Why You Can't Always Think Your Way Out of Trouble

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Humans are thinking creatures. More than any other animal on Earth, we have the ability to think, reason, analyse, remember our past and imagine a future that hasn’t even happened yet. That is because of the cortical layer of our brain, especially the prefrontal cortex – the most evolved part of our brain, which is involved in high-level, executive functions like impulse control, rational thought and predicting the consequences of behaviour.

And this miraculous supercomputer in our skulls is what allowed humans to write symphonies, build the Pyramids and fly to the Moon. That uniquely human brain is also what allows me to practice psychotherapy, or write this post. And it helps you problem-solve your way out of difficult situations – a vital and sometimes lifesaving skill.

When thinking is not your friend

But if you are struggling with your mental health, feeling highly stressed, anxious or depressed, thinking may not be your friend. That’s because the kind of thinking we do when we’re experiencing high levels of painful emotion can be deeply unhelpful. Let me give you an example.

Jane is a highly anxious, frequently worried type of person. And when she hits bumps in her life, she tries to think her way out of them. Jane engages that thinking brain and then worries, obsessively, projecting into the future with hundreds of ‘what if’ thoughts (‘What if my boss doesn’t like my work and I get sacked?’, ‘What if I can’t find another job?’, ‘What if I lose my home and end up on the street?’).

These obsessional, catastrophic thoughts are especially bad at night, when Jane lies there for hours worrying, worrying, worrying. This just makes her more anxious, stressed and, of course, exhausted. So the next day her resources are low and she feels ten times worse.

Keep it simple

In schema therapy language we would say Jane has a Perfectionistic Overcontroller mode, which tries to be in control all the time, hates uncertainty or feeling out of control, and believes that there is always a perfect solution if she just thinks long and hard enough! If I were helping Jane I would work with this mode to help it calm down a bit and give her a break from the relentless worrying.

I would then help Jane to develop a range of activities that did not involve thinking. This would first involve drawing up a list of coping skills. Try this yourself – write ‘coping skills’ on top of a blank sheet of paper. Then come up with 10 skills, with different types of activities you can use at different times. The first four skills I teach clients are always my Posture, Compassionate Breathing, Supportive Touch, Compassionate Self-Talk sequence (read all about those in this post).

Use what works for you

The other six are negotiated with my client, depending on what they find helpful, calming or relaxing. Yoga is fantastic, if it works for you. Mindfulness or other forms of meditation often go on the list. We might also add taking a long, luxurious bath; watching a TV show or movie you find comforting; calling a trusted friend; getting a hug from someone you love; stroking your favourite pet; drinking a warm, milky drink; going for a walk, preferably in some green space; reading a blog like this one, which focuses on improving mental health; listening to a song you find moving or joyful…

The list is endless, really. It’s just about finding ten things that will help you feel (depending on the emotion you are struggling with) calmer, more peaceful, more grounded, happier, more energised, or mindfully in touch with the present moment. Try it now – write up a list and then stick it on the wall next to your computer, on in your bedroom, where you will see it every day.

Then practice those skills, on a daily basis, until they become so familiar it’s like muscle memory. Over time, you will find that you are able to take the edge off whatever painful emotion you are feeling – that also gives you a strong foundation to begin therapy, use self-help books, or whatever way you choose to work on the deeper wounds that cause those painful emotions to bubble up.

I hope that helps. In my experience, it really does, so I hope it benefits you as much as it has hundreds of my clients.

Warm wishes,

Dan

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

Online Therapy Available During the Pandemic

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As we all find a way to manage the coronavirus pandemic as well as possible, I have moved all of my therapy sessions online. I now offer sessions via Zoom. This means I can offer help to people all over the UK, as well as those living anywhere in the world. I am offering both short-term therapy, to help people through the current crisis, as well as my usual long-term schema therapy.

This is an anxiety-provoking and stressful time for everyone. But it can be especially hard for people who already struggle with day-to-day anxiety, or have an anxiety disorder like health anxiety or OCD. If you have experienced trauma in your life, it may also be triggering unpleasant memories for you, or you may be struggling to cope with the flood of scary headlines about the outbreak.

