CBT

How to deal with suicidal thoughts

If you are having suicidal thoughts, you are not alone. Sadly, thinking about harming yourself is extremely common. And tragically, many people in the UK and around the world take that one step further and either attempt to hurt themselves or succeed in taking their life. In the UK, suicide is the leading cause of death among men under 50 – more than heart disease, cancer or road accidents.

But it doesn't have to be this way. I have worked with hundreds of people who had thoughts of harming themselves – and helped them see that suicide is not the answer. It is devastating for those left behind. It might seem like the only solution, but it never is. And suicidal thoughts come and go, so if we can help people through the worst – often quite short – period of time, those thoughts and impulses will naturally recede.  

Helping with depression

One of the most important messages I give people is that thoughts of suicide are completely natural, especially when we are feeling depressed. That's because our thinking becomes very negative and it's hard to see anything good in life, or to believe that things will ever get better. Depression is also really tough to deal with day to day, so ending your life seems like a way to stop the pain. But we can now treat depression extremely effectively with CBT, so once your mood lifts you will no longer feel that way. 

It's heartbreaking for me every time I hear of someone taking their own life, because I always think, It didn't have to be that way. Someone could have helped them and they would still be here today.

Mental-health professionals know that some psychological problems bring greater risk than others. These include depression, alcohol abuse, anorexia, psychosis and schizophrenia, bipolar disorder and 'personality disorders' like Borderline Personality Disorder. So if you or someone you love is suffering from one of these problems, please do keep an eye on them. Reach out to them often and ask how they are. Also be straight and say, 'I'm worried about you, are you thinking of killing yourself?' Just asking that question could help save their life, because if the answer is yes you should contact their GP or one of the numbers below.

If you are reading this and thinking of hurting yourself, please don't. Tell someone, even if it seems like the hardest thing in the world. I promise you that help is available – and that, a year from now, you will look back and feel the deepest gratitude that you kept yourself safe and can still enjoy all of the wonderful things life has to offer.

Warm wishes,

Dan

If you are thinking of taking your own life, or know someone who might be, please call one of the numbers below:

The Samaritans – available 24 hours a day, 365 days a year on 116 123 or email jo@samaritans.org

Childline – for children and young people under 19. Call 0800 1111 – the number won't show up on your phone bill

The Silver Line – for older people. Call 0800 4 70 80 90

SANE provides confidential support for people with mental-health problems, every day of the year from 4.30pm to 10.30pm on 0300 304 7000

Campaign Against Living Miserably (CALM) – for men. Call 0800 58 58 58 – 5pm to midnight every day

Papyrus – for people under 35. Call 0800 068 41 41 – Monday to Friday 10am to 10pm, weekends 2pm to 10pm, bank holidays 2pm to 5pm. Text 07786 209697 or email pat@papyrus-uk.org

 

 

Are you a Highly Sensitive Person?

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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

 

 

 

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 am trained in both cognitive behaviour therapy (CBT) and schema therapy – two of the most effective forms of 'talking therapy' currently available – and provide schema therapy 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 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

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 recurrent 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. 

Warm wishes,

Dan

 

Acceptance vs change in cognitive therapy

A common dilemma for people engaged in cognitive therapy is understanding when to try and change a thought, behaviour, feeling, situation, relationship, etc and when to accept it. One way I explain this apparent contradiction is to say that the first stage of cognitive therapy is all about change. We identify specific problems in the client's life and come up with goals embodying the ways that person's life would be different if we solved those problems – this is all about change.

We then identify the thoughts, beliefs and behaviours that are maintaining the person's problems and start to modify those – again, our agenda here is change.

But more advanced cognitive therapy places far more emphasis on acceptance than change. Increasingly, the new 'third wave' forms of cognitive therapy like compassion-focused therapy (CFT), dialectical behaviour therapy (DBT) or acceptance and commitment therapy (ACT) are a fusion of mindfulness, cognitive therapy and other approaches, such as experiential or psychodynamic therapies, to help treat more longstanding or hard-to-reach problems and conditions.

Mindful acceptance

Acceptance is at the core of mindfulness theory and practice, because the Buddhists who originally harnessed the power of mindfulness understood that in life there are many things we can neither change nor control. We all get older and eventually die, as do those we love and care for. We all suffer from problems with our health, especially as we get older. Many things appear entirely beyond our personal control, such as climate change, the fluctuating economy, wars, natural disasters and even the actions of our own Government. So it is fruitless for us to spend hours worrying or disturbing ourselves about the things we cannot change – the Buddha discovered 2,500 years ago that an accepting mindset will greatly reduce our distress and unhappiness.

