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Anxiety is something that all humans experience. In fact, if you did not experience any anxiety you would be considered to be abnormal! Our anxiety system developed in Hunter-Gatherer years and at that time it was a very useful system in helping us to survive and thrive into this day and age. The problem with the anxiety system is that although it was useful in hunter-gather times it really is not very useful today.

Demystifying the physical symptoms of anxiety.The ‘fight and flight’ response enables humans to become much stronger, and was useful, for example when a human needed to fight off a wild animal or be able to run away. There are stories where someone was able to show super human strength, when their child was in danger – that is the ‘fight and flight’ response at work.   The Brain mechanism: In the brain there is the amygdala.  The amygdala is a central part of the limbic system, which is the most ancient part of the brain and this area of the brain reacts before any other part. The limbic system reacts to danger without thinking about whether it is actually dangerous or not.   What happens in our body? When the ‘fight and flight’ response is triggered we take in more oxygen, our breaths are faster and shallower. Our heart beats faster and this allows the blood to be pumped around the body quicker - carrying the oxygen to the muscles to make them stronger. Adrenalin and cortisol are released and these are stress hormones.   The parts of the body that are not needed stop working or work less well. For example, we stop digesting food, this sometimes gives the sensation of ‘butterflies’. We stop sending so much oxygen to the brain, this gives the sensation to some people that they feel light-headed or dizzy. Some people feel faint when they are feeling anxious, but in fact because our blood pressure has gone up, rather than down, it is impossible for us to faint in these circumstances.   Although the ‘fight and flight’ response can be a very useful survival mechanism, in our day and age it appears to be triggered in situations where we perceive ourselves to be in what we term ‘social danger’.   The ‘fight and flight’ response is triggered in these ‘social danger’ situations because we hypothesise that if we make a fool of ourselves than we may be rejected by others, if we are rejected by others we are more likely to live alone, if we live alone we are less likely to survive. So the ‘fight and flight’ response is not only triggered by immediate physical danger, but it also seems to be triggered by cultural understandings of shame and rejection.

When we are anxious we breathe more shallowly and do not breathe out a full breath. The idea when learning how to breathe properly, is that it should be a natural and relaxed breath in and breath out. There are many suggestions about how to relax your breathing but our aim is to just understand how to lower anxiety through breathing using a full natural breath. We need to be able to do this anywhere - if we are sitting in a meeting or at a social event. We need to practice this if we hope to use it when we are feeling stressed. Breathing properly involves filling the lungs. If we fill the lungs our stomach should expand on the in breath.   Sit either comfortably but upright or lie down. Notice how you are breathing.   Place your hands on your stomach.   Imagine your lungs behind your ribcage.   As you breathe in, your lungs fill and your stomach should expand. Imagine if you had a balloon in your stomach and as you breath in this inflates.   Your abdomen rises with the in breath and falls with the out breath.   Take a natural breath in and a natural breath out. An in breath is generally anything between 2 and 3 seconds. Count how long your natural breath in is – don’t force it. Whatever your natural breath in is, make your breath out the same amount.   Continue breathing in and out – making sure the out breath is about the same length as the in breath and each time we breath in, our abdomen raises and each time we breath out it falls.   If we have been ‘stressed’ breathing for many years – this will take some practice.   It is useful to set yourself a reminder on your phone to check your breathing each hour or every two hours. Just check you breathing and do a few relaxed breaths.

Breathing is a fundamental element of our anxiety/calming system in the body. Here we will discuss how 'box' breathing can help to calm the body.   The systems involved in this process are known as the Parasympathetic and the Sympathetic nervous system. All we really need to remember is that we can not be completely relaxed and highly anxious at the same time...the two systems in the body work in opposition to each other. If you imagine an on and off switch. When one is switched on the other is switched off and visa versa. For evolutionary purposes, this system has helped us humans to survive but we really do not need it so much in this day and age.   In order to have some control over our 'anxiety' system, we need to try to trigger our 'calm' system. Look again at the picture...she radiates calm. Ideally this is how we would be all of the time. Unfortunately, however, often our brain decides there is danger around and triggers our anxiety system. At those times, our 'calm' breathing changes to 'anxiety' breathing. Sometimes this can happen without us even noticing it but at other times it is very noticeable and it feels difficult to catch our breath.   Four square or box breathing can be used at times when we need a significant distraction from our surroundings and when our anxiety is high. I have also found that for those where the 'relaxed breathing' does not really work, box breathing can help. Navy SEALs in the US use this type of breathing when they are plunged into freezing water to stop them from dying...good to know.   It is simple but again, useful to practice thoroughly throughout the day so that it becomes familiar to us. When we are highly anxious, it is difficult for us to remember things and so the more familiar something is the better.   Basically, you breathe gently in for four seconds. Try to imagine there is a balloon in your stomach and as you breathe in you fill the balloon. Then hold this breath for four seconds. Then breathe out for four seconds. Then hold for four seconds and repeat.   I have often been asked whether people should breathe in or out through their mouths or noses. There is no right or wrong way - try different ways and see which one works for you.

