How to Manage Your Coronavirus-Related Health Anxiety

Image from CDC

Do you struggle with health anxiety? If so, you’re not alone. Millions of people around the world face a daily battle with this anxiety disorder. I often tell my clients that, if you’re prone to anxiety, your health is one of the easiest things to obsess about, because of course humans are vulnerable to health problems.

We all struggle with our health, dealing with everything from mild problems like the common cold to serious illnesses like diabetes and cancer. And we are all mortal, so have to accept that one day, our life will end. It’s natural — in some ways even logical — to worry about your health.

Now, of course, we are facing an unprecedented public health crisis. In the UK, as I write this over-70s are encouraged to self-isolate, many businesses have shut down and all schools are closing from tomorrow, we are all being encouraged to adopt social distancing and stay home as much as possible. And I’m sure the restrictions will get more and more severe.

The reality is that Covid-19 is a scary, unpredictable and long-term problem that we are struggling to understand and contain across the globe.

Kryptonite for the health-anxious

So I am anxious. My friends, family, colleagues and neighbours are anxious. Anxiety is a normal, healthy, proportionate response to a global crisis like this. It’s hard for everyone right now.

But I think — as well as the high-risk groups of people who are especially vulnerable to a serious reaction to the virus — this crisis is extremely tough on people with two types of mental-health problem: contamination-focused OCD and those with health anxiety (formerly known as hypochondria). I am going to focus on the latter problem in this story, but there is a huge amount of information about, and help with OCD on the MIND website, if you need it (mind.org.uk).

Health anxiety is one of the anxiety disorders, in which people develop an unhelpful preoccupation with their health. A useful definition I once read is: ‘The catastrophic misinterpretation of benign physical symptoms’.

That means that, if you have health anxiety, you will catastrophise — one of the common forms of unhelpful thinking styles treated with cognitive therapy — about benign physical symptoms. This means that, if you get a tension headache, you start Googling symptoms (always a bad idea!) and become convinced you have a brain tumour.

If your heart rate speeds up, because you’re stressed, anxious or engaging in physical exercise, you are 100 per cent sure you have a heart problem. You notice a tiny mole on your forearm and worry obsessively that it’s skin cancer.

Coronavirus-related anxiety

If this sounds familiar, I feel deeply compassionate for you right now. It must be hell. Every time you look at a newspaper, Twitter or your Facebook feed, you are confronted with frightening, doom-laden headlines about this awful virus that is sweeping through the global population. You, like so many of my clients right now, must be overwhelmed with anxiety.

But you can’t let anxiety dominate your life. This crisis is likely to go on for months, so you need to take swift and decisive action to help yourself. Here are three pieces of advice to get you through this:

1. Engage your rational brain

Because this all feels so threatening, the ancient, emotional parts of your brain have taken over — primarily your ‘threat system’, which is on red alert right now. This system triggers the fight-flight-freeze response to danger. If you’re super-anxious, you are in flight mode much of the time.

One answer to this is to use your rational brain — the frontal cortex — to calm down the parts that are freaking out. This virus is truly awful, but the vast majority of those who contract it will only develop cold- or flu-like symptoms, then make a complete recovery. Many health-anxious clients I have worked with are young, fit, healthy, often vegan and teetotal — some of the healthiest people I have ever met!

If that’s you, remember that it is overwhelmingly likely you will be fine, even if you get it. So stop catastrophising and take sensible precautions to minimise your risk of contracting the virus: social distancing, mask-wearing, regular hand-washing, and so on.

2. Breathe

When the fight-flight-freeze response has kicked in, your breathing goes haywire. Basically, you start breathing like a hot dog panting — rapid, shallow breaths that will make you feel dizzy, tight-chested and breathless. Not good, if you’re already worrying about a virus that targets your lungs.

So you need to slow your breathing right down, breathe abdominally, for roughly four seconds in and four seconds out. Do that for at least a minute, more if possible. I call this ‘compassionate breathing’, but it’s just deep breathing, so you can do it anywhere, any time if you need to calm yourself down.

Trust me: it’s awesome and it really works.

3. Get some help

Please don’t suffer alone. We are all struggling right now and need all the help we can get. There are plenty of charities set up to help with health anxiety and other anxiety disorders. Here are just a few for those living in the UK:

• Young Minds (youngminds.org.uk)

• Anxiety UK (anxietyuk.org.uk)

• OCD Action (ocdaction.org.uk)

If you need more help than this, I would recommend either cognitive or schema therapy. I have helped dozens of health-anxious people with both approaches and they are proven to be the most effective forms of psychotherapy for anxiety disorders. In the UK, you can get cognitive therapy on the NHS, but it will probably be a long wait. If you’re looking for a qualified private cognitive therapist, visit BABCP’s site (babcp.com).

If you would like schema therapy from me, use my contact form to get in touch.

So if you are having a tough time right now, know that help is out there for you. We will get through this. Humans are remarkably resilient. We will develop a vaccine and treatments for Covid-19 are already being trialled.

Wherever you are in the world, sending you love and warm thoughts from London,

Dan

Online Therapy Available During the Pandemic

Image by Jud Mackrill

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

The Schema Linked to Low Self-Esteem

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Many of us are overly self-critical, focusing on our perceived failings and ignoring our many strengths and good qualities. For example, you may think you are a failure, or just not good enough in some fundamental way. This kind of thinking is, clearly, extremely unhelpful – and can lead to low self-esteem, depression, eating disorders, anxiety disorders and many other psychological and life-limiting problems.

In schema therapy, we see one or more schemas at the root of these problems, particularly Defectiveness/Shame, which is perhaps the most common schema I see in my clients. This might form in early childhood, for example if you have parents who tell you that you’re slow, or stupid, or a bit too chubby.

You might get bullied by your siblings, or find it hard to measure up to them, especially if you’re the youngest. Or the schema might develop at school, if you have (especially undiagnosed) dyslexia, struggle with one or more subjects, or find it hard to make friends.

How negative beliefs develop

As a child, you might start to think ‘Maybe I am a bit stupid,’ or ‘Why can’t I keep up with the other kids? Maybe it’s true - I am clumsy and useless at sports.’ These thoughts begin to coalesce into deeply held beliefs – the cognitive layer of a schema.

