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If you've experienced a traumatic event, it's essential to recognize that your feelings are normal responses to an abnormal situation. The symptoms of PTSD can feel overwhelming, but they are your brain’s way of coping and trying to make sense of what happened. Here are some evidence-based strategies that may help in the early stages of recovery. Recognize Your Reactions as a Normal Response The fear, hypervigilance, emotional numbness, or intrusive memories you’re experiencing are all common reactions after trauma. These feelings may be alarming, but they are your brain’s natural response to protect and process. You are not "going mad." Your brain is doing what it’s wired to do in times of extreme stress. Manage Intrusive Memories Through Distraction In the days and weeks following a traumatic event, you might encounter intrusive thoughts or mental images. While it's tempting to dwell on these memories, research suggests that distraction can help reduce their intensity. Engaging in focused, absorbing activities can redirect your brain and help it calm down. For instance, consider playing a visually demanding video game or doing vigorous exercise while watching something engaging. Stick to Your Routines Routine provides structure and stability — crucial elements that can feel lost after trauma. Try to maintain your usual schedule as much as possible. Even if you don’t feel like attending social events or going to work, pushing yourself to do so may ground you. These moments of normalcy can help counterbalance PTSD symptoms. Tell Your Story: Integrating the Experience Re-narrating the story of your trauma can aid the brain in processing and integrating the experience. When intrusive memories arise, consciously recount the full story. Don’t only focus on the moment of impact. Include what happened next. For example: "I was injured, but then help arrived. I went to the hospital. I was treated and kept safe." Emphasizing survival and safety can help your brain move the memory from crisis mode to something it can file away. Challenge “What If” Thinking After trauma, your mind may flood you with hypothetical scenarios: “What if it had been worse?” or “What if someone else had been hurt?” These thoughts attempt to predict and prevent future harm, but they often feed anxiety and keep you stuck in survival mode. Acknowledge these thoughts, but avoid engaging with them. Remind yourself: “That didn’t happen. I am safe now.” Gradually Revisit the Scene of the Trauma Avoiding the place where the trauma occurred can reinforce fear. When you feel ready, consider revisiting it gradually. Use a “fear ladder” approach. For example, if your trauma happened on a train, start by visiting a station. Then sit on a platform, and eventually take a short train ride. Once you’re comfortable, work up to returning to the location itself. Facing the fear in manageable steps can help your brain relearn that the place is no longer dangerous. Reconnect With Enjoyable Activities Even if these activities don’t bring immediate pleasure, engaging in hobbies, socializing, or spending time in nature can help restore a sense of normalcy and joy. These activities activate parts of the brain that trauma tends to shut down, playing an important role in recovery. Seek Support: You Are Not Alone You don’t need to navigate PTSD alone. These strategies may help, but support from a qualified therapist can make a significant difference. Reaching out for help is a sign of strength, not weakness. Consider finding a professional who can guide you through the healing process. Conclusion In conclusion, healing from PTSD takes time and effort. Remember to be patient with yourself as you work through your feelings. By implementing these strategies and seeking support, you can navigate your way through this challenging journey. Always remember that you are not alone, and help is available. Lastly, the recovery process can sometimes be more effective with guidance. So, if you're feeling overwhelmed, consider professional support. It might just change your life.

