How to cope with Coronavirus / Covid-19 and Self-Isolation or Quarantine (with print-outs)

We know that when humans live in situations where they are under a threat (like Coronavirus / Covid-19) it can have negative consequences on their psychological health. Those under threat might have disrupted thought processes and heightened risk perception, increased emotional reactions, increased perception of their own vulnerability, increased suspicion and distrust of others, reduced perceived control of situations and reduced social interactions. We also know that after ‘outbreaks’ of other diseases that depression rates go up and anxiety and panic can be triggered.

In response to these difficulties, we’ve collated a list of ways in which we can all look after our mental wellbeing, and that of those around us, from respected health authorities and sources.

How to Cope

Coping with coronavirus for the General Population

  • If you feel worried about coronavirus or Covid-19, then try not to watch, read or listen to news articles about it. If you must find out information, focus on what you can do to protect yourself and your loved ones and limit it to once a day for a short amount of time.
  • Look after yourself but also support others if they need help.
  • Share and talk about the stories of people who have recovered or who have supported someone with the virus. Offer appreciation for and celebrate those who are caring and supporting people affected.
  • The virus is affecting everyone from all ethnicities and walks of life. Be empathetic to anyone affected by it.
  • Don’t refer to people with the coronavirus as ‘victims’ or ‘cases’; they’re humans with their own identities who are a lot more than the virus that they have been unlucky enough to catch.
  • If you are healthy and have time, volunteer to support those who are self-isolating or those who are supporting people who are infected with Covid-19.

Coping with coronavirus for care-workers and health workers

  • It is normal to feel more stressed at times like these; it doesn’t mean you aren’t coping or you’re weak.
  • Take time to look after yourself physically and mentally.
  • Rest, eat, hydrate, stay active with exercise and maintain contact with people you love and trust, avoiding alcohol, tobacco or drugs.
  • Some people may want to avoid you because they think being in your presence might increase their risk of catching the virus. If this happens, try to stay in touch using digital methods and share your experiences with colleagues; they’re probably going through the same.

Coping with coronavirus for Managers

  • Communicate clearly and accurately in ways which everyone can understand.
  • Be a role model for self-care.
  • Rotate workers regularly, pair colleagues up so they have support, particularly when in the community.
  • Check that people are having enough breaks
  • Be compassionate to those whose families are affected; they might need more time out than others.
  • Signpost colleagues to places they can get physical and mental health support.
  • Ensure that colleagues are trained in basic psychological first aid.

Coping with coronavirus for those looking after children

  • Help children express their emotions through talking, play and art in a safe place; this will bring them relief.
  • Explain how to prevent infection in terms they understand, and explain why it is important. Use visual reminders and help them practice handwashing if needed.
  • Try to keep children with their parents or guardians if possible. If separated, then ensure they maintain contact through digital means or age-appropriate social media.
  • Try to be honest, in ways they can understand about what is happening and update them when there are changes to the situation as appropriate.
  • Try to keep their routine; ensure they have activities to keep them occupied.
  • Be a role model for how to cope in times of stress; they will often copy you, and if you are calm then they will reflect this.

Coping with coronavirus for those looking after older adults

  • At times of stress, older adults with physical or mental health conditions may become more anxious, agitated or withdrawn. Provide emotional support and consult local health services if needed.
  • Share information about what is going on and how to reduce risk of infection in ways which they can easily understand. Explain why it is important. Repeat if necessary, with patience.
  • Use visual reminders and help them practice handwashing if needed.

Coping with Self-isolation
Quarantine has been shown to prompt symptoms of post-traumatic stress, anger and confusion. After coming out of quarantine people have experienced stigma, financial difficulties and boredom. Even if you’re not in quarantine but are self-isolating, humans are not designed to live in social isolation.

Social isolation is linked with higher rates of depression, anxiety and mental and physical health conditions. If you are self-isolating, then you have probably changed your daily routine too; maybe you’re working from home, not going to college or school and not going to the same activities you used to. Reducing activity levels in this way is also linked with low mood and depression.

Below we’ve listed FIVE key principles of wellbeing which might help you cope with your self-isolation period.

Connect with others
Even though you’re not going to see people face to face, stay connected. Speak on the ‘phone, text, message, email, Skype or FaceTime. Maybe you can reach out to someone you haven’t spoken to for a long time. You can support each other emotionally, distract yourself from negative thoughts and emotions and still make plans for when the health risks have reduced.

