Find Your Own Path: Choosing the Right Approach to Healing

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Have you ever been in therapy? I’m guessing, as you are currently reading this post on a blog all about mental health, that the answer is yes. If so, did it help? I certainly hope so, but sadly many people try different therapists, as well as different flavours of therapy, and find them either minimally helpful or not much help at all.

Of course, this doesn’t mean that all therapies are unhelpful. It’s just that, in my experience, people often choose therapists without really understanding the exact type of therapy they offer, why it’s better/worse than other approaches, or whether it’s the best approach for them.

Let me give you a concrete example. If you have experienced trauma in your life, you will probably need professional help to recover from that. And so you may find yourself a nice, friendly, caring counsellor, who says what you need is to talk through those traumatic events in great detail. But for many people just talking about what they have been through, in an unstructured way, will not only be unhelpful, but actually re-traumatising.

You would need a trauma-informed therapy like EMDR, sensorimotor psychotherapy, somatic experiencing, trauma-informed stabilisation treatment, schema therapy or trauma-focused CBT. All of these approaches will help you process your traumatic memories in a safe, structured and focused way. Just talking about your experiences, in this case, is not the way to heal them.

Let me be clear – I’m not knocking counselling here. There are some wonderful counsellors out there and the work they do is invaluable. It’s especially helpful to get you through a tough time, like bereavement or divorce, when a kind, empathic, non-judgemental person is exactly what you need. But mainstream counselling is not designed to help with trauma, which is why it’s not the right choice if that’s the kind of help you need.

Finding your own path

The longer I do this work and the more therapy models I study, the more I believe that there is no one-size-fits-all approach to healing, whatever kind of psychological problem you are struggling with. I often think to myself, ‘What does this person need, at this moment, in this session?’ And I then draw from a wide range of theories, techniques and strategies in my mind to find just the right one for that person, in that moment.

You might also find that you need different therapies at different times in your life – where a highly focused, time-limited approach like CBT may be perfect for one phase of your life, a longer-term, less-structured modality like IFS may be right for another phase, or set of problems.

With that in mind, if you are considering therapy, here are some suggestions for finding your own path to healing, happiness and a flourishing life:

1. The relationship is everything. Whichever of the many wonderful therapies you choose, remember that the primary healing agent in any therapy is the relationship between you and your therapist. This is especially true in longer-term approaches, like schema therapy or psychodynamic therapy. But even in short-term models like CBT, feeling safe in the room (or online) with someone, that they get you, care about you, are warm and nurturing, is crucial. I often tell people to shop around – if you have an assessment with someone and it doesn’t feel right, trust your gut and find another person.

2. Trauma-informed therapies for trauma-processing work. As I mentioned earlier, it’s so important to find a trauma-informed therapy/therapist if you have experienced trauma in your life. The bigger and more impactful the trauma, the more important this is. So ask your prospective therapist about their model, experience and plans to help you heal. If their answers seem a little off, or unconvincing, keep shopping.

3. Therapy is just one piece of the pie. As well as integrating various therapy models in my work, I am also a holistic practitioner. I talk to my clients about many things, but top of the list is how much sleep they are getting and whether they exercise regularly. We are only beginning to understand the importance of sleep for mental and physical health (spoiler alert: it’s profoundly important).

   And getting regular exercise is right up there with good-quality therapy, in my opinion. We need to move our bodies, in ways we enjoy, as often as possible. I’m talking weight-training, HIIT, spin classes, walking, swimming, yoga, dancing, running, vigorous gardening, rock climbing… Every system in your brain and body is built to work optimally when you’re moving, your heart rate is up, blood is pumping, your breaths are deep and skin is warm.

   Extensive research shows that exercise is a powerful healing agent for stress, anxiety and depression – the three main types of psychological problem people struggle with. Meditation is also key, as are warm, loving relationships, a healthy (ideally Mediterranean) diet, moderate drinking, a healthy microbiome, mind-opening books and podcasts… Therapy is an important piece of the pie, but it’s certainly not the only one.

I hope you found that thought-provoking and helpful. I also hope you find the right person/approach for you, as that can be life-changing.

And if you are struggling right now, sending you love and warm thoughts ❤️

Dan

How Can Trauma-Focused CBT Help You Overcome Trauma Symptoms?

PTSD is estimated to affect one in three people after a traumatic event. If you are struggling with trauma symptoms it can be useful to begin considering your support options. There are many different therapies available to support trauma and one of those is Trauma-Focused Cognitive Behavioural Therapy, or TF-CBT for short, but what is this type of therapy, and what does it involve? 

Psychologists Ehlers and Clark (2000), in their Cognitive Model of PTSD, propose that there are certain factors that keep the vicious cycle of trauma going, and these factors essentially prevent the trauma memory/memories from being processed. These factors include:

1. Poorly elaborated memory of the trauma and that the memory has not been contextualised (the memory does not equal the situation within which it existed or happened).

2. Excessive negative beliefs and meanings attached to the trauma memory.

3. Behavioural and cognitive strategies. Cognitive strategies include pushing thoughts away (suppression) and dwelling on events (rumination). Behavioural strategies may include withdrawing socially, avoiding internal and external reminders of the event/s, little or no engagement in previous hobbies or interests, use of drugs and alcohol. There can be many more strategies people may use, we recognise every individual has different coping strategies to try to minimise or eliminate their suffering.