You probably feel your confidence sinking through the floor, or a deep sense of shame at your perceived failings – this is the emotional part of the schema. And you feel those emotions in your body – shame can feel like a horrible prickling sensation in the skin, nausea or tightness in the throat. And this is the physiological part of the schema.

What then happens is that, as you get older, this psychological construct gets triggered by people, situations or events that remind you of the stressful events from your childhood. You fail your driving test and suddenly your Defectiveness schema gets triggered and you are gripped by intense feelings of worthlessness and shame, which are completely disproportionate to the situation (you could just take another test – it’s not such a big deal). This is how schemas operate, which is what makes them so painful and the root cause of every psychological problem.

Schemas can be healed

The good news is that, although they are stubborn and hard to change, schemas can be healed. Using techniques like imagery and chair work, or the attachment-based relational approaches that make up ‘limited reparenting’, we can slowly but surely start to challenge and modify the schema.

We might help to modify some of those unhelpful beliefs about being stupid or useless; work on the unhelpful modes that keep you behaving in self-destructive or self-limiting ways; help you focus on and enjoy your successes, which you probably discount or ignore; keep pointing out your strengths and good qualities, to meet those parenting needs that were not met for you as a child.

Using these techniques and ways of understanding your problems, schema therapy offers a powerful, effective and deeply compassionate way of helping even the most hard-to-treat problems.

Warm wishes,

Dan

How to Stop Fearing Abandonment in Relationships

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Many of my clients show up with deep-rooted fears and sensitivities around being rejected or abandoned. In some ways, that’s a normal aspect of being a human being – fear of rejection is hard-wired into our brain, because for most of human history being rejected from the group was, literally, a matter of survival. Finding yourself alone, outside the village stockade, surrounded by hungry animals and hostile tribes, was not a good place to be.

So we are all sensitive to signs of rejection by friends/colleagues/family, or worries about our partner being unfaithful or leaving us. But for some people, this sensitivity dominates their lives. These people probably have an Abandonment/Instability schema – one of the most painful schemas we can have, which can start to imprint in our brain from birth onwards.

And this makes it especially overwhelming when it gets triggered in later life – because the emotions and bodily sensations we feel might be pre-verbal, pre-cognitive and those of an infant; hugely powerful and utterly overwhelming.

Problems start in childhood

For example, Sonya comes to see me because she is having problems in her relationship. ‘Every time I think my boyfriend is going off me – even a tiny bit – I just freak out and start bombarding him with texts because I feel so anxious. I can’t bear it.’

When we start to explore her history, Sonya tells me that her mother was an alcoholic, so even though she did not physically abandon the family, she was often drunk and emotionally unavailable for Sonya and her siblings.

This speaks to part two of the schema: Instability. Even though Sonya was not actually abandoned, the attachment to her mother was not stable or secure, so she felt abandoned on a daily basis.

Stephen’s case is easier to understand. When he was five his father – who he adored – suddenly left his mother and started a new family. Virtually overnight his dad went from an attachment figure that Stephen loved and relied on to being completely absent from his life.

This clearly was an abandonment, so Stephen’s schema developed then. He now gets fiercely jealous if his wife even speaks to other men – because his schema gets triggered and he is overwhelmed by a wave of jealousy, fear and insecurity.

Healing the core wound

In schema therapy, we work on the Abandonment schema like every other – with a combination of experiential techniques (especially imagery and chair work) and ‘limited reparenting’, where we try to meet Sonya and Stephen’s core needs that did not get met in childhood.

For both people, the biggest need I would be striving to meet would be love and a secure attachment – to me, primarily, but later to other friends, partners and family members. This takes time, but magically we can heal even the deepest, most painful schemas – and help you feel calmer, happier and more secure.

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

The Anger-Management Skills Everyone Needs to Know

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Pick up a newspaper, watch a movie or the TV news and you'll get the message, loud and clear, that anger is a Very Bad Thing. Road rage, desk rage, trolley rage – if we believe the media then anger is scary, destructive and something we should avoid at all costs.

In fact, the problem is not anger, it's aggression: the unhealthy distortion of a perfectly natural emotion. Like sadness, fear or love, anger is neither good nor bad, it just is.

The problem comes when you express anger in one of two dysfunctional ways: you become aggressive and struggle to control your angry outbursts, using threatening language and behaviour to exert control over others.

When you’re seething inside

Or passive, becoming scared of anger – both your own and other people's – meaning that you give away your power, struggling to impose yourself on the world or fight back when bullied, even though you might be seething inside.

Both distortions of anger can be extremely damaging. The first damages those around you, as you attack or intimidate them. Eventually, of course, if you keep lashing out you cause problems for yourself too – when your destructive behaviour gets you sacked, divorced or arrested.

If you belong to the second group, you mostly hurt yourself – bottling up your anger causes stress, anxiety, depression, cardiovascular disease, high blood pressure, stroke... the list goes on. 

Assertiveness, not aggression

Either way, you need to learn how to express anger cleanly and healthily – responding with appropriate, proportionate anger in situations that demand it (a rude co-worker; a bullying spouse; a salesman trying to rip you off). Anger gets a very bad press, but if felt and expressed healthily it's a great source of power and strength. The whole evolutionary purpose of anger is to protect yourself and those you love from attack. So the key is to be assertive, not passive or aggressive.

Some of humanity's greatest leaders have been the living embodiment of assertiveness, like Gandhi or Martin Luther King. Both practised non-violence, but transformed the lives of millions of people through sheer determination: they could not be bullied or intimidated, and maintained great dignity in the face of brutality and aggression.

If you would like to be more assertive, next time someone upsets you try this exercise:

1. Get the person's attention. This won't work if they're reading the paper or fiddling with their Blackberry.

2. Describe the behaviour you found difficult. Do this without personalising it or making accusations. Just stick to the facts: 'In that meeting you kept interrupting, talking over me and dismissing my ideas.'

3. Tell them how it made you feel. Use 'I statements' and take responsibility for your feelings: 'When you constantly interrupt me I find it frustrating and annoying.' Avoid emotions like anger, hurt or jealousy, because these will undermine your attempt to be assertive.