A body scan is a relaxation technique that can help us to control anxiety or unhelpful emotions. It works in two ways: firstly, it helps us to reduce the physical symptoms of anxiety but also, because we are focusing on something, it helps by providing the mind with a focus other than worrying or stressful thoughts. When we first start doing body scans, it is sometime difficult to feel anything inside of our body but with time and practice, we realise that we can actually feel quite a lot. The most important thing is to just have a go…there is no right or wrong way.   Obviously, it is much easier to follow someone talking you through a body scan and so this can be found on our youtube channel here:   Firstly, find a comfortable position, either lying or sitting down. Make sure that all of your body is able to rest against a bed, chair or floor. If you are lying flat, place a pillow below your knees, otherwise your lower back may start to feel tense. Place your hands gently on your stomach. Take a slow gentle breath in through your nose and then, as if you were blowing through a straw, gently breathe out through your mouth. Do this a few times and as you do, close your eyes. Try to keep the slow gentle breathing rhythm throughout this practice. Gentle breath in through your nose and gentle breath out, as if you were breathing through a straw.   Now, place your hands by your sides, or in a comfortable position.   I want you to bring your attention to your right foot. See how your right foot feels. Does it feel hot or cold? Tense or relaxed? How ever your foot feels just notice that. If you feel tension in a particular part, which part is that? You may feel nothing and that is fine too. As you breathe gently in and then as you breathe out, just relax the muscles inside your foot a bit more. Imagine the foot dropping down slightly or imagine the muscles relaxing as you breathe out – you may hardly notice this but see if you can feel the muscles just relaxing a fraction.   I want you now to focus on your left foot. How does your left foot feel? Again, is it hot or cold? Tense or relaxed? What ever you notice, just mark that. Maybe there is another way you would like to describe what you feel here? Remember, there is no right or wrong. Take a gentle breath in through your nose and, as you slowly breathe out through your mouth, just imagine the muscles in your left foot relaxing ever so slightly. Feel your foot dropping down either in to the floor or the bed. Breathe gently in and gently out.   Now, let us focus on the bottom of the right leg – the area from the ankles, up through the calf and around the shin area. Does this area feel hot or cold? Tense or relaxed? If you can feel any difference in temperature or tension, just notice that. Where is it? Do you feel tense or relaxed in a particular part or is it over the whole area? As you breathe gently in and gently out, again as if you are blowing gently through a straw, just let any tension release. Try to imagine your muscles dropping down a fraction. Feel them drop slightly in to the floor or bed.   We now move on to the bottom of the left leg – the area from the ankles, up through the calf and around the shin area. What do you feel in this area? Does it feel hot or cold? Tense or relaxed? Maybe there is another way you would like to describe what you feel here? What ever you feel, just mark that feeling as you breathe gently in and gently out. Just imagining this area of the left leg dropping down slightly as you relax the muscles.   Now bring a focus to both feet and the bottom half of both of your legs. Breathe gently in and as you breathe gently out, see if you can relax the muscles in this area a bit more. Just imagine the muscles dropping down slightly as you feel it relaxing. If you are lying on a bed, it might be as if this area moves slightly down in to the bed, as it relaxes. Feel the chair or the bed beneath you – this solid mass holding your body.   The next area that we are going to bring our attention to is the upper part of the right leg. From the knee area, around the thigh and the back of the leg up to the buttocks. What do you feel in this area? Is it hot or cold? Tense or relaxed. Are there particular parts that feel tenser than others? What ever you feel, just note that. As you breathe gently in and gently out, just relax all the muscles in this area. Drop them down in to the chair or the bed.   Now let us move on to the upper part of the left leg. Again, from the knee area, around the thigh and the back of the leg up to the buttocks. How does this area feel? How does it compare to the right leg? Does it feel the same or different? More or less tense? Is the temperature in this area of your left leg different? What ever you notice, just mark that. Take a moment to focus back on the breath and make sure that you are gently breathing in and gently breathing out. As long as the breath is gentle and you are taking a full breath in and breathing fully out, you are doing just fine. As you breathe in and as you breathe gently out, just allow the muscles in this area of the leg to drop down – imagine them releasing and relaxing.   As you are sitting or lying there, I want you now to focus from the top of both of your legs and down through the knees, the lower legs, ankles and feet. As you breathe in and breathe out, if you can, imagine any tension flowing down through the legs and out through the toes. If this is difficult to do, as you breathe out, just relax your muscles down a bit. Feel your legs dropping slightly more into the chair, bed or ground.   