CBT Therapy Archives - Brighton and Hove Psychotherapy

May 5, 2025 by BHP Leave a Comment

How do I stop overthinking?

This is a question that I am often asked. Everyone overthinks sometimes however for some people this can feel like a constant. Some people worry a lot about what others think of them, they can rehash conversations they’ve had, worry about what they’ve said and if they should have said this or that or whether they may have upset someone. Some people overthink making decisions and this can lead to immobilisation. Others think about worse case scenarios that could potentially happen.

This type of thinking is often accompanied with distressing images of possible disasters. Either way overthinking can be all consuming and have a significant impact on mood. Overthinking tends to fall into two categories, either rumination about the past or worry about the future. If we are ruminating on past, we are replaying situations or events in our mind or questioning decisions that we have made. Rumination is often linked to low mood and low self-esteem. Persistent worry thoughts involve negative predictions about the future, usually catastrophic, and often linked to anxiety.

Rumination and worrying can be seen as unhelpful behaviours. This is when we don’t consider the content, we try to change the behaviour. The content of the rumination and worry are the unhelpful thoughts and to work with these we use thought challenging. Ideally, we need to challenge both behaviours and thoughts to make a change. This is what CBT aims to do. Both worrying and ruminating can become habitual and so you don’t always recognise when you are doing it until you are well into a cycle. Increasing awareness is the first step. Really notice when you are getting into a worry or ruminative cycle. By increasing awareness, you can make an intervention to change sooner. Start to really try and notice when you are getting into these cycles. Usually there will be a shift in mood, either worry and anxiety or feeling low and depressed.

When you notice that you are ruminating or worrying, remind yourself that this is not productive, thinking in this way is only helpful if it leads to a positive action. Is what you are worrying about an actual problem or a hypothetical one? If it’s hypothetical or one that you have no control over, then a strategy that can be helpful is to really try and shift your focus of attention to something else and engage in the present. This might be doing something physical, such as gardening or exercise, or engaging in conversation, or doing an activity that you find really absorbing such as baking, creative arts, a word puzzle or Sudoku. It’s normal for your thoughts to try and hook you back in. Just notice that this is what is happening, don’t engage with the thought, let it go. Focus on the activity that you are doing, notice what’s going on in the here and now. It might help to think about what you can see, hear, smell, taste. You want to try and be truly present to your external surroundings. The principle of this strategy comes from mindfulness. You are doing something in a mindful way. This strategy can also be used for ruminating on the past. We can’t change the past, so it is not helpful to keep going over it. Often when we are ruminating, we are being self-critical and understandably this is going to negatively impact our mood. We can get stuck in cycles of worrying about the future or ruminating on past. We want to shift our focus of attention to the present and be truly present to the here and now.

It can be helpful to write worry thoughts down, to ‘park’ the worry. Then allocate yourself a limited period of time later in the day to come back to these worries and allow yourself to think about them. This is referred to as ‘worry time’.

If what you are worrying about is an actual problem or something that you do have control over, then you can problem solve. Consider all the possible solutions, pick one that you consider will be the most do-able and helpful, and devise an action plan. Once you have your plan of action decide if you can implement this right now or do you need to schedule it. This is a positive action and productive. Once you have implemented your plan you can let it go and shift your focus of attention.

When getting into lots of negative thoughts it can be helpful to thought challenge. Firstly, it can be useful to consider if you are getting into unhelpful thinking patterns such as mind reading, catastrophising, emotional reasoning, being self-critical, making judgements, black and white thinking, negative mental filter, shoulds and musts. If this is what you are doing, remember thoughts aren’t facts, even if they might feel that they are. Ask yourself, is there any factual evidence to support these thoughts or are they opinions? Would your evidence be permissible in a court of law? (This is the fact/opinion approach). You can also use the STOPP approach. STOPP is an acronym: Stop, Take a breath, Observe, Pull back and put in some perspective, Practise what works. Ask yourself is there another way of looking at this? What would your best friend say to you in this situation? What advice would you give to someone else in this situation? Will it matter in six months’ time? Answering these questions can help you to gain a different perspective, hopefully a more realistic one. Once you have a more realistic perspective you can test this out by doing something different, consider what would be more helpful to you at this time and is it in line with being the person you want to be.