Goals in Trauma-Focused CBT

Therefore together our goals in TF-CBT are to:

1. Reduce flashbacks and nightmares by opening up the memory and being able to discriminate with reminders of the trauma what is then (at the time of the trauma) and what is now (in the present moment). We may recall the memory spoken out loud or by use of writing in session using the present tense. Some people may revisit the site of trauma in this part of the work to aid adding context to the trauma memory.

2. Modify excessive negative beliefs of the trauma, changing perspectives to create new more helpful beliefs. For example ‘it was my fault X happened’ becomes ‘it was not my fault X happened’ we may develop a more compassionate response towards the self. In therapy we may do this through careful and gentle questioning to explore different perspectives. We then incorporate the more helpful belief into the trauma memory.

3. Remove unhelpful behavioural and cognitive strategies that maintain intrusions and the current sense of threat and danger. We may do this in therapy by exploring the advantages and disadvantages of each strategy both in the short and long term.

As we come towards the end of treatment we often hear people we support reporting a reduction or ceasing of intrusions, a decreased sense of danger in the present moment and an improvement in mood as the person begins regaining and rebuilding their life after after the traumatic event/s.

Please see the video below if you would like to learn more about the different stages of the therapeutic journey when we work with trauma using TF-CBT. 

Emma McDonald, CBT & EMDR Therapist

•If you are looking for a Trauma Focused-CBT specialist we have a team of therapists who can offer this support face to face or online – further information can be found on our website www.thepsychotherapyclinic.co.uk

How do Online Sessions Work for Schema Therapy?

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During this stressful time, many of us will be struggling with anxiety or low mood, especially if you are self-isolating or on lockdown, with few chances to leave the house. If you are finding it hard to cope during the coronavirus outbreak, first and foremost connect with your friends and loved ones.

Social distancing is, in my opinion, not the most helpful term right now. Instead, we should all be physically distancing but socially connecting – by phone, social media, Skype, Zoom or any other way that lets us stay in touch with those we love, while keeping them and ourselves safe.

If you need more help than that, do reach out to me or another mental-health professional, who can offer guidance and support during this hard time. I have long worked with clients online via Zoom. It also means I can help people all over the world, which is wonderful. I am offering both short-term and long-term therapy during the current crisis.

Here are a few guidelines about how online therapy works:

1. I use Zoom for online sessions – it has revamped its privacy/security recently, so I am confident it’s a secure and confidential platform for therapy. Using Zoom is very simple. Before your session, I will send you a link via email, which you click on to join an online ‘waiting room’. At the start of the session, I click on your name to begin our session, then lock the meeting to ensure complete confidentiality.

2. I will create a shared folder on Dropbox, so that we can share important documents like an intake form, or notes I want you to read after a session. This means that all communication is confidential (Dropbox also has strict security measures in place).

3. You may feel uneasy about having therapy online. But, having provided hundreds of online sessions over the years, I find it works very well for schema therapy. We get to see each other and hear each other’s voice. And clients tell me they feel safe and connected to me.

4. That said, we need to be flexible to make it work. Exercises like chair work are obviously a bit trickier online! But I do them, regularly, and will explain how to make them work. After the session I will send you an iZettle invoice, so you can pay quickly and securely. And that’s it!

If you have any questions about online session with me, email dan@danroberts.com or use the contact form to get in touch.

Warm wishes,

Dan

What Are Unhelpful Thinking Styles in Cognitive Therapy?

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Although difficult life events such as financial setbacks, divorce or family conflict are hard for anyone to deal with, you make these events either easier or harder to deal with because of your thoughts and beliefs about them. This is the basic principle in cognitive therapy, which is why cognitive therapists such as myself place so much importance on understanding the way people think, especially when they are upset.

If you can become aware of your automatic thoughts (which run through your head all day, providing a commentary on things you see, say and do) you can then start to identify unhelpful ways of thinking and try to change them.

What are negative automatic thoughts?

Negative automatic thoughts, or NATs, are the ones most strongly linked to unpleasant feelings like anger, hurt or anxiety. For example, when you feel angry you may be thinking someone has disrespected you, or endangered you or your loved ones in some way. When you are anxious, you may be worried about future threats such as redundancy or health problems.

Either way, in cognitive therapy we see the NATs as the source of your problem, because they are often exaggerated or based on interpretations, judgements or perceptions rather than concrete evidence.

It's also a vicious circle, because when we are upset the volume of NATs increases and we are more likely to use unhelpful ways of thinking rather than perceiving things as they are. Everyone does this, to a greater or lesser extent, and we all tend to use certain kinds of thinking more than others.

If you want to change unhelpful ways of thinking, identifying your own commonly-used thinking styles is a good place to start. Take a look at the following list and see which seem familiar to you.

Unhelpful thinking styles

1. All-or-nothing thinking. This is when you look at things as absolutes: good/bad, success/failure, black/white. There's no room for shades of grey. 

Examples: If I don't get an A on this test I'll be a total failure. Second place is for losers. 

2. Catastrophising. Exaggerating how bad things have been or will be, using words like ‘awful’, ‘nightmare’ or ‘disaster’.

Examples: If she breaks up with me it will be a nightmare. God, this party is bound to be a disaster.

3. Overgeneralisation. You view a single negative event as a never-ending pattern of defeat, or take one situation that doesn't work out to mean that life is always this way. 

Examples: That dinner party didn’t go well – I must be a terrible host. My partner seemed really grumpy with me last night – she’s obviously going off me and thinking about ending it. 