We are now going to move on to the back. This is often the area where people hold tension. We will come on to the shoulders next, so for this one, focus on the area of the lower back and up to the upper back just below the shoulders. Can you feel any tension in this area? If you feel uncomfortable in any way, slightly shift your body so that you move in to a more comfortable position. Focusing on this area, how does it feel? Hot or cold? Tense or relaxed? You may be someone plagued by lower back pain – or upper back pain. Try to not allow your thoughts to be distracted by this. Just focus back on to the back area and see what you feel there. As you breathe gently in and gently out, let any tension that you feel go.   An area that many people hold tension is the shoulders and neck. If this is something that you feel is familiar to you, try to make sure that throughout your day, you move your neck and shoulders around. Gently rolling your shoulders back and forth and moving your head in a circular motion – first one way and then the other. For our current practice, we want to keep things as calm as possible. If you are feeling tension in this area, you may want to do a few gentle movements to help to release some of the tension here. Remember to breath gently in and out as you go. Focus now on this area. Do you feel any tension here? Are there other ways that you would like to describe what you feel? What ever that is, just mark it. As you breathe in and breathe out, just drop your shoulders down a little. Try to release any tension in your muscles as you breathe out.   We will now focus on the right arm and right hand. How does this area feel? Does it feel relaxed as it is resting on the arm of a chair or on the floor or bed? You may feel tension in this area? You may feel that it is hot or cold or you may want to use other words to describe it. What ever you notice, or even if you notice nothing, there is no right or wrong. As you breathe gently in and out through the mouth, as if you were breathing out through a straw, just imagine any tension you are feeling dropping down. You may feel the muscles slightly relaxing or you may be able to imagine any tension flowing down from your shoulder and out through the tips of your fingers.   Let us now move on to the left arm. You are familiar now with bringing your attention to these areas. What do you feel here? You may feel something or you may feel nothing? There may be some tension in a particular part or you may feel your arm feels hot or cold or maybe it feels just right. What ever you feel, just note that. As you breathe gently in and gently out, imagine the muscles in your arm dropping down in to the arm of the chair, in to the floor or sinking a little further in to your bed.   One final area we are going to focus on is the face. It is interesting to me that actually, we do sometimes hold tension in this area. Just focus on your face and as you breathe in and breathe out, let your muscles drop a bit. You may notice that your mouth drops slightly open or your cheeks feel a little droopier.   As you sit in your chair or lie on the bed or floor, take a few last gentle breaths in and out. As you do so, focus on the whole of your body. Imagine any last bits of tension dropping down through your body gently breathing in and out. Now, when you are ready, slowly open your eyes.   As you go through your day, remember this feeling and, if you can, take a few moments to scan your body. Do a few gentle breaths and try to let some or all of your tension go.

A very important component of stress is the physical tension we carry around. In fact people who experience high levels of stress and anxiety can be so physically tense much of the time that it becomes their normal physical state. This exercise has two parts. The first part involves tensing each muscle group so that you become aware of holding physical tension. The second part is a progressive relaxation of each of these muscle groups so that you have the experience of purposefully letting go of tension and being in a more comfortable, restful state. Instructions: Find a quiet, comfortable place. A reclining chair is ideal as you want to be relaxed but remain awake. Make sure your clothes are comfortable and take off your shoes. Take five nice slow, calm breaths from your stomach. Now you need to consider your muscles in groups; focusing on tensing the muscles in a certain area (for example the hand) before then going on to release this tension. So turn your mind’s attention to your left hand. Slowly and gently tense up the muscles in your hand until your hand is as tight and tense and gripped as you can manage. Hold this tension for five seconds before releasing. Fully release this tension at the same time as breathing out. Spend about fifteen seconds really noticing how relaxing the muscles in your hands feels different from tensing them. Noticing this difference is the most important part of the exercise. After fifteen seconds move on to the next muscle group and repeat the steps of tensing and then relaxing that muscle group. Muscle groups to focus on: Foot, lower leg and entire leg; then other foot etc Hand, entire arm including shoulders; then other hand etc Buttocks (squeeze) Stomach (squeeze) Chest (take deep breath) Neck and shoulders (tense up to ears) Mouth (open mouth wide and clench) Eyes (clench shut) Forehead (raise eyebrows) How to make the most of this exercise For the first week do this exercise twice a day. Set aside ten to fifteen minutes in a quiet place. Practicing a lot in the first week will mean that you learn this skill more thoroughly and can then quickly notice when you are holding tension and relax yourself. It is best if this exercise is done when you are feeling calm and rested but it can also be used to reduce tension. You might find it easier to listen to recorded instructions. There are many audio versions of progressive muscle relaxation exercises available on the internet.

