Brighton and Hove Psychotherapy

01273 921 355
Online therapy In the press

by Leave a Comment

Understanding exercise addiction

In a previous blog we discussed the links between exercise and mental health and how exercise can be hugely important for raising and maintaining our mood. In this blog, we will discuss how the healthy habit of exercise can sometimes become addictive, and can actually harm both our physical and mental health.

When healthy habits turn harmful

For most people, exercise is a beneficial part of life. It boosts mood, enhances cardiovascular health, and offers a constructive way to manage stress. However, when the pursuit of fitness becomes obsessive, it can lead to exercise addiction. This condition is characterised by a compulsive need to work out, even in the face of injury, illness, or social isolation. Exercise ceases to be a pleasurable activity and becomes a ritualistic behaviour performed out of anxiety or guilt.

Often, exercise addiction emerges in tandem with body image issues. Many people who develop an unhealthy relationship with exercise are also preoccupied with how their body looks, which can overlap with symptoms of eating disorders. These eating disorders—such as anorexia nervosa, bulimia nervosa, or binge eating disorder—are complex mental health conditions where food intake and self-image become interwoven with one’s emotional state.

The psychological roots of compulsive exercise

At its core, exercise addiction is often about more than just physical fitness. It may represent an attempt to gain control over other areas of life that feel unpredictable or overwhelming. For some, the gym or running track becomes a sanctuary, a place where effort translates directly into visible progress. The immediate gratification of sweating out stress can mask deeper emotional pain or unresolved trauma. Over time, this behaviour can become a maladaptive coping mechanism—a substitute for addressing the underlying issues.

Often people can initially view their commitment to exercise as a form of self-care, only to later recognise that their routines are fuelled by deeper emotional distress. They may feel compelled to maintain rigorous exercise schedules to compensate for feelings of inadequacy or to assert control in an otherwise chaotic world. This psychological dependency can lead to a cycle where the body is pushed beyond its natural limits, resulting in physical injuries, chronic fatigue, or even immune system suppression.

It is also worth pointing out that a highly competitive sports person might also display characteristics of exercise addiction. There often needs to be a level of discipline and obsession in the sports to get to the championship winning level. So, understanding if the level of exercise and the obsession with the sport is healthy or not can be a difficult balance.

Intersecting pathways: exercise addiction and eating disorders

The connection between exercise addiction and eating disorders is profound. Often, the excessive drive to work out is linked with a distorted body image and a harsh inner critic. For instance, those who suffer from anorexia may engage in relentless physical activity as a way to further lose weight, believing that burning more calories will bring them closer to an ideal self-image. Similarly, those with bulimia might use exercise as a means to counterbalance episodes of binge eating. Also, an eating disorder can morph into exercise addiction – so food is no longer restricted, but exercise entirely replaces the need to restrict.

Both exercise addiction and eating disorders share a common trait: the relentless pursuit of perfection. This obsession can trap individuals in a vicious cycle where progress is measured by self-imposed, often unrealistic standards. The result is a continuous loop of reward and punishment, where every workout or meal becomes a test of one’s worth. Recognising this interconnectedness is crucial, as treatment must address both the behavioural components and the underlying emotional triggers.

Paths toward recovery

Recovery from exercise addiction and eating disorders involves a holistic approach. Cognitive behavioural therapy (CBT), mindfulness practices, and support groups can play pivotal roles in helping individuals regain balance. Also, creating a more compassionate relationship with yourself can be a key component in overcoming exercise addiction. This involves challenging the notion that self-worth is solely determined by physical appearance or performance in the gym or sports field.

An important part of the healing journey is understanding that recovery does not mean abandoning exercise altogether. Instead, it’s about reclaiming exercise as a healthy, enjoyable activity rather than an obligatory chore. Professional guidance from both a personal trainer and a psychotherapist can help reframe exercise habits, ensuring that they serve as a tool for wellbeing rather than a source of self-punishment.

While exercise is an essential aspect of a healthy lifestyle, it’s important to remain mindful of its potential to become addictive. When combined with factors like body image issues and eating disorders, the consequences can be both physically and emotionally damaging. Seeking psychotherapy can be an important step forward to acknowledging and tackling exercise addiction.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person-Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available at our Lewes clinic and also works online.

 

Further reading by Dr Simon Cassar –

Can Buddhist thinking help with our emotions?

Exercise and mental health

Are you too sensitive?

Is spirituality an escape from reality?

Sleep and mental health

by Leave a Comment

Can Buddhist thinking help with our emotions?

There has been a growing interest in Buddhist thinking over many years, which is perhaps influenced by the popular practice of mindfulness to help with anxiety and many other emotional issues. Often people will come to psychotherapy and use the technique of mindfulness as part of their therapeutic journey. Some then become curious about the underlying philosophy that is behind the practice of mindfulness. Others are interested in exploring their spiritual side and Buddhism can be one approach that can resonate well with many people in the modern world. In this blog we will take a brief look at some of the ideas of Buddhism and consider how they might help with emotional issues and help us find inner peace.

