March 2020 (COVID-19) – Blog Post 2: Coping with Uncertainty and other difficult thoughts and feelings – The Guildford Psychologist

24.3.20 Once again, I just want to say I hope you and you loved ones are well at this difficult time. This is my second blog on tips I hope you will find helpful. The first blog titled ‘Tips to maintain your wellbeing’ can be found below this one.

Today’s blog is on coping with difficult thoughts and feelings that may naturally come up at this time. I wanted to write something a bit different from the standard basic tips I was seeing on the internet. However, because of this, some of what is written in this post may take a bit of time to get your head around. Therefore, if you have any questions or want me to clarify anything please do feel free to email or phone me. I’d be more than happy to talk through it with you.

Stay safe,

Ben

Coping with Uncertainty and other difficult thoughts and feelings

Firstly, I really want to stress that at these difficult times it is completely normal to be feeling anxious. We are in an environment that most of us are not used to and our brains are having to negotiate through it with a lot of uncertainty.

The brain, naturally, is not a fan of uncertainty. Uncertainty in the past (caveman/woman times) often meant ‘danger’ (more chance of being attacked/eaten). Part of our brain has not evolved since these times. Therefore, when there’s a lot of uncertainty, our brain will naturally try to think ways to get more certainty so it feels safe. Unfortunately, achieving certainty is not always possible, so the brain just stuck on the loop of trying and this can lead to worry++ and be very tiring. So here’s some tips:

 

Tip 1: Recognise what you can control, and what you can’t control and try to focus more on the former.

Make a list of the things you can control and the things you can’t and try to focus on the former. Examples of each might be:

Things we can’t control:

  • How long this virus situation will last for
  • How others react in this scenario
  • Whether others follow social distancing rules
  • The amount of pasta left on the shelves….

Things we CAN control:

  • What you do with your hands, feet and mouth right now
  • Your positive attitude
  • Trying to find fun things to do at home
  • Your own decision whether to socially distance
  • Whether you try to be kind and thoughtful
  • If you go on social media, listen to the news
  • Whether we try to be the best human we’d like to be at this moment

 

Tip 2a: Understand the difference between our ‘thinking-self’ and our ‘observing-self’

As I say, when we’re anxious, or dealing with uncertainty, we often have similar thoughts going round and round our head. For example, ‘What if I/(other person) gets COVID-19’ or ‘How do I make 100% certain others follow social distancing rules?’. We can recognise that we can’t achieve certainty, but sometimes our brain still stays stuck on the topic and this can be draining.

One answer may be to stop these thoughts. However, unfortunately, we don’t have a lot of control over our thoughts. For example, try not to think of a pink elephant for thirty seconds…… it’s tricky! Trying to stop a thought rarely works and nor does distraction. If distraction does work, generally it’s not for much time, particularly if it’s about something we’re very worried about.

Since controlling or stopping these thoughts invariably gets us nowhere, the trick is to do the opposite. This involves being more accepting of these thoughts.

So how do we accept our thoughts? Firstly, by accepting our thoughts, I don’t mean we agree with them. I simply mean that we accept that they exist, that they’re there in our head. It can also be helpful to recognise the difference between our thinking self and our observing self, and this exercise can help with that:

For the next thirty seconds, just pause for a moment and notice what you mind is thinking. Perhaps your mind is naming the objects around you. Maybe it’s thinking ‘I’ve got no thoughts’. Perhaps it’s even generated an image in your mind. If no thoughts appear, just keep listening until they restart. And that’s it. You’ve recognised the part of your mind that talks – the thinking self – and the part of your mind that listens – the observing self.

 

Tip 2b: Use your observing-self to help you accept your thoughts/thinking-self

Now, to accept a thought, we want to use our observing self. With our observing self we want to observe the thought/thinking-self non-judgmentally. I often suggest to clients to think of a name for their thinking self, like ‘Bob’ or ‘Goober’ (if it makes you smile, all the better!).

So, if you notice that your ‘Bob’ is thinking in a loop (aka worrying), try using the following techniques to help adopt an acceptance approach to the thoughts, and help you focus more on the things you can control:

  • politely thanking ‘Bob’ for the alert then move on with our day.
  • politely inform Bob that we know it’s worried and that’s just a sign we care, but we can’t control this problem
  • put Bob’s thoughts on a cloud and watch them drift by, and when they come back just put them on another cloud – accepting the clouds/thoughts in the sky
  • putting the thoughts on a leaf and imagine them floating down a river (there’s a great youtube video that can help you practice this): https://www.youtube.com/watch?v=r1C8hwj5LXw
  • thinking about the BBC News Channel, with the ticker tape going along the bottom with all the headlines – imagine your thoughts scrolling on that ticker tape, just round and round – but notice how you can still observe the newsreader if you wish.

