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

Overcoming public speaking anxiety

Public speaking anxiety is extremely common – in fact, I would say that more of us are anxious about speaking in public than not. You can think about it as a hierarchy of anxiety: speaking to one person you don't know can make you a little nervous; two, three, four, more anxious still; addressing a group of people you haven't met, a bit more difficult; giving a presentation to a small room-full of strangers, just that bit worse; then finally, way up there on the anxiety scale, giving a speech to a conference, or appearing on live TV – too hard to even contemplate for some people.

The first thing to remember is that anxiety is a perfectly normal human response to situations we find scary or threatening. It's not bad or wrong, any more than joy or sadness are. In fact, anxiety is very important – if we didn't feel anxious when, say, we walked down a dark alley at 3am, or our toddler opened up a toolbox full of sharp objects, we would fail to prevent potentially bad things from happening.

But when we get super-anxious about giving a 10-minute speech to a small room of friendly, interested people, we are clearly feeling anxiety that is disproportionate to the situation. When we get this anxious we are likely to experience a racing heartbeat, get sweaty and dry-mouthed, possibly go blank or have trouble concentrating, think lots of worrying, worst-case-scenario thoughts... no fun at all.

The good news is that this form of anxiety is treatable, either with cognitive-behaviour therapy (CBT), which is very effective for anxiety-related problems, or using self-help techniques like this one, which I often teach my clients:

Change the movie

When we get anxious about something in the future, we usually play a movie (let's call it the Scary Movie) in our heads about all the things that might go wrong – we imagine ourselves drying up and having nothing to say; forgetting our speech notes, so we have to wing it for 10 horrible minutes; other people seeing how nervous we are and judging us for it; or our audience looking bored, yawning, fidgeting and talking among themselves because our speech is so dull. Play this movie in your head enough times and, guess what? You will succeed in making yourself extremely anxious and, ironically, causing the exact problems you are worried about on the day.

So let's change the movie to... let's call it the Problem-Solving Movie. First, write down all the things you think might go wrong and find solutions for them. Worried about being dry-mouthed? Take a bottle of water with you. Worried your speech is dull? Read it to a colleague and ask for constructive criticism. Worried about appearing worried? Practice deep breathing to calm yourself down before and during the speech.

Then play this new movie every day in your head, in which everything goes well – you solve any little problems that come up, imagine everyone looking interested and engaged, giving you a big round of applause at the end, then see yourself looking proud and happy after the speech. The more detail you can include the better, especially about how things look/feel/sound, because then your brain will believe it's actually real and has already happened (our brains have exactly the same response to imagery like this and real-life experiences). This will help you feel less anxious on the day. Incidentally, this technique also works really well for driving tests, first dates, meeting in-laws, job interviews...

If you would like some help with your public speaking problems, email dan@danroberts.com

Warm wishes,

Dan

Five common myths about cognitive therapy

In some ways, cognitive therapy is the victim of its own success. Since it was developed by Aaron Beck in the 60s, cognitive therapy (also known as cognitive behaviour therapy, or CBT) has become the dominant form of 'talking therapy' in numerous countries around the world, including the US and UK. This is mainly because it works so well – research consistently shows CBT to be the most effective form of therapy we currently have. But it's also about economics – the NHS has embraced it partly because it's cost-effective too. Many problems can be resolved in under 20 sessions, some (such as phobias) in five or six.

However, as I explain below, this is not how Beck intended cognitive therapy to be practised. His initial therapy model was a 20-session treatment for depression, which I think is about right for most people. I strongly disagree with the (financially-driven) short-term treatments many people receive on the NHS for anxiety, depression and other serious psychological problems. This is just one of the myths I try to bust with my clients, and when I am teaching cognitive therapy to students. Here are some more:

1. CBT is all about filling in forms

Not true. Although some CBT techniques do involve written work for clients (such as daily thought records), good cognitive therapy is based on the relationship between therapist and client. This should be warm, trusting and supportive, as with other approaches to counselling and psychotherapy. And many of the techniques I and other cognitive therapists use involve stories, metaphors, working with imagery, role-playing, mindfulness-based techniques, drawing, Gestalt-style 'empty-chair' work... none of which involve forms!

2. CBT is a short-term, quick-fix approach

Nope. In my own practice, I always tell people that there is no such thing as a quick fix for complex, highly sensitive problems; so our work will be slow and incremental. A few problems – especially 'specific phobias' – can be resolved quickly. Most others take time – somewhere between 10 and 20 sessions, in my experience; while deep-rooted, hard-to-shift problems might take a year or more.