These are different CBT strategies used to manage overthinking. Change is difficult and takes time.

It’s a challenge. As with anything, these strategies will take practice. They may not always work and that’s okay too. Often, we are trying to change a way of being that has been around for a long time, so it is important to try and be gentle with yourself. Remember, you’re not alone, overthinking is something we can all do.

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch. Online therapy is available.

April 14, 2025 by BHP Leave a Comment

How can I manage my emotions better?

This is a common question clients ask therapists.

Sometimes clients describe having mood swings, one minute they are feeling fine and the next are feeling very low, and for others it can be suddenly feeling irritable or angry. Sometimes there is an obvious trigger to the change in mood but often clients report no trigger, just a general feeling of their mood having changed.

Understandably this can feel frustrating as well as being difficult for those around them – clients often say that their mood swings impact on their relationships.

In therapy we might start by looking at the bigger picture. We might ask the client if this is something they have always experienced or is relatively new. It could be that there has been a build-up of stressors or that the client’s work-life balance has become unbalanced, and so as stress has increased it has become more difficult to manage their moods. Often stress can creep up on us. We have an expectation that we can maintain a permanent level of ‘doing’ however this isn’t true. Often people think because they used to do all these things they should be able to keep on doing all these things. We can often compare ourselves to how we used to be and hold an expectation that we should be able to keep going. However, stress can accumulate and over time this can become more difficult to manage. The analogy of the stress bucket is useful here. If you imagine the size of the bucket represents a person’s stress tolerance and this is influenced by personality, genetics, upbringing and experience. The bucket fills up with stressors from home, work, family, finances, illnesses etc. When the bucket is full up it can lead to problems such as low mood, anxiety, fatigue, headaches, sleep disturbance and overwhelm. We need strategies to stop the bucket overflowing.

This is where therapy can help. Together we can explore stress management strategies and talk through the stressors. Often difficult experiences build up and we don’t allow ourselves time to properly process them.

For others it could be that they have always found it difficult to manage their emotions. This could be because they’ve never really learnt to manage difficult emotions and so they struggle with tolerating them. Sometimes unhealthy ways to manage develop such as drinking too much alcohol, comfort eating, sleeping or taking drugs. These are different ways to avoid feeling difficult emotions. However, these only work in the short term, can be difficult to give up and can lead to mental health difficulties such as depression, anxiety and low self-esteem.

Cognitive behavioural therapy (CBT) is an effective treatment in managing emotions. It looks at the interaction between our thoughts, moods, physical symptoms and behaviours. It can be useful to use the basic CBT model to start to breakdown what’s going on when you first notice the shift in emotion/mood. When you first notice that shift in your mood ask yourself what was going through my mind at the time, what were the words my mind was saying (i.e. your internal dialogue); name the moods/emotions that you were feeling at the time (there can be more than one mood); how were you feeling inside of your body, what were the physical sensations; and what is it you were doing or not doing (behaviours). Also try to identify the trigger, what were you reacting to? Was it an event or situation or was it that you started to think about something, and this triggered a shift in your mood. By breaking down your experience in this way we can really look at what is going on. We can start to identify early signs and symptoms that happen when your mood changes. We can look at what might be unhelpful in the way you are thinking that could inadvertently be maintaining the cycle. We can see what you are doing or not doing that also might be contributing to maintaining the cycle.

It can help to write these answers down. The process of recording can help to give us clarity and can be a strategy in its own right. Once we have gathered this information and identified what’s unhelpful, we can start to look at ways to make changes, what might be more helpful.

Noticing your emotions and naming your feelings can be useful, but it’s not always easy to do this if it’s something you’re not used to doing. When we notice physical sensations happening in our body, we can think about why these might be happening. Was it that you were thinking of something that’s happened in the past or worrying about something in the future? Or was it that you were feeling a certain way and started to give a meaning to what you were feeling? How we are thinking impacts on how we feel emotionally and physically. Just as how we are feeling in our mood and in our body will impact on how we think.