Understanding our suffering

Right at the heart of Buddhist philosophy lies the concept of ‘dukkha’, which is often translated as suffering or dissatisfaction. Buddhism teaches that suffering is an inherent part of life, stemming from our attachment to things we desire, aversion to things we don’t like, and the impermanence of everything around us. While this might sound bleak, recognising that suffering is an inherent part of life can be empowering. It can help us to shift our perspective, and see that emotional pain is not a personal failing but a shared human experience. This insight can reduce feelings of isolation and self-blame, which are often at the core of emotional distress. Additionally, the Buddhist path is a developmental path which is aimed at leading us out of everyday suffering.

Mindfulness as a way of life

One of Buddhism’s most widely recognised contributions to mental health is mindfulness. This practice involves bringing our full attention to the present moment with curiosity and without judgement. When faced with difficult emotions, our instinct is often to suppress or ignore these feelings or react impulsively to try to get away from the painful feelings. Mindfulness offers an alternative: to observe our emotions with compassion and acceptance. By doing so, we create a space between ourselves and our feelings, reducing their power to overwhelm us.

For instance, when anxiety arises, instead of becoming consumed by it, mindfulness allows us to notice the physical sensations, thoughts, and behaviours associated with it. We might observe a racing heart, a tightening chest, or a stream of worry-filled thoughts. This act of observation can diminish the intensity of the emotion and prevent it from spiralling out of control, because if we are able to observe these feelings, then we are not fully immersed in them. To do this takes a lot of practice, which is why mindfulness needs to be a way of life and not just a discrete meditation practice. Being mindful when performing daily tasks can keep us in the present moment and takes us away from ruminating or unhelpful thoughts.

The practice of non-attachment

Another key aspect of Buddhist thinking is the idea of non-attachment. It is important to state here that non-attachment doesn’t mean detachment or indifference, but rather a balanced relationship with our emotions and experiences. Emotional suffering often arises when we cling too tightly to pleasurable experiences or resist unpleasant ones. By practising non-attachment, we learn to let emotions come and go without becoming overly caught up in them.

Compassion

Buddhism places a strong emphasis on compassion, both towards others and oneself. Some of our emotional struggles come with harsh self-criticism, which only exacerbates inner pain. Practising self-compassion involves treating ourselves with the same kindness and understanding we would offer a dear friend. This might include acknowledging our pain without judgement, and offering ourselves words of comfort and encouragement. Learning how to be kind to ourselves, and soothe our inner pain reduces our suffering and allows us to be more compassionate to others.

The impermanence of emotions

Buddhist philosophy also highlights the impermanence of all things, including emotions. When we’re in the grip of a difficult feeling, it can seem as though it will last forever. However, recognising that emotions are like waves—rising, cresting, and eventually subsiding—can provide hope and perspective. This understanding encourages us to ride out emotional storms, knowing they are temporary. Keeping in mind that all of our emotions will pass helps us with non attachment, and also to be more of an observer as we learn from our mindfulness practice.

Integration into everyday life

Buddhism can be seen as a religion or as a philosophy, and for some this becomes their new belief system that informs their way of being in the world. It can be a path to spiritual development and finding meaning in life. However, you don’t need to adopt Buddhism to that degree if that isn’t for you. You can work with some Buddhist practices like mindfulness meditation, journaling about impermanence, or reciting compassionate affirmations and this can make a profound difference. These tools help cultivate a deeper awareness of our inner world, enabling us to respond to emotional challenges with greater clarity and equanimity.

Incorporating some or all of these ideas into our daily life can help us to regulate our emotions, have a kinder and more compassionate view of ourselves and the world, and bring about inner peace. Combined with psychotherapy, Buddhist thinking and practices can help us find fulfilment and meaning in life and can be a key part of our healing journey.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person-Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

 

Further reading by Dr Simon Cassar –

Exercise and mental health

Are you too sensitive?

Is spirituality an escape from reality?

Sleep and mental health

Spirituality and mental health

by 1 Comment

Exercise and mental health

We have all heard it: exercise is good for you. Exercise can help combat or improve symptoms of a wide range of health conditions from high blood pressure, cardiovascular conditions, diabetes, some cancers, depression and anxiety to name but a few. It can help prevent some of these conditions in the first place, promoting bone density as we get older, supporting weight control, lowering blood pressure etc. 

But it is a big word, exercise. What does it mean? And what are the benefits to our mental health?

At its most basic, exercise is engaging in any physical activity that involves movement and increasing the heart rate beyond sedentary or resting levels. The World Health Organization for example suggests that for physical activity to become exercise we must add repetitions and a goal. We may have heard of the number of steps that we ‘should’ do daily, or how much exercise per week we should strive for. This may be presented in minutes or indeed intensity minutes. The definition changes fairly dramatically depending on where one reads and who the target audience is, which can be confusing. 

What these generic measures can do is prompt us to increase our level of activity and improve our overall fitness – within the bounds of our physical body. Setting a realistic activity goal can be a great way of starting out, whether it is 3000 or 10,000 steps. As always, if you are thinking of significantly increasing your level of exercise, or starting out on your exercise journey, it is best to consult a medical practitioner first.

Apart from fitness and physical wellness, some of the neurobiological benefits experienced as we increase the amount and intensity of exercise, can significantly impact our mental health. 

The most well-known one is the release of hormones called endorphins when we are engaged in intense exercise. We may experience a euphoric feeling and a sense of happiness that can last for hours after exercise, sometimes called ‘runner’s high’ although it may be experienced with any intense exercise. Endorphins also act as a natural painkiller, reducing our perception of pain. 