4. Check your interpretation and ask them to respond. Your interpretation of events may have been completely inaccurate, so it's very useful to check them against reality. 'Do you think you interrupted a lot? Did you feel dismissive of my ideas?'

5. Listen to the other person's response. Try to be non-defensive (this can be hard, but it will really help) and expect their interpretation to be different than yours. That's OK – they are entitled to their opinion, but you don't have to accept it.

6. Tell them how you would like it to be. This means expressing preferences ('I would appreciate it if you stop interrupting me in meetings'), not demands ('I'm sick of you interrupting – don't ever do it again!').

Of course, this is a bit of a lengthy process. Once you've got the hang of it you can boil it down to a much shorter exchange. And if you do this, regularly, you'll be amazed at the difference it makes to the way you feel and the relationships with your partner, family and colleagues.

Because it's so important, I would like to repeat this: expressing your anger healthily does not mean attacking anyone else, either verbally or physically. That is both unhealthy and destructive for all concerned. Managing your anger is about finding ways to be more assertive, expressing what you really feel and need without lashing out or stuffing your angry feelings.

Warm wishes,

Dan

What is the Detached Self-Soother Mode in Schema Therapy?

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One of the key aspects of schema therapy is working with people’s ‘modes’, which are different sides of their personality that may serve a particular purpose for them. Some of these are known as ‘coping modes’, because they help us cope with difficult thoughts and feelings, interpersonal problems, or stressful events or situations.

And a common coping mode is the Detached Self-Soother, which helps us detach from our painful feelings or cope with a tough situation using a substance or behaviour that is numbing or soothing.

In the UK, our go-to strategy for self-soothing is with alcohol. And, of course, the odd beer or glass of wine with dinner is not a problem at all – I like a nice glass of red myself at the weekend. It’s just when that glass turns into a bottle, or the occasional pint with friends becomes four or five pints, then a daily habit, or in the worst case we find ourselves sliding into addiction.

We can also use behaviours or activities to self-soothe, such as spending hours on Facebook or Instagram; compulsively shopping; gambling; computer games; or endlessly surfing the Web or slumping in front of the TV. Again, none of these activities are bad per se – it’s all about how much we do them and why.

Escaping painful feelings

When we detach with this mode, one of the main problems is that we are avoiding our feelings – and in schema therapy we see that as ignoring/silencing our Vulnerable Child mode. This psychologically young, vulnerable part of us needs attending to, not ignoring. For example, if you feel sad or lonely because you don’t have a partner, it’s important to acknowledge the loneliness of your Vulnerable Child and help him/her feel better by trying to meet someone you can connect to.

Or if you feel really anxious about leaving the house, because you’re agoraphobic, it’s helpful to listen to and try to soothe/reassure your Vulnerable Child, then seek professional help if you need it to overcome your problem.

In neither case would it be helpful to compulsively avoid or ignore your feelings, numbing yourself with alcohol or distracting yourself with a Facebook binge. It’s important to remember that you don’t need to feel bad or guilty for self-soothing in this way. We all have to find ways of coping with painful feelings – and many of us do so using some form of this mode.

At the same time, just because we have done something habitually for a long time doesn’t make it a good idea, or mean we can’t seek to change.

Warm wishes,

Dan

Healthy Ways to Release Your Anger

Everybody gets angry – it’s a normal human emotion, like sadness, fear or joy. And there is nothing wrong with anger, despite its bad reputation and the damage it can cause. Like all emotions, the problem is not the anger, but the ways we either try to suppress and swallow it, or let it come spilling out, harming ourselves and those around us.

One of the main lessons I teach my clients in schema therapy is how to feel, express and so release their anger. And that’s not easy, because most of us have a problematic relationship with this most volatile of emotions – we may have grown up in a family where anger was never permitted expression, so we learned that anger was scary and shameful, to be kept inside at all costs. This means we now swallow our anger, which is not good for our health, physical or mental.

Or we might have grown up in a family that expressed anger too freely or even violently, with lots of screaming, breaking things or hitting. So again we are now probably afraid of anger, seeing it as threatening and unsafe, because we associate bad things with it. We may either have learned to hold it in, or followed our family’s example and now explode all over the place (using attack as the best form of defence against other people’s threatening behaviour), raging at other drivers or screaming at our partners/kids. This too is not good.

Healthy anger-release

I only have two rules for anger expression with my clients:

1. When expressing anger, they don’t hurt themselves.

2. When expressing anger, they don’t hurt anyone else.

Bearing these rules in mind, here are two ways to let your anger out safely and healthily (releasing all the energy from your Angry Child mode, which is the part of you that is so furious). First, try writing an angry letter to the person that has hurt or upset you. This may be your boss, partner, friend, colleague – or a person from the past, such as a critical parent. Write it on a blank Word document, allowing yourself to say whatever you need – swear as much as you like, use capitals and exclamation marks. Don’t censor in any way. When you’re done, print the letter and tear it into tiny pieces or burn it, imagining all that hostility and frustration leaving your body as you do. (And remember this letter never gets sent! It’s just for you and to release all that bottled up anger energy).

Second, get a towel and twist it until it’s really tight. Then keep twisting, saying ‘I am so angry with you!’, ‘I am so *!**!** angry with you!’ over and over, twisting the towel util your arms get tired (this should be hard work!). Make sure you stick with ‘I’ statements and the way they have hurt or upset you, rather than just blaming or attacking. You will eventually find that all the anger drains out of your body and you feel tired. And other feelings might bubble up too, like hurt or sadness. Let them be there and have a cry if you need to. This will help you feel better (and be soothing for your Vulnerable Child, which is the part of you that feels all the hurt, pain or fear that lies beneath the anger).

Warm wishes,

Dan

What is the Detached Protector Mode in Schema Therapy?

Image by Kelly Sikkema

One of the most common ‘modes’ in schema therapy is the Detached Protector, which tries to protect us by suppressing our painful emotions. When we are in this mode we are very much in our heads, being overly rational and cut off from our feelings. I guess if I were to think of the living embodiment of this mode, it would be Sheldon in The Big Bang Theory – someone who lives completely in his head, who doesn’t feel much or understand other people's emotions at all.

