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E MDR (Eye Movement Desensitisation and Reprocessing) What is EMDR? EMDR is a form of therapy based on the understanding that the experience of trauma can affect the way the brain processes memories. Memories of a traumatic event can be overwhelming and intense. People struggling with trauma can feel as though they are actually reliving the event and re-experiencing the things that happened, and which they have remembered. The approach was started by Francine Shapiro, a psychologist, who in 1987 made the chance observation that under certain conditions eye movements can reduce the intensity of distressing thoughts. It has evolved since this time and is now a standardized set of protocols which incorporate elements from different treatment approaches, and extend beyond the use of just eye movements. What does EMDR do? EMDR enables you to revisit your trauma in a safe and therapeutic environment and reduce the intensity of these memories so that you no longer relive your experience. In terms of how this works, no-one knows exactly how any form of therapy works neurobiologically. However, we know that brain processing is affected when someone is upset, and traumatic memories can therefore be ‘frozen in time’ in the brain. These memories can have a negative impact on a person’s beliefs, thoughts and behaviour. EMDR seems to return the brain’s processing to a more normal level. It is thought to work a bit like REM (rapid eye movement) or dreaming sleep, where the brain sorts through the information it needs and incorporates and integrates it into the memory networks in the brain. The result, therefore, is to reduce the emotional intensity of the memory, whilst not removing the memory itself. What happens in a session of EMDR? An EMDR therapist will ask you to concentrate your mind on your trauma whist at the same time providing your brain with sensory input. The sensory input could take one of several different forms, but the important factor is that the input provides bilateral stimulation of the brain. The methods can include, for instance, tapping both of your knees, listening to sounds through headphones, or following your therapists fingers with your eyes. It is thought that recalling memories whilst also receiving this external stimulus enables the brain to change the way in which the memories are processed. Experience during a session may include changes in thoughts, images or feelings. At the end of successful treatment you will still be able to recall the events, but the sense of distress should leave you. What can EMDR be used for? EMDR is most known as a treatment for PTSD (Post-traumatic stress disorder). However, clinicians have reported that it has also been used successfully to treat problems where there has been some kind of difficult emotional experience, such as: Anxiety and panic attacks Sleep problems Depression Problems with self-esteem Pain Phobias Grief Stress Addictions Relationship difficulties including childhood attachment trauma By Gemma Lutwyche

Anxiety and stress in children can show up in a number of ways. This can depend on your child’s age, personality and coping skills, for instance. As a result of this, the symptoms can sometimes be hard to spot. This article will help you as a parent to be able to spot and make sense of your child’s anxiety, and have some strategies to help them manage their feelings. Symptoms of anxiety If you think about it in terms of how the body reacts to stress and anxiety, it is to make sure that you are ready to either fight or flee, the ‘flight or flight’ response as it is called. So, the symptoms tend to be a manifestation of this, but they lasts longer than a fleeting moment and become more of a feature of day to day behaviour, thoughts and emotions. In terms of trying to flee, you might see your child withdrawing from activities they used to enjoy, or saying they don’t want to go to school. They might have problems concentrating or sleeping, or they could develop a nervous habit such as pulling their hair or biting their nails. They might complain of physical symptoms associated with being in a high state of alert from anxiety, such as headaches, or stomach pains, and this could lead to problems with eating. They might also wet the bed. They may ask for a lot of reassurance, either about their health, or about situations they find themselves in. Some children respond more with the ‘fight’ response, and in this situation, you might have observed your child becoming more oppositional or argumentative, being short tempered, moody or aggressive. They might get into trouble at school. It is easy to see this as just bad behaviour, but if this represents quite a change for them, then it might be worth talking to them to see if there is something bothering them. What causes anxiety in children? What children need mostly is some security and routine. Anything which impacts on this could have a negative impact on their emotions. So, for instance, moving home, having a new baby, a parent getting a new job which takes them out of the house for longer, could all be triggers for anxious feelings. Arguments at home, or family separation can be particularly difficult. Children rely on consistency, and are so sensitive to change, because they are faced with so much new information each day, if things which are usually settled are suddenly different, then this can be overwhelming. Other issues such as tests and exams, or having learning problems, can also make them feel anxious as they can affect their self esteem. If other children at school are bullying them, then this can affect their sense of belonging, and make them feel worried. Some children can be worried by things they watch on the TV, for instance even the news, if they get anxious about negative news stories and how they could affect themselves or their family. What can I do if I think my child is stressed or anxious? Firstly, it is good to talk to them, and find out what is happening. Is it something that they have misunderstood, and maybe worrying about needlessly? Or is it something you can resolve? If that is not the case, or if you feel that they need some more support from you, then it is first helpful to explain a bit more about why we get anxious and what it feels like, so they can understand it better. I often talk about anxiety being like a table with four legs; these legs are the physical feelings, emotions, thoughts and actions. So, for instance if your child has just got a new sibling, their ‘table’ might look like this: - Emotions: anxious, angry, and jealous. - Physical sensations: tummy ache, headache - Thoughts: no one cares about me anymore, I’m not important - Behaviours: being more clingy, finding ways to get attention These legs all work together to keep the anxiety (table top) up, and the way to resolve this is to knock the legs away, and bring the anxious feelings down. Helping them to work on their anxiety The reason behind the anxiety will obviously shape what is the best way to resolve how they are feeling. However, some basic principles can be of help. Emotions : in relation to this, after they have learned a bit about how anxiety works, then helping them identify when they are feeling anxious can be really helpful. It is sometimes useful to think with them about what the anxiety looks like, for instance by drawing it, or giving it a name. This helps them to realise that they are separate from it, and gives them a sense of control over it. If they had called the worry their ‘scary monster’ for instance, you might notice them withdrawing and say ‘I wonder if you are getting that feeling in your tummy now, has the scary monster come to bother you again?’ Depending on your child’s age, you could also think with them about how much the anxiety is bothering them, from 0-10, or use sad and happy faces if they are a bit younger. Physical feelings : Activities such as breathing and relaxation can be helpful for children. For younger children, you could get them to pretend to blow up a balloon when they get the anxious feelings, or you could get them to imagine they are floppy ‘like a rag doll’ to help them relax. If they are a bit older, then doing some basic breathing strategies, or tensing and releasing type relaxation, could work for them. Please see the other articles we have written to help here. Thoughts : If you notice that they are often down on themselves, for instance if they are worried that they have to take a test and they are saying things like, ‘What if I do badly? What if I don’t know how to answer the questions?’ then it is helpful to think with them about how they can answer those thoughts back. How true is it that they will do badly? What would their friend say if they told them they were worrying? What would happen if they did do badly? This approach can also work in helping them solve situations that they are worried about, for instance helping them to work out the best way to proceed if they are not sure what to do. For instance’ helping them think about the pros and cons of different choices can help them feel more confident in making decisions. Another strategy which can be helpful is to set aside a time to talk to your child each day, if they are worried. Getting them to write down their worries in a notebook, or put them in a box, and then go through them at your assigned time can help to create some structure, so that the worries don’t take over. You could encourage them to put the worries out of their mind, unless it is the time to discuss them. Younger children may benefit from their parent keeping hold of the box, as this helps them feel like their grown up is taking care of the worries and gives the child more of a feeling of being looked after. Behavioural : This part involves thinking about what they can do differently to help fight the anxiety. For instance, is the anxiety stopping them from doing something? One way to help them with these kinds of problems is to break the issue down into manageable parts. For instance, they might be worried about performing at their school assembly. You might get them to build their confidence by initially getting them to practise on their own in their room, then in front of just you, then a small group of people, and so on. They could make use of some of the other strategies above, to get control of difficult thoughts and physical sensations and gradually build their confidence. If you know that there are difficult events coming up or changes which will impact on your child, it can be helpful to talk to them about this, so that they are prepared, and you can think with them about what they might need to be able to cope. How you manage stress matters too! Another point is about how you as a parent both manage your own anxiety, and how you show that to your child. I’ve often heard parents say to me, ‘so it’s all my fault!’ I usually respond that that’s not a helpful way to look at it, but you are a huge part of the solution. They will always look to their parents as models for their own behaviour, so it might be helpful to think about whether you are taking enough care of yourself, and managing your own stress. Could you also benefit from doing some breathing, or relaxation, or challenging yourself when you doubt yourself? Also, are you able to manage your own feelings, so that you are able to hold your child’s in mind, and help prepare them for any changes and tricky situations? This is not about being a perfect parent, but about modelling how you can manage difficult feelings and cope with challenging situations, in a way to allow you to get past them. A final note… If after trying these strategies you are still concerned about your child, please seek professional advice. By Gemma Lutwyche

So, we are all stuck at home, only allowed out for limited reasons. The kids are off school, you and your partner are probably working from home. The usual stresses and responsibilities you have are somewhat reduced, you can’t shop for fun, meet friends for coffee, go and see family or go to the gym, to name a few things. What ever you are facing during this time, it is likely that your pace of life has changed. Although many are enjoying the different pace of life, for some, there are added stressors, such as trying to manage work alongside homeschooling. But in amongst all this stress, what can you do? What is the opportunity? What can you do that will make a difference in your life? This free time stuck at home gives a rare opportunity. I have heard many times in therapy, ‘I haven’t had time to think about what we discussed last session.’ This is a common and understandable barrier in our busy lives. However, you now have free time that you are unlikely to get again, EVER! So, you can either binge on Netflix, become a TV expert, or you take the time for some in depth self development, knowing that you have the time, both mentally and physically, to devote to it. Therapy involves changes in insight, being reflective, learning new patterns of thinking and behaviour. There will be elements of practical applications which might be more challenging to actually do right now, but the mental reflections, reading and exploration you could do make this a time of potentially tremendous growth and development. You will need to set aside some time each week, or even each day, if you can. You can devote some of this time to reflect on something that you have been putting off...maybe something that was niggling in the back of your mind. There are a number of books that we would recommend that have helped us during our years of being therapists. If you have a particular issues, such as OCD, an Eating Disorder or another specific issue, then the 'Overcoming' series of books are a useful read. If you are someone who is highly self-critical then Paul Gilberts work focusing on Compassion Focused Therapy is used by thousands of psychologists across the country. Other work, such as Acceptance and Commitment Therapy, is useful across the board and can help us to see our behaviours and thoughts from another angle. Russ Harris' 'The Happiness Trap' is another well used book by psychologists and clients alike. Focusing more on younger children, a book that underpins most NHS led parenting workshops is Webster-Stratton's 'The Incredible Years'. This has some good tips for all parents and not just those who are struggling. For those with older children, 'The Teenage Brain' may be of use. Although this does not provide any specific strategies for dealing with teenagers, as one mother said, it made her feel she was not the only person who got it wrong! If you feel you finally have a bit of time to develop further skills relating to your psychological health or understand something further, at DSA we are still providing therapy. We can do this over the phone or via video conferencing. Many individuals feel that therapy can not be conducted over a video call but actually we have found that it can work just as well. If you have worries about remote/online therapy, just bear in mind that if you are comfortable with video calls, then you will probably be very comfortable using this medium for therapy. So, you could either come out of this and resume your life as it was, or you could use the opportunity to learn new insights and skills, and heal any emotional wounds. This could help you to come out of the lockdown with an increased strength, able to have greater impact and success.