And we often find that, counterintuitively, mindfully accepting aversive or unpleasant feelings such as anxiety or anger and 'breathing into' them, rather than struggling, fighting or resisting them, helps those feelings naturally decrease and even dissolve. Acceptance can be both a powerful and empowering approach to solving some of our most painful problems.

In summary, change what you can and accept what you can't – not easy, by any means, but a very helpful way to live if you can manage it.

If you would like to arrange a session, 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

Overcoming postnatal depression

Postnatal depression, or PND for short, is a very common illness that affects between 10 to 15 in every 100 women having a baby. The symptoms are similar to those in depression at other times, but there are some differences related to being a new mum, worries about your baby's health and wellbeing and being able to cope.

Symptoms include:

•Feeling low, unhappy or tearful for much or all of the time

•Feeling irritable or angry with your partner, baby or other children

•Feeling utterly exhausted and lacking energy

•Despite your tiredness, you may have insomnia and lie there worrying about things throughout the night

•You may lose your appetite, ability to enjoy things and interest in sex

•You might have guilty or negative thoughts

•And you may feel anxious, worrying about your baby's health or whether you are doing a good job as a mother.

As with most health problems, these symptoms can vary in how strongly you feel them and how long they last – if they continue for more than two weeks you may have postnatal depression.

The first thing to say is that, especially if your symptoms are severe or you worry about harming yourself or your baby, it's very important that you see your GP.

If you are not having these thoughts, or your symptoms are milder, it's still really important that you talk to your GP, health visitor, partner and family about it. PND is not your fault, it is nothing to be ashamed of and is very common, so there's no reason to suffer in silence. It worries me that, according to a recent survey, nearly half of all mothers with PND didn't seek help because they were afraid of what might happen to them or their baby. Remember that your GP and health visitor only want to help you with any problems you're having adapting to life as a new mum – including postnatal depression – so there's no reason to keep it secret.

For mild symptoms, just getting a bit more support from your partner, family or close friends will be enough to help. You may also need some help from a counsellor or therapist like me (cognitive behavioural therapy is the most effective treatment for PND). For more severe symptoms you may need a combination of antidepressants and talking therapy – ask your GP about this.

If you want to know more about PND and how to treat it, the PND leaflet on the Royal College of Psychiatrists' website is excellent; I also recommend Overcoming Postnatal Depression: A Five Areas Approach by Christopher Williams, which is a self-help book based on the principles of CBT.

If you would like to book a session with me, 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

Bibliotherapy for anger issues

'Bibliotherapy' is an important part of cognitive therapy, either to run alongside a course of therapy or as a self-help tool. I often recommend books to my clients, partly because there is only so much time in a session, so it's much more useful for them to read up about their particular issue and for us to discuss their findings next week. But I also find that many people like to understand why they might be having problems and find their own strategies for solving them – another important idea in cognitive therapy, because ultimately I am trying to help my clients to be their own therapist.

You can read one or all of these books, depending on which appeal to you. You can also read the whole book or dip in to the chapters that seem most relevant to you.

1. Overcoming Anger and Irritability: A Self-help Guide Using Cognitive Behavioral Techniques, by William Davies. Part of the excellent Overcoming... series, this is designed as a CBT workbook, which you can use either instead of or alongside a course of cognitive therapy. As with any issue in CBT, problems with anger (either struggling to express or control it) are seen as a consequence of unhelpful thoughts and beliefs. So if you change the way you think, you will change the way you feel and behave.

CBT is proven to be an excellent tool for tackling unhealthy anger, with plenty of good-quality research confirming its effectiveness. This book is easy to read; packed with useful information about why we develop anger problems and how to overcome them; and provides a step-by-step programme of exercises to tackle your own problematic anger. And at just £9.99, it's a fair bit cheaper than a course of CBT too!

2. The Compassionate Mind Guide to Managing Your Anger, by Russell L Kolts. I am currently reading – and thoroughly enjoying – this warm, wise and helpful book, so can strongly recommend it. Kolts is an American clinical psychologist specialising in anger issues, with vast experience of working with groups such as prisoners, for whom destructive anger is clearly a major problem. He draws on Paul Gilbert's compassion-focused therapy (in which I am currently training) to explain the evolutionary/psychological basis of anger, especially its role in protecting us from threats, either real or perceived.

As Buddhists have known for 2,500 years, compassion is a wonderful antidote to anger, aggression, hostility and hatred – a fact that is increasingly recognised by Western mental health professionals. Learning to treat ourselves and others with greater kindness, compassion and tolerance is a major step on the road to reducing the destructive impact of anger on our lives. If you only read one of these books, I would choose this one, as it is both profound and a pleasure to read.