3. Feelings are not important in cognitive therapy

Ironically, cognitive therapy is all about emotions. Despite the name (cognitions being all of the thoughts, values, beliefs, memories, etc that make up our minds) we only focus on changing unhelpful thinking because that has a powerful impact on feelings and moods. Nobody comes to therapy saying 'I want to think more rationally'! They come because they are hurting in some way; my job is to help them feel better on a consistent, long-lasting basis.

4. Cognitive therapy is all about positive thinking

A common myth, this one. In fact, cognitive therapy is all about rational, realistic, balanced thinking, which is not necessarily positive. If you are in a horrible job or relationship, thinking positively about it would be both impossible and unrealistic. Someone once said that cognitive therapy is all about seeing things as they really are. Life is full of pain, hardship, loss, struggle... as well as joy, wonder, love, delight. The key is to give both equal weight, rather than focusing purely on the negative (common to both anxiety and depression, in different ways).

5. CBT only offers superficial symptom-relief

A common criticism from my non-cognitive counselling/therapy peers. It's true that CBT can help people feel better much more quickly than other approaches. That's one of the reasons it's so popular and successful. But this is only the start. If you suffer from depression, say – which has a high chance of relapse – as well as helping you feel better in the short-term, my aim is to teach you new ways of thinking and behaving which protect you from depression in the long-term. Again, we have very good evidence to back this up, as well as my own experience of staying in touch with clients after therapy ends to see how they're doing.

So, hopefully you now have a clearer idea of what cognitive therapy is and is not. If you would like to book a session, email dan@danroberts.com

Warm wishes,

Dan

Learning to love yourself

Derek Walcott

Derek Walcott

I was reminded of this Derek Walcott poem at a recent talk by Jon Kabat-Zinn, founder of the Western mindfulness movement (and one of my heroes). It seems to embody not just a self-compassionate, mindful attitude, but also the key idea in schema therapy – that to heal our past hurts we must learn to love ourselves, even if we have long held negative, self-limiting/critical beliefs.

Also, it's a beautiful poem – I hope you enjoy it...

Love After Love
The time will come when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other's welcome,
and say, sit here. Eat. 

You will love again the stranger who was yourself.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you
all your life, whom you ignored
for another, who knows you by heart. 

Take down the love letters from the bookshelf, 
the photographs, the desperate notes, 
peel your own image from the mirror. 
Sit. Feast on your life.

Best 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

Do you have trouble managing your anger?

Anger is a tricky emotion. In pure evolutionary terms, anger is our signal to fight a threat, as part of the fight, flight or freeze response (anxiety is the emotion that tells us to freeze or flee). This is all well and good if you are facing a hungry lion, but not so helpful if your boss has just criticised you, or another driver cuts you off in traffic. But this primitive, self-protective threat response explains why we can react so strongly, violently even, if we feel threatened – in a very crude way, that's what anger is for.

Most of my clients have some kind of problem with anger, roughly falling into two camps. The first group is scared of or uncomfortable with anger – theirs and other people's. If this describes you, it may be because one of your parents was given to angry outbursts, which as a child were very frightening. That vulnerable child inside you learns to be scared of anger, even when you are – on the outside at least – now an adult. It's also possible that your family were rather buttoned-up, viewing any expression of anger as rude and uncivilised (a very British way to deal with anger!), so you learned to keep your angry feelings stuffed deep down inside you. As an adult, it's now hard to access and express them, even when it's appropriate to do so.

The other problematic form of anger is expressing it too often and too volcanically. This is the cause of domestic violence, bar brawls, violent crime, road/air/trolley rage and aggressive bullying. It's just as harmful as repressed anger, both to those around you and ultimately yourself – you will probably end up in serious trouble, perhaps even prison, if you cannot contain your anger and explode at the smallest provocation. People with this 'anger style' may come from very angry, combustible families in which everyone was always shouting at/being aggressive to each other. They may also have been hurt, neglected or abused as children, so that child inside is absolutely furious at the world and can't help but express it, even when it's dangerous or destructive to do so.

The angry modes

In schema therapy, when people are expressing anger in a problematic way, we see this showing up as one of three angry modes. If you find yourself blowing up all the time, perhaps shouting or swearing at other people, being threatening or even physically violent, you are in Bully/Attack mode. This is the most problematic angry mode, so a major part of your therapy would involve learning how to respond to triggering situations in a calmer, more rational manner. Anger-management strategies can be helpful here, as well as longer-term healing of schemas such as Abandonment, Mistrust/Abuse or Vulnerability that can trigger this attack-is-the-best-form-of-defence style of responding to threats or challenges.

