If you've experienced a traumatic event, it's essential to recognize that your feelings are normal responses to an abnormal situation. The symptoms of PTSD can feel overwhelming, but they are your brain’s way of coping and trying to make sense of what happened. Here are some evidence-based strategies that may help in the early stages of recovery. Recognize Your Reactions as a Normal Response The fear, hypervigilance, emotional numbness, or intrusive memories you’re experiencing are all common reactions after trauma. These feelings may be alarming, but they are your brain’s natural response to protect and process. You are not "going mad." Your brain is doing what it’s wired to do in times of extreme stress. Manage Intrusive Memories Through Distraction In the days and weeks following a traumatic event, you might encounter intrusive thoughts or mental images. While it's tempting to dwell on these memories, research suggests that distraction can help reduce their intensity. Engaging in focused, absorbing activities can redirect your brain and help it calm down. For instance, consider playing a visually demanding video game or doing vigorous exercise while watching something engaging. Stick to Your Routines Routine provides structure and stability — crucial elements that can feel lost after trauma. Try to maintain your usual schedule as much as possible. Even if you don’t feel like attending social events or going to work, pushing yourself to do so may ground you. These moments of normalcy can help counterbalance PTSD symptoms. Tell Your Story: Integrating the Experience Re-narrating the story of your trauma can aid the brain in processing and integrating the experience. When intrusive memories arise, consciously recount the full story. Don’t only focus on the moment of impact. Include what happened next. For example: "I was injured, but then help arrived. I went to the hospital. I was treated and kept safe." Emphasizing survival and safety can help your brain move the memory from crisis mode to something it can file away. Challenge “What If” Thinking After trauma, your mind may flood you with hypothetical scenarios: “What if it had been worse?” or “What if someone else had been hurt?” These thoughts attempt to predict and prevent future harm, but they often feed anxiety and keep you stuck in survival mode. Acknowledge these thoughts, but avoid engaging with them. Remind yourself: “That didn’t happen. I am safe now.” Gradually Revisit the Scene of the Trauma Avoiding the place where the trauma occurred can reinforce fear. When you feel ready, consider revisiting it gradually. Use a “fear ladder” approach. For example, if your trauma happened on a train, start by visiting a station. Then sit on a platform, and eventually take a short train ride. Once you’re comfortable, work up to returning to the location itself. Facing the fear in manageable steps can help your brain relearn that the place is no longer dangerous. Reconnect With Enjoyable Activities Even if these activities don’t bring immediate pleasure, engaging in hobbies, socializing, or spending time in nature can help restore a sense of normalcy and joy. These activities activate parts of the brain that trauma tends to shut down, playing an important role in recovery. Seek Support: You Are Not Alone You don’t need to navigate PTSD alone. These strategies may help, but support from a qualified therapist can make a significant difference. Reaching out for help is a sign of strength, not weakness. Consider finding a professional who can guide you through the healing process. Conclusion In conclusion, healing from PTSD takes time and effort. Remember to be patient with yourself as you work through your feelings. By implementing these strategies and seeking support, you can navigate your way through this challenging journey. Always remember that you are not alone, and help is available. Lastly, the recovery process can sometimes be more effective with guidance. So, if you're feeling overwhelmed, consider professional support. It might just change your life.

