T’is the Season To Be Jolly.. Or Else?

So, I returned from an appointment the other week (back in November, actually!), to discover that my neighbours had already started decorating for Christmas 😐 this is something that does not make me happy; in fact, I had been hoping to hold off on the ‘Christmas Blog’ for a few more weeks yet. But, when another neighbour decorated with lights outside their house (in a bizarre pattern!) last week, I felt that I could not contain this blog anymore; batten down the hatches, Christmas is coming (not said in a Game of Thrones style, I promise).

So, when DO we start getting ready for Christmas and how does all this affect us? I am a bit of a traditionalist; to me, Christmas decorations and trees should not appear before the 15th December, as the earliest! However, there has been a growing pattern of people starting the festivities earlier and earlier; the first year we moved in here, four years ago, the decorations came out the first week of December and they have crept earlier and earlier every year since!

This made me think- am I being ‘Bah humbug’ or are other people feeling the same as me? I found a study by (Werner, Peterson-Lewis and Brown, 1989) that suggests that neighbours who decorate their houses, and perhaps do not have many friends in their street, are doing so to show their openness and cohesiveness in their local community. So, does that mean I don’t want to get involved with my neighbours? Well, yes, to a certain extent, but this doesn’t explain WHY people decorate so early? Maybe it is to welcome the neighbours to the coming festivities?

What about those people whose decorations are ridiculous to the extremes? And I am thinking this;

http://www.bbc.co.uk/news/uk-20669944

Now, perhaps this level of decoration could actually alienate the neighbours? Who wants to live next door to lights of that extreme, or that many visitors during December? The only positive thing I can think of, is that I think your house would be fairly safe from burglars throughout the whole of December?

So, if lights can either make you more (or less) tolerant and accepting of your neighbours, what does give you the ‘Christmas Spirit’? Well, a popular study I have found, cited by all the Christmas Naysayers, is from a couple of scientists in the Journal of Happiness Studies. (Kasser and Sheldon, 2002) asked 117 people, ranging in age from 18-80. They asked them to answer questions about their satisfaction, stress, and emotional state during the Christmas season, as well as questions about their experiences, use of money, and consumption behaviors during the festive period!

Now, I don’t know if this was what you were expecting, but peoples satisfaction was actually greater for the festive period, when it was based around family and religious experiences, rather than spending loads of money and giving/receiving gifts. Was that what you were expecting? I don’t know if I was; I know that, for me, I am very lucky and have a wonderful family, so Christmas is all about being with them. I don’t really mind present giving and receiving, or maybe that is because I am far too old, and bah humbug!

I find it hard to get too exited about Christmas until late December because, for me, it can’t start without my family. So until I am doing those activities like the Christmas food shop, or the kids start the school holidays it really is not Christmas time.

The Christmas period starting in late November, or early December is more about retail. Shops have to be able to sell goods and toys for two paydays before the 25th to give people a chance to buy things. For many people this leads to Christmas fatigue before Christmas arrives, and this is why I choose to ignore the holiday season for as long as possible.

So, I guess this brings us to the crux of the issue; what if it isn’t about spending, money and presents. What if it is about spending time with loved ones. And, lets just say, you are alone and don’t have any loved ones to spend it with. What then? What if you are left alone for Christmas, and I don’t mean in a cutesy ‘Home Alone’ movie style? What happens then?

It can be very hard to be alone for Christmas, but conversely, some people love being alone at this time! So, what can you do to keep yourself from being lonely at Christmas?

Scouring the Internet, the ideas are all the same;

  • Volunteer- helping others always makes us feel good about ourselves, and lets be honest, Christmas is probably the best time to volunteer!
  • Say YES to everything you are invited to- even if you are not feeling up to it, say YES! You can always leave early and go home; you never know what you might be missing out on, if you don’t even try
  • Work, Work, Work- if you enjoy working, then work! We are all different and different things make us happy. If it isn’t interrupting your life, perhaps you can get a jump-start on next quarters budgets!
  • Indulge yourself- comfort food, stay in your pajamas all day, dancing around the front room, watch your favourite movies all day long, whatever it is, DO IT!
  • Don’t wallow in your loneliness; find some support, internet, friends, chat rooms, whatever- just don’t feel like you are on your own!
  • Planning your time in advance is a good way of staving off the loneliness; if you have planned your time in advance, you know that you are not going to get bored and lonely, as you have a full itinery of things to do. Sounds like a plan to me J
  • Random acts of kindness and having faith can be quite important; I don’t mean an all encompassing faith that demands your presence at church 24/7, but perhaps some Mindfulness meditation, some relaxation or just getting in touch with your spiritual side and your ideas of what life is all about. Whatever it is that can make you happy.

So, there you have it, you’ve got some ideas to get you going. But what if none of those things appeal to you, and you don’t have anyone special to spend the holidays with? Well I would say that you do… You are special, buy yourself a present and enjoy it, you deserve it!


Kasser, T. and Sheldon, K. (2002) ‘What Makes for a Merry Christmas?’, Journal of Happiness Studies, vol. 3, no. 4, December, pp. 313-329.

Werner, C., Peterson-Lewis, S. and Brown, B. (1989) ‘Inferences about homeowners’ sociability: Impact of christmas decorations and other cues’, Journal of Environmetal Psychology, vol. 9, no. 4, December, pp. 279-296.

 

 

One Year On and Has There Been Any Real Change?

One year ago today, the world was rocked by the unexpected death of Robin Williams. He had been suffering from severe depression and, sadly, took his own life. What caused him to do this is unknown, and sadly, suicide remains very prevalent in our modern society.

According to The Samaritans 2015 report, Suicide Statistics 2015,

  • In 2013, 6,233 suicides were registered in the UK. This corresponds to a rate of 11.9 per 100,000 (19.0 per 100,000 for men and 5.1 per 100,000 for women).
  • The male suicide rate is the highest since 2001. The suicide rate among men aged 45-59, 25.1 per 100,000, is the highest for this group since 1981.

SuicideChart

 

Screen Shot 2015-08-11 at 18.10.11

So, why is this happening and what is going on? The rates of suicide are increasing- but aren’t we more aware of our mental health now, more than ever? The Mental Health Foundation estimates that;

  • One in four people will experience a mental health problem at some point in their lives.
  • Around one in ten children experience mental health problems.
  • Depression affects around one in 12 of the whole population.
  • Rates of self-harm in the UK are the highest in Europe at 400 per 100,000.
  • 450 million people worldwide have a mental health problem.

So, mental health issues are pretty common place- so why are the suicide rates increasing? One reason that is consistently studied is the idea of stigma that is attached to admitting that one is suffering from a mental health difficulty. Different forms of stigma include personal stigma (negative attitudes towards others), perceived stigma (perceived attitudes of others) and self-stigma (self-attribution of others’ negative attitudes), so we can see the possible effects of ‘owning up’ to a mental health difficulty.

A study published this year asked 350 members of the public and university students to complete an online survey assessing their knowledge and contact with depression and anxiety, perceived stigma and self-stigma for both anxiety and depression (Grant, Bruce and Batterham, 2015). They found that (surprise, surprise!) the more contact you have with anxiety and depression- be it yourself or a friend or colleague- the less stigma you perceived from other people.

Men reported that they felt more personal stigma around depression and anxiety than women and the more the participant had personal experience of anxiety and depression, the higher their levels of self-stigma were towards mental health illnesses. So, really, there were no surprises. The more you experience mental health difficulties, the more you think other people will judge you negatively. So, now are we getting to the crux of why suicide’s are rising year on year? Despite the fact that we all think we are tolerant towards mental health illnesses, there is still a huge amount of perceived stigma, particularly from people who are suffering.

If you are feeling bad, who is going to want to risk telling people, who may then judge them and make them feel worse? Or just the idea that we have a mental health difficulty can be enough to stop you even acknowledging it, and certainly stop you getting help for it. What this study found was that we need to increase interventions aimed at increasing help-seeking behavior- we need to make it easier and less traumatic and worrying to get help.

We still assume that we are going to be penalized, personally, financially and professionally if we admit to having difficulties; but, and here is the crazy part, ONE IN FOUR PEOPLE will experience mental health problems at some point in their life. It could be you, your mum, dad, partner, children, best friends or colleagues from work. How would you feel if your loved one was feeling depressed, or, heaven forbid, suicidal, but didn’t want to tell anyone for fear of shame?