As well as accepting your uncertainty thoughts, it can be helpful to try to accept your uncertainty feelings too. This takes practice, but, as with the thoughts, the idea is to be able to step back and observe these feelings inside. Accept that, at this time, it’s completely understandable to feel this way. Then, with the time you’d use to typically fight/stop these feelings, try to be the best version of you that you can be (see Tip 3), even if means the emotions are still there. Russ Harris is world-renowned for his literature on acceptance, and he’s done a great video on ‘the struggle switch’ which explains the idea of accepting our emotions: https://www.youtube.com/watch?v=rCp1l16GCXI

 

Tip 3: Work out what matters and try to focus on being the best version of you that you want to be.

When we don’t spend so long trying to stop / distract ourselves from our thoughts, we often find we have more free time. With this time, focus on being the best version of you that you can be. To work out what the ‘best you’ is, it can be really helpful to think about what values you’d like to live by.  This can be tricky and does take a little bit of thought. One way to work out the values that matter to you can be to ask yourself the following two questions:

  • Imagine it’s your (insert your age + 2 years) birthday. You’re having a party and your family and friends are there. Invariably you come up in conversation (!). How, would you like your friends/family to be describing you / your personality amongst themselves?
  • Think of some people you really admire. These may be people you know personally, maybe film stars/celebrities, maybe even a cartoon character. What is it about them that you admire? What qualities do they have?

If after thinking through these questions you struggle to come up with some values, that’s okay. Hopefully this list of values may help: https://www.actmindfully.com.au/wp-content/uploads/2019/07/Values_Checklist_-_Russ_Harris.pdf. The list has a task attached to it, specifically for the purpose of helping you to work out what values matter most to you.

 

Tip 4: Set some goals around these values

Now that you’ve an idea on some key values you’d like to live by, set yourself some clear, realistic goals on how you could live in accordance with them. For example, let’s say one of the values you choose is ‘Caring’. You may set a goal to make a loved one a cup of coffee in the morning. Another may be to give a relative a ring to check out how they are.


Since how we behave invariably impacts our thoughts and our feelings, behaving in a way that is congruent with the person we’d like to be often makes us feel content in ourselves.

 

I hope you found this helpful. If you did, it may be worth checking out Russ Harris’s booklet on COVID-19 for more detailed tips! Russ is a well known practitioner in the world of Acceptance of Commitment Therapy (ACT) and he’s written lots of helpful books on the treatment.

His COVID-19 handout can be found on: https://coronadosafe.org/blog/face-covid/#.XnkDNYj7RPY

 

As always, any questions, please do not hesitate to contact me.

July 2017 – Grief and Bereavement – The Guildford Psychologist

Sometimes, after the death of a loved one, it can be a real struggle to adapt to life without them. On the one hand we can recognise that we need to build a different (or new) life. On the other hand we don’t want to let go of life as it previously was.

However, over time we invariably begin to realise that we need to choose a new life. This can sometimes be a very difficult decision. It’s not uncommon to feel that building a new life means forgetting the loved one or ‘getting over’ the loved one. It can feel that we would be betraying them. Often we can recognise that this is not the case, but sometimes this can be difficult for someone and therapy can invariably help here. The aim of the therapy is to learn how to incorporate  the memories and experiences we have of a loved one into our present life, rather than learn how to forget them.

In cognitive behavioural therapy (CBT), we recognise that our thoughts and behaviour play a key role in forming the new path.

Thoughts

Recent research has suggested that frequent worrisome thoughts about the future can impact the adjustment process (Eisma et al 2017). This makes sense given the amount of research that has shown that that thoughts that bring about a sense of hope can be really valuable at this time. However, it is easy to get caught up in worrisome thoughts. It is common for people to think that the pain will not ease, that they will not find a renewed sense of purpose in life, their loved one will be forgotten and that they will not be happy again. The aim of CBT is to help others recognise that this need not be the case. Knowing others have gone on to find happiness again can form the basis of this hope, and letting yourself know these things are possible is a start.