So this is a part of us that gets activated when, say, we are upset and fear becoming overwhelmed. Our Detached Protector (unconsciously) kicks in and we change focus from the painful feelings to change the subject, tell a tangential story, or rationalise the way we feel until we're not feeling it any more. Very commonly when my clients are in this mode they will be talking about an upsetting experience without actually feeling that upset in any way.

This part of us almost always develops in childhood, when we may have learned to shut down to cope with overwhelming emotions. A good metaphor for this process is the way a circuit breaker gets triggered when there’s a power surge – it shuts the system down so nothing gets damaged. So something in your brain gets triggered and switches off its emotional circuitry, to protect you from unbearably intense emotion that you are too young and undeveloped to deal with (managing big emotions and self-soothing when they are upset is not something that young children are able to do).

We also call this process ‘dissociation’, which basically means disconnection or detachment from our inner experience or the world around us. The younger you are, the harder it is to regulate your emotions, so if you are scared because someone is hurting or threatening you, the only way to protect yourself is to trigger this circuit breaker in your brain.

From helpful to habitual

This shutting down was both helpful and necessary when you were little, but over time it became a habit and led to an increasing number of problems. For example, imagine that Stephen comes to therapy because his wife is threatening to leave if he doesn’t stop going quiet and withdrawn whenever they have a problem in their marriage. When Stephen comes to see me, he tells me he's deeply worried about losing his wife, who he loves very much. But when they have conflict, he just ‘clams up’ and feels empty and numb inside.

This is Stephen’s Detached Protector kicking in – probably because conflict situations were scary or threatening for him as a child, so he learned this self-protective behaviour. In schema therapy, a big part of the work would be helping him learn to feel and express his emotions a bit more – also to communicate with his wife when things got bumpy. These simple changes could make a profound difference to Stephen’s day-to-day life and even save his marriage!

It's important to repeat that this part of you is a protector mode – it’s not bad or mean in any way. It's just that, like Stephen’s experience, what starts out as helpful and even life-saving becomes a hindrance over time. So with Stephen, it would be important to teach him healthier way of managing his feelings – talking about them to me, his wife or a friend; using deep breathing, helpful ways of thinking or mindfulness techniques to feel calmer and more relaxed, even when conflict flared up. Over time, bit by incremental bit, this could be transformative for him – and, if you have a Detached Protector, for you too.

Warm wishes,

Dan

Why Might You Experience Dissociation?

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Dissociation is a self-protective mechanism in the brain that we all experience from time to time. It’s what happens when you feel overwhelmed and your brain shuts parts of itself down so you can cope with the situation. For example, when people have a car crash, they often report strange things happening, like time slowing down, floating above the scene of the accident, or not feeling any pain despite being injured. These are symptoms of dissociation, as the brain has shut down a bit to help them deal with the overwhelming and upsetting situation.

Think of dissociation like a circuit breaker being triggered. If there’s an electrical surge, a circuit breaker gets tripped to switch circuits off, so no electrical devices get damaged. That’s what happens in your brain when you dissociate.

If you experienced traumatic events as a child, your brain will have shut down to protect you. This was a healthy, ‘adaptive’ response to overwhelming feelings and sensations that your little self could not handle. But over time, dissociation becomes a habitual response, so your brain shuts down even when you experience much milder feelings, like a little anxiety.

Symptoms of dissociation

Unfortunately, dissociation causes various problems for us – we may feel spacey, empty, numb or weird in some other way (this is called ‘depersonalisation’). We might go blank, or struggle to hear what someone’s saying to us. Some people say everything looks far away, or it’s as if they are looking through a thick glass wall at the world (known as ‘derealisation’). When we dissociate we struggle to concentrate or remember important information. Not helpful if you are in a meeting, or about to take an exam.

You might experience dissociation when your anxiety is high – it’s a common symptom of panic attacks, for example. Or when you feel threatened in some way, your schemas getting triggered by a stressful event or situation that reminds you of something threatening from your past. I recently wrote a post about the ‘Detached Protector’ mode which we work with in schema therapy – this is a dissociative mode.

The good news is that dissociation can be treated – I have helped many people with dissociative problems using schema therapy – so find a good therapist who understands dissociation and can help you be more present in the precious, unfolding moments of your life.

Warm wishes,

Dan

How Schemas Distort the Way We See the World

Image by NASA

I recently watched a report on the Guardian website about ‘flat Earth theory’, on the growing number of people who believe that the Earth is not in fact a sphere, but a flat disc. It’s intriguing and well worth watching, but I think it also tells us a great deal about the way schemas can distort the way we see the world (whatever shape we think it is).

Here is a photograph of the Earth, taken from space by an astronaut on the Apollo 17 mission. I would say that looks very much like a sphere, a view backed by every serious scientist in the world. There is no doubt or debate about this, it’s just a simple scientific fact – as is the way that all large objects in space form spheres because of the shaping and smoothing effect of gravity.

So how do the Flat Earthers manage to ignore the overwhelming evidence against their passionately held position? We could ask the same question about climate-change deniers, or anti-vaxxers – both groups fiercely defend their views despite clear scientific evidence to the contrary.

How schemas work

One way to explain this is to think about schemas and how they affect our thinking. If you have a Defectiveness schema, say, you might strongly believe that you are stupid, even if you do well on your GCSEs, or get a 2:1 in your degree. You may believe you are ugly, even if your partner, friends and family tell you again and again that you are in fact very pretty. That’s because the schema affects the information-processing systems in your brain, distorting the way you think.

Schemas affect our memories, belief systems, our imagined view of the future and the way we interpret sensory information such as what we see or hear. When triggered, they distort the way we think about ourselves, our actions, what people say to us and what we read or see on the internet.

So if you have a Flat Earth schema, it tells you that all the supposed scientific evidence is part of a grand conspiracy to fool and control you. It tells you that Newton’s theory of gravity is nonsense, that you should believe spurious theories on YouTube or in your Facebook feed more than genuine, evidence-based facts and information. Sadly, we are currently seeing this sort of thinking more and more, which also explains Trump and the rise of populism around the world.

As a (fairly) rational person and evidence-based practitioner, this worries me deeply, as it is doing great harm to our world – for example, denying climate change at the very moment humanity needs to take drastic action to keep the planet inhabitable for humans and other species. But if you understand the way that schemas work, it’s not surprising that people hold bizarre or impossible-to-prove beliefs.

