Rebecca Mead Blogs - Brighton and Hove Psychotherapy

As we come out of lockdown, will a number of us be feeling socially anxious?

April 24, 2023 by BHP Leave a Comment

Food and Mood

The links between mood, mental health, sleep quality and nutrition are areas of research interest. Associations between the type and quality of a person’s diet and risk of anxiety and depression are increasingly described in literature. Complexities around the multidirectional relationship between diet and mental health are becoming more understood (Firth et al 2020) and it has been long established that poor sleep increases inflammation and stress hormones in the body.

Brain function requires a steady supply of glucose as its primary fuel which comes mostly from starchy carbohydrates. Energy which is slowly released, such as low glycaemic index carbohydrates, provide the optimal energy release for use by the body https://glycemicindex.com/. The brain also requires dietary fats as it is made up of 50 per cent fat, with brain cells needing fats to maintain their structure. Data supports unsaturated fats and omega-3 helps to ensure the brain is well nourished. Whereas trans-fats found in processed and packaged foods (meats, cakes, biscuits) seem to be harmful to brain structure and function.

Protein is essential for the growth, maintenance, and repair of all body cells, including the brain. Total protein intake and the quality of protein intake is important to ensure the body receives all the essential amino acids required for health. Good sources of protein include fish, chicken, lean red meat, meat substitutes, beans, quinoa, and nuts. Furthermore, protein contains tryptophan, an essential amino acid which is a precursor of serotonin synthesis and is thought to help with less depressive symptoms and anxiety. Tryptophan sources include fish, poultry, eggs and game, some green leafy vegetables such as spinach, pulses and seeds.

Specific evidence looking at nutrients directly linked to mental health include B vitamins (including folate) and zinc with research suggesting that these nutrients are important in managing depression. Vitamin D has also received attention as to whether vitamin D deficiency causes depression. There is no evidence that this is the case, however there is a correlation between people who have depression and low levels of vitamin D. This is likely to be a causal effect from the social withdrawal and isolation from feeling depressed. There is evidence that not having enough vitamin D leads to depression symptoms. Eating a colourful variety of fruit and vegetables at least 5 portions per day (1portion = 80g), consuming foods fortified with vitamin D and getting safe sun exposure helps provides a wide range of vitamins and minerals sufficient for health and well-being. In addition, some researchers think that omega-3 oils, found in oily fish, may also help with depression. Oily fish twice per week such as salmon, sardines, mackerel, and trout is recommended.

A healthy brain contains up to 78 per cent water, therefore dehydration may also affect mood. Caffeine can lead to dehydration, withdrawal headaches and to low or irritable mood when the effects wear off. Drinking too much alcohol causes dehydration and can lead to B vitamin deficiencies, which increases depressive feelings or anxiety. Alcohol should be limited to within safe limits of units per week along with at least two alcohol free days per week.

Eating and drinking pattern is also important. Regular eating ensures optimal blood sugar control and as described above, links to our body’s functions, including brain health.

Avoiding over-eating and eating a main meal by 7.30pm encourages better sleep quality, which in turn supports our body’s natural circadian rhythm or body clock. Lack of good sleep also affects how much we eat. Research at King’s College, London, found that even partial sleep deprivation increased daily calorie intake of the equivalent of four slices of bread.

A recent area of interest is the link between our gut microbiome and mental health. As well as supporting our gut health, the microbiome is linked to stress and sleep quality and conversely sleep deprivation is known to negatively affect the gut microbiome after only two days of reduced sleep quantity and quality.

Such preventative measures to help with optimising mental health, gut health and overall well-being is key to maintaining a long-term positive lifestyle and will pay dividends in your overall health and happiness.

For further food examples, please refer to my blog called ‘Practical Examples for Food and Mood‘.

Further reading by Rebecca Mead –

Online vs in-person therapy

Loneliness and CBT

As we come out of lockdown, will a number of us be feeling socially anxious?

Resources:
• https://www.bda.uk.com/resource/fat.html
• https://www.bda.uk.com/resource/omega-3.html
• https://www.bda.uk.com/resource/fruit-and-vegetables-how-to-get-five-a-day.html
• https://www.bda.uk.com/resource/vitamin-d.html
• https://www.bda.uk.com/resource/probiotics.html
• https://www.bda.uk.com/resource/the-importance-of-hydration.html
• https://www.bda.uk.com/resource/depression-diet.html
• https://www.bda.uk.com/news-campaigns/campaigns/one-blue-dot/sustainable-
september/nutritional-considerations-for-dietitians.html
• https://www.nhs.uk/live-well/alcohol-advice/the-risks-of-drinking-too-much/

References

Al Khatib HK, Harding SV, Darzi J, Pot GK (2017) The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr;71(5):614-624. DOI: https://doi.org/10.1038/ejcn.2016.201

Appleton KM, Rogers PJ, Ness AR (2010) Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. American Journal of Clinical Nutrition. 91(3):757-70.