Be Active
You might not be at the gym or ParkRun but it will help to stay active. Can you dance in your room to your favourite track? Can you do a yoga session you find on YouTube? Can you do a few sit-ups? Can you walk up and down stairs? If you Keep your body moving it will help your body stay in good condition and will lift your mood too. It’s also essential for a good night’s sleep.

Learn New Skills
You might feel bored at home without your normal routine. To avoid boredom and lift your mood, try learning a new skill. There are plenty of videos on YouTube for different hobbies and apps which can help you learn a language. Maybe you have some books which you always intended to read? Now might be the time to finally get round to practicing playing that instrument you started years ago! Learning a new skill gives us a sense of achievement and mastery which increases wellbeing.

Give to Others
This can be difficult when you’re not leaving your home but there are still ways to give back. You might want to volunteer for a charity helpline. You might want to offer your skills to a charity you support. Maybe there is some fundraising you can take part in. It might be as simple as helping someone you know solve a problem they have or simply listening to them on the ‘phone. Giving to others has been shown to make us happier than when others give to us.

Pay attention to the present moment
This is also known as mindfulness. It means practicing noticing what is happening right now rather than worrying about the past or the future. One way of doing this is to go through your sense one by one asking “What can I see? What can I hear? What can I feel (emotionally and physically, both inside your body and outside)? What can I smell? What can I taste?”. Take time to really find a range of different sensations, and notice when they change.

Here are some further tips which studies have shown will help you maintain mental wellbeing:
Eat regularly, and drink water: even if you don’t have an appetite, your brain needs fuel.
Keep a routine: by getting out of bed at the same time and going to bed at the same time you reduce the risk of sleep problems. Have a shower or bath just like you would normally. Get dressed for the day, even if people aren’t going to see you; the closer to normal your routine is, the easier it is for your mind and body to adjust.
Take time away from screens: Current advice is that we should turn off your screens and give your body and mind time to become less alert at least an hour before bed.

Advice Leaflets for printing

I’ve created some easy-to-read documents which you can print out and provide to any of your contacts you you think might need some tips on how to stay well, psychologically during the coronavirus outbreak.

For the general public: Coping with Covid19 Public

For staff: Covid19 Staff Advice for Coping

Sources:
World Health Organisation: BPS – COVID-19 Psych Perspectives
British Psychological Society: WHO – mental health considerations and COVID-19
Associations of Clinical Psychologists
NHS

Mindfulness: The top 5 best mindfulness apps

Mindfulness has been trendy for a while, but it’s a bit more than just a fad!

The NHS have approved its use with a variety of mental health difficulties. Most often prescribed for use with recurrent depression, frequently cited as helpful with anxiety, some studies show it helps with managing chronic pain; so if these are things you struggle with, it’s probably worth a go.

What is Mindfulness?

Originating as a non-religious version of buddhist meditation, mindfulness is a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations.

What does that actually mean in the real world?

NOTICE

Firstly, to be mindful is to notice what you’re experiencing. It might be that you notice how your body feels (i.e. tiredness), or what thoughts are racing through your head (i.e. worries about tomorrow). It might be that you feel some emotions (i.e. sadness) or you might notice an urge to do something (i.e. stand up and leave the room). You can also be mindful about what you can sense, like the sounds, smells, sights, tastes, temperatures and textures around you. Often mindfulness meditations will ask you to notice your breath, as that is one things which is always present.

ACCEPT

Secondly, if you’ve noticed something, then you accept it for what it is and try not to change it or judge it. For example, you might notice that your heart is beating quickly. Rather than judging it as ‘unhealthy’ or taking deeper breaths to try to control it, you would simply observe it and perhaps you might be curious about it, but that is all.

GUIDE BACK

Thirdly, if your brain does wander off into the content of some of your worries, or if your brain starts to judge some of the things you’ve noticed, then there’s no need to berate yourself. Gently, kindly, calmly, mindfully, choose to direct your concentration or attention back to the present moment. Often this is most easily done by re-focussing on the breath or your body.

The process is summarised by the acronym SNACK:

Sounds straightforward, so how do I learn?

It is straight forward but although it’s logical, mindfulness is a skill that needs to be learnt. For years our brains have been focussing on the past and the future and not the present; so you have to learn to be mindful.