Exercise can also boost the production of neurotransmitters such as serotonin and dopamine, and these can help balance our mood. There may be a reduction in the release of stress hormones such as cortisol, and added to the physical release of tension in the body, we can experience less stress. 

Although it may seem counterintuitive, exercise has been shown to improve symptoms of fatigue and tiredness, promoting oxygen circulation within our bodies, and giving our cell’s mitochondria the oxygen they need to produce energy. Along with this, we also may see an improvement in concentration and alertness.

Exercise can promote quality sleep which is crucial for mental health. After exercise we can fall asleep faster and sleep deeper, meaning we wake up feeling more energised, well rested and better able to tackle the day ahead. 

The psychosocial benefits of exercise are well documented. A team or group exercise gives social interaction and even community. But even going for a brisk walk on our own can improve our mood as we step out of our usual environment and have a sense of the world beyond ourselves. We can take a moment to notice our breathing and perhaps even be thankful that we are breathing. 

We may notice an increase in our self-esteem and confidence as we take control of our bodies and our routines. Seeing physical changes and improvements through setting and achieving realistic goals can be empowering. As we start to get more in tune with our body, we can feel more ‘embodied’ and rooted in the world and this can help us feel more present, taking us away from our distracted lives.

Stepping away from our normal situation and engaging in exercise can help us bring back perspective that might be lost when we are stuck in an anxious or depressive cycle. Exercise can give a release of the tension that anxiety can cause, and take us away from our anxious thoughts, giving us a healthy distraction from them. In terms of depression, research indicates that, for some people, regular exercise can be as effective in reducing depression as some antidepressant medication.

In our technologically remote-controlled world of convenience, our opportunities to have a physically active lifestyle are reducing. No more do we need to run to the bank on our lunch break, or even leave our chair for a doctor’s appointment. Already twenty-first century employees are more sedentary than ever before. In these times when working from home is becoming more and more prevalent, a person who previously at least had their commute, however tedious or not that may have been, to interact in the world, now may not have reason to leave their home, or even bedroom, for days. For many this will mean that they will not get beneficial physical activity, and the psychosocial losses for mental health should also not be ignored as our external engagement shifts. 

Our bodies and our environment offer a multitude of tools and resources that we can use for our wellbeing, and self-care. When we engage in psychotherapy or counselling, and also add in regular exercise, we are taking a more holistic approach to wellbeing and the combination of both can help us toward a more fulfilled life.

So start where you are and do a little, and then a little more…

 

Dr Simon Cassar is an integrative existential therapist, trained in Person-Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

 

Further reading by Dr Simon Cassar

Are you too sensitive?

Is spirituality an escape from reality?

Sleep and mental health

Spirituality and mental health

Living with borderline personality disorder

by Leave a Comment

Are you too sensitive?

People often come to therapy who are struggling with their emotional sensitivity. Feeling things deeply, they can find living in the world a challenging and sometimes painful experience. The question ‘Am I too sensitive?’ can arise, along with a wish to be less sensitive. But can we be too sensitive?

Emotional sensitivity is a natural part of being human and everyone is sensitive to a certain degree, although the levels of sensitivity can vary from person to person. There are various ways in which sensitivity can manifest, such as feeling deeply about some experiences, being emotionally responsive to certain situations or having a heightened awareness of the emotions of others.

There can be quite a broad spectrum of emotional sensitivity. There are less sensitive people, who might have more subdued emotional responses, be more practical and rational and could be more resilient in challenging situations. Next there are moderately sensitive people who might have more balanced emotional responses, can empathise in a boundaried way and could be more adaptable in emotionally demanding environments. Finally, there are highly sensitive people, who might be the ones who feel they are too sensitive.

Highly sensitive people (a term popularised in the 1990s by Dr Elaine Aron, who has written and researched extensively in this area) have some of these key characteristics:

Deep processing: People who are highly sensitive can tend to process information deeply, and may think about and reflect on experiences more thoroughly than others.

Overstimulation: Due to their heightened sensitivity, they can become easily overwhelmed by too much sensory input or emotional stimuli. Crowds, loud noises, and busy environments can be particularly challenging.

Emotional reactivity and empathy: Due to their high level of sensitivity, they can have strong emotional reactions to both positive and negative events. Also, they can be more empathetic, feeling others emotions deeply.

Sensitivity to subtleties: They are usually more aware of subtleties in their environment, such as slight changes in mood, light, or sound, and they often notice things that others might miss.

Sensitivity to stimuli: This includes being more affected by caffeine, medications, or even pain.

Having this level of sensitivity, when in balance, can be of enormous benefit to the sensitive person. They can have a high degree of empathy, be highly creative and have an incredible attention to detail – seeing things that others are unaware of. The down side, however, is that they can be easily overwhelmed, can be very sensitive to criticism and the intensity of emotions can be difficult to manage.

So what should you do if you feel you are a highly sensitive person and are ‘too sensitive’?

Firstly, make friends with your sensitivity! This can seem counterintuitive, especially when it can seem like your sensitivity cause you a lot of suffering. However, acknowledging and accepting your sensitivity is the first step to getting it into balance. The next steps could be working with some of the following:

Learning how to moderate: Moderating our sensitivity is an important skill to learn. Being able to dial it down in overwhelming and stressful situations is key to not becoming dysregulated with emotions.

