that our central nervous system is unusually sensitive (which is neither good nor bad, just a largely genetic trait), we get easily overwhelmed by things. Bright lights, loud noises, strong smells, traffic, too much information, too many strong emotions, big crowds, strangers, public speaking, aggressive or loud people... the list is a long one but will be unique to you – some of these may be triggers for you, some not, but you will definitely have your triggers. Personally, I like to talk and think about things slowly. I am more into deep thinking and powerful, one-to-one conversations than social chit-chat. Slow is good for me, even if I don't always remember that.

  • Alone time helps us recharge. As Elaine Aron points out, not all HSPs are introverts. You can be a highly sensitive extrovert, but common sense says that most HSPs will prefer small groups, close friends or time alone. I am certainly one of those – although I love seeing clients all day, or even teaching large groups, I do find some alone time in the day invaluable. It helps me rest and recharge, as well as giving time for processing everything I have thought, seen and experienced that day (see point one). As with all of these points, it's important to remember that none of this is good or bad, it's just how I and probably most people reading this are wired. Learning to love and accept yourself as you are is a crucial component of schema therapy, so recognise your need to be alone sometimes and carve out that time for yourself.

And if you would like some help, call me on 07766 704210, email dan@danroberts.com or use the Contact form to get in touch.

Warm wishes,

Dan 

 

How to deal with difficult emotions

If you want to understand how we are meant to feel emotions, look at a small child. When kids feel their emotions they really feel them! If they are angry, they will shout and scream and have a tantrum. If they are sad, they will cry. If they're scared, they will run away, or hide behind their mum's legs until the threat has passed. Now, I'm not saying that as adults we should indulge ourselves in tantrums, but neither should we repress or swallow our feelings.

Sadly, as we grow older we tend to stiffen up. We learn that (for men) it's not OK to cry when we are sad, or to tell our friends if we're going through a rough time. Or (for women) that being angry or assertive is unacceptable. We start to feel bad for feeling bad. We learn to hide our feelings, sometimes even from ourselves. Or we use a substance (alcohol/weed/cocaine/food/cigarettes) or an activity (gambling/hours spent on Facebook/gaming/shopping/sex) to numb or avoid uncomfortable feelings like anxiety, sadness, loneliness, anger or hurt. And the message we are giving ourselves is that emotions are somehow bad, wrong or even threatening.

Let's go back to the kids. Watch a child getting angry: they feel the anger, intensely. Then they release it, verbally and physically. Then they seek a trusted person to soothe and comfort them. And then... the anger is gone. They see a butterfly and chase after it, utterly delighted and distracted, with no trace of the anger left in their body or mind. This is how we are supposed to feel, process and seek solace when we experience strong emotion. I have started summing it up for my schema therapy clients with a simple formula:

1. Feel it. If you're sad, be sad. If you are angry, let yourself be angry. It's just an emotion and can't do you any harm – in fact, the only harm we can do is if we try to avoid the emotion (leading to problems like addiction or anxiety disorders such as OCD).

2. Release it. If you are sad, and alone, have a cry. If you're angry, write a (never-to-be-sent) letter to the person you're angry with, then burn or tear it into tiny pieces. Vent the emotion and let it go.

3. Get soothed (by yourself or a trusted person). Just as children need soothing when they are upset, so do adults – we're just not very good at doing it for ourselves or seeking it from those we love and trust.

Learning to detach

One of the unconscious ways we learn to suppress or avoid our feelings is by detaching, which involves a psychological process called 'dissociation'. This is something we all do, to a greater or lesser extent, but will have learned to do a great deal if we suffered trauma, abuse or neglect as a child. Dissociation is an unconscious process in which the brain shuts down to protect us from overwhelming stress. It's a bit like a fuse blowing on a circuit board when there is a power surge, to stop electrical devices getting fried.