Behaviours

Involving ourselves in life without our loved one is also important for the adjustment process. This can be difficult, but thinking of activities to engage with as part of our new life is a step. One of the unhelpful cycles we can get into is to spend a lot of time indoors thinking about our loved one. It can be important to give ourselves time for this. However, it’s equally it’s important for us to show ourselves that life is continuing and we can continue. Therefore, engaging in some activities can be really valuable too and help us begin a different life. These activities can be things you’ve done before, or can be new interests. They can be anything from going for a coffee with a friend or doing an activity never previously considered. It may feel difficult to start something new, and indeed continue with old activities. This is where others may be of help  – perhaps  go with someone else first of all, or just go for a very short time.

During the initial grieving period, there will be times that things feel easier and times that will feel harder. At times you may feel like progress is slow. But, over time things will hopefully feel a little easier as we naturally adjust to our new life….. without forgetting our old one.

As always, please feel free to ask me any questions. I will be more than happy to help.

 

August 2015 – Sleep difficulties – The Guildford Psychologist

For this month’s blog I thought I’d write about an area that causes a lot of people difficulty – sleeping difficulties –  and just give a couple of very quick tips that I hope will help.

Happy woman laying on bed
It is very common for people I see to be suffering from sleep difficulties. However, often that is not the reason they contacted me. Instead it is feelings of low mood or heightened anxiety that they’ve been suffering with. One of the questions I will always ask in an assessment though is around sleep. Simply put, although sleep may not be the primary concern, poor sleep can certainly be a contributing factor in maintaining depression and anxiety.

There are a couple of proven methods to combat sleep. The first is medication. There is no doubt that one can take prescribed sleeping tablets to help get to sleep. However, these tablets are commonly prescribed for only a short period – simply because they can be so addictive and can easily be relied upon as the ‘only’ way to sleep. Therefore, when they are not available, the sleep problem returns. Their effectiveness also wanes with time.

The second proven method is psychological therapy, namely Cognitive Behavioural Therapy (CBT). CBT for insomnia has been assessed in over 100 RCTs (randomised controlled trials – known as the ‘gold standard’ of research). The results show that on average 70% of people with even very long term poor sleep obtain lasting benefit from the treatment. CBT explores and works on two areas:

– the mental (or cognitive) factors associated with insomnia, such as the ‘racing mind’.
– the behavioural element that is hindering the development of a ‘pro-sleep’ routine and stopping one achieving a strong connection between bed and successful sleep.

The aim of CBT is therefore to use cognitive techniques to help with the former and behavioural techniques to work on the latter.

Cognitive

The cognitive techniques will often explore the anxious thoughts that may be hindering sleep. For example, typical thought processes that can hinder sleep are those focusing on:

– planning or problem-solving (this is what we do in the day and stimulates / switches on the brain)
– how we are not yet asleep and the effect this will have on your day ahead. This typically generates anxiety, and the brain typically thinks that if we’re feeling anxious then we must be in some sort of danger – and therefore sleep is not advisable)
– sounds in our environment that appear different – again this ‘switches on the brain

Techniques adopted may look at unhelpful thinking styles and we would work together on how you can tackle these. Mindfulness approaches can be helpful here to help us observe, rather than engage with our troublesome thoughts. We may also explore the content of thoughts and use diaries or thought records to help. Each area will typically involve a different technique, tailored to you.

Behavioural

In relation to behavioural techniques, the aim here is to focus on strengthening the relationship between your bed and sleep. There are a number of behaviours that can keep us awake and stop this connection growing. Given this, I thought it would be helpful if I laid out a few behavioural tips that may help improve your sleep. There’s loads of these about, but I thought I’d focus on some that many find helpful:

– Try to go to bed and get up at the same time – even at weekends! This helps your body get into a natural rhythm
– Avoid caffeine and nicotine for at least 4-6 hours before bed as they stimulate the brain.
– Avoid alcohol. Same as above, it’s best to avoid alcohol for at least 4-6 hours before sleep. It’s worth noting here that even though some people think alcohol helps them to get to sleep, alcohol negatively affects the quality of the sleep.
– Avoid ‘blue light’ in bed. Laptops, ipads, smartphones all emit ‘blue’ light. The brain can interpret this as meaning it’s the morning and so should ‘wake up’.
– Try not to clock watch. It often leads to ‘Oh no, I’ve only x hours till I wake up’. This creates anxiety and wakes up the brain. Try to cover any clocks and rely on an alarm to tell you when to wake up.
– Have a bedtime routine. Train the brain to know when it is bed time. You can create sleeping rituals such as 15 minutes of light-reading before sleep, or sitting down with a mug of tea before bed (caffeine-free of course!)