3. The Superstress Solution, by Roberta Lee MD. Don't let the title throw you off – I have included this book in both the anger and stress sections of my bibliotherapy course, because anger and stress and often inextricably linked. Think of it this way: if you are prone to irritability, remember how you felt after your last holiday. I'm guessing that all the little things that normally drive you to distraction didn't seem like such a big deal – and you probably dealt with them without becoming in the least bit cross or frustrated. Why? Because you had de-stressed and were relaxed, so your levels of patience and what's known as 'frustration tolerance' were far higher than in your pre-holiday, stressed-out state.

That's why, if you have a problem with anger, managing your stress levels is extremely important. Dr Lee is an integrative physician who takes a holistic approach to reducing the stress levels many of us suffer from in our always-on, over-stimulated, over-caffeinated, under-rested modern world. Covering everything from diet and exercise to meditation and lifestyle changes, this is a wonderfully clear, sensible and helpful book. Follow her advice and both your stress and anger levels should reduce significantly.

I hope these books prove helpful – if you would like to book a session with me, email dan@danroberts.com

Warm wishes,

Dan

How to set goals in cognitive therapy

One of the most important elements of the first session with my clients is setting some clear goals for their therapy. This is a key strategy in cognitive therapy, for a few reasons. First, although I see some clients for years, most people come for between 10 and 20 sessions, some less, some more, but that’s the number I always have in mind for straightforward problems like a fear of public speaking or single episode of depression. So we need to be clear about what we are trying to achieve, which of the client’s many problems we are hoping to tackle and, crucially, how we will both know when we have managed that.

When I ask about people’s goals, they often say something quite vague, like ‘I want to be less depressed’ or ‘I don’t want to worry so much about my health’. Now of course I want to help them achieve both of these end results, but it’s important that we get really specific about what exactly would be different if they were not depressed or health-anxious. Here’s how to set yourself specific goals: 

Start with a ‘problem list’. 
You, like me and every other person on the planet, probably have all sorts of problems in your life. You may be dissatisfied with your job, or unhappy in your marriage. Your kids might be hard to manage, or having difficulties at school. You might drink a bit too much or have money worries. Clearly, a relatively brief course of therapy is not going to help you solve all those problems! So be succinct and specific.

Turn the problems into goals 
Your goals should be the positive opposite of your problems. So if your biggest problem is being unable to stop worrying, your goal should be Worrying less. Ask yourself a series of questions to make this concrete:

Imagine you finish therapy and it helps you feel less worried – if I were talking to the less-worried you, how would I know? How would you be thinking, feeling and behaving differently?

What would you have space to think about if the worry didn’t take up so much of your mental energy? Enjoyable things to do with your partner, kids, or friends, maybe. Domestic tasks you have put off for ages that would give you a real sense of achievement to get done. Aspects of your life you would like to improve, but haven’t had the energy or mental space to attend to.

What positive feelings might you have more of that you don’t have right now? If you want to be less anxious, perhaps that would help you feel more calm, secure, strong, confident, peaceful or rested.

How would you behave differently if you were less worried? You may be less likely to fret about things you cannot control, for example. Or allow your teenage daughter to go to a party without it ruining your evening, as you sit at home worrying about every little bad thing that might happen to her. You might feel more able to attend social events, or just to switch off and relax – taking a long, hot bath, or listening to some beautiful music – without always being keyed up and full of restless energy.

Remember to use moderated language like ‘feeling less anxious’, or ‘being more confident at work’, ‘thinking more positively and compassionately about myself’. Your goals should be achievable, otherwise you will get disappointed and discouraged when you don’t reach them, so watch out for goals like ‘Having no anxiety at all’ or ‘Being the best public speaker in my company’, as these might be a tad hard to achieve.

Now write your goals – three or four of a paragraph each – and remember to keep referring back to them as you go through therapy.

If you would like some help with setting goals and want to arrange a session, email dan@danroberts.com

Warm wishes,

Dan

Five simple steps to combat depression

It’s natural for our mood to fluctuate – everyone feels a little down sometimes. But when that low mood persists for days or weeks, you may be suffering from depression. Telltale signs include persistent negative thoughts; a loss of appetite or libido; feeling exhausted and sleeping more (or less) than usual; struggling to keep up with daily chores; and wanting to avoid other people – what psychologist Paul Gilbert calls ‘go to the back of the cave’ thinking, when you just want to pull the duvet over your head until you feel better.