The benefits of exercise on stress and how to get yourself exercising. The evidence on the link between exercise and improved mood, concentration, health and wellbeing is strong, clear and consistent. Amongst the most common findings cited are that: · Exercise increases bodies production of endorphins · Exercise clears the mind of repetitive thoughts and worries · Exercise raises your mood · Exercises improves the quality of your sleep The mechanism for these effects are thought to be multiple. For example exercise is thought to act by increasing the neurotransmitter serotonin (acted on by antidepressants). It increases the growth of neurons thereby influences adaptive brain functioning. It regulates sleep which acts to support and facilitate many health giving processes. In psychological terms exercises provides a productive, effective activity which is often lacking in other environments. It facilitates social engagement and structures free time. Finally there is evidence that exercises boosts the brains ability to deal with stress and heightened emotions. Since exercise is so effective why is it that it is so difficult to stick with? One reason may be that there are so many pulls on our time and attention. We are motivated to exercise but our concentration and attention is often pulled in other directions. How to motivate yourself to exercise: An effective way to think about motivation is as something which is multiple. Think of yourself as having lots of motivations rather than having one pot of motivation which runs to empty by the end (or even the middle) of the day. You might be motivated to go to the gym but also motivated to watch the television. Motivated to eat dinner but also motivated to look online for a new car. Now one way to use this conception of motivation is to ensure the behaviour you would like to increase becomes the behaviour you are most reminded about. So if you were to see your trainers in the hallway as you get home you would be more likely to be motivated to go to the gym then if you were to enter the sitting room and see the tv. Another effective strategy arising from this way of seeing motivation is to link a big motivator (catching up on an audiobook) with something less motivating (going for a run). The important thing is to limit listening to an audiobook to the gym so that you have to go to find out what happened next…. Routine is your friend. If Tuesday, Thursday and Saturday all become associated with some form of exercise then you are reminded of your intention and other activities are less likely to pop into your schedule and sideline exercise. If you’re motivated by socialising aim for a sport which will allow this such as tennis, squash or badminton. Arrange to exercise with a friend. And finally….. Don’t be overambitious. Aim for small regular doses rather than overdoing it less often. If you are new to exercise go for low impact exercise initially. High impact exercise, which causes discomfort, is linked to exercise drop out when you begin exercising. There are some great online exercises classes available. Combine these online exercises classes with going to the gym to help you stay interested. Don’t forget walking. Walking to work once a week can be recuperative and strengthening and allows you to step off the treadmill of the commute. Finally for a doubly effective boost to your mood and mental strength exercise outside. Mountain biking, open air football, jogging on the Heath all provide dual benefits. See for example Weir (2011) The Exercise Effect. The American Psychological Association, 42 (11), p48.

Research shows that if we have the same routine for between thirty minutes and an hour each evening before going to sleep, then our brains develop the understanding that that particular set of behaviours results in us going to sleep. After a short time of having the same routine each night, when we carry out the first behaviour in the set of behaviours, our brain starts to shut down in preparation for sleep. As such, a sleep routine is really important. A sleep routine is very much dependent on the type of evening that we generally have but a typical sleep routine might look like the following: 1. Watch something on the computer or TV downstairs sitting on a chair. 2. At 10pm turn off the computer and the TV. 3. Place items in the kitchen and turn off the lights. 4. Go in to the bathroom and have a shower/wash/brush teeth. 5. Go back in to bedroom and dim the room lights. 6. Change in to night clothes. 7. Get in to bed and do whatever it is that you generally do before sleep. Ideally, this would be to read but it is important to remember that the hue from some gadgets will tell the brain that it is day time, so the light of the gadget needs to be turned down or turned to a red hue. 8. As soon as you feel sleepy then go to sleep. 9. Do not finish the page or decide to watch the end of the program, as you can pass through a sleepy stage and in to a wakeful stage and it is far more difficult to get to sleep in a wakeful stage. 10. If, after 20 minutes of trying to sleep, you feel awake, or if you were not tired when you came in to your bedroom, then sit somewhere that is not your bed (bed must be only associated with sleep) and do some relaxation exercises. Please see 'breath work' and 'progressive muscle relaxation' for two examples. 11. Watch and wait until you feel tired and as soon as you do get in to bed and relax. For more tips on getting to sleep - please see the other sleep articles in this series.