Mindfulness is often taught in classes by mindfulness teachers who guide you through a mindful meditation. More and more, now, it is taught via CDs, YouTube and apps. Below I’ve listed some great resources but importantly, I’ve listed the Top 5 mindfulness apps 2018, as tested by me.

Once you’ve learnt the basic principles, you can then practice mindfulness wherever you are and at whatever time you choose.

Where do I find Mindfulness courses near me?

There are often plenty of free taster courses available in your local area, most classes will allow you to go along for the first class to see if it’s for you.

Some NHS services in your area provide free classes; to find a service, type in your location in this link.

MeetUp also provides links to Mindfulness courses in your area, some of which are free. You have to register first, but that’s free and then you can find every type of course, not just mindfulness.

The Top 5, Best Mindfulness Apps 2018

1. Headspace (click here for: Android / iOS)

This app is free upfront but for access to more material it’ll cost ya. The cheapest way to access the full version is to become a member of Anxiety UK (click here) for £30 and you get free Headspace access (which normally costs £70 a year)

2. Mindfulness Daily (iOS)

Free and simple. Great for beginners and has short sessions of 5 minutes but 21 different tracks so you won’t get bored.

3. Smiling Mind (click here for: Android / iOS )

This app is free and perhaps best for a wide range of ages, it has mindfulness tracks for children too, as well as adults

4. Insight Timer (Android / iOS)

This is free and has the most content. There isn’t just mindfulness on here so you’ll have to search around but there’s plenty to get going with and a lot for the more experienced mindfulness-er

5. 10% Happier (Android / iOS)

Free for the first bit and then you pay. Best for the sceptics, the busy people and those who don’t think mindfulness work on them in a million years.This app doesn’t just have mindfulness exercices, it has other techniques too but it’s put across in a no-nonsense way.

Best Mindfulness Website with free mindfulness audio tracks and resources

These sites have free audios for you to listen to online or download. Some of them also add and update their resources regularly so you’ll never run out!

Free Mindfulness (click here)

Frantic World (click here)

Mindful.org (click here)

Best Mindfulness book

Mindfulness: A Practical Guide to Finding Peace in a Frantic World by Mark Williams and Danny Penman (click here)

This seems to be a best seller, time and time again. It comes with a free CD too.

Best Mindfulness CD

Guided Mindfulness Meditation Audio CD by Jon Kabat-Zinn (click here)

This guy is the father of mindfulness so you’re in safe hands.

Anna Batho is a qualified Senior Psychological Wellbeing Practitioner, Trainee Clinical Psychologist working for the NHS and private therapist working in London and based in Stoke Newington, Dalston and Hackney.

Bereavement, Grief, Mourning and Loss

So I went on a training day about bereavement and loss, because many of the people I treat have experienced one of these, and for some of them it is this loss which stops them from moving forward. I felt I needed the training because I haven’t gone through that much loss myself and I wanted to understand their perspective a little better and how to help them.
What surprised me was that we learnt that we don’t need someone to die to feel bereaved. We can feel that loss at so many things; divorce, diagnosis of a long-term illness, redundancy, when children fly the nest; I could continue ad infinitum. And as a result I learnt that whilst I (luckily) haven’t had so many people die with whom I’m close, I have experienced some of those other losses and this can help me, and others, understand some of what people feel when they feel bereaved.

The most important lesson I learnt is that grief can be delayed or immediate, severe or mild, prolonged or brief because we are all different. And because of that, we should approach those who are grieving with an open mind, without assuming we know what has happened, what they are experiencing and what they will be going through.

How grief works (or doesn’t)

We can use different terms to signify grief but I think the best explanation of what it is is as follows:

  • Bereavement = what happens to you
  • Grief = the feeling afterwards
  • Mourning = what you do

To help us understand grief and mourning we use different models.
The one with which most of us are familiar is the Kubler-Ross model of grief which explains that following a loss, we go through different stages of grief as follows (but not in a any particular order):

• Denial – when we act as if the loved one has not gone, or avoid talking about it

• Anger – we feel angry that this has happened to them and us and dwell on the injustice

• Depression – we feel low and hopeless, demotivated to do anything because what is the point?

• Bargaining – we think of the ‘what if’s and the ‘if only’s which would have prevented it happening in the first place or which might bring them back or prevent worse happening in the future

• Acceptance – we accept that what is gone has gone and we continue with life despite this loss

A lot of us might be able to relate to this model. The difficulty with this model is that it suggests that the stages are part of a process which we go through in order to achieve something or to come out the other side. But for people who have lost someone, there is often no other side, their world is changed permanently and there is no resolution.

