Mental health

How to look after your Vulnerable Child

One of the most important ideas in schema therapy is that we all have different 'modes' – aspects of our personality that get triggered in different situations. For example, many of us have a Demanding Parent mode, which is the part of us that pushes us hard to achieve and be successful. Because this mode pushes us too hard, it can lead to stress, exhaustion or burnout, because our drive to achieve exceeds our internal resources and so we struggle to cope with the relentless demands. 

Another part – the most important one in schema therapy – is the Vulnerable Child mode. We call this Little Dave, or Sue, or Steven, and so on (mine is called Little Dan) and it's the part that holds all of our vulnerability, anxiety, unhappiness, loneliness, feelings of rejection or being bullied, depending on our experiences as a child. For example, if your parents were harshly critical of you throughout your childhood, this part will feel defective and incompetent – as if nothing you ever do is good enough. If one of your parents died or left the family when you were young, your Vulnerable Child will feel abandoned and, as an adult, you will be hypersensitive to being left or rejected by those you love. 

In schema therapy, we work hard to look after this part of you – to help him or her feel protected, safe, cared for. In fact, we try to meet those core needs that were not met when you were a child. So if your parents were flaky or untrustworthy, as your therapist I would work very hard to be a solid, dependable, trustworthy person for you. If one or both of your parents was cold and unloving, I would try to be extra-warm, friendly and kind. In this way (as well as using all of the schema therapy techniques, especially imagery) we would, over time, heal your Vulnerable Child – and help you feel calmer, stronger, more confident and secure. It's quite magical to watch this transformation take place – even with the deepest, most sensitive wounds.

Caring for yourself

Of course, you don't need schema therapy to start this healing process yourself. Learning to be kinder and more compassionate to yourself is a good start – take a course in mindfulness, visit a Buddhist centre near you or check out Dr Kristin Neff's website, where there are many free resources on self-compassion training. Yoga is another great way to heal your mind and body, as is reading one of the many wonderful self-help books available – try Loving-Kindness: The Revolutionary Art of Happiness, by Sharon Salzberg; or Get Your Life Back: The Most Effective Therapies for a Better You, by Fiona Kennedy and David Pearson, for starters. If you are using alcohol, drugs or food to deal with painful emotions, you may need help to tackle your compulsive behaviour. Visit my Resources page to find a whole range of useful organisations working in this area.

It is my strong belief that, whatever has happened to us in our past, it is never too difficult or too late to change. You may not be able to do this on your own – if so, seek help from me, another schema therapist or any psychotherapist sufficiently well trained and competent to tackle deep-rooted problems. Ultimately, healing yourself begins with a decision – that you are worthy of love and happiness; that you do not want to spend the rest of your life suffering because of painful experiences that were not your choice, not your fault in any way. We only have one life, so it's up to all of us to make the most of it, however hard it has been up to now.

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

Warm wishes,

Dan 

 

 

How to deal with suicidal thoughts

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

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

Helping with depression

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

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

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

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

Warm wishes,

Dan

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

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

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

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

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

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

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

 

 

How self-criticism affects your mental health

It's common sense that being overly harsh or self-critical in your thinking will have a negative impact on your mood, confidence and overall wellbeing. But I think it's important to understand exactly why this is the case. Because of the miracle of magnetic resonance imaging (MRI) scans, we now have an intimate knowledge of how the brain operates under stress. We can see which parts of the brain 'light up' when we are feeling stressed or attacked – this is known as the 'threat system', a powerful self-protective network in the brain that detects and responds to any kind of danger or threat.

When you engage in self-critical thinking, calling yourself an idiot, or saying you are stupid or useless – especially if your internal dialogue has an harsh or hostile tone – MRI scans show the same threat system lights up in your brain as if someone else was shouting at or scolding you. It's no surprise that this kind of thinking is closely linked with depression, problems with anger and anxiety, as well as a lack of confidence or low self-esteem.