When managing our emotions it’s important to be kind to ourselves: to think self compassionately; to treat ourselves how we would treat others; to forgive ourselves when we make mistakes; and not give ourselves a hard time when we don’t achieve everything we would’ve liked to. Be mindful of the way we talk to ourselves. We need to accept our different emotions rather than trying to fight them. It’s okay to feel ‘negative’ emotions, it’s part of being human. Telling ourselves we shouldn’t feel like this, judging ourselves harshly or criticising ourselves doesn’t help. Just as trying to avoid or dismiss the emotion doesn’t help. We need to learn how to self-soothe and reach out to others for support.

CBT helps us learn how to recognise unhelpful thoughts and challenge them, and to identify unhelpful behaviours. If we can make changes in these areas this will have a direct impact on our emotions.

We can all experience difficult emotions at times, it’s normal, just as we can all need a little help in how we manage them.

October 28, 2024 by BHP Leave a Comment

Learning to embrace uncomfortable emotions

Is there an expectation that we will not have uncomfortable emotions?

To have different emotions is to be human. Life is about feeling emotions. We notice our emotions and label them. Emotion is normal, we have to feel it to get past it.

How we look at things and process information is based on our early experiences. In psychological terms we develop schemas. These determine how we look at the world and act as a guide to our cognitive processes and behaviour:

‘A schema is a cognitive framework or concept that helps organise and interpret information. Simply put, a schema describes patterns of thinking and behaviour that people use to interpret the world.’ Very Well Mind 2024.

Emotions can be problematic and we can hold negative beliefs about unpleasant emotion, i.e. emotional schemas, and this can lead us to wanting to avoid the negative emotion. In other words, we have appraisals about our emotions. For example: If you get angry then you will lose control; if you cry then you are weak; if you are afraid then you are a coward; you shouldn’t be upset because others have it worse than you; if you are sad then you are selfish. As a result of these beliefs, we may develop problematic emotional schemas such as: I am weak and childish if I have these feelings; my emotions are a burden to others; I will be punished for my feelings; other people don’t feel this way; I should stop feeling this way.

These appraisals guide us in managing the emotion and can make it difficult to express feelings, and a fear of expressing feelings may develop. This can then lead to mental health difficulties such as anxiety disorders, depression, low self-esteem.

Emotional schema development is influenced by all the same factors that influence our core beliefs, i.e. our early experiences, and significant others.

Think about the emotional environment you grew up in. How did people respond to your emotions? How did they make you feel about your emotions?

As a child you may not have been allowed to express your upset, you may have been told not to cry, to get over it and move on. However, crying is part of life. It’s linked to a normal emotion.

Parents may have had emotional styles, e.g. dismissive – denying the significance of a child’s emotion; disapproving – criticising and over controlling of a child’s feelings; or emotional coaching – assist in expressing, identifying and differentiating emotions, and problem solving. Emotional coaching obviously being the most helpful.

Many people fear not being able to control their emotions and so fear expressing them. However, we need to make room for these emotions, let the emotion in. You can have a feeling of anger and not act in a hostile way.

We can become anchored to our emotion if the emotion is intense. Intense emotion can be interpreted as long lasting and increasing in intensity. We can over focus on the emotion and use the current emotion to interpret current situations and predict future situations. This then maintains the problem. This can happen with anxiety, and the more anxious about situations we become, the smaller our world becomes. These negative feelings can lead onto other negative feelings such as hopelessness and helplessness.

However, if we can look at the situation from the perspective of a different emotion, might this change? For example: Be curious – what can I learn from this? Challenge – what can I do to make things better? Find meaning – how does this tell me what matters? Compassion – towards self or other. Emotions change. Can you think of your feelings as waves that come and go? It can be helpful to observe the emotion, notice if it goes up and down. Neither positive or negative feelings last indefinitely.

When we feel grief at the loss of a loved one and don’t want to feel like this anymore, does this mean we would rather not have had that person in our life, to not have had a relationship with them so that we can avoid experiencing the loss of the person? I suspect not.

We need to make room for the loss and the pain, build a life around this. Life is about having uffering. The suffering is worth it, to have experienced the love, the relationship, etc. We need to remember emotion is temporary. Think of when you experienced this emotion before, how did you move on from it? Think about past ways you coped, did what you fear happen? How did the emotion come to an end?

Problematic coping is when we try and avoid – we use drugs, alcohol, ruminate, stop doing things. Alcohol or drugs work in the moment but longer term we feel worse, and may need more to get the same effect and then feel even worse.