The simplest model of grief and mourning is the Dual Process Model of grief (Stroebe & Schut). It explains that when we’re grieving, we move from action to emotion and back again, continuously. For example, we might be consumed with sadness in the morning, but then in the afternoon we might call the funeral directors, but by the evening we might be crying uncontrollably again and then the next week we might decide to take the deceased’s clothes to the charity shop. It suggests that it is natural for us to engage in a little bit of both which I think helps us give ourselves permission to cry, to take time to dwell on things and then to throw ourselves into something practical.

A further model is the Biographical Model of grief (Walter) which simply suggests that as we talk about the lost person, and what happened and what they were like, it helps us understand and process what has happened and ‘write the last chapter’. This can help us come to terms with what has happened so that the distress we experience is reduced.

Another model which helps us understand grief is the Fried Egg model of grief. It explains that, if we imagine our grief to be the yolk of the egg and the white of the egg is the rest of our life, most of us would expect the yolk part to decrease over time; from this:


To this:


 

Not so. What changes is not the yolk (the grief), but the white (the rest of our life). Sometimes the white gets smaller so that all we can see in our life is the grief.


Sometimes the rest of our life expands, so that there is more white, and so, whilst the grief has not diminished, it is, proportionately, a smaller part of the total of what we are experiencing and focussing on.

In brief; our grief remains but our life expands. I love this model. It’s simple and makes sense and it pays respect to what is lost and does not ask us to ‘move on’.

There is an element of truth in all of these models.

When grief gets more complicated

Some people may have difficulty with some of the things which we do to cope, normally because they are concerned for your wellbeing and may interpret your behaviour as you being stuck in a certain stage of grief and that you are not ‘moving on’. I think this would only normally be a problem if you are struggling to recognise the reality of the loss or the fact that you can’t change the situation after a significant amount of time.

The reality is that when we lose someone, we are at higher risk of mental and physical health problems. So it doesn’t hurt for others to keep an eye out for you, or indeed you for yourself.

Multiple, unexpected or untimely bereavements and lack of support can have a bigger impact on those who are left. These complications can chip away at your capacity to cope, no matter how resilient you are.

If you know someone who is grieving ask yourself:

• Do they feel supported or isolated?

• Are they able to talk about feelings with family and friends?

• If the death was predicted, were they able to plan and talk about their expectations beforehand?

• Are they still in denial?

• Are they still angry?

• Are they experiencing financial or medical difficulties or another life change at the same time?

If the answer above is yes to any of these then the path of grief can be impeded and they may benefit from further support.


What helps when grieving

Support

When we talk about what’s best to do when grieving, the simplest answer is “do what you need to do”.

It means, really, that there is no formula for grieving well, because everyone is different, everyone copes differently and everyone finds different things meaningful or helpful.

We heard of a client who took her childhood teddy to a church the morning after she miscarried a child. We were told of someone who kept their grandma’s room as she left it for a year. If it helps you cope. Do it.

It’s also worth remembering that death often affects more than one person and family dynamics are complex. Everyone has different needs, expectations and desires from the beloved and others affected by the grief and this can cause conflict and confusion. It is normally impossible to manage all of this or help everyone at the same time or in the same way, so try not to make assumptions and be realistic about what you can do.

Importantly, though, the single, most positive factor in encouraging a healthy grieving journey is being able to talk, unconditionally, without judgement, about the loss with someone who listens.

For those supporting someone grieving it can be daunting.

“What should I say to someone grieving?” is something I’ve often asked others when talking with grieving individuals.

What helps, is knowing that if what they need most is someone who listens, we don’t even need to worry about what to say; someone who listens does not give advice, because responses don’t make people better, connections do.

So reaching out to them, being there, or simply saying something like “I don’t even know what to say right now I’m just so glad you told me” can be enough.

When we talk about listening, it’s not just letting someone talk but trying to understand what is happening for them. Doing this takes empathy, and it needs to come from within you (which can be exhausting) but it is, in brief:.

• Perspective taking – try to reach where they’re coming from

• No judgement – your opinion is not needed right now

• Recognising emotion – try to see what they are feeling, it might not be simple sadness

• Communicating that you recognise it – letting them know you’re understanding a little of what’s happening for them

Be mindful though, that the differences between us and the person we are supporting also make a difference to how we interpret the loss, so it’s important to be reflective and aware of this so that we can come ‘alongside’ and not project our perspective on others.