It can be very distressing to have an anxious child. Perhaps they are refusing to go and meet with family, complaining they have a stomach ache. Maybe they are declining invites to a friend’s house, and cannot explain why they don’t want to go. It is common to find that all the reassurance, compassion and kind words have no impact on the situation. Anxiety happens in children and teens much as it does with adults. Something feels like a threat, and our fight or flight response kicks in, with cortisol and adrenaline being produced at a rapid rate. This can make them feel dizzy, nauseous, tight-chested, hot and sweaty. They might experience hot flashes, fast breathing, and tight muscles. These feelings can impact on what your child is able to participate in, for instance finding it hard to sleep, go to school or socialise. Below are some ideas to try to help relieve your child’s physical symptoms. Please be aware that this article just focuses on the physical strategies, and there may be some other solutions which are more thought or behaviour based which they could benefit from. I would advise giving any strategy a good try, before you decide that it is not the right one for your child. Although they are broadly divided into strategies for children and teens, some of these are interchangeable, depending on their developmental level and their interests. Strategies for children Deep breathing: This is something they can practice when they are feeling calm, and can then be of use when they are feeling anxious to help calm their heart rate and manage their physical symptoms. Having a visual focus can help them learn these techniques more effectively. · Balloon Breathing Ask your child to close their eyes and imagine blowing up a balloon. They can choose the colour of the balloon, and then explain that they need to exhale slowly to inflate the balloon. You could teach them to breathe in for a count of four, hold for four, and then breathe out to inflate the balloon for a count of four. They can repeat this until the balloon is inflated. If it helps they could write a worry onto the balloon before they let it go and watch it float away. · Rainbow breathing Ask your child to lie down, and play some calming music if this helps. Teach them to inhale slowly, and then pause and breathe out, and imagine releasing a colour in the breath. You could get them to think about things which are that colour, which could be in their imagined breath. Repeat for all the colours of the rainbow. Give yourself a hug When people hug, a hormone called oxytocin is released. As well as giving your child a hug, you might want to teach them to also hug themselves. Teach them to fold their arms and squeeze their body. Dealing with nausea Feelings of nausea can make children feel that they don’t want to eat. Again, a balloon image can be helpful here. It could be useful to imagine a balloon filling the stomach, causing the nauseous feelings, and you could get your child to pop the balloon in their imagination. They might want to draw a picture of it to help them do this. Relaxation techniques To help with the sensation of tight muscles, you could use a relaxation exercise, where they imagine being ‘floppy’ like a rag doll. A good example of this is in the link below. If the rag doll doesn’t really fit with them, it could also be a teddy or other soft toy. https://www.greenchildmagazine.com/guided-relaxation-ragdoll/ Another way of getting children to relax is to get them to push against a wall, thus tightening their muscles in the process. Get them to push against a wall, with all their might, making sure that they include their arms, legs, stomach and back, hold for a count of 10, then rest, and repeat 3 times. Dancing is also a good way to help children relax. Get them to put on some of their favourite music, and you could join them in some freestyle moves! They could also sing along, too. Strategies for teens Depending on their age and interests, they might find some of the strategies in the previous section helpful. Here are some additional techniques for the older age group. Yoga Stretching muscles i.e. by doing yoga poses is a good way to help relieve some of the physical tension in their muscles and reduce their heart rate. They might want to try a class, or use a DVD at home, or look up some videos on YouTube. Progressive muscle relaxation They might feel ready to do a longer relaxation exercise. Please see the blog entitled progressive muscle relaxation, for some techniques around this. Sweat it out Exercise releases endorphins, the feel good chemicals in our bodies. Intense exercise, more intense than normal physical activity, can reduce the body’s response to anxiety. Cycling, running, hiking and climbing would all be good challenges for your teen. Having a relaxing scent Smell goes straight to the emotional centres of our brain, and a relaxing smell can therefore bring quick relief to anxious feelings. You might want to get them to find a smell which they find comforting, e.g. a favourite shower gel, perfume or soap, and get them to find a portable version of this that they can carry around with them. As already mentioned above, give all these strategies a chance to work, before you decide that they are not the best for your child. by Gemma Lutwyche

You may have heard of the idea of a 'safe place'. A safe place is a technique that psychologists use that can help to reduce down our anxiety system. If we are feeling overwhelmed by emotions, if we feel unsafe or if we are facing something that we fear - bringing out 'safe place' to mind can help. However, as with most things, this comes with some practice. We need to bring our 'safe place' to mind often and then really think about how we would feel when we are in our safe place. This reminds me of the poem by Roger Robinson called A Portable Paradise, which I think is a much more beautiful way of describing it. And if I speak of Paradise, Then I am speaking of my grandmother Who told me to always carry it on my person, concealed, so no one else would know but me. That way they can't steal it, she'd say. And if life puts you under pressure, trace its ridges in your pocket, smell its piney scent on your handkerchief, hum its anthem under your breath. And if your stresses are sustained and daily, get yourself to an empty room - be it a hotel hostel or hovel - find a lamp and empty your paradise on to a desk: your white sands, green hills and fresh fish. Shine the lamp on it like the fresh hope of morning, and keep staring at it until you sleep. By Roger Robinson We all need a Portable Paradise - what is yours? You need to think it through. Is it the memory of a favourite holiday with the sun glistening off the sea and the soft sand flowing between your toes with the sound of the gentle waves lapping on the shore in front of you? Is it a memory of your favourite place as a child...your bedroom or the space behind the tree in your back garden or local park? Is is winter with the fresh snow on the ground and you and a friend hurling snowballs to each other? It may be the woods in Autumn - the beautiful cacophony of colours raining down on you. If you have a memory you can use - remembering how wonderful you felt then. Try to remember the smell - what you saw - what you could hear. If you don't have a memory then you can make up your Portable Paradise. We have an abundant imagination. Where does yours take you? When you have your Portable Paradise clear in your mind, keep it there and hold it close by. Feel the calm it brings. And then, when you are going through a difficult time, you can bring to mind your Portable Paradise.