Arens U (2018) Authorised EU health claims for carbohydrates and maintenance of normal brain function. In: Foods, Nutrients and food Ingredients with Authorised EU Health Claims – volume 3. Woodhead Publishing.

Cuomo A et al (2017) Depression and Vitamin D Deficiency: Causality, Assessment, and Clinical Practice Implications. Neuropsychiatry. 7(5) 606-614.

Firth J, et al (2020). Food and mood: how do diet and nutrition affect mental wellbeing? BMJ; 369;m2382 doi:10.1136/bmj.m2382.

Gomez-Pinilla, F (2008) Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci 9 (7) 568-578.

Kraguljac NV, et al (2009) Efficacy of omega3 Fatty acids in mood disorders – a systematic review and meta analysis. Psychopharmacology Bulletin. 42(3):39-54.

Lespérance F, et al (2011). The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry. 2011 Aug;72(8):1054-62. doi: https://doi.org/10.4088/jcp.10m05966blu

Letchumanan V, Thye AY, Tan LT, et al (2021) Gut feelings in depression: microbiota dysbiosis in response to antidepressants. Gut;70:A49-A50.

Lin PY, Huang SY, Su KP (2010) A meta-analytic review of polyunsaturated fatty acid compositions inpatients with depression. Biological Psychiatry. (68(2):140-7.

Lindseth G, Helland B, Caspers J (2015) The effects of dietary tryptophan on affective disorders. Arch Psychiatr Nurs. 29(2):102-7. doi: https://doi.org/10.1016%2Fj.apnu.2014.11.008

Martins JG. (2009) EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. Journal of the American College of Nutrition. 28(5):525-42.

Mischoulon D et al. (2009) A double-blind, randomized controlled trial of ethyl-eicosapentaenoate for major depressive disorder. Journal of Clinical Psychiatry 70(12):1636-44.

Murakami K, Sasaki S. (2010) Dietary intake and depressive symptoms: a systematic review of observational studies. Molecular Nutrition & Food Research 54(4):471-88.

Penckofer S, et al. (2010) Vitamin D and depression: where is all the sunshine? Issues Ment Health Nurs. 31(6):385-93. doi: https://doi.org/10.3109%2F01612840903437657

Pouwer F, et al (2005) Fat food for a bad mood. Could we treat and prevent depression in Type 2 diabetes by means of omega-3 polyunsaturated fatty acids? A review of the evidence. Diabet Med. 2005 Nov;22(11):1465-75. doi: 10.1111/j.1464-5491.2005.01661.x

Rocha Araujo DM, Vilarim MM, Nardi A (2010) What is the effectiveness of the use of polyunsaturated fatty acid omega-3 in the treatment of depression? Expert Review of Neurotherapeutics 10(7):1117-29.

Rogers, PJ. (2007) Review: Caffeine, mood and mental performance in everyday life. Nutrition Bulletin 32, pp.84-89

Rondanelli M, et al. (2010) Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr 29(1):55-64.

Royal College of Psychiatrists (2019) Alcohol and depression. [online] Available at: https://www.rcpsych.ac.uk/mental-health/problems-disorders/alcohol-and-depression [Accessed 27 March 2023]

Somer E (2000). Food & Mood: The Complete Guide to Eating Well and Feeling Your Best, Second Edition

Walker JG, et al (2010) Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial. Br J Psychiatry Jul;197(1):45-54

Wurtman, RJ., et al (2003) Effects of normal meals rich in carbohydrate or protein on plasma tryptophan and tyrosine ratios. American Journal of Clinical Nutrition 77 (1) pp.128-32

November 28, 2022 by BHP Leave a Comment

Online versus In-Person Therapy

When Covid struck we could no longer deliver therapy face-to-face and so this meant that many of us had to adjust to therapy online using a video web platform such as Microsoft Teams or Zoom. This was both challenging for the therapist and the client, however many people now prefer therapy online.

Research has shown that therapy using a video web platform is just as effective as in person therapy. Studies published in the Journal of Psychological Disorders and the Journal of Affective Disorders, Behaviour Research and Therapy have shown that online CBT and counselling are as effective as in person therapy in helping people address a wide range of issues including anxiety and depression.

There are some obvious benefits to online therapy such as therapy in the comfort of your own home, not having to leave your house so no travelling to appointments; the convenience of accessing appointments anywhere providing you have internet access and privacy. I have had some clients attend appointments in their car or sitting in their garden and even whilst on holiday. There is also the anonymity of not having to go to a therapy practise setting for appointments. There is also something about not having to meet your therapist in person which can allow some clients to open up more.