Please take all sensible precautions to keep yourself and others safe and well, especially older people or those in high-risk groups.

If you would like to know more about how online sessions with me work, I explain all the details in this post. And if you would like help getting through this difficult time, 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

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

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

Acceptance Versus Change in Cognitive Therapy

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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

What are Anxiety Disorders?

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In either cognitive or schema therapy we first try to understand exactly what is causing someone’s problems, before going on to help solve them. If someone is struggling with anxiety, part of this understanding is making a diagnosis of exactly which ‘anxiety disorder’ someone is struggling with.

Some people find this idea a little uncomfortable, but it’s just like your GP diagnosing whether you have the common cold or flu, so they can prescribe the right treatment.

There are seven anxiety disorders, which I summarise briefly below – map your symptoms on to the disorder to see whether you might have one. If you are unsure, please get an assessment from a cognitive or schema therapist; and remember that it’s common to suffer from more than one of these disorders at the same time, as well as other problems like depression or low self-esteem.

Panic disorder and agoraphobia

A panic attack involves a sudden increase in anxiety, accompanied by physical symptoms of anxiety, such as a racing heart rate, breathlessness or dizziness. Panic disorder involves recurrent panic attacks and may or may not lead to agoraphobia – anxiety about being in situations in which escape would be embarrassing or help would not be available in the case of a panic attack. People with agoraphobia may struggle to leave the house or be in open or public places, like shopping centres.

Health anxiety

Health anxiety (also called ‘hypochondriasis’) involves a fear of having a serious illness, like cancer or heart disease, and a preoccupation with bodily symptoms. The problem will not go away with medical reassurance and is often extremely distressing – you may be convinced you have a serious health problem but that no-one believes you, which is understandably frustrating and upsetting.

Social phobia

People with social phobia have a fear of social or performance situations, or both; you may feel comfortable with one trusted friend, but become anxious if their friend joins you. You might be fine in small groups, but the bigger the group the more your anxiety grows. And you might struggle in performance situations, like public speaking or university seminars – you may hate being put on the spot or have the feeling that everyone can see how anxious you are and will think badly of you in some way.

Specific phobia

This involves the persistent fear of a particular object of situation – it’s ‘specific’ because you fear that and not a wide range of things. The most common phobias are a fear of heights, public speaking, snakes, spiders, being in enclosed spaces, mice, needles and injections, crowds, clowns, darkness and dogs. Of course, some people struggle with more than one phobia. And it’s worth noting that specific phobias are relatively easy to treat with CBT – in around six sessions or less.

Generalised anxiety disorder (GAD)

GAD is defined as excessive anxiety and worry occurring more days than not for a period of at least six months and about a number of events or activities. The two key features of this disorder are ‘free-floating’ anxiety, which attaches itself to one thing after another; and persistent worry, which is more severe than normal worry, seems hard to control and causes distress and/or makes it difficult to function.

Obsessive-compulsive disorder (OCD)

If you are suffering from OCD, you will experience obsessions (intrusive images, impulses or thoughts) and/or compulsions (repetitive behaviours engaged in to minimise the anxiety or upset caused by the obsessional thought or because of rigid rules). Although the compulsion – which could involve checking, washing, prayers or replacing negative thoughts/images with positive ones – is intended to reduce distress or prevent a feared outcome, like someone you love being harmed. Unfortunately, the compulsion only provides short-term relief and is a key element of what maintains the OCD.

Posttraumatic stress disorder (PTSD)

PTSD occurs as a reaction to a profoundly distressing event that threatened death or serious injury to yourself or other people; a response that involved intense fear, helplessness or horror; and key symptoms of re-experiencing, avoidance and hyperarousal. There is some debate over whether PTSD is an anxiety or stress/trauma disorder, but as it does involve very high levels of anxiety, I have included it here.