4. Mental filter. You dwell on the negatives and ignore the positives. So, if your university tutor gives you a glowing assessment including one mild criticism, that’s what you fixate on. 

Example: My appraisal seemed to go well, but all I can think about is that criticism of my grammar.

5. Discounting the positive. You reject all positive experiences, compliments or praise by telling yourself, ‘They don't count’, or ‘They're just saying that to be polite.’ 

Examples: That’s really kind, but anyone could have done it. We did get the best sales figures ever, but it’s all down to my team – I didn’t have much to do with it.
 
6. Jumping to conclusions. Making assumptions with little or no evidence, in two ways:

a) Mind reading. You assume you know what people are thinking – and it’s usually negative.

Examples: I know this girl thinks I'm boring. I’m sure they’re judging me behind their smiles.

b) Fortune-telling. You think you can predict the future – and assume things will turn out badly.

Examples: I definitely failed that test. I’m bound to be the one who gets made redundant.

7. Permission-giving thinking. Finding excuses to do something that provides short-term pleasure or relief but causes long-term difficulties. 

Examples: I’ve had a really stressful day so I deserve another whisky. I feel a bit down today so I’ll buy that dress/those shoes/that flatscreen TV and worry about it later.

8. Emotional reasoning. This is when you assume something is true because you feel it so strongly, assuming that your negative emotions reflect the way things really are. 

Examples: I’m so anxious I just know this plane will crash. I feel so jealous, I know he’s cheating. 

9. Should statements. Placing excessively harsh demands on yourself, others or the world by using the words ‘should’, ‘must’, ‘have to’ or ‘ought to’.

Examples: I should be happier, what’s wrong with me? I have to lose 10lb or I’m pathetic.

10. Labelling. Calling yourself or others names like ‘idiot’, ‘failure’ or ‘bastard’.

Examples: I’m rubbish at maths – I’m such a failure. That Mrs Jones is such a witch. 
 

Warm wishes,

Dan

How to Deal With Suicidal Thoughts

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If you are having suicidal thoughts, you are not alone. Sadly, thinking about harming yourself is extremely common. And tragically, many people in the UK and around the world take that one step further and either attempt to hurt themselves or succeed in taking their life. In the UK, suicide is the leading cause of death among men under 50 – more than heart disease, cancer or road accidents.

But it doesn't have to be this way. I have worked with hundreds of people who had thoughts of harming themselves – and helped them see that suicide is not the answer. It is devastating for those left behind. It might seem like the only solution, but it never is. And suicidal thoughts come and go, so if we can help people through the worst – often quite short – period of time, those thoughts and impulses will naturally recede.  

Helping with depression

One of the most important messages I give people is that thoughts of suicide are completely natural, especially when we are feeling depressed. That's because our thinking becomes very negative and it's hard to see anything good in life, or to believe that things will ever get better. Depression is also really tough to deal with day to day, so ending your life seems like a way to stop the pain. But we can now treat depression extremely effectively with CBT, so once your mood lifts you will no longer feel that way. 

It's heartbreaking for me every time I hear of someone taking their own life, because I always think, It didn't have to be that way. Someone could have helped them and they would still be here today.

Mental-health professionals know that some psychological problems bring greater risk than others. These include depression, alcohol abuse, anorexia, psychosis and schizophrenia, bipolar disorder and 'personality disorders' like Borderline Personality Disorder. So if you or someone you love is suffering from one of these problems, please do keep an eye on them. Reach out to them often and ask how they are. Also be straight and say, 'I'm worried about you, are you thinking of killing yourself?' Just asking that question could help save their life, because if the answer is yes you should contact their GP or one of the numbers below.

If you are reading this and thinking of hurting yourself, please don't. Tell someone, even if it seems like the hardest thing in the world. I promise you that help is available – and that, a year from now, you will look back and feel the deepest gratitude that you kept yourself safe and can still enjoy all of the wonderful things life has to offer.

Warm wishes,

Dan

If you are thinking of taking your own life, or know someone who might be, please call one of the numbers below:

The Samaritans – available 24 hours a day, 365 days a year on 116 123 or email jo@samaritans.org

Childline – for children and young people under 19. Call 0800 1111 – the number won't show up on your phone bill

The Silver Line – for older people. Call 0800 4 70 80 90

SANE provides confidential support for people with mental-health problems, every day of the year from 4.30pm to 10.30pm on 0300 304 7000

Campaign Against Living Miserably (CALM) – for men. Call 0800 58 58 58 – 5pm to midnight every day

Papyrus – for people under 35. Call 0800 068 41 41 – Monday to Friday 10am to 10pm, weekends 2pm to 10pm, bank holidays 2pm to 5pm. Text 07786 209697 or email pat@papyrus-uk.org 

Are You a Highly Sensitive Person?

Elaine Aron is an American clinical psychologist who has spent her career researching, writing about and providing therapy to Highly Sensitive Persons (HSPs). Aron discovered this group and set about testing her theory that some people are more sensitive than most – she believes HSPs make up about 20 per cent of the population. Her book, The Highly Sensitive Person: How to Thrive When the World Overwhelms You, is written for HSPs like herself, as she is an unusually sensitive individual too. 

I must admit that this book has had a huge impact on me. Not only does it describe at least 90 per cent of the people I work with, but it also describes me with eye-opening accuracy. HSPs, according to Aron, have an unusually sensitive nervous system.