There is no doubt that some clients prefer the connection of in person therapy. They feel it allows for a more fulfilling relationship. In addition, some clients are already having to work online and don’t want to do anymore ‘on screen’. The issue of privacy and being interrupted by family members can be difficult as well. In person therapy allows for a neutral location, a safe space for the client to share private information away from everyday life.

In person therapy has always been considered as preferable and certainly this was the case before Covid, but now this is shifting and we are learning that online therapy is also a valid option.

Further reading by Rebecca Mead –

Loneliness and CBT

As we come out of lockdown, will a number of us be feeling socially anxious?

May 9, 2022 by BHP Leave a Comment

Loneliness and CBT

People feel lonely for a wide range of reasons. Loneliness can be linked to mental health difficulties such as depression, anxiety, social anxiety, perfectionism, low self esteem or eating disorders. It can also be linked to autism, loss, difficulties disclosing, early adulthood, elderly. This is not an exhaustive list but illustrates how many factors can be linked to the problem of loneliness.

Loneliness is the perceived discrepancy between what we want and what we’ve got, a mismatch between actual and desired social situation, a lack of meaningful relationships. Social isolation doesn’t have to equal loneliness. We can be alone without feeling lonely.

Triggers to feeling lonely can be internal psychological factors, such as attitudes to participating in social interaction / having a negative interpersonal appraisal, e.g. other people don’t like me; or external factors, such as bereavement or living far away from friends and family. These factors evoke an emotional response such as anxiety or sadness
and can lead to counter productive behaviour such as avoidance and a decrease in valued social contact or unhelpful cognitive processes in the social domain, e.g. self focused attention or hypervigilance to rejection. This then impacts on our perception and our interpretation of our relationships / social situations and can inadvertently become a
perpetuating cycle of loneliness.

Social media also has a big impact on loneliness, particularly in early adulthood. People share and post what they want us to see and we can end up comparing ourselves to others. The pandemic too has had an impact on loneliness. Spending less time with friends and family, self isolating and shielding are all contributory factors to feeling lonely. If we struggle with technology this too may play a part.

So how do we change things? In CBT we look at four domains: the individual, their relationships, social relations and the community. In terms of strategies behavioural activation is key with a focus on increasing the amount of social interaction, social contact and social networks. We can explore values and once we have identified these set goals to
help meet where the person wants to be in their values. We can introduce and identify unhelpful thought patterns and beliefs, and learn techniques to restructure these. We can learn strategies to reduce rumination and use behavioural experiments to make changes and gather information, e.g. finding out what happens if you do disclose and share with others. Additionally whilst engaging in behavioural activation we can practise exposure
whilst reducing safety behaviours.

Everyone is different and because loneliness can be for many different reasons there is no one size fits all. Other strategies may also be used, such as social skills and communication training, mindfulness, mapping social opportunities, emotional awareness and psycho-education.

To address loneliness in older adults Age UK and the befriending service, such as Silverline, can be a great resource. Age UK offer all sorts such as social activities, lunch clubs, IT Training, transport, day centres. Younger adults may benefit from Meet Up groups, Young Minds or The Mix.

Reaching out, connecting with others and using the supports that are available to us are fundamental in combatting loneliness. Remember we all feel lonely at times in our lives.

To enquire about psychotherapy sessions with Rebecca Mead, please contact her here, or to view our full clinical team, please click here.

Further reading by Rebecca Mead –

As we come out of lockdown, will a number of us be feeling socially anxious?

December 20, 2021 by BHP Leave a Comment

Enhancing the Positive Self

Why is it that we find it so difficult to identify the positives in ourselves and so easy to see the negatives?

As human beings we seem to be programmed to be able to identify our failings, e.g. what we’re no good at, what we haven’t done or what didn’t go well. Or it might be that you can’t stop thinking about the one negative comment that was made about something you did at work or the one criticism that you received amongst all the compliments. It maybe that you find it really difficult to accept compliments, that you dismiss them, play them down or bat them back instead of fully accepting them.

We can have a bias to notice our faults rather than our qualities. This can stem from being taught in our early experiences to focus on our mistakes and wrong doings and being told as a child to do better.

We may also have encountered disapproval or ridicule if we have shown appreciation of our own successes. Consequently we may have stopped valuing our achievements and come to believe that anything we do well is luck.
We can find it difficult to think well of ourselves. To think well of ourselves or to say positive statements about ourselves can feel uncomfortable, risky or just wrong. This may stem from being told to not be big headed, to not boast or blow your own trumpet and not to get to big for your boots.

Thinking negatively of ourselves can lead to low self esteem, depression and anxiety. If we hold negative beliefs about ourselves we tend to screen for evidence from our experience that these beliefs are true. This leads to negative thoughts, in particular self critical thoughts or anxious predictions, which then corroborates and strengthens the belief.

