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

Are You a Highly Sensitive Person?

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

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

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

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

Sensitivity is no bad thing

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

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

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

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

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

Warm wishes,

Dan

Are You an Orchid or a Dandelion?

Image by Petra Kessler

One of the key ideas I always share with my clients is that we all have a certain temperament, which we are born with and which has a profound impact on the way that life experiences, good or bad, affect us. Many of my clients have a sensitive, emotional temperament, which means that they are much more affected by problems in the family than someone with a robust, more intellectual temperament.

It's important to emphasise that having a certain kind of temperament is neither good nor bad – it's just like being born with brown or blonde hair, blue or green eyes, not your choice or fault in any way but simply how you arrived on this planet.

I also tell my clients that I have a sensitive, emotional temperament too. This can make life difficult at times, as I am affected deeply by negative experiences and my childhood was pretty bumpy, to say the least. But it also bestows on me particular talents and gifts – I could not be a therapist without this kind of temperament. After all, you wouldn't want a therapist who was insensitive, unempathic or unkind! 

Dandelion children

Psychologists have, in recent years, been investigating the theory that we are all either orchids or dandelions. This is based on the Swedish idea that 'dandelion children' are pretty robust and do well in any environment, even if the parenting and family dynamic are less than perfect.

US psychologists Bruce Ellis and W. Thomas Boyce extended this idea to include 'orchid children', who were especially sensitive and so needed just the right conditions to thrive. In practice, that means loving, nurturing parents; a relatively calm and stable family environment; and no traumatic experiences during childhood.

If orchids have a difficult family dynamic, they will struggle – developing a number of schemas which will affect them throughout their life and very likely experience depression or anxiety, among other problems, when these schemas are triggered by stressful events. But, if these sensitive children are well-nurtured, they will bloom into beautiful young people and later adults – just like the orchids above.

Warm wishes,

Dan

What is Mindfulness Meditation?

Image by Patrick Schneider

Mindfulness is a real buzzword at the moment. From an obscure Buddhist practice it has become recognised by some of the world's leading doctors, scientists and psychologists as a remarkably simple, easy-to-learn yet highly effective tool for improving our physical and mental wellbeing.

Jon Kabat-Zinn is one of the leading figures in this mindful movement, and if you want to learn more about it his wonderful book, Wherever You Go, There You Are: Mindfulness Meditation for Everyday Life, is the best place to start. There's also a great video of him teaching mindfulness to Google employees on YouTube, if you're more visually-minded.

Mindfulness is backed up by a substantial body of research proving it to be an effective weapon against a wide variety of physical and mental ailments. Kabat-Zinn's mindfulness-based stress reduction (MBSR) programme at the University of Massachusetts Medical Center has been running since the 1970s. It has proven effective for people suffering from chronic stress, generalised anxiety disorder and panic, chronic pain, fibromyalgia, MS, psoriasis and cancer.

What is MBCT?

Mindfulness-based cognitive therapy (MBCT) is an integration of MBSR with cognitive therapy. It was developed by three clinical psychologists – Mark Williams, John Teasdale and Zindel Segal – to teach patients who had experienced depression skills to disengage from habitual, automatic and unhelpful patterns of thought, especially 'rumination', in which the mind goes over and over negative thoughts. The evidence shows that MBCT can halve the relapse rate in patients who repeatedly suffer from depression.

So what is mindfulness? Well, put simply, it's a way of developing the ability to pay deliberate attention to our experience from moment to moment. Rather than worrying about the past or fantasising about the future, it's about being aware of what's going on in our mind, body and day-to-day life – and doing this without judgement. One of the reasons mindfulness is so powerful is that it teaches us to suspend judgement and self-criticism, to regard ourselves and others with kindness and compassion.

At the heart of mindfulness are meditations like the one below – ideally, we will develop a daily practice, even for just 10 minutes every day. Having finally knuckled down to my own daily practice, I can assure you that the results are well worth it. I feel calmer, more centred and less buffeted by the day's many trials and tribulations.