The link between exercise and improved mood, concentration, health and wellbeing is strong, clear and consistent.   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   Exercise provides a productive, effective activity which is often lacking in other environments. It facilitates social engagement and structures free time.   There is evidence that exercise 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: Think of yourself as having lots of motivations rather than having one pot of motivation which runs to empty by the end of the day.   You might be motivated to go to the gym, to watch the television, to eat dinner and to look online for a new car.   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 see your trainers in the hallway as you get home you would more likely be motivated to go to the gym than if you were to enter the sitting room and see the tv.   Another strategy 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.  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 sideline exercise.   If you’re motivated by socialising, aim for a sport 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 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.   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.

Please click the images below to see the individual blogs to help in overcoming physical symptoms of anxiety Relaxed Breathing When we are anxious we breathe more shallowly and do not breathe out a full breathe. Square or Box Breathing Breathing is a fundamental element of our anxiety/calming system in the body Body scan A body scan is a relaxation technique that can help us to control anxiety or unhelpful emotions. Progressive Muscle Relaxation A very important component of stress is the physical tension we carry around. Exercise and Stress The evidence on the link between exercise and improved mood, concentration, health and well being is strong, clear and consistent.

The Difficulties of Being a Parent A child arriving into the world is a wondrous thing. But often times we are not prepared for how life changes. A lack of sleep, a lack of time, a lack of enough support can make us feel depressed and anxious and stressed beyond anything we thought possible. Our struggles to get pregnant, our struggles with pregnancy and traumatic births can all add significantly to how we feel. I will outline some of the more common issues below. Children are not born with an understanding of how to sleep through the night. This is something that needs to be taught. As a psychologist, my children should have been perfect from the moment they were born. I had read the books and knew what the literature said...but I found myself walking my son around my coffee table, in a sling, with a dummy in his mouth with the vacuum cleaner on for white noise, for hours and hours every week. Then, when he was finally old enough to sleep in a cot on his own, I patted his back for at least an hour each night. If he noticed my move away from him before he slept, I had to start again. It was exhausting. The anxiety of wanting him to be okay - he was slightly premature and did not thrive as a baby, was unbelievable. And, the books might tell us that we are creating problems we will have to unpick later on unless we get them sleeping in a bed, on their own in the dark, but I wonder if those that wrote the books have ever been sleep deprived. Sleep deprivation means we will do anything to go back to sleep, so we end up sleeping in a chair with white noise and of course we know it is not ideal but at least it is sleep. Evolution increases anxiety when we have children. It makes us more hypervigilant to danger and has helped our species survive. So on top of sleep deprivation, we feel anxious. And we go from having time to ourselves to no time at all. If we are lucky, we have some support but heightened anxiety and exhaustion do not bode well for relationships, so often times couples argue. As children grow into toddlers , they need to learn how to keep safe, about right and wrong and don't understand the importance of eating their greens when cake tastes so nice. They don't know how to control their emotions and can be fine one moment and screaming with anger the next. When we are the parent of a tantruming child, we might assume everyone is looking to us as the problem - why cant we control our child? Why are we such a bad parent? We might begin to see all of the well behaved children around us and assume that the problem is in fact with us. However, the majority of parents can identify with what is being said here and a child that tantrums is in a space where they feel allowed to tantrum and there is a lot to be said for that. When children are old enough to go to nursery or school, morning routines can be exhausting and end up in a shouting mess before piling children in to the car for the school run. It might be that your particular difficulty is that your children will not get dressed alone, remember to do things, such as eat breakfast or brush their teeth, without being told numerous times. It may be that they become easily distracted and you find them with the paints out just as you need to leave to make it to school on time.  The evening routine can be just as hard. After-school clubs, playdates, homework, snacks, dinner, bath, bed time and then arranging everything for the following day. The tasks are never ending. To have to deal with a child who wants to do none of this makes the situation a lot harder. It may be that your younger children don't seem to understand the meaning of 'no' and are constantly testing you. They may not want to share and hate their siblings. You may be sick of repeatedly asking your child to do something and ashamed when your child has a full-blown tantrum at the school gates. With older children negotiating social media, screen time, homework and sleep can be a daily battle.  