“I can’t wait to get up on stage and share my ideas, I’m going to be amazing”

“I’m really excited to get to work tomorrow and see what my boss does next, and how well I cope with it”

“I am really looking forward to the Christmas party where I know nobody and don’t speak the language, it will be an adventure”

Does this sound like you? Probably not, but it’s a great technique to help people conquer their fears by flipping their thoughts around from fear to excitement; from crippling to enabling.

The process of anxiety involves our brain surveying our environment, deciding there is a potential danger and flooding the body with stress hormones such as cortisol, the fight or flight sequence that enables us to respond quickly. Often this process is triggered by memories of times when we have felt fear, such as standing up to speak in public or entering a crowded room at a party where we don’t know anyone, and while there isn’t a life-threatening situation, our brain still reacts as though there is.

Of course, this isn’t necessarily true if we are facing a true danger such as being in the path of an oncoming car, when your brain needs to signal to your body that you need to save yourself. That’s when our anxiety system is working well for us. However, there are other times when it fails us, opportunities where we can be feeling fear about a situation to the extent that it becomes overwhelming, even crippling.

At these times, most people say take some deep breaths to try and calm down, but instead say ‘I am excited’. Here’s why this works - both fear and excitement are states of high arousal where the body is preparing for action, so it’s much easier to go from anxious to excitement than from anxious to calm, which is generally what we are asking our brain and body to do when we combat the fear with breathing or just avoidance (the latter can set us up for all kinds of problems down the road, so it’s generally better to avoid avoidance!).

Here are some things to remember:

• We all have things that make us anxious, so there is nothing unusual about your thoughts and feelings.
• We DO have control over our thoughts and feelings.
• When we get irrational fear-based thoughts and feelings, we need to grab them and deal with them before they settle down and decide to stick around
• Both the emotions of fear and excitement come from the same starting place, it is how we choose to respond to them that will inform our experience
• When you change a threat mindset to one of opportunity, from what could go wrong to what could go well, research shows that our performance improves, so take the high arousal and flip it around to your advantage.
  

Give this technique a try next time you feel anxious about something you are putting off or dreading and see what happens!

Dr Jules

If the subject matter in this article resonates with you, then counseling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you. Find my details on the Contact page and drop me an email, and I'll contact you to arrange a no-obligation chat where you can tell me more about your problem and ask questions about the process of therapy.

Obsessive Compulsive Disorder (OCD) is a condition that is increasingly talked about, and many people now joke about being a “bit OCD” to explain a quirk such as a preference for things to be clean, ordered or tidy.

In reality, OCD is an anxiety related condition that can be extremely debilitating as it increasingly interferes with a person’s ability to function in normal life.  OCD is characterized by anxiety provoking persistent thoughts, worries or impulses, that are experienced as intrusive and not under the person’s control; while the compulsive element describes repetitive behaviours that the person feels compelled to carry out in an attempt to reduce the anxiety. While the person usually knows the thoughts are irrational, they nevertheless feel the compulsive behaviour is the only way to relieve the anxiety, or to stop any harm coming to someone they care about.

In the U.S. and U.K., it is estimated that about 12 in every 1,000 people are living with OCD, but this may be an underestimate as many people either don’t recognize the problem in themselves, or are too embarrassed to seek help.
Typically a person’s OCD will fall into one of four main categories:

• Checking
• Fear of Contamination
• Hoarding
• Ruminations / Intrusive Thoughts
  

Clients I have seen with OCD have displayed worries around using public bathrooms or certain supermarkets, leaving the house without checking everything numerous times, travelling on public transport or being in busy public spaces, to name just a few examples.

Brain scans of OCD patients have revealed there is a worry-circuit as several parts of the brain - notably the caudate nucleus, orbital cortex, and thalamus - tend to be running in overdrive.

Interestingly, there is a cultural element to OCD as in the West, people tend to worry about cleanliness and hygiene, or safety and checking things are switched off/locked, while in the Middle East it has been reported that OCD tends to be more commonly associated with the correctness of how religious rituals are observed. So, typically people develop OCD around more widespread cultural narratives, but the commonality is the power of the obsessions to shape and define behaviour.

