Overcoming postnatal depression

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

Symptoms include:

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

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

•Feeling utterly exhausted and lacking energy

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

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

•You might have guilty or negative thoughts

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

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

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

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

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

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

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

Warm wishes,

Dan

What is the anxiety formula?

Two of the most common questions my clients ask me are:

•Why do we get so anxious about seemingly innocuous things?

•Why do some people suffer from anxiety when others seem to take things in their stride?

There are, of course, a multitude of factors that make up the answers to these questions, including our temperament – we know that some people are born with a highly sensitive temperament, while others are much more thick-skinned and robust – our family dynamics, traumatic experiences we might have in childhood or adolescence, whether our parents were anxious and so served as 'models' for our anxiety...

But another, simpler way to understand why we can get so anxious about things like developing a serious illness, or spending time in enclosed spaces, is using the 'anxiety formula'. This simply means that high levels of anxiety are caused by a combination of how likely we think it is that a feared event will happen, plus the cost of that event to us. And this in turn is affected by how well we think we might cope if the feared event happened, plus whether we think anyone could help or rescue us.

This sounds fiendishly complicated, but it's really not – let me give you a concrete example:

If I am anxious about, say, having a panic attack in a shopping centre, the degree of my anxiety will depend on how likely I think that is to happen. If I think it's only 10% likely, I won't get very anxious on my drive to the shops; if I think it's 90% likely, I will be very anxious indeed. If I then think that I if I do have a panic attack, I will only be 5% embarrassed (perhaps because I can hide in the toilet until I feel calmer), my anxiety might come down a bit; if I think I will be 95% embarrassed (because everybody will see me panicking and think badly of me), my anxiety will go up, not down.

The next bit of the formula involves coping and rescue factors. So if I think to myself, 'Well, I might have a panic attack, but my therapist taught me how to use deep breathing to calm myself down, so I'm sure I could cope with it and eventually be OK,' (coping) my anxiety would ease off a bit. If I thought, 'Having a panic attack would be absolutely awful – I might faint and end up in hospital,' up goes my anxiety again. And finally, if I thought people would be kind and help me (rescue), I might feel slightly reassured; but if I imagined people might ignore me or even be unkind, I could feel very alone and even more anxious.

You can apply this anxiety formula to anything that's making you feel worried or afraid and it will always explain why that seems manageable in one situation but deeply uncomfortable in another. Crucially, this formula not only helps us understand why we get so anxious, but how to modify the unhelpful thinking that amplifies risk while making us underestimate our coping resources to deal with whatever life throws at us.

I strongly believe that no-one needs to struggle alone with their anxiety, so do get some help from me, another cognitive therapist or a charity like Anxiety UK in treating your problem – if you would like to book a session with me, email dan@danroberts.com

Warm wishes,

Dan

Excellent self-help book on worry

I am always keen to promote the best sources of information to help people gain insight into their problems, because without insight into what is making us unhappy, we cannot hope to overcome it. I'm currently reading Dr Robert L Leahy's The Worry Cure: Stop Worrying and Start Living – one of the best self-help books I have read for a long time. Dr Leahy is one of the world's pre-eminent cognitive therapists and condenses 25 years of clinical experience into this informative and highly readable book.

As I often tell my clients, there is nothing wrong with worry per se – it is a normal and even helpful cognitive strategy for thinking about and solving problems. But, as Dr Leahy so eloquently explains, for some of us worry can be both excessive and distressing. Chronic worry is associated with a wide range of psychological problems, from depression to anxiety disorders including OCD, health anxiety, social phobia and especially generalised anxiety disorder (GAD), in which persistent worry is one of the distinctive features.

The Worry Cure explains why some of us worry more than others; offers a range of questionnaires and other diagnostic tools to help you understand what your 'worry profile' is; and, crucially, provides a wealth of tips and techniques to help you reduce your worry and learn to confront the problems that unhelpful worry actually stops you solving.

One of the paradoxical things about worry is that it can be a way of avoiding actually solving your problems. Although you may spend many hours fretting about them, which gives the illusion of control and makes you think you are tackling them, it can actually get in the way of confronting problems head-on; separating the things you can control from those you cannot; coming up with solutions to those problems and taking action to actually solve them, not just spend fruitless hours worrying about them.

So do buy the book – and if you want help with chronic worry, email dan@danroberts.com

Warm wishes,

Dan

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

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 dan@danroberts.com

Warm wishes,

Dan

Bibliotherapy for anger issues

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

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

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

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

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

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

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

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

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

Warm wishes,

Dan

How to set goals in cognitive therapy

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

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

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

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

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

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

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

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

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

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

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

Warm wishes,

Dan

Do you find meditation a struggle?