What can also help is validating and normalising what they’re going through so that they don’t feel so alone, or like they’re going out of their mind. This might come from you, but equally, support groups for those who have experienced similar situations can be hugely helpful.

Rituals

Rituals or traditions, or symbolic gestures which we do after a death can help because they mark in a symbolic way a transition from one position to another. They can be almost like a stake in the ground communicating to the world, yourself and others that something has happened and thus the world has changed but that now you are moving on your way forward.

Some different rituals which people might find helpful are:

• Burial within 24 hours

• Washing the body and preparing for the deathbed

• Playing certain music

• Sending cards

• Planting trees

• Letting balloons off

• Making memory boxes

• Funeral

• Sprinkling ashes

• Flowers set somewhere

• Writing a letter

• Lighting a candle

I hope that this article has conveyed what I feel are important and useful ideas in understanding and helping support people who are bereaved.

www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.You can contact her here.

Asking Powerful Questions

Asking the right thing,  at the right time, and listening to that answer is one of the most important skills any of us can ever learn.  But it’s an art, not a science so here I’ve tried to look at how we can ask better questions which will in turn help therapists (and anyone trying to support a friend or family member) to create meaningful,  constructive and positive conversations.

Most of us have heard of Socrates, he was a philosopher, born in Ancient Greece about 470BC.  A lot of people think of him as the father of Western Philosophy.

Many of us will have heard of Socratic questioning too, as a way of asking ourselves about things in a structured way, so that it narrows our focus in (eventually), towards the truth. It’s used in order to gain further insight into a topic, often when we already know a little bit about it.

But when is Socratic questioning useful and why is is used so often in therapy?

In the therapy world, it’s important for a client to understand what they’re going through themselves. So, Socratic questioning it is a way we can guide our client’s  discovery of their own difficulties. It’s not trick questioning where we lead the client to discover what we always knew, it’s a joint discovery where the new information provides fresh perspectives on problems and solutions.

It can be defined by:

  1. Asking the client questions about something they already know something about
  2. Drawing focus towards relevant topics but topics which may have not previously been considered
  3. Moving from a concrete issue toward a more abstract view of it
  4. Encouraging the client, at the end, to use this new information to come to a new perspective in the issue which can help them move forward

A great example of some Socratic questioning in therapy is provided below (taken from Christine Padesky’s speech to the European Congress of Behavioural and Cognitive Therapies in London in 1993):

Client: I’m a failure in every way

Therapist: You look defeated when you said that. Do you feel defeated?

C: Yes, I’m no good

T: What do you mean by that?

C: I’ve completely screwed up my life, I haven’t done anything right

T: Has something happened which led you to this conclusion or have you felt like this for a long time?

C: I think I see myself more clearly now

T: So this is a change in your thinking?

C: Yes. I went to that family reunion and saw my bother and his kids and wife. They all looked so happy. And idealised that my family’s not happy. And it’s all my fault because of my depression. If they were in my brother’s family they would be better off.

T: And so, because you care about your family you then decided you were a complete failure, that you’ve let them down.

C: Thats right.

T: You also indicated that this was a change in your thinking. You’ve been depressed many times. And you’ve seen your brother and his family many times. How did you think about this in the past?

C: I guess I always used to think I was ok because I tried to be a good father and husband, but I see now that trying isn’t enough.

T: Why is trying not enough?

C: Because no matter how hard I try, they are still not as happy as they’d be with someone else

T: Is that what they say to you?

C: No, but I can see how happy my brother’s kids are.

T: And you’d like your kids to be happier…

C: Yes

T: What things could you do differently if you were less depressed or a better father in your own eyes?

C: I think I’d like to talk to them more, laugh more, encourage them like I see my brother do

T: Are these things you could do even when you are depressed?

C: Well, yes, I think I could

T: Would that feel better to you- trying some new things as a father, rather than simply doing the same things?

C: Yes, I think it would. but I’m not sure it would be enough if I’m still depressed.

T: How would you find that out?

C: I guess I could try it out for a week or so.

