How chronic pain and illness affect your mood

As I sit writing this, I am in a moderate amount of pain. Like millions of people around the world, I suffer from chronic musculoskeletal (back and hip) problems, so most days come with either a small or large dose of pain, depending on how well I am looking after myself, how stressed I am, how much sitting I do that day, and various other factors.

Having been in some degree of daily pain for almost two years now, I have learned a few things about the relationship between physical pain and mental suffering:

  • It's important to distinguish between 'primary' and 'secondary' pain. I learned this from Vidyamala Burch, founder of the excellent Breathworks. This organisation provides the Mindfulness-Based Pain Management programme, which has a strong research base behind it and helps many people in the UK and beyond deal with chronic pain and illness.

  • Burch also co-wrote Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing with Danny Penman. In this superb book the authors explain that primary pain is the actual raw data caused by, say, a gash in your leg. Intriguingly, the majority of the pain you end up experiencing is secondary – the pain created by your brain as it amplifies that raw data, depending on the way you think about and respond to your primary pain.

  • This only became clear to me recently when I visited my osteopath during a bad patch physically, feeling down and hopeless about resolving my problems. He reminded me that the pain was significantly better now than when I first came to see him; and that it was crucial to remain as positive as possible, because my negative thoughts ('I will never get over this'; 'Nothing will help'; 'I can't stand the pain any more') were undoubtedly making the pain worse (this is essentially what the Buddha taught – that human life inevitably involves pain, but we create suffering by our response to that pain. But that's a topic for another day).

Managing the pain

I think it's important to note here just how hard it is to maintain a positive, optimistic mood in the face of chronic pain or illness. As anyone with a long-term condition knows, it grinds you down, especially when it flares up or your symptoms get worse for whatever reason. Please don't think I underestimate the impact of physical ailments on your mood – it is a struggle and gets everyone down from time to time, as well as causing stress and worry/anxiety about the future.

I couldn't understand that vicious cycle any better. But once you understand the relationship between pain sensations in the body and the way that your brain either amplifies or minimises those sensations, it seems crucial to me that you do all you can to use your brain/mind to help your body.

 When I first hurt my back and was really struggling, Vidyamala Burch's guided meditations really helped pull me through. Here is a great one on being more compassionate to yourself, available for free, if you would like to try it. And if you are dealing with chronic pain or illness, my thoughts and well wishes go out to you – I hope you get the medical help you need and manage to overcome your problem soon.

If you would like some help with the psychological aspects of your condition, call me on 07766 704210, email or use my Contact form to get in touch.

Warm wishes,


Cognitive therapy and chronic pain

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

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

The mindful approach to stress

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

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

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

If you would like help with chronic pain, email

Warm wishes,


The difference between pressure and stress

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

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

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

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

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

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

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

Warm wishes,


Why exercise is key for good mental health

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

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

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

Stress-relieving exercise

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

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

And if you would like to book a session, call me on 07766 704210 or email

Warm wishes,


How to use mindfulness in daily life

In recent years, mindfulness has gone from being a little-known (in the West) form of Buddhist meditation to a hugely popular, much-written-about practice. It's hard to pick up a Sunday supplement these days without reading something about mindfulness, whether it's being taught to schoolchildren to deal with exam stress, or embraced by corporations such as Google, Facebook and eBay – it has become one of the buzzwords of our age.

This, of course, is a great thing – I strongly believe that everyone should meditate, and if we all lived our lives along Buddhist principles many of the world's problems and most of our cruelty and inhumanity to each other would be transformed overnight. But I am concerned about the misunderstandings of mindfulness, so wanted to set the record straight.

Mindfulness – especially in a psychotherapy context – is a skill. I teach my clients mindfulness techniques like I teach them any other skill, like how to identify and challenge negative thoughts; how to use relaxation techniques to de-stress and reduce anxiety; or how to 'push against' their avoidance in order to face and overcome their fears. 

To understand this, it's helpful to think about the difference between formal and informal mindfulness practices. Formal practices involve sitting (usually, although they can include movement) in a quiet room, closing your eyes and concentrating for 20 or 30 minutes on your breath, body, thoughts or some other point of focus. Informal practices simply involve waking up to the sensory experience of your moment-to-moment experience, whether that's looking intently at a leaf, cloud or sunset; concentrating on the many and varied sounds coming to your ears; eating your apple or sandwich and relishing every taste, smell, texture and colour of the food.