If we dissociate a lot as a child, it becomes an automatic process that we over-use, shutting down when we feel any kind of difficult emotion. This leads to us developing a 'mode' called the Detached Protector – one of the most common modes in my clients. We may feel numb, empty or spacey when this mode is triggered. We might also feel disconnected from other people, even experiencing strange sensations such as feeling far away, seeing the other person as very small, or feeling like there is a glass wall between us and the world. These are all common symptoms of dissociation.

None of this is bad or wrong – it's just what we learn to do to protect ourselves from overwhelming pain or stress. Part of my job is helping people unlearn this unhelpful coping strategy, feel their emotions as described above, and learn to build up their 'emotional muscles', so they feel stronger, more resilient, and can live a rich and fulfilling life. After all, emotions – the full range, both those we like and the ones we would rather not feel – are what make us human.

If you would like some help with your uncomfortable emotions, call me on 07766 704210, email dan@danroberts.com or use the contact form to get in touch.

Warm wishes,

Dan

 

Are you a Highly Sensitive Person?

HSP book cover.jpg

I have been reading a self-help book recently by Elaine N Aron – an American clinical psychologist who has spent her career researching, writing about and providing therapy to Highly Sensitive Persons (HSPs). Aron discovered this group and set about testing her theory that some people are more sensitive than most – she believes HSPs make up about 20 per cent of the population. Her book, The Highly Sensitive Person: How to Thrive When the World Overwhelms You, is written for HSPs like herself, as she is an unusually sensitive individual too. 

I must admit that this book has had a huge impact on me. Not only does it describe at least 90 per cent of the people I work with, but it also describes me with eye-opening accuracy. HSPs, according to Aron, have an unusually sensitive nervous system. This means that they pick up on far more of the information in their environments than less-sensitive people. They are affected by bright lights, loud noises, crowds and strong smells. If there is tension in a room, they will pick it up and find it uncomfortable. They will intuit which people in a group are friends and who dislikes each other. They are like tuning forks for subtle interpersonal vibes.

Aron is quick to point out that being an HSP does not make us superior to our less-sensitive friends, family members or colleagues. This sensitivity is a trait – largely genetic but also affected by our life experiences – that is neutral. In some ways, it is a real advantage – I always tell my clients that I could not be a schema therapist without a high level of sensitivity. Being this sensitive makes me, and all other HSPs, more thoughtful, empathic, attuned to other people and their needs, as well as a whole host of other good things.

Sensitivity is no bad thing

But perhaps the most important point that Aron makes – and one I really want you to take on board – is that being sensitive is in no way a bad thing. I don't know about you, but all my life people have told me I should be less sensitive. 'It's just a joke – stop taking things so seriously!' Or, 'Why do you always make such a big deal about things? Just man up and toughen up, for God's sake.' Don't be so shy/introverted; be the life and soul, speak louder, be more of a 'character'. 

For men especially, sensitivity is often seen as a weakness, or something to be ashamed of. Many HSPs get bullied at school, for precisely this reason. And extra-sensitive women are often told they are crazy, or over-emotional, because they feel things deeply and cannot just lighten up, or get a grip, or let it go. So if this describes you, please understand that there is nothing wrong with you – and certainly nothing to be ashamed of. You are just genetically, temperamentally, a bit different from most other people. This probably means that you have been very much affected by difficulties in your childhood, or family of origin.

You may have an anxiety disorder, or get depressed. You may even have personality problems, or struggle with addiction. All of these things need help, from a professional like me or one of my colleagues, who are trained to help sensitive people (and less-sensitive ones, of course) become happier and healthier. I would also strongly recommend reading this book. And if it describes you, give it to your partner, friends and family, so they can better understand you and why you behave as you do.

If you would like some help, call me on 07766 704210, email dan@danroberts.com or use the contact form to get in touch.

Warm 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 experience 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 not 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, call me on 07766 704210 or email dan@danroberts.com

Warm wishes,

Dan

 

Schema therapy or CBT – which is right for you?

caterpillar-butterfly_0.jpg

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

Warm wishes,

Dan 

 

Can anxiety lead to depression?