And the toddler eventually grows into a teenager . The teenage period is a time of intense emotions and the transition from being a child to being an adult is rarely a smooth one. Many of the behaviours of teenagers baffle and exasperate parents. It may be that your teenage child wants to be an adult and do the things adults do without any interference from Mum or Dad. It is difficult to find the balance between allowing them to make mistakes and learn and keeping them safe.  Parenting can be the best of times and the worst of times. All parents struggle and all parents make mistakes. My top tips for parenting are as follows: Love your children unconditionally. Give yourself a huge pat on the back because being a parent is not easy. Rather than criticising yourself for mistakes, try to think about what you have done well. If you behaved in ways that you were not proud of, think about how you would like to behave in the future and put a plan in place to behave in the way you want to. Forgive yourself if you get it wrong - we all get it wrong and to admit to that and discuss this with our children can help them to understand that it is okay to not be perfect. Saying 'sorry' helps your children make mistakes too. Try to set clear boundaries and stick to them. Praise your children when ever they do anything well and especially when this involves a behaviour that makes your life easier. Try to understand how your own experience of growing up might be impacting on your parenting style. If you feel your parents did not care enough, do you over compensate by giving up your life to be a caring parent? Did one or other of your parents make you feel like you were not good enough? Do you feel like your children think the same? Children can say some awful things to their parents. A confident parent will brush this off as normal. A parent lacking in confidence, may find the words of their child crushing and believe they are the truth. If you experienced a trauma in your life are you hypervigilant to that happening for your children and stifle their growth because of your fears? Remember that the way a child will succeed is if they feel good about themselves, so, returning to number 1 - love your children unconditionally. They may not be perfect and they may not get it right but that is a normal part of being human and if they can feel your love they will be happy and find their way, eventually. If you are thinking about therapy, then make sure you find someone who has the expertise to help you. Ideally, this would be a psychologist or therapist who has worked in a CAMHS service in the NHS. At Dr Stuart Psychologists have highly trained CAMHS psychologists as part of the team. Please do be in touch if you would like to understand how we can help to navigate this most difficult time of life. ​ ​

Phobias - What are they and when do they become a problem?   Phobias are grouped into different categories - Complex Phobias and Simple Phobias. Complex phobias, such as agoraphobia and social phobia, will be discussed in other blogs. Simple Phobias are outlined below and what we will be focusing on today.   What is a Phobia?    A marked fear or anxiety about a specific object or situation. When presented with that object or situation, it will provoke an overwhelming and a debilitating sense of fear or anxiety. How we might think about this is that you might have an intense fear of chairing a meeting, attending an interview, taking an exam. The anxiety you feel might be severe and intense but with a phobia, either you would run a mile or be unable to function in the situation. The anxiety or fear about the object or situation is out of proportion to the actual danger posed.   To be diagnosed with a Specific Phobia (like a diagnosis for depression or a diagnosis of obsessive-compulsive disorder), your fear must also be present for at least 6 months and, here is the important bit, it must cause significant distress or impairment in social, occupational or other important areas of functioning. So basically, if you can live day to day with your phobia and it only causes significant distress on the occasion you meet with it, it would not be viewed as that problematic by health professionals.   But I bet it feels problematic to you.   It is interesting to me that most people can live their whole lives with a phobia and are very clever at surreptitiously avoiding the thing they fear. People have said they are rational human beings but when faced with their phobic object or situation, without the option to run, they can turn into a screaming, unhinged reck - not my words. Not the kind of impression most of us want to give to the world.     Symptoms of a phobia.   When faced with the thing we fear, the brain triggers the fight and flight response and an uncontrollable reaction in the body occurs. The brain releases the stress hormones - cortisol and adrenaline. These flood the body making people feel a wave of anxiety and intense hypervigilance.   You might notice your breath begins to be shallow as your body takes in more oxygen. Your heart might pump fast - taking this oxygen to your muscles. Muscles can feel tense or tight as they prepare for danger. You might feel nausea or butterflies in your tummy, as energy is diverted from breaking down food to preparing the body for battle. You might start to sweat or feel shaky. Another common symptom is to feel lightheaded or dizzy.   