The second mode, Angry Protector, is less destructive but still problematic. This is when you express anger in more subtle ways, perhaps non-verbally by scowling or with a closed-off body posture; with sarcasm or cutting humour; angrily complaining about or being harshly critical of other people. This mode is all about keeping a distance between yourself and others, perhaps because deep down your vulnerable child is scared of attack or rejection. You may also be uncomfortable with any kind of criticism or challenge, so respond with subtle but unmistakeable shows of anger to shut that down.

Anybody can become angry – that is easy. But to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy.
— Aristotle

The third mode is the most helpful, even if it doesn't at first appear that way! This is the Angry Child mode, and is evident in the way a person expresses their anger – often disproportionately to the perceived insult or infraction. You may have a tantrum, smashing or throwing objects (not to hurt others, just to release your anger). You might also get very tearful or upset. And beneath the anger is always hurt, fear or sadness, so if we were working together I would help you express your anger in a non-attacking, non-destructive way, so we could contact and soothe the hurt, upset or fearful vulnerable child lying just beneath the angry surface. 

When we get people into Angry Child mode, teach them how to express their anger verbally or by doing something safe but physical, like twisting a towel or punching a cushion, they experience a tremendous sense of relief – all the anger literally drains out of their bodies. It can then be deeply healing and soothing to deal with the hurt that lies beneath – over time, your anger subsides as you feel happier, safer, stronger and calmer.

If you have a problem with anger and would like my help, email dan@danroberts.com

Warm wishes,

Dan

 

Do you struggle with romantic relationships?

Many people have difficulties with relationships, for all sorts of reasons. Finding a suitable person to be with and then maintaining a reasonably happy, stable relationship is not easy, for any of us. But if you avoid romantic relationships altogether; if you find yourself repeating the same pattern over and over again in every relationship you have; or if you are in a long-term relationship but feel consistently unhappy, perhaps feeling disproportionately angry with or jealous of your partner, it's possible that unhelpful schemas are the root of your problems. As I explain in this article about schemas, they are unconscious, deeply-rooted ways of thinking and feeling that get triggered by certain situations – and romantic relationships are among the most common triggers.

If you avoid relationships, perhaps for fear of getting hurt or rejected, you may have an Abandonment schema. This is often linked to the death of a parent, or a significant member of the family leaving in a sudden and upsetting way. The love and care you received as a child may also have been unstable and unpredictable, perhaps because one of your parents had mental-health problems, or was just not cut out to for the complex business of parenting. So avoiding relationships altogether is one way to make sure that this painful schema never gets triggered – sadly though, that means your life will be lonely and unfulfilling (if you actually want a relationship, which most of us do), so this is clearly not the most helpful strategy. 

Watch out for schema chemistry

If you find yourself playing out similar patterns in relationships again and again, or perhaps choosing a certain type of man or woman in one relationship after the next, 'schema chemistry' may be to blame. This describes the unconscious, schema-driven forces that make a certain kind of person irresistibly attractive. When you feel very strong physical chemistry with someone, as if you can't get enough of them and feel like they are perfect for you in every way, tread with caution. It may just be healthy sexual attraction, of course, in which case there is nothing to worry about. But if you have a history of falling in love with unsuitable people, that lightning bolt of chemistry – though exciting and seductive – is not to be trusted.

If you are in a relationship but it's not a happy one, again that is not unusual – long-term relationships are hard work, requiring commitment, sacrifices and a huge amount of love and patience on both sides. But if you have the same kind of argument over and over – volcanically losing your temper about fairly minor domestic incidents, becoming very anxious or consumed with jealousy every time your partner speaks to a member of the opposite sex – then your schemas may be to blame again.

The good news is that the schemas which cause all of these problems can be healed. Although that's not easy, it's far from impossible. There are now a number of therapeutic approaches designed to help people with these deep-rooted, life-disturbing problems, such as schema therapy or compassion-focused therapy. When I am working with people who have these kinds of problems, one of our long-term goals is for them to find a happy, healthy, stable relationship – after all, what is life for but to love and be loved? And a healthy relationship as an adult is one of the best ways to heal the wounds of childhood, so a little work in this area goes a long way.  

If you would like some help from me in finding and maintaining a healthy relationship, 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

 

 

Cognitive therapy and chronic pain

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

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

The mindful approach to stress

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

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

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

If you would like help with chronic pain, email dan@danroberts.com

Warm wishes,

Dan

How does 'exposure' work in CBT for anxiety?