Warm wishes,

Dan

Overcoming Postnatal Depression

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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

Excellent Self-Help Book on Worry

I am always keen to promote the best sources of information to help people gain insight into their problems, because without insight into what is making us unhappy, we cannot hope to overcome it. I'm currently reading Dr Robert L Leahy's The Worry Cure: Stop Worrying and Start Living – one of the best self-help books I have read for a long time.

Dr Leahy is one of the world's pre-eminent cognitive therapists and condenses 25 years of clinical experience into this informative and highly readable book.

As I often tell my clients, there is nothing wrong with worry per se – it is a normal and even helpful cognitive strategy for thinking about and solving problems. But, as Dr Leahy so eloquently explains, for some of us worry can be both excessive and distressing.

Chronic worry is associated with a wide range of psychological problems, from depression to anxiety disorders including OCD, health anxiety, social phobia and especially generalised anxiety disorder (GAD), in which persistent worry is one of the distinctive features.

Your worry profile

The Worry Cure explains why some of us worry more than others; offers a range of questionnaires and other diagnostic tools to help you understand what your 'worry profile' is; and, crucially, provides a wealth of tips and techniques to help you reduce your worry and learn to confront the problems that unhelpful worry actually stops you solving.

One of the paradoxical things about worry is that it can be a way of avoiding actually solving your problems. Although you may spend many hours fretting about them, which gives the illusion of control and makes you think you are tackling them, it can actually get in the way of confronting problems head-on.

This means separating the things you can control from those you cannot; coming up with solutions to those problems and taking action to actually solve them, not just spend fruitless hours worrying about them.

Warm wishes,

Dan

Five Simple Steps to Combat Depression

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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

Bibliotherapy on Compassion

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'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 clients to be their own CBT therapist.

In this post I will focus on compassion and compassion-focused therapy – a new form of cognitive therapy designed to help with deep-rooted issues such as long-term or cyclical bouts of depression, low self-esteem or unhelpful self-criticism. 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. The Buddha's Brain: the Practical Neuroscience of Happiness, Love and Wisdom, by Rick Hanson and Richard Mendius. If, like me, you are interested in the science behind meditation and talking therapies like CBT, this is the book for you. The authors explain how our brains are actually shaped by the things we think every day – think negatively and you build neural pathways that make negative thinking your default approach; but focus on feelings like kindness, pleasure, gratitude, generosity and warmth and you build a brain that naturally focuses on these self-nurturing qualities.

Don't be put off by the science – it's also a rich, wise, beautifully written book that's packed with common sense techniques you can use to help yourself feel better. This is one of the books I recommend to all my clients, because it just makes you feel so good to read it. 

2. The Compassionate Mind Guide to Managing Your Anger, by Russell L Kolts. This warm, wise and helpful book is written by 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 to explain the evolutionary/psychological basis of anger, especially its role in protecting us from threats, either real or perceived.

CFT focuses on strengthening the parts of our brain that help us feel calm, confident, strong, peaceful and safe; these act as a direct antidote to feelings like hostility or aggression, so are fundamental to feeling less angry and generally happier and more emotionally balanced.

3. Happiness: A Guide to Developing Life's Most Important Skill, by Matthieu Ricard. Another life-changing book for me – as someone with a strong interest in Buddhism and Buddhist psychology, I found Happiness at the same time inspiring and humbling because it showed me how much I still have to learn, both personally and professionally.

Ricard was an eminent French scientist before his interest in Buddhism led him to become a monk, living in the Himalayas and studying with some of the great Tibetan Buddhist teachers. Developing self-kindness and compassion is a key focus in Tibetan Buddhism (which is why the Dalai Lama so often talks about compassion).

The author explains, with great clarity and simplicity, how anyone can learn to free themselves of what the Buddha called the 'three poisons of the mind': greed, hatred and delusion.

You don't need to be interested in Buddhism to love this book – its message will appeal to anyone on the path of personal growth or who just want to be happier. And that means everyone, doesn't it?

Warm wishes,

Dan

Bibliotherapy on Mindfulness

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'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 clients to be their own CBT therapist.