Emotional regulation: Similar to moderating sensitivity, is learning how to regulate. With the former we are turning down our sensitivity, with the latter it is about learning how to step back when our sensitivity is becoming overwhelming.

Boundaries: Learning how to set boundaries is very important for highly sensitive people, and having firm boundaries can protect you emotional wellbeing.

Self-care: Highly sensitive people should pay particular attention to self-care, such as regular breaks, enough sleep, good diet, exercise, and having quiet time to recharge.

Mindfulness: Learning mindfulness can not only help us with relaxation and stress management, it can also help us to notice our underlying thought patterns. The more we start to notice them, the more able we are able to step out of them.

Support: Getting support from a therapist who has a good understanding of high sensitivity and how to manage it can be vital, as learning to manage sensitivity takes time and can be challenging.

If you feel you are highly sensitive, then do remember that this a natural and important trait, and once it is in balance it becomes an incredible gift.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person-Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

 

Blogs by Dr Simon Cassar

Is spirituality an escape from reality?

Sleep and mental health

Spirituality and mental health

Living with borderline personality disorder

Online therapy

by Leave a Comment

Spirituality and Mental Health

Spirituality is an often-used term these days, and around 20% of the population in the UK define themselves as spiritual, but not in the religious sense. So what does it mean to be spiritual?

There are many definitions of spirituality but generally we could say that it involves having a sense of something bigger than ourselves – a transcendental view of life where we start to realise that there is more to life that we see around us. This can include a sense that there is a God or creator, an intelligence in the universe, or maybe a deeper wisdom that we all carry. However we conceptualise it, spirituality often leads to a greater sense of purpose and meaning as we start to step back from the everyday world and see a bigger picture playing out before us. Spirituality also includes a sense of connectedness, which might be with others, ourselves or with something more transcendental. This feeling of connectedness can bring us a great deal of peace as we start to realise that perhaps we are not alone in the world. 

Spirituality is different from religion, but is linked to it. Religion is about adhering to a set of doctrines that define each particular faith. Religion will often have a spiritual component – a worldview that has an idea of something greater than us (God, for example) and may also involve a spiritual connection as part of the religious practice. However, you do not need to be religious to be spiritual, and indeed being religious doesn’t need to be spiritual!

So how important is spirituality to our mental health and wellbeing? There has been a lot of research over the past decade that considers this question. The findings show that engaging in spiritual practices have a positive impact on our mental health. Lower levels of depression can be found in those who are actively involved in spiritual communities. Levels of stress and anxiety can be lowered by engaging in spiritual practices, and spirituality can be instrumental in the recovery from trauma. Also, there can be a greater sense of purpose and meaning from having a spiritual perspective, which can have a positive impact on our wellbeing. 

Having a committed spiritual practice – whether it is mediation, prayer, or whatever feels right for you – reading spiritual philosophy and engaging with a spiritual or religious community can be hugely beneficial in improving and maintaining positive mental health. Even if you don’t consider yourself to be spiritual, it is worth spending a few moments thinking about life and the wonders that we see around us. It is easy to see that there is more to life than our own limited worldview and when we step back and consider this, our problems and daily issues can be put into perspective as we gain a more holistic view of life.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

 

Further reading by Dr Simon Cassar –

Living with borderline personality disorder

Online Therapy

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

Online Therapy

We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?

There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.

There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?

Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.

Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.

A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.

Here are a few points you might want to consider if you want to access therapy online:

  • You will need to have a good, stable internet connection for the duration of your session.
  • It is best to have a few connection options available – such as wifi and data, and a couple of different options of apps – such as Skype and Zoom, to allow for tech difficulties.
  • You need to be comfortable working online and familiar with the tech you are using. It’s a good idea to turn off any notifications for the duration of your session as these are very distracting when you are trying to work with your therapist.
  • You need to ensure that the location you are in is private and confidential.
  • You should check the credentials and qualifications of your therapist before you engage in any online therapy. There is a growing number of people setting up online as ‘therapists’ with little or no training. Make sure your therapist is registered with a professional body such as UKCP.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

Living with Borderline Personality Disorder

Borderline Personality Disorder (BPD), also know as Emotionally Unstable Personality Disorder, is a thought to affect between 0.7 and 2% of the general population. While estimates vary, it is considered that the disorder is predominantly diagnosed in women (75%).

So what is BPD? On a generic level, BPD is characterised by having difficulties in how you feel and think about yourself and other people. This can manifest in feeling insecure in relationships and consistently worrying that people will abandon you. This can bring about intense feelings that are very painful and difficult to mange, and they can last anything from a few hours to many days. This can make it hard to make and maintain stable relationships as the intense emotions and abandonment fears can push other people away. People with BPD often don’t have a strong sense of self and will try to change who they are depending on the person they are relating to.

The difficult feelings that are associated with BPD can often lead people to act impulsively, have strong feelings of anger that are hard to control and often self-harming or suicidal feelings. At the most difficult times, they may also experience paranoia or dissociation.