After all, because everyone has schemas everybody does have distorted or unhelpful beliefs, even if we don’t think the Earth is in fact a big, blue Frisbee suspended in space…

Warm wishes,

Dan

How to Look After Your Vulnerable Child

Image by Ben Hershey

One of the most important ideas in schema therapy is that we all have different 'modes' – aspects of our personality that get triggered in different situations. For example, many of us have a demanding mode that pushes us hard to achieve and be successful.

Because this mode pushes us too hard, it can lead to stress, exhaustion or burnout, because our drive to achieve exceeds our internal resources and so we struggle to cope with the relentless demands. 

Another part – the most important one in schema therapy – is the Vulnerable Child mode. We call this Little Dave, or Sue, or Steven, and so on (mine is called Little Dan) and it's the part that holds all of our vulnerability, anxiety, unhappiness, loneliness, feelings of rejection or being bullied, depending on our experiences as a child.

For example, if your parents were harshly critical of you throughout your childhood, this part will feel defective and incompetent – as if nothing you ever do is good enough. If one of your parents died or left the family when you were young, your Vulnerable Child will feel abandoned and, as an adult, you will be hypersensitive to being left or rejected by those you love. 

In schema therapy, we work hard to look after this part of you – to help him or her feel protected, safe, cared for. In fact, we try to meet those core needs that were not met when you were a child. So if your parents were flaky or untrustworthy, as your therapist I would work very hard to be a solid, dependable, trustworthy person for you.

If one or both of your parents was cold and unloving, I would try to be extra-warm, friendly and kind. In this way (as well as using all of the schema therapy techniques, especially imagery) we would, over time, heal your Vulnerable Child – and help you feel calmer, stronger, more confident and secure. It's quite magical to watch this transformation take place – even with the deepest, most sensitive wounds.

Caring for yourself

Of course, you don't need schema therapy to start this healing process yourself. Learning to be kinder and more compassionate to yourself is a good start – take a course in mindfulness, visit a Buddhist centre near you or check out Dr Kristin Neff's website, where there are many free resources on self-compassion training.

Yoga is another great way to heal your mind and body, as is reading one of the many wonderful self-help books available – try Loving-Kindness: The Revolutionary Art of Happiness, by Sharon Salzberg; or Get Your Life Back: The Most Effective Therapies for a Better You, by Fiona Kennedy and David Pearson, for starters. If you are using alcohol, drugs or food to deal with painful emotions, you may need help to tackle your compulsive behaviour.

It is my strong belief that, whatever has happened to us in our past, it is never too difficult or too late to change. You may not be able to do this on your own – if so, seek help from me, another schema therapist or any psychotherapist sufficiently well trained and competent to tackle deep-rooted problems. 

Ultimately, healing yourself begins with a decision – that you are worthy of love and happiness; that you do not want to spend the rest of your life suffering because of painful experiences that were not your choice, not your fault in any way. We only have one life, so it's up to all of us to make the most of it, however hard it has been up to now.

Warm wishes,

Dan

Self-Care for the Highly Sensitive Person

I recently wrote a post about Elaine Aron's wonderful book, The Highly Sensitive Person: How to Thrive When the World Overwhelms You. I also admitted that it was a particular eye-opener for me because I realised she is writing about me – I am a highly sensitive person and proud of it. And probably at least 50% of my clients are HSPs too, so this concept has helped me immensely, both personally and professionally.

As a follow-up, here are three of the things I have realised about how we highly sensitive folk need to take care of ourselves day to day:

• We need time to process. Sometimes, in my downtime between seeing clients, writing up session notes, and all the many other things I do as part of my (wonderful) job as a therapist, I notice that I am compulsively surfing the Web. Having recently take a break from social media, I realised that looking at The Guardian's website and depressing myself with the latest scary thing happening in the world, or just reading football-related nonsense, was my new digital addiction. I also realised that it made me feel, well, just bad. HSPs need time to process stuff, because we are so attuned to every detail of what is happening that it's easy to get flooded (what Aron calls being over-aroused). So more mindfulness for me, less scary news and screen time.

• Slow is (generally) good. Linked to the first point, because being an HSP means that our central nervous system is unusually sensitive (which is neither good nor bad, just a largely genetic trait), we get easily overwhelmed by things. Bright lights, loud noises, strong smells, traffic, too much information, too many strong emotions, big crowds, strangers, public speaking, aggressive or loud people... the list is a long one but will be unique to you – some of these may be triggers for you, some not, but you will definitely have your triggers. Personally, I like to talk and think about things slowly. I am more into deep thinking and powerful, one-to-one conversations than social chit-chat. Slow is good for me, even if I don't always remember that.

• Alone time helps us recharge. As Elaine Aron points out, not all HSPs are introverts. You can be a highly sensitive extrovert, but common sense says that most HSPs will prefer small groups, close friends or time alone. I am certainly one of those – although I love seeing clients all day, or even teaching large groups, I do find some alone time in the day invaluable. It helps me rest and recharge, as well as giving time for processing everything I have thought, seen and experienced that day (see point one). As with all of these points, it's important to remember that none of this is good or bad, it's just how I and probably most people reading this are wired. Learning to love and accept yourself as you are is a crucial component of schema therapy, so recognise your need to be alone sometimes and carve out that time for yourself.

Warm wishes,

Dan

How to Deal With Difficult Emotions

Image by Motoki Tonn

If you want to understand how we are meant to feel emotions, look at a small child. When kids feel their emotions they really feel them! If they are angry, they will shout and scream and have a tantrum. If they are sad, they will cry.

If they're scared, they will run away, or hide behind their mum’s legs until the threat has passed. Now, I'm not saying that as adults we should indulge ourselves in tantrums, but neither should we repress or swallow our feelings.

Sadly, as we grow older we tend to stiffen up. We learn that (for men) it's not OK to cry when we are sad, or to tell our friends if we're going through a rough time. Or (for women) that being angry or assertive is unacceptable. We start to feel bad for feeling bad. We learn to hide our feelings, sometimes even from ourselves.