This means that they pick up on far more of the information in their environments than less-sensitive people. They are affected by bright lights, loud noises, crowds and strong smells. If there is tension in a room, they will pick it up and find it uncomfortable. They will intuit which people in a group are friends and who dislikes each other. They are like tuning forks for subtle interpersonal vibes.

Aron is quick to point out that being an HSP does not make us superior to our less-sensitive friends, family members or colleagues. This sensitivity is a trait – largely genetic but also affected by our life experiences – that is neutral. In some ways, it is a real advantage – I always tell my clients that I could not be a schema therapist without a high level of sensitivity. Being this sensitive makes me, and all other HSPs, more thoughtful, empathic, attuned to other people and their needs, as well as a whole host of other good things.

Sensitivity is no bad thing

But perhaps the most important point that Aron makes – and one I really want you to take on board – is that being sensitive is in no way a bad thing. I don't know about you, but all my life people have told me I should be less sensitive. 'It's just a joke – stop taking things so seriously!' Or, 'Why do you always make such a big deal about things? Just man up and toughen up, for God's sake.' Don't be so shy/introverted; be the life and soul, speak louder, be more of a 'character'. 

For men especially, sensitivity is often seen as a weakness, or something to be ashamed of. Many HSPs get bullied at school, for precisely this reason. And extra-sensitive women are often told they are crazy, or over-emotional, because they feel things deeply and cannot just lighten up, or get a grip, or let it go.

So if this describes you, please understand that there is nothing wrong with you – and certainly nothing to be ashamed of. You are just genetically, temperamentally, a bit different from most other people. This probably means that you have been very much affected by difficulties in your childhood, or family of origin.

You may have an anxiety disorder, or get depressed. You may even have personality problems, or struggle with addiction. All of these things need help, from a professional like me or one of my colleagues, who are trained to help sensitive people (and less-sensitive ones, of course) become happier and healthier. I would also strongly recommend reading this book.

And if it describes you, give it to your partner, friends and family, so they can better understand you and why you behave as you do.

Warm wishes,

Dan

Schema Therapy or CBT – Which is Right for You?

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If you are struggling with psychological problems, you may be thinking about having some therapy – but which kind of therapy should you choose? I am trained in both cognitive behaviour therapy (CBT) and schema therapy – two of the most effective forms of 'talking therapy' currently available – and provide schema therapy at my North London practice. Here is a guide to which therapy is the best fit for different kinds of problems...

CBT is widely recognised to be the most effective, evidence-based form of therapy ever created. Founded by Dr Aaron Beck in the 1960s (originally as just 'cognitive therapy' – the B was added later on), CBT has been proven to be effective at treating depression, anxiety disorders such as OCD or health anxiety, panic attacks and agoraphobia, eating disorders, anger management problems, addiction... the list goes on.

If your problem is relatively short-term (for example, one episode of depression rather than many); if you are functioning fairly well in most aspects of your life, but struggling with a specific problem like anxiety or depression; if you would prefer a short-term treatment; and if, perhaps, you have had CBT before and found it helpful, or have been recommended CBT by your GP or another medical professional, then CBT is probably the right choice for you. It is always possible to have CBT to reduce upsetting symptoms, such as panic attacks, and then move on to schema therapy afterwards to address more deep-rooted problems.

When schema therapy is the best option

In general, it's best to opt for schema therapy (ST) if your problems are longstanding – for example, if you have been struggling with recurrent episodes of depression for much of your life. Problems related to a difficult childhood, to extremely critical parents, say, or if you experienced abuse, neglect or traumatic incidents as a child, are best treated with schema therapy.

CBT will be helpful up to a point, but schema therapy is designed to heal painful/unhelpful ways of thinking, feeling and behaving at a deep level – otherwise you may find problems coming back after therapy when you experience a period of stress, say, or a relationship breakup.

Schema therapy was developed by Dr Jeffrey Young in the 1990s to treat people with personality problems – especially Borderline Personality Disorder, which can have a profound effect on someone's life and was poorly treated before approaches like schema therapy and dialectical behaviour therapy (DBT) came along.

Because it's intended to help with deep-rooted problems, schema therapy is a slower, longer-term approach than CBT. Generally, I tell my clients that 20 sessions are the minimum – and therapy can last for a year or more for really hard-to-treat problems. It's important to note that schema therapy is not just for personality problems – it is now used to treat all of the difficulties people seek therapy for.

In terms of how it feels to have ST versus CBT,  I would say that schema therapy is a warmer, more compassionate, more nurturing approach than CBT. It's much more focused on the relationship between therapist and client, rather than specific techniques to change thinking or behaviour, which form the bulk of treatment in CBT. But of course because schema therapy is just a newer form of cognitive therapy, all of the CBT techniques are still available, if I think they will be helpful for you.

Warm wishes,

Dan

Should You Take Antidepressants?

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If you are struggling with anxiety, or have been depressed for a few weeks and visit your GP, they are likely to prescribe antidepressants. But should you take them? And is medication really what you need? In a large number of cases, I think not.

Before I explain why, let me be really clear – if you are severely depressed, your mood may be so low that some of the alternatives I'm about to suggest just won't work. In that case, you may need a course of antidepressants to lift your mood enough for talking therapy, for example, to work.

If you have bipolar disorder, you will probably need to take a combination of different medications, such as a mood stabiliser and possibly antidepressants. And, crucially, if you are currently taking antidepressants you should never stop taking them without consulting your psychiatrist or GP. This can be extremely risky, so please don't do it.