To change this negative view of ourselves we need to focus more on all the positive aspects of ourselves. A useful exercise to shift your focus to a more positive view of yourself is to write a list of all the positive aspects of yourself, to consider all your achievements, skills, qualities, strengths, and good characteristics of yourself.

We rarely pay attention to all the positive things we do, our qualities, positive outcomes or positive comments from others. The fact that we don’t do this can make this a challenging exercise to do. It maybe that you only come up with a few to start with and that’s ok. It doesn’t mean that you don’t have any qualities or strengths, it means you are out of the habit of noticing them.

It can be useful to ask for the help of a close friend or family member, someone you know who would be supportive and may have a different perspective of you than you do of yourself. Be aware you may still get into negative self evaluations or discount the positives as being small or not significant. You wouldn’t do this with the negatives so don’t with the positives! Also remember you don’t have to do these positive things 100% of the time, that wouldn’t be possible.

To build on this it can be useful to keep a positive data log in which you recognise examples of your positive attributes on a daily basis, i.e. at the end of each day write down examples from your day that illustrate certain positive qualities you have. For example: listened to a work colleague – considerate and a good listener, did the hoovering – being house proud, played with the children – fun to be with. By keeping a daily record you will not only be acknowledging your positive qualities as things you did in the past, but also acknowledging them as things you do everyday.

Increasing your awareness of your positive qualities on a regular basis can have a positive impact on how you feel about yourself. It can help you to view yourself more kindly, to appreciate and value yourself. This in turn can help to improve self esteem and self worth.

Melanie Fennell (2009) writes on Overcoming Low Self Esteem and suggests the following questions to help in identifying your good points:

What do you like about yourself, however small and fleeting?
What characteristics do you have that are positive?
What are some of your achievements, however small?
What are some challenges you have overcome?
What are some skills or talents that you have, however modest?
What do others say they like about you?
What are some attributes you like in others that you also share?
What aspects of yourself would you appreciate if they were aspects of another person?
How might someone who cares about you describe you?
What bad qualities do I not have?

To enquire about psychotherapy sessions with Rebecca Mead, please contact her here, or to view our full clinical team, please click here.

Further reading by Rebecca Mead –

As we come out of lockdown, will a number of us be feeling socially anxious?

As we come out of lockdown, will a number of us be feeling socially anxious?

August 23, 2021 by BHP Leave a Comment

Is that a fact or an opinion?

Now we are all starting to go out more and socialise again, I wanted to acknowledge how we can all experience anxious or self critical thoughts.

I have noticed, when meeting up with various girlfriends recently, how we’ve all shared thoughts of feeling slightly anxious about how others are perceiving us. Due to the various lockdowns over the last year and a half, we’ve been working from home, not exercising as much and possibly eating and drinking more, and for some of us, this has resulted in a slight change in appearance. Perhaps we’ve put on weight, are not as toned as we once were or are not looking so primped and preened as we used to. Various friends have shared some form of self criticism about their appearance. One friend referred to this as her ‘lockdown arse’. Another friend said she couldn’t possibly come out socially until she’d had her hair done and lost a few pounds. It occurred to me how we can all be self conscious and bothered by what others are thinking of us when we’ve not seen them for a while.

It’s normal.

We worry about what we think we should look like and worry that our friends will make judgements or look at us in a negative light if we are not the same shape/size as we were when they last saw us. Our internal dialogues are often talking to us in a critical way. We forget that we are acceptable to our friends however we are because it’s our friendship that is valued. Others want to see us for who we are and because we’re their friend not for what we look like.

If it wasn’t appearance that was being fretted about it was not having anything to say. Again because of lockdown and not being able to do much, friends would worry about not having anything to talk about, being dull and boring and having nothing interesting to say. Forgetting that we have all been in the same boat.

When these worry or self critical thoughts creep in they can have a profound effect on how we are feeling. They can make us feel anxious, low and even depressed. Our thoughts are very influential over our emotions and our behaviours. They can prevent us from doing what we’d really like to do. Thoughts not only affect our moods and behaviours but can affect our self esteem and our self worth. Yet when you unpick thoughts they are often not facts, they are our opinions. Thoughts can feel believable, real and true, yet really they are just a string of words. Our thoughts can be quite bullying, they can tell us that we’re not good enough, that we should be this or that, they come thick and fast and once you get on the negative spiral it can be quite difficult to get off. They are instantaneous and we often don’t question them. Our thoughts are our internal dialogue and can be very harsh and self critical. We wouldn’t talk to others as we do ourselves. So why is that ok?