The causes of BPD aren’t clear, but there are some factors that appear with most people that can lead to a diagnosis of BPD. These are environmental factors when growing up, such as feeling unsupported, afraid or upset, with little validation. Family difficulties such as addictions in the parents or any kind of neglect or abuse can also lead to BPD. In additions to these factors, having an inherent emotional sensitivity can also be a factor that can lead to BPD.

So what should you do if you have been diagnosed with BPD? The first thing to consider is whether or not the diagnosis is correct. BPD is a controversial diagnosis as in itself it is hard to diagnose. The disorder shares a lot of commonalities with other personality disorders, and also with other conditions such as depression, bipolar-disorder and PTSD. For some people the diagnosis is a relief as the difficult feelings they experience now start to make sense. For others, having the label of BPD is unhelpful and doesn’t seem to capture their experience. Whatever way you feel about your diagnosis, it is important to get help so you can learn to manage your difficult emotions.

While there are a few treatments available for BPD, the one that is recommended by the NICE guidelines is Dialectical Behaviour Therapy (DBT). In DBT therapy, you will focus on acceptance and change. Accepting yourself is a fundamental part of building a sense of self, and leads the way to making positive changes in how you experience life. You will also start to learn emotional regulation skills so you are not swamped by difficult emotions, but instead learn to accept them and let them go. One of the key tools for this is mindfulness, as this allows you to really see what you are thinking and feeling, and allows you to distance yourself from these thoughts and feelings and stay rooted in the present moment. DBT therapy does take commitment to change, but it can allow you experience life in a more positive and balanced way.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Online Therapy

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

Online Therapy

We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?

There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.

There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?

Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.

Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.

A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.

Here are a few points you might want to consider if you want to access therapy online:

  • You will need to have a good, stable internet connection for the duration of your session.
  • It is best to have a few connection options available – such as wifi and data, and a couple of different options of apps – such as Skype and Zoom, to allow for tech difficulties.
  • You need to be comfortable working online and familiar with the tech you are using. It’s a good idea to turn off any notifications for the duration of your session as these are very distracting when you are trying to work with your therapist.
  • You need to ensure that the location you are in is private and confidential.
  • You should check the credentials and qualifications of your therapist before you engage in any online therapy. There is a growing number of people setting up online as ‘therapists’ with little or no training. Make sure your therapist is registered with a professional body such as UKCP.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

So what exactly is Mindfulness?

The term ‘mindfulness’ is much spoken about these days, especially in relation to mental health and wellbeing. But what does it really mean? Mindfulness generally relates to a meditation practice that has its origins in Buddhism. It is thought that the Buddha was practicing mindfulness when he gained enlightenment, and it is one of the key meditation practices for Buddhists.

However, the practice of mindfulness has been taken by psychologists out of its Buddhist origins and used as a technique to help with gaining better mental health and having a healthier and calmer outlook on life. Mindfulness is often used to help treat anxiety and depression, and is recommended by the NICE guidelines for people with depression to help prevent further depressive episodes.  

How do I practice mindfulness?

To practice mindfulness is really quite simple. You just need to be aware of what is going on in your body, with your thoughts and emotions, and keep your focus trained on a meditative object such as your breath. Find a quiet place to sit, where you won’t be disturbed for a few minutes, close your eyes, and pay attention to your breathing. Notice the air coming in through your nose or your mouth. Notice how it feels, notice how your chest or abdomen rise and fall with each breath. Notice how your body feels different with each in-breath and out-breath. This seemingly simple practice is actually quite hard to do. You will notice that as you try to focus on your breath, your mind will start to wander. You’ll start thinking about things you need to be doing, planning your next activity, or wondering if you are doing it right. Also, you might start to notice feelings coming to the surface. Maybe you will feel anxious, or notice some sadness connected to an event that happened earlier in the day. When thoughts and feelings arise, all you need to do is to notice that they are there. Give them a label “I’m feeling sad” or “I’m planning” then bring your attention back to your breath. Do this gently and kindly. With regular practice, this will become easier, and you will find that your times of practicing mindfulness will become calmer and you will feel more peaceful. Also, you will start to notice how your mind wanders. You’ll notice the patterns of your thoughts and your emotions and you’ll become less entangled  with them. After a while, you’ll start to realise that while you have thoughts and emotions, your are not your thoughts and emotions. They are part of you, but you don’t have to become consumed by them.

 By having a regular practice of mindfulness, you can learn to regulate your emotions, and be able to tolerate more difficult emotions easier. You’ll also have more control over your thoughts and be able to step back from your thoughts when they are leading you to dark places. With time, mindfulness can help you become more compassionate to yourself and the others in your life.

And for how long?

It is often asked how often and for how long we should practice mindfulness meditation. The answer to this really depends on how much you want to commit to your wellbeing. A regular, daily practice is important. So try to practice every day if you can. In terms of duration, start small with about 5 – 10 minutes each day. Then start to work up to longer durations. Most people find that it will take about 20 minutes for the mind to really start to settle, and it is after that you will gain some of the deeper benefits of mindfulness. If you can, set aside 40-60 minutes each day to practice mindfulness. However, as we live in a busy world, setting aside this amount of time can be difficult, so if you can’t spare it, or just don’t want to do so much, stay with a smaller amount and keep your practice regular.

Mindfulness is a very important meditation practice that is accessible to all. The are many free videos and podcasts that will guide you in your practice, and many course available to teach it.