While OCD is a chronic condition, it is also very treatable. Treatment is typically psychotherapy with a focus on cognitive-behavioural techniques to break the cycle of worry, and indeed research suggests that psychological therapy has a very biological effect on changing the way the brain works, enabling the client to take control of their thoughts and therefore change their behaviours.

If you have a concern that you or someone close to you has OCD, then I highly recommend you contact a counsellor or psychotherapist to help break the cycle before it becomes further entrenched.

Dr Jules
If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you.

Lately it feels like every time we turn on the news we are faced with world events that are terrible but out of our control. How can we solve the Brexit situation? How do we stop gunmen killing children in schools in America? How do we end suffering in Syria? We feel we cannot ignore the chaos and hurt of the world, and yet it hurts us to witness it every day. Without considerable resources, we often feel powerless and frustrated to improve the world, and that can be incredibly stressful.

Despair is a common experience we all share. We feel it during difficult times in our lives. We sometimes despair about our work, our relationships, our financial situation, our love life (or lack of it), and of course we despair over world events each time we tune into the media. Typically, this feeling dissipates and quietens down until the next time, but sometimes it actually gets deeper, takes control of us, and forms a clinical condition where we constantly feel hopeless, pessimistic and powerless. Ultimately, we feel out of control.

We cannot control the government, the weather, other people’s opinions, our spouse, but we can take small steps so these feelings of despair don’t overwhelm us. This is generally true in counselling, where my clients are not always able to change the circumstances of their lives, but when they realise they can change the way they feel and think, it is significantly more empowering than continuing to think that if they could just control circumstances they’d feel better. We can’t un-do the past, but we can control how we deal with it in the now; we can’t control how others behave, but we can control how we react.
So how do we begin to take control when we feel despair at the world?

• An obvious way to take control is to limit our exposure to news that distresses us, whether it be the television or social media such as Facebook, learn to switch off when you start getting overwhelmed.
• Experts suggest we can instead think about how to improve things that matter closer to us, such as our home, family, community, etc. Sometimes we can become so consumed by the suffering of animals and people in other countries that we overlook what is happening within our neighborhood. What about old people who are living alone, or kids that need a steady and loving foster-home, or local animal shelters that need people to spend time with the dogs and fund raise so they have warm bedding? You might not have wealth in terms of money, but likely you have gifts and talents, such the ability to organize a bake sale, help in a neighbour’s garden, or write an email or letter of support and encouragement for someone who is going through a tough time.
• If you feel particularly powerless some days, then do something small such as cleaning your bathroom or having a turn out of your wardrobe, so you get a sense of accomplishment.
• Seek solace in other people. We can get lost in the fog that pervades our minds sometimes, and talking to a wise and trusted friend, or having a session or two with a counsellor, can help to clear that fog.
• Recognize when the best thing you can do is take care of yourself: eat, sleep, nurture yourself so you can regain some perspective.
• Be aware of signs that your emotional bank account is becoming exhausted. Those bad news stories about the world may be the final straw rather than the real cause of the problem. If you are more tearful or angry than usual, then you need to retreat and take stock so you feel less over-extended. Be honest about your priorities and where you are expecting too much of yourself.

Ultimately, we need to find ways to feel more in control and hopeful about the world, and our small place in it. A sentence that sticks in my mind from something I once read is that “people can live weeks without food, days without water, minutes without oxygen, but not a moment without hope”. And if you sometimes think the world is going crazy, you might be reassured to know that according to cognitive psychologist Steven Pinker, the human race is now healthier, more prosperous, and safer than ever before. The problem, he argues, is not the state of the world, it is our bias towards a negative representation of it. So, take heart, and take control of your thoughts, and the world will seem like a better place where courage and compassion can triumph over despair.

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you.

We hear a lot these days about the power of positive thinking, but can changing our thoughts really have much of an effect? Research in neuroscience suggests that it can.

Our brains build new neural pathways by repeatedly firing sets of neurons that wire together. When we start learning something new, such as taking a course or the first few weeks of a new job, we can feel like our brain is full and overloaded, and for a while it really is. As we keep repeating the new information input, or practicing a skill, the brain starts to make these pathways more robust and efficient, rather like an information super-highway.