In this post I will focus on mindfulness, an ancient Buddhist practice that, since the 1970s, has been adapted by Western psychologists to help treat a range of physical and mental difficulties. 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. Wherever You Go, There You Are: Mindfulness Meditation for Everyday Life, by Jon Kabat-Zinn. This beautifully written, wise, eminently readable book is one of my favourites. Kabat-Zinn is, more than anyone else, responsible for introducing mindfulness to the West. He started using mindfulness techniques to help people with chronic stress, physical pain or serious illness at the University of Massachusetts Medical Center in the '70s, which paved the way for other practitioners to use mindfulness either as a standalone technique or combined with other approaches like cognitive therapy.

The author explains with great clarity exactly what mindfulness is and how you can integrate it into your life, either with 'formal' practices like sitting or walking meditation, or 'informal' practices such as being completely mindful of whatever it is you're doing, from washing the dishes to gazing at a glorious sunset or preparing and eating a delicious meal. If you're new to mindfulness or meditation in general, this is the perfect place to start.

2. Mindfulness: A Practical Guide to Finding Peace in a Frantic World, by Mark Williams and Danny Penman. Another good beginner's guide, this introduction to mindfulness theory and practice is written by Mark Williams, a clinical psychologist and one of the UK's leading mindfulness teachers, and Danny Penman, a health journalist and author. It offers a clear, easy-to-follow path through all the basic mindfulness techniques, and includes a CD of guided meditations by Williams – who has an incredibly gentle, soothing voice.

As an aside, if you ever get the chance to see him speak, grab the opportunity. He is an excellent speaker who really embodies the calm steadiness that regular meditation can bring.

3. The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, by Mark Williams, John Teasdale, Zindel Segal and Jon Kabat-Zinn. If you want to take a mindfulness course for issues like stress, anxiety, depression or chronic pain, there are two basic formats: mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

Both run over eight weeks, with a combination of meditation, guided imagery, yoga and other exercises in the class and at home. Jon Kabat-Zinn developed the MBSR programme first (see above) and in the early '90s the other three authors began exploring the use of mindfulness to treat depression, especially repeated bouts of depression which can be hard to treat.

They combined elements of Kabat-Zinn's MBSR programme with cognitive-behaviour therapy to come up with MBCT, which has proven extremely effective at treating recurrent bouts of depression – as effective as antidepressants, in fact.

This is another warm, rich, wise book, which leads you through the steps of an MBCT programme, while explaining why we get depressed, what we now understand about depression and the brain from MRI scans and other research into its physical make-up and functioning, and how psychologists around the world are now exploring the meeting point of Buddhist psychology, neuroscience and cognitive therapy, with intriguing results.

It also includes a CD of guided meditations by Kabat-Zinn, which I use as part of my daily practice, so can thoroughly recommend.

Warm wishes,

Dan

Overcoming Panic Attacks

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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

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'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?

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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

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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

Bibliotherapy to Help With Your Stress

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What is bibliotherapy? Well, health professionals increasingly see the benefit of reading for people suffering from a wide range of physical and psychological problems. In fact, a Government-backed scheme – Reading Well Books on Prescription – 'prescribes' specific books for people struggling with, say, depression or worry through their GP.

I have always recommended books to my clients, so this post is part of my ongoing bibliotherapy series (here are my posts on the best books for anxiety, mindfulness, compassion, anger issues and depression).

If you are suffering from stress, you will find these books helpful in managing your stress levels:

1. The SuperStress Solution: 4-week Diet and Lifestyle Programme, Roberta Lee, MD. Dr Lee is an integrative physician, which means she combines the best of evidence-based Western medicine with strategies and techniques from alternative approaches, focusing on meditation and relaxation techniques, sleep, exercise, work/life balance, diet and nutrition.