For most people there is nothing better than getting in to bed and relaxing before dropping off to sleep. For others, this process can be a painful one of fretting, worrying and hours of trying to sleep. Here we will briefly outline the important areas of consideration when wanting to drop off easily. Let’s begin with the important things to remember during the day. Day-time events: · It is important to try to exercise each day – if we use our muscles during the day this can help us to sleep better at night. · It is important to watch our caffeine intake. We are all different here, but if you are someone that is affected by caffeine then try not to consume it after lunch-time; instead stick to decaffeinated drinks. Do remember, though, that some decaffeinated coffees still have caffeine in them. Environmental factors: · The temperature of the bedroom: not too hot or too cold. · The light of the bedroom: make sure there is no outside light coming in. · The amount of light that we have in the hour before we sleep is also important: turn any bright lights down and make sure we block out light from outside. If you can, turn any gadgets to a red hue. Waking and sleeping times: · It is important, if we have problems with insomnia, for us to go to sleep at around the same time each night. Our brain takes in light during the day to help the brain decide when it is time for sleep. If we sleep at around the same time, the brain will make the connection between that time and sleep and will start to prepare for sleep, which will help us if we struggle with getting to sleep. · Waking up at the same time is also important. If we wake up at the same time each morning then we will naturally be sleepy at around the same time every night. As already mentioned, our brain gets used to this and expects this and then will also begin to switch off when we are coming close to that time. · Sleep Routine: it is also important to remember to carry out a sleep routine (please see the ‘sleep routine’ information in this series). So, we are finally at the point of getting in to bed! Circadian Rhythms: · You may have heard of circadian rhythms. These are the rhythms of the brain that make us feel awake and sleepy. They are influencing our brain during the day but they become more prominent when we are getting ready to sleep. · Our circadian rhythms take us through ‘sleepy’ stages and ‘wakeful’ stages. Have you ever had the experience of sitting in front of the TV and feeling like you are just about to fall to sleep? You get up and turn off the TV, take the cup or glass in to the kitchen, turn off whatever needs to be turned off and get your home ready for the night. You then go to the bathroom and prepare for bed – wash and brush your teeth. You then get changed ready for bed and then when you finally get in to bed you feel wide awake. How annoying! This is your circadian rhythms at play: you have passed through a sleepy stage and you have arrived at a wakeful stage. · There is about 45 minutes between the height of a ‘wakeful’ stage and the middle of a ‘sleepy’ stage. There is no point in trying to sleep during a wakeful stage. o The best course of action is to relax in bed – read or do something that relaxes you. Nowadays, there are lots of relaxation apps or videos to listen to on YouTube. Please find one that works for you and have it ready to listen to when you go to bed. We have examples of ‘breath work’ and ‘progressive muscle relaxation’ in the anxiety series – it is important to familiarise yourself with them, so you don’t have to read them when trying to sleep. o Wait until you feel your sleepy stage coming on and then tuck in to bed and allow yourself to fall to sleep. Troubleshooting: · What happens if you don’t fall gently off to sleep? Firstly, it may be because your brain has associated getting in to bed with fretting and worrying about things. It is important for this association to be broken but it can take months for this to happen. · Firstly, if worrying about something is keeping you awake. Write it down and put aside a time in your diary to deal with it (this is, of course, easier said than done sometimes). · Secondly, make sure that all you do in bed is sleep. Your bed has to be associated with sleep. Not with working, or watching films or reading for hours and hours on end. · It is important to try to get to sleep for about twenty minutes by doing relaxation exercises. If this fails and you still feel wide awake then get out of bed and sit in a chair, on cushions or a beanbag – anything that is comfortable but is out of bed. Sit wrapped in a blanket to keep warm and repeat all of the relaxation tasks. · We are all aware of the feeling that we have just before we fall to sleep – we are suddenly thinking less and the body feels relaxed. At that point, get back in to bed and fall to sleep. · If that does not work, then repeat the above time and time again until it does work.