Development and course...or Nature/Nurture. We are born with two innate fears - a fear of falling and a fear of loud noises. These would have served us well in hunter-gather time. But there is some suggestion that we also have an innate fear of spiders and snakes.   Most phobias, however, develop through learned responses, in other works, in relation to a traumatic event. It might be that you remember the time you were stuck in a lift or your neighbour’s evil cat did not let you pass it on the stairs or the turbulence in the plane sent your parents into a spin. Or it might be that you cannot remember. Most phobias develop before the age of 10 and because we find a way to live with them (or avoid them) most phobias remain throughout a person’s life. It is also a known fact that if our parent has a fear of an animal, they will pass on that fear to us.     Types of phobias There are a wide variety of objects or situations that someone could develop a phobia about. In fact there are over 100. Some might make more sense, such as a fear of flying or dogs. But what about a fear of air or a fear of numbers? Specific phobias are divided into 4 main categories. I have included some of the more common phobias below. Fear of problems in the natural environment Astraphobia - a fear of thunderstorms and lightening Acrophobia - fear of heights Dendrophobia - a fear of trees Fears of animals Arachnophobia - fear of spiders Ailurophobia - fear of cats Cynopphbia - a fear of dogs Fear of Medical Treatments or Issues Dentophobia - fear of dentists and dental treatment Hemophobia - fear of blood Trypanophobia - a fear of needles or injections Fears related to specific situations. Claustrophobia - fear of closed in spaces, such as lifts. Glassophobia - fear of heights Aerophobia - fear of flying.   When does a phobia become a problem? Most people choose to live with a phobia and take great care to avoid the thing they fear. Most individuals do not seek professional help until a situation or event in life presents itself and the phobia can no longer be avoided. Some examples of this might be: We are offered our dream job - but the office is on the 50th floor of a building. Our child is getting married, but the wedding is taking place the other side of the world. The office for our current job moves and either we take 3 hours to get there by public transport or 1 hour by car, but this involves driving on a motorway. We have booked our dream trip but realise that we will arrive in the rainy season and thunder and lightning strikes will be a daily occurrence. Treating Phobias One of the problems with living with a phobia is that by trying to constantly avoid the thing you fear you are telling your brain there is actually a problem. So, every time you cross the street to avoid the dog, your brain will believe it was a lucky miss because that dog was definitely going to bite you. Every time you avoid going on a train, your brain is convinced that you had avoided a certain disaster. Every time you avoid a hospital appointment your brain will be convinced the doctor was going to carry out a procedure that would lead to certain death. The point here is that unless you actually face the thing you fear your brain can never find out whether the thing you fear is actually a problem . This is the important bit... we have to show our brains that the thing that it is frightened of is actually benign. How do we do that? The obvious answer is to face our fears. But when we approach the object or situation of our phobia our brains tells us: RUN!!!!! YOU WILL DIE IF YOU DO NOT RUN!!!!!! So overcoming a phobia is not easy...but it can be done.     Step 1: Understanding Anxiety It is important to understand anxiety and why your body responds in the way it does when faced with your fear.   Step 2: Practice Anxiety Reducing Techniques. It is important to practice this outside of the feared situation. When we are in a situation where our brain is telling us we are going to die, stopping to try to remember how to breath properly does not work.   Step 3: Develop an exposure program that involves a graded hierarchy or a 'fear ladder'. This involves coming up with several steps starting with things we have mild anxiety towards and moving towards things we have intense anxiety for.   An example of exposure therapy for fear of spiders: 1.     Look at a picture of a small spider. 2.     Look at a dead spider in a jar. 3.     Look at a picture of a larger spider. 4.     Watch a video of a small spider. 5.     Watch a small alive spider in a jar. 6.     Be in a room with a small spider. 7.     Be in a room with a larger spider. 8.     Be in a room with a number of spiders. 9.     Hold a small spider in our hands. 10.  Hold a large spider in our hands.   An example of exposure therapy for a fear of heights: 1.     Stand on a low stool. 2.     Go up 5 rungs on a ladder. 3.     Go up one flight of stairs and look over the banister from a distance 4.     Go up 10 rungs on a ladder 5.     Go up one flight of stairs and look over the banister close by. 6.     Go up two flights of stairs and look over. 7.     Go up five flights of stairs and look over. 8.     Go up 10 flights of stairs and look out a window. 9.     Go up 20 flights of stairs and look out of a window. 10.  Go up 20 flights of stairs and look out from a balcony.   An example of exposure therapy for a fear of needles 1.     Think about having an injection 2.     Listen to someone talking about having an injection 3.     Look at photos of needles 4.     