Finding the right therapist can be a transformative journey, especially in a bustling city like London. With a diverse population and numerous options available, it is essential to narrow down your choices based on your specific needs. This guide aims to help you navigate this process, ensuring you find a therapist who not only understands your concerns but also provides support tailored to you. How to Find a London Therapist When searching for a therapist in London, begin by identifying your specific needs. This can include areas such as anxiety, depression, relationships, or trauma. Having a clear idea of what you're seeking will make it easier to find a therapist with the appropriate specialty. Next, consider your preferences for the type of therapy you desire. Options range from cognitive behavioural therapy (CBT) to psychodynamic therapy, and even art therapy. Research each method to find one that resonates with you. Once you have outlined your needs and preferences, start your search. Utilize platforms like Psychology Today or TherapyRoute.com to find qualified professionals. These sites often list therapists by location, specialty, and even client reviews. High angle view of an urban therapy practice in London Making the Most of Online Resources In today’s digital world, many therapists have online profiles or websites that provide valuable information. These can be great resources for potential clients. Here are some tips for effectively using online resources: Check Credentials : Look for therapists who are licensed and have appropriate qualifications. Most professional bodies in the UK, such as the British Psychological Society and the UK Council for Psychotherapy, provide search tools for registered members. Read Reviews : Online reviews can shed light on other clients’ experiences. These insights can guide you toward therapists with positive feedback and strong reputations. Virtual vs. In-Person : Consider whether you prefer in-person sessions or the convenience of online therapy. Many therapists in London offer both options, making care more accessible than ever before. Close-up view of a laptop with a therapist's profile open Initial Consultations An essential step in finding the right therapist is scheduling an initial consultation. This meeting allows you to assess if the therapist is a good fit for you. Many therapists offer this session for free or at a reduced rate. During the consultation, consider asking the following questions: What is your approach to therapy? What is your experience with issues similar to mine? How do you measure progress in therapy? This is also an opportunity for you to share your concerns and gauge how comfortable you feel with the therapist. Remember, a good therapeutic relationship relies heavily on trust and comfort. Understanding Costs and Logistics Before committing to therapy, it's essential to understand the financial implications. Therapy costs in London can vary widely. On average, sessions range from £50 to £150. Some therapists may offer sliding scale fees based on income levels, so don't hesitate to ask. Additionally, consider logistical factors: Location : Is the therapist's office easily accessible from your home or workplace? Think about travel time and convenience. Availability : Look at the therapist’s schedule. Are they available during the times that suit you? Flexibility might be necessary, especially if you have a busy lifestyle. Insurance : If you have health insurance, check if the therapist is covered under your plan. This can significantly reduce your out-of-pocket costs. Eye-level view of a serene counseling room with comfortable seating The Importance of Cultural and Personal Fit Finding a therapist also involves a cultural and personal fit. Your therapist should understand your background, values, and cultural nuances. This understanding can enhance communication and help establish a stronger therapeutic connection. When speaking with potential therapists, consider asking about their experience with clients from backgrounds similar to yours. A therapist’s familiarity with your cultural context can significantly improve the effectiveness of the therapy. Moreover, don't hesitate to trust your instincts. If you don't feel a connection during the initial consultation, it's perfectly acceptable to seek another therapist. In London, the options are plenty, and the right therapist for you is out there. Taking the First Step Ready to take the first step on your therapeutic journey? Start by researching and reaching out to several therapists. Remember that it’s okay to meet with multiple therapists before making a choice. Therapy is a deeply personal experience, and finding someone who aligns with your goals and resonates with you is crucial for success. Embrace the process, and trust that the right support will lead you towards healing and growth. As you navigate this journey, consider using resources to support your mental health outside of therapy, such as mindfulness apps, local support groups, or educational workshops. Take charge of your mental well-being, and don’t hesitate to reach out for help. A therapist in London can make a remarkable difference in your life. Finding the right therapist may take time, but every step you take brings you closer to understanding yourself and achieving emotional health. Navigate through options, seek connections, and most importantly, prioritize your well-being.

Understanding Trauma and PTSD Trauma is not a one-size-fits-all experience. It affects everyone differently and can show up in various forms. Broadly, we talk about three types of trauma: acute , chronic , and complex . Acute trauma  involves a single, sudden event — for example, a car accident or a violent incident. Chronic trauma  stems from repeated or prolonged exposure to distressing experiences, such as ongoing bullying, childhood neglect, or being in an abusive relationship. Complex trauma  occurs when someone is exposed to multiple traumatic events over a long period, often beginning in early life. In this post, I’ll focus on acute (or "simple") trauma . How Trauma Affects Us Human beings are complex, and so is our response to trauma. How we process a traumatic experience is shaped by many factors — our beliefs, our past experiences, the support we receive, and even how people treated us during or after the event. For instance, if you were involved in a road traffic accident, the emotional aftermath can be vastly different depending on how others responded. Were people kind and supportive, or dismissive and