Before reading this article, I would like you to familiarise yourself with the basic model used in Cognitive-Behavioural Therapy, called the five-area model, which can be found here: https://www.drstuartpsychologists.com/post/cognitive-behavioural-therapy. I am writing this on the 29th January, 2021, which I believe is one of the best times of the year to talk about guilt but before we discuss ways of dealing with guilt, we will understand together how it fits within evolution. Guilt is something that the vast majority of humans feel. There is some suggestion that people who are known as psychopaths, do not experience guilt. They have areas of the brain that are faulty. However, putting that aside, we can see that guilt is an important part of being human. Evolution has favoured guilt as being an emotion that has endured because we are more likely to survive if we live in social groups. If each time we felt annoyed by someone we decided to hit them and felt no sense of guilt about that, we would be ostracised by the group and less likely to survive. Parents can also understand that, at times, children can drive us to distraction and it is better that our guilt and conscience systems, at those times, stop us from chucking them in the bin. So, as we can see, guilt has an important part to play in our survival. There are also ways that guilt can be problematic and stop us from achieving our full potential. The Five-Area Model If you are not familiar with the five-area model, here is one for you to look at whist I discuss the different elements: Okay, firstly, when looking at the five-area model, please look at the circle titled ‘Mood’. This circle represents all of our emotions. There are multiple emotions but some of the main ones are anxiety, depression, surprise and guilt. We do not have a direct access to our emotions and what I mean by this, is that we can not click our fingers and change them. This, I believe, is one of the most unfortunate things about our brains. If only we could click our fingers and stop feeling anxious or click our fingers and feel happy when we are sad. Instead, then, what we have to do to change an emotion is change one of the other systems outlined in the five-area model: ‘Thoughts’, ‘Physical Reactions’, or our ‘Behaviour’. I am going to turn firstly to physical reactions. This circle on the five-area model represents how our body responds to particular emotions. We all know how our physical body changes when we feel anxious. Our heart beats faster, we may breathe more shallowly, we may feel nausea, or hot, or tingly. With depression, we generally have less energy and feel more lethargic. I have always found it difficult to describe exactly how ‘guilt’ feels in the body but we all know that it does have a very particular physical response. There is an uncomfortableness there and I would say a tension. Now I will turn to thoughts: when our brains trigger the emotion ‘guilt’ we will begin to think about all of the things that we did wrong. This might then lead on to us thinking about what a bad person we are and how the future is going to be bleak because we are so useless. Well, that line of thinking does not help anyone to bring about change or build confidence, which in my experience as a psychologist is certainly something that holds people back. Finally, we will turn to the influence of behaviour. When we feel guilt, we are driven to change our behaviour. Now, obviously sometimes this can be positive. If, we decided that our behaviour was not useful to us or to others then if we think though how we would like to act if the same situation were to arise in the future, then this can be positive. However, if we just feel terrible about ourselves and so guilty that it makes us withdraw from relationships, work opportunities, or social situations, then obviously this is not a positive outcome. Now we understand how guilt influences us, it is useful for us to think about what we can do to reduce the impact it has. Of course, as mentioned above, we need to think firstly about whether we want to repeat the behaviour again. It might be that we shouted at our partners/children/family member/friends. Or we behaved badly at work or at a social event. If we did something that was destructive to our body or to others and we decide that we do not want to behave like that again, then maybe the guilt that we feel can have a positive outcome where we can think about how we would like to act the next time we are faced with the same situation. However, there are so many times that we feel guilty when guilt does not actually help us to make improvements in our lives and feel better. We just focus on feeling bad and think about how awful we are. There are a multitude of things that individuals I have worked with over the years have felt guilty about and here are a few: not playing with children enough, not being there for family/friends/partners/work enough. Not doing enough exercise. Eating too much or drinking too much alcohol. Working too much and not seeing partners/children/friends/family. Individuals feel guilt when their own mental health impacts on loved ones – shouting when we feel stressed or feeling bad that our anxiety or low mood impacts on others. I know that we can all connect with some of these – I know that I can! Obviously, at this time of year, how many of us have broken our new year’s resolutions? We need to have a different relationship with guilt. Firstly, when we feel guilt – recognise how it feels in the body . Become familiar with guilt. Recognising that we feel a particular emotion can help us to then watch what happens next. It is useful for us to spend some time thinking about what we feel guilty about. Is it something that we would like to change? If so, think about what we will do differently next time. We have to remember, though, that we only have so much time in our lives and we can not do everything for everyone else at the expense of having time for ourselves. If we are constantly doing things for others then we will feel stressed and miserable and that is not good for us or for others because we are more likely to be irritable when feeling stressed. Or, if we have failed at something that we wanted to do: a new exercise regime, a diet, job applications, meditation, more time for family/friends etc. Then, think about whether we are expecting too much of ourselves. It is better to break down what ever we want to achieve in to small step and carry out step one. When we have achieved this, we can move on to the next step. In that way, we built our confidence in our achievements and won’t be bogged down by failures. Rather than a strict diet, what about trying to eat three sensible meals with two snacks in between and a treat every day? Rather than running a mile, what about increasing exercise every other day, starting with a five minute jog? Rather than applying for multiple jobs, spend 30 minutes each day on an application. If we feel guilty about the impact that our own mental health has had on others, try to turn the situation around and imagine if that other was the one with the problems. You would probably be happy to be there for them. The key to all of this is, I believe, being realistic about how much we can give or do and forgiving ourselves when we mess up. Good luck!