Look at photos of someone having an injection 5.     Watch a video of someone handling a needle 6.     Watch a video of someone having an injection 7.     Hold a needle in your hand 8.     Watch someone having an injection in the same room as you 9.     Place or hold a needle close to the site of injection 10.  Have an injection in your arm   Step 4: Prior to carrying out the first point on your fear ladder, carry out relaxation techniques to calm the body.   Step 5: Begin working through the hierarchy.     Top tips : Ask friends and family to celebrate your journey with you.  This can help with motivation. There will be items on the fear ladder that feel quite easy. Enjoy the feeling of achievement and watch your brain dismissing how hard it actually was to do it. Often, we will get to a point in a ladder where we feel stuck and cannot do the thing. Break this item down again as perhaps there are more steps involved. Plan a celebration at the end - maybe buying your child the dog they always wanted or throw a party on the top floor of a high building. Or maybe just have a cup of tea and bask in the wonderful feeling that you have overcome your fear, and it will never plague you again.

Disorder vs Stress Reaction Firstly, before I talk about how the pandemic may have had a significant effect on individuals, I would like to clarify a few things about the difference between a normal ‘stress’ reaction to an abnormal event and a ‘disorder’. A ‘disorder’ is a cluster of symptoms, severe enough to have a significant effect on our ability to be able to function. This ‘cluster’ of symptoms is seen time and time again and then extensive research carried out before the decision to warrant a ‘disorder’ status. To explain further: you will all have heard of the term ‘Post-Traumatic Stress Disorder’. An individual is diagnosed with this disorder when they display a cluster of different recognisable symptoms following a traumatic event, including things such as nightmares, flashbacks, a significant change in beliefs, a change in mood, such as a constant state of severe anxiety or low mood. For many individuals, their whole life is shattered and they feel that they need to pick up the pieces and start again. Generally, following a trauma, most individuals will naturally get better from a mental health perspective, within about one year. There are a multitude of reasons why some get over a trauma quicker than others but I shall not elaborate on that here. There has not been enough time or research carried out to date for us to know whether Post-Pandemic Stress Disorder exists. Never-the-less, for many individuals the pandemic has been a time of significant stress, trauma and flux. For many, it will take months or even years to return to normality. For those who have lost individuals to Covid-19, their lives may never be the same. For some, however, the pandemic has been a positive experience and I will turn to that first. Positive Impacts of the Pandemic Positive impacts of the pandemic have been discussed extensively. Those who always felt they had no time to spend at home or with family. Those who felt life was too busy with no time to reflect or slow down. Those who prefer time alone than time spent with others. Those who have been able to use this time to build a skill. Those who have, in the end, found that a change of career has been positive for them. Those who have benefited from working from home, rather than commuting. The list goes on. From a psychological point of view, those who have the support of family and friends around have fared better. Alternatively, individuals who are more introverted, in other words, they get their energy from being alone, have found the pandemic easier to cope with. For many, however, the pandemic has been difficult and for others it has caused a stress reaction that may take some time to overcome and for the brain to return to normal levels. Negative Impact of the Pandemic Research suggests that 18 to 24-year-olds, full-time students, unemployed people, single parents, those with enduring mental health conditions and those with long-term disabling health conditions, have found this to be particularly difficult. 18 to 24-year-old have generally just left school and are either off to university or looking for employment. For those who started university in 2020, the normal process of fresher’s week, parties, meeting new friends and socialising, turned in to lectures on-line and strict social distancing rules. For many, being away from home for the first time and stuck in a room with little opportunity for building a social network, has been very difficult. From an evolutionary perspective, our ability to be able to work and look after ourselves, is fundamental to our survival and when this is threatened in anyway, our fear network is triggered. So, not only was this a difficult time for those starting out on the road of employment but many lost their jobs because of the pandemic. Whole areas of industry were wiped out. Many small businesses, or businesses that could not function within social distancing rules have suffered. Individuals have faced financial hardship beyond anything they have ever experienced and this worry and anxiety about how to survive or provide for families has caused a severe stress reaction. Another group that have struggled during the pandemic have been families but especially single parent families. Looking after young children can be relentless and the break that nursery or school gives, helps parents survive. With schools closed and young children to teach or