unhelpful? That context matters. What Happens in the Brain After Trauma? When we experience something deeply threatening — like a serious accident or assault — the brain goes into survival mode. It rapidly stores information about the event in vivid detail. Why? Because it wants us to learn  from the experience and avoid similar danger in the future. To illustrate: try to recall what you had for breakfast last Thursday. Unless something unusual happened, you probably don’t remember much. But if I asked you about a traumatic experience, you might recall the smells, sights, sounds, feelings — even the smallest details. Trauma memories tend to be intense and sensory-rich. However, trauma can also interfere with memory. Some people find they can't  remember key aspects of what happened, especially the parts that feel most important. This can be incredibly frustrating and distressing — but it’s also a common part of how trauma impacts the brain. Symptoms of Trauma and PTSD Many people experience intrusive symptoms  after trauma. These are sudden, unwanted memories that surface in your mind, often triggered by reminders of the event. They can also show up as nightmares or vivid flashbacks. You might also begin to avoid  people, places, or situations that remind you of the trauma — for example, avoiding driving after a car crash, or staying in after dark if you were attacked at night. This avoidance is your brain’s attempt to protect you from further harm. Other common symptoms include: Low mood or emotional numbness Loss of interest  in activities you once enjoyed Increased irritability or anger Changes in belief systems , such as feeling the world is unsafe or that danger is always around the corner Hypervigilance , or being constantly on edge Sleep problems  and difficulty concentrating What Helps? The good news is that for many people, these symptoms begin to ease over time. Within six months, there is often noticeable improvement, and by about one year, things can look and feel much better. Here are some strategies that can help in the healing process: Stick to your routines  as much as possible. Structure and familiarity can be stabilizing. Challenge “what if” thinking.  Remind yourself that the danger has passed — you are safe now. Tell the story of the trauma , especially when intrusive memories arise. Repeating the narrative, including how you survived , helps the brain process and integrate what happened. Revisit the place where the trauma happened.  This might seem counterintuitive, but returning to the scene can often be healing — seeing it as it is now, rather than through the lens of trauma. Keep doing the things you used to enjoy.  Even if they don’t feel pleasurable at first, engaging in them can slowly bring back a sense of normalcy and joy. Recovery from trauma is possible. Everyone’s path looks different, but with the right support and understanding, your brain and body can begin to let go of the constant state of alarm.

The benefits of exercise on stress and how to get yourself exercising. The evidence on the link between exercise and improved mood, concentration, health and wellbeing is strong, clear and consistent. Amongst the most common findings cited are that: · Exercise increases bodies production of endorphins · Exercise clears the mind of repetitive thoughts and worries · Exercise raises your mood · Exercises improves the quality of your sleep The mechanism for these effects are thought to be multiple. For example exercise is thought to act by increasing the neurotransmitter serotonin (acted on by antidepressants). It increases the growth of neurons thereby influences adaptive brain functioning. It regulates sleep which acts to support and facilitate many health giving processes. In psychological terms exercises provides a productive, effective activity which is often lacking in other environments. It facilitates social engagement and structures free time. Finally there is evidence that exercises boosts the brains ability to deal with stress and heightened emotions. Since exercise is so effective why is it that it is so difficult to stick with? One reason may be that there are so many pulls on our time and attention. We are motivated to exercise but our concentration and attention is often pulled in other directions. How to motivate yourself to exercise: An effective way to think about motivation is as something which is multiple. Think of yourself as having lots of motivations rather than having one pot of motivation which runs to empty by the end (or even the middle) of the day. You might be motivated to go to the gym but also motivated to watch the television. Motivated to eat dinner but also motivated to look online for a new car. Now one way to use this conception of motivation is to ensure the behaviour you would like to increase becomes the behaviour you are most reminded about. So if you were to see your trainers in the hallway as you get home you would be more likely to be motivated to go to the gym then if you were to enter the sitting room and see the tv. Another effective strategy arising from this way of seeing motivation is to link a big motivator (catching up on an audiobook) with something less motivating (going for a run). The important thing is to limit listening to an audiobook to the gym so that you have to go to find out what happened next…. Routine is your friend. If Tuesday, Thursday and Saturday all become associated with some form of exercise then you are reminded of your intention and other activities are less likely to pop into your schedule and sideline exercise. If you’re motivated by socialising aim for a sport which will allow this such as tennis, squash or badminton. Arrange to exercise with a friend. And finally….. Don’t be overambitious. Aim for small regular doses rather than overdoing it less often. If you are new to exercise go for low impact exercise initially. High impact exercise, which causes discomfort, is linked to exercise drop out when you begin exercising. There are some great online exercises classes available. Combine these online exercises classes with going to the gym to help you stay interested. Don’t forget walking. Walking to work once a week can be recuperative and strengthening and allows you to step off the treadmill of the commute. Finally for a doubly effective boost to your mood and mental strength exercise outside. Mountain biking, open air football, jogging on the Heath all provide dual benefits. See for example Weir (2011) The Exercise Effect. The American Psychological Association, 42 (11), p48.