I’ve also come across a few really powerful therapeutic questions that my colleagues in the therapy world use regularly to help clients explore the meaning of what they’re going through. I’ve listed a few of the best therapeutic questions below :

  • If I could wave a magic wand and you were happier, what would you be doing differently?
  • If you weren’t scared what would you do?
  • If the person you loved most in the world was thinking the way you are what would you say to them?
  • In five years from now will this situation matter?
  • What is the worst that can happen in this situation? (don’t use this as a stock phrase,  but ask this genuinely, out of interest)
  • What would your best friend say to you right now?
  • What does this say about you?
  • What does this say about others?
  • What does this say about the world we live in?
  • If someone observed you for a week, without taking to you,  what would they say you cared about most in the world?
  • What would they be surprised you care about?

Knowing the right question to ask at the right time takes skill and experience, but I believe the two most important aspects of these questions, are to ask these questions without expecting a certain answer and then to listen and react to the answer itself, not some pre-prepared structure. Then we are truly working empirically, as scientists, testing hypotheses and evaluating the results, but together with our clients.

www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.

You can contact her here.

Post Traumatic Stress Disorder – what is it and how to treat it

What is Post Traumatic Stress Disorder (PTSD)?

PTSD is when, following a traumatic incident, individuals experience distressing symptoms such as flashbacks, nightmares and intrusive thoughts about the incident. This can mean that they re-experience the event, they might avoid any memories of the event or even small triggers which bring on memories of the event and they often exhibit symptoms of low mood, anxiety and depression and negative thoughts about themselves, others or the future. Individuals with PTSD are often very sensitive to things around them; this might manifest itself in being on guard more than other people, maybe jumpy or quick to react to small things. They might also come across as more aggressive or reckless because small things might make them more stressed than usual and they therefore react in a more extreme way than they would have normally.

What kinds of traumas cause PTSD?

Normally the events are ones where the individual feared for their life or someone else’s life. Individuals can develop PTSD if they were victim to the event, saw the event or even if they heard about it happening to someone who was important to them.

Events such as road traffic accidents or assaults of any nature may bring on these symptoms, burglary and rape too. Sometimes repeated exposure to the details of an event through work can cause the same effects.

Why does it happen?

Shapiro said that when we experience a threatening event, our brain’s memory systems don’t work as well as normal. When it’s processing the traumatic event it can be too upsetting to process and so it simply doesn’t turn it into a memory. This means it remains a current event in our minds so that our body reacts as if it is in that event again, and so it can feel like it’s happening now (rather than in the past) and right here (rather than where the event happened).

How do they treat it?

Government guidelines recommend CBT therapy, EMDR or anti-anxiety and anti-depressants as a treatment for PTSD.

What is EMDR?

Do you know the saying, ‘sleep on it’? Or ‘everything feels better after a good night’s sleep’? This is because when we sleep, and enter REM (Rapid Eye Movement) sleep, the brain starts to process what happened the day before, and to make sense and store the memories of it in a helpful, useful way. This way, when we wake up, we can access the information from the day before in an easier and more accessible way. EMDR is said to work in a similar way but for traumatic events.

EMDR stands for Eye Movement Desensitisation and Reprocessing Therapy.

EMDR is complex, thorough and goes through 8 phases of treatment including History and Treatment Planning, Preparation (where trust between the client and the practitioner is established), Assessment, Desensitisation, Installation (of a new positive belief), Body Scan and Closure.

It is perhaps the Desensitisation stage for which the treatment is most known. In it, the therapist will encourage the client to identify some of the disturbing emotions they are experiencing and asks them to move their eyes through different sets of structured movements as they focus on different aspects of the trauma. This movement, which is thought to mimic that of REM, desensitises them to the trauma.

If you think that you or someone you know are suffering from PTSD and would like to receive therapy for PTSD then I would encourage you to refer yourself to your local IAPT service which is part of the NHS and which provides free treatment for this disorder. Your GP can provide this number. In Buckinghamshire please google Healthy Minds Bucks. If you do not wish to have to wait for treatment then please search for EMDR therapist in your local area.

www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.

You can contact her here.

Why Depression Happens

In this article I’d like to explain a way of looking at and understanding depression which has just been published and which I feel pulls together a lot of what we know about depression from the fields of genetics, neurochemistry, neuroscience, behavioural psychology and social psychology.  I think that, if you can understand where depression might come from and why it happens, it may help you find a way out of it.