entertain and work to carry out both at home and through employment, many have felt overwhelmed. Obviously, those with enduring mental-health conditions already have enough to cope with and adding a pandemic to their issues has sent many spiralling into dark and difficult places. Issues surrounding the fear of contracting covid-19 have fuelled the fear that many with health anxiety or Obsessive-Compulsive Disorder, have. Where all around us we are reminded of how easy it is to catch the disease and how difficult it is for us to know how it will impact on us physically, a constant state of fear has been difficult to bear. Finally, for those with underlying health conditions, this time has been particularly difficult. The level of stress and anxiety related to catching the disorder, or a loved-one catching it, has created a constant and daily struggle with anxiety. Isolation from friends and family has made this time particularly difficult for many. As already mentioned, social support is fundamental to mental health. Post-Pandemic Stress Reaction and ways to get back to normal As mentioned in the introduction, many individuals who have found the pandemic difficult and have noticed an increase in stress or anxiety, will, as things return to normal, find that their anxiety returns to normal levels. It is best to remember this: accept that things may be difficult at the moment but keep in mind that it is likely things will naturally return to normal. This helps us to worry less, which can be a maintaining factor in anxiety. For others, however, the impact of the pandemic will be more enduring and if they are struggling, I would recommend they speak to their GP about help that is on offer, both through the NHS or privately. From an evolutionary point of view, our anxiety system or fear network has developed and endured because it has helped us survive. Ideally, it helps us to face a threat and then when that threat is past our system has the time to return to normal. One thing that has happened during the pandemic is lots of small traumas or on-going stressful events. One way of looking at this is if we think of living in a warzone. Daily stressors or threats cause our brain to shift on to ‘high alert’ and it can take years of calm for our brains to realise that the danger has past. If you find that your anxiety system seems to be triggering or you feel you are on ‘high alert’ every day and this is not improving, then there are many ways to help. I have written lots of articles on managing anxiety and there are many apps and websites available with information. Here are a few suggestions: 1. Rebuilding our lives : When coming out of a traumatic situation, it can seem that rebuilding our lives is like climbing a mountain. If we look up at the mountain (or look at what we have to achieve) then we feel overwhelmed. What we can do instead is put a plan in place about some ideas of how to return our lives to how they were and just take one step at a time. Do not think about how far you need to go – just focus on that next step. 2. Thinking element of anxiety and stress : The pandemic may have caused a state of feeling we are on ‘high alert’ all of the time. Intense levels of stress and anxiety does not help anyone. It is important for us to help our brains understand whether danger is real – in other words are we about to be attacked? Or is the danger just something that our minds are making up? Your brain may be telling you to focus on all of the things that could potentially go wrong. Although this helped us in hunter-gather times, it is less useful now. If the danger is not there in front of you at that very moment then try to change your focus of attention. You can do this by playing a game, doing a crossword, watching something, talking to someone – anything that takes your mind off from thinking about what could possibly go wrong. Many people think that being aware of everything that could potentially go wrong helps them to be prepared. This is actually not the case because we can never know what difficulties we may face in the future or how we will deal with them at the time. 3. Physical element of anxiety and stress: The physical elements of stress and anxiety are generally experienced as tension, shallow breathing, raised heartbeat, etc. There are many ways to reduce physical elements of stress and anxiety. You could set a reminder on your phone to come on every hour. Check your body for signs of stress and try to do some breathing exercises or relaxation . Meditation is another way to reduce physical tension. Exercise is an important de-stressor - you need to physically stress your body for happy hormones to be released and these happy hormones have a direct impact on reducing the stress hormones. Having a freezing cold shower – just for 30 seconds – has been shown to reset our body. Also, and far more pleasurable in my opinion, is a hot bath . 4. Finding a balance: Life is about finding a balance between work, rest, exercise and play. When we are getting over a difficult time, it is really important to prioritise things that make us feel better. There are things that we have to do – we need to work to provide for ourselves and our family; we need to look after our children and pets (if we have them), we need to eat and drink water; we need to sleep; and we need to clean ourselves. Apart from that, everything else is something that we feel we need to do but actually we do not. When trying to reduce stress and anxiety, we must prioritise the things that make us feel better, even if that sounds crazy when we look at our ‘to do’ lists.