But the beauty of mindfulness is that you can practice anywhere, doing anything: washing up, eating, walking, cycling, brushing your teeth. Try taking a break from what the Buddhists call your 'monkey mind' on the way home from work today. Feel the breeze on your skin; really listen to the birds singing and distant murmur of traffic; see the leaves shivering on trees; look at the infinite beauty of clouds and sky. How does it feel? 

Here's a short mindfulness meditation for you to try – I recommend doing this as soon as you wake up, when the day's distractions haven't yet crowded their way in. You can also use this any time you feel stressed or anxious:

Mindfulness of breath meditation

1. Switch your phone to silent, then set a timer for 10min, so you're not worrying about how long you’ve been meditating.

2. Get comfortable – sit in a chair, cross-legged on the floor or lie down.

3. Close your eyes and become aware of your breathing. Nothing more, just become aware of the flow of air over your lips and nostrils, in and out. Don’t try to change your breathing, just breathe in and out naturally.

4. When your mind gets bored and demands your attention (as it inevitably will), don't give up or criticise yourself. Remember that through meditation we are trying to cultivate awareness – so be aware of your thinking, as you are aware of the sounds you hear and sensations in your body. Gently turn your attention back to your breathing until the timer goes off.

5. Once you feel comfortable sitting for 10min, try 15min, then 20min, and so on. And remember that, like anything, the more you practice the easier it gets.

The best thing about mindfulness is that it's free, can be practised anywhere and only takes a few minutes. If you suffer from stress, anxiety, depression or one of the physical ailments listed above, I strongly recommend it.

Warm wishes,

Dan

Schema Therapy or CBT – Which is Right for You?

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

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

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

When schema therapy is the best option

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

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

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

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

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

Warm wishes,

Dan

Should You Take Antidepressants?

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

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

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

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

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

Numbing the symptoms

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

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

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

Warm wishes,

Dan

Overcoming Public Speaking Anxiety

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

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

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

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

Change the movie

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

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

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

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

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

Warm wishes,

Dan

Learning to Love Yourself

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I was reminded of this Derek Walcott poem at a recent talk by Jon Kabat-Zinn, founder of the Western mindfulness movement (and one of my heroes). It seems to embody not just a self-compassionate, mindful attitude, but also the key idea in schema therapy – that to heal our past hurts we must learn to love ourselves, even if we have long held negative, self-limiting/critical beliefs.

Also, it's a beautiful poem – I hope you enjoy it...

Love After Love
The time will come when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other's welcome,
and say, sit here. Eat. 

You will love again the stranger who was yourself.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you
all your life, whom you ignored
for another, who knows you by heart. 

Take down the love letters from the bookshelf, 
the photographs, the desperate notes, 
peel your own image from the mirror. 
Sit. Feast on your life.

Warm wishes,

Dan

Do You Struggle with Romantic Relationships?

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Many people have difficulties with relationships, for all sorts of reasons. Finding a suitable person to be with and then maintaining a reasonably happy, stable relationship is not easy, for any of us.

But if you avoid romantic relationships altogether; if you find yourself repeating the same pattern over and over again in every relationship you have; or if you are in a long-term relationship but feel consistently unhappy, perhaps feeling disproportionately angry with or jealous of your partner, it's possible that unhelpful schemas are the root of your problems.

As I explain in this page about schemas, they are unconscious, deeply-rooted ways of thinking and feeling that get triggered by certain situations – and romantic relationships are among the most common triggers.

If you avoid relationships, perhaps for fear of getting hurt or rejected, you may have an Abandonment schema. This is often linked to the death of a parent, or a significant member of the family leaving in a sudden and upsetting way. The love and care you received as a child may also have been unstable and unpredictable, perhaps because one of your parents had mental-health problems, or was just not cut out to for the complex business of parenting.

So avoiding relationships altogether is one way to make sure that this painful schema never gets triggered – sadly though, that means your life will be lonely and unfulfilling (if you actually want a relationship, which most of us do), so this is clearly not the most helpful strategy. 

Watch out for schema chemistry

If you find yourself playing out similar patterns in relationships again and again, or perhaps choosing a certain type of man or woman in one relationship after the next, 'schema chemistry' may be to blame. This describes the unconscious, schema-driven forces that make a certain kind of person irresistibly attractive.