Although I encourage my clients to develop a formal practice – and have a daily practice myself – it's the informal practices that can be so powerful if you are suffering from a psychological problem like depression, anxiety, chronic stress or an eating disorder. That's because they allow you to choose where to place your attention – on the negative thoughts swirling through your mind, the painful emotions and physical sensations in your body, or... something else. Anything else.

Here's an example:

You are sitting in a cafe, having a pleasant day, when you receive a text message from your ex-boyfriend saying they want to see you. You have only just got over the breakup and this text, out of the blue, triggers a cascade of 'what if' thoughts...

'Why does he want to see me? What if he's changed his mind? Does he still love me? Maybe he's met someone else and wants me to hear it from him. God, that would just kill me...'

Unsurprisingly, these thoughts trigger a wave of powerful emotions: anxiety, upset, hope, fear, sadness, jealousy...

Within a few seconds, you have been catapulted from feeling happy and calm to being tossed around on waves of emotion. Then you remember your mindfulness training, close your eyes and take a few deep breaths. You sit upright and let your tense shoulders drop and relax. You focus on the warm, milky, chocolatey cappuccino in front of you, inhaling deeply of its aroma and then take a sip, tasting the coffee and noticing the sensation as it travels down your throat. Your mind keeps trying to pull you away with a string of 'what ifs' but each time you simply notice the thoughts, then gently but firmly bring your attention back to the coffee.

Your emotions naturally subside and you feel calmer. You put your phone away, deciding to respond to the text tomorrow, rather than rushing a reply you might regret. And you smile, at how just being mindful helped you out of a dark place.

Of course, it's best to develop both a formal and informal practice, but understanding why you are doing so can help you overcome the inevitable trials and tribulations involved. Developing this skill is, I believe, one of the simplest but most powerful steps you can take in overcoming your problem, whatever it might be. And once you learn how to apply them, mindfulness techniques are free, with no horrible side-effects, unlike some of the other treatments on offer.

If you would like to find out more about how mindfulness could help you, email

Warm wishes,


Sleep, mental health and wellbeing

When I start working with someone, one of the first questions I ask them is how much sleep they are getting. This is for two reasons: first, if someone is having disrupted or not enough sleep, that is often a symptom of deeper psychological problems like chronic stress, anxiety or depression. And second, not getting the sleep we need – especially on an ongoing basis – can make problems like these much worse.

It's common sense that we all need to sleep (different people needing more or less, but probably around 7.5 to 8 hours for most of us) but researchers are increasingly understanding the role of sleep and what is happening in our brains and bodies during our night-time rest. For example, we now know that dreaming is the way the brain processes and stores all of the important information we absorb during the day. Your brain has to sift through vast amounts of information, discarding most of it and storing all the things it thinks you will need at some point. So if we don't have enough nocturnal downtime, or our sleep is broken, we don't get enough REM (rapid eye movement) sleep, which is when we dream.

Sleep and your mood

Anyone who has kids knows only too well the impact that sleep deprivation has on our ability to function throughout the day. I often think that you don't know the value of sleep until you have a small baby, when it becomes like gold dust! Bleary-eyed parents will find it harder to concentrate, have perspective on their problems and make decisions; and their short-term memory will also be affected. Unfortunately, they will probably also be more impatient, snappy and irritable, as well as being prone to low mood and potentially depression.

Humans need sufficient sleep, rest and downtime – our bodies and brains are hard-wired for them, just as they need oxygen, food and water to survive. So if you are suffering from insomnia, you need to take that seriously. It could be related to (or causing) a psychological problem; it could also be draining your energy and joie de vivre, making life seem a bit bleak and joyless.

The good news is that fairly straightforward things like exercise, diet, caffeine and alcohol consumption, as well as sleep hygiene can make a huge difference to the amount and quality of sleep you are getting. So if you are struggling to sleep please don't suffer in silence – do see your GP, or get help from me or another therapist.

And if you would like to make an appointment to see me, email

Warm wishes,


Yoga and mental health

Girl doing yoga.jpg

As a late convert to yoga, I cannot recommend it highly enough. Having dabbled with ashtanga yoga a decade ago, when I wasn't quite ready for it, I thought it was a good idea to try again. And I'm so glad I did – the benefits for my mental and physical health are tremendous. My back pain has vanished, I feel physically stronger, calmer and much more relaxed on a daily basis.

Intriguingly, I recently learned that the main purpose of hatha yoga (the physical postures, which are actually just one aspect of yoga practice) was originally to prepare for meditation – developing the flexibility, stamina and settled mind required for extended periods of sitting. And yoga certainly dovetails perfectly with my daily meditation practice, each enhancing and strengthening the other.