   Her argument is that the kind of stress those of us living a 21st-century urban life now suffer is far worse than our parents faced, so it has evolved into SuperStress; a type of chronic stress that is insidious and creeps up on us, given the constant drip, drip of stressors such as 24/7 digital media never letting us relax; the pressure to be perfect parents, partners, family members and employees; the endemic lack of job security; too much sugar, caffeine and alcohol; insufficient sleep and rest; and rolling news bombarding us with scary and upsetting stories. Her argument is very persuasive and it's an excellent book, so highly recommended.

2. 2. How to Deal With Stress, Stephen Palmer & Cary Cooper. This is a sensible, practical guide to reducing your stress by two world-leading experts in stress management. Having trained with Stephen Palmer at the Centre for Stress Management, I can personally vouch for his expertise in this area (he is also an excellent CBT therapist).

   The authors explain how to identify the cause of your stress, then offer a plan to help manage it. They offer practical guidance on time-management (hardly a scintillating topic, but important if you have a never-ending to-do list and not enough time to do everything on it), exercise and relaxation techniques, as well as nutrition. It's also the shortest of the three books listed here, so is helpful for the time-poor.

3. 3. Overcoming Stress: A Self-help Guide Using Cognitive Behavioral Techniques, Leonora Brosan and Gillian Todd. When I start working with someone using CBT, I always recommend a book from this Overcoming... series, as they are all written by leading CBT experts in their particular field.

   Not only will this give you an excellent introduction to stress and its physical, psychological and behavioural impact on you, but it will also explain CBT and how it works; with a particular emphasis on the role of unhelpful thinking in driving your problems with stress.

Warm wishes,

Dan

Is Schema Therapy the Right Approach for You?

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Schema therapy is a form of cognitive therapy that was developed by psychologist Dr Jeffrey Young in the 1990s. Unlike cognitive behaviour therapy (CBT), schema therapy is a longer-term, more intensive treatment designed for people with longstanding, hard-to-treat problems such as recurrent patterns of depression, long-term OCD or other anxiety disorders, problems with intimate relationships and difficulties linked to painful experiences in childhood or adolescence. 

Schema therapy is a warm, compassionate form of therapy that emphasises the relationship between therapist and client as an important part of the healing process. Clients are encouraged to stay in touch between sessions, especially if they are struggling, which can be very helpful when times are tough.

In therapy we first identify which schemas a person has and how they developed in childhood (for example, someone may have an Abandonment schema, because one of their parents left the family or was emotionally unavailable for them).

We also identify your modes – distinct sides of you that become active at different times. For example, you may have a critical mode, which is the part of you that criticises and attacks for you for perceived failings or mistakes. Clearly, this is not very helpful, so we work together on transforming this mode to become an advisor rather than a critic.

And your Vulnerable Child mode is the part that feels vulnerable, lonely, anxious or threatened – this part needs nurturing, healing and protecting, which is a central part of the work in schema therapy.

CBT or schema therapy?

I would say that for most psychological problems, such as chronic stress, anger management, phobias, health anxiety, one-off episodes of depression, social anxiety, and so on, CBT is the most effective therapy for you. Having been a CBT therapist for many years, I am passionate about this practical, problem-solving, highly effective approach. It works really well for most problems, most of the time.

But I decided to train in schema therapy to help the people for whom CBT did not seem to be enough. Some of my clients just did not respond to CBT at all; others responded well for a while, then we seemed to hit a wall. Especially for problems related to childhood trauma, abuse or neglect, 'treatment-resistant' depression or anxiety disorders, or across-the-board problems affecting every area of someone's life, CBT techniques just did not work as well as I or my clients hoped.

Dr Young created schema therapy for people with exactly these kinds of problems. Because schema therapy involves working at a much deeper, more emotionally-focused level than with CBT, we can heal those past hurts that are causing you problems today.

Using experiential techniques like imagery and chair work, we can help you release and process stuck or painful emotions, while shifting unhelpful ways of thinking and behaving that make day-to-day life a struggle.

Schema therapy is a highly effective, potentially transformative approach – and may well help even if you have tried CBT or other therapies before, with little success.

Warm wishes,

Dan