We really like to think of ourselves as sophisticated and non-judgmental, but, if this were the case, more people would seek help for their health, and surely, suicide rates would decrease? Mental health difficulties don’t discriminate; the old, young, rich, poor, male, female, cultural differences- it doesn’t matter. So, if mental health illnesses don’t discriminate, why should we?

What Robin Williams sad death highlighted for our society was the fact that no matter how rich or successful you are, if you are feeling low, depressed or anxious, money and fame and success won’t fix it- it’s time we were more open about mental health. Life is hard, sometimes, and we all need help from time to time; why should we have shame and stigma attached to that?

I wrote a blog piece earlier in the year on teenage depression, but, you know what? A lot of the symptoms are the same! The other point about this piece I am writing, is that even if you are not suffering from depression or anxiety, it’s really helpful to know what the symptoms are, so we can help and support our friends and family! Also, what’s the harm in spreading information and destigmatizing the issue of mental health? Anyway, back to the point of this particular paragraph; when it comes to mental health illnesses, please seek some help if you are experiencing three or more of these;

  • Do you feel a sense of hopelessness or sadness? It can be for no reason at all.
  • Do you have thoughts of death or suicide? ‘Everyone would be better off if I wasn’t here’ can sometimes be a common thought.
  • Do you suffer from a lack of energy? Are you fatigued more than normal?
  • Are there any changes in your eating habits? Eating more, or less?
  • Are there any changes in your sleeping habits? Sleeping more, sleeping less, night waking and being unable to return to sleep, waking up early?
  • Have you withdrawn from family and friends? Does work seem harder than usual, for no particular reason?
  • Are you tearful? Do you cry easily? Are you crying frequently?
  • Have you lost interest in your usual activities? Is there a sense of apathy that wasn’t there before?
  • Are you agitated? Restless? Unable to sit still?
  • Are you suffering from feelings of worthlessness and guilt?
  • Have you developed difficulties in concentrating?
  • Have you lost your usual enthusiasm? Have you developed a lack of motivation?
  • Are you feeling irritable? Angry? Hostile?
  • Have you any increased feelings of anxiety?
  • Have you become extremely sensitive to criticism?
  • Do you have unexplained aches and pains? Headaches or stomach aches, for example?

Please do go and see a Doctor. Seek out some help. Everybody goes through a rough patch at some point or another and sometimes things are just really difficult to deal with.

There are lots of different ways to tackle depression- medication is not the only thing available! I work in the NHS with clients who are referred from their Doctors surgeries. Sometimes, just talking to someone can help. Knowing that you are not the only one who feels that way can help to normalise what is going on for you. The NHS offers CBT therapy and courses to help deal with depression, anxiety and other issues. Please believe me when I say that you are not alone, many, many others feel this way too.

It might sounds ridiculous, when you are feeling so rough that you don’t want to get out of bed, but try and see your friends and family- research shows that getting out there and talking to people really does make you feel better. It is hard work, I know, but the more you see your friends and family, the easier it gets to go out and see them and the less you isolate yourself from the people who care.

Get some exercise! Go for a walk, run, swim- whatever it is that makes you feel better! Exercise releases endorphins, which are the feel good hormones in our body, so after we exercise, we get a hit of endorphins that makes us feel good. Even If it is just a walk- it will still do the same!

Concentrate on ‘me’ time- whether that’s a face pack, a bath, and meeting friends, going to the cinema. Whatever it is that will relax you. I know, I know, there are far too many things that need to be done before you can have some relaxation. But, the dishes will still be there when you have spent some ‘me’ time, and you know what? Doing those dishes might not be such a big deal when you have had time to relax.

As adults, especially if we have families to look after, we don’t feel like we deserve to have ‘me’ time, but realistically, having some ‘me’ time can help you so much more than you think it will! Spending a small amount of time de-stressing yourself will make all those things you need to deal with easier. Go on, try it- what have you got to lose?

Are you worrying too much? Do you find yourself spending all your time worrying? One thing that can really help is to have a ‘worry book’ on hand. Every time you have a worry, write it in your worry book. Then allocate yourself a period of time during the day to acknowledge your worries- make sure its not bedtime though, as those thoughts will just swim around your head! Take 30 minutes (no more- it’s worry time, not worry hours!), perhaps after dinner, or when you’ve put the kids to bed, and get your worry book out. Have a look at your worries. Can you do something about it? If so, it’s a problem, not a worry- and problems we can do something about!

If it is something in the past, or something that we physically cant do anything about, it is a worry. Write it in your worry book, acknowledge it in your worry time, and whenever it pops back in to your head during the day, say to yourself ‘Yep, that’s a worry for me- but, it’s in my worry book/I’ll put it in my worry book, and I will look at it later in worry time!’ distinguishing between what is a worry and what is a problem can be very helpful and give us some perspective about things we can do and things we cant.

Finally, seek out help- if you are feeling low, call a friend, call the Samaritans, CALM or SANE to talk to someone. Don’t suffer alone! If you don’t feel like your GP is taking you seriously, talk to another one. Just like some people specialise in holiday insurance and others in pet insurance, GP’s have specialisms too! Some are just better dealing with mental health difficulties than others!

If you do decide to go for counselling, it is really important that you find a counsellor who fits with the way you think and feel. If you don’t feel safe and listened to by one counsellor, go to another- as counsellors, we really want you to feel confortable with us; we wont take offense if you don’t! You cant like everyone in this life!

So, don’t let your mental health get to the point that you feel there is no hope. There is help out there, if only you can find it. And, you know what? People are a lot less judgemental than you think, and that stigma you perceived from your colleague? Well, maybe they just don’t really know what to say, but they do want to help!

 


Grant, J.B., Bruce,  .P. and Batterham, P.J. (2015) ‘Predictors of personal, perceived and self-stigma towards anxiety and depression’, Epidemiology and Psychiatric Sciences, vol. 1, August, pp. 1-8.

Samaritans 08457 90 90 90

SANE 0845 767 8000

CALM 0800 58 58 58 or by text on 07537 404717

 

 

 

When is a Therapy not a Therapy?

I have been on a lot of training lately- some I have loved, and some I have found less impressive-  the techniques just don’t resonate with me, so I have decided not to adopt them in my therapeutic work. That isn’t to say that the types of therapy do not work, I just don’t see them fitting in to my practice, be it because of a lack of a rigorous scientific background, or I just didn’t like the form of therapy! This got me to thinking- who is to say what works and why? Whilst pondering this (eternal) question, I found a study in the Psychological Bulletin that really intrigued me.

The study is called The Effects of Cognitive Behavioural Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis, so perhaps from this, you can see why my interest was piqued! The study is a meta-analysis, which means that they have taken all the studies (between 1977 and 2014) that are about CBT (Cognitive Behavioural Therapy) (Johnsen and Friborg, 2015) and have analysed them to produce an overall investigation in to the efficacy (how it is working) of CBT. The results are, interesting, to say the least!

The study tracked the fluctuations in the effectiveness of CBT over time, and what the study found was that CBT appears to becoming less effective over time. This is not good news for the NHS, as this is the main type of therapy that they advocate. So, why does it appear to be falling out of grace, and why?

The study shows that over a period of time, 1977 to 2014, CBT has become roughly half as effective in treating depression as it used to be. I have to say, that from my clinical practice, I am finding that clients are becoming more and more resistant to CBT- in my (limited!) opinion, it is because we are becoming more self aware, and the more self aware we become, the less we can justify it to ourselves. But then, I am just one psychologist and that is my opinion!

One theory that is being bandied around is the idea of the placebo effect, which I am sure you have all heard of. The placebo effect is the idea that if you take a pill for your headache, and you believe it is paracetamol, but it is actually just a sugar pill, that the power of your mind is so strong that you will believe that this ‘tablet’ has made you better and your headache disappears, even though there was no ‘active ingredient’ in the pill you took.

Perhaps, like a popular friend in your network of friends, CBT’s reputation precedes it; the fact that CBT was hailed as a miracle cure, could mean that people really thought it worked (the placebo effect) when in actual fact, it didn’t work as well as was expected.

Part of this theory is about our expectations, which kind of ties in with my theory on the efficacy of CBT- in comparison to when CBT came about, when it was developed by Dr Aaron Beck in the 1960’s, our expectations of life have changed greatly. We are more realistic about life, in general. So, perhaps we do not expect a ‘miracle cure’ anymore? Perhaps we accept that we are who we are, and we can only change things if we want to? Who knows? That, my friends, is another study waiting to happen!