How do we develop beliefs and how could evolution be working against us? What do you think it would be like if we were not able to predict anything about the world? What if we could not predict whether we would be attacked by the next human we met? Or predict where we might be able to get our next meal? This would be a scary world to live in. So, beliefs are important because they make us feel the world is predictable and this makes us feel safe. If the world was unpredictable it would be highly anxiety provoking and very unpleasant. Example: Two children grow up in neighbouring houses: Tom and Pippa. The have very similar lives except Pippa’s parents believe that the only way their daughter will improve is by criticising her. Tom’s parents believe that positive reinforcements are the best form of parenting so they always praise their son when they think he has done well. Does Pippa grow up feeling good or bad about herself? Does Tom grow up feeling good or bad about himself? Unfortunately the approach of Pippa’s parents has the undesired effect of the her feeling that she is not good enough. However, Tom has a positive sense of himself. They go to the same school and both work hard and do equally well in their exams – achieving grades of above 85% for each paper. The parents of Pippa tell her that she has not done well enough and it just shows that she is a failure. The parents of Tom are complimentary of his efforts tell him that they are proud of him and the results. What do you think Pippa will think of her future – good or bad, success or failure? What about Tom? It is likely, of course, that Pippa will believe that she is not good enough and will not do well. On the other hand, Tom may think the opposite. Now remember, once we have developed a belief about something, we hold on strongly to it because if the world is not predictable then it is a scary place. So, we hold on to beliefs whether they are good or bad for us. What we can see from the above example is that our beliefs develop because of our experiences. So how do we know our beliefs are true? Which child is right about themselves? Pippa or Tom? Let us say that both children meet with their teacher. The teacher tells them both that they have done well and thinks that they will continue to do well in the future because they both work hard and have the aptitude for the subjects. Let us remember how important it is that we hold on to our beliefs, even if they are negative. What do you think Pippa (with the negative self-esteem) is more likely to think – that her teacher is telling the truth, or that her teacher is just saying it to be nice? What do you think Tom is more likely to think? So, what we can understand from this is, depending on our experience, we find information in the environment that fits with our belief and we discard information that does not fit. If an individual thinks they are not good enough and ninety-nine compliments are paid to them they will find a way of dismissing them: “they didn’t mean it”; “they were mistaken”; “they were just being nice”; “they don’t really think that” and so on. However, if that person is criticised then they will believe that as the truth. Now, if a scientist looked at that data they would say that it was overwhelming evidence that the person was positive. This process is what us psychologists called ‘confirmation bias’. Although this process helps us to feel that the world is predictable and this makes us feel safe, at times this evolutionary mechanism has the unfortunate by-product of confirming negative self-beliefs when there is overwhelming evidence to the contrary.

Research shows that if we have the same routine for between thirty minutes and an hour each evening before going to sleep, then our brains develop the understanding that that particular set of behaviours results in us going to sleep. After a short time of having the same routine each night, when we carry out the first behaviour in the set of behaviours, our brain starts to shut down in preparation for sleep. As such, a sleep routine is really important. A sleep routine is very much dependent on the type of evening that we generally have but a typical sleep routine might look like the following: 1. Watch something on the computer or TV downstairs sitting on a chair. 2. At 10pm turn off the computer and the TV. 3. Place items in the kitchen and turn off the lights. 4. Go in to the bathroom and have a shower/wash/brush teeth. 5. Go back in to bedroom and dim the room lights. 6. Change in to night clothes. 7. Get in to bed and do whatever it is that you generally do before sleep. Ideally, this would be to read but it is important to remember that the hue from some gadgets will tell the brain that it is day time, so the light of the gadget needs to be turned down or turned to a red hue. 8. As soon as you feel sleepy then go to sleep. 9. Do not finish the page or decide to watch the end of the program, as you can pass through a sleepy stage and in to a wakeful stage and it is far more difficult to get to sleep in a wakeful stage. 10. If, after 20 minutes of trying to sleep, you feel awake, or if you were not tired when you came in to your bedroom, then sit somewhere that is not your bed (bed must be only associated with sleep) and do some relaxation exercises. Please see 'breath work' and 'progressive muscle relaxation' for two examples. 11. Watch and wait until you feel tired and as soon as you do get in to bed and relax. For more tips on getting to sleep - please see the other sleep articles in this series.

