Cognitive therapy

Schema therapy or CBT – which is right for you?

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

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

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

When schema therapy is the best option

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

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

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

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

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

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

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

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

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

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

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

Bibliotherapy on compassion

'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 want my clients to be their own CBT therapist.

In this post I will focus on compassion and compassion-focused therapy – a new form of cognitive therapy designed to help with deep-rooted issues such as long-term or cyclical bouts of depression, low self-esteem or unhelpful self-criticism. 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. The Buddha's Brain: the Practical Neuroscience of Happiness, Love and Wisdom, by Rick Hanson and Richard Mendius. If, like me, you are interested in the science behind meditation and talking therapies like CBT, this is the book for you. The authors explain how our brains are actually shaped by the things we think every day – think negatively and you build neural pathways that make negative thinking your default approach; but focus on feelings like kindness, pleasure, gratitude, generosity and warmth and you build a brain that naturally focuses on these self-nurturing qualities. Don't be put off by the science – it's also a rich, wise, beautifully written book that's packed with common sense techniques you can use to help yourself feel better. This is one of the books I recommend to all my clients, because it just makes you feel so good to read it. 

2. The Compassionate Mind Guide to Managing Your Anger, by Russell L Kolts. This warm, wise and helpful book is written by 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 to explain the evolutionary/psychological basis of anger, especially its role in protecting us from threats, either real or perceived. CFT focuses on strengthening the parts of our brain that help us feel calm, confident, strong, peaceful and safe; these act as a direct antidote to feelings like hostility or aggression, so are fundamental to feeling less angry and generally happier and more emotionally balanced.

3. Happiness: A Guide to Developing Life's Most Important Skill, by Matthieu Ricard. Another life-changing book for me – as someone with a strong interest in Buddhism and Buddhist psychology, I found Happiness at the same time inspiring and humbling because it showed me how much I still have to learn, both personally and professionally. Ricard was an eminent French scientist before his interest in Buddhism led him to become a monk, living in the Himalayas and studying with some of the great Tibetan Buddhist teachers. Developing self-kindness and compassion is a key focus in Tibetan Buddhism (which is why the Dalai Lama so often talks about compassion). The author explains, with great clarity and simplicity, how anyone can learn to free themselves of what the Buddha called the 'three poisons of the mind': greed, hatred and delusion. You don't need to be interested in Buddhism to love this book – its message will appeal to anyone on the path of personal growth or who just want to be happier. And that means everyone, doesn't it?

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 mindfulness

'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 want my clients to be their own CBT therapist.

In this post I will focus on mindfulness, an ancient Buddhist practice that, since the 1970s, has been adapted by Western psychologists to help treat a range of physical and mental difficulties. 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. Wherever You Go, There You Are: Mindfulness Meditation for Everyday Life, by Jon Kabat-Zinn. This beautifully written, wise, eminently readable book is one of my favourites. Kabat-Zinn is, more than anyone else, responsible for introducing mindfulness to the West. He started using mindfulness techniques to help people with chronic stress, physical pain or serious illness at the University of Massachusetts Medical Center in the '70s, which paved the way for other practitioners to use mindfulness either as a standalone technique or combined with other approaches like cognitive therapy. The author explains with great clarity exactly what mindfulness is and how you can integrate it into your life, either with 'formal' practices like sitting or walking meditation, or 'informal' practices such as being completely mindful of whatever it is you're doing, from washing the dishes to gazing at a glorious sunset or preparing and eating a delicious meal. If you're new to mindfulness or meditation in general, this is the perfect place to start.

2. Mindfulness: A Practical Guide to Finding Peace in a Frantic World, by Mark Williams and Danny Penman. Another good beginner's guide, this introduction to mindfulness theory and practice is written by Mark Williams, a clinical psychologist and one of the UK's leading mindfulness teachers, and Danny Penman, a health journalist and author. It offers a clear, easy-to-follow path through all the basic mindfulness techniques, and includes a CD of guided meditations by Williams – who has an incredibly gentle, soothing voice. As an aside, if you ever get the chance to see him speak, grab the opportunity. He is an excellent speaker who really embodies the calm steadiness that regular meditation can bring.

3. The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, by Mark Williams, John Teasdale, Zindel Segal and Jon Kabat-Zinn. If you want to take a mindfulness course for issues like stress, anxiety, depression or chronic pain, there are two basic formats: mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). Both run over eight weeks, with a combination of meditation, guided imagery, yoga and other exercises in the class and at home. Jon Kabat-Zinn developed the MBSR programme first (see above) and in the early '90s the other three authors began exploring the use of mindfulness to treat depression, especially repeated bouts of depression which can be hard to treat. They combined elements of Kabat-Zinn's MBSR programme with cognitive-behaviour therapy to come up with MBCT, which has proven extremely effective at treating recurrent bouts of depression – as effective as antidepressants, in fact.