That said, I do worry that many hard-pressed GPs now dole out antidepressants far too easily. I don't blame them for this – they have so little time with patients now that they are often forced into the simple solution that medication represents.

They may also want to refer a patient for a talking therapy such as cognitive-behavioural therapy (CBT), but know the waiting list is so long it would not be helpful for someone who was struggling (some of my clients say they faced a 12-month wait for CBT on the NHS – an impossibly long time to wait if you're in a bad way).

Numbing the symptoms

One of the biggest problems with antidepressants, though, is that they only help with the symptoms of depression as long as you're taking them. When you stop, unless you have addressed the issues that made you depressed in the first place (like negative or overly self-critical thinking, or low self-esteem) you are likely to get depressed again. That's why all the evidence shows that combining antidepressants with psychotherapy is far more effective than the meds alone.

Research also shows that regular cardiovascular exercise is just as effective as antidepressants for mild to moderate depression. As is mindfulness-based cognitive therapy (MBCT), which is especially good at preventing relapses. Both are completely free, once you've learned how to do them, have no nasty side effects and work straight away, unlike the 2-6 week wait for the meds to take effect.

So I'm not saying you should never take antidepressants. Just that they are powerful drugs that don't help everyone, have strong side effects and should not be taken lightly. And – especially for milder forms of anxiety or mild to moderate depression – other approaches work just as well.

Warm wishes,

Dan

Overcoming Public Speaking Anxiety

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

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

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

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

Change the movie

When we get anxious about something in the future, we usually play a movie (let's call it the Scary Movie) in our heads about all the things that might go wrong – we imagine ourselves drying up and having nothing to say; forgetting our speech notes, so we have to wing it for 10 horrible minutes; other people seeing how nervous we are and judging us for it; or our audience looking bored, yawning, fidgeting and talking among themselves because our speech is so dull.

Play this movie in your head enough times and, guess what? You will succeed in making yourself extremely anxious and, ironically, causing the exact problems you are worried about on the day.

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

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

This will help you feel less anxious on the day. Incidentally, this technique also works really well for driving tests, first dates, meeting in-laws, job interviews...

Warm wishes,

Dan

When Someone You Love is Depressed

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It seems to me that we don't give enough help and support to the loved ones of people with mental health problems. If your partner, child, sibling or parent has a mental health problem like an anxiety disorder, depression or an eating disorder, it can place a huge strain on you.

They may be the one who is struggling – and, hopefully, receiving the right help to resolve their problems – but it's easy to overlook the impact that can have on the people around them.

If someone close to you is depressed, you may feel out of your depth as you try to help them. Your normal strategies, like being encouraging or trying to look on the bright side, might not actually be helpful for your depressed loved one – and may even make them feel worse.

Coming up with solutions for the many problems they perceive in their lives might also be unwelcome right now. And we know that depression can be 'contagious', meaning that you might also feel low, or become influenced by their negative and hopeless view of events.

Here are three ways you can help your loved one as they struggle with depression:

1. Understand what they are going through

If you have never experienced depression yourself, it can be bewildering when someone close to you is depressed. But it's incredibly common – one in four people will experience some kind of mental health problem in the course of a year, with the most common form being mixed anxiety and depression. Understanding what depression feels like, what causes it and especially what can help is key.

I strongly recommend Overcoming Depression: A Self-help Guide Using Cognitive Behavioural Techniques, by Paul Gilbert – one of the world's leading experts on depression. You can also find a wealth of information online from charities such as Mind and the Mental Health Foundation.

2. Remember that it's not your job to fix them

When people we love are struggling, it's the most natural thing in the world to try and help them feel better. But when you are depressed it can be incredibly hard to lift your mood, or solve even minor problems that still seem utterly insurmountable because you lack energy, motivation and hope that things will get better.

So rather than trying to fix them or gee them up just listen to them, keep showing them you love and care about them, and encourage them to see a mental-health professional, who does have the knowledge and skills to help them get better.

3. Help them take small steps to becoming more active

When you are depressed, you commonly stop doing the things you used to enjoy – partly because you have no energy, and partly because you don't take much pleasure in them any more. But if you stop doing things you enjoy, or that give you a sense of self-worth, your mood will clearly keep getting lower.

So – gently – encourage them to do small things, such as going for a walk or to the park, doing some gardening, seeing close friends, going to the cinema, or if they feel up to it helping someone else, like an elderly neighbour (we know that this is especially helpful when you feel down).

If they are drinking heavily, encourage them to cut down or even stop for a while, as alcohol is a depressant. If their diet is really poor, try to get them eating more healthily – perhaps cooking healthy meals for their freezer. And if they aren't doing any exercise, see if you can help them start – regular cardiovascular exercise like swimming or brisk walking is as effective as antidepressants for mild to moderate depression.

Finally, if their depression does not lift after a few months, they may need talking therapy such as cognitive behaviour therapy (CBT), or schema therapy if they have had recurrent episodes of depression. You may need to encourage them to see a therapist – this is especially hard for men – but remind them that one in four people experience a mental health problem at some point in their life; and that therapy is now extremely effective, so it's definitely worth seeking help if their life is a real struggle.

I hope you find this helpful – please also remember to take care of yourself, as this will be a tough time for you too. 