Or we use a substance (alcohol/weed/cocaine/food/cigarettes) or an activity (gambling/hours spent on Facebook/gaming/shopping/sex) to numb or avoid uncomfortable feelings like anxiety, sadness, loneliness, anger or hurt. And the message we are giving ourselves is that emotions are somehow bad, wrong or even threatening.

Let's go back to the kids. Watch a child getting angry: they feel the anger, intensely. Then they release it, verbally and physically. Then they seek a trusted person to soothe and comfort them. And then... the anger is gone. They see a butterfly and chase after it, utterly delighted and distracted, with no trace of the anger left in their body or mind.

This is how we are supposed to feel, process and seek solace when we experience strong emotion. I have started summing it up for my schema therapy clients with a simple formula:

1. Feel it. If you're sad, be sad. If you are angry, let yourself be angry. It's just an emotion and can't do you any harm – in fact, the only harm we can do is if we try to avoid the emotion (leading to problems like addiction or anxiety disorders such as OCD).

2. Release it. If you are sad, and alone, have a cry. If you're angry, write a (never-to-be-sent) letter to the person you're angry with, then burn or tear it into tiny pieces. Vent the emotion and let it go.

3. Get soothed (by yourself or a trusted person). Just as children need soothing when they are upset, so do adults – we're just not very good at doing it for ourselves or seeking it from those we love and trust.

Learning to detach

One of the unconscious ways we learn to suppress or avoid our feelings is by detaching, which involves a psychological process called 'dissociation'. This is something we all do, to a greater or lesser extent, but will have learned to do a great deal if we suffered trauma, abuse or neglect as a child.

Dissociation is an unconscious process in which the brain shuts down to protect us from overwhelming stress. It's a bit like a fuse blowing on a circuit board when there is a power surge, to stop electrical devices getting fried.

If we dissociate a lot as a child, it becomes an automatic process that we over-use, shutting down when we feel any kind of difficult emotion. This leads to us developing a 'mode' called the Detached Protector – one of the most common modes in my clients. We may feel numb, empty or spacey when this mode is triggered.

We might also feel disconnected from other people, even experiencing strange sensations such as feeling far away, seeing the other person as very small, or feeling like there is a glass wall between us and the world. These are all common symptoms of dissociation.

None of this is bad or wrong – it's just what we learn to do to protect ourselves from overwhelming pain or stress. Part of my job is helping people unlearn this unhelpful coping strategy, feel their emotions as described above, and learn to build up their 'emotional muscles', so they feel stronger, more resilient, and can live a rich and fulfilling life.

After all, emotions – the full range, both those we like and the ones we would rather not feel – are what make us human.

Warm wishes,

Dan

How to Deal With Suicidal Thoughts

Image by Charles Chen

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 

Why Humans Need Connection

Image by Chermiti Mohamed

Humans are born wired for connection – it's in our DNA, as strong a need as food, water and warmth. And if you look at a newborn baby, that makes sense.

Unless babies successfully attach to their mother, they won't be able to survive – human infants are born completely helpless, so we are entirely reliant on our caregivers. A loving, secure relationship is literally a matter of life and death for babies.

So in our brains is an 'attachment system', which gives us a magnetic attraction to others – (usually) first mum, then dad, siblings, grandparents, aunts and uncles, school friends, teachers, adult friends, colleagues, mentors and later romantic partners and our own family, when the whole cycle starts over again.

Jeffrey Young, the founder of schema therapy, understood this need for attachment – that's why it is one of the core developmental needs he identified in all children (along with the need for safety and protection; to be able to express our feelings and emotions; spontaneity and play; and boundaries/being taught right from wrong).

Another psychotherapy pioneer to understand this fundamental need was psychoanalyst John Bowlby, often called the 'father' of attachment theory. Bowlby realised that all children (and adults) need a secure attachment to their caregivers, especially mum. If we are lucky enough to develop this secure attachment in infancy, this 'attachment style' will remain constant throughout our lifetime and help us form strong, stable, loving relationships with friends, romantic partners and then our own children.

Strengthening your connections

Most of the people I see for schema therapy were not so lucky. For various reasons, their attachments were not secure as children, so they have all sorts of problems in relationships now. Perhaps they struggle to commit, or dive in too quickly and deeply (especially if they are a Highly Sensitive Person - read about them here). They may avoid relationships altogether, because they are just too painful.

But, as I always tell my clients, although these patterns are firmly established in our brains, they are not set or fixed in any way. Our brains are always changing, throughout our lifetime (because of neuroplasticity). This remarkable discovery means that we can learn to attach more securely and so learn to love, to trust, to allow others into our lives.

This is one of the most moving and beautiful aspects of therapy – seeing people learn to deepen and strengthen their connections, first with me, then family, friends and later a romantic partner, even if this seems like an Everest-sized obstacle at the beginning of our work! However daunting it seems, remember that you are never too old and it is never too late to let love blossom.

We are born ready to love – it's just the painful experiences we have when young that throw us off the path toward fulfilling relationships. All you have to do – with help, guidance and support – is step back on to the path... 

Warm wishes,

Dan

Try These Simple, Powerful Relaxation Techniques

Image by Hannah Oliver

When you are stressed or anxious, it's often hard to relax. So you will probably have a great deal of tension in your muscles – this is one reason for the muscular aches and pains, headaches, stiff neck, tight chest and back pain people suffering from stress or anxiety often experience. Learning to relax is a vital step on your route back to health and happiness. It's also an excellent way to combat insomnia.

Before I explain the techniques, a couple of general points. First, like any new skill, you may find these techniques take practice to master. It's like learning a musical instrument: you wouldn't expect to sit at a piano and play a complex classical piece on your first day.

Your stress or anxiety may have been building over months or even years, so it will take time both to learn these techniques and gradually reduce your levels of tension.

Second, the more you try these techniques when you are not stressed, anxious or upset, the more skilled you will become and so can use them even when you feel overwhelmed (I find that many clients stop using self-help techniques when they are having a rough time – which is, of course, when they need them the most).

And then the key is to use them every day. Like other cognitive therapy techniques, these are lifelong skills, available to you whenever your symptoms return.

Soothing-rhythm breathing

This simple breathing exercise (which is one of the key techniques in compassion-focused therapy) is an effective way to reduce stress or anxiety and increase feelings of calm, peacefulness and safeness. When you become anxious, your respiration becomes fast and shallow 'chest breathing'.