When you speak to yourself harshly, it's as if there is a bully in your head judging everything you say or do and putting you down at every turn. Not helpful. If you do tend to engage in self-critical thinking, try the following exercise to start being kinder to yourself:

The best friend test

When you make a mistake, have a setback or feel like you have failed at something important to you, you might find yourself slipping into a well-worn groove of negative, self-critical thinking: 'I am such a loser – why do I always screw things up?', or 'God, that was pathetic, I really am a failure.'

Unsurprisingly, these words will hurt and you will find your mood dipping and confidence ebbing away.

Instead, try to start noticing when you talk to yourself like that and take a step back. Imagine your best friend had just made the same mistake, had a setback or failed at something they valued. What would you say to them? Would you be harsh, mocking or critical? Probably not. I'm guessing you would try to be supportive, encouraging and help them see that it wasn't the end of the world.

You might say things like, 'Don't worry, it seems bad right now but you will feel better about it soon,' or 'Everybody makes mistakes sometimes – that doesn't make you stupid or a bad person, just human.'

Now try and start talking to yourself in the same way. If you notice that self-critical thinking kicking in, use the Best Friend Test to be a bit more kind and compassionate to yourself. Over time, it will help you feel calmer, stronger and more at peace. After all, life is hard enough, so why make it harder by being unkind to yourself?

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

Warm wishes,

Dan

What is the Healthy Adult mode in schema therapy?

One of the key ideas in schema therapy is that we all have different 'modes', or parts of our personality, which are more or less helpful for us in our lives. One of the most important of these modes is the Healthy Adult, which is the part of you that does all the important day-to-day stuff like going to work, being a caring parent and partner, paying the bills, going to the gym, not drinking too much, and so on. 

So the Healthy Adult does all the important, healthy stuff that you often take for granted, but without which life would quickly grind to a halt. This part is also very protective, again in terms of the outside world, being assertive when you need to stand up to an aggressive boss, say, or dealing with the teenage neighbour who loves blasting their favourite house music at 2am.

Silencing your inner critic

The Healthy Adult also protects you from yourself. In schema therapy, we also work with two 'maladaptive parent' modes, the Demanding Parent and Punitive Parent. The first drives you way too hard, often leading to stress or burnout – nothing is ever good enough. And the second is your inner critic, telling you that you are stupid, or fat, or useless. Both modes need to be disempowered, told to shut up and leave you alone. It's the Healthy Adult's job to do that. 

Finally, and perhaps most importantly, the Healthy Adult looks after the most vulnerable, wounded part of you, the Vulnerable Child. This part holds a lot of your most difficult schemas, so is the mode that is triggered when you feel anxious, upset, threatened or ashamed. All of our work in schema therapy is about healing this part of you, at first with my help but later through your Healthy Adult.

Working together, we will build this healthy, protective part of you like an inner muscle, until it is strong enough to calm you down when you're upset, or help you through a challenging job interview or parent's evening at school. You will feel yourself getting stronger and stronger; making increasingly healthy choices in your life; letting go of self-soothing strategies like excessive drinking or spending... And you will find yourself becoming more like the person you always wanted to be, but never knew how.

If you would like to find out more about how schema therapy can help you, call me on 07766 704210 or email dan@danroberts.com

Warm wishes,

Dan

 

Are you an orchid or a dandelion?

One of the key ideas I always share with my clients is that we all have a certain temperament, which we are born with and which has a profound impact on the way that life experiences, good or bad, affect us. Many of my clients have a sensitive, emotional temperament, which means that they are much more affected by problems in the family than someone with a robust, more intellectual temperament. It's important to emphasise that having a certain kind of temperament is neither good nor bad – it's just like being born with brown or blonde hair, blue or green eyes, not your choice or fault in any way but simply how you arrived on this planet.

I also tell my clients that I have a sensitive, emotional temperament too. This can make life difficult at times, as I am affected deeply by negative experiences and my childhood was pretty bumpy, to say the least. But it also bestows on me particular talents and gifts – I could not be a therapist without this kind of temperament. After all, you wouldn't want a therapist who was insensitive, unempathic or unkind! 