When I’m aware I’m starting to get into worry thoughts about what others might think I find it quite useful to ask myself is that a fact or an opinion? Often I’m making an assumption or mind reading. If this is the case it can be helpful to ask yourself if there’s another way of looking at this? What would my best friend say to me in this scenario? Or what advice would I give to someone else? And would this matter in 6 months time? These sorts of questions can help us to gain an alternative perspective, to a more balanced way of thinking, that is kinder and more realistic.

These questions are some of the prompts on a CBT technique called a STOPP record.*

So the next time you are worrying about going out with your friends because you may look a little different or not have much to say try challenging those thoughts, ask yourself is that a fact or an opinion? Remind yourself that we can all have unhelpful thoughts at times, its normal.

(* The STOPP record technique can be found here: https://www.getselfhelp.co.uk/docs/STOPP5.pdf)

To enquire about psychotherapy sessions with Rebecca Mead, please contact her here, or to view our full clinical team, please click here.

Further ready by Rebecca Mead –

April 19, 2021 by BHP Leave a Comment

As we come out of lockdown, will a number of us be feeling socially anxious?

For the past year we have largely been confined to our homes, a lot of us working from home and only going out for regular exercise. Our social lives have been depleted, we’ve not been able to see friends and family and generally life may have become quite repetitive.

As we come out of lockdown there will be mixed feelings, some people may feel really ready to socialise again and are already filling their calendars with get togethers and events. For others, they might be more cautious and be worried about feeling anxious in group settings.

Perhaps you’ve always found social gatherings difficult and so the lockdowns gave you permission to not have to socialise. By having to keep ourselves to ourselves anxiety has not been triggered or challenged and so confidence in social settings may have reduced. The prospect of now going into situations where there are more than two people may feel quite daunting.

Because we’ve not had much going on in our lives we may start to worry that we have nothing to talk about. Or perhaps our appearance has changed a little, we’ve put on some weight, or we’re not as toned as we were or our hair is more grey than it was, and so we are worried we will not look physically good enough. Or perhaps we are worried whether our friends will still want to see us after all this time.

These are normal thoughts that we may experience but they aren’t helpful and we may have to work at keeping them in check. It’s worth reminding ourselves that thoughts are not facts and whilst we may have these thoughts about ourselves it doesn’t mean that others are having these thoughts about us.

We’ve all been socially deprived over the last year and when you haven’t done something for a while it can feel uncomfortable going back into it, its normal to feel some level of anxiety. Just as the more we avoid something the harder it becomes to do. Be kind to yourself, don’t expect yourself to be able to go straight into large social gatherings. It’s better to return to socialising in a graded way. If it feels too big it’s ok to say you’re not ready.

When we are feeling socially anxious we can start to worry about how we come across to others and feel like we’re in the spotlight. The more we focus on ourselves the more self conscious we can become and the more this happens the more we end up in our own head. The more we start to judge ourselves and the more difficult it becomes to interact with others. We can’t be concentrating on what is going on around us or what others are saying if we’re so busy in our heads judging ourselves. Try shifting your focus onto others, paying attention to what’s being said rather than your internal dialogue. By shifting your focus of attention outwards to others, from internal to external, you can keep more relaxed.

A common fear to have when socially anxious is thinking you should be interesting all of the time. How realistic is this? particularly given that none of us have had very interesting lives recently. Take the pressure off yourself to perform, it’s about being with others, not entertaining others. Share how bored you’ve been, I’m sure others will have been to. Try to reduce those high expectations of yourself.

Another fear is to think that others can see your anxiety however the research tells us that this is not the case. What feels magnified and obvious to you, such as shaking or sweating, isn’t visible to others.

It is also unhelpful to prepare things to talk about as this again puts pressure on yourself to perform and maintains self focus. If you’re so busy thinking about the list of things you’ve prepared you’re not going with the flow of conversation, you become more self focused and can appear uninterested in what’s being said or aloof.

Lastly don’t allow yourself to replay or dwell on what you said or did later. No one else will be giving a second thought to what you’ve said or done, they will have moved onto the next thing in their day. You’re the only one analysing yourself and giving yourself a hard time.

Remember social interactions are a two way street, it’s not all your responsibility. The more we can focus on the social event rather than ourselves the more we are likely to enjoy the social interaction.

To enquire about psychotherapy sessions with Rebecca Mead, please contact her here, or to view our full clinical team, please click here.

Further reading by Rebecca Mead –

February 1, 2021 by BHP Leave a Comment

New Year’s Resolutions

In my last blog I wrote about goals for change and linking these to our values. When someone decides to come into therapy it is often because they would like to make changes and it can help to set goals as a means of knowing when these changes have been achieved.

Given this is a time of year when we might have made New Year’s Resolutions it seems quite fitting to talk a little more about setting ourselves goals for change. It is often the case that at the start of the year we have all these wonderful ideas of what we want to achieve and we start off really motivated with all good intentions and then several months in we start to lose heart and give up.