Warm wishes,

Dan

Acceptance Versus Change in Cognitive Therapy

Image by Ross Findon

A common dilemma for people engaged in cognitive therapy is understanding when to try and change a thought, behaviour, feeling, situation, relationship, etc and when to accept it. One way I explain this apparent contradiction is to say that the first stage of cognitive therapy is all about change.

We identify specific problems in the client's life and come up with goals embodying the ways that person's life would be different if we solved those problems – this is all about change.

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

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

Mindful acceptance

Acceptance is at the core of mindfulness theory and practice, because the Buddhists who originally harnessed the power of mindfulness understood that in life there are many things we can neither change nor control. We all get older and eventually die, as do those we love and care for. We all suffer from problems with our health, especially as we get older.

Many things appear entirely beyond our personal control, such as climate change, the fluctuating economy, wars, natural disasters and even the actions of our own Government. So it is fruitless for us to spend hours worrying or disturbing ourselves about the things we cannot change – the Buddha discovered 2,500 years ago that an accepting mindset will greatly reduce our distress and unhappiness.

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

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

Warm wishes,

Dan

Do You Want to Learn Mindfulness Meditation?

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

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

Learning to meditate

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

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

If you would like to take an MBCT course, make sure you find a reputable place to study, like the Mindfulness Project in London (londonmindful.com). I also think that a blend of mindfulness and schema therapy is an excellent way to tackle a wide range of psychological problems.

Warm wishes,

Dan

Overcoming Postnatal Depression

Image by Andreas Kretschmer

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

Symptoms include:

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

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

• Feeling utterly exhausted and lacking energy

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

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

• You might have guilty or negative thoughts

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

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

Talk to your GP

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

If you are not having these thoughts, or your symptoms are milder, it's still really important that you talk to your GP, health visitor, partner and family about it. PND is not your fault, it is nothing to be ashamed of and is very common, so there's no reason to suffer in silence.

It worries me that, according to a recent survey, nearly half of all mothers with PND didn't seek help because they were afraid of what might happen to them or their baby. Remember that your GP and health visitor only want to help you with any problems you're having adapting to life as a new mum – including postnatal depression – so there's no reason to keep it secret.

Support is key

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

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

Warm wishes,

Dan

Bibliotherapy for Anger Issues

Image by Ricardo Gomez Angel

'Bibliotherapy' is an important part of cognitive therapy, either to run alongside a course of therapy or as a self-help tool. I often recommend books to my clients, partly because there is only so much time in a session, so it's much more useful for them to read up about their particular issue and for us to discuss their findings next week.

But I also find that many people like to understand why they might be having problems and find their own strategies for solving them – another important idea in cognitive therapy, because ultimately I am trying to help my clients to be their own therapist.

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

1. Overcoming Anger and Irritability: A Self-help Guide Using Cognitive Behavioral Techniques, by William Davies. Part of the excellent Overcoming... series, this is designed as a CBT workbook, which you can use either instead of or alongside a course of cognitive therapy.

As with any issue in CBT, problems with anger (either struggling to express or control it) are seen as a consequence of unhelpful thoughts and beliefs. So if you change the way you think, you will change the way you feel and behave.

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

2. The Compassionate Mind Guide to Managing Your Anger, by Russell L Kolts. I am currently reading – and thoroughly enjoying – this warm, wise and helpful book, so can strongly recommend it. Kolts is an American clinical psychologist specialising in anger issues, with vast experience of working with groups such as prisoners, for whom destructive anger is clearly a major problem.

He draws on Paul Gilbert's compassion-focused therapy (in which have trained) to explain the evolutionary/psychological basis of anger, especially its role in protecting us from threats, either real or perceived.

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

3. The Superstress Solution, by Roberta Lee MD. Don't let the title throw you off – I have included this book in both the anger and stress sections of my bibliotherapy course, because anger and stress are often inextricably linked. Think of it this way: if you are prone to irritability, remember how you felt after your last holiday.

I'm guessing that all the little things that normally drive you to distraction didn't seem like such a big deal – and you probably dealt with them without becoming in the least bit cross or frustrated. Why? Because you had de-stressed and were relaxed, so your levels of patience and what's known as 'frustration tolerance' were far higher than in your pre-holiday, stressed-out state.

That's why, if you have a problem with anger, managing your stress levels is extremely important. Dr Lee is an integrative physician who takes a holistic approach to reducing the stress levels many of us suffer from in our always-on, over-stimulated, over-caffeinated, under-rested modern world.

Covering everything from diet and exercise to meditation and lifestyle changes, this is a wonderfully clear, sensible and helpful book. Follow her advice and both your stress and anger levels should reduce significantly.

Warm wishes,

Dan

Five Simple Steps to Combat Depression

Image by Hannah Wei

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

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

1. Get some exercise. I can’t speak highly enough of exercise – it’s what evolution designed our bodies for, so when we don’t do it, we suffer. And research has proven cardiovascular exercise like jogging, cycling, swimming or dancing to be as effective as antidepressants for mild to moderate depression.

If you’re feeling really low and sluggish, and the thought of vigorous exercise is just too much right now, try going for a walk. Even a few times round the block and a little fresh air will make you feel better.

2. Call a friend. When we get depressed, we tend to isolate ourselves because we can’t be bothered to see other people, or worry about being a burden on them. But isolating yourself means you will just ‘ruminate’ (thinking about your problems over and over) and make yourself feel worse.

Call a close friend for some support or, if you’re up to it, an evening’s laughter with friends is wonderful therapy when you’re feeling blue.