Dandelion children

Psychologists have, in recent years, been investigating the theory that we are all either orchids or dandelions. This is based on the Swedish idea that 'dandelion children' are pretty robust and do well in any environment, even if the parenting and family dynamic are less than perfect. US psychologists Bruce Ellis and W. Thomas Boyce extended this idea to include 'orchid children', who were especially sensitive and so needed just the right conditions to thrive. In practice, that means loving, nurturing parents; a relatively calm and stable family environment; and no traumatic experiences during childhood.

If orchids have a difficult family dynamic, they will struggle – developing a number of schemas which will affect them throughout their life and very likely experience depression or anxiety, among other problems, when these schemas are triggered by stressful events. But, if these sensitive children are well-nurtured, they will bloom into beautiful young people and later adults – just like the orchids above.

If you are a dandelion, you may not need my help. But if you're an orchid whose childhood was not what you needed, life may be a struggle. If you would like some help, call me on 07766 704210 or email dan@danroberts.com

Warm wishes,

Dan

 

Should you take antidepressants?

If you are struggling with anxiety, or have been depressed for a few weeks and visit your GP, they are likely to prescribe antidepressants. But should you take them? And is medication really what you need? In a large number of cases, I think not. Before I explain why, let me be really clear – if you are severely depressed, your mood may be so low that some of the alternatives I'm about to suggest just won't work. In that case, you may need a course of antidepressants to lift your mood enough for talking therapy, for example, to work.

If you have bipolar disorder, you will probably need to take a combination of different medications, such as a mood stabiliser and possibly antidepressants. And, crucially, if you are currently taking antidepressants you should never stop taking them without consulting your psychiatrist or GP. This can be extremely risky, so please don't do it.

That said, I do worry that many hard-pressed GPs now dole out antidepressants far too easily. I don't blame them for this – they have so little time with patients now that they are often forced into the simple solution that medication represents. They may also want to refer a patient for a talking therapy such as cognitive-behavioural therapy (CBT), but know the waiting list is so long it would not be helpful for someone who was struggling (some of my clients say they faced a 12-month wait for CBT on the NHS – an impossibly long time to wait if you're in a bad way).

One of the biggest problems with antidepressants, though, is that they only help with the symptoms of depression as long as you're taking them. When you stop, unless you have addressed the issues that made you depressed in the first place (like negative or overly self-critical thinking, or low self-esteem) you are likely to get depressed again. That's why all the evidence shows that combining antidepressants with psychotherapy is far more effective than the meds alone.

Research also shows that regular cardiovascular exercise is just as effective as antidepressants for mild to moderate depression. As is mindfulness-based cognitive therapy (MBCT), which is especially good at preventing relapses. Both are completely free, once you've learned how to do them, have no nasty side effects and work straight away, unlike the 2-6 week wait for the meds to take effect.

So I'm not saying you should never take antidepressants – far from it. Just that they are powerful drugs that don't help everyone, have strong side effects and should not be taken lightly. And – especially for milder forms of anxiety or mild to moderate depression – other approaches work just as well.

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

Warm wishes,

Dan

How to combat your inner critic

Many of us are self-critical, on a spectrum ranging from mild at one end to severe at the other. If we are mildly- self-critical, we might rebuke ourselves if something goes wrong, but not be too upset about it. If that criticism is harsh, we might be extremely sharp, even angry with ourselves – jumping on every mistake we make, however small, and beating ourselves up severely. Most, if not all, of my clients criticise themselves in this way.

One of the many things I love about schema therapy is that it's extremely effective at combatting this inner critic. We even have a name for this 'mode', or side of you – the Punitive Parent. This may simply be the internalised voice of one of your parents, especially if they were consistently harsh or judgemental with you when you were growing up.

Or it may be a way you learned to speak to yourself, perhaps if you felt unloved or flawed as a child, so assumed there must be something wrong with you that needed constant correction. For example, if you have a Defectiveness schema, you may have a frequent nagging sense that you're not good enough or a failure in some way. You might think that other people judge you harshly for these (supposed) defects, so you should judge yourself harshly too – either to make sure you don't repeat a mistake, or to try and pre-empt saying or doing things you will later regret and feel bad about. 