It is how we cope with the uncomfortable emotion that enables us to progress. In CBT we learn to do this by drawing on various strategies including distraction, problem solving, acceptance, social support, cognitive restructuring, decreasing the arousal, behavioural activation and modifying beliefs about emotion.

Being human means you will have unpleasant emotions. Pain, tragedy and loss are part of having a full life. Disappointments are inevitable. To manage disappointment, we readjust our expectations. We have to get through the difficult emotion to get to what we want. Emotions go up and down, we have to learn to tolerate them. You do the hard things so that they become easier in the future. If you believe the emotion goes on forever then it maintains the problem. We have other emotions than the one we’re thinking of right now. Think of feelings as coming and going, allow them to come and pass. We can’t suppress emotion, if you try to it comes back. The same with our thoughts, we can’t stop them coming. We have to make room for them, observe them, accept them and let them go.

September 23, 2024 by BHP Leave a Comment

Your brain is not for thinking – it’s for survival and balance

When most of us think about the brain, we tend to associate it with thinking—solving problems, making decisions, or engaging in intellectual discussions. However, according to Dr Lisa Feldman Barrett in her chapter ‘Your Brain Is Not for Thinking’ from Seven and a Half Lessons About the Brain, thinking is not the brain’s most fundamental function.

In fact, the brain’s primary function, from an evolutionary and developmental perspective, is to ensure our survival by managing the body’s resources—a process she refers to as maintaining the body budget.

In this article, I focus on this key concept from the first part of Dr Barrett’s book. For a deeper understanding of how the brain works, I highly recommend reading the full book, where Dr Barrett explores additional fascinating insights into the brain’s role in our functioning.

What is allostasis (body budget)?

The concept of the ‘body budget’ represents how the brain constantly works to manage the resources that our body needs to function. Imagine your brain as the accountant of your body, ensuring that essential functions like heart rate, energy levels, digestion and oxygen supply are balanced in real time. Much like a financial budget where you monitor deposits and expenditures, the brain tracks energy reserves and adjusts our body’s functions to maintain equilibrium.

Scientifically, this process is called ‘allostasis’. Allostasis is a physiological mechanism of regulation in which the brain anticipates and adjusts the body’s energy use in response to environmental demands. Rather than merely reacting to changes, allostasis involves the brain predicting needs and making proactive adjustments to ensure stability. This constant balancing act allows the body to maintain optimal functioning in a changing environment.

For instance, when you are physically tired after a long day of work, it is not just because your muscles are worn out—your brain has monitored and calculated your energy expenditure throughout the day, signalling that it is time to rest and restore your body budget.

The role of prediction in body budgeting

Dr Barrett emphasises that the brain’s primary role is not reactive but predictive. Rather than merely responding to what is happening in the environment, the brain is constantly forecasting what resources your body will need based on past experiences and current conditions. This predictive function allows the brain to make micro-adjustments before the need arises, ensuring that you remain balanced, healthy and alert.

For example, when you reach for your morning coffee, your brain is not just reacting to your craving for caffeine—it is predicting that the caffeine will help increase your energy and regulate your body budget for the day ahead.

Similarly, in moments of stress, the brain prepares the body by releasing stress hormones like cortisol, anticipating the need for extra energy to handle the challenging situation.

How emotions tie into the body budget

What does this have to do with emotions? Dr Barrett argues that emotions are not abstract feelings disconnected from the physical world but are deeply tied to the brain’s management of your body budget. Emotions like fear, anxiety or happiness are signals that the brain sends to prepare or adjust your body’s resources.

Consider fear: when your brain perceives a potential threat, it triggers the fight-or-flight response, releasing adrenaline to ensure that your body has enough energy to either confront or escape danger. In this case, fear is not just a mental state—it is an emotion deeply connected to your brain’s prediction that you will need extra resources to protect yourself.

Practical implications: why the body budget matters for health and wellbeing

Understanding the concept of the body budget has important implications for everyday life, particularly in managing stress, emotional regulation and mental health. When we ignore the body’s signals—like pushing through fatigue or suppressing emotions—we disrupt the body budget.

For instance, if you continue to push through fatigue without resting, it’s like overspending from a financial budget without replenishing your resources. Over time, this can lead to an ‘energy bankruptcy’, making it harder to function effectively. Chronic stress and emotional suppression can result in burnout, physical illness, or mental health disorders like anxiety and depression.