What is depression? The term depression comes from the Latin ‘deprimere’ which means to ‘press down’. It is far more, however, than just feeling down and affects not only how we feel but how we think about things, our concentration, sleep, energy levels and interest in hobbies, for instance. Officially, the symptoms of depression are the following: - Low mood -Marked loss of pleasure Plus 4 of the following: - Significant change in appetite and a loss of 5% of body weight - Disturbed sleep - Agitation or feeling of being slowed down - Loss of energy every day - Feeling worthless, having low self esteem and feeling guilty - Loss of ability to concentrate - Thoughts of suicide There are different types of depression but whichever you are experiencing it is likely that it will be very disturbing to your life. What causes depression? Sometimes depression results from something that has been ‘turned on’ in us. Some aspects of depression seem to relate to mechanisms that evolved a long time ago, for instance coping with the loss of a loved one, being subordinated, defeated or trapped. How can CBT help with depression? CBT (cognitive behaviour therapy) can help on various levels with depression. If we think about the different parts of the CBT model, which outlines that a human function is made up of thoughts, feelings, behaviours and physical sensations. In treating depression it is helpful to think of each of these in turn. Looking at physical reactions – breathing and relaxation As depression is often related to an overloading of the stress system, and excessive cortisol, it can be helpful as part of therapy to start to get this under better control. Ways of doing this can include breathing exercises (please see ‘Breath Work’ in this series), and relaxation strategies, so that you can start to become more aware of your stress and have some control over your bodily reactions. At this early stage it can also be good to start looking at strategies to stay in the moment, such as mindfulness, which help to add to the feeling of being in control and help to prevent the mind wandering into a negative spiral, which can bring in the physical symptoms of stress. Changing behaviours – encouraging activity When someone is depressed they often feel that they have no energy, or that they have lost excitement for things they once used to do. It can be the case that they may be at work and functioning, and just stopped doing their hobbies. Or their depression could be more severe and they could find that they cannot even get up, shower and brush their teeth. One initial step is therefore to look at the amount of physical activity they are doing in a day, and try to increase it, with ‘activity scheduling’. This helps to reduce low mood on the basis that if someone is giving in to the low mood and not doing anything, the more they do that - the more depressed they are likely to feel. So, if they are able to do the opposite, and engage in activity, this should improve their mood. You may then in therapy devise a weekly schedule of things you will try to do, based on your current functioning. At some stage of therapy it can be helpful to introduce behavioural experiments, which look at helping you to tackle some of the situations which your depression is making difficult for you. For instance, if you used to like playing tennis, and have felt unable to go because of your mood, it could be that in therapy you design an experiment to go and visit the tennis court, or go with a friend and just play for a few minutes, as an initial step. Later experiments could help to build on this, encouraging you to be able to stay for longer, until you are able to return to your original activity. The experiment would support you as well, by helping to think about any barriers that might get in the way, and what help you might need. Managing difficult thoughts and feelings People with depression tend to have a negative thought pattern, which involves negative thoughts about themselves, the world and their future. CBT can help by initially using diaries to track the ‘automatic thoughts’ which come into your mind, for instance, ‘I can never do things right’ or ‘No one likes me’. Being able to be aware of these thoughts is a helpful first step to being able to change them. Sometimes, if you are aware of a change in your mood, that can help to alert you to what is going on in your mind. Challenging thoughts, and showing compassion The next step, once you are able to identify your thoughts in a particular situation, is to start thinking about how you can answer those thoughts back. For instance, if you were waiting for a friend to call and they don’t, and then you find yourself thinking ‘no-one cares about me’, then you can start to unpick this and assess the reality of this. Is there an alternative explanation, and what might that be? The friend may have been busy, could be unwell and therefore no deliberately trying to avoid you, for instance. It can also be good at this stage to start to develop feelings of compassion towards yourself, and to say, what would someone who cares about me think right now? How can I be kinder to myself in this situation? Understanding the patterns of your thinking Once you have spent some time assessing your thoughts, it can be good to start identifying the patterns in your thinking. We often find that people have a tendency towards particular patterns such as overgeneralising, for instance when something goes wrong, saying to yourself, ‘everything in my life ends badly’. Another common pattern is people jumping to conclusions for instance if you were not invited to a friend’s party, assuming that you have upset them, without waiting to find out what happened. These patterns can be helpful to understand, as they show us the ‘rules for living’ that we have identified for ourselves, which can often not serve us well. Looking at core beliefs In therapy, the process of looking at thought patterns and thinking errors can allow you to identify the core beliefs that you have about yourself which are likely to be driving your behaviour. For instance, you might identify that you often have thoughts around being accepted by others, and you may have the underlying belief that you are not loveable. You might alternatively have thoughts about your worth, and assume that you will fail at things and therefore it is not worth trying; ‘I’m a failure’ or ‘I’m not good enough’. Sometimes it can be helpful to explore the origins of these beliefs, but it can also be helpful to look at ways to show exceptions to these ways of looking at yourself. For instance, in the example of not being good enough, you might monitor times when you do feel good enough, and also think about ways in which you were good enough in the past. The depressed brain state can make these beliefs hard to access without the right support. Case example (This is a fictitious example