Battling the Punitive Parent

When I see people beating themselves up in this way, it always makes me sad. Nobody deserves to feel this bad about themselves – and, in schema therapy terms, the part of you that feels bad is your Vulnerable Child, who feels attacked and victimised by the Punitive Parent's constant belittling and criticism. There is a famous quote attributed to the Buddha. These are not exactly his words (most of the Buddha's 'quotes' we see on Facebook or floating around the Web are modern interpretations of what he actually said) but they carry the gist of what he wrote – and I love the sentiment behind them:

You, as much as anyone in the universe, deserve your love and respect.
— Buddha

You are worthy of love, kindness, respect. Whatever your flaws, real or imagined. However many things you have done in your life that you regret, or wish had turned out differently. That scared, vulnerable child inside you craves love and affection, not shaming and harsh rebukes. And all of the research shows that talking to yourself in that way is one of the things that makes you vulnerable to depression, chronic stress, problems with anxiety and anger. So it's very important that you learn to battle the Punitive Parent, to get it to shut up and leave you alone.

For many people, this is a central component of our work in schema therapy. You can also explore other avenues to defeat that critical voice, such as compassion-focused therapy (like schema therapy, a proven approach to increasing self-compassion, wellbeing and contentment), learning mindfulness meditation, or exploring Buddhism, which for 2,500 years has been helping people be kinder and more compassionate to themselves. See my Resources page to find out more about these and other routes to better mental health.

And if you would like my help with becoming less self-critical, email dan@danroberts.com

Warm wishes,

Dan

Why is your 'attachment style' so important?

Humans, like all mammals, are hard-wired to attach to their parents from the moment they are born. When you are a tiny baby, the first person you usually attach to is your mother, followed by your father, grandparents, siblings, aunts and uncles, friends, teachers, colleagues, romantic partners, and so on, throughout your life. This 'attachment system' in your brain is very powerful, because when you are small and helpless it is literally a matter of life and death whether your parents – usually starting with your mother – love, feed and keep you safe. So attaching to them is absolutely vital.

The first person to really understand this was John Bowlby, a psychoanalyst who argued that all babies have this attachment system and, depending on their relationship with their mother, form either a secure on insecure attachment. A secure attachment means your mother has looked after you well enough, given you lots of love and hugs, changed you when you were wet, fed you when you were hungry, made plenty of eye contact, sung to you – and all the other things babies need to feel safe and secure.

Attachment and relationships

If your attachment was insecure, your mother – for all sorts of reasons, often because her own attachment with her mother was not secure – couldn't meet your needs as a baby, so you didn't feel 100% loved by or safe with her. One of Bowlby's  groundbreaking ideas was that the kind of attachment style you developed as a baby would stay with you into adult life. Why is this so important? Because people with an insecure attachment will struggle to form strong, lasting, happy relationships with friends, colleagues and especially romantic partners.

In schema therapy terms, these people may have an Abandonment schema, so constantly worry about being left or rejected by their partner. Understandably, this causes all sorts of problems and makes it very hard to have a stable, happy relationship with anyone. The good news is that, as Bowlby and later attachment researchers found, you can learn to have stronger attachments – and therefore better relationships – throughout your life. Schema therapy is one of the approaches that is very good at making these changes. If you do have an Abandonment schema, for example, we would work together on healing it so you felt happier, more confident, more trusting and relaxed in relationships.

As I always tell my clients, however difficult things were in your childhood, and however much you are still affected by those experiences as an adult, it's never too late to change. Heal your schemas and you heal the most painful and vulnerable parts of you – this really can be life-changing, as I have seen time after time with the people I work with.

If you would like to find out more about schema therapy, email dan@danroberts.com

Warm wishes,

Dan

 

 

How mindfulness meditation helps with anxiety & depression

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

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

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

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

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

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

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

Warm wishes,

Dan

When someone you love is depressed

It seems to me that we don't give enough help and support to the loved ones of people with mental health problems. If your partner, child, sibling or parent has a mental health problem like an anxiety disorder, depression or an eating disorder, it can place a huge strain on you. They may be the one who is struggling – and, hopefully, receiving the right help to resolve their problems – but it's easy to overlook the impact that can have on the people around them.