Combining mindfulness with psychotherapy is a very powerful way to understand your inner world and to make significant changes in your way of being in the world.

Simon Cassar is an experienced integrative existential psychotherapist and mindfulness practitioner providing long and short-term psychotherapy to both individuals and couples in Hove and Lewes.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by 1 Comment

Crisis of Meaning

We live in a complex world which, for the most part, seems to demand that we achieve certain things to ‘be someone’ and have a successful and happy life. These ‘certain things’ are the obvious trappings of society – having a good education, getting that well-paid job or rewarding career, finding that perfect relationship, having the right house and the right car, and so on. While these can bring certain levels of happiness and contentment for some people, those feelings are usually transitory and once the excitement of the achievement dies down, it leaves us with the yearning for the next thing on the list, the next achievement that will bring us happiness.

Materialistic society

This, of course, is how our materialistic society works. It is based on continued consumption of good and products, a continued movement towards bigger and better things, with very little time to sit and wonder what it is all about. When we do find the time to do so, we are often left with the nagging feeling that there must be more to life than this. Do we really want to spend our days working really hard, burning ourselves out to earn more money, just to buy more stuff? Is the purpose of our life just to make money, achieve some social status, maybe raise a family and then die? Is this truly and deeply where we want to be in our life?

When these sorts of questions start to arise, we can quickly face a crisis of meaning, which is arguable the epidemic of our times. While we can avoid thinking about these deeper issues for a while by living a busy life and staying at the surface level, these deeper questions with the unsettling feelings they can bring with them will keep bubbling up again and again. For many people this can manifest in a lack of motivation, a lack of joy or excitement in life, and indeed in depression.

What is a crisis of meaning?

So what can we do when we face a crisis of meaning? While there is no easy and straightforward answer to this we can consider two distinct ways of finding meaning in life. The first is to create meaning – to invest our time an energy in something that seems meaningful to us. Being a parent for example, can give some people a meaning in life, or doing some voluntary work, engaging in something that spreads positivity in the world, writing a book etc – all of these can give people meaning. The key is to engage in something that is bigger than you, that propagates out into the world and helps people in one way or another. While creating a meaning can be very satisfying, for many there is a deeper level still to this, and they want to find their true meaning in life – to answer the deeper question of ‘what are we here for?’ In order to find our meaning in life (rather than create it), takes quite a different approach. We need to spend time being with ourselves, listening to our inner voice, spending time in quiet contemplation. For some this will naturally lead in a spiritual direction, as contemplating the deeper recesses of our psyche will invariably move us to transcendental thinking. Engaging with spirituality, whether in an organised way by attending a spiritual or religious group, or just reading and thinking about it, can go a long way to helping us find meaning in life. It is also worth mentioning that spending time in quiet contemplation can also entail facing some of our inner demons, as we come in touch with our deeper emotional side. Understanding and resolving our deeper feelings can be fundamental to living a more contented and meaningful life. 

Psychotherapy and meaning

Engaging in psychotherapy can be a very fruitful journey on the path to finding meaning in life. With your therapist you can find ways to face your inner fears, get in touch with your inner self and express the meaningful life that is yours.

Simon Cassar is an experienced integrative existential psychotherapist, supervisor and academic, providing long and short-term psychotherapy to both individuals and couples at our practices in Hove and Lewes.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

What is Existential Psychotherapy? An interview with Dr. Simon Cassar – VLOG

 

Recently Mark Vahrmeyer interviewed Dr. Simon Cassar on the topic of Existential Psychotherapy.  This is the first in a series of interviews and VLOGS into the topic of psychotherapy generally.  So, please check out the interview and we would welcome any feedback or suggestions for future VLOGS.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy.  He works from our Hove and Lewes practice.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

What is Bipolar Disorder?

Bipolar disorder, previously known and manic depression, is a mood disorder that is thought to effect about 1% of the UK population.

Typically, the onset of Bipolar disorder is at around 15-19 years, although some may develop it later on.

What are the symptoms of bipolar disorder?

The symptoms of Bipolar disorder are mood related, and range from feeling high (manic) and very low (depressed).

Manic phases

In the manic phases, you can feel euphoric, have a great sense of wellbeing, have racing thoughts, a feeling of being invincible or special and have increased sexual energy. A manic phase can last for a week or longer and during that time you may end up losing your social inhibitions, take serious risks with your safety and take on big projects with extensive time and financial commitments. 

During a manic phase, you may also experience psychotic symptoms such as delusions and hallucinations. In a manic phase, your daily life is likely to be significantly disrupted and at the severe end, you may need hospitalisation.  A lower threshold of mania, called hypomania, may also be experienced which is typical in Bipolar II disorder. This phase generally lasts less than a week and the symptoms are similar to those of mania, but to a lesser degree and without the psychotic features. Hypomanic phases can also be disruptive and there will be a noticeable change in your behaviour, but normally you can still continue your daily routine.

 Depressive phase

The other side of Bipolar disorder is the depressed phase. In this phase, you can experience a lower self-esteem and lack self confidence.

You can feel hopeless, tearful and agitated, and sometimes feel suicidal. Often the depressed phase can feel harder to deal with than the manic phases, and the contrast between the two can make the depressed phase feel much worse.