for the purpose of illustration only) Angela was in her early forties, she had been feeling depressed for a few months following the end of her marriage. She found that she was frequently irritable, and wanted to escape from her children who were 6 and 3 years old respectively. She felt guilty about wanting to be away from them but irritated by them as well, which meant she was often short tempered. She had had to take some time off work as she felt unable to concentrate, and at times her mood dipped to the point where she was feeling suicidal. She felt tired most of the time, but was also having problems sleeping at night. She found herself withdrawing from her friends, and also stopped going to the gym as she felt she lacked the energy. In Angela’s case, her depression was triggered by the loss of a loved one (her spouse, with the end of the relationship) and she felt trapped in her role as a single parent. Therapy for Angela started by looking at how to help her to gain some control of her stressful reactions through the use of relaxation and breathing techniques. She also started using mindfulness (please see ‘Controlling Unhelpful Thoughts’ in this series) to help her stay focused on times when she was with her children, and not get distracted by her depressed mood. She reported finding that focusing on the present, through the mindfulness strategies also helped her to stay in the moment, and take one day at a time, and not become preoccupied with uncertainty around her future due to her changed circumstances. Her therapist helped her to start building more activity into her week, including taking the children to activities, and helping her to attend work again. Getting back to the gym was more difficult as she was feeling a lack of confidence from the marriage break up, and she was given the homework task of trying to go first to the entrance, and then to the changing room, before going to a 20 minute session and then being able to get back to a class. She was feeling that others would ask where she had been and she would feel self-conscious. In therapy she discussed what she could say in those situations, but once she returned there she found that she was welcomed and that people had missed her. Angela got into the habit of tracking her thoughts, and found that she was often feeling hopeless about the future, that she was ugly and no-one liked her. She gradually started to challenge these thoughts, as her mood improved, so that she could realise that she still had goals and things to look forward to, and her taking care of herself better helped her feel better about herself generally. She started to try and challenge the beliefs around her not being good enough, by being kinder to herself and more realistic about her expectations. By Gemma Lutwyche

The 'Observing Mind' and the 'Thinking Mind' You may have heard the term ‘ mindfulness ’. One way of explaining this is in terms of the Observing Mind and the Thinking Mind. The Thinking Mind is something which switches on from the moment we wake up and it continues throughout the day. We think about the future, the past, what we are going to eat, what we are going to do that day, conversations, what people are saying, what people think, etcetera. Off it goes from the moment we wake up, and we hardly get any rest from it until the moment that we go to sleep. There is another part of our mind which we call the Observing Mind, which is the part of the mind that uses the senses in order to be in the present moment. We might use the example of people who enjoy walking: they may walk up a hill and then suddenly at the top see a beautiful scene of countryside that goes on for miles and miles, and in that moment they stop and just look at what they can see. It is not that they are thinking about the view but they are experiencing the view through the sense of sight. Or it might be that we walk out into the garden or from our front door and hear birdsong, so we may stop and listen to the birdsong. It is not that we are thinking about the birdsong, it is just that we are using our hearing sense to listen to the birdsong. In those Observing Mind moments, it is not that we are thinking about what we are doing, it is that we are using our senses to experience whatever is happening in that moment. Everyone has something which they become immersed in: it may be watching our children play, going for a walks, playing a musical instrument, cooking or gardening. We all recognised that in those moments, we have a moment of calm. What psychologists have noticed is that children are using their Observing Mind far more than they are using their Thinking Mind. If you ask a child who is young enough ‘what are you thinking about?’ they will describe what they are doing or what they see or what they hear. At some point we lose this and the Thinking Mind becomes the more prominent mind that we use. During our teenage years we use the Observing Mind less and less, and through a lack of use we lose the ability to be able to use it. It is very difficult to develop the Observing Mind; studies have shown that even Buddhist Monks who spend hours a day meditating or being ‘mindful’ find it very difficult to focus or use their Observing Mind all of the time. The Thinking Mind comes in and it takes over. We have evolved to think; thinking is a survival mechanism. We need to think about the past in order to learn from it and we need to think about the future in order to plan for it and overcome any difficulties that we may face. In order to harness the Observing Mind there are a number of strategies that we can use: · You might sit in the room that you are in and you might spend a few minutes just describing to yourself exactly what you see. Do not think about what you see, just name the colours, the patterns, the structure, the size, etc. We may have been in a particular room multiple times but not actually taken in every detail. · You might spend a few minutes listening to noises. Generally, we are not aware of noises until we actually tune into them. They do not have to be prominent noises, it does not have to be birdsong. It could just be the sound of the creaking of buildings, the sound of air-conditioning or the sound of breathing, talking or laughter. Developing the Observing Mind does not have to be something that you sit down to do for forty minutes each day, although the research does suggest that this can bring significant benefits. In our busy lives it can be difficult for anyone to do this. But setting a reminder on your phone every hour just to spend a few moments observing what is going on around you and using your senses to be in the moment and stop the thinking thoughts. Then when we are in a very difficult situation and we find that our thoughts are incredibly unhelpful and we would like to stop them we can use this strategy in order to help us distract from our unhelpful thoughts.