At the same time, the brain is also de-cluttering by getting rid of old pathways that we are not using anymore, or in effect pruning and making space, as the underused pathways literally get marked for removal by a protein that attaches to them.
This has important implications because as we become aware of the how the brain works, we can begin to take advantage of this process and actively label which pathways are for growth, and which are for reassignment to the trash. Habits of mind reinforce new skills, behaviours and thinking patterns, so what is important is the combination of repeated practice along with the mindfulness to be aware of what you are focusing your thoughts on. And that is vital, because if you choose to focus your thoughts on ideas of revenge against your boss at work, or all the reasons why your spouse upsets you, or you constantly ruminate on why your life isn’t working out, then guess what? You are wiring yourself up to be more practiced and successful at the very things you need to avoid.

The research therefore seems to lend strong support to the idea that keeping your thoughts focused in a positive direction can indeed help to create a consistently more hopeful mood and a greater sense of vitality. To further aid the process, it is important to get a good night’s sleep. During sleep the brain rejuvenates itself and clears the toxins; it also does its important work of growing and pruning, although that procedure is far from understood at this point. Even a quick nap of 20 minutes during the day will give the brain some downtime to focus on these background tasks. When we are sleep-deprived our brain is overloaded and unable to repair itself, which is why the day after a poor night of sleep can feel like wading through treacle.
So, if you want an easy and fundamental way of taking care of your mental health, keep building those superhighways of positivity and get plenty of good quality sleep. Your brain will thank you for it!

Dr Jules

If the subject matter in this article resonates with you, then counselling might be a good option to help you to move forward. I offer a free 20-minute consultation so we can explore how I might be able to help you.

This week I take a look at shyness. Research suggests about 90% of us say we have felt shy at some point, such as when we have to walk into a room full of people we don’t know, but many of us have figured out a defense system such as laughing or talking a lot. For some people this shyness develops into a more problematic situation and about 13% of the population could be diagnosed as having social anxiety, where our apprehension of being around others starts to inhibit areas of our life. It is a bit like imagining we each have a shyness thermostat inside us that leads us to interpret social situations with differing levels of fear, ranging from minimal to overwhelming.

Symptoms of higher levels of shyness or social anxiety include: blushing, sweating, shaking, racing heart, avoidance, apprehension of being around other people, self-consciousness, avoiding eye contact, appearing quiet and isolated at social occasions (which can also make you appear superior or you can be labelled anti-social), fear of being embarrassed or rejected, and in general being there without really being there.

Over time, if the anxiety continues we become conditioned to associate others with our fearful reaction and unpleasant feelings, and because we anticipate a poor outcome we avoid what we assume will be a loss in terms of creating relationships. This distancing from people before we even give them a chance means that we lose the opportunity to seek pleasure from a sense of affiliation as well as the chance of closeness with people who could become more important to us.

Imagine a teenage boy who is starting to have opportunities to interact with girls, and feeling a great deal of anxiety to the point where he freezes whenever he is around them. He then starts to avoid girls so he can feel less anxious, but over time as he compares himself to other boys this feeds into his sense of self, and his internal thoughts are that he is ineffective and unmanly. Eventually he pushes himself to go to a party and has a few drinks to try and calm himself down, but when a girl tries to talk to him he feels overwhelmed and leaves in a hurry. Word gets around his social circle that he is weird or possibly gay, which leads to him becoming even more isolated and then he starts showing signs of being depressed. It can be too easy to spiral into a self-defeating situation.

It is important to remember that humans are inherently social animals; we evolved to thrive on having a relational group to exist within, and if you do therefore find yourself becoming isolated in a way that leads to you to feel unhappy then here are 10 tips to help you:

1. To overcome your shy feelings, you need to act in the opposite way, e.g., be non-fearful and outgoing. Make a list headed ‘How would I act if I was not shy?’ List all the behaviors people would see, e.g., making eye contact, smiling, being communicative. Then go out and practice, practice, practice, and keep a note of the level of discomfort you feel each time. Over time your discomfort level will decrease.
2. Find a common interest group so you already have something to talk about, and when you find that group commit to yourself that you will keep showing up rather than making it a one-time deal.
3. Communicate via social media some of the time so you can express yourself without that awkward feeling you get in person. This will help you to build some rapport and commonality with people you are interested in developing an association with.
4. Test out whether your shyness thermostat has become set too high by going to a social occasion that you would usually avoid, and then compare your expectations with what actually happened, e.g., “I expected nobody would want to talk to me, but I struck up a conversation with someone and it went well”.
5. Vow to test out your hypothesis that ‘other people are a potential risk’ with each new person you encounter. Most people will be okay, but know that if they prove your hypothesis to be correct by behaving badly then that says something about them, and not about you.
6. Volunteer to take a role or to host, as this allows you to approach others at the event with specific requests, such as asking them to come and eat or pose for photos. Having something to talk about or a role you have to play can be a helpful way to ease into social occasions.
7. Make a 10% change in your behavior, such as asking one more question in class or sitting one row closer to the front, and then when that proves to be survivable, make it another 10% next time.
8. Think of open ended questions ahead of time so you have something to say, such as “how did you both meet?” or “I’m looking for something decent to read, what books have you read lately that you would recommend?” Know that lots of people are either hoping someone else will take the lead, or they like talking about themselves and appreciate the opportunity!
9. Take a deep breath and commit to see a good therapist who will support you through your transition to setting your thermostat from socially anxious to liking yourself and being comfortable around other people.
10. Remember that shyness is not valued in our society, whereas being assertive and extrovert is. In fact though, shy people can be more sensitive to what is going on around them and they often make keen observers of others, which can be a skill in many areas of life. Think about this quote by John Amodeo from his book The Authentic Heart: "If you experience shyness, consider it a blessing. Shyness is an entrance into a tender fold within your authentic heart … If you can allow yourself to experience shyness when it arises—if you can gently turn your attention toward the place in your body that feels this shyness—then it becomes a friend, not a threat. Embraced shyness transforms into sweetness … As your tolerance for shyness grows, there are greater possibilities for breakthroughs into the exhilarating pleasure of connecting."

Lastly, remember that while Facebook makes it seem as though everyone except you has hundreds of friends, in reality most people have just a couple of people they can call true friends, and it is those connections that count. Focus on being more socially comfortable and eventually you will make the acquaintances that lead to real friendship.

Dr Jules

If you are facing a challenge in your life because of social anxiety and can’t see a way forward, then counselling can be helpful in providing support and a non-judgmental space to learn to find balance and confidence. For more in-depth help and counselling, consider contacting me in person. I also invite questions to be answered on my blog.

I hope you have all had a good summer and got a break from your usual routine. To get myself back into the routine of writing I have decided to take an overview of what Counselling and Psychotherapy is, as this might help any of you who are considering seeking help. While my weekly Agony Aunt column and radio slot gives me a chance to offer some general thoughts on various topics, my real ability to help people lies in the therapy work I do with people in person.

What is Counselling & Psychotherapy?
Counselling & Psychotherapy is based on talking, and the respectful and trusting relationship that builds up over time between therapist and client. Clients overcome personal difficulties and are helped to facilitate change and growth through this relationship. As a result of years of training and experience the counsellor knows how and when to ask the right questions to help the client gain insight and make effective changes.

• The counsellor gives time, attention and respect, their role is to help the understanding and change take place, not by giving advice or taking over direction from the client, but by assisting the client in their own understanding and ability to take control.
  
• The client has an opportunity to explore and understand their situation, and then discover and activate ways of living more effectively and with a greater sense of well-being. As a client you get to know yourself and understand your feelings and behavior better, which in turn helps you to feel more in control of your life.

Is there a difference between Counselling and Psychotherapy?
Counselling often focuses on a specific problem while Psychotherapy might deal with more deep seated issues and encourages you to look more closely at the past and patterns that may be repeating in your life. In practice there is a great deal of overlap between the two and while you might feel you have a preference for a particular type of therapy, in reality it is often the skill of your therapist, your motivation to change, and the quality of the relationship you develop with your therapist that will be the most powerful factors in your growth.

You talk about Psychotherapy, how is that different from the other ‘Psychs’?
Anything to do with ‘Psych’ is to do with the mind, as in the Greek word for Psyche which means a mixture of mind, feelings and spirit. Psychotherapy and Counselling refers to talk therapy which helps a person with current personal problems or a need for deeper self-exploration. This differs from Psychology which is a science exploring how the mind works and patterns of behavior in humans and animals, or Psychiatry, which is a branch of medicine where psychiatrists must first train as medical doctors, and then go on to specialize in a study of the mind and mental health. They tend to treat patients with drug therapies and have the authority to diagnose and prescribe. Sometimes clients find a mixture of drug and talk therapies to be very beneficial, so the different disciplines are not mutually exclusive.