Another theory is that, as any therapy develops and becomes more popular (which is inevitable!), that the number of incompetent or inexperienced therapists applying these techniques increases. This means that the efficacy of the therapy decreases- if you are not attending CBT therapy with an experienced practitioner, it is not going to work as well. It’s like taking your Porsche to the Skoda garage- it’s similar, but not quite the same, and a Porsche has a specialist management system, so a Skoda garage wont be able to give you as good service as the Porsche garage will; although your car may be fixed to a certain extent, there is still work left to do.

Whatever the reason, life has changed and therapy changes with it. Who is to say that the placebo effect can’t actually help? I mean, if CBT works for you, who cares if it is the placebo effect at work? As long as it works, right? The problem though, lies in if it doesn’t work for you because you have been to an inexperienced therapist, or perhaps, as in my experience, you are actually self-aware and you know what is happening for you. Either way, if the only therapy available to you is CBT, and it doesn’t work, what do you do?

Well, the current therapy du jour happens to be mindfulness. Now, I have been using mindfulness for a few years, and just attended a course to brush up on my techniques, learn any new theories and to make sure I am not an inexperienced practitioner! But, is mindfulness just the next buzz word- in 40 years time, will the studies be there to show us that, just like CBT, mindfulness has become less effective also?

Last week I attended training on a course called Havening Techniques®. Yes, yet another new form of therapy. I have not had enough experience with Havening to fully make my mind up about it, which is why I need volunteers to work with. But, this brings in to question, again, the efficacy of a therapy and the placebo effect- who is to say what is right and what is wrong? If a therapy works for you, and a competent therapist is treating you, then does it really matter what the modality of therapy is? Perhaps, in our ever-changing world in which we live in, the changing modality of therapies is actually useful. Perhaps therapy is adjusting to our different lifestyles and expectations in life?

Back when Freud was just at the beginning of his Psychodynamic theory, life was very different. People did not understand how their emotions effected, and affected their lives. The ‘new therapy’ gave us an understanding of what was happening in our lives. But now we understand, we want to solve our problems. And, in true modern fashion, we don’t want to wait; we want to fix them NOW.

Perhaps this is where Havening® could fit in? Dealing with trauma and emotions in a focused way, whilst, at the same time, giving you techniques to practice at home, where you do not have to be an expert? I don’t know, but I do know one thing- I am looking forward to finding out!


 

★ if you have contacted me with regards Havening therapy; I am in the process of writing contracts etc. to begin the therapy. I hope to be in contact with you in the next week or so to book appointments!


Johnsen, T.J. and Friborg, O. (2015) ‘The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis’, Psychological Bulletin, May.

Being Mindful of Mindfulness!

I was on a Mindfulness course last week- Mindfulness is a really hot topic with Mental Health workers at the moment. I have been working with Mindfulness for around 4 years, so I thought I would scrub up on my techniques and ideas and get back into my Mindful practice for myself!

Did you know that in 2012 there were 40 new papers on mindfulness published every month according to Google Scholar? Guardian journalist Barney Ronay noted that 37 new books had been released that week alone! I think that this demonstrates just how popular mindfulness has become.

Mindfulness, the act of paying attention, in a non-judgmental way, to ones own experiences of the here and now. So, what exactly does that mean? Well, exactly what it says- paying attention to what is happening to you, around you, in the moment that you notice them.

Whenever anyone is going on a mindfulness course, the first thing people who are experienced in mindfulness will say to him or her is “Wait until you do the raisin exercise!” What? What on earth is that? Well, a good way to explain mindfulness is to take a raisin. Don’t eat it- you are jumping the gun there! Hold it in your hand. Have you ever really looked at a raisin? Have you noticed the colours? Have you held it up to the light and looked at the brown and amber hues that are in front of you? Have you ever looked at the creases, the ridges, and the folds? The size of the raisin or the shape of it? Have you felt it between your fingers? Is it squishy? Hard? Smooth? Textured?

No? I am sure you haven’t. Not really. Not closely.

Well, let’s not stop there! Pick up the raisin. Put it to your ear. Do you hear anything? No, of course you don’t, but then roll the raisin between your fingers. Can you hear the squeakiness of the raisin now? The slight grinding as you roll the raisin between your fingers?

Take the raisin and hold it up to your nose. Take a deep breathe in- can you smell it? What does it remind you of? Christmas cake? Cinnamon rolls? Is it a slight smell, or pungent?

Now, put the raisin in your mouth- but don’t chew it or swallow it! Roll it around in your mouth and really feel it. Put it between your teeth, give it a little squeeze. Can you feel the textures and the taste starting to spread? Gently chew the raisin, experience the flavour. Is it sweet? Bitter? Finally, swallow.

Now. I bet you haven’t experienced a raisin like that before, have you? You could do the same with making a cup of tea or brushing your teeth- any activity that you do during the day, that you can break down and really pay attention too!

So, what on earth has fiddling with a raisin for the last 10 minutes done for you, eh? Well, by exercising all of your five senses, your cortisol level has decreased (stress hormone) and you will feel calmer than you did before you started. By looking at things from a visual, auditory, kinaesthetic, gustatory and olfactory sense (see, hear, touch, taste, smell!) you have brought yourself into the present moment. You are not thinking of that annoying colleague today at work and you are not thinking of all the work you need to do tonight to prepare for tomorrow. You are in the moment, and that moment is peaceful and calm.

So, by practising this every day (for those of you in the know, it is VAKGO. Yep, snazzy, eh?) we can just stop what is happening, take a few minutes out of life to relax and calm down, before we go on to the next busy period of the day.

So, how exactly does being mindful, which can actually be a personality trait anyway, actually be beneficial? A study in 2011 suggests that

Evidence suggests that mindfulness practice is associated with neuroplastic changes in the anterior cingulate cortex, insula, temporo-parietal junction, fronto-limbic network, and default mode network structures” (Hölzel et al., 2011)

Say, what?! Well, what this means is that by practicing mindfulness, area’s of the brain, associated with neuroplastic changes (referring to changes in neural pathways and synapses that occur due to changes in behavior, environment, neural processes, thinking, and emotions – as well as to changes resulting from bodily injury) in areas of the brain that are responsible for attention, focus and regulation. Simply put, by utilizing mindfulness you can actually change the structure of your brain (the area’s that are ‘plastic’) for your benefit; to increase your sense of personal perspective awareness, your attention and focus, your emotional regulation and your body awareness.

Nah, that’s not real. Once your born, your brain doesn’t change. Well, actually it does- as we grow so does our brain. Our neural pathways and synapses develop and change, according to our environment, what we learn, what we don’t learn and genetics. So, if we train our brain to be present in the moment, really present, we can grow the area that we use to focus and pay attention. What magic is this, I hear you ask? Well, it is simply the wonder of the human mind- although science has come along way over the last 100 years, we still do not really know how the brain functions; we are learning more every week.

So, if mindfulness is so magic, why isn’t everyone doing it? Well, I cannot answer that one, I am afraid! What I can say is that mindfulness is NOT a cure all. It is a technique you can use to develop and enhance your day-to-day life. In fact, there are studies available that say certain people should not practice mindfulness; a study in 2012 concluded that there was not enough data available to fully analyse who should or should not partake in mindfulness meditation or therapy, but that people for whom there are deep-seated mental health difficulties or long term psychological affects, mindfulness meditation may not be appropriate (Dobkin, Irving and Amar, 2012).

The reason that mindfulness may not be appropriate for some people is that the act of mindfulness takes us deep in to meditation- by doing so, we are relaxing and allowing ourselves to be in the moment. If you have any traumatic experiences that you perhaps haven’t dealt with, or that still trouble you, the by going in to the mindful state can reduce your inhibitions, and the safety mechanisms, the defence mechanisms you have in place, to protect you from your difficult thoughts, are suddenly lowered, which can leave you in a very troubled place.

So, this blog then becomes a cautionary tale! Mindfulness, to some, seems like it is a waste of time, however, this is not what we are seeing from the studies that are coming out. Mindfulness has been shown to reduce anxiety and depression and to help with many other issues people have. However, it is not a one size fits all therapeutic achievement. In fact, if you are not in the right place in your life, in the right state of mind, mindfulness could in fact be quite dangerous for you- raising traumatic memories that you have repressed, hidden deep down or simply memories that you actually don’t want to, or can’t, deal with. Mindfulness is not the be all and end all that we originally thought it to be, the studies are showing this, but. That said, it could really work for some people.