We have talked about overcoming anxiety in this series but how to overcome panic is different. With panic - the symptoms are generally so awful that we think we are going to die. Why then, would we not avoid situations where those symptoms come up? The problem here is that by avoiding the situations we are not finding out if the thing we fear will happen and then the fear continues. This is the fundamental element of overcoming panic....you must test out your fear. Firstly, write down the thing that you fear. Generally with panic it will be 'I might die' or 'I will faint' or 'I will make a fool of myself and everyone will think I am crazy' or 'I will go crazy with fear'. None of these are pleasant to say the least. To overcome panic we have to test out our fears. Who likes the idea of seeing if you might die? Or go 'crazy'? We might as well ask you to jump in to a sea full of sharks and keep your fingers crossed. But don't worry......because by doing the following you can live a life without panic and imagine how wonderful that would be. The next task is to write down all the things down that you are avoiding due to your fear. Rate them from 0 (no fear) to 10 (high fear). Then put them all in a list from lowest to highest. There is some suggestion that we then group them in to 'low fear' 'medium fear' and 'high fear'. It is important to think through each situation carefully. For example, if a person's fear is that they will have a panic attack on the underground...they will need to break this down in to steps. For example: - Go to the station with a trusted other when it is quiet. - Go to the station with a trusted other when it is quiet and sit on the platform. - Go to the station alone when it is quiet. - Go to the station alone when it is quiet and sit on the platform. - Go one stop on the tube with a trusted other. - Go one stop on the tube alone. - Then you would increase the distance that you go on the tube and differ the times that you go in order to increase the amount of people that are around. - Eventually, you want to be travelling along the busiest line at rush hour. Remember, the idea when overcoming panic is to go in to a situation that we believe will bring on panic symptoms and remain in that situation until we have seen whether the thing that we fear happens. This is not too easy when the thing we fear happening is death! That is why this can be so difficult but only YOU can find the strength and determination to do this. There is no one else who can make you do this...just you. Some people find writing a statement that they can read to themselves before they go in to a situation that they believe will bring on panic. This might be: - You have faced fears before and you can face this one. - Just take one step at a time. - Remember how awful life is living with panic and this will help me to overcome it. - Imagine a life without panic - how wonderful that would be. - Think of all the things I could do if I were not crippled by panic. Another strategy to help you to remain in a situation, rather than running away from it when every bone and muscle in your body is telling you to escape - is to do a body scan. This needs to be practiced thoroughly before going in to a situation where you will experience symptoms of panic, otherwise the panic symptoms will overcome you. Please click on the video for a guided body scan. Just think of how you will feel when you have faced and overcome the thing you fear. Good Luck!