This can cause hyperventilation, as you inhale too much oxygen and become dizzy and light-headed. Instead, you need to breathe slowly and deeply, which turns off your ‘stress response’ and switches on your ‘relaxation response’.

Please note – these are only guidelines, not a set of rules. The most important thing is that you find a style and rhythm of breathing that feels calming and soothing to you. So vary the length of breaths, whether you breathe your nose or mouth, and so on, to find the approach that works best for you.

1. Find somewhere private and quiet, then sit comfortably and close your eyes. Switch off your phone so you won't be disturbed. Take a deep breath through your nose to a slow count of four. It can be helpful to count each number in your mind as you breathe, so thinking One, two, three, four on each breath.

2. Exhale through your nose to a slow count of four.

3. Continue to breathe slowly, deeply and evenly, in and out through your nose. If you are breathing deeply, you should naturally feel your abdomen rising on the in-breath and falling on the out-breath – don’t force this or worry if your abdomen isn’t moving. Breathing slowly and deeply is the most important thing.

4. Repeat this cycle for at least a minute.

5. Once you feel comfortable with this exercise, try increasing the time to five minutes or more. The key here is to breathe slowly and deeply – this has the physiological effect of slowing your heart rate and sending messages to the brain that everything's fine, you can relax.

Progressive muscular relaxation (PMR)

It's important to breathe slowly and regularly while doing this exercise. Tense your muscles, without straining, and concentrate on the sensation of tension. Hold for about five seconds, then let go of the tension for 10-15 seconds. Tune into the sensation of how your muscles feel when you relax them.

1. Feet. Pull your toes back and tense the muscles in your feet. Relax and repeat.

2. Legs. Straighten your legs and point your toes upward. Relax, let your legs go limp and repeat.

3. Abdomen. Tense your stomach muscles by pulling them up and in. Relax and repeat.

4. Back. Arch your back. Relax and repeat.

5. Shoulders & neck. Shrug your shoulders, bringing them up and in towards your chest and pressing your head back. Relax and repeat.

6. Arms & hands. Stretch out your arms and hands. Relax, let your arms hang limp and repeat.

7. Face. Tense your forehead and jaw, lower your eyebrows. Relax and repeat.

8. Whole body. Finally, tense your entire body: feet, legs, abdomen, back, shoulders and neck, arms and face. Hold the tension for a few seconds, relax and repeat.

If you still feel tense at the end of the routine, go through it again. If only certain body parts still feel tense, repeat the exercise in those areas. When you have finished and feel relaxed, stay where you are for a few moments, then stand up slowly and stretch gently.

Warm wishes,

Dan

Be a Force for Good in the World

Image by Unseen Histories

This post is a bit different from my usual writing on this blog. As a therapist, I am passionate about helping people – those I see in my office, the ones I can reach through my writing, and those who are suffering all over the world.

For me, promoting kindness,  compassion and good mental health and believing in social justice go hand in hand. And it currently seems that many of our leaders and corporations, rather than striving to make the world a better place, are doing a great deal of harm. 

Reading the news on a daily basis, it's easy to feel overwhelmed by all the negative things that are happening around the world. In the UK, we have a government that has done terrible damage to beloved and life-saving institutions like the NHS; and years of austerity have done real and lasting harm to the mental and physical health of millions of – mostly poor – families in the UK. As mental health problems increase at worrying speed among our young people, it's not hard to see the impact of these policies on people's lives.

“The arc of the moral universe is long, but it bends toward justice.”

— Martin Luther King

In the US, we have a President who attacks the very foundations of democracy on a daily basis, while promoting an agenda which encourages the worst elements of humanity at home and abroad. If you, like me, are a liberal, what should we do? It's tempting to give up and retreat, to focus on the small daily pleasures that life brings and try to ignore the news, hoping it all eventually goes away.

But, as someone who believes passionately in social justice; whose life is dedicated to bringing more kindness and compassion into the world; who is deeply proud of living in the wonderful multiracial and multicultural melting pot that is London, I think we have to do all we can to stand up for the forces of light in the world.

What you can do

As the descendant of Russian Jews, who emigrated to Britain in 1905 to escape the Pogroms; whose grandparents worked for a Jewish charity helping immigrants fleeing Hitler in the 1930s, I know all too well where nasty, dehumanising ideologies can lead. And I think we all need to do everything we can to stop them. 

So instead of feeling overwhelmed and helpless, here are three things you can do today:

• Be a digital activist. Sign petitions (they do work, whatever people say), write to your politicians, post on Facebook walls and tweet to corporations and others who are causing harm.

• Boycott companies which are behaving unethically (here is a list of the most and least ethical companies in the world). Write to them and tell them why you are no longer a customer – this is the most effective way to get big companies to change, because losing money and negative PR are the most important influences on them to behave more ethically.

• Support campaigning organisations like Greenpeace, WWF, Amnesty International USA, the American Civil Liberties Union (ACLU), Earthjustice, Hope Not Hate – they are fighting to protect the environment, human and civil rights in the courts, which is a powerful strategy to effect positive change.

And don't succumb to hatred or bitterness – another Martin Luther King quote comes to mind: 'Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.'

Warm wishes,

Dan

How Chronic Pain and Illness Affect Your Mood

Image by Toa Heftiba

As I sit writing this, I am in a moderate amount of pain. Like millions of people around the world, I suffer from chronic musculoskeletal (back and hip) problems, so most days come with either a small or large dose of pain, depending on how well I am looking after myself, how stressed I am, how much sitting I do that day, and various other factors.

Having been in some degree of daily pain for almost two years now, I have learned a few things about the relationship between physical pain and mental suffering:

• It's important to distinguish between 'primary' and 'secondary' pain. I learned this from Vidyamala Burch, founder of the excellent Breathworks. This organisation provides the Mindfulness-Based Pain Management programme, which has a strong research base behind it and helps many people in the UK and beyond deal with chronic pain and illness.

• Burch also co-wrote Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing with Danny Penman. In this superb book the authors explain that primary pain is the actual raw data caused by, say, a gash in your leg. Intriguingly, the majority of the pain you end up experiencing is secondary – the pain created by your brain as it amplifies that raw data, depending on the way you think about and respond to your primary pain.