So, if you are having difficulty sleeping, or are feeling stressed from your busy life, why not take 10 minutes out of your busy day to practice some mindfulness meditation (as long as you are not in the group of people discussed above, for whom mindfulness is contradictive!)? It doesn’t have to be the raisin, although, why not? Perhaps you are just going to use the VAKGO to notice what is going on around you, or you are just going to close your eyes and concentrate on your breath. In and out, slowly, clearly, purposefully. You never know. After 10 minutes of it, you may feel like a whole new person!


 

Dobkin, P.L., Irving, J.A. and Amar, S. (2012) ‘For Whom May Participation in a Mindfulness-Based Stress Reduction Program be Contraindicated?’, Mindfulness, vol. 3, no. 1, March, pp. 44-50.

Hölzel, B.K., Lazar, S.W., Gard, T., Zev, S.O., Vago, D.R. and Ott, U. (2011) ‘How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective’, Perspectives on Psychological Science, vol. 6, no. 6, November, pp. 537-559.

 

 

Medication or Therapy- Which is Better?

Depression- we all know the signs, right? Wrong. I have lost count of the amount of clients I have seen, who have sat in front of me saying “But, I’m not depressed though, am I?” after having reeled off a very impressive list of depressive attributes. Depression creeps up on you, slowly. At first, you’re just having a bad day. Then a bad week, and before you know it, you’ve had so many bad weeks; they’ve turned into months and possibly years.

There has been a lot of academic argument lately, within the Institute’s of Psychiatry and Psychology- an argument is being put forward that the long-term use of psychiatric medication is causing more harm than good. Professor Peter Gøtzsche, the director of the Nordic Cochrane Centre at Rigshospitalet in Copenhagen is currently arguing that the ‘minimal’ benefits of psychiatric drugs are exaggerated and the harms (including suicide) are underestimated (Gøtzsche, Young and Crace, 2015). For those people who are on medication, and find it works, I am sure that they would argue the odds with these authors, and be angry at their assertion that medication has minimal benefits. Medication, which for some people is a lifeline, seems to be being dismissed so out of hand and so easily.

There have also been articles with regards to Mindfulness – and other talking therapies, that have appeared recently, advocating the benefits of Mindfulness Based Cognitive Therapy (MBCT), which was developed as an explicit intervention to reduce relapse and recurrence in depression; the study goes on to find that there is no evidence that MBCT is better at avoiding depressive relapses than antidepressant treatment (Kessler et al, 2015). So, what does that mean for the ‘layperson’? Well, it means that talking therapies can be as effective as medication, but that it depends on the illness that is being treated and the person themselves, but also how that person responds to the medication and the talking therapy.

Let’s not forget- medication needs to be taken regularly, and may need to be adjusted to find a dose that works for the person effectively, or that the medication prescribed is not actually working for the individual and a change of medication may be needed. But also that, in terms of talking therapies, it is crucial that you find a therapist that you can get along with, that you trust and that you can open up to- creating the working alliance of the therapeutic relationship is key to ‘good’ therapy (Clarkson, 2003).

The combination of using medication and talking therapies can prove to be very useful for some people- the medication can work to combat the symptoms of the depressive illness and the talking therapy can help to support the patient to deal with any underlying issues that may have caused the depression (Hollon et al, 2014). So, as you can see, a two-pronged attack seems to work also. There was another study in 2013 that suggested that neither medication nor talking therapies worked any better than each other (Cuijpers et al, 2013) which was a meta-analysis- a meta-analysis is where all the current studies for the related field are looked at, and an overall summation of the findings is given.

So, what does that leave you with? You are not a study, cohort or focus group- all the studies I read tell me what I may find, but in reality we are all very different and we each need to find what works for us. A doctor can help you find the right medication, and a therapist can supply the therapy – the important thing is that whether its meds of therapy type, if it did not work for you, don’t give up, try something else; another therapist, go back to you doctor, go to a new doctor. Keep trying until you find the help and support you need.

Well, in my experience, medication is great- if you can find one that works, get the dosage right, then it can really help to resolve the physical manifestation of depressive illness. Sometimes, we do not know what has triggered the depressive illness, and sometimes we do- when we do know what has caused it, coming to therapy can really help gain a sense of perspective, or put old ghosts to rest. Even if you don’t know what has caused your depression, talking to a professional can really help and may even help you understand the cause. As therapists we are there to listen and be non-judgmental; we wont tell you to ‘buck up’ or ‘snap out of it’, as we know that saying that to you wont help you and it certainly wont work! If you could really just ‘snap out of it’, wouldn’t you have done that months ago?

The World Health Organization (WHO) believe that 1 in 10 of us will suffer with depression at some point in our lives, and it is the leading cause of disability in the world (yes, really!). Depression can affect anyone, at any time. We don’t know what causes depression and much, much more research needs to be done in the area. Depression does tend to run in families and it can be caused via a genetic and environmental combination. You may not realise you are depressed to start with, other people may recognise it in you first, or you may recongise that you are just not feeling as good as you used to.

It can be difficult to support someone going through a depressive illness, especially if you have no experience of depression and don’t understand what is happening to your loved one or friend. The important thing is to listen to them; be patient and encouraging, but above all, show kindness and compassion. And, you know what? The same applies to yourself, if you are suffering with depression- be kind to yourself, acknowledge that you are going through a bad period and do not beat yourself up over it. Something I like to say to my clients is “What would you say to a friend, if they were in your situation?” because, you can guarantee, you wouldn’t be harsh on a depressed friend, so why be harsh on yourself?


 

Clarkson, P. (2003) The Therapeutic Relationship, London: Whurr Publishers.

Cuijpers, P., Sijbrandij, M., Koole, S.L., Andersson, G., Beekman, A.T. and 3rd, C.F.R. (2013) ‘The Efficacy of Psychotherapy and Pharmacotherapy in Treating Depressive and Anxiety Disorders: a Meta-analysis of Direct Comparisons’, World Psychiatry, vol. 12, no. 2, pp. 137-148.

Gøtzsche, P., Young, A.H. and Crace, J. (2015) ‘Does long term use of psychiatric drugs cause more harm than good?’, British Medical Journal, vol. 350, May, p. h2435.

Hollon, S., DeRubeis, R., Fawcett, J., Amsterdam, J., Shelton, R., Zajecka, J., Young, P. and Gallop, R. (2014) ‘Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial.’, JAMA Psychiatry, vol. 71, no. 10, October, pp. 1157-64.

Kessler, Lewis, G., Watkins, E., Brejcha, C., Cardy, J., Causley, A., Cowderoy, S., Evans, A., Gradinger, F., Kaur, S., Lanham, P., Morant, N., Richards, J., Shah, P., Sutton, H., Vicary, R., Weaver, A., Wilks, J., Williams, M., Taylor, R.S. et al. (2015) ‘Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial’, The Lancet, April, Available: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62222-4/fulltext [20 May 2015].

 

 

Troll; a New Name For An Old Game

So, I was going to write a blog piece about how this week is Mental Health Awareness week in the UK, however, I recently made a flippant comment on social media, and all kinds of furore ensued. As I have said before, I won’t argue Politics, Religion or Music; changing people’s opinion is not my mission in life- supporting people to achieve their missions in life, however, is.

I am a fairly laid back person- I believe in the right to freedom of speech and I believe in the right for people to have their own opinions. What I don’t believe in, in any way shape or form, is bullying, and this folks, is what I became subject to- the infamous ‘Internet Troll’! Now, this got me thinking- we can all Pop Psychologise the schemas and mind-set’s of an Internet troll, but actually, what is going on for them and why do they do what they do?

In this day and age, I don’t think anyone under the age of 60 doesn’t communicate in some way via social media, email or text messaging (I have no statistics on this, so this is just a rough guess!) so this made me wonder- what are the studies out there? Has anyone studied Internet trolling? How many people have experienced Internet Trolling and if so, what is the usual outcome?

This might not seem like it would affect you or be something you would come to Therapy with, but, actually, cyber bullying is on the increase- in 2012-2013 Childline (a UK charity) saw an 87% increase in the contact they had with children complaining of cyber bullying. To put this in context, there were 4,507 children who actually had a counselling session from Childline, in a one-year period, specifically about cyber bullying. I couldn’t find any statistics for adults, but if the statistics for children have increased, I would imagine, so too, have the statistics for adults.

My experience of being ‘trolled’ was from someone I did not know, over a comment I made, expressing my own opinion. This person then took it upon themselves to bring me to task for being irrational and abusive- of which, I believe, I did no such thing. The troll decided that I had caused an affront to people and as such, it was their task to chide me. It was, to say the least, intimidating that someone so vehemently, aggressively and dogmatically was ‘baying for my blood’. This person wanted me to pay for what I had said- they felt the need to publicly vilify me, and would not give up until they did.