For most people there is nothing better than getting in to bed and relaxing before dropping off to sleep. For others, this process can be a painful one of fretting, worrying and hours of trying to sleep. Here we will briefly outline the important areas of consideration when wanting to drop off easily. Let’s begin with the important things to remember during the day. Day-time events: · It is important to try to exercise each day – if we use our muscles during the day this can help us to sleep better at night. · It is important to watch our caffeine intake. We are all different here, but if you are someone that is affected by caffeine then try not to consume it after lunch-time; instead stick to decaffeinated drinks. Do remember, though, that some decaffeinated coffees still have caffeine in them. Environmental factors: · The temperature of the bedroom: not too hot or too cold. · The light of the bedroom: make sure there is no outside light coming in. · The amount of light that we have in the hour before we sleep is also important: turn any bright lights down and make sure we block out light from outside. If you can, turn any gadgets to a red hue. Waking and sleeping times: · It is important, if we have problems with insomnia, for us to go to sleep at around the same time each night. Our brain takes in light during the day to help the brain decide when it is time for sleep. If we sleep at around the same time, the brain will make the connection between that time and sleep and will start to prepare for sleep, which will help us if we struggle with getting to sleep. · Waking up at the same time is also important. If we wake up at the same time each morning then we will naturally be sleepy at around the same time every night. As already mentioned, our brain gets used to this and expects this and then will also begin to switch off when we are coming close to that time. · Sleep Routine: it is also important to remember to carry out a sleep routine (please see the ‘sleep routine’ information in this series). So, we are finally at the point of getting in to bed! Circadian Rhythms: · You may have heard of circadian rhythms. These are the rhythms of the brain that make us feel awake and sleepy. They are influencing our brain during the day but they become more prominent when we are getting ready to sleep. · Our circadian rhythms take us through ‘sleepy’ stages and ‘wakeful’ stages. Have you ever had the experience of sitting in front of the TV and feeling like you are just about to fall to sleep? You get up and turn off the TV, take the cup or glass in to the kitchen, turn off whatever needs to be turned off and get your home ready for the night. You then go to the bathroom and prepare for bed – wash and brush your teeth. You then get changed ready for bed and then when you finally get in to bed you feel wide awake. How annoying! This is your circadian rhythms at play: you have passed through a sleepy stage and you have arrived at a wakeful stage. · There is about 45 minutes between the height of a ‘wakeful’ stage and the middle of a ‘sleepy’ stage. There is no point in trying to sleep during a wakeful stage. o The best course of action is to relax in bed – read or do something that relaxes you. Nowadays, there are lots of relaxation apps or videos to listen to on YouTube. Please find one that works for you and have it ready to listen to when you go to bed. We have examples of ‘breath work’ and ‘progressive muscle relaxation’ in the anxiety series – it is important to familiarise yourself with them, so you don’t have to read them when trying to sleep. o Wait until you feel your sleepy stage coming on and then tuck in to bed and allow yourself to fall to sleep. Troubleshooting: · What happens if you don’t fall gently off to sleep? Firstly, it may be because your brain has associated getting in to bed with fretting and worrying about things. It is important for this association to be broken but it can take months for this to happen. · Firstly, if worrying about something is keeping you awake. Write it down and put aside a time in your diary to deal with it (this is, of course, easier said than done sometimes). · Secondly, make sure that all you do in bed is sleep. Your bed has to be associated with sleep. Not with working, or watching films or reading for hours and hours on end. · It is important to try to get to sleep for about twenty minutes by doing relaxation exercises. If this fails and you still feel wide awake then get out of bed and sit in a chair, on cushions or a beanbag – anything that is comfortable but is out of bed. Sit wrapped in a blanket to keep warm and repeat all of the relaxation tasks. · We are all aware of the feeling that we have just before we fall to sleep – we are suddenly thinking less and the body feels relaxed. At that point, get back in to bed and fall to sleep. · If that does not work, then repeat the above time and time again until it does work.