E MDR (Eye Movement Desensitisation and Reprocessing) What is EMDR? EMDR is a form of therapy based on the understanding that the experience of trauma can affect the way the brain processes memories. Memories of a traumatic event can be overwhelming and intense. People struggling with trauma can feel as though they are actually reliving the event and re-experiencing the things that happened, and which they have remembered. The approach was started by Francine Shapiro, a psychologist, who in 1987 made the chance observation that under certain conditions eye movements can reduce the intensity of distressing thoughts. It has evolved since this time and is now a standardized set of protocols which incorporate elements from different treatment approaches, and extend beyond the use of just eye movements. What does EMDR do? EMDR enables you to revisit your trauma in a safe and therapeutic environment and reduce the intensity of these memories so that you no longer relive your experience. In terms of how this works, no-one knows exactly how any form of therapy works neurobiologically. However, we know that brain processing is affected when someone is upset, and traumatic memories can therefore be ‘frozen in time’ in the brain. These memories can have a negative impact on a person’s beliefs, thoughts and behaviour. EMDR seems to return the brain’s processing to a more normal level. It is thought to work a bit like REM (rapid eye movement) or dreaming sleep, where the brain sorts through the information it needs and incorporates and integrates it into the memory networks in the brain. The result, therefore, is to reduce the emotional intensity of the memory, whilst not removing the memory itself. What happens in a session of EMDR? An EMDR therapist will ask you to concentrate your mind on your trauma whist at the same time providing your brain with sensory input. The sensory input could take one of several different forms, but the important factor is that the input provides bilateral stimulation of the brain. The methods can include, for instance, tapping both of your knees, listening to sounds through headphones, or following your therapists fingers with your eyes. It is thought that recalling memories whilst also receiving this external stimulus enables the brain to change the way in which the memories are processed. Experience during a session may include changes in thoughts, images or feelings. At the end of successful treatment you will still be able to recall the events, but the sense of distress should leave you. What can EMDR be used for? EMDR is most known as a treatment for PTSD (Post-traumatic stress disorder). However, clinicians have reported that it has also been used successfully to treat problems where there has been some kind of difficult emotional experience, such as: Anxiety and panic attacks Sleep problems Depression Problems with self-esteem Pain Phobias Grief Stress Addictions Relationship difficulties including childhood attachment trauma By Gemma Lutwyche

Anxiety and stress in children can show up in a number of ways. This can depend on your child’s age, personality and coping skills, for instance. As a result of this, the symptoms can sometimes be hard to spot. This article will help you as a parent to be able to spot and make sense of your child’s anxiety, and have some strategies to help them manage their feelings. Symptoms of anxiety If you think about it in terms of how the body reacts to stress and anxiety, it is to make sure that you are ready to either fight or flee, the ‘flight or flight’ response as it is called. So, the symptoms tend to be a manifestation of this, but they lasts longer than a fleeting moment and become more of a feature of day to day behaviour, thoughts and emotions. In terms of trying to flee, you might see your child withdrawing from activities they used to enjoy, or saying they don’t want to go to school. They might have problems concentrating or sleeping, or they could develop a nervous habit such as pulling their hair or biting their nails. They might complain of physical symptoms associated with being in a high state of alert from anxiety, such as headaches, or stomach pains, and this could lead to problems with eating. They might also wet the bed. They may ask for a lot of reassurance, either about their health, or about situations they find themselves in. Some children respond more with the ‘fight’ response, and in this situation, you might have observed your child becoming more oppositional or argumentative, being short tempered, moody or aggressive. They might get into trouble at school. It is easy to see this as just bad behaviour, but if this represents quite a change for them, then it might be worth talking to them to see if there is something bothering them. What causes anxiety in children? What children need mostly is some security and routine. Anything which impacts on this could have a negative impact on their emotions. So, for instance, moving home, having a new baby, a parent getting a new job which takes them out of the house for longer, could all be triggers for anxious feelings. Arguments at home, or family separation can be particularly difficult. Children rely on consistency, and are so sensitive to change, because they are faced with so much new information each day, if things which are usually settled are suddenly different, then this can be overwhelming. Other issues such as tests and exams, or having learning problems, can also make them feel anxious as they can affect their self esteem. If other children at school are bullying them, then this can affect their sense of belonging, and make them feel worried. Some children can be worried by things they watch on the TV, for instance even the news, if they get anxious about negative news stories and how they could affect themselves or their family. What can I do if I think my child is stressed or anxious? Firstly, it is good to talk to them, and find out what is happening. Is it something that they have misunderstood, and maybe worrying about needlessly? Or is it something you can resolve? If that is not the case, or if you feel that they need some more support from you, then it is first helpful to explain a bit more about why we get anxious and what it feels like, so they can understand it better. I often talk about anxiety being like a table with four legs; these legs are the physical feelings, emotions, thoughts and actions. So, for instance if your child has just got a new sibling, their ‘table’ might look like this: - Emotions: anxious, angry, and jealous. - Physical sensations: tummy ache, headache - Thoughts: no one cares about me anymore, I’m not important - Behaviours: being more clingy, finding ways to get attention These legs all work together to keep