If you – like most people in the West – suffer from stress, yoga is for you. And if you have any physical health conditions, such as headaches, digestive issues or back pain, yoga can help with those too. It may be more difficult to commit to any form of regular exercise if you are struggling with more serious mental health issues, such as depression or an anxiety disorder, but if you can try even a little yoga – say once or twice a week – it will really help.

Exercise combats depression

There is a large body of evidence showing the benefits of physical exercise for all psychological problems. For example, regular cardiovascular exercise like running, weights, playing sport, cycling, swimming – or more strenuous forms of yoga, such as vinyasa or ashtanga – is proven to be just as effective as antidepressants for mild to moderate depression. With no side effects (well, apart from feeling happier, healthier and more relaxed!).

If you do have a mental health problem, I would not recommend either meditation or yoga as a substitute for proven treatments like cognitive or schema therapy; but they are excellent additions to Western psychology. And, of course, Eastern practices like mindfulness meditation are increasingly used as part of talking-therapy treatments such as CBT.

If you would like to know more about the way Eastern practices such as yoga or meditation can be used alongside therapy, email

Warm wishes,


5 myths about mindfulness meditation

It's wonderful that mindfulness has gained so much popularity in recent years – it's hard to read a newspaper or Sunday supplement without finding a story extolling the benefits of meditation. Unfortunately some of these stories are not entirely accurate, and many people have misconceptions about what meditation is and how it can help. Here are five of the most common myths and misunderstandings I hear about meditation, to help you gain a clearer insight into this potentially life-changing technique:

1. Meditation is just for Buddhists

Not so. Although mindfulness meditation is a 2,500-year-old Buddhist technique, it is increasingly used in Western psychological, medical, educational and business settings. If you learn meditation from me, or another therapist, you are essentially learning a technique, like using thought records to challenge unhelpful thinking. Although I do have a strong interest in Buddhist psychology and philosophy, I only talk about that to my clients as far as they are interested in it. So you don't have to believe in any form of religion to benefit from mindfulness, all you have to do is sit quietly for a short period every day and watch your breath. That alone is proven to have a raft of benefits, from reducing stress and anxiety to lowering blood pressure. Simple.

2. You have to clear your mind of all thoughts

Again, no. If your mind is empty of all thoughts, you have a very unusual mind indeed. We are always thinking – even when we sleep – so the idea that we should somehow magically stop thinking when we meditate is neither helpful nor realistic. Instead, if we are trying to focus on our breath, say, when we find our mind carrying us off into thinking about lunch, we notice that and gently bring our attention back to the breath. Again, again, again – it might happen 100 times during a 20-minute meditation, but that's not a problem at all. In fact, this is the practice, because each time you notice and bring your attention back, you are strengthening your ability to focus, which is the whole point of meditation.

3. You have to meditate somewhere quiet

In some ways, this is true – it's helpful to meditate in quiet places, for example at home in the early morning. But mindfulness is a skill we are trying to cultivate for when we need it – on the Tube, in a meeting, in a shopping centre. So the more you practice in everyday situations, the more that skill is available to you when you most need it – like your toddler having a meltdown in the supermarket. I often meditate on the Tube, because it can be an unpleasant place – noisy, packed with people, hot, glaring lights... Far better to close your eyes and focus on sounds, say, than ride along grimly trying to ignore it all.

4. Meditation should always make you feel relaxed

Sometimes yes, sometimes no. There's a saying in Zen meditation: 'Just sit'. This means just meditate, every day: hard/easy, enjoyable/frustrating, relaxing/no change. It doesn't matter, because we meditate for the long-term benefits of daily practice. If you do it most days for a period of time, you will probably feel calmer, more grounded, less stressed, happier, more able to deal with stressors without reacting impulsively or unhelpfully. That's why we do it (and why I have, most days, for six years now – and will for the rest of my life).

5. Meditation is New Age hocus-pocus

It's true that meditation conjures up images of bearded, be-sandalled folk, incense and crystals. But mindfulness meditation, as well as having that 2,500-year history behind it, has been rigorously studied and researched in prestigious medical establishments since the 1970s. There is a huge body of research proving its effectiveness for a wide range of psychological problems, such as stress, anxiety and depression; and for medical problems like chronic pain and high blood pressure.

If you would like to find out more about mindfulness meditation, email

Warm wishes,


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

Warm wishes,