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Most of us now know that meditation is good for us. Part of the recent upsurge of interest in meditation – and especially mindfulness practices – has been a deluge of media articles explaining why mindfulness is so helpful. And, of course, it is. There is a large and growing body of research proving that regular mindfulness meditation can reduce stress, tackle anxiety and recurrent episodes of depression, help us feel more relaxed, centred and in tune with our lives. And let's not forget 2,500 years of Buddhist psychology and mind-training, in which mindfulness is a key tool.

The only trouble is, many people start meditating with the best intentions, only to give up when they find it way more difficult than expected (and advertised in all those glossy magazine articles). I have been meditating almost every day for six years and, let me assure you, it is still a struggle on some days. My mind is restless and I find my thoughts wandering for minutes at a time. I am fidgety and my body just won't settle into a comfortable posture. Sometimes, I even think 'What's the point of this? It's such a struggle, maybe I should just give up!'

Practice, practice, practice

But I don't, because I am committed to that daily practice for the rest of my life. Why? Because I also know how wonderful meditation can be, especially when we sit for longer periods. That's when the mind naturally settles – like sediment in a bowl of water – and we can reach deep states of calm, quiet and peacefulness. 

I also know that these pleasurable states are rare – and are actually not why I practice. Counter-intuitively, the practice is not necessarily about feeling peaceful and relaxed. It's about being disciplined, sitting every day at (ideally) the same time, making that deep commitment to my personal growth and development.

And sitting there while my mind tells me it's bored, restless, irritable, dissatisfied and that I should open my eyes and make the coffee now is developing my mental muscle – the one that helps me deal with daily irritations and upset with calm and steadiness (known as 'equanimity' in Buddhism). The one that helps me resist cravings for the chocolate bar I don't really need, that extra glass of wine, the must-have shirt that's 50% off in a sale.

That is why I practice – and it's why just sitting with the discomfort, without acting or reacting, is one of the reasons meditation has such profound long-term benefits.

As the Zen saying goes: 'Just sit'. Meaning: just meditate, every day. Easy, hard; relaxing, frustrating; fascinating, boring. Just do it and over time you will feel the benefits.

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

Warm wishes,

Dan

Five simple steps to combat depression

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

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

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

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

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

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

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

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

Warm wishes,

Dan

The healing power of imagery

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Imagery techniques are increasingly used in both cognitive and schema therapy, as they can be much more powerful and transformative than just talking about a problem. The most common imagery technique in schema therapy is called 'rescripting', which means accessing an upsetting memory (usually from childhood, but it can also be a more recent memory) and changing the narrative in some way, to reduce the emotional charge associated with that memory.

For example, if your mother was extremely critical of you as a child, this may have had a long-term impact on your confidence and self-esteem. As an adult, you might find criticism of any kind hard to accept; and have particular problems with dominant or critical people such as partners, friends or colleagues. This might also have led to the formation of a Defectiveness or Subjugation schema, which would be triggered whenever anyone was critical of or angry towards you.

Imagery in schema therapy

If we were working on this in schema therapy, I would ask you to close your eyes and allow an image to come of a time when you felt criticised or attacked as a child. When you accessed a memory – say of your mother telling you off harshly for making a mistake in your homework – I would get you to relive the experience as much as possible, to make it vivid and real. We would then change the image in some way – like adding a new ending to a movie – that would fundamentally alter the memory you still carry of that event.

This can be transformative, removing most or all of the negative emotions you feel when you remember that incident. Over time, this helps heal your schemas – so you don't find criticism so hurtful, or people so hard to deal with – and increases your sense of resilience, confidence and self-worth.

The focus on 'experiential' techniques like this is one of the things that makes schema therapy such an effective, powerful approach – allowing us to heal deep-rooted, hard-to-treat problems that other therapies might have failed to tackle.

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

Warm wishes,

Dan

Bibliotherapy on compassion

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

In this post I will focus on compassion and compassion-focused therapy – a new form of cognitive therapy designed to help with deep-rooted issues such as long-term or cyclical bouts of depression, low self-esteem or unhelpful self-criticism. The idea is that you can read one or all of these books, depending on which appeal to you. And you can read the whole book or dip into the chapters that seem most relevant to you.