Brief summary
Depression is the body adapting in order to conserve energy after we perceive that we’ve lost out on something important like a relationship, something which forms part of our identity (like a job) or a personal asset (such as our home, health or mobility) after we’ve invested in it. It does this, because from an evolutionary perspective, if we conserve energy then we are more likely to survive.
Below, I explain in more detail how this comes about and how it might help us to understand depression from this angle.

Predisposition
Some things can pre-dispose us to depression as follows:
Traumatic Experiences
If we’ve had early traumatic experiences – i.e. loss of a parent, abuse or a difficult childhood it an affect our brain’s development, affecting learning and memory areas of the brain which in turn makes us more vulnerable to depression.

Genetics
Genetics can play a part too. If we carry the 5-HTTPLR genetic variant (linked with serotonin which helps us maintain a good mood) or some variants of the FKBP5 gene or the BDNF gene we are more likely to experience depression following a stressful life event.  Ultimately, if our family had depression, we are more likely to develop it.

Negative Thinking Biases
Whilst we know that people who are depressed tend to notice negative information more than others, they are more sensitive to negative feedback, and remember negative information more readily, we often think it’s a symptom of depression, but actually, it may be the reverse.  If our brain works in these more biased ways, we are actually more prone to depression. This might be because certain parts of the brain simply function differently.  It might also be because the genetics we talked about above are in some way impacting on the way we process information.  Equally, the childhood trauma we spoke about may impact on these processing abilities too.

Body Sensitivity
In addition, the way our body reacts to stress may have an effect on our susceptibility to depression. If our stress regulation system (the HPA) is out of balance, then we are more prone to depression.  We’ve found that stress hormone levels are higher in depressed people when they are exposed to stressful situations.  This may even cause cells in our brain to die off which in turn can impact on the way we think and remembers things and again makes our stress reaction in the HPA even more out of balance.  The part of the brain which processes emotion (the amygdala) is activated to a higher level in individuals with both the gene variations which we spoke of earlier, and those with childhood trauma, meaning that the stress response is higher and thus linked to depression in these individuals.  This hyper-activated emotional processing means we remember things in a biased way and our emotions are more unstable too.


Low Self Esteem

The way we develop can influence our predisposition too.  If at an early age we develop low self-esteem, or develop a tendency for our self-esteem to drop when things go badly, then this can predict depression later on in life.  People with depression also tend to blame themselves and predict that things go badly and these negative beliefs keep the cycle of depression going.

Triggers
If we’re predisposed however, we normally still need something to trigger off this depression.  This theory suggests that the trigger is when we think we’ve lost something in which we’ve invested resources. This might be rejection by a lover, death of a child, and decline in productivity at work. It doesn’t have to be a singular event though, it can be a gradual build up in say, stress at work.

Depressive Belief
However, the important thing to recognise is that the things which trigger depression only have an effect when we think that we have no control over them and believe it’s irreversible.  This negative appraisal of the situation is key.
Over time, if we’re experiencing more and more stress, unfortunately we develop a lower and lower tolerance of stressful situations, because our brain is trying to protect us from the same again, so it becomes more sensitive.  Our brain has developed a ‘depressive belief’ or attitude to these situations and so small events re-ignite the distress we felt at previous situations; it then tries to solve it with depression.
How predisposition + trigger + despressive belief  = depression
So, some of us might have a pre-disposition and there may be a trigger as well as a despressive belief too.  But why does that bring on all the symptoms of depression?

How we survive
Three systems within our personality help us work towards survival – they are our emotions, our behaviours and our cognitive systems.
Our behavioural system ensures that we do things which meet our needs, our urges and cravings.
Our emotional system provides the positive and negative reinforcement which gives us feedback along the way of how we’re doing.
The cognitive system – our thoughts – is in control, coordinating the other two.

In depression we can end up doing less, thinking negatively and feeling emotionally low, sad, flat, so how does this help towards survival?  We can understand how below.

Conserving energy
Depression can be understood as a means of conserving energy.
For example, relationships allow us to achieve the evolutionary goal of survival because being in a couple gives us more protection and security, is likely to mean more resources because two people are providing an income, food, skills, resources and support.  So when a relationship stops or gets bad,  we feel the need to compensate for this loss of resources by stopping or the limiting activity which doesn’t help us survive. So we are programmed to reduce libido (because we don’t need another mouth to feed), appetite (if I eat less then I can save food for later and it will last longer),  sleep too much (to replenish energy)  and even reduce parenting skills (I need to survive, not others).
In a similar way, we can sometimes react to environmental turns for the worse such as winter weather because we see it as there being fewer resources and thus we need to spend less energy and do less.
The problem comes from the fact that this response was more useful previously, when lack of resources really would endanger our lives, and now, this isn’t the case; our depressive response might be a bit excessive. It depends on whether you’re experiencing mild or severe symptoms.
Social withdrawal, slow movements and slowing down or simplifying the way we think also help our energy conservation. This might also be the reason why we have less enjoyment when we’re feeling depressed, because our body decides to reduce the reward (or pleasure) were receive when expending energy in an aim to discourage us from doing things which will expend energy.

