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 dan@danroberts.com

Warm wishes,


How mindfulness meditation helps with anxiety & depression

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

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

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

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

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

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

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

Warm wishes,


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,