In therapy, the body budget concept can be applied through various approaches. For example, cognitive behavioural therapy (CBT) often begins with psychoeducation, helping clients recognise how their thoughts, behaviours, emotions and physical sensations are interconnected. By understanding how stress and emotions impact their body budget, clients can identify early warning signs and make proactive choices to maintain balance and prevent exhaustion.

Acceptance and commitment therapy (ACT), another approach, helps clients ‘sit with’ uncomfortable emotions while still engaging in meaningful activities. This strategy allows clients to navigate emotional discomfort without further draining their body’s resources.

Conclusion

The brain’s primary role is not limited to thinking or intellectual activity—it is the critical organ that ensures our survival by maintaining our body budget. Understanding this function and recognising how our brains predict and regulate our body’s needs can offer us profound insights into managing stress, emotional health and overall wellbeing.

By paying attention to our body budget, we can make more informed choices that not only keep us healthy but help us thrive.

Lucie Ramet is an experienced Chartered Psychologist and CBT & ACT Therapist offering short and long-term individual support to adolescents (16+) and adults. She works in English and French. She works Mondays and Fridays from our Brighton and Hove practice, She also offers online sessions.

Lucie is inspired by research in psychology, sociology and neuroscience that explores the keys to wellbeing and the science behind happiness, compassion and purpose. She finds it essential to apply these findings in her therapeutic work to promote a thriving and resilient society.

Recommended Reading: Dr Lisa Feldman Barrett, Seven and a Half Lessons About the Brain.

Further reading by Lucie Ramet –

Emotions: hardwired tools from our evolutionary past

Embracing a mindful new year: Achieving resolutions with ACT therapy

October 23, 2023 by BHP Leave a Comment

How does CBT help with low self esteem?

What is Low Self Esteem?

This is when we think negatively about ourselves, we don’t feel good enough. We are likely to get into self-critical thinking, think others are better than us and blame ourselves when things go wrong. We are likely to focus on our negatives and not on our achievements, struggle to accept compliments and avoid challenges for fear of failure. We may become overly upset when receiving criticism or disapproval. Our internal dialogue tends to be negative, particularly towards the self. It’s not uncommon to feel worthless, depressed, sad, anxious or undeserving.

What causes Low Self Esteem?

Low self-esteem often stems from our early experiences. We may have been bullied at school, struggled with education, told we could do better, had difficulty living up to our parent’s expectations, come from a poor background, felt that we didn’t fit in with our peers, been neglected or abused.

These experiences can lead to the self-belief ‘I’m not good enough’.

Low self esteem may also come from stressful life events such as significant loss, serious illness or relationship difficulties.

What is the impact of low self-esteem?

We may have difficulties at work, for example: feeling that you can’t say no, that you have to work as hard as possible all the time, go the extra mile, or the opposite you may avoid situations in which you may feel judged and go for jobs in which you know you won’t be challenged. We may have difficulties in relationships such as always having to put the other first or thinking they are better than us. We may have a negative body image and always be comparing ourselves to others. We may set unrealistic high expectations for ourselves. We may avoid social situations, lack assertiveness or do anything to avoid confrontation. Generally, we tend to experience a negative bias in life.

Living with low self-esteem can impact on our mental wellbeing. Our mood can be affected, we can feel sad, low, ashamed or anxious.

We may also develop unhelpful habits as a way of coping such as drinking too much alcohol, comfort eating, smoking or taking drugs.

What can we do to improve our self-esteem and how can CBT help?

We can start to notice the things that go well in our life, record our achievements however small. We can think about, and write down, what we are good at (our strengths), write down the positives about ourselves (our qualities) and the good things that others say about us. All of us are good at something, this can often be things that we enjoy.

We can stop striving for perfection as there is no such thing and remind ourselves that it is OK to make mistakes, this is how we learn.

CBT can help us to shift our focus away from the negative bias. In CBT we lookout for those negative/unhelpful thoughts and learn to challenge them and look for alternative perspectives. We can learn to be self-compassionate, being kinder to ourselves when we would usually be self-critical. What would you say to someone else in a similar situation? Would you ever talk to others how you talk to yourself?