When you feel very strong physical chemistry with someone, as if you can't get enough of them and feel like they are perfect for you in every way, tread with caution. It may just be healthy sexual attraction, of course, in which case there is nothing to worry about. But if you have a history of falling in love with unsuitable people, that lightning bolt of chemistry – though exciting and seductive – is not to be trusted.

If you are in a relationship but it's not a happy one, again that is not unusual – long-term relationships are hard work, requiring commitment, sacrifices and a huge amount of love and patience on both sides. But if you have the same kind of argument over and over – volcanically losing your temper about fairly minor domestic incidents, becoming very anxious or consumed with jealousy every time your partner speaks to a member of the opposite sex – then your schemas may be to blame again.

The good news is that the schemas which cause all of these problems can be healed. Although that's not easy, it's far from impossible. There are now a number of therapeutic approaches designed to help people with these deep-rooted, life-disturbing problems, such as schema therapy or compassion-focused therapy.

When I am working with people who have these kinds of problems, one of our long-term goals is for them to find a happy, healthy, stable relationship – after all, what is life for but to love and be loved? And a healthy relationship as an adult is one of the best ways to heal the wounds of childhood, so a little work in this area goes a long way.  

Warm wishes,

Dan

How Mindfulness Can Help with Chronic Pain

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If you suffer from a medical condition that causes you chronic pain, life can be gruelling. Nobody likes being in pain, so over time it can really grind you down. Musculoskeletal problems like hip, knee or lower-back pain, arthritis and other ongoing, hard-to-treat conditions can sap your strength and energy over time, making it hard to stay positive or hopeful that a solution will eventually be found. Dealing with pain can make you stressed or depressed, as the ongoing struggle – unsurprisingly – causes sadness and low mood.

But if you or someone you care about is struggling with a painful condition, it's important to know that there is very good evidence for the impact that psychological treatments can have – in particular, cognitive therapy and mindfulness meditation.

Of course, thinking differently about your problem, the core strategy in cognitive therapy, will not take away the pain (although it can significantly decrease the amount of pain you are in). Instead, it will help you stop thinking so negatively about the problem, which will boost your mood and stave off the risk of depression. 

The mindful approach to stress

Since the 1970s, mindfulness – in particular, mindfulness-based stress reduction, or MBSR – has been used to help people with a wide range of psychological and physical ailments. MBSR's founder, Jon Kabat-Zinn, developed his revolutionary approach to help people who had been failed by traditional Western medicine.

He worked with patients suffering from treatment-resistant spinal problems and even terminal illness – and had a remarkable success rate at lowering their stress levels and improving the quality of their daily lives.

As with all forms of suffering, whether emotional or physical, the mindful approach is to change our relationship to the thoughts, feelings and physical sensations, enabling us to stop fighting or resisting them and – counterintuitively – accept them, even if we do not want them to be there.

Over time, we find that this stance of acceptance is an extremely powerful one, allowing the 'aversive' experiences to come and go, so they don't get stuck or morph into other forms of suffering like self-criticism or anger.

I want to be clear: I am not minimising how hard or upsetting it can be to live with chronic pain (as someone with ongoing back, hip and other musculoskeletal problems, I know that only too well). But being human inevitably means dealing with stressors, large or small; and, if we cannot free ourselves from them, we must find the best possible way to live with them.

Warm wishes,

Dan

How Mindfulness Meditation Helps with Anxiety and Depression

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Mindfulness is a real buzzword at the moment. It's hard to pick up a newspaper without coming across an article extolling its virtues. Mindfulness meditation programmes have been introduced into corporations like Google and Facebook, as well as schools, government departments and a whole host of other settings – it feels like everyone has suddenly switched on to the power of meditation.

But what exactly is mindfulness and how can it help with psychological problems like depression or anxiety? The first thing to say is that, although we in the West are only learning about mindfulness now, in the East people have been using mindfulness techniques for 2,500 years. Mindfulness is a cornerstone of Buddhist practice, used to calm and focus the 'monkey mind' (which normally just jumps around from one thing to the next).