If you feel anxious about something, the most understandable reaction is to avoid it. If you're scared of heights, you will avoid tall buildings; if it's spiders, rooms that look cobwebby will be a no-no; if you're scared of dogs, you may avoid parks, and so on. The problem is that, although this is understandable, it's not helpful. Every time you avoid, you are giving yourself the message that the 'phobic object' (a high place, spider or dog) is a scary, dangerous thing to be avoided at all costs. In fact, it's only because you avoided that you didn't fall off the edge or get bitten.

So if you see a cognitive therapist like me for help with a phobia, a central plank of the treatment is 'exposure' – doing the thing you are scared of, even though it's scary. This may just seem mean, but in fact it's extremely effective and is backed up by decades of research. We know that every time you do something scary, your brain gets more and more used to the scary thing, learning that it's not in fact dangerous and nothing bad really happens. This is called 'habituation'.

If you are phobic of spiders, as well as working on your anxiety-provoking thoughts about arachnids, I will get you to look at pictures of spiders in magazines or on the internet. We will work up to having a spider in a glass jar in the room, then you holding the jar and, ultimately, touching or holding the spider. And if you go through this exposure process, your phobia will be completely cured – something that may have completely blighted your life will be gone forever.

The only way out is through 

That's why, even though it can be tough, it's so important to use some form of exposure in a CBT treatment of any anxiety 'disorder' (what psychologists call the different kinds of anxiety-related problem people commonly experience). This applies to panic disorder, agoraphobia, health anxiety, obsessive-compulsive disorder (OCD), phobias, post-traumatic stress disorder (PTSD), body dysmorphic disorder (BDD), and generalised anxiety disorder (GAD).

As I often tell my clients, when you're treating anxiety the only way out is through. So if you're scared of the Tube, you have to end up taking the Tube. If it's pigeons, we'll need to look at lots of pictures of birds and maybe send you to Trafalgar Square. With OCD, you will need to actively imagine – and probably do – the things you try so hard to avoid thinking about and doing. With PTSD, you will need to run through the traumatic experience again as an imagery exercise with me, and visit the place where the trauma happened.

Exposure really works

As I also tell my clients, if I had a magic pill that would solve their problem, I would give it to them in an instant. But until that day, exposure is the closest thing we have to a magic cure, because I have seen it work miracles with people – if you stick at it, this treatment can literally change your life. And I will be with you every step of the way, encouraging, supporting, explaining the science behind it and problem-solving any difficulties you may encounter.

So if you or someone you care about has problems with anxiety, I strongly recommend you give CBT, and exposure, a try – remember that CBT is the only talking therapy recommended by the NHS for all anxiety disorders. That's because it works, while I'm afraid most other forms of counselling or therapy – while they might help with bereavement, say, or depression – really don't help with anxiety disorders.

If you would like some help with anxiety, email dan@danroberts.com

Warm wishes,

Dan

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

Acceptance vs change in cognitive therapy

A common dilemma for people engaged in cognitive therapy is understanding when to try and change a thought, behaviour, feeling, situation, relationship, etc and when to accept it. One way I explain this apparent contradiction is to say that the first stage of cognitive therapy is all about change. We identify specific problems in the client's life and come up with goals embodying the ways that person's life would be different if we solved those problems – this is all about change.

We then identify the thoughts, beliefs and behaviours that are maintaining the person's problems and start to modify those – again, our agenda here is change.

But more advanced cognitive therapy places far more emphasis on acceptance than change. Increasingly, the new 'third wave' forms of cognitive therapy like compassion-focused therapy (CFT), dialectical behaviour therapy (DBT) or acceptance and commitment therapy (ACT) are a fusion of mindfulness, cognitive therapy and other approaches, such as experiential or psychodynamic therapies, to help treat more longstanding or hard-to-reach problems and conditions.

Mindful acceptance

Acceptance is at the core of mindfulness theory and practice, because the Buddhists who originally harnessed the power of mindfulness understood that in life there are many things we can neither change nor control. We all get older and eventually die, as do those we love and care for. We all suffer from problems with our health, especially as we get older. Many things appear entirely beyond our personal control, such as climate change, the fluctuating economy, wars, natural disasters and even the actions of our own Government. So it is fruitless for us to spend hours worrying or disturbing ourselves about the things we cannot change – the Buddha discovered 2,500 years ago that an accepting mindset will greatly reduce our distress and unhappiness.