Cognitive behavioural therapy is known to be effective for a wide range of psychological problems. Studies into the use of CBT for couples have shown its use for improving communication, reducing distress and conflict for couples in romantic relationships. What is the idea behind CBT for couples? It is based on the idea that most people have particular expectations about how their partner should be or behave. This influences the behaviour or characteristics which each partner attends to, which affects their appreciation of their partner and their relationship. So, for each person, thoughts, behaviours and emotional are all interrelated, and each member of the couple can impact on the other. What would happen if I come for CBT as a couple? Firstly, the couple will be seen for an assessment. This will cover a wide range of issues such as what the nature of the difficulties are, how long they have lasted, and what attempts have been made already to try and improve the relationship. Why do couples come for therapy? There are often a wide range of reasons why a couple come for therapy, including to look at issues of conflict they cannot resolve or issues which are in one member of the couple but having an impact on the relationship such as anxiety, depression, alcohol and sleep problems. They may also have some parenting issues, or problems with infertility or infidelity. Regardless of the main concern, it is important for the therapist to have a clear picture of how this impacts on the couple relationship. To do this, each individual member will need to be willing to look at their own thoughts, behaviour and emotions, as well as thinking about how this impacts on the other, by keeping diaries to help track this information at the start of the therapeutic process. They will also need to be willing to carry out tasks at home to help therapy progress. Will the therapist take sides? The therapist will be equally aligned to both parties, and indeed if anyone is coming to therapy for couple work in order to show how bad the other person is, and hope that the therapist will take their side, then the therapy is not likely to be effective. What are the main techniques used in CBT? After the initial assessment phase, when it has been possible to gain a clear picture of how each partner is having an impact on the other, then it will be helpful to think of some goals for the couple. These could be individual, or joint goals for the relationship. Therapy can then focus on how to help people to reach their goals, using one of the following strategies. Communication skills training The couple will learn some basic strategies which aid communication, both in helping them to talk to each other clearly and without blame, and also to listen openly and without judgement. They can then practice these skills in the session, and also for homework between sessions. The purpose of this is not to solve problems, but to be able to really listen to each other and appreciate each other’s feelings. Problem solving The couple will learn some strategies to think through specific problems they are experiencing, and then practice this during the session and again for homework. For instance, Rachel was getting increasingly frustrated with Simon’s snoring at night, and had started to sleep in another room. Simon was upset about this, and felt it was having a detrimental effect on their relationship. They talked this though in therapy and brainstormed different possible ways forward, until they found a solution which worked for both of them. Cognitive restructuring Each partner will keep a diary throughout the work to help identify and then challenge the thoughts and beliefs which are impacting on the relationship. These can be explored and challenged, in a way to help improve the communication and understanding between the couple. For instance, Ellie was feeling that Richard didn’t care about her because he had started coming home late from work and then focusing on his phone. Ellie feared, ‘He doesn’t love me’ and started to feel, ‘I’m not important.’ Talking this through, Richard was able to help Ellie challenge her beliefs, by showing that he was concerned to help them move out of their home and had been working longer hours, and was still working on his phone when he got home. He in turn, felt that everything was his responsibility, and that Ellie was being, ‘insensitive and thoughtless’. Being more open about the thoughts each of them had helped them to challenge each other and find a better way forward. Emotional strategies It is sometimes helpful in couple work to identify emotions which might be hidden, such as fear, anxiety, or anger. These can be explored and discussed in a safe way. Sometimes emotions can be heightened, and techniques might be needed in order to help people manage these strong feelings. It is important to do this to help reduce conflict and help with problem solving, as when there are intense emotions, it is difficult for people to think logically. Sexual problems A couple may come to therapy to help improve their sexual relationship, and deal with any problems. If there is significant sexual dysfunction, this is better dealt with by a specialist in this area. However, many issues in the sexual relationship can be addressed in couples CBT work, such as addressing any emotional concerns which are getting in the way of intimacy, and using communication training to help increase affection and connection between a couple. It can also be helpful to look at any thoughts or beliefs which are getting in the way of sexual pleasure, for instance addressing any unrealistic or negative expectations. A few closing points Couple work needs to be entered into with openness and trust. If there is violence in the relationship and there are issues of safety, then therapy is not the best way forward, and it would be better to have some space and individual work before coming as a couple, if that becomes appropriate. It might be that the goals of the therapy are to help a couple separate. If that is the case, and it is agreed on, then the therapy can help think through how to manage this difficult time in an amicable way. Sometimes, just to think things through with someone outside of the couple can be helpful. You do not have to be at the end of a relationship or with serious problems for couples therapy to help.