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

2. The Compassionate Mind Guide to Managing Your Anger, by Russell L Kolts. This warm, wise and helpful book is written by an American clinical psychologist specialising in anger issues, with vast experience of working with groups such as prisoners, for whom destructive anger is clearly a major problem. He draws on Paul Gilbert's compassion-focused therapy to explain the evolutionary/psychological basis of anger, especially its role in protecting us from threats, either real or perceived. CFT focuses on strengthening the parts of our brain that help us feel calm, confident, strong, peaceful and safe; these act as a direct antidote to feelings like hostility or aggression, so are fundamental to feeling less angry and generally happier and more emotionally balanced.

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

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

Warm wishes,

Dan 

Overcoming panic attacks

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

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

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

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

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

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

Warm wishes,

Dan

Bibliotherapy on mindfulness

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

In this post I will focus on mindfulness, an ancient Buddhist practice that, since the 1970s, has been adapted by Western psychologists to help treat a range of physical and mental difficulties. The idea is that you can read one or all of these books, depending on which appeal to you. And you can read the whole book or dip into the chapters that seem most relevant to you.

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

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

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

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

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

Warm wishes,

Dan

Bibliotherapy on anxiety

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

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

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

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

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

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

Warm wishes,

Dan

What is 'thought-action fusion'?

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

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

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

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

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

Generalised anxiety disorder

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

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

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

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

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

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

Warm wishes,

Dan

Try loving-kindness meditation

Three of the core Buddhist meditation practices are the body scan, mindfulness of breathing and Metta Bhavana, or loving-kindness meditation. 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, or 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 is traditionally in five stages, so here are the first two – I will go through the full practice in a later post:

1. This practice will take 10 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. After 10 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 

Living a compassionate life

Compassion is one of those words, like kindness, that some people seem to feel uncomfortable with. When I suggest that a self-critical client could be more compassionate to themselves, they often say, 'But how would I motivate myself?' Or 'How could I stop my standards from slipping?' This idea, that being harshly self-critical is the best form of motivation, often baffles me. Think of it this way: if your child was struggling with maths at school, would you want their teacher to shout at them and tell them they were stupid and pathetic? Or would you want a teacher who was encouraging, helped them understand what they were doing wrong and kindly taught them, step by step, how to improve their work?

It's a no-brainer, isn't it? So why do we think that being harsh and unkind to ourselves, using names like 'idiot', 'stupid' and 'loser', will do anything but drain our self-confidence and make us feel stressed, anxious and unhappy. We also know from MRI scans of the brain that our brains cannot distinguish between external attack – from a bully, say – and internal attack, when we are punishing and angry in our thoughts and self-perceptions.

There is also an idea that kindness and compassion are fluffy, wishy-washy concepts – fine as ideas but of no use when dealing with the harsh realities we often face in daily life. Not so. When learning about compassion, I have been deeply struck by the teachings of Tibetan Buddhists like the Dalai Lama and his French interpreter, Matthieu Ricard. In his wonderful book, Happiness: A Guide to Developing Life's Most Important Skill, Ricard describes the often harrowing stories of Tibetans who have suffered terribly at the hands of the Chinese military – China has occupied Tibet since 1950, killing and imprisoning hundreds of thousands of innocent people.

But the Tibetans, who have been tortured or seen their loved ones murdered, are neither bitter nor full of hatred for their tormentors. Instead, their deep resources of compassion allow them to retain their sanity and equilibrium. The Buddha teaches us that hatred is a poison for the mind; it causes as much suffering for the hater as the object of his or her hate. When I read these stories I am humbled, because of people who have suffered so much can forgive their invaders, I can certainly forgive the petty annoyances and difficulties people cause me.

The Dalai Lama tells us that compassion is not just for the easy people in our lives – those we love and care about. Compassion is for everyone, whether we like them or not; those who help us and those who do us wrong; the easy and the difficult, likeable and dislikable. As he says, 'Everyone wants happiness; nobody wants to suffer'.

So, try to be a little more compassionate in your life – both to those you come into contact with and yourself. Compassion really is like a healing balm to a troubled mind.

If you would like to learn more about being kinder and more compassionate to yourself, and would like to arrange a session, email dan@danroberts.com

Warm wishes,

Dan

Thoughts racing? This meditation will help

When you are feeling stressed or anxious your thoughts might race, making it hard to slow down or focus on what you're doing. Although this is completely normal, it can feel really unsettling, as the content of those thoughts is likely to be negative or frightening, so it's a bit like watching a scary movie stuck on fast-forward... If this is a problem for you, here is a simple mindfulness meditation technique that can really help:

Mindfulness of breathing

1. First, make some quiet time for yourself – take 10 minutes out of your busy day, that to-do list can wait! Switch your phone to silent and make sure you won't be disturbed. Find a comfortable position, either cross-legged on a cushion on the floor, or sitting on a straight-backed chair. Make sure your spine, neck and head are in alignment – erect but not tense, so you are sitting with a sense of calm alertness.