If someone close to you is depressed, you may feel out of your depth as you try to help them. Your normal strategies, like being encouraging or trying to look on the bright side, might not actually be helpful for your depressed loved one – and may even make them feel worse. Coming up with solutions for the many problems they perceive in their lives might also be unwelcome right now. And we know that depression can be 'contagious', meaning that you might also feel low, or become influenced by their negative and hopeless view of events.

Here are three ways you can help your loved one as they struggle with depression:

1. Understand what they are going through

If you have never experienced depression yourself, it can be bewildering when someone close to you is depressed. But it's incredibly common – one in four people will experience some kind of mental health problem in the course of a year, with the most common form being mixed anxiety and depression. Understanding what depression feels like, what causes it and especially what can help is key.

I strongly recommend Overcoming Depression: A Self-help Guide Using Cognitive Behavioural Techniques, by Paul Gilbert – one of the world's leading experts on depression. You can also find a wealth of information online from charities such as Mind and the Mental Health Foundation.

2. Remember that it's not your job to fix them

When people we love are struggling, it's the most natural thing in the world to try and help them feel better. But when you are depressed it can be incredibly hard to lift your mood, or solve even minor problems that still seem utterly insurmountable because you lack energy, motivation and hope that things will get better. So rather than trying to fix them or gee them up just listen to them, keep showing them you love and care about them, and encourage them to see a mental-health professional, who does have the knowledge and skills to help them get better.

3. Help them take small steps to becoming more active

When you are depressed, you commonly stop doing the things you used to enjoy – partly because you have no energy, and partly because you don't take much pleasure in them any more. But if you stop doing things you enjoy, or that give you a sense of self-worth, your mood will clearly keep getting lower. So – gently – encourage them to do small things, such as going for a walk or to the park, doing some gardening, seeing close friends, going to the cinema, or if they feel up to it helping someone else, like an elderly neighbour (we know that this is especially helpful when you feel down).

If they are drinking heavily, encourage them to cut down or even stop for a while, as alcohol is a depressant. If their diet is really poor, try to get them eating more healthily – perhaps cooking healthy meals for their freezer. And if they aren't doing any exercise, see if you can help them start – regular cardiovascular exercise like swimming or brisk walking is as effective as antidepressants for mild to moderate depression.

Finally, if their depression does not lift after a few months, they may need talking therapy such as cognitive behaviour therapy (CBT), or schema therapy if they have had recurrent episodes of depression. You may need to encourage them to see a therapist – this is especially hard for men – but remind them that one in four people experience a mental health problem at some point in their life; and that therapy is now extremely effective, so it's definitely worth seeking help if their life is a real struggle.

I hope you find this helpful – please also remember to take care of yourself, as this will be a tough time for you too. 

Warm wishes,

Dan

 

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 dan@danroberts.com

Warm wishes,

Dan

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 dan@danroberts.com

Warm wishes,

Dan

Why is your temperament important?

We are all born with a certain temperament, which varies from child to child – even siblings in the same family may have very different characters. Exactly what gives us our temperament is still being investigated by psychologists, but it's probably a combination of our genes and brain makeup, as well as experiences during pregnancy and early infancy.

One thing is for sure: your temperament is extremely important, because it determines how much you are affected by the experiences – both good and bad – you have in the family and at school, throughout childhood and into early adulthood, when your brain, personality and ways of thinking, behaving and coping with life are all being formed. In schema therapy, we are also very interested in schemas and modes, which are also formed in part because of your temperament.

You can think about temperament in terms of spectrums, for example between being introvert and extrovert, rational and emotional, sensitive and thick-skinned, passive and aggressive... If you plotted where you fall on all of these spectrums, that would be your temperament.