It is that time of year when exams are looming. Here are my top tips to help you survive this time. Revision 1. Comparisons : Remember that everyone is different and it is important to not compare to others but focus on what you feel able to do. Just because Joe Blogs is studying for hours every day, it might be that your brain does not work like that. Feeling bad because we are not doing what we feel we should be doesn’t help the situation. It is better to work out how your brain works and do as much as you can. 2. Attention spans : Our brains can only focus for a particular period of time. Different research suggests different things but for some this means 25 minutes of focus for five minutes of rest and for others it might be 45 minutes of focus for 10 minutes of rest. For others, it might be that they can focus for longer periods of time and need a longer rest. Keep an eye on your attention span and when you begin to feel tired, or find that the information you are trying to retain is no longer going in, give yourself a short break. Remember, don’t compare to others with this. Just because your friends can work for hours without taking a break (although I would argue that it is likely their minds drift off at times and they are actually giving their minds a rest), every brain is different and it is best to discover what works best for you. 3. Socialising : For some, studying is more fruitful if they have things to look forward to, such as a night out with friends. They feel they can work hard because there will be a reward at the end of the day or week. Others feel more comfortable if they leave the socialising until after the exam period. There is no right or wrong here, we just need to do what ever works for us. 4. Retaining information : There are three main ways that we take in information: For some, reading the topic and making lists will be the most beneficial. For this group flash cards might be your best friend. For some, visualising information is the most reliable way for recalling it. This group should look at using simple mind maps or spider diagrams. Or, drawing small pictures – maybe linking two ideas together in the picture, will help to recall some information that does not appear to be sticking. For a final group of people, talking about the topic and discussing the ideas around it helps to retain that information. If you are one of those then speak to your family members, start a study group, or even talk to yourself about a topic and imagine someone questioning you about it. What ever works! And lastly, repetition, repetition, repetition. Going over and over something will always help. There is some suggestion that if we read something, then read it again 24 hours later, then again 24 hours later, then in three days, then in seven days, this will help the information move from our working or short-term memory into a longer-term store. 5. Anxiety: most young people I work with feel anxious about exams or how much work they have to do for their exams. Although small amounts of anxiety are supposed to be good for us, more moderate or severe anxiety will hinder revision. Worrying about exams is pointless but we all do it! Each time you notice a sense of impending doom, try to refocus your attention on something else. Ideally, we should push away the thoughts and refocus on studying but that is easier said than done at times. If you find that difficult, try a short relaxation, such as a body scan, or do five minutes of intense exercise, of have a cold shower. If none of those work and you are finding the anxiety too intense to study, do some exercise – go for a run or a cycle ride. Keep going until you find the anxiety reducing and then you will be able to refocus on revision. The Night Before and Day of the Exam 1. Sleep: Try to get an early night. If you can not get to sleep, don’t worry about it. Do lots of relaxation exercises and mindfulness (there are lots of apps or you tube videos to help you with this). If we relax our bodies enough, this can also be restorative. You will eventually fall asleep but being anxious about how long that will take or if it will ever happen, will lessen the likelihood for sleep. So, try to take your mind off sleep or exams by reading something you enjoy or listening to something relaxing. When you feel tired then immediately stop reading or turn off what ever you are listening to and drop off to sleep. If you can’t sleep then repeat the above. 2. Don’t learn anything new on the day of the exam : Trying to take in new information should stop the day before the exam, as this may muddle what we have already learned. Our brains need time to process information and this is done whilst we sleep. Going over flashcards or mind maps or revision notes on the morning of the exam is fine but ideally, we would give ourselves a break. 3. Exercise: If you have time, do some exercise. This helps to reduce tension and increase the endorphins we need to feel okay. 4. Fuel for the body: Some people go off food on the morning of the exam, or leading up to it. However, it is important that our blood sugars to remain stable, so that our brains work as well as they can. If you can not face food then drink a smoothie and a protein shake. Taking protein will help to stabilise your blood sugars and will help you to concentrate. 5. Hydration: The last thing you want in an exam is a headache, which dehydration can cause. Remember to have plenty to drink before the exam. 6. Anxiety : Remember the tip above about anxiety – this is even more important on the day of the exam. However, some people find distracting away from the feelings of dread even more difficult. Try to think that, ‘it is what it is’ and there is nothing you can do about it now. So, give it your best shot. During the Exam 1. Anxiety: Take a moment to breath and focus your attention. If at any point in the exam, you feel overwhelmed by anxiety, again, take a moment to breath and try to relax all the muscles in your body. 2. Comparison: Do not compare yourself to what others are doing…they might be writing a lot but it might be complete nonsense! 3. Keep an eye on the clock. 4. If you can not answer something then mark it, move on and return to it if you have time at the end. 5. Let it go: What ever happens in an exam, just move on. Put that ‘essay’ ‘question’ ‘exam’ behind you and focus on the next. What is done is done and dwelling on things does not help us. I have worked with so many people who have thought that if they do not do well in their exams then their lives will fall apart. For many, they do just fine. For some, they do not do as well as they expected. It can take a bit of time to get our heads around this but generally, life has a way of working itself out in the end. For those I have worked with who did not get their first choice of university it actually worked out well for them in the end and they realised it did not matter as much as they thought it had. Good luck!

We have evolved to think. From the moment we wake up in the morning - off our thoughts go. We think, think, think about the future and think, think, think about the past. But why is it that our thoughts are the way they are? Evolution provides an explanation. The main drive of evolution is for us to survive. Do you think, therefore, that your brain would prefer it if you were thinking happy thoughts all of the time and never worrying. Is this a better way to survive? Or, is it better for us to be aware of all that might go wrong both by looking at our mistakes from the past and trying to learn from them, and by looking at everything that could go wrong in the future and planning to avoid potential pitfalls? Well, of course, our brains have evolved to be aware of all of the negatives because that way we are more likely to survive. Your brain does not care if you are happy or sad or whether you have an enjoyable life or not…it just cares if you survive. In this day and age, however, we are not faced with the dangers that hunter-gatherers faced and it would be much better if our brains were more focused on positives. Unfortunately, this does not come naturally to our brains and a lot of the time we have to create our own happiness. Of course, the above is just one of the influences on how we think…human are vastly complex. Our environment also plays a huge role in how we look at the world. If we grow up in an environment where both of our parents are depressed and constantly point out everything that is negative, then it might be that we begin to see the negatives as well. Psychologists call the process of thinking about thinking – metacognition. Generally, we do not think about the types