There are three types of Bipolar disorder: Bipolar I, which is where you experience more manic episodes, Bipolar II, which is where you experience more depressive episodes and experience hypomania, and Cyclothymia which is where you experience both manic and depressive episodes, but at a lower threshold than you would if you had Bipolar I or II.

How to manage bipolar disorder

When given a diagnosis of Bipolar disorder, it is important to take some time to notice how you feel about it. Some people will reach with relief as it will give context and understanding to the difficult mood swings.

For others, the diagnosis can be hard to accept and indeed they might not agree with it. However you feel about the diagnosis, it is best to get informed about what the disorder means, how it can be managed, and to get some support.

Medication will often be offered in the treatment of Bipolar disorder to manage the depressive episodes, keep your moods stable and sometimes antipsychotics will be needed during manic phases. In addition to medication, psychotherapy can provide a very good way of coping with Bipolar disorder. It can help you gain insight into the triggers, and the warning signs that you are entering a manic or depressed phase and help you to deal with the complex and often painful emotions that can accompany them.

The supportive therapeutic environment can enable you to process and make sense of what you are feeling and to understand the affect it is having on you and those around you.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy.  He sees clients from our Hove and Lewes practices.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

Managing Work Stress

Most of us have to work in order to live. For many, work can take up a large proportion of our waking lives with up to a third of our lives being spent at work.

While the primary reason for working is to make money, our work life can (and should) be much more than that. Working and having a career can become an intrinsic part of our identity and can indeed give us meaning and purpose in the world.

When we meet a new person, one of the first questions we often ask them is: “What do you do?” We can identify ourselves by our work and the position we hold within it, and our work can become one of the most important aspects of our life.

When our work life becomes stressful, our emotional response to it can become out of proportion to the actual situation. We can feel that our livelihood is jeopardized and at a deeper level it may feel like the very core of our being is threatened. Stressful situations at work can soon spiral out of control as we lose our clarity and our ability to stay objective in the face of these perceived threats.

What is stress?

 There is no clear medical definition of stress, but generally speaking we can say that stress is our body’s natural response to demands or threats that are put upon it. The stress response is usually the ‘fight or flight’ response that can help protect us in dangerous situations.

Under normal circumstances, stress is healthy and can help us stay alert, focussed and be more energetic. It can give us the motivation to get up in the morning and get on with our day.

However, if we have a demanding job or there are conflicts at work we can end up in a heightened stress state for a prolonged period of time. This can have a negative affect on both our physical and emotional health and we need to be mindful of the signs that we are becoming too stressed.

 What are the common symptoms of stress?

Cognitive symptoms: Inability to concentrate, constant worrying, racing thoughts, seeing only the negative in situations.

Physical Symptoms: Frequent colds of flu, aches and pains, nausea, dizziness, chest pains, rapid heart beat, loss of sex drive.

Behavioural Symptoms: Changes in sleep pattern, using alcohol or drugs to relax, changes in eating habits, withdrawing from other people.

Emotional symptoms: Depression, anxiety, mood swings, irritability and anger, feeling overwhelmed, loneliness and isolation.

What is causing your stress?

As well as noticing the signs and symptoms stress, we also need to identify the situation that is causing us stress. Some of the main work issues that can cause stress are: being overloaded, conflict with colleagues, management style of the organisation or our line manager, change and personal factors such as work/life balance. Some of these will be easier to address than others, but as a starting point, don’t carry the stress alone.

What can you do?

If possible, speak to colleagues and your line manager, and to your HR department if you have one. Letting others know that you are stressed will enable them to step in and help if they can.

Additionally, think about your work/life balance. Are you spending too much time at work with not enough down time? It’s easy to fall into the trap of needing to work more because you are stressed, which means you have less downtime and hence more stress. Re-addressing priorities in an important part of dealing with stress – make some time for yourself. If you able, do some physical exercise to help you unwind the physical tension. Start a mindfulness practice to allow your mind some ‘time off’. Speak to your GP if you are experiencing the physical symptoms mentioned above. And finally, if it becomes overwhelming, consider speaking to a counsellor or psychotherapist to help you process the emotions than can arise from feeling stressed.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

Student mental health – how to stay healthy at university

After the long summer, thousands of new students are heading to university. The start of the academic year is an exciting time for many, but it can also be a difficult, worrying time for some. Students today are subject to different pressures from earlier generations – financial, academic, social – that didn’t affect previous students to the same degree. Higher study costs means that an increasing number of students have to balance their study with part-time work. This means that they have less time to form and nurture close friendships and a social support network with their peers.

For those leaving home for the first time, it can be a stressful transition towards independent adulthood. If we look to wider society, the uncertain and competitive job market can put an inordinate amount of pressure on students to perform well as they face an uncertain future. In addition to this, many serious mental health conditions manifest themselves for the first time in young adulthood. The Higher Education Statistics Agency recently revealed that the number of students who drop out of university with mental health problems has more than trebled since 2009-10, with a record 1,180 university students with mental health problems abandoning their studies in 2014-15, the most recent year for which data was available.

It is important, therefore, to keep yourself healthy if you are heading off, or back to university. There are many good resources out there that will give good tips on how to look after your mental health while studying at uni, and here are a few tips that might point you in the right direction.