After a few comments, I politely declined to continue- ‘know when to pick your battles’ is something I have been taught by my parents over the years, and I can spot a troll fairly easily. To be fair, I shouldn’t have even replied to them once, but, I am only human, and so I did. Mistake number 1.

Mistake number 2 was not pushing it to the back of my mind and forgetting about it. It bugged me. Someone was being incredibly rude about me on a public forum, whether deserved or not, and it made me feel uncomfortable.

So, what could I do? Well, I could research- go to my books and look for a reason as to why people like this person feel the need to belittle people and ignore their opinions. What makes the Internet troll think they are right and that everyone else in the world, who doesn’t agree with them, is wrong?

So, firstly, what is an Internet Troll? What is the definition? Well, I found this online, from the good old Oxford Dictionary;

‘Make a deliberately offensive or provocative online post with the aim of upsetting someone or eliciting an angry response from them.’

Now, I have met a few of these in my time, both personally and professionally, but I have never had the displeasure to greet one online. And, linking in to one of my other blog posts (about how we behave and what we write when we are hidden behind a computer screen), I wondered whether Internet trolls are the same in real life, or was it just the safety of the computer that gave them the edge and bravado to behave however they wanted to?

Actually, I guess this does tie in with Mental Health Awareness week- after all, if someone is being/has been trolled for a period of time (or even just once could be enough), this could seriously upset and trouble them. Bullying is bullying, be it online or face to face and we know from statistics, that bullying does cause people to become depressed, suicidal and to even feel like they have no choice left but to take their own life.

So, what makes a troll? Well, according to a study in 2014, ‘trolls operate as agents of chaos on the Internet, exploiting ‘‘hot-button issues’’ to make users appear overly emotional or foolish in some manner’ (Buckelsa, Trapnellb and Paulhusc, 2014). So, an Internet Troll is a very specific type of person- they are actively seeking to make users appear overly emotion or foolish. I can certainly identify with that as being my experience. This study took place in Canada, and consisted of 1215 participants. They were recruited from an Amazon website and were given several, notable and rigorously tested personality scale questionnaires- the Short Sadistic Impulse Scale (SSIS), the Varieties of Sadistic Tendencies Scale (VAST) and a 27 item Short Dark Triad Scale (SD3). Short Dark what? The Dark Triad is effectively a Tetrad of Personality- people who experience and identify more with Sadism, Psychopathy and Machiavellianism. These scales, when filled in, give the researchers an idea of what types of personality make up an Internet Troll. After all, the people who took part in the study were, admittedly, Internet Trolls; so, who better to ask?

What the study found was that the participants, a mix of men and women, commented, on average, at least 1 hour per day. That is 1 hour per day that these Trolls give up to their ‘hobby’. If you had an hour free, per day, I wonder what you would want to fill it with? Perhaps being kind to yourself and allowing yourself some ‘me’ time to do something that makes you feel good? I guess, that is the point for Internet Trolls- trolling does make them feel good; albeit in an odd way. Younger people commented for longer and men spent a greater time commenting that women.

The troll persona would appear to be a combination of a malicious virtual avatar, which reflects their own personality and their ideal self. Of all the personality measures that were studied, sadism was associated most with trolling and was specific to the trolling behaviour. The personality measures also show that trolling had a positive correlation with Psychopathy and Machiavellianism- as the authors of the study describe, ‘cyber-trolling appears to be an Internet manifestation of everyday sadism. Wow. I was not expecting to come across this information. Now, I am in no way saying that my troll had any of these issues that I have discovered evidence for- I cannot possibly know that, and I cannot ‘psychologize’ someone I have never met. For all I know, my troll didn’t understand what they were doing. So, please do not assume I am tarring every troll with the same brush- as with everything in life, there is no black or white, only shades of grey.

Another study claims that trolling is both ‘real and pretend, both playful and malicious’ (Phillips, 2011). So, does that mean that they are just playing with your emotions? Purely for ‘the game’ and ‘the lulz’? In the Phillips study, the troll lays the blame firmly at the recipient’s door- saying that they are free to leave the public forum/social media and just not look at it anymore. But what about the invasion of privacy for the victim of the troll? And why should they be forced out of their social media- don’t we all have a right to be online, how we want and when we want?

Another study describes trolls as ‘Trolls attempt to hijack a discussion through harassment or inflammatory content, hoping to provoke an emotional response. The troll ‘wins’ when discussions descend into virtual shouting matches’ (MacKinnon and Zuckerman, 2013). So, being at the end of a troll’s wrath is a no-win situation. Another study states that ‘the order of society is maintained by morality. Morality has definite rules and conducts, which every member of the society agrees upon and depends on. Morality is functional since it has authority and regularity. Therefore people know how to behave and what is right or wrong offline. In the Internet space, however, people do not perceive clear codes of conducts on the Internet, nor authority and regularity, according to the result of this study. Unlike offline morality reinforced by education, that online morality have not been shared and not even discussed so provides the existence of Troll.’ (Shin, 2008)

For some people, trolling is obviously a hobby- a mean one, but one that they enjoy. The victims, not so much. The effects of online bullying are far-reaching. People who troll online are not necessarily devoid of morals in real life, so, the question remains, why do it online?

Victims of cyber bullying are often told if you cant handle it, get offline. But why should you? So, how do you deal with something as serious as online bullying? Where do you go and what do you do, if you don’t want to go ‘offline’? There is support out there, but the convention seems to be, step away from the Internet! Sometimes, however, the damage is already done.

So what does all this mean, well a person will not necessarily consciously decide to find a deserving victim and become the Troll. But someone will rather come across a situation that fulfills their specific trigger requirements – say an offense to their pragmatic morality, and will punish that victim until they see the error of their ways. They may not see their behavior in same way as an external perspective, and without the feedback inherent in more involved forms of communication, continue without mercy. Cyber-bullying is a relatively new concept, but bullying is not. The same feelings can apply in real life, as well as the virtual.

In my practice, I have worked with clients that have been bullied- some for a short time and some for years and years. The damage that it does to them is intense, traumatic, and to some extent, irreversible. Being the victim of a bully changes you forever; it changes the person you were and creates a whole new person who has to learn to deal with the changes that have happened. Some of the changes can be good- the victim can find strength in standing up to a bully, but this can be rare. Most of the time, the changes are not positive; they wear on you as time goes on.

Coming to therapy can really help the victim; they can talk about what has happened to them and explore what the impact has been on them. However, sometimes, victims feel like they are all alone and have no one to turn to- this is when bullying can take a vicious turn. What the bully feels is just ‘a little bit of fun’ can lead to far reaching ramifications for the victim; ‘Beyond the immediate trauma of experiencing bullying, victims are at high risk of later physical and emotional disorders.’ (Vanderbilt and Augustyn, 2010). And here we are, full circle to Mental Health Awareness Week.

So, a warning for all you Internet savvy people; ‘Both trolls and sadists feel sadistic glee at the distress of others. Sadists just want to have fun … and the Internet is their playground!’ (Buckelsa, Trapnellb and Paulhusc, 2014), Perhaps it is time to be mindful of what we are saying to people, especially online. After all, you never know when it might be you who are the victim of bullying, and not the perpetrator. I know it has made me think twice about posting things online and has certainly made me more wary of how I interact online. I don’t find the Internet my playground, and I don’t want to be teased. Therefore, the only answer is to step away from the keyboard, and make a cup of tea!


Buckelsa, E.E., Trapnellb, P.D. and Paulhusc, D.L. (2014) ‘Trolls Just Want To Have Fun’, Personality and Individual Differences, vol. 67, September, pp. 97-102.

MacKinnon, R. and Zuckerman, E. (2013) ‘Don’t Feed the Trolls’, Digital Frontiers, vol. 41, no. 4, pp. 14-24.

Phillips, W. (2011) ‘Meet The Trolls’, Index on Censorship, vol. 40, no. 2, pp. 68-76.

Shin, J. (2008) ‘Morality and Internet Behavior: A study of the Internet Troll and its relation with morality on the Internet’, Society for Information Technology & Teacher Education International Conference, Las Vegas, 2834-2840.

Vanderbilt, D. and Augustyn, M. (2010) ‘The Effects of Bullying’, Paediatrics and Child Health, vol. 20, no. 7, July, pp. 315-320.

 

 

 

 

 

 

Disappointed with the Result? Bear this in Mind!