A common goal at this time of year is dry January and this can quite often be successful because its time limited. We know that after a month we can return to our favourite tipple. However, for some this is difficult, particularly in the current situation with the stressors of Covid. Complete abstinence can be too challenging as its very all or nothing. It might be more helpful to consider cutting down and reducing frequency, e.g. limit to just one drink once or twice a week. In this way we can make the goal more achievable. Making our goals for change realistic and time limited is really important for achievement.

Another common goal for this time of year is to get fit and start exercising. To start with when we are motivated it goes well. It’s the trying to keep it up that’s difficult. Part of the battle is finding what exercise you enjoy. There’s no point pushing yourself to do something you don’t like. Often when people think of exercise they think they have to do something cardio related. However, there are lots of low impact workouts that are good forms of exercise, such as walking, yoga and pilates. Whatever choice you make its important to start small and build up. It’s the achievement that helps to maintain the motivation. So the first week or two you might aim to exercise for 20 minutes twice a week and then the third week, 3 times per week. Once you have comfortably achieved the first goal you set another, building on the first to push yourself that little bit further. All the time holding in mind where you want to be and this is where it can be useful to link goals to your values. In this example its values around physical well being and of course exercise is also great for our mental health.

Losing weight or eating healthier is another very common goal for people to set themselves at this time of year. And again is another that can be difficult to maintain. So rather than push yourself to go on a really restrictive diet or to cut out entire food groups consider aiming for a ‘better’ diet. Try reducing unhealthy food groups, reducing treats, and swapping to more healthy options. It can be more helpful to aim to eat healthily for 75% of the time or to eat healthily in the week and let yourself indulge a little at weekends. Again, it’s about trying to set more realistic goals for yourself. For example if your norm is to eat half a packet of biscuits with your cup of tea to allow yourself just 2 biscuits rather than going for complete abstinence.

Thinking about setting the right goals is really important and if you don’t achieve them, that’s o.k. There’s no such thing as a failed goal. If you don’t achieve your goal then there is still useful information – ask yourself why wasn’t I able to achieve this? What got in the way? What is the learning from this? What can I do differently next time? Are there any supports available to me to assist in this? Often we don’t achieve our goals because they are too big and need to be broken down further.

None of this is rocket science but we all to easily forget the basics. We can impose high expectations on ourselves and then become disheartened when we don’t achieve them. Our self critical voice kicks in and this can have a negative impact on our mood. Given the difficulties we are all facing currently its even more important to be kind to ourselves and realistic of what we can and can’t achieve.

To enquire about psychotherapy sessions with Rebecca Mead, please contact her here, or to view our full clinical team, please click here.

Further reading by Rebecca Mead –

Face to Face and Online Therapy Help Available Now

December 7, 2020 by BHP Leave a Comment

Making Changes

As well as working privately, I work within an NHS IAPT Service providing psychological therapy for depression and anxiety disorders and when a client comes into therapy, one of the first things we discuss is goals for treatment.

What is it the client is hoping to change by the end of treatment? Is there anything that the client is not able do now, because of their difficulties, that they would like to be doing in the next couple of months?

Goals help to focus the therapy. It’s quite common that the client will say they would like to increase their confidence or to improve their self esteem, to be less anxious or to be happy. These are very broad goals, would be difficult to measure and don’t tell us what the client would actually be doing differently if they were to be confident, have better self esteem, be less anxious or be happier. So we work together to work out what this might look like.

One way to help determine goals for change is to think of our values. When considering values we need to think about what is really important to us, what gives our life meaning and purpose. Values are what we care about and are different for everybody. They can change over time depending on where we are in our life. Meaningful activity is value driven. Values are fluid and don’t have an end point, they are how we want to live our lives, they help us to be the person we want to be.

We hold values in different areas of our life: intimate relationships / marriage / being a couple; family relations; friendships & social relationships; parenting; career / employment; physical wellbeing / healthy living; connecting with the community; spirituality; education / training / personal growth; mental wellbeing.

It can be useful to consider what values you hold in each of these areas and rate how important each domain is to you and where you are in achieving that domain. For example what kind of values do you hold in physical wellbeing? How do you want to look after yourself physically? Is it to take regular exercise, eat healthily, get enough sleep and rest? Are you achieving this as much as you would like to be? What sort of friend do you want to be and how would you like to act towards your friends? For example, loyal, trustworthy, to spend time with friends, to share, to listen, to have fun together. What kind of values might you want to model as a parent? For example, to be curios, have courage, be adventurous, have determination, gratitude kindness and have fun (to name but a few). Values can be described as compass directions in which we live our life.