Although it's common for people to suffer from mixed anxiety and depression, and both problems have negative thinking at their root, there are key differences between the two. When we are anxious, our thinking will be overwhelming threat-related – we worry about danger of some kind, or bad things happening to us or those we love. When we are depressed, our thinking commonly focuses on themes of loss, regrets about the past, being stuck or trapped, or feeling hopeless about the future. So in cognitive therapy we treat depression and anxiety in different ways, based on different theoretical models and using slightly different techniques.

But something I often see is that people with an anxiety 'disorder', such as health or social anxiety, over time become depressed as well. Although this can be doubly frustrating and upsetting for the person, who now has depression to deal with on top of their anxiety problem, if you think about the effect that chronic anxiety problems have on us, it's not surprising. Let's take health anxiety as an example: when someone's worry and anxiety focus on their health, they will be hypersensitive to any physical symptoms, however minor, such as headaches or variations in their heartbeat. For the health-anxious person these – usually benign – symptoms mean they have a brain tumour or life-threatening heart condition.

Anxiety can be exhausting

Clearly, this is extremely worrying and upsetting for them, as they may spend most of their waking hours feeling highly anxious about getting a serious illness. Over time, this will wear them down – they may be sleeping badly, so will become physically and mentally drained and exhausted; they might feel emotionally wrung out from all the worrying; they may also feel stuck and hopeless about getting anyone to believe them, because doctors keep telling them there is nothing wrong, even though they are 100% sure there is. Put all this together and, over time, this poor health-anxious person may also become depressed.

In my experience though, if you help them overcome their health anxiety, the depression naturally lifts too. So it's very important that they get the right kind of help and support – if not, they might stay anxious and low for many years. I strongly believe that no-one should suffer from anxiety or depression in silence, because both problems are treatable with cognitive behaviour therapy (CBT). So please do get some help from me or another cognitive therapist soon.

If you would like to book a session, email dan@danroberts.com

Warm wishes,

Dan

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, email dan@danroberts.com

Warm 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, email dan@danroberts.com

Warm 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, email dan@danroberts.com

Warm 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, email dan@danroberts.com

Warm 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, email dan@danroberts.com

Warm 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, email dan@danroberts.com

Warm 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, email dan@danroberts.com

Warm 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, email dan@danroberts.com

Warm wishes,

Dan

Do you want to learn mindfulness meditation?

Mindfulness meditation is very much in the news these days. Mindfulness is increasingly being taught in schools, corporations, to athletes, veterans, the police and even MPs in the Houses of Parliament! And for good reason – a regular meditation practice has been proven to help you feel calmer, less anxious and depressed, to respond better to stressful events, deal with chronic pain or illness with greater balance and equanimity, improve concentration, memory and overall wellbeing. 

As someone who teaches my clients to meditate, I have seen first-hand what a difference it can make for people struggling with mental health problems. And as a regular meditator for over six years, I know from personal experience what a profound difference it makes to one's life. I genuinely believe that life is so much happier and more positive as a direct result of my meditation practice and am deeply grateful that I made meditation a part of my daily life.

Learning to meditate

When I am teaching clients to meditate, I first direct them to Mark Williams and Danny Penman's excellent book, Mindfulness: A Practical Guide to Finding Peace in a Frantic World. Mark Williams is a British psychologist who helped develop mindfulness-based cognitive therapy (MBCT), an eight-week programme to help people deal with stress, anxiety and especially recurrent bouts of depression. 

This book is based on the MBCT course, but is also a wonderfully clear and simple guide to mindfulness meditation – it's the perfect place to start if you are interested in bringing the transformative power of mindfulness into your life. It also includes a CD of guided meditations by Mark Williams, which will really help when you're getting started.

If you would like to take an MBCT course, visit the Resources section of my site to find a reputable place to study. I also think that a blend of mindfulness and schema therapy is an excellent way to tackle a wide range of psychological problems. If you would like to know more, email dan@danroberts.com

Warm wishes,

Dan

What are anxiety disorders?