Finally, sleep difficulties can be very frustrating and challenging, so I would not want anyone to think that I’m implying that just by doing the above it’ll be fixed. Indeed, you may be reading this and thinking you’ve tried the above techniques to little effect. Whether you’d tried them or not, I’d be happy to speak to you further and discuss whether CBT could be of benefit.

 

 

May 2015 – Exam Stress – The Guildford Psychologist

Around this time of year, many children and young adults struggles with the stress of exams. If you’re going through this, or you know someone who is, my aim is to help reduce your / their stress levels and help this period to be as productive as possible.

Often when a child, adolescent or adult comes to see me for exam stress, they are displaying a number of signs of anxiety and/or low mood including:

Thoughts
– Negatively predicting how the exams will go and what will happen if they do not do as well as they hope
– Self-critical thoughts about what it’ll mean about them if they do not do well. Also self critical thoughts when they’re struggling to learn/understand something they are revising.

Feelings
– Feeling despondent
– Feelings of panic
– Feelings of guilt when not revising
– Feeling inadequate
– Lack of interest or pleasure in things

Behaviour
– Struggling to start revising (procrastination)
– Struggling to stop revising and take helpful breaks
– Sleeping difficulties
– Being easily annoyed or irritable
– Having difficulty relaxing

Physiological Symptoms
– Lack of energy
– Tiredness

These thoughts, feelings, behaviours and physiological symptoms may be interrelated. However, whilst it can be easy for someone on the outside to see an unhelpful cycle a student is engaging in, the student themselves may be too enmeshed in the cycle to recognise what is occurring – i.e., unable to see the wood for the trees. This is where an objective person (family member, friend, teacher or therapist) can be of help.

In using Cognitive Behavioural Therapy (CBT), my aim is to help a student recognise and work on unhelpful cycles they may be engaging in and come up with alternative cycles. The goal would never be to delete stress – after all, a level of stress can help us motivate ourselves – instead, the goal is to lower this stress level so that it does not negatively impact on performance and feel overwhelming.

Tips
Here are a few quick tips I hope will help.

1. Aim for ‘good enough’
When revising, sometimes we can get caught in the perfectionism cycle. For example, we may want to ensure we’ve understood something 100% before we move onto the next topic. Or we may not even try to understand something because we do not believe we’ll be able to fully understand it.

If you’re struggling with this, allow yourself to be ok with not knowing all of something, and just to know enough. Speak to yourself in a kind and compassionate way when you find yourself struggling to understand something and ask yourself how you would motivate someone who was also struggling with this.

2. Healthy body, Healthy mind
It may look like revising takes up little energy (after all, you’re just sitting down!), but the brain requires lots of fuel during revision. Therefore, try to ensure you’re putting the right amount of nutrients into your body (see http://www.nhs.uk/Livewell/Goodfood/Pages/eatwell-plate.aspx) for a healthy plate)

Also exercise can be helpful – a short brisk walk can be really helpful and help the brain step back from the stress of exams / revising.

3. Reward yourself
We all work well with rewards. Allow yourself time off from revision to do fun stuff – this’ll help motivate you to continue revising, and also keep your mood levels up.

4. Sleep well
Get a sleep routine in place. Aim to go to bed and get up at the same time each day and give yourself a minimum of an hour to wind down in the evening before you go to bed – this’ll help the quality of your sleep.
If you revise as well as you can, then how you do is irrelevant. You’ve strived to do as well as you can and so therefore if:
– a question comes up that’s not your forte
– you have a random brain freeze
– you have a dodgy examiner
– you’re ill on the day

then you have still strived to do your best and you can not do any more than that.

Do get in touch if you’d like further support with exam stress. I can offer support to either the student or their family members.

April 2015 – The Guildford Psychologist

Welcome to the first blog on my site. I often get asked questions regarding diffierent aspects of my work, for example surrounding the specific therapies, the conditions I treat, the commonality of particular symptoms (to name but a few). My plan is to use this blog space to give you information about these and to keep you up to date with research in the field of cognitive behavioural therapy, mindfullness, acceptance and committment therapy and Eye Movement Desensitisation Reprocessing. Please do feel free to get in touch if you have any questions and I’d be happy to speak to you.