If you feel that you are not where you would like to be within a particular domain, how can you bring this value further into your life? This is where goal setting comes in. Values are a direction we want to progress in. Goals can be set to help us achieve that direction. For example, if we place value upon exercise and physical health we might have the goal of going for a swim twice a week or we might have a goal of completing a qualification, which sits within the value of education and personal growth. Goals can be achieved and have an end point. You maybe familiar with the acronym SMART goals. This means goals are specific, measurable, achievable, realistic and time limited. So if we wanted to make the goal of ‘going for a swim twice a week’ into a really SMART goal we could add a set time period, i.e. ‘going for a swim twice a week for half an hour’. By setting SMART goals we break down the areas of change into manageable chunks.

Change is difficult and if we are feeling low or stressed and anxious we can often feel overwhelmed. It is likely that areas of our life that are important to us have become affected and we don’t know where to start to change this.

Setting ourselves small goals for change in line with our values is a useful starting place. It’s important to remember that there is no such thing as a failed goal. If we don’t achieve our goal it still give us useful information. Perhaps we set ourselves an unrealistic goal, in which case we might consider how we can break this down further into smaller, more manageable chunks. We can explore the process along the way whilst trying to achieve our goals and moving towards our values. In this way change takes place and has a positive impact on our mental wellbeing.

To enquire about psychotherapy sessions with Rebecca Mead, please contact her here, or to view our full clinical team, please click here.

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November 9, 2020 by BHP Leave a Comment

Social Connections

“Social connection can lower anxiety and depression, help us regulate our emotions, lead to higher self-esteem and empathy, and actually improve our immune systems. By neglecting our need to connect, we put our health at risk.”
JS House, KR Landis, D Umberson (2019)

Social connection can be difficult to do right now as we find ourselves amidst the Covid-19 Pandemic. We have been told we must socially distance, limit our social connection with others to no more than 6 people at any one time and stay in our established support bubbles. We are now told that we are at risk of a ‘second wave’ and socially connecting can seem even more frightening and confusing.

As we continue to live amidst global uncertainty, we may have found our social connections inadvertently diminishing.

So how do we stay socially connected to maintain our mental wellbeing?

Rather than discussing the various means which we are now using to stay connected, such as Zoom, Facebook, What’s App, etc, I would like to explore how we might identify the people in our lives that can help support us through these difficult times. It is very easy to get caught up in our daily lives, trying to get a balance between work, children, school, hobbies, self-care and more. All too easy our social connections fall by the way side and this can have a detrimental impact to our wellbeing.

I would like to draw upon the Interpersonal Psychotherapy (IPT) approach to help explore this. IPT is based on the premise that there is a relationship between the way people interact with others and their psychological symptoms. The focus of IPT is to improve the quality of a person’s interpersonal relationships and social functioning to help reduce distress. Part of the process in doing this is to identify a person’s interpersonal inventory. This is an exploration of the relationships in a person’s life and identifying ways in which these relationships can contribute to a person’s recovery from emotional distress.

What can be useful in the first instance is to consider all your relationships in your life, in particular those that make you feel better. It’s important to remember no relationship is perfect and no one person can meet all your needs so try to be as inclusive as possible. It is also helpful to consider what support is available to you? When we consider support it is not just emotional support that is important, it can also be social, motivational, practical, educational and even financial. Finally, how available are these relationships to you? This doesn’t have to physically be in person. Not everyone is available all of the time and it can be helpful to identify when different people are likely to be available, e.g. in the evenings or at weekends.

Identifying all the people in your life enables you to have an overview of your relationship world – the overall itself might tell you something important, e.g. that you have few people in your life but they are all very close to you and provide a lot of support.

You can draw a diagram of all the people in your life using concentric circles this allows you to show how close you feel to each person (don’t forget to write yourself in the middle). The most immediate circle to yourself would include those that you are closest to – this would typically be the people that you spend most time with and that are emotionally involved with. Just because these are your closest relationships doesn’t mean they are perfect but they are likely to be your most significant.

Try to ensure that you include everyone, i.e. those that you see in your daily lives, family, children, friends, work colleagues, neighbours, those that you don’t see very often but still regard as friends, those that you may share interests or hobbies with, children’s school friend’s parents, your extended family, even pets.

This exercise enables you to identify who is in your life and how close you feel to them, to consider the support those in your life provide and to consider how available they are or when they would be available.

By having a visual reminder of who we have in our lives we can begin to work at reaching out to our social network – Who haven’t we been in contact with for a while? Who can we pick up the phone to or go for a walk with? Who can we arrange a Zoom meet up with or create a What’s App chat with? We might need to set ourselves weekly goals to pick up that phone or send a message to stay connected, or to reach out for support in these difficult times. Just having a chat with someone can have a positive impact on how we are feeling or being in someone else’s company.