of thoughts we are having, well at least not in any detail. One of the main areas of CBT is the process of looking at the types of thoughts that individuals have. One of the things that you could do is to start to write down your thoughts. Sometimes, it is useful to do this when we experience a particular emotion strongly. This might be when we are feeling particularly sad or frightened. We may feel embarrassed or self-conscious. At such time, try to remember the content of the thoughts and write them down. There are lots of apps nowadays that can help you. Or, you could just write them down on your notes section of your phone, on your computers or on paper. Then, at a later time, when you are experiencing the emotion less intensely, go back to the thoughts and see where you may have been making unhelpful assumptions. Please read on to see what types of assumptions we make. In my opinion, if a thought makes us feel good about ourselves and if that thought is not going to hurt us or others in any way, then I think those thoughts are just fine and we can leave them well alone…even if we don’t have the evidence for them. Examples of such thoughts are: ‘It is going to be a wonderful day!...My haircut is fabulous!....My boy/girlfriend thinks I am the most wonderful person in the whole world! Or just….Maybe I have got this right. Maybe I am good enough…Maybe I don’t need to be liked by everyone or maybe I can make mistakes sometimes and it doesn’t mean I am a complete failure. (You will hopefully have picked up that I am a huge fan of these last few). On the other hand, if a thought makes us feel bad about ourselves and we have no evidence for that thought then that is really unhelpful. What follows is what psychologists call ‘Unhelpful Thinking Styles’. There has been a lot of research looking at the way we think. There are types or groups of thoughts that have been shown time and time again in individuals and not just those who are suffering from depression or severe anxiety. I am going to go through them one by one. Mental Filter or Confirmation Bias is a term used by psychologists relating to that we develop beliefs about ourselves, others and the world and then hold on strongly to them, even if they make us feel rubbish. One example is if we think we are not good enough then we will dismiss all compliments no matter how many compliments we get. Also, if we tell ourselves we are rubbish enough times then this can also feel like information that confirms how bad we are. A useful way of thinking about this is to think what a friend would think of us or say….if you do not think that your friend is a liar then surely they see something that we can not. And, if they see that then maybe others will too. Maybe it is just us that see ourselves in a negative light. Try to notice the compliments and accept them as something that might actually be the truth. Mind Reading is where we assume we know what someone is thinking about us. If we are feeling self-conscious, anxious or low, we generally think that what others are thinking of us is negative. But, do you believe in telepathy? If not, then why try to mind read? Now, of course, if we think that someone thinks we are great and that boosts our self-esteem, I am all for that…but the negative bit just makes us feel bad and with NO EVIDENCE! Research suggests people who have been in relationships for decades can not predict exactly what their partner is thinking so how on earth do we expect to know what a stranger is thinking? Someone may be thinking badly of us but then again, they may not. Predicting and Catastrophising : Do you believe in future telling? If not, please don’t assume that something in the future is going to go horribly wrong or be an awful time when we have no idea what the future has in store for us, apart from that we will all die one day. The situation may go badly but it might be unexpectedly enjoyable. Assuming something is going to go badly just makes us feel bad in the moment. Personalisation : This is where we take full responsibility for a conversation or event when others are involved. If the conversation or event goes badly then we blame ourselves. An interesting point here is about silence. Different people have different levels of toleration for silence. For some, silence is fine. For others, the briefest silence can feel uncomfortable. Sometimes we feel we are the ones responsible for the silence and to make the event amazing, fun, animated. This puts pressure on us and actually makes the event far less enjoyable. Mountains and Molehills : You will have heard the saying, ‘Don’t make a mountain out of a molehill’. Sometimes we look at a situation and think it was a complete disaster. It is useful for us to think about whether the event will be something that affects us in 6 months’ time…or in one year. If it will not then it might be okay to just let it go. We have all done things we feel embarrassed of, it is just we generally don’t remember others’ embarrassing moments but do our own. Comparisons : We often compare ourselves unfavourably to others. If we think we are fat or ugly we may compare ourselves to models. If we feel we are not intelligent we may compare ourselves to a person we think is very bright. There are always people in the world who are brighter/better looking/ have a better job/etc etc than us. But also, there will always be people where we have those qualities and they do not. When making comparisons, compare yourself to every fourth person you see…this is a much better example of the general population. Emotional reasoning is a term used by psychologists relating to where we make assumptions about things based on how we feel. Our feelings or emotions can get it very wrong. A good example here is that a person suffering with anorexia will feel fat! Equally so, when we feel anxious our brain is telling us that we are in imminent danger, when actually maybe we are perfectly safe. Be careful when listening to your emotions…instincts can be right but can also be wrong. Should and Must statements should be avoided (this is the only should I agree with here) . I should be better at my job! I should be able to give 100% all of the time. I should have been more successful! I should be slimmer/fitter/healthier! I should have stayed calm! I should know how to deal with my emotions! I should be a perfect mother/father/daughter/ son/partner etc etc! I must always do better in the future! Goodness me how exhausting. Maybe it is better to accept that we are human and to be human is to be imperfect and make mistakes. Have you ever found yourself going over an event and feeling mortified at what you said or how you behaved? Don’t worry, we have all been there. This is called Post event analysis and involves us going over in our minds what we said in a conversation and feeling embarrassed. Or we may wish we had said something better/funnier/more intelligent/etc. DON’T DO IT! It is unlikely that whomever you were speaking to will remember what you were saying. In fact, research suggests that people generally do not remember what we said but they do remember how we made them feel. If you are someone who gets anxious in social situations and feel you want to plan exactly what you are going to say, this can actually make us feel less relaxed and is something psychologists call ‘ pre-event analysis ’. You can have some ideas but those ideas may or may not work. Imagine instead that you are going to meet and speak to a good friend. What ever you might say to that good friend is okay to say. What makes us feel more anxious is if we start to think that we should find something witty/intelligent/meaningful to say when we may not be feeling very witty or intelligent. It does not mean that we are not witty or intelligent. Are you always at your best with your friends? Probably not and that is okay. If your friend likes you just for who you are then maybe others will too. Critical thoughts : We should be very careful of criticising ourselves. If you imagine that you told a friend that you had a boyfriend/girlfriend who criticised you in the way you criticise yourself…what would they say? They would probably suggest that you dump them. However, it is much easier to dump a boyfriend or girlfriend than to dump ourselves. Try to notice the critical thoughts and ask yourself what your friend would say about that. Listen to your friend’s voice…they are generally a much better mirror to ourselves than we are. There is a lot of information to take in here. I have, below, put a handy print out sheet for you to keep close by and to help you to make less assumptions and lead a more fulfilled life. Good luck!