Who goes for Counselling & Psychotherapy?
We all go through phases where we feel we can’t cope, or we feel stuck. This is quite normal and when we look back on these phases we can see that they are just part of life, but at the time we can feel overwhelmed, sad, anxious or depressed. We don’t always like to burden others with our problems; friends can be great at listening but they often have their own problems. In addition, they can find it difficult to remain objective, or we might find our problems are too personal to share with them. A therapist is trained to listen attentively and objectively, their job is to offer the concentrated time and impartial perspective that friends cannot.

Sometimes people also come to therapy when they are not in crisis, but because they are looking for a way to get to know themselves better, to improve their relationships and get more out of life.

Countless people seek help from a counsellor or psychotherapist at some point in their lives. Men, women, children, couples, individuals, families … people from all walks of life go to therapy, and needing help certainly doesn’t mean you are self-obsessed or going mad, so don’t be embarrassed to reach out and ask. The therapist won’t ‘do’ anything to you, they can’t read your mind, and they don’t rake up the past or force you to talk about something that you would prefer they didn’t.

In reality, we all know that emotional problems don’t go away if we just push through them or ignore them. Trying to do so can lead to headaches, low energy, sleep problems, stress, irritation with loved ones, depressed feelings and angry outbursts – our mental health is clearly linked to our physical health, so it makes sense to take care of both.

It is worth knowing that most therapists have been through therapy themselves, in order to deepen their understanding of themselves, to resolve their own issues, and to help their appreciation of the therapy process.

What kind of problems are typically dealt with in Therapy?
Some counsellors specialize in specific problems such as working with addiction or sexual issues, but most will cover a wide range of general problems. If you aren’t sure, then ask prospective therapists about the concerns you are having. Often people seek one to one help with a therapist and this can allow you to concentrate on yourself and your own needs. Sometimes it is also helpful to seek Couples Therapy, where you sort out your emotional problems together, or Family Therapy, which is a highly effective way of helping everyone get along rather than letting one person (often a child who is acting out) take the blame for problems in the way the family or couple is functioning. 

What happens in a Counselling Session?
Typically, a session lasts for one hour and takes place once a week or regularly over a period of weeks or months, depending on the arrangement that works best for the client and therapist. Usually there is a goal that you form with the counsellor, or something you are working towards together, and your counsellor helps you to stay on track in working towards that. You spend the hour talking together, and sometimes your therapist will suggest things they would like you to do in-between sessions, kind of like homework, to keep the momentum going.

Most people initially go for short term help to tackle a specific issue and to see if therapy works for them. As things develop you might find you want to extend the therapy, or you might want to take a break and go back for more help later.

Therapy might be offered for free through your health service or through your school or employer. Otherwise, you might want to seek a private therapist. Fees vary widely and should be openly advertised by the counsellor; there may also be some concession available if you have a low income, so it is worth asking. Counsellors often offer a free or low cost initial meeting where you can decide if you want to work together. When you first meet the counsellor, take the opportunity to ask questions and decide if this is the person you want to work with. Ask yourself if you feel comfortable being open with this person? The more open you can be, the more you will get out of the therapy process. Don’t be afraid to ask them about their training, their experience, their supervision and anything else about their counselling qualifications that seems important.

Where can I find a good counsellor or psychotherapist?
If you are in the U.K., start with your GP to see what is available on the NHS, or see if there is a service available through your school or workplace. You can also try looking on the British Association for Counselling & Psychotherapy website at http://www.itsgoodtotalk.org.uk/therapists/. If you are outside the U.K. and in Europe you can also try your local health service, or look at this site for France and Spain, and know that many therapists in Europe now offer services via Skype so that distance doesn’t have to be a problem: http://counsellinginfrance.com/

It is also worth asking around your friends and local community for recommendations to a good therapist. You might be surprised to find out how many people you know have already seen a therapist!

I am of course available to consult if you are considering entering into therapy, and I wish you the best of luck on your journey!
Dr Jules (Julie Askew, PhD).