What is depression? The term depression comes from the Latin ‘deprimere’ which means to ‘press down’. It is far more, however, than just feeling down and affects not only how we feel but how we think about things, our concentration, sleep, energy levels and interest in hobbies, for instance. Officially, the symptoms of depression are the following: - Low mood -Marked loss of pleasure Plus 4 of the following: - Significant change in appetite and a loss of 5% of body weight - Disturbed sleep - Agitation or feeling of being slowed down - Loss of energy every day - Feeling worthless, having low self esteem and feeling guilty - Loss of ability to concentrate - Thoughts of suicide There are different types of depression but whichever you are experiencing it is likely that it will be very disturbing to your life. What causes depression? Sometimes depression results from something that has been ‘turned on’ in us. Some aspects of depression seem to relate to mechanisms that evolved a long time ago, for instance coping with the loss of a loved one, being subordinated, defeated or trapped. How can CBT help with depression? CBT (cognitive behaviour therapy) can help on various levels with depression. If we think about the different parts of the CBT model, which outlines that a human function is made up of thoughts, feelings, behaviours and physical sensations. In treating depression it is helpful to think of each of these in turn. Looking at physical reactions – breathing and relaxation As depression is often related to an overloading of the stress system, and excessive cortisol, it can be helpful as part of therapy to start to get this under better control. Ways of doing this can include breathing exercises (please see ‘Breath Work’ in this series), and relaxation strategies, so that you can start to become more aware of your stress and have some control over your bodily reactions. At this early stage it can also be good to start looking at strategies to stay in the moment, such as mindfulness, which help to add to the feeling of being in control and help to prevent the mind wandering into a negative spiral, which can bring in the physical symptoms of stress. Changing behaviours – encouraging activity When someone is depressed they often feel that they have no energy, or that they have lost excitement for things they once used to do. It can be the case that they may be at work and functioning, and just stopped doing their hobbies. Or their depression could be more severe and they could find that they cannot even get up, shower and brush their teeth. One initial step is therefore to look at the amount of physical activity they are doing in a day, and try to increase it, with ‘activity scheduling’. This helps to reduce low mood on the basis that if someone is giving in to the low mood and not doing anything, the more they do that - the more depressed they are likely to feel. So, if they are able to do the opposite, and engage in activity, this should improve their mood. You may then in therapy devise a weekly schedule of things you will try to do, based on your current functioning. At some stage of therapy it can be helpful to introduce behavioural experiments, which look at helping you to tackle some of the situations which your depression is making difficult for you. For instance, if you used to like playing tennis, and have felt unable to go because of your mood, it could be that in therapy you design an experiment to go and visit the tennis court, or go with a friend and just play for a few minutes, as an initial step. Later experiments could help to build on this, encouraging you to be able to stay for longer, until you are able to return to your original activity. The experiment would support you as well, by helping to think about any barriers that might get in the way, and what help you might need. Managing difficult thoughts and feelings People with depression tend to have a negative thought pattern, which involves negative thoughts about themselves, the world and their future. CBT can help by initially using diaries to track the ‘automatic thoughts’ which come into your mind, for instance, ‘I can never do things right’ or ‘No one likes me’. Being able to be aware of these thoughts is a helpful first step to being able to change them. Sometimes, if you are aware of a change in your mood, that can help to alert you to what is going on in your mind. Challenging thoughts, and showing compassion The next step, once you are able to identify your thoughts in a particular situation, is to start thinking about how you can answer those thoughts back. For instance, if you were waiting for a friend to call and they don’t, and then you find yourself thinking ‘no-one cares about me’, then you can start to unpick this and assess the reality of this. Is there an alternative explanation, and what might that be? The friend may have been busy, could be unwell and therefore no deliberately trying to avoid you, for instance. It can also be good at this stage to start to develop feelings of compassion towards yourself, and to say, what would someone who cares about me think right now? How can I be kinder to myself in this situation? Understanding the patterns of your thinking Once you have spent some time assessing your thoughts, it can be good to start identifying the patterns in your thinking. We often find that people have a tendency towards particular patterns such as overgeneralising, for instance when something goes wrong, saying to yourself, ‘everything in my life ends badly’. Another common pattern is people jumping to conclusions for instance if you were not invited to a friend’s party, assuming that you have upset them, without waiting to find out what happened. These patterns can be helpful to