Here in the UK, we have just had our General Election, which we have once every five years. Now, I know that some of you out there are going to be left feeling disappointed and disenfranchised, but others will be feeling the opposite (I will not be pledging my own Political allegiance here- I learnt at a very young age not to argue about Politics, Religion and music!). And this is where this blog is going- disappointment and how it affects our lives.

There is a general feeling of apathy and dysphoria in the Nation, at this moment in time- I am wondering, have you ever felt that in your life? Do you sometimes wonder where you are going with your life, why you are in a cycle of repeating mistakes, or just that you seem to be disappointed with your lot in life? We all do, at some point in our lives, but it can become a problem if this is our outlook for extended periods of time. In fact, for some people, even just a short period of time feeling like this can be extremely detrimental to their mental health. You know, ‘cos Mental Health Matters, don’t it?

Lots of people are sceptical about therapy- I encounter it all the time. “Oh, you’re a Psychologist? Read my mind then” or the other familiar “Oh. You’re a Psychologist.” Then nothing. They don’t want to talk because they think I will psychoanalyze them the whole time! This doesn’t happen, I just want you all to know this- even Psychologists need time off to kick off our DM’s and enjoy a party!

Saying that, there has been some articles in reputable UK publications of late, to do with something you may never have heard of; Mindfulness. “What is Mindfulness?” I hear you ask! The Dictionary definition of Therapeutic Mindfulness is;

“A mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique.”

 I bet you’re thinking “Mumbo Jumbo?” Well, according to a recent study published in the most ‘reputable’ of medical publications, The Lancet (Kuyken, 2015), Mindfulness-based Cognitive Therapy (MBCT) is nearly as effective as taking prescription Antidepressants alone- out of 424 participants, after two years, 44% of the MBCT patients relapsed as opposed to 47% of Medication only patients. So, what does this tell us? Well, surprisingly, MBCT is more effective than first believed.

There are a few issues here, with the Mindfulness study- the scientific description of Mindfulness changes from provider to provider. Now, because it is available on the NHS, MBCT has proven its efficacy (that it works) and so, if it can work on the NHS, then maybe, going to a reputable provider (if seeking private therapy), will also be the same.

The main critique with this study is that the Mindfulness patients had already suffered three or four bouts of depression (depression can be a right b*gger that way) and were already on a maintenance dose of medication. The common thinking has been that the combination of talking therapies, be it MBCT or CBT or Person-Centered, with medication is the best form of support for someone with recurring depression.

So, where does this fit in with disappointment? Well, disappointment and depression can both be caused by life’s tribulations. In one study, disappointment was ascribed to being the resultant causes of ‘what might have been’ or the ‘outcome of unfavourable decisions’ (Zeelenberg et al., 1998). Sound familiar to anyone? Mixed up in there is also the emotion of regret; perhaps you regret your vote yesterday? Perhaps you regret making a decision that ‘could’ of had a more favourable outcome? Whatever it is, life is full of mistakes, disappointment and regret- as well as happiness, joy, love and positivity! The problems only come when these two opposing forces are unbalanced.

So, that Mindfulness stuff, eh? How does that work then? Well, MBCT blends Mindfulness with CBT, so we learn to be in the present, instead of focusing on the future and the past. It helps us to come to terms with the decisions we have made; the disappointment, the regret, and focus on the here and now and how we can make the most of our lives as they are.

MCBT looks at what is going on for you now, and how the impact can be lessened for you- it gives you a specific set of skills, to practice for everyday life. No, it is not just meditation, it is being mindful of what is happening, your surroundings and not skipping forward to the end result.

According to the London School of Economics, 1 in 6 adults will be affected by depression during their lifetimes. That is a significant number; really, a lot. So, if you are feeling that way, please know that you are not alone and there is help available.

If you are interested in Mindfulness based therapy, have a look at the NHS website for more information. Many of your local GP surgeries, in the UK, will also offer free courses in Mindfulness. So, what are you waiting for?


 

 

Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial; Dr Willem Kuyken, Rachel Hayes, PhD, Barbara Barrett, PhD, Richard Byng, PhD, Tim Dalgleish, PhD, David Kessler, PhD, Glyn Lewis, PhD, Edward Watkins, PhD, Claire Brejcha, BSc, Jessica Cardy, BSc, Aaron Causley, BSc, Suzanne Cowderoy, MSc, Alison Evans, MSc, Felix Gradinger, PhD, Surinder Kaur, BSc, Paul Lanham, Nicola Morant, PhD, Jonathan Richards, BSc, Pooja Shah, Harry Sutton, Rachael Vicary, PhD, Alice Weaver, BSc, Jenny Wilks, MSc, Matthew Williams, MSc, Rod S Taylor, PhD, Sarah Byford, PhD The Lancet, April 2015.

Zeelenberg, M., Dijk, W.W.v., S.R.Manstead, A. and Pligt, J.d. (1998) ‘The Experience of Regret and Disappointment’, Cognition and Emotion, vol. 12, no. 2, pp. 221-230.

 

 

The Issue Behind The Headlines.

The murder suicide of Andreas Lubitz last week, with Germanwings flight 9525 was a terrible tragedy, for all concerned- the 149 victims and their families must be devastated by what the Co-Pilot chose to do. In all the news reports, there has not been any sympathy garnered for Andreas, or his family. Some may say that he does not deserve it, but I would be one of the first to disagree with this perspective. I am not saying that Andreas is absorbed from any responsibility for his actions; I am saying we need to learn and grow from them.

This kind of murder-suicide has happened before- from my research, at least 9 times before. That is a lot. Too many times, if we are being honest. From the news reports, it would appear that there have been failings at many levels- both from the Co-pilot himself, and the process of risk and safety and security from the airlines. One can only hope that these processes have all been re-evaluated in the light of 24th March’s events, and that the situation of one person being alone in the cockpit will not happen again.

I am no aviation expert; I do not know the rules and regulations of air flight. What I do know, are people. Although not an expert in people, I have dedicated the last 10 years of my life towards learning about the ‘human condition’ and what makes us ‘tick’. Over the years, the stigma of depression has decreased, but as demonstrated in the last week; we are still not over the fact that 1 in 6 people suffer depression in their lifetime, and that this is a completely normal illness.

The failing here, I believe, was in company policy- had Germanwings had a policy that there was always to be two people in the cockpit at any given time, as in the US, Andreas would not have had the opportunity to do what he did. So, this then begs the question- was it premeditated or a spontaneous act?

When people suffer with depression, usually, the only people that they are willing to hurt are themselves. Suicide is a form of self-harm; an extreme form of self-harm, but self-harm none the less. The problem with screening for this type of event, is that it would bring up too many false positive’s (Eliason, 2009); making it unfeasible both ecologically and financially.

Most murder-suicides are actually between couples, or estranged couples (Eliason, 2009) and premeditating factors are; substance abuse; divorce and separation; 88% of the time, the victims are female; depression was a risk factor, but in most of the cases of murder-suicide, this was between a couple who had broken up- not an aircraft full of men, women and children. The supposition that Andreas had recently split from his partner is there, but as yet there is no proof to determine this, or indeed if it was a cause or effect of his mental state. But aren’t we getting away from the point here, just a little?

Murder-suicide is rare, especially of this magnitude. Not everyone who is depressed is going to kill themselves, let alone anybody else; so, surely the question here, is why is someone who was mentally ill being demonised for actually being… well, mentally ill? We do not know the factors involved, but what we do know is that the resulting chaos in the press has served to stigmatise mental illness even further. Headline such as ‘Crazed Pilot’ from the Daily Mail; web articles with titles such as ‘Mad, Sad or Bad’ are screaming out the prejudice that society still serves towards mentally ill people.

Dr Paul Keedwell, a Psychiatrist at Cardiff University, was quoted in the Independent newspaper as saying “Among cases of murder suicide in general, the rate of previously diagnosed depression varies from 40 to 60 per cent, depending on the context. Of those who are depressed, very few are being treated for it..” (Connor, S 2015). But most crucially, amongst professionals, the consensus is that murder-suicide is not explainable by depression. Therefore, something more is going on in play here, but, because most of the people who are involved in murder-suicide, who know the perpetrator, are actually the victims of the crime, we cannot get a real psychological pathology of what was going on for the perpetrator at the time (Eliason, 2009).

But again, surely there is something wrong here? Yes, a crime has been committed, and the person who committed it, who we are calling the perpetrator, well, surely they, too, could be considered a victim? I don’t know about you, but the above statistic is actually quite frightening- up to 60% of people among murder suicide cases are not being treated for depression- what we have to ask, is why? If they are not being treated for depression, and the consensus is that murder-suicide is more than just depression- where are the health care system, and employers, letting us down?