Sensitivity: a double-edged sword

Most of the people I see for therapy have sensitive, emotional temperaments, which means they are much more vulnerable to negative experiences in their family such as abuse, emotional neglect, harsh criticism, angry outbursts, excessively strict parents, or those struggling with drug, alcohol, or mental health problems as they try to raise their children. Having a sensitive temperament means you will be much more affected by even minor problems in the family – this will lead you to form painful schemas, which will be triggered in adult life when you experience similarly difficult events.

But as I often tell my clients, having a sensitive and emotional temperament is a double-edged sword. It does make life difficult, but it also gives you great gifts – of kindness, empathy, intuition, creativity, the ability to love and nurture others. I know this to be true, because this describes me very well too! Being a sensitive and emotional sort of person has made life difficult at times but also makes me – I hope – a kind, compassionate, insightful therapist.

So if you are struggling with the impact of a painful childhood, remember that a big part of this story is your temperament – which, of course, is not your fault, because it's something you were born with. Try to be compassionate to yourself as you embark on a journey to heal your painful schemas, free yourself from the long-term effects of a tough childhood and become a happier, stronger, more self-nurturing person.

If you would like help with healing your schemas, email dan@danroberts.com

Warm wishes,

Dan 

 

 

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 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

Loving-kindness meditation - part two

I recently posted about Metta Bhavana, or loving-kindness meditation, giving you the first two steps of directing loving-kindness to yourself, then a friend – you can find the full meditation below. Just to recap, in Pali, the Buddha's language, metta means ‘love’ (in a non-romantic sense), friendliness, or kindness. Bhavana means development or cultivation. But you don't have to be a Buddhist, or have any interest in Buddhism, to benefit from this practice – mindfulness meditation is increasingly taught as a secular, non-religious series of practices – loving-kindness is one of these.

As a therapist, I help many people who are harshly self-critical or full of self-dislike. Sadly, this internal self-attack often leads to psychological problems like depression, low self-esteem, chronic stress, anger or anxiety. Increasing your sense of kindness and compassion – towards yourself and others – is a proven way to generate positive mental states such as joy, love, calmness, equanimity and strength.

The practice

The full Metta Bhavana practice traditionally encompasses five stages, so allow five minutes for each stage. Here is a step-by-step guide to the practice:

1. This practice will take 25 minutes, so switch your phone to silent (if it has a timer, set it to repeat after 5 minutes) and make sure you will not be disturbed. As with all meditation, it's important to attend to your posture, making yourself comfortable on a cushion on the floor or a straight-backed chair, sitting with your spine, neck and head in alignment. Your posture should be upright and alert but relaxed.

2. Bring your awareness into your body, starting in your feet and travelling slowly all the way up to your scalp. If you notice any tension or discomfort, allow that part of the body to soften and relax. Then bring your awareness to the heart region – it can help to place your hand over your heart and feel the warmth this generates. Allow this warmth to permeate into your practice.

3. In stage one, you direct metta towards yourself. You can visualise your face, perhaps seeing the metta as a golden light shining from your heart and enveloping your whole being. Or remember a time when you felt happy, or proud of yourself – there is no set rule, so whatever helps you get in touch with positive feelings towards yourself is fine. (If you don't feel anything, that's not a problem – feelings will come in time, so don't try to force them). Repeat these phrases in your mind: 'May I be well. May I be happy. May I be free from suffering.' Say them slowly and deliberately – this a great gift you are offering yourself, so don't rush it.

4. If you become distracted by thoughts, sounds or body sensations, that's not a problem. Simply notice that your attention has wandered and gently bring it back to the phrases.

5. In part two, we direct metta towards a friend – this should be someone you feel positive about, not a person with whom you have conflict or difficulty. Repeat: 'May you be well. May you be happy. May you be free from suffering.' If you feel like varying the phrases to suit this person, that's fine – so it could be 'May you be free from stress. May you be confident. May you be free from anxiety.' Again, don't force this, but if it happens naturally that's fine.

6. In part three, we direct metta towards a neutral person. This can be someone you see regularly but have never spoken to, maybe in the supermarket or your favourite coffee shop. See this person's face in your mind's eye, then repeat 'May you be well. May you be happy. May you be free from suffering.'