What are anxiety disorders?

In either cognitive or schema therapy we first try to understand exactly what is causing someone’s problems, before going on to help solve them. If someone is struggling with anxiety, part of this understanding is making a diagnosis of exactly which ‘anxiety disorder’ someone is struggling with. Some people find this idea a little uncomfortable, but it’s just like your GP diagnosing whether you have the common cold or flu, so they can prescribe the right treatment.

There are seven anxiety disorders, which I summarise briefly below – map your symptoms on to the disorder to see whether you might have one. If you are unsure, please get an assessment from a cognitive or schema therapist; and remember that it’s common to suffer from more than one of these disorders at the same time, as well as other problems like depression or low self-esteem.

Panic disorder and agoraphobia
A panic attack involves a sudden increase in anxiety, accompanied by physical symptoms of anxiety, such as a racing heart rate, breathlessness or dizziness. Panic disorder involves recurrent panic attacks and may or may not lead to agoraphobia – anxiety about being in situations in which escape would be embarrassing or help would not be available in the case of a panic attack. People with agoraphobia may struggle to leave the house or be in open or public places, like shopping centres.

Health anxiety
Health anxiety (also called ‘hypochondriasis’) involves a fear of having a serious illness, like cancer or heart disease, and a preoccupation with bodily symptoms. The problem will not go away with medical reassurance and is often extremely distressing – you may be convinced you have a serious health problem but that no-one believes you, which is understandably frustrating and upsetting.

Social phobia
People with social phobia have a fear of social or performance situations, or both; you may feel comfortable with one trusted friend, but become anxious if their friend joins you. You might be fine in small groups, but the bigger the group the more your anxiety grows. And you might struggle in performance situations, like public speaking or university seminars – you may hate being put on the spot or have the feeling that everyone can see how anxious you are and will think badly of you in some way.

Specific phobia
This involves the persistent fear of a particular object of situation – it’s ‘specific’ because you fear that and not a wide range of things. The most common phobias are a fear of heights, public speaking, snakes, spiders, being in enclosed spaces, mice, needles and injections, crowds, clowns, darkness and dogs. Of course, some people struggle with more than one phobia. And it’s worth noting that specific phobias are relatively easy to treat with CBT – in around six sessions or less.

Generalised anxiety disorder
GAD is defined as excessive anxiety and worry occurring more days than not for a period of at least six months and about a number of events or activities. The two key features of this disorder are ‘free-floating’ anxiety, which attaches itself to one thing after another; and persistent worry, which is more severe than normal worry, seems hard to control and causes distress and/or makes it difficult to function.

Obsessive-compulsive disorder (OCD)
If you are suffering from OCD, you will experience obsessions (intrusive images, impulses or thoughts) and/or compulsions (repetitive behaviours engaged in to minimise the anxiety or upset caused by the obsessional thought or because of rigid rules). Although the compulsion – which could involve checking, washing, prayers or replacing negative thoughts/images with positive ones – is intended to reduce distress or prevent a feared outcome, like someone you love being harmed. Unfortunately, the compulsion only provides short-term relief and is a key element of what maintains the OCD.

Posttraumatic stress disorder (PTSD)
PTSD occurs as a reaction to a profoundly distressing event that threatened death or serious injury to yourself or other people; a response that involved intense fear, helplessness or horror; and key symptoms of re-experiencing, avoidance and hyperarousal. There is some debate over whether PTSD is an anxiety or stress/trauma disorder, but as it does involve very high levels of anxiety, I have included it here.

If you think you might have an anxiety disorder and would like to arrange a session, email dan@danroberts.com

Warm wishes,

Dan

What is the anxiety formula?

Two of the most common questions my clients ask me are:

•Why do we get so anxious about seemingly innocuous things?

•Why do some people suffer from anxiety when others seem to take things in their stride?