James Joyce was the first writer in history to try in his book, Ulysses, to capture the thoughts of one man – Mr Leopold Bloom, as he proceeds through one day. We can see from his writing that to capture thoughts is actually quite difficult. Thoughts can be fleeting and make no sense. They can be enquiring, rude or bland. What we all know, however, is that from the moment we wake up, off our mind goes and we think think think all day long. We think about the future and think about the past and think about the present or think about the multitude of things we make up that have nothing to do with the past, present or future. There is rarely a moment in the day when our thoughts are quiet. Trying to quieten the mind is something that Buddhist monks have been attempting for many years. After years of mindful practice, which involves trying to allow thoughts to pass gently out of the mind without focusing on them, no matter how many hours they spend doing this, the thinking part of our mind always finds a way to insert a suggestion here or a comment there. Over the years, I have concluded that it is better if we try to understand our minds and accept the way they are whilst, at the same time, recognising that to bring about change takes effort.   When trying to understand the brain, we must look to evolution for an explanation. As I have already spoken about in this series, our brains are hardwired for survival. However, the majority of our evolution took place over hunter-gather years and much of what helped them to survive, in terms of thoughts, is rather redundant today. Let us consider this together.   Firstly, if we study the types of thoughts that aid survival lets us consider two individuals. Person A sits under a tree contemplating the meaning of life, stopping occasionally to take some sustenance or exercise. Person B, thinks all day long about the future and what might go wrong. They consider all of the different possibilities and come up with a plan in order to overcome them. They also think about the past and criticise themselves for what has been in an attempt to do better in the future. We can see from these two extreme examples that evolution will favour person B because that type of thinking will help with survival. But, which person will be happier? Which less anxious? I would argue that person A will be much happier. You may question where they are going to get the food for their sustenance but as long as that is not a problem, they are more likely to enjoy their lives that person B who will be miserable and anxious.   An interesting point to remember here is this:   Your brain does not care whether you are happy or sad, it only cares if you survive. We have to make our own happiness.   Now this statement is easy to understand but far far more difficult to follow through with because hunter gather life style was around for about 200,000 years, the beginnings of agriculture started about 10,000 years ago and our industrial civilisation has been around for less than 300 years. So, the hunter-gather brain is the one that is what we are working with. Wishing we would all have happy clappy thoughts, is unfortunately not a useful task. We need to work at it on a daily basis. Many of my clients say that becoming well following mental illness is sometimes harder than just allowing our brains to be miserable or anxious and I really do get that.   In this next section, I am going to give you a few ideas about how we can begin to look at our thoughts and hopefully challenge some of the less useful ones and tell the really useless ones to get lost!

Moving from one year into another, for many, provides a natural time of reflection - a moment to look back over the year we are leaving and forward to the year to come. It can be a time we use to reset, make changes, plan for improvements. It can be a time to bid good riddance to a year full of heartache, stress, and loss. Whatever this time is for you, I would like us all to think about how best to bring about change without feeling the burden of failure. Because to move forward, fail we will. Fail we must.   Samuel Beckett in his 1983 story Worstward Ho, wrote, "Ever tried. Ever failed. No matter. Try again. Fail again. Fail better." And although he goes on, in my opinion, to talk about how unbelievably difficult this can be, we can take something from his words. How often do we, with good intentions, make New Year’s resolutions, or plan significant change, only for them to fail or for life to get in the way? Statistically one in five resolutions set will last less than one month. So here are my top tips for bringing about change.   1.     Set some goals but not too many. Goals should be something achievable. So, for example, I want to be fitter. Is better than I will go to the gym five days a week.   2.     Remember that we need to find a balance between work, rest, play (or pleasurable activities) and health. There are only so many hours in the day and days in the week, so we will need to accept we may not be able to do everything we desire immediately. The most important thing is to keep a balance and accept that some goals may take longer than we would wish.   3.     Break each goal down into manageable steps. Ideally a step would seem easy to do, so it is achievable, and the brain is not put off doing it. So, rather than, 'I am going to work out at the gym for an hour.' It might be you start with a five-minute walk on the treadmill. Underdoing something and building from there is much better than doing nothing at all. Another example, if you want to lose weight, the goal might be to eat more healthily and reduce portion sizes. This is much more sustainable in the long run. Then you might make one or two swaps per week. So, a large plate for a medium plate. When this feels easy, a medium plate for a small plate. By the end of the year, you will never be able to eat a large plate of food again without feeling sick. Another idea is to start with one day when only healthy foods are eaten alongside one or two small treats. Then when this feels easy, increase it to two days and so on.   4.     Find time in your diary for one of the steps. If your goal is to get your finances in order, you might set aside an hour in your diary each week to focus on doing this. Or an hour to do exercise or an hour to plan healthy eating. If you find you do not have the motivation or time to carry out the activity, then move it to another time in your diary when you do have time. Keep doing this and remain focused on the end goal.   5.     If you find you have not done what you set out to do, plan to do it again. Each day is a new day and just because we were unable to complete our set task the day/morning/afternoon etc before, it does not mean that we should give up.   6.     Goals and tasks may need to be redefined as new information comes in. So, if your goal was to change your job but you find you are spending days applying for new jobs and disheartened by the process, set yourself time to carry out the activity that leads to your goal and time to do pleasurable things. A balance in life is key to good psychological health.   7.     Keep focused on the end goal. Remember, every day is a new day.   8.     Be compassionate. Remember the wise words of Beckett. If you decide you want to change your goals or the goal you set was not right for you, at this time, be kind to yourself. Ultimately, we all want to feel good about ourselves so being critical for changing our minds or deciding to focus on something else, is not going to help.   Good luck and I wish you a wonderful 2024.

A bodyscan is a relaxation technique which can help us control anxiety or unhelpful emotions. This is a 5 minute bodyscan. You can do this bodyscan sitting up or lying down. Try and find a comfortable position.