This is another warm, rich, wise book, which leads you through the steps of an MBCT programme, while explaining why we get depressed, what we now understand about depression and the brain from MRI scans and other research into its physical make-up and functioning, and how psychologists around the world are now exploring the meeting point of Buddhist psychology, neuroscience and cognitive therapy, with intriguing results. It also includes a CD of guided meditations by Kabat-Zinn, which I use as part of my daily practice, so can thoroughly recommend.

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

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

Bibliotherapy for depression

'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 want my CBT 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 Depression: A Self-help Guide Using Cognitive Behavioral Techniques, by Paul Gilbert. Part of the excellent Overcoming... series, this is written by one of the world's leading experts on depression. It explains perhaps better than any other book I have read on depression exactly why we get depressed, with particular emphasis on the way our brains are wired to make us vulnerable to depression when we are threatened, or suffer major losses in our lives. Warm, compassionate and eminently readable, this book is also full of practical tools and techniques you can use to tackle your own low mood, with or without the help of a CBT therapist.

2. The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, by Williams et al. This also serves as the perfect introduction to mindfulness meditation, if that interests you – and comes with a CD of guided meditations by Jon Kabat-Zinn, one of the leading figures behind the marriage between mindfulness and modern psychology. As well as providing a wealth of information about why we get depressed and what we can do about it, this book is based on the principles of mindfulness-based cognitive therapy (MBCT), an eight-week meditation programme that research shows is highly effective at treating recurrent bouts of depression. Like Gilbert's book, it is warm, wise and kind-hearted, so is a soothing companion when you're feeling down. 

3. Mind Over Mood: Change How You Feel by Changing the Way You Think, by Dennis Greenberger and Christine A. Padesky. This seminal book remains the best introduction to CBT, almost 20 years after it was first published. Although not written specifically about depression (it is just as useful for any of the other issues mentioned above), if you are suffering from low mood it offers a clear, simple, step-by-step guide to modifying the negative thinking that is at the root of depression. Padesky is perhaps the world's foremost CBT therapist (she was taught by and remains very close to CBT's founder, Aaron Beck), so you can rest assured that the techniques and strategies outlined here are to be trusted.

I hope at least one of these proves helpful – if you would like to book a session with me, email dan@danroberts.com

Warm wishes,

Dan 

Bibliotherapy for stress

What is bibliotherapy? Well, health professionals increasingly see the benefit of reading for people suffering from a wide range of physical and psychological problems. In fact, a Government-backed scheme – Reading Well Books on Prescription – 'prescribes' specific books for people struggling with, say, depression or worry through their GP. I have always recommended books to my clients, so this post is part of my ongoing bibliotherapy series (here are my posts on the best books for anxiety, mindfulness, compassion, anger issues and depression).

If you are suffering from stress, you will find these books helpful in managing your stress levels:

1. The SuperStress Solution: 4-week Diet and Lifestyle Programme, Roberta Lee, MD. Dr Lee is an integrative physician, which means she combines the best of evidence-based Western medicine with strategies and techniques from alternative approaches, focusing on meditation and relaxation techniques, sleep, exercise, work/life balance, diet and nutrition. Her argument is that the kind of stress those of us living a 21st-century urban life now suffer is far worse than our parents faced, so it has evolved into SuperStress; a type of chronic stress that is insidious and creeps up on us, given the constant drip, drip of stressors such as 24/7 digital media never letting us relax; the pressure to be perfect parents, partners, family members and employees; the endemic lack of job security; too much sugar, caffeine and alcohol; insufficient sleep and rest; and rolling news bombarding us with scary and upsetting stories. Her argument is very persuasive and it's an excellent book, so highly recommended.

2. How to Deal With Stress, Stephen Palmer & Cary Cooper. This is a sensible, practical guide to reducing your stress by two world-leading experts in stress management. Having trained with Stephen Palmer at the Centre for Stress Management, I can personally vouch for his expertise in this area (he is also an excellent CBT therapist). The authors explain how to identify the cause of your stress, then offer a plan to help manage it. They offer practical guidance on time-management (hardly a scintillating topic, but important if you have a never-ending to-do list and not enough time to do everything on it), exercise and relaxation techniques, as well as nutrition. It's also the shortest of the three books listed here, so is helpful for the time-poor.

3. Overcoming Stress: A Self-help Guide Using Cognitive Behavioral Techniques, Leonora Brosan and Gillian Todd. When I start working with someone using CBT, I always recommend a book from this Overcoming... series, as they are all written by leading CBT experts in their particular field. Not only will this give you an excellent introduction to stress and its physical, psychological and behavioural impact on you, but it will also explain CBT and how it works; with a particular emphasis on the role of unhelpful thinking in driving your problems with stress.

I hope these books prove helpful. If you would like any more help in dealing with your stress, email dan@danroberts.com

Warm wishes,

Dan