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

4. Help someone else. This may sound odd, but studies consistently show that giving to others helps us feel better about ourselves. Offer to do your elderly neighbour’s shopping or mow their lawn; help out at a homeless shelter; sign up for a charity event for a cause you believe in.

When we’re depressed, it’s easy to forget there’s a big world out there – doing something for other people helps you remember that and takes your mind off your own difficulties.

5. Watch what you eat and drink. When we feel bad, it’s easy to drink more alcohol than usual so we can relax and numb uncomfortable feelings. But alcohol is a depressant – so you will feel worse the next day. It also disrupts your sleep, which may already be a problem if you’re down. Go easy on the booze until you feel better.

Also watch out for caffeine, because it stimulates the adrenal system. Depression is often mixed with anxiety, so the last thing you need is more adrenaline in your bloodstream. Go for herbal tea instead of regular tea, coffee or chocolate.

Warm wishes,

Dan

Overcoming Panic Attacks

Image by Rosario Janza

If you have ever suffered a panic attack, you will know how unpleasant they can be. During an attack, you may feel extremely anxious, hot, wobbly, dizzy and light-headed, with palpitations (increased heart rate), heart pounding or missing a beat, breathlessness and possibly 'derealisation', when everything seems unreal or you feel as if you are floating, or disconnected from reality.

Your thoughts will probably race and you may also experience visual disturbance, when colours or shapes seem to change. Because the physical symptoms of a panic attack feel so strong, people commonly fear they are physically ill and end up in hospital, only to be told there is nothing physically wrong with them and it's 'only' anxiety.

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

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

2. Distract yourself. When you feel your anxiety rising and you feel any of the above symptoms, use distraction to take your focus away from the physical sensations in your body. Try staring intently at anything non-threatening, such as the second hand on your watch, or count anything – books on a bookshelf, bricks in a wall, tins in the cupboard – nearby.

If you can concentrate, doing sudoku or crossword puzzles is good, as are times tables or counting down in twos from 100. Try different distraction techniques until you find the right one for you.

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

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

Warm wishes,

Dan

Bibliotherapy for Anxiety

Image by Tom Hermans

'Bibliotherapy' is an important part of cognitive or schema therapy, either to run alongside a course of therapy or as a self-help tool. I often recommend books to my clients, partly because there is only so much time in a session, so it's useful for them to read up about their particular issue and for us to discuss their findings next week. 

And people usually like to understand why they might be having problems and find their own strategies to solve them – another important idea in cognitive therapy, because ultimately I want my clients to be their own CBT therapist.

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

1. Overcoming Anxiety: A Self-help Guide Using Cognitive Behavioral Techniques, by Helen Kennerley. I often recommend books from the Overcoming... series to my clients, because they are excellent introductions to CBT, and can be used either as a self-help workbook or alongside a course of CBT therapy. 

Overcoming Anxiety is packed with useful information about what causes anxiety, how best to deal with and practical, easy-to-use techniques for reducing your anxiety levels. And at £10.99 it's also a good deal cheaper than a course of therapy!

2. The Compassionate Mind Guide to Building Social Confidence: Using Compassion-Focused Therapy to Overcome Shyness and Social Anxiety, by Lynne Henderson. This is one of the first wave of books based on the principles of compassion-focused therapy (CFT), a new form of CBT that helps you treat yourself more kindly and compassionately.

Another book in the series (by Dennis D Tirch) deals with anxiety more generally - this one focuses specifically on shyness and social anxiety. Like Helen Kennerley's book, above, it's full of useful techniques you can use yourself to start feeling more socially confident. Given that social anxiety is often caused by harsh self-criticism and fear of rejection/criticism from others, CFT is uniquely well-suited to softening that criticism, which is usually excessively punitive and self-downing.

3. Overcoming Obsessive Compulsive Disorder: A Self-help Guide Using Cognitive Behavioral Techniques, by David Veale and Rob Willson. Obsessive compulsive disorder (OCD) can be a horrible illness, which may end up completely dominating someone's life. David Veale is one of the world's leading experts in the treatment of OCD, so he's certainly worth listening to.

I have to say that, as someone who specialises in treating anxiety disorders such as OCD, this condition is probably too difficult to overcome on your own, but this book will certainly give you a good idea of why you suffer from OCD and what you need to do to banish it from your life. You will then need to work with a CBT or schema therapist (OCD is one of the conditions that doesn't respond well to other forms of therapy).

Warm wishes,

Dan

What is Thought-Action Fusion?

Image by Roman Bilik

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

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

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

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

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

Generalised anxiety disorder

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

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

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

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

You can see how the latter part of her second belief is an example of thought-action fusion. Like many people, Clare thinks there is a causal relationship between worrying (a type of thinking) and her children coming to harm (an action). Logically, although of course it's good to be careful about your children's safety, constantly worrying about them will not keep them safe, especially when they are not with Clare.

But despite the stress and exhaustion that all this worrying causes her, it helps Clare manage her discomfort with uncertainty – another key feature of GAD. Learning to think in a more rational, balanced and helpful way is key to overcoming any anxiety disorder.

Warm wishes,

Dan

Finding Your Way Through Depression

Image by Aiony Haust

When you get depressed, it's easy to think you are the only person who has ever felt this bad – but anyone can become depressed, especially when they suffer a major loss such as bereavement or divorce. Depression can also be a response to feeling overwhelmed by life, when the stress or upset are just too much to bear. Even the strongest of us have our limits, so when we take on too much, or life overloads us with problems, it’s easy for our mood to dip.