If you have severe depression – and especially if you are having suicidal thoughts – you should see your GP straight away, because you may need a combination of antidepressants and cognitive-behavioural therapy (CBT). But if you have mild or moderate depression, there are plenty of things you can do to lift your mood and start feeling better, either with or without therapy. Here are five of the most helpful strategies I have found for clients suffering from depression:

1. Get some exercise. I can’t speak highly enough of exercise – it’s what evolution designed our bodies for, so when we don’t do it, we suffer. And research has proven cardiovascular exercise like jogging, cycling, swimming or dancing to be as effective as antidepressants for mild to moderate depression. If you’re feeling really low and sluggish, and the thought of vigorous exercise is just too much right now, try going for a walk. Even a few times round the block and a little fresh air will make you feel better.

2. Call a friend. When we get depressed, we tend to isolate ourselves because we can’t be bothered to see other people, or worry about being a burden on them. But isolating yourself means you will just ‘ruminate’ (thinking about your problems over and over) and make yourself feel worse. Call a close friend for some support or, if you’re up to it, an evening’s laughter with friends is wonderful therapy when you’re feeling blue.

3. Stop bullying yourself. When we get down it’s all too easy to start berating ourselves for all the things we wish we had done better, or the mistakes we’ve made in the past. Stop. It does you no good at all and is guaranteed to drag your mood down. Use the ‘best friend test’ – when you are being harsh or unkind to yourself, ask ‘Would I say that to my best friend?’ I bet that 9 times out of 10 you wouldn’t dream of it, so don’t talk to yourself that way either.

4. Help someone else. This may sound odd, but studies consistently show that giving to others helps us feel better about ourselves. Offer to do your elderly neighbour’s shopping or mow their lawn; help out at a homeless shelter; sign up for a charity event for a cause you believe in. When we’re depressed, it’s easy to forget there’s a big world out there – doing something for other people helps you remember that and takes your mind off your own difficulties.

5. Watch what you eat and drink. When we feel bad, it’s easy to drink more alcohol than usual so we can relax and numb uncomfortable feelings. But alcohol is a depressant – so you will feel worse the next day. It also disrupts your sleep, which may already be a problem if you’re down. Go easy on the booze until you feel better. Also watch out for caffeine, because it stimulates the adrenal system. Depression is often mixed with anxiety, so the last thing you need is more adrenaline in your bloodstream. Go for herbal tea instead of regular tea, coffee or chocolate.

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

Warm wishes,

Dan

Overcoming panic attacks

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If you have ever suffered a panic attack, you will know how unpleasant they can be. During an attack, you may feel extremely anxious, hot, wobbly, dizzy and light-headed, with palpitations (increased heart rate), heart pounding or missing a beat, breathlessness and possibly 'de-realisation', when everything seems unreal or you feel as if you are floating, or disconnected from reality. Your thoughts will probably race and you may also experience visual disturbance, when colours or shapes seem to change. Because the physical symptoms of a panic attack feel so strong, people commonly fear they are physically ill and end up in hospital, only to be told there is nothing physically wrong with them and it's 'only' anxiety.

Cognitive therapy is proven to be extremely effective at treating panic attacks (and anxiety in general), so if you are having problems with panic, email dan@danroberts.com to book a session with me. There are also some simple, effective techniques you can use to help yourself:

1. Stay where you are. If you feel panic rising, don't try and rush somewhere safe. Just stay where you are until the panic subsides – it can be dangerous to try and drive, for example, during an attack.

2. Distract yourself. When you feel your anxiety rising and you feel any of the above symptoms, use distraction to take your focus away from the physical sensations in your body. Try staring intently at anything non-threatening, such as the second hand on your watch, or count anything – books on a bookshelf, bricks in a wall, tins in the cupboard – nearby. If you can concentrate, doing sudoku or crossword puzzles is good, as are times tables or counting down in twos from 100. Try different distraction techniques until you find the right one for you.

2. Breathe. Because people often feel they can't get enough air when they're anxious or panicky, they tend to gulp big breaths, which is what causes the feelings of dizziness and light-headedness. Consciously slow your breathing right down to a slow, steady count of three in through your nose and out through your mouth.

Finally, remember that anxiety may feel really unpleasant – but it cannot do you any harm at all. It always passes (usually in a matter of minutes) and can definitely be treated.

Warm wishes,

Dan

Bibliotherapy on anxiety

'Bibliotherapy' is an important part of cognitive therapy, either to run alongside a course of therapy or as a self-help tool. I often recommend books to my clients, partly because there is only so much time in a session, so it's useful for them to read up about their particular issue and for us to discuss their findings next week. And people usually like to understand why they might be having problems and find their own strategies to solve them – another important idea in cognitive therapy, because ultimately I want my clients to be their own CBT therapist.