Professor Michael Anestis, director of the Suicide and Emotional Dysregulation Lab at the University of Southern Mississippi states that ‘we are not particularly good at detecting risk; who’s going to do it and when’ (Bruenig, E. 2015). Reasons cited for not disclosing mental illness are fear or repercussions professionally and personally. And there in lies the problem. Mental illness, of any form, is still so radically stigmatized that the people who genuinely need the help, are not seeking it. Suffering a mental illness does not have to mean that your life is over; it does not have to mean that you lose your job. What it does mean, is that if you look for, and get support for your illness, there is help available.

In the UK, we are not used to paying for healthcare; we expect everything to be free, as we are lucky enough to have our NHS (National Health Service). However, with budget cuts and a rapidly expanding population, more prone to mental illness (or is it just the fact that we are more likely to report it? That, my friends, is an issue for another blog post!), it means that we are having to look to private healthcare to gain the mental health support we need, and perhaps that is where the model falls down? By having private therapy, individuals who are worried about their professional or private lives, can try to mitigate some of the fall out. Not all, but some. We think nothing of paying £45 for a pair of shoes or a console game, but when it comes to our mental health, we just don’t want to part with the money. So, herein lies the trap- individuals in need do not want to go to their Doctors, but they also deem private care too expensive. Where is the middle ground?

Well, it revolves around reducing the stigma attached to depression and mental illness. The more we can remove this stigma, the more people will seek help for their difficulties. This wont stop every murder-suicide- it would be impossible to catch everyone with one net- but it could help to change peoples lives.

Why are we still stigmatizing mental health, in this day and age? We know that there can be genetic factors involved; we know that stressful events can trigger depression and we know that sometimes, due to our brains physiology, depression can just happen. So, if it could happen to you, then surely it could happen to me? And you. And you. And you. See? If we keep the stigma of mental health, at some point it may affect you or someone you love.

From the headlines I have seen, it is fairly true to say that there is still a huge stigma towards mental illness in the media- an Australian Mental Health Charity, Sane, found ‘that SANE research from 2007 found that inaccurate and prejudiced assumptions about people with a mental illness could be reduced through increased accurate and helpful reporting in the media.’ So, have the headlines of the last few weeks really been helpful? Or have they just served to increase our societal prejudice towards mental health issues?

We need more empathy, more concern and more understanding towards mental health; if we do this, people will not be so afraid to come forwards to get the help they really need. It isn’t fair to all those families out there, suffering because of a silent illness. After all, how do you know that your family isn’t suffering because of a loved one’s health? Or if you do, are you too scared to open up about it, because of what others will think?

Either way, more tolerance is needed. I am not saying this would of stopped Andreas from his horrendous actions, but perhaps, just perhaps, openness, understanding and awareness of mental health issues could stop people feeling like they have no other option, by reaching them before they get to this point. It’s your choice- choose to reduce the stigma.


Bruenig, E.S. (2015) The Germanwings Mass Murder–Suicide Shows the Importance of Depression Intervention, 30 March, [Online], Available: http://www.newrepublic.com/article/121405/germanwings-pilot-andreas-lubitz-struggled-severe-depression [01 April 2015].

Connor, S. (2015) Germanwings Plane Crash: ‘Murder-suicide’ cannot be explained as depression, say experts, 27 March, [Online], Available: http://www.independent.co.uk/news/world/europe/germanwings-plane-crash-murdersuicide-cannot-be-explained-as-depression-say-experts-10140104.html [02 April 2015].

Eliason, S. (2009) ‘Murder-Suicide: A Review of the Recent Literature’, Journal of the American Academy of Psychiatry and Law Online, vol. 39, no. 3, September, pp. 371-376.

Is My Teenager Depressed, Or Just Hormonal and Moody?

I don’t know if you have read the recent news about children’s mental health care and cuts over the last 5 years (the cuts equate to 5% or £50 million) (Buchanon, 2015), but children’s mental health is a big issue, and it appears to be affecting more children now then before. I guess this means, that as parents, we need to be more observant than ever before. It is unknown if instances of teenage depression are actually on the increase, or it is just that through education and the fact that depression is no longer such a taboo, we are reporting cases of it more.

Children nowadays are under so much pressure- with the Internet and Social Media- the pressure is actually 24 hours a day, 7 days a week. It’s amazing how resilient teenagers are, given the constant pressure. But how do we know whether what they are going through is normal, hormonal teenage behaviour or an actual depressive illness? However, the average onset of depression is about 14 years old. By the end of the teenage years, 20% of teens will have had depression; of those, 70% will improve through treatment and 80% of these teens don’t ever receive help for their depression. Between 1 in every 12 children and 1 in every 15 young people self harm deliberately (Green, 2013).

So, as you can see, depression is actually a lot more prevalent than you might believe, with around 1 in 5 teens suffering. Depression can often run in families and can be preceded by a traumatic event, such as a divorce, death, a break-up or an abusive situation.

Firstly, it is really important to note that each person experiences depression in a different way from the next- our experience’s are unique to ourselves, and, although we can empathise (put ourselves in the other persons shoes) to a certain extent, we can never fully know what they are going through.

Yes, hormones are raging for teenagers, and it is a turbulent time to live through, but most teens manage their angsts with normal, sociable activities- meeting up with friends, sports, arts, music, and pride about success in school or outside activities. All of this helps to balance out the negative feelings and increase the teen’s sense of self. Bad moods, moodiness, grumpiness or ‘acting out’ (arguing, using their defence mechanisms to protect themselves from what is going on) and it is all part of the teenage years and the need to find your sense of self- if you are a parent, remember back to your teenage years? Perhaps they were difficult; perhaps you acted out? Remember that it is not an easy time; have some patience and try and listen to what your teen is telling you.

Although these moods are to be expected, there is a very big difference between moodiness and depression. Depression can challenge, and even destroy, a teens very idea of themselves or who they want to be. Depression causes overwhelming sadness and despair, which cannot be resolved by being told to ‘man up’ or ‘buck up your ideas’.

One of the most important things to recognise about depression is that your teen may not always appear sad; they could be putting on a front to hide their sadness. Teenagers are trying to assert their own independence over their parents, so the arguments and moodiness could just be that. However, for some depressed teens, symptoms can be rage, irritability and aggression, making it quite difficult to actually ascertain what is going on for them.


 

Signs and Symptoms of Teenage Depression


 

Some of the main signs and symptoms of depression (NHS, 2014) in teens can be easy to spot- others not quite so.

  • Does your teen feel a sense of hopelessness or sadness? It can be for no reason at all.
  • Does your teen have thoughts of death or suicide? ‘Everyone would be better off if I wasn’t here’ can sometimes be a common thought.
  • Do they suffer from a lack of energy? Are they fatigued more than normal?
  • Are there any changes in their eating habits? Eating more, or less?
  • Are there any changes in their sleeping habits? Sleeping more, sleeping less, night waking and being unable to return to sleep, waking up early?
  • Have they withdrawn from the family and their friends?
  • Are they tearful? Do they cry easily? Are they crying frequently?
  • Have they lost interest in their usual activities? Is there a sense of apathy that wasn’t there before?
  • Are they agitated? Restless? Unable to sit still?
  • Are they suffering from feelings of worthlessness and guilt?
  • Have they developed a difficulty in concentrating? Have their grades at school dropped?
  • Have they lost their usual enthusiasm? Have they developed a lack of motivation?
  • Are they feeling irritable? Angry? Hostile?
  • Have they increased feelings of anxiety?
  • Have they become extremely sensitive to criticism?
  • Do they have unexplained aches and pains? Headaches or stomach aches, for example?

Headaches, stomach aches, withdrawing from people or hanging out with a new crowd, anger, irritability and sensitivity to criticism are more common in teenage depression than they are in adult depression.


 

What is the effect of Depression on Teenagers?


 

So, what is the actual effect of depression on your teen (Medlar, 2014)? Again, this is a very unique perspective- what happens for one teen may not be what happens for another, so it is important to go by your own experiences and not others!