When you are feeling depressed, it's easy to imagine that everything is hopeless, or that you will never get better. You may be tired all the time, unable to sleep properly, taking little interest or pleasure in the things you used to enjoy. You might feel angry or irritable about every little thing, or be fearful and anxious for no obvious reason. You may also have suicidal thoughts, which are very common when we are depressed.

It’s important to distinguish between different kinds of depression. Mental health professionals talk about mild, moderate and severe depression, which are just ways of distinguishing between how much it is affecting you, your day-to-day mood and ability to function. I think it’s also useful to recognise that some people only ever have one episode of depression – usually in response to a loss or life crisis – while others have ‘chronic’ depression, which means they experience repeated bouts of low mood for years or even throughout their life.

There is much debate about what causes depression, but in the cognitive therapy model we see depression as a result of persistent negative thinking, which may be triggered by a painful life event, but is also linked to underlying negative beliefs.

Negative beliefs are key

Aaron Beck, the founder of cognitive therapy, calls these beliefs the ‘cognitive triad’, meaning negative beliefs about yourself, your experiences and your future. These beliefs may lie dormant throughout your life, until they are triggered by a loss or crisis, when they become active and start to dominate your thinking.

People with depression use all sorts of images and metaphors to describe their experience, but commonly talk about viewing the world through dark glasses, being under a black cloud, or everything looking grey (Winston Churchill, one of many famous people who have suffered from depression, talked about the ‘black dog’ that followed him everywhere). These images reflect the overwhelmingly negative bias to your thinking when you are down, making everything seem a bit bleak, hopeless and too much to cope with.

Withdrawing from the world

When you are depressed you also stop doing the things you used to enjoy, like going to movies, spending time with friends or cooking delicious food. This is absolutely normal, and in many ways perfectly understandable, because these things no longer give you any pleasure, so why would you bother?

You may also be exhausted, so lack the energy to go out and engage with the world. More than that, you might find interacting with other people difficult or even painful, so again it makes sense to withdraw from your relationships with others.

The key point here is that, although completely normal and understandable, when you stop doing things you used to enjoy or seeing other people you get increasingly withdrawn and isolated. If you spend all day in bed, you will probably not be resting, but instead engage in ‘rumination’, with all those dark thoughts going round and round your head.

Think of it this way – who wouldn’t get depressed if they never did anything fun and spent all day thinking about everything that was wrong with them and their lives?      

Re-engaging with life

So one of the first things I do with depressed clients is to help them start doing things again – very gently at first, but slowly re-engaging with life. If you are really down, this might just be doing the laundry and tidying your flat; for other people it may be doing some gentle exercise, cooking at least one healthy meal a day, or planning a trip so they have something to look forward to.

Gradually their mood lifts until they feel well enough to tackle those negative thoughts – again, slowly and steadily, but persistently examining and talking back to the thoughts that tell them they are rubbish, hopeless or a failure. Over time they realise that once they take off those dark glasses, they can see life is not so bleak, that there is hope and that – with a little help, guidance and support – they can find a way through depression.

Warm wishes,

Dan

Bibliotherapy for Depression

Image by Sharon McCutcheon

'Bibliotherapy' is an important part of cognitive therapy, either to run alongside a course of therapy or as a self-help tool. I often recommend books to my clients, partly because there is only so much time in a session, so it's much more useful for them to read up about their particular issue and for us to discuss their findings next week.

But I also find that many people like to understand why they might be having problems and find their own strategies for solving them – another important idea in cognitive therapy, because ultimately I want my CBT clients to be their own therapist.

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

1. Overcoming Depression: A Self-help Guide Using Cognitive Behavioral Techniques, by Paul Gilbert. Part of the excellent Overcoming... series, this is written by one of the world's leading experts on depression. It explains perhaps better than any other book I have read on depression exactly why we get depressed, with particular emphasis on the way our brains are wired to make us vulnerable to depression when we are threatened, or suffer major losses in our lives.

   Warm, compassionate and eminently readable, this book is also full of practical tools and techniques you can use to tackle your own low mood, with or without the help of a CBT therapist.

2. The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, by Williams et al. This also serves as the perfect introduction to mindfulness meditation, if that interests you – and comes with a CD of guided meditations by Jon Kabat-Zinn, one of the leading figures behind the marriage between mindfulness and modern psychology.

   As well as providing a wealth of information about why we get depressed and what we can do about it, this book is based on the principles of mindfulness-based cognitive therapy (MBCT), an eight-week meditation programme that research shows is highly effective at treating recurrent bouts of depression. Like Gilbert's book, it is warm, wise and kind-hearted, so is a soothing companion when you're feeling down. 

3. Mind Over Mood: Change How You Feel by Changing the Way You Think, by Dennis Greenberger and Christine A. Padesky. This seminal book remains the best introduction to CBT, almost 20 years after it was first published. Although not written specifically about depression (it is just as useful for any of the other issues mentioned above), if you are suffering from low mood it offers a clear, simple, step-by-step guide to modifying the negative thinking that is at the root of depression.

   Padesky is perhaps the world's foremost CBT therapist (she was taught by and remains very close to CBT's founder, Aaron Beck), so you can rest assured that the techniques and strategies outlined here are to be trusted.

Warm wishes,

Dan