CBT teaches us to be aware of our unhelpful behaviours and helps us to make changes and start to value ourselves. For example, we may set ourselves small goals to do something differently, such as practising ‘saying no’ and prioritising yourself, allowing yourself ‘me time’ to do something enjoyable, joining an exercise class or accepting a social invitation. Achieving goals for ourselves helps us to build self-esteem.

Any change in behaviour is going to be a challenge therefore likely to feel uncomfortable. It’s normal to feel nervous or afraid of doing things sometimes. This doesn’t mean we shouldn’t do it. It simply means we are out of our comfort zone and the more we do something the easier it becomes.

CBT can be very helpful in improving self-esteem. Whilst the primary focus is on the present and learning CBT strategies to make changes in the way we think and our behaviours, we do also look at past, to provide context of why we might be experiencing the difficulties that we are. This helps us to make sense of our experience. With increased understanding and awareness, we are more able to make changes and improve our self-esteem. CBT aims to provide us with a ‘toolkit’ of strategies to establish and maintain those changes.

October 9, 2023 by BHP Leave a Comment

How does CBT Work?

Cognitive Behaviour Therapy (CBT) is particularly interested in our thoughts and our behaviours. It looks at the interaction between our thoughts, feelings (moods), physical sensations, and behaviours. When we experience a triggering situation, we often notice an internal shift in how we are feeling physically and/or emotionally and we may become consumed with our thoughts. Thoughts then often drive our behaviour.

In CBT we are on the lookout for what can be described as unhelpful thoughts and unhelpful behaviours. Unhelpful thoughts are negative in nature however they seem completely believable and plausible, they are automatic/instantaneous and often spiral. Our thoughts are very powerful and can strongly impact on how we are feeling in our mood. This is referred to as the thinking feeling connection. This can then guide what we do or don’t do in terms of our behaviour. Unhelpful behaviour is either avoidant or involves the use of ‘safety’ behaviours.

What is a CBT Maintenance Cycle (sometimes referred to as vicious cycle)?

Let’s look at the following example: Triggering situation: I receive an invitation to a friend’s party.
I might start to think about who will be there, will I know anyone, will there be a lot of people, what will I say, I won’t have anything interesting to talk about, people might look at me, I might not fit in, no one will like me, they might think I’m odd, etc. If I have all these thoughts going on it would be understandable for me to feel anxious in my mood. I might also feel physically uncomfortable: tense, a knot in the pit in my stomach, my heart rate may increase or my breathing maybe shallow. To cope with experiencing all these symptoms (thoughts, moods, physical sensations) it’s quite possible that I decide it’s easier to not go to the party. So, my behaviour is to avoid the situation so that I don’t have to tolerate these uncomfortable symptoms. The problem with this is it only works in the short term and so I am inadvertently maintaining the problem.

Additionally, if I avoid going to the party it is likely set off another spiral of thoughts:
I’m useless, I’ve let my friend down, I won’t be invited again, I’m lonely, I’ve failed again. These thoughts are likely to result in my feeling low in mood or even depressed. And then I’m even more likely to withdraw from others and isolate myself further. Again, inadvertently forming an unhelpful maintenance cycle.

Working with Thoughts:
There are various types of unhelpful thinking patterns that we can get into and it’s not uncommon to fall into a number of these in one situation. Hence, we ‘spiral’. Broadly speaking unhelpful thoughts tend to be either anxious predictions or self-critical thoughts.

In CBT we learn to notice and identify our unhelpful thoughts and use strategies to manage them. One such strategy is thought challenging to generate more realistic alternatives. This involves working through a series of steps that enable us to put the brakes on from ‘spiralling’.

Working with Behaviours:
Changing behaviour is also fundamental. Again, CBT introduces us to various strategies to do this. If we are feeling low or depressed, then the approach tends to be around activation. This may involve setting small, meaningful goals in line with personal values and having a go of doing something regardless of how you feel. If the difficulty is related to anxiety, then the approach is likely to involve graded exposure. Of course, it does depend on the type of anxiety we are working with but broadly speaking graded exposure of some description is used.

We may also make a change in our behaviour to test out our alternative thoughts to enable us to build evidence to strengthen these.

Whichever CBT model we are using it will involve exploration of our cognitions and making changes in our behaviour.

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.

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)