Physical health

Looking after your physical health is key, especially when you are entering a potentially stressful situation and experiencing big life changes. Having a regular routine of physical activity can be a great help in maintaining good emotional health. This could be team sports, the gym, walking rather than getting the bus – whatever works for you. Also, having a healthy diet and adequate nutrition will also help maintain the energy level that is needed when you are studying and partying hard!

Social health

Going to uni is a social experience. Creating new social networks is part of the attraction of studying in a new area. It can be a lot of fun, and a good social network is intrinsic to having good mental health. But don’t underestimate the impact of not being around your close friends. Keeping in contact with your existing friends who know you well is important too, as building deep friendships where you can open up about your inner world takes time.

Psychological and emotional health

Looking after your psychological and emotional health is obviously a key part in maintaining good mental health. Spend some time noticing your thoughts – what are you telling yourself? Notice also your emotions – how are you feeling on a day-day basis? Being able to identify your thoughts and feelings and to express them in some manner, whether through talking to friends or writing them down, can help you maintain a healthy inner world.

Spiritual health

People often forget about their spiritual health, but this is an important part of our lived experience. Looking after your spiritual health can be simple. You could spend some time alone on a regular basis, spend time in nature, or learn to meditate. Of course, if you are religious, then engage more with your religion. Spiritual health doesn’t need to be about religion, and can be just spending time by yourself and noticing the amazing world that is around us.

Staying healthy at university

Keeping these four areas in mind on a daily basis can go a long way to maintaining a healthy lifestyle. However, when things get a little more difficult, then use the support services that will be available at your university. There will invariably be counselling services and learning support services who will be able to help in your university journey.

Kate Connolly and Simon Cassar

Click here to download a PDF version of this post.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

Four domains – maintaining wellbeing in turbulent times

Recent geopolitical events, notably the new American administration and the Brexit vote, have for many of us brought on feelings of uncertainty about the future. Facing this type of uncertainty can lead to feelings of  anxiety driven by a loss of what we thought we could rely on or expect from life. Alternatively, we can experience despair and ultimately, depression about our powerlessness to affect what may happen in the future. While we may not be able to predict or have a big impact on what may be coming, we can do a lot to look after our wellbeing. This may enable us to face the future with a degree of equanimity.

 The concept of wellbeing is much spoken about, and can be viewed from a complex academic perspective. At the other end of the spectrum, it can become a rather glib, throwaway term. However, we can look after our own personal wellbeing by paying attention to four important domains in our lives. Putting a bit of effort into each can help us to feel better in ourselves and can contribute to us maintaining a positive worldview.

The Physical Domain

Looking after our physical health is a key part of wellbeing. For some, this is a part of everyday life. Going to the gym, running or playing team sports are great ways to increase physical fitness, and all enable us to feel more rooted in our body.

However, this level of physical effort is not for everyone. We can do a lot to increase our physical health by simply walking a little more than we might do normally. This is promoted actively by the NHS, which outlines the positive physical and emotional benefits of being more active each day. 

It may seem daunting to reach the desired goal of 10,000 steps per day, however, merely increasing how much we move around in our bodies each day takes us a long way towards increasing our physical health and fitness. For example, we might choose a longer route when we have to walk, stroll around the block after dinner, or walk up stairs rather than using the lift.

 Of course, increasing our physical activity is only part of the matter. We also need to consider our diet and aim to eat as healthily as possible.

The Emotional Domain

Looking after our emotional health is also very important in improving our overall wellbeing. This can be as easy has having open and honest conversations with those who are close to us, which is a great way to deepen our relationships. Alternatively, writing a daily journal to explore our deepest thoughts and feelings can help us understand ourselves better and make sense of our inner world. Seeking professional help from a therapist is also an important step if our emotional world becomes overwhelming, or if we are unable to make sense of what is going on for us.

The Intellectual Domain

Our intellectual health is another very important area. It can often be overlooked once we have finished with formal education and then again when we retire from paid employment. However, keeping our minds sharp and alert to new ideas can be very inspiring and satisfying. It also helps us to approach the world from a fresh perspective. We can look after our intellectual health by taking a course (there are many free online courses available), reading an inspiring book that gives us new knowledge, or even by watching some of the short, powerful talks we can find on websites such as TED. 

The Spiritual Domain

The spiritual domain can often be overlooked, but can be hugely important to our overall wellbeing. For those who are religious, this can consist of spending a little more time in contemplation or prayer. For those who are not religious, spending a few moments each day in quiet meditation or practicing mindfulness (or even taking one of the many available mindfulness courses) can be very beneficial and can help to attain greater inner peace and an enhanced perspective on the world. If none of these appeal, you could simply spend a few moments each day noticing the beauty of the natural world around us. A key element of mindfulness is connecting with you body whilst connecting with the wider world simultaneously. Simply being in your body whilst noticing the smells, sounds and feelings that arise is a form of mindfulness practice.

Actively working for a short while in each of these domains every week can do a great deal to improve physical and mental energy levels. It can also give a sense of control of one thing we can have a huge impact on… our own wellbeing.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy.

Click here to download a PDF version of this post.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Hove clinic
49 Church Road, Hove, East Sussex, BN3 2BE

Lewes clinic
Star Brewery, Studio 22, 1 Castle Ditch Lane, Lewes, BN7 1YJ

Copyright © 2025