7. Part four entails directing metta towards a difficult person in our lives. At first, it's best to choose someone you are having a little difficulty with, not your worst enemy. Unsurprisingly, this is generally the hardest stage, but remember that when you fill your mind with negative, angry, hostile thoughts, or fill your body with emotions like resentment or hatred, you are the one who is suffering, not them. And the Buddha taught that all beings deserve our compassion, not just the ones we like!

Repeat 'May you be well. May you be happy. May you be free from suffering,' perhaps visualising golden light flowing from your heart to the difficult person. If you struggle, place your hand over your heart to generate warmth in this region, then try again. If you feel numb or angry, that's fine, just accept these feelings and continue repeating the phrases, as having a positive intention is the most important thing.

8. Finally, we direct metta to all life. You may want to start by imagining yourself your friend, the neutral and difficult persons, sending metta to each in turn. ('May we be well. May we be happy. May we be free from suffering.') Then expand that circle to include all of your friends, family, community, residents of your city, country, continent... expanding the flow of metta until you cover the whole globe. Then include insects, fish, birds, mammals, reptiles... ('May all life be well. May all life be happy. May all life be free from suffering.')

6. After 25 minutes, allow yourself to sit quietly, noticing if you feel any different than when you started. If not, that's fine, but you may notice a greater sense of softness, an uplift in your mood, or feelings of warmth and friendliness. Just allow whatever's happening right now to be there, then slowly open your eyes and start moving your body; and take this new attitude into the rest of your day.

I very much hope this practice proves helpful for you. If you would like to know more about cultivating greater kindness and compassion for yourself, email dan@danroberts.com

Warm wishes,

Dan

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 dan@danroberts.com

Warm wishes,

Dan

Feeling stressed or depressed? Go easy on the news

The media has always portrayed the world through a distorted lens, focusing on and exaggerating bad news, while ignoring or discounting the good. But before 24/7 rolling news and the rise of digital media, it used to be much easier to filter out all the scary, upsetting things happening around the world. Now, they are very hard to avoid – look at any news website, watch TV or check your Facebook feed and you are bombarded with stories that can make the world feel like a scary, dangerous place. It's easy to feel that we are under threat too, which is not helpful if you are prone to anxiety, as you probably over-perceive threats to your safety or wellbeing already.

Although we do face some really unpleasant and frightening threats right now, it's important to remember a few things:

1. We are living through the safest, least violent period in human history. Despite what the media might tell you, crime rates in the West have plummeted over the last 50 years. If we are lucky enough to live in a stable, Western democracy, we are actually extremely safe.

2. Although there have been a spate of truly awful terror attacks throughout Europe, this is not a new phenomenon. I grew up in London, which faced constant threats of attack and regular bombings by the IRA; other terror groups were active throughout Europe, so without downplaying how shocking and horrible the recent attacks have been, we have lived through similar problems before. And the probability of you being involved in a terror attack now is still extremely low.

3. Fear sells. The media have long known this and, sadly, some sections of the media – especially tabloid newspapers – have lost any semblance of caring about their readers' wellbeing, printing lies, mistruths and highly distorted versions of reality that make everything seem frightening and bleak. Just take their treatment of the refugee crisis as an example, or the blatant lies and fearmongering that persuaded so many people to vote for Brexit. 'Never let facts get in the way of a good story,' as the old journalists' joke goes. 

4. If you are struggling with any kind of mental health problem – like stress, anxiety or depression – it might be good to take a news break for a couple of weeks. Reading upsetting stories, or watching violent movies/programmes is not good for your brain, as it will ramp up your feelings of insecurity, fearfulness and being under threat. Be kind to yourself and take a break – remember that just a couple of hundred years ago humans would mostly only get news about their extended family and local community, by word of mouth; no lurid headlines or minute-by-minute coverage of shocking events across the globe. Our brains are not designed for this media bombardment, and countless studies show the negative impact it has on our psychological health.  

So, if you are having a hard time right now, treat yourself with care and either limit or give up your news intake completely for a while. And if you would like help with any kind of psychological problem, email dan@danroberts.com

Warm wishes,

Dan