And we often find that, counterintuitively, mindfully accepting aversive or unpleasant feelings such as anxiety or anger and 'breathing into' them, rather than struggling, fighting or resisting them, helps those feelings naturally decrease and even dissolve. Acceptance can be both a powerful and empowering approach to solving some of our most painful problems.

In summary, change what you can and accept what you can't – not easy, by any means, but a very helpful way to live if you can manage it.

If you would like to arrange a session, email dan@danroberts.com

Warm wishes,

Dan

Is someone close to you narcissistic?

Psychologists talk about 'personality types' when they are describing ways of thinking and behaving that are common to us all, such as being a bit selfish/self-focused, obsessive about tidiness, or consistently avoiding things we feel uncomfortable with. We are all on a spectrum with these traits, but for some of us they are much more pronounced than others.

You may also have heard the term 'personality disorder', which is when someone strongly exhibits characteristics of one or more of these types, to such an extent that it affects their whole personality (not just their mood, as in a 'mood disorder' like depression) and typically makes life very difficult for themselves and the people around them.

Another term commonly used (and often misused) in the media is 'narcissistic'. Correctly used, narcissism describes someone who tends to be extremely self-focused, viewing the world and the people they encounter as being there to serve their needs. They will probably have an Entitlement schema and so feel entitled to special treatment, attention and recognition of their unique skills, knowledge or personal qualities. Narcissistic people also have a black-and-white view of the world and how things should be, with a strong belief that they are always right and that bad things in their life are other people's fault, not theirs.

Not every narcissist is willing to change , but some will – with enough leverage, incentive and assistance.
— Wendy Behary

Again, it's important to remember that we all have some of these traits and beliefs – it's how strongly those beliefs are held that's key. When these beliefs are deeply and rigidly held, then someone might be diagnosed with narcissistic personality disorder (NPD). Because people with NPD tend to be extremely single-minded about getting what they want, we see these individuals at the top of a number of professions, such as banking, politics, law, professional sports, music and acting.

It's tough to be in a relationship with a narcissistic person, because they tend to be very perfectionistic and critical. Because empathy is not their strong suit, they just don't get why or how they have hurt someone, and will tend to fly into a rage when challenged or criticised (behaving like the angry little person above). If any of this sounds like someone close to you, they may need help in learning to relate to others in a more compassionate, less self-serving way.

Schema therapy can help with that, if they can be persuaded to come along, which is often challenging. People with these characteristics usually end up in therapy because people – an angry boss or partner on the verge of leaving – have pressurised them to do so.

The most important thing is to understand why they are acting in baffling and sometimes hurtful ways – and remember that it's definitely not your fault. Knowledge is power, so read up on narcissism (I strongly recommend Disarming the Narcissist: Surviving and Thriving with the Self-absorbed, by Wendy Behary, a leading schema therapist specialising in narcissism) and develop strategies for protecting yourself and maintaining healthy boundaries.

If you or someone close to you is narcissistic, and you would like help with that, email dan@danroberts.com

Warm wishes,

Dan

Do you want to learn mindfulness meditation?

Mindfulness meditation is very much in the news these days. Mindfulness is increasingly being taught in schools, corporations, to athletes, veterans, the police and even MPs in the Houses of Parliament! And for good reason – a regular meditation practice has been proven to help you feel calmer, less anxious and depressed, to respond better to stressful events, deal with chronic pain or illness with greater balance and equanimity, improve concentration, memory and overall wellbeing. 

As someone who teaches my clients to meditate, I have seen first-hand what a difference it can make for people struggling with mental health problems. And as a regular meditator for over six years, I know from personal experience what a profound difference it makes to one's life. I genuinely believe that life is so much happier and more positive as a direct result of my meditation practice and am deeply grateful that I made meditation a part of my daily life.

Learning to meditate

When I am teaching clients to meditate, I first direct them to Mark Williams and Danny Penman's excellent book, Mindfulness: A Practical Guide to Finding Peace in a Frantic World. Mark Williams is a British psychologist who helped develop mindfulness-based cognitive therapy (MBCT), an eight-week programme to help people deal with stress, anxiety and especially recurrent bouts of depression. 

This book is based on the MBCT course, but is also a wonderfully clear and simple guide to mindfulness meditation – it's the perfect place to start if you are interested in bringing the transformative power of mindfulness into your life. It also includes a CD of guided meditations by Mark Williams, which will really help when you're getting started.

If you would like to take an MBCT course, visit the Resources section of my site to find a reputable place to study. I also think that a blend of mindfulness and schema therapy is an excellent way to tackle a wide range of psychological problems. If you would like to know more, 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