In this post I will focus on anxiety disorders, an area that includes health anxiety, social anxiety, generalised anxiety disorder, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). The idea is that you can read one or all of these books, depending on which appeal to you. And you can read the whole book or dip into the chapters that seem most relevant to you.

1. Overcoming Anxiety: A Self-help Guide Using Cognitive Behavioral Techniques, by Helen Kennerley. I often recommend books from the Overcoming... series to my clients, because they are excellent introductions to CBT, and can be used either as a self-help workbook or alongside a course of CBT therapy. Overcoming Anxiety is packed with useful information about what causes anxiety, how best to deal with and practical, easy-to-use techniques for reducing your anxiety levels. And at £10.99 it's also a good deal cheaper than a course of therapy!

2. The Compassionate Mind Guide to Building Social Confidence: Using Compassion-Focused Therapy to Overcome Shyness and Social Anxiety, by Lynne Henderson. This is one of the first wave of books based on the principles of compassion-focused therapy (CFT), a new form of CBT that helps you treat yourself more kindly and compassionately. Another book in the series (by Dennis D Tirch) deals with anxiety more generally - this one focuses specifically on shyness and social anxiety. Like Helen Kennerley's book, above, it's full of useful techniques you can use yourself to start feeling more socially confident. Given that social anxiety is often caused by harsh self-criticism and fear of rejection/criticism from others, CFT is uniquely well-suited to softening that criticism, which is usually excessively punitive and self-downing.

3. Overcoming Obsessive Compulsive Disorder: A Self-help Guide Using Cognitive Behavioral Techniques, by David Veale and Rob Willson. Obsessive compulsive disorder (OCD) can be a horrible illness, which may end up completely dominating someone's life. David Veale is one of the world's leading experts in the treatment of OCD, so he's certainly worth listening to. I have to say that, as someone who specialises in treating anxiety disorders such as OCD, this condition is probably too difficult to overcome on your own, but this book will certainly give you a good idea of why you suffer from OCD and what you need to do to banish it from your life. You will then need to work with a CBT therapist (OCD is one of the conditions that doesn't respond well to other forms of therapy).

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

Warm wishes,

Dan

What is 'thought-action fusion'?

One of the many kinds of unhelpful thinking that can make us stressed, anxious or worried is 'thought-action fusion'. This is especially common in obsessive-compulsive disorder (OCD), but is also found in other anxiety disorders such as generalised anxiety disorder (GAD), health anxiety, panic disorder, phobias and social anxiety.

The problem here is that we can confuse thoughts with actions, believing that one has a direct link with the other. Let me give you an example, commonly found in people with OCD (as with the other case studies on this blog, this is a composite of different people and not about any particular client):

Marie has obsessional thoughts (the O in OCD) about running people over when she is driving. As with most OCD sufferers, she worries about this because she is a nice, caring person – it's precisely because the thoughts are so upsetting that she has become obsessive about them. She worries about hurting people before, during and especially after driving from her home to the office.

She thinks, 'Did I just hit someone? I'm sure I did.' Unsurprisingly, this thought makes her very anxious, so she has to engage in compulsions (the C in OCD), like driving back over her route and double-checking there is nobody injured, to 'neutralise' the upsetting thoughts and calm herself down.

One of the reasons Marie gets upset is because she believes the act of thinking about running people over makes it more likely to actually happen. And after her drive she is convinced that because she keeps worrying about hitting people, and even seeing images of that happening in her mind, it means she has actually hit someone. Such is the logic-defying slipperiness of OCD, which makes it challenging to treat.

Generalised anxiety disorder

Another example, of someone who is prone to excessive worry:

Clare has generalised anxiety disorder (GAD), which means she has 'free-floating' anxiety that attaches itself to one thing after the next; she also struggles with chronic worry, lying awake late into the night worrying about her children's safety, their performance at school and countless other things. As with other worriers, Clare has beliefs related to the act of worrying itself that maintain her worry problem. She thinks:

a) 'It's useful to worry – it helps me stay on top of all the family problems I have to deal with every day.'

b) 'If I don't worry about my kids, who will? Worrying about them helps keep them safe.'

You can see how the latter part of her second belief is an example of thought-action fusion. Like many people, Clare thinks there is a causal relationship between worrying (a type of thinking) and her children coming to harm (an action). Logically, although of course it's good to be careful about your children's safety, constantly worrying about them will not keep them safe, especially when they are not with Clare. But despite the stress and exhaustion that all this worrying causes her, it helps Clare manage her discomfort with uncertainty – another key feature of GAD.

Learning to think in a more rational, balanced and helpful way is key to overcoming any anxiety disorder. If you would like to book a session with me, email dan@danroberts.com

Warm wishes,

Dan