It’s important to remember we are not alone and by reaching out to others for support we will also be helping others to feel more connected and supported. Staying connected is fundamental in maintaining our mental wellbeing now more than ever.

(Reference: Chapter 9, Your Interpersonal Inventory – Rosalyn Law, Defeating Depression.)

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April 6, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Back to ‘BACE’ics

Work life balance is fundamental to our mental wellbeing and can easily become out of sync without us even realising it, particularly when we are feeling stressed. This imbalance can lead to depression and anxiety. Going back to basics and keeping an activity diary for a week or two can provide us with useful information. Broadly speaking we are interested in 4 different areas:

1/ Bodily Self Care – this would include how we look after our physical body, i.e. exercise, nutrition, rest and sleep, self-grooming, medication, etc.

2/ Achievement – this would include work, study, housework, any tasks / activities that gives us a sense of having achieved something.

3/ Connecting with others – this can be family, friends, work colleagues – in person, over the telephone or social media. It can simply be being in an environment where there are others as long as we feel connected. It can also include connecting with animals. Our pets can be very therapeutic.

4/ Enjoyment – hobbies, interests, fun activities, relaxing activities – anything that gives us a sense of pleasure

Each day categorise how you are spending your time into each of the areas. Sometimes one activity may fulfil more than one category, e.g. walking the dog can be exercise so would meet bodily self care, it could also be an achievement if you really didn’t feel like going, it could be connecting with others as you may have met other dog walkers, and you may have enjoyed it.

By monitoring our activity according to these categories we can gather information and gain a sense of where there are gaps, where we might need to make some changes in our lives.

In my work as a CBT therapist I see all too easily how we can forget to enjoy ourselves. We can get so caught up with work and what we think we should be doing we can lose sight of enjoyment and connecting with others. Or we may have crammed so much into our day that we have no time to stop and just be. Activity monitoring can be a useful tool for anyone who wants to take stock and see whether they are tending to their mental wellbeing. To help us do this we can use a form called BACE (https://www.get.gg/docs/BACEdiary-weekly.pdf) which is a daily activity monitoring form. You will notice that the word BACE is an acronym for the four areas.

Once we have gathered information and highlighted the areas that need to be addressed we can use the same form as a daily planner to set ourselves small goals to address the gaps.

Sometimes the simplest strategies are the most helpful.

Further reading by Rebecca Mead –

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December 16, 2019 by Brighton & Hove Psychotherapy Leave a Comment

Interpersonal Therapy (IPT) Explained

When we are feeling depressed it is common to withdraw from those that we are close to, to shut ourselves away, turn down social invitations and generally pull away from friends and family. By doing this we are refusing the help and support of others, possibly because we feel bad about ourselves or that we have failed in some way, or that we will burden others. Friends and family may feel hurt and rejected by our withdrawal, they may not understand and feel that they are being shut out consequently may start to pull away from us. We may then interpret this behaviour as confirmation of our view of ourselves as ‘a burden’ or ‘a failure’ consequently perpetuating, and even increasing, our symptoms of depression. Thus a vicious cycle is inadvertently created.

This example illustrates the fundamental concept of IPT – that depression can be understood as a response to current difficulties in relationships and in turn depression can affect our relationships. If a focus on your current relationships makes sense to you then IPT could be the therapy approach for you.

IPT is time limited, usually between 12 and 16 sessions, its structured and is recommended in the NICE Guidelines (National Institute for Health and Care Excellence). NICE is like the NHS Bible and recommended treatments are well researched and evidence based.

The main focus of treatment is on relationship difficulties and on helping you to identify how you are feeling and behaving in your relationships. IPT typically focuses on the following relationship problems:

Conflict within relationships – this can often be difficulties within a significant relationship where the relationship has become ‘stuck’ in arguments or disagreements and has become a cause of stress and is having a significant impact on mood.
Change in circumstances such as redundancy, breakup of relationship or other life event that has affected how you feel about yourself. This can include happy changes such as becoming a parent or moving. However significant change can be difficult to adjust to and have an impact on how we feel about ourselves and others.
Bereavement – it is natural to grieve for the loss of a loved one however sometimes we don’t seem to be healing from the loss. We can continue to struggle to adjust to life without that loved person.
Isolation – Difficulties in forming and maintaining relationships – this can be due to not feeling close to others or not having many people around. Not having company or support of others can be stressful and leave us feeling very alone.

During the first few sessions of therapy we will gather information about your difficulty, create a time line of your symptoms and discuss current and past relationships in your life. Once we have gained a good understanding of the problem and the connected relationship difficulties we will collaboratively agree on which of the 4 areas therapy will focus on.

The benefits that IPT can bring include: Improvement in relationships, including relating to others and communication, learning to cope with emotions and life changes, problem solving, processing loss and grief, and overall an improvement in mood and psychological distress.

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