  • They may become violent, or more violent than usual. Usually, this is boys, but girls can become violent too. Sometimes they have been the victim of bullying, and are ‘acting out’ in the only way that they know how.
  • Some teens develop problems at school; and some excel, as they throw themselves in to their work, rather than deal with what is going on. Depression can make you feel tired, give you difficulties in concentrating and with the added aches and pains, it can lead to low attendance at school or an apathy to not engage in the way they used too.
  • Low self esteem- being depressed, your teen will already be in a low mood cycle. This can then intensify their feelings of guilt, shame, worthlessness, failure and even ugliness. They may even start to see problems where there are not problems.
  • Some teens turn to drug and alcohol abuse- substances are a common way of dealing with feelings. Whilst we are drinking or on drugs, it can make us feel temporarily better and focus us away from the problems. The only problem is that substance abuse actually makes things worse for the depressed teen.
  • High- risk behaviours, such as unprotected sex, sleeping around, out of control behaviours become common, as the teen is searching for a way to alleviate their pain.
  • Some depressed teens may start to talk about running away; some may even run away. These are usually cries for help, so if this happens, it is important to listen to your teen.
  • Self-harm can also be a way of expressing their depression. Keep an eye out for teens that appear to be hiding parts of their body with long tops, or a refusal to wear shorts in warm weather. It might be a fashion statement, but it could be a sign of something else.

 

What about Suicidal Tendencies?


 

Teens that are seriously depressed may make statements expressing suicidal tendencies. Although some of these statements may well be a way of getting attention, or a cry for help, some of these statements are real and the seriously depressed teen could act on their threats. So, when should you worry? What is a warning that your teen may well attempt suicide?

Firstly, is your teen expressing thoughts that they would be ‘better off dead’ or ‘there’s no point’ ‘things will never get better’? Negative statements that are really quite dark in thought and deed? Are they joking about committing suicide? This too can often be a cry for help, as can writing stories or poems about death, suicide and dying. Are they storing medications? Asking for pills or hiding pocketknives or razor blades in their rooms? More obvious signs would be saying goodbye to friends and family, as if this is the last time they will see them. And of course, reckless behaviour- are they getting hurt a lot because they are putting themselves in dangerous positions?


What Can I do If I Suspect My Teenager Is Suffering With Depression?


 

So, what do you do if you suspect your teen is suffering from depression? Well, the first thing to know is you are not alone! There is probably nothing you have done wrong or could of done differently to stop this happening. Even if you don’t know if it is depression, talk to your teen. Find out how they are doing. Perhaps knowing that someone is interested and there for them will help them to open up about what they are finding difficult.

Try and be empathic and non-judgemental; keeping your temper with them is tricky, but the more you can appear open to discussion, the more your teen will feel they can open up. Don’t over question your teen- this could stop them from trying to reach out; teenagers do not like to be pushed into doing things they don’t want too! Try not to patronize, or say things like ‘when I was your age’- imagine someone saying that to you, when you’re feeling down? It isn’t helpful, is it?

Do listen without lecturing- try not to pass judgement or criticize- it takes a lot of guts to open up, when feeling very depressed. The most important thing here is that your teen is trying to communicate with you! You cannot talk your teen into feeling better- listen and acknowledge how bad they are feeling; their pain and sadness. Let them know that you are taking what they say seriously and that it is of importance to you.

Your teen might be too scared too talk to you, or feel that they cannot open up about what is going on. If this is the case, get in touch with your G.P who can refer your child on to the Children and Adolescent Mental Health Team (CAMHS) or there may even be a Psychology Practitioner in your surgery who your teen can talk too. It is really important that your teen, if prescribed medication, does not rely on this alone. Evidence suggests that a combination of drug therapy and talking therapy or CBT (Cognitive Behavioural Therapy) has been shown to be the most effective way to deal with depression.

It is also important to note that some medications can increase the suicidal thoughts; if this is the case, get in touch with your GP. Particularly if there are new suicidal thoughts, failed suicide attempts, difficulty sleeping, panic attacks, restlessness or agitations, new/worse irritability, hyperactive or any other unusual changes in your teen’s behaviour.

Finally, be kind to yourself and your teen- try to factor in some ‘me’ time, where you do something important to you; be it reading, a bath, socialising or going out for a coffee or swim. The more positive experiences we have, the better we feel, especially if we can remain connected to other people. This isn’t an easy task to do, and perhaps your teen really isn’t feeling like doing any of it. Try to respect their space, but gently encourage positive activities.

Remember, your teen may not understand their feelings or how to verbalise them, so trying to get them to talk to you could be really difficult- if you don’t understand it yourself, how can you explain it to someone else?


References:

Buchanon, M. (2015) Childrens Mental Health Services Cut by £50 million, 9th January, [Online], Available: http://www.bbc.co.uk/news/education-30735370 [26 February 2015].

Green, H. (2013) Mental Health Statistics, 8 June, [Online], Available: http://www.youngminds.org.uk/training_services/policy/mental_health_statistics [26 February 2015].

Medlar, F. (2014) Signs of Depression, 8 June, [Online], Available: http://psychcentral.com/blog/archives/2012/07/21/a-few-signs-your-teenager-may-be-depressed/ [27 February 2015].

NHS (2014) Depression, 5 June, [Online], Available: http://www.nhs.uk/Conditions/Depression/Pages/Symptoms.aspx [20 February 2015].

 

 

Cognitive Behavioural Therapy didn’t work for my friends; why should it work for me?

In response to a question that I have been asked on the Facebook group, here is a piece I have written on CBT (Cognitive Behavioural Therapy) and how it works, or may not work for you!

CBT, or Cognitive Behavioural Therapy is a kind of therapy that is popular within the NHS. The reason that it is so popular is that it is an evidence-based practice; meaning that there have been scientific studies which prove that the therapy works (Whitfield and Williams, 2003). That isn’t to say that Cognitive Behavioural Therapy (CBT) works for everyone, just that it works quite often! We are all incredibly individual- just as you and your friend have very different needs when it comes to relationships; so do we all have very different needs when it comes to therapy!

Cognitive Behavioural Therapy works by looking at how our thoughts affect our feelings, which affect our behaviours, which in turn, affect our physical feelings- it’s sometimes called the CBT donut, as all of these behaviours and emotions affect each other! An outside situation happens, which in turn, makes us think and feel an interaction- sometimes these are good, and sometimes these are bad. When the interactions are negative, this is where Cognitive Behavioural Therapy can work.

CBTDonut

CBT can be very helpful for certain conditions; Panic Attacks, Anger, Depression, Phobia’s, OCD (Obsessive Compulsive Disorder), PTSD (Post Traumatic Stress Disorder), Sexual problems and Health problems. In simple terms, if your issue is quite specific, (for example a phobia of spiders) the more likely it is that CBT could help you. That is not to say that Cognitive Behavioural Therapy will work for you, if you have one of these issues!

During the Cognitive Behavioural Therapy sessions, you will set goals with the Therapist; specific goals, that you will work towards each week. The techniques that you learn to achieve your goals during your Cognitive Behavioural Therapy, can be utilised in other areas of your life, and are tools in your toolbox for dealing with issues as you go through life, and let’s be honest, we could all do with learning tips that might make the journey of life a little easier!

CBT tends to deal with the present, the here and now, which is where Cognitive Behavioural Therapy differs from other talking therapies. With CBT, we do not go in to the past and deal with issues you may have had since childhood; and for some issues, this is ok, as you only seek to change how you make sense of, and react to, certain situations.

However, for some people, Cognitive Behavioural Therapy is not enough- they need to go back into their past and to deal with the issues that they have experienced during their lives. Talking therapies are non-directive, and deal with support and empathy. Although your CBT Therapist may well be empathic and supportive, it is within the remit of Cognitive Behavioural Therapy to be directive- this means that the Therapist will give you advice, ideas and techniques as to how to help your issues. This, though, is very different from being told what to do- and I am sure you will agree, nobody likes being told what to do!

My practice is considered to be Integrative- this means that I utilise different types of therapeutic techniques. My main modality is to be Person-Centered; which, to you and me, just means that I am empathic, supportive and offer a non-judgemental listening ear, whilst we work together to get to a therapeutic ending. Sometimes, this does mean that I use Cognitive Behavioural Therapy; but I am not limited to just that. Perhaps a mix of therapies is what you’re after? After all, sometimes we just don’t know what the issues are, or that the issue is grounded in our experience from a long time ago. Either way, perhaps CBT may not be for you, but it could be worth a try!


 

Links to read:

NHS CBT (Cognitive Behavioural Therapy) Website

Royal College of Psychiatry Information on CBT

Patient.co.uk Website CBT


Whitfield, G. and Williams, C. (2003) ‘The evidence base for cognitive–behavioural therapy in depression: delivery in busy clinical settings’, Advances in Psychiatric Treatment, vol. 9, no. 1, Jan, pp. 21-30.