There are, of course, a multitude of factors that make up the answers to these questions, including our temperament – we know that some people are born with a highly sensitive temperament, while others are much more thick-skinned and robust – our family dynamics, traumatic experiences we might have in childhood or adolescence, whether our parents were anxious and so served as 'models' for our anxiety...

But another, simpler way to understand why we can get so anxious about things like developing a serious illness, or spending time in enclosed spaces, is using the 'anxiety formula'. This simply means that high levels of anxiety are caused by a combination of how likely we think it is that a feared event will happen, plus the cost of that event to us. And this in turn is affected by how well we think we might cope if the feared event happened, plus whether we think anyone could help or rescue us.

This sounds fiendishly complicated, but it's really not – let me give you a concrete example:

If I am anxious about, say, having a panic attack in a shopping centre, the degree of my anxiety will depend on how likely I think that is to happen. If I think it's only 10% likely, I won't get very anxious on my drive to the shops; if I think it's 90% likely, I will be very anxious indeed. If I then think that I if I do have a panic attack, I will only be 5% embarrassed (perhaps because I can hide in the toilet until I feel calmer), my anxiety might come down a bit; if I think I will be 95% embarrassed (because everybody will see me panicking and think badly of me), my anxiety will go up, not down.

The next bit of the formula involves coping and rescue factors. So if I think to myself, 'Well, I might have a panic attack, but my therapist taught me how to use deep breathing to calm myself down, so I'm sure I could cope with it and eventually be OK,' (coping) my anxiety would ease off a bit. If I thought, 'Having a panic attack would be absolutely awful – I might faint and end up in hospital,' up goes my anxiety again. And finally, if I thought people would be kind and help me (rescue), I might feel slightly reassured; but if I imagined people might ignore me or even be unkind, I could feel very alone and even more anxious.

You can apply this anxiety formula to anything that's making you feel worried or afraid and it will always explain why that seems manageable in one situation but deeply uncomfortable in another. Crucially, this formula not only helps us understand why we get so anxious, but how to modify the unhelpful thinking that amplifies risk while making us underestimate our coping resources to deal with whatever life throws at us.

I strongly believe that no-one needs to struggle alone with their anxiety, so do get some help from me, another cognitive therapist or a charity like Anxiety UK in treating your problem – if you would like to book a session with me, email dan@danroberts.com

Warm wishes,

Dan

Excellent self-help book on worry

I am always keen to promote the best sources of information to help people gain insight into their problems, because without insight into what is making us unhappy, we cannot hope to overcome it. I'm currently reading Dr Robert L Leahy's The Worry Cure: Stop Worrying and Start Living – one of the best self-help books I have read for a long time. Dr Leahy is one of the world's pre-eminent cognitive therapists and condenses 25 years of clinical experience into this informative and highly readable book.

As I often tell my clients, there is nothing wrong with worry per se – it is a normal and even helpful cognitive strategy for thinking about and solving problems. But, as Dr Leahy so eloquently explains, for some of us worry can be both excessive and distressing. Chronic worry is associated with a wide range of psychological problems, from depression to anxiety disorders including OCD, health anxiety, social phobia and especially generalised anxiety disorder (GAD), in which persistent worry is one of the distinctive features.

The Worry Cure explains why some of us worry more than others; offers a range of questionnaires and other diagnostic tools to help you understand what your 'worry profile' is; and, crucially, provides a wealth of tips and techniques to help you reduce your worry and learn to confront the problems that unhelpful worry actually stops you solving.

One of the paradoxical things about worry is that it can be a way of avoiding actually solving your problems. Although you may spend many hours fretting about them, which gives the illusion of control and makes you think you are tackling them, it can actually get in the way of confronting problems head-on; separating the things you can control from those you cannot; coming up with solutions to those problems and taking action to actually solve them, not just spend fruitless hours worrying about them.

So do buy the book – and if you want help with chronic worry, email dan@danroberts.com

Warm wishes,

Dan