Maintaining Vigilance
Keeping our guard up is important for survival as we can pre-empt any threats which might endanger us.  The areas of the brain which do this are more active in depression.  Feeling restless, difficulty concentrating and insomnia may have all developed to increase our ability to notice danger, in the same way that anxiety and irritability may work – they aim to protect us from danger. Equally, social withdrawal may also help us avoid risks.

In Summary
Depression is activated by a combination of an external event and a ‘perceived loss of a vital investment’. If the individual is predisposed then there is even more likelihood that they will develop more severe adaptations and thus symptoms.
If we think of depression in evolutionary terms it acts by mobilising the behavioural, emotional and thought systems of our personality. Stress alone doesn’t make this happen but a stressful event plus a depressive belief often make us appraise a situation negatively. Thus when we think that we’ve lost something vital in which we’ve invested resources (time, effort, vulnerability) the evolutionary depressive system kicks in to help us conserve energy.
The extent to which it occurs depends on how much we feel we’ve lost. This depressive reaction can be helpful, but if we have developed feelings of hopelessness or helplessness alongside this, then the depression can become unhelpful and thus we experience severe symptoms.

There is Hope
Whilst we can’t change our genetic makeup, or our childhood, or sometimes even the stressful events themselves, there are ways forward.
Medication can of course impact on the chemical imbalance regarding serotonin, cortisol, adrenalin and other hormones for some. But the fact that this ‘depressive belief’ is part of the formula for depression is what can help us.
Ultimately, this conservation of energy (or depression) has been influenced by the way we think about a stressful situation.
We know that when our beliefs change back again the depressive response stops and this change in perspective can happen spontaneously or with our own effort.
Because this is often hard (because some of us may have had years of thinking in these depressive ways) that is where therapies can help; by helping you challenge these long-standing beliefs and attitudes and helping to re-train your brain out of the negative bias, and into a more balanced way of looking at things.

Taken from:
Beck, A. T., & Bredemeier, K. (2016). A unified model of depression integrating clinical, cognitive, biological, and evolutionary perspectives.Clinical Psychological Science, 2167702616628523.
Full article here: http://cpx.sagepub.com/content/early/2016/03/26/2167702616628523.abstract

www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.
You can contact her here.

Motivation Tips

This is one of the most common difficulties reported by clients with depression. We all know how it feels too, there can be so many things to do, and what there is to do just doesn’t appeal to us. Even worse, what there is can be so overwhelming, we don’t even know where to start or if we can cope. People who don’t have depression can often mistake it for laziness, but it’s very different, because in reality, a lack of motivation can be so debilitating, it can prevent people from going to work, getting up, washed, dressed, eating, even paying bills.

So, how do you fix it?

Well, the way motivation works is a bit like a car battery, to keep you and your life going, you can’t leave it unused for any length of time, you’ve got to take it for a run around on a regular basis. That means keeping on keeping on! Simply doing something can give it a boost to keep it going the next day, and the next, and so on.

And what to do if you have no motivation at all? There is no easy answer, you just have to force yourself to push on through, and do something. You can’t wait for motivation to come along, because it won’t.

Sometimes people find antidepressant medication useful for a short time, because it can lift your mood for long enough for you to find the will to do something, and then once you’ve got the momentum, and are living more actively, people may find that, with guidance from their GP, they can reduce their medication because the motivation has returned.

But! If you want to boost your motivation, here are some motivation tips (the last one is the best):

  • Make a plan, and write it down
  • Tell someone about your plan
  • Make your plan realistic and achievable, it may help to break your plan down into small steps
  • When it comes to it, go with the plan, not the feeling
  • Follow the 5 minute rule: tell yourself that you’ll do it for 5 minutes, and if you hate it then you can stop after 5 minutes, but most people find that once started, they want to continue