• This only became clear to me recently when I visited my osteopath during a bad patch physically, feeling down and hopeless about resolving my problems. He reminded me that the pain was significantly better now than when I first came to see him; and that it was crucial to remain as positive as possible, because my negative thoughts ('I will never get over this'; 'Nothing will help'; 'I can't stand the pain any more') were undoubtedly making the pain worse (this is essentially what the Buddha taught – that human life inevitably involves pain, but we create suffering by our response to that pain. But that's a topic for another day).

Managing the pain

I think it's important to note here just how hard it is to maintain a positive, optimistic mood in the face of chronic pain or illness. As anyone with a long-term condition knows, it grinds you down, especially when it flares up or your symptoms get worse for whatever reason. Please don't think I underestimate the impact of physical ailments on your mood – it is a struggle and gets everyone down from time to time, as well as causing stress and worry/anxiety about the future.

I couldn't understand that vicious cycle any better. But once you understand the relationship between pain sensations in the body and the way that your brain either amplifies or minimises those sensations, it seems crucial to me that you do all you can to use your brain/mind to help your body.

 When I first hurt my back and was really struggling, Vidyamala Burch's guided meditations really helped pull me through. Visit her website (www.vidyamala-burch.com) to find out more. And if you are dealing with chronic pain or illness, my thoughts and well wishes go out to you – I hope you get the medical help you need and manage to overcome your problem soon.

Warm wishes,

Dan

How Compassion Can Improve Your Mental Health

Image by Jude Beck

The most exciting new developments in psychotherapy at the moment are a fusion between three approaches: cognitive therapy, neuroscience and Buddhist psychology. Cognitive therapy is the most effective form of 'talking therapy' for a whole host of problems, such as anxiety, depression, eating disorders and phobias.

Neuroscience has come on leaps and bounds in recent years, mainly because of MRI scans of the brain, which show us which parts of the brain 'light up' when, say, we get angry or excited. And Buddhist psychology – a 2,500-year-old discipline for training the mind and freeing us from suffering – is increasingly being incorporated into Western approaches to psychotherapy.

Mindfulness and compassion

The Buddha said the two core concepts in his teaching were mindfulness and compassion. I have said plenty about mindfulness on other areas of the site, but I increasingly realise the importance of compassion and teach my clients to be kinder and more compassionate to themselves.

To explain just why compassion is so important for mental wellbeing, I need to explain a little about how the brain works, according to the Compassion-Focused Therapy model. There are three affect-regulation systems in the brain (affect just means emotion, so these three systems control how we feel):

• Threat-protection system

• Drive-excitement system

• Soothing-contentment system

The threat-protection system is, as the name suggests, all about protecting us from danger. It's linked to the fight-or-flight response and reacts in split seconds if it senses a threat, causing a ripple of strong emotion that acts as an alarm and motivates us to act.

So anger (fight) and anxiety (flight) are triggered by this system when we face both genuine threats, like a gang of hoodies or speeding bus hurtling towards us; or 'psychosocial' threats like a dressing down from our boss or warning letter from the bank.

The drive-excitement system helps us achieve and get things we want, so it's linked to ambition, success, starting exciting projects or conquering our nerves to ask someone out on a first date. It's largely helpful, but can cause problems if we get blocked or thwarted – this leads to anger and frustration because we are too determined to get what we want out of life.

Soothing-contentment system

And the soothing-contentment system is all about calmness, peacefulness, contentment, feeling safe and secure. It's a counter-balance to the threat-protection system, calming us down after the threat has passed and making us feel relaxed and at ease. It's also the system that both activates and responds to kind and compassionate thoughts, feelings and fantasies.

So, what does all that mean for you? Well, if you suffer from chronic stress, anxiety or depression; if you are prone to harsh self-criticism or self-blame; if you feel angry and dissatisfied much of the time, your threat-protection system is over-stimulated and your soothing-contentment system needs strengthening. None of these systems are good or bad – they all have an important function in keeping us alive, in helping us achieve our goals and making us feel loved, safe and secure.

The trouble starts when they get out of balance, so an important part of therapy is helping you develop more kindness and compassion to yourself and turning down the volume on that loud, harsh, self-critical voice that finds fault with everything you do.

If you want to know more about why compassion is so important, or about compassion-focused therapy, read Paul Gilbert's The Compassionate Mind or Overcoming Depression: A Self-help Guide Using Cognitive Behavioral Techniques, both wonderful books; you could also read Happiness: A Guide to Developing Life's Most Important Skill, a life-changing book by scientist/Buddhist monk Matthieu Ricard; or Loving-Kindness: The Revolutionary Art of Happiness, by meditation teacher Sharon Salzberg. And visit Paul Gilbert's Compassionate Mind Foundation for details of workshops and talks.

Finding your compassionate self

You might also like to try this simple guided imagery exercise, which aims to strengthen your compassionate self:

• First, find a place where you can be alone and quiet. Sit comfortably and breathe slowly and evenly for a few minutes.

• Now imagine you are a wise and compassionate person. Think about all the qualities you would love to have as such a person and imagine you have them. Remember that it doesn't matter if you have these qualities or not – research shows that just imagining you do will change your brain in positive ways.

• Imagine having great wisdom and understanding; imagine having strength and fortitude; imagine having warmth and kindness and never being judgmental again. Spend some time thinking about what each of these feel like.

• Think about what other qualities you would like to have in your compassionate self and imagine you have them. Adopt a kind and gentle facial expression and body posture and spend time exploring them. Think about yourself 'at your best', recalling a time you felt calm, kind and wise and – as you keep breathing slowly and steadily – focus on these memories and qualities.

• Finally, imagine the sound of your voice, your tone, pace and rhythm when you speak from this compassionate self. Imagine the emotion and feelings that are in you and expressed in the way you speak.

• Every day, spend a little time playing with this role of being a 'calm, compassionate self'.

Finally, remember that it may be quite hard to feel kindness or compassion towards yourself, especially at first. But through those MRI scans we know that simply trying to create those feelings activates the soothing-contentment system, which is a small but powerful first step on the road to feeling stronger, happier and more at peace.

Warm wishes,

Dan