Mindfulness was first introduced into the medical mainstream by Jon Kabat-Zinn in the 1970s – he developed an eight week mindfulness-based stress reduction (MBSR) programme, to help people with chronic pain and other serious medical problems. This proved so successful that a team of psychologists adapted it to help people with psychological problems, especially recurrent episodes of depression. They called this new programme mindfulness-based cognitive therapy (MBCT) and it proved equally effective.

The key idea in mindfulness practice is learning to focus on your moment-to-moment experience, rather than being swept away by the storms of anxious or depressive thinking that drive psychological problems. As with both cognitive and schema therapy, we have a large body of evidence showing that mindfulness works.

On a personal note, I have had a daily meditation practice for years, and absolutely vouch for its power to calm and centre me for the day ahead. I have also taught many clients to meditate and seen the huge impact it has had on their problems with anxiety and depression.

Mindfulness of breath meditation

Here is a simple sitting meditation you can try right now:

1. Switch your phone off, then set a timer for 10 minutes, so you don't have to worry about how long you’ve been meditating.

2. Sit in a straight-backed chair, cross-legged on the floor or lie down. Try to relax your body, letting your shoulders drop and face muscles soften.

3. Close your eyes and become aware of your breathing – the flow of air over your lips and nostrils, in and out. Don’t try to change your breathing in any way, just breathe naturally.

4. If your mind gets bored and gets distracted (as it probably will), don't give up or get frustrated. Every time you notice your mind has wandered gently turn your attention back to your breathing until the timer goes off.

5. Once you feel able to meditate for 10 minutes, extend the time to 15 minutes, then 20 minutes, and so on. And remember that, like anything, the more you practice meditation the easier it gets.

Warm wishes,

Dan

When Someone You Love is Depressed

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

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

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

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

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

1. Understand what they are going through

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

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

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

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

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

3. Help them take small steps to becoming more active

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

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

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

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

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

Warm wishes,

Dan

The Difference Between Pressure and Stress

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People often tell me that they 'thrive on stress'. I respond that they might be confusing pressure – which can be energising and motivating, if we respond to it well – and stress, which always has a negative impact on us. Let me give you two examples:

James is a 30-year-old entrepreneur, who has recently launched a startup website selling his own brand of clothing. James is passionate about his new business and thrives on the pressure he puts himself under to make it successful.

He works long hours, but knows this is necessary to get a new business up and running. James thoroughly enjoys every minute of his working day, so never feels stressed or overwhelmed – the fact that his business is doing well helps him stay positive and optimistic about the future. 

So for James, it's clear that the – self-imposed – pressure is a positive thing; it gives him the energy and drive he needs to make his new business a success.

Emma is a 26-year-old nurse working in a busy hospital in inner London. Over the last year, she has seen wave after wave of cuts in the number of nurses and support staff working on her ward. She and her colleagues work very long hours with no breaks – Emma wolfs a sandwich during her daily meeting with the other nurses. Sometimes she goes hours without even a drink of water or toilet break, as she is swamped with constant crises and demands from her patients.

Emma's nerves are stretched and jangling, she feels exhausted and irritable all the time – recently she snapped at a difficult patient, which shocked and upset her. Emma is so stressed that she doesn't know how much longer she can take it and is seriously considering quitting nursing before she becomes seriously ill.

The impact of chronic stress

It's clear that Emma is suffering from chronic, debilitating stress, which is affecting her physically and psychologically. Like many people suffering from stress, she feels overwhelmed, under-supported and out of control of her working life. If she doesn't do something soon, she may will burn out or develop a more serious illness, as all the research shows that long-term stress is harmful to the body and mind.

In schema therapy terms, this kind of stress is generally caused by a demanding part, which drives us on to work harder and harder, never feeling that what we do is good enough. This part can also make us feel under pressure – but it's not the kind of positive, motivating pressure James thrives on. This pressure is unpleasant, debilitating and overwhelmingly negative.

James's enjoyable pressure is probably coming from his Healthy Adult, which encourages and motivates us, rather than being critical or undermining of our best efforts.

If you are struggling with short-term stress, cognitive behaviour therapy (CBT) will be extremely helpful. If becoming stressed is a pattern for you, or it's affecting every area of your life, schema therapy may be more suitable.

Warm wishes,

Dan