2. Set a repeat timer on your phone to 5 minutes, then close your eyes and settle into your body. Do a quick scan of your whole body, from the tip of your toes to the top of your head, noticing any areas of tension and allowing those parts of the body to soften and relax. You can imagine breathing into the tense area, then releasing any tension on the out-breath.

3. Bring your attention to your breath, following the entire breath cycle as it travels into the nostrils, down the back of your throat, into the lungs, then back along the throat and out of your nose. Notice the way your chest and belly rise with each in-breath, then fall on the out-breath. Don't try to change or control the breath in any way, just let your body breathe itself – which it does every second of your life, whether you notice or not.

4. Start counting after each breath cycle, beginning with 1 – so breathe in, out and mentally count 1; in, out, 2; in, out, 3 and so on until you reach 10. If you find yourself carried off by thoughts, that's fine – be kind and gentle with yourself, direct your attention back to the breath, then go back to 1.

5. If you find yourself counting 20, you have got distracted! Again, just go back to 1 and start again.

6. When you hear the first timer signalling 5 minutes, you can choose to continue counting, at the beginning of each breath cycle – so count 1, in, out; 2, in, out; 3, in, out and so on. Or, if your thoughts have settled and quietened down you can drop the counting and just focus on your breath.

7. When you hear the second timer, that's 10 minutes. Slowly open your eyes and gently move your body. Resume your day, carrying this calm, mindful attention into your next activity.

I really hope that helps. And if you would like to know more about mindfulness meditation, email dan@danroberts.com

Warm wishes,

Dan

Compassion for all - including you

The Buddha taught that we should have compassion for all living beings: every bird, animal, fish, insect... and human on this planet. This is not easy. Leaving aside the thorny question of what we are supposed to eat if we take this idea to its logical extreme, let's focus on people, because that's complicated enough. For example, it's easy to feel compassion for those we love or like. We can forgive those closest to us pretty much anything, because we have such a strong bond with them.

Our friends, parents, siblings, children, spouse – if we are lucky enough to have good relationships with these people, feeling compassion for them is not hard. But what about that colleague you don't get on with at work – the one who talks about you behind your back? Or the guy who just cut you up in traffic, nearly causing a nasty accident?

Taking it one step further, how about politicians like Donald Trump who promote violence and racism? Should we really feel compassion for him? And harder still, how about a murderous dictator like Stalin or Hitler – surely they are the last people on earth we should feel compassion for.

As someone who is passionate about Buddhist psychology's depth, richness and practical wisdom, I have long struggled with this idea. But as far as I understand it, the Buddha would say that we should feel compassion for everyone, even those we find abhorrent, because the alternative is to fill our minds with hatred, anger and hostility, which he called poisons of the mind.

If I spend my days hating Trump, who suffers? Not him, for sure. I can fundamentally disagree with his odious behaviour without succumbing to hatred – instead, I can wish for him to change, to become a less hate-filled and harmful person, because that will reduce the suffering he causes in the world.

And I can't believe that anyone who is so full of anger and hatred is truly happy; so I can have compassion for their unhappiness without approving of the person in any way.

Compassion for yourself

If this all seems hard to grasp, surely it's easier to think about feeling compassion for yourself? Sadly, in my experience of helping people with all sorts of psychological problems, this is neither simple nor easy. Time and time again I am saddened by the harshly critical way in which people talk to themselves in their minds.

They call themselves names like 'idiot' or 'failure', say they are 'pathetic' or 'crazy' or worse. And this, of course, creates suffering – research shows that harsh self-criticism is linked with depression, low self-esteem, anxiety, eating disorders, anger-management problems, and more.

So a key focus with all of my clients is encouraging them to be kinder to themselves. Mindfulness meditation really helps with this, as do a wide range of cognitive and schema therapy techniques. But you can start today, simply by catching yourself using harsh words when you speak or think about yourself. Ask the simple question, 'Would I talk to my best friend like this?' If the answer is no (and it almost always is), try speaking to yourself a little more kindly. It could make a huge difference to the way you feel day to day.

And if you would like to learn more about compassion, email dan@danroberts.com

Warm wishes,

Dan

Yoga and mental health

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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