understand, as they show us the ‘rules for living’ that we have identified for ourselves, which can often not serve us well. Looking at core beliefs In therapy, the process of looking at thought patterns and thinking errors can allow you to identify the core beliefs that you have about yourself which are likely to be driving your behaviour. For instance, you might identify that you often have thoughts around being accepted by others, and you may have the underlying belief that you are not loveable. You might alternatively have thoughts about your worth, and assume that you will fail at things and therefore it is not worth trying; ‘I’m a failure’ or ‘I’m not good enough’. Sometimes it can be helpful to explore the origins of these beliefs, but it can also be helpful to look at ways to show exceptions to these ways of looking at yourself. For instance, in the example of not being good enough, you might monitor times when you do feel good enough, and also think about ways in which you were good enough in the past. The depressed brain state can make these beliefs hard to access without the right support. Case example (This is a fictitious example for the purpose of illustration only) Angela was in her early forties, she had been feeling depressed for a few months following the end of her marriage. She found that she was frequently irritable, and wanted to escape from her children who were 6 and 3 years old respectively. She felt guilty about wanting to be away from them but irritated by them as well, which meant she was often short tempered. She had had to take some time off work as she felt unable to concentrate, and at times her mood dipped to the point where she was feeling suicidal. She felt tired most of the time, but was also having problems sleeping at night. She found herself withdrawing from her friends, and also stopped going to the gym as she felt she lacked the energy. In Angela’s case, her depression was triggered by the loss of a loved one (her spouse, with the end of the relationship) and she felt trapped in her role as a single parent. Therapy for Angela started by looking at how to help her to gain some control of her stressful reactions through the use of relaxation and breathing techniques. She also started using mindfulness (please see ‘Controlling Unhelpful Thoughts’ in this series) to help her stay focused on times when she was with her children, and not get distracted by her depressed mood. She reported finding that focusing on the present, through the mindfulness strategies also helped her to stay in the moment, and take one day at a time, and not become preoccupied with uncertainty around her future due to her changed circumstances. Her therapist helped her to start building more activity into her week, including taking the children to activities, and helping her to attend work again. Getting back to the gym was more difficult as she was feeling a lack of confidence from the marriage break up, and she was given the homework task of trying to go first to the entrance, and then to the changing room, before going to a 20 minute session and then being able to get back to a class. She was feeling that others would ask where she had been and she would feel self-conscious. In therapy she discussed what she could say in those situations, but once she returned there she found that she was welcomed and that people had missed her. Angela got into the habit of tracking her thoughts, and found that she was often feeling hopeless about the future, that she was ugly and no-one liked her. She gradually started to challenge these thoughts, as her mood improved, so that she could realise that she still had goals and things to look forward to, and her taking care of herself better helped her feel better about herself generally. She started to try and challenge the beliefs around her not being good enough, by being kinder to herself and more realistic about her expectations. By Gemma Lutwyche

The 'Observing Mind' and the 'Thinking Mind' You may have heard the term ‘ mindfulness ’. One way of explaining this is in terms of the Observing Mind and the Thinking Mind. The Thinking Mind is something which switches on from the moment we wake up and it continues throughout the day. We think about the future, the past, what we are going to eat, what we are going to do that day, conversations, what people are saying, what people think, etcetera. Off it goes from the moment we wake up, and we hardly get any rest from it until the moment that we go to sleep. There is another part of our mind which we call the Observing Mind, which is the part of the mind that uses the senses in order to be in the present moment. We might use the example of people who enjoy walking: they may walk up a hill and then suddenly at the top see a beautiful scene of countryside that goes on for miles and miles, and in that moment they stop and just look at what they can see. It is not that they are thinking about the view but they are experiencing the view through the sense of sight. Or it might be that we walk out into the garden or from our front door and hear birdsong, so we may stop and listen to the birdsong. It is not that we are thinking about the birdsong, it is just that we are using our hearing sense to listen to the birdsong. In those Observing Mind moments, it is not that we are thinking about what we are doing, it is that we are using our senses to experience whatever is happening in that moment. Everyone has something which they become immersed in: it may be watching our children play, going for a walks, playing a musical instrument, cooking or gardening. We all recognised that in those moments, we have a moment of calm. What psychologists have noticed is that children are using their Observing Mind far more than they are using their Thinking Mind. If you ask a child who is young enough ‘what are you thinking about?’ they will describe what they are doing or what they see or what they hear. At some point we lose this and the Thinking Mind becomes the more prominent mind that we use. During our teenage years we use the Observing Mind less and less, and through a lack of use we lose the ability to be able to use it. It is very difficult to develop the Observing Mind; studies have shown that even Buddhist Monks who spend hours a day meditating or being ‘mindful’ find it very difficult to focus or use their Observing Mind all of the time. The Thinking Mind comes in and it takes over. We have evolved to think; thinking is a survival mechanism. We need to think about the past in order to learn from it and we need to think about the future in order to plan for it and overcome any difficulties that we may face. In order to harness the Observing Mind there are a number of strategies that we can use: · You might sit in the room that you are in and you might spend a few minutes just describing to yourself exactly what you see. Do not think about what you see, just name the colours, the patterns, the structure, the size, etc. We may have been in a particular room multiple times but not actually taken in every detail. · You might spend a few minutes listening to noises. Generally, we are not aware of noises until we actually tune into them. They do not have to be prominent noises, it does not have to be birdsong. It could just be the sound of the creaking of buildings, the sound of air-conditioning or the sound of breathing, talking or laughter. Developing the Observing Mind does not have to be something that you sit down to do for forty minutes each day, although the research does suggest that this can bring significant benefits. In our busy lives it can be difficult for anyone to do this. But setting a reminder on your phone every hour just to spend a few moments observing what is going on around you and using your senses to be in the moment and stop the thinking thoughts. Then when we are in a very difficult situation and we find that our thoughts are incredibly unhelpful and we would like to stop them we can use this strategy in order to help us distract from our unhelpful thoughts.

We have talked about overcoming anxiety in this series but how to overcome panic is different. With panic - the symptoms are generally so awful that we think we are going to die. Why then, would we not avoid situations where those symptoms come up? The problem here is that by avoiding the situations we are not finding out if the thing we fear will happen and then the fear continues. This is the fundamental element of overcoming panic....you must test out your fear. Firstly, write down the thing that you fear. Generally with panic it will be 'I might die' or 'I will faint' or 'I will make a fool of myself and everyone will think I am crazy' or 'I will go crazy with fear'. None of these are pleasant to say the least. To overcome panic we have to test out our fears. Who likes the idea of seeing if you might die? Or go 'crazy'? We might as well ask you to jump in to a sea full of sharks and keep your fingers crossed. But don't worry......because by doing the following you can live a life without panic and imagine how wonderful that would be. The next task is to write down all the things down that you are avoiding due to your fear. Rate them from 0 (no fear) to 10 (high fear). Then put them all in a list from lowest to highest. There is some suggestion that we then group them in to 'low fear' 'medium fear' and 'high fear'. It is important to think through each situation carefully. For example, if a person's fear is that they will have a panic attack on the underground...they will need to break this down in to steps. For example: - Go to the station with a trusted other when it is quiet. - Go to the station with a trusted other when it is quiet and sit on the platform. - Go to the station alone when it is quiet. - Go to the station alone when it is quiet and sit on the platform. - Go one stop on the tube with a trusted other. - Go one stop on the tube alone. - Then you would increase the distance that you go on the tube and differ the times that you go in order to increase the amount of people that are around. - Eventually, you want to be travelling along the busiest line at rush hour. Remember, the idea when overcoming panic is to go in to a situation that we believe will bring on panic symptoms and remain in that situation until we have seen whether the thing that we fear happens. This is not too easy when the thing we fear happening is death! That is why this can be so difficult but only YOU can find the strength and determination to do this. There is no one else who can make you do this...just you. Some people find writing a statement that they can read to themselves before they go in to a situation that they believe will bring on panic. This might be: - You have faced fears before and you can face this one. - Just take one step at a time. - Remember how awful life is living with panic and this will help me to overcome it. - Imagine a life without panic - how wonderful that would be. - Think of all the things I could do if I were not crippled by panic. Another strategy to help you to remain in a situation, rather than running away from it when every bone and muscle in your body is telling you to escape - is to do a body scan. This needs to be practiced thoroughly before going in to a situation where you will experience symptoms of panic, otherwise the panic symptoms will overcome you. Please click on the video for a guided body scan. Just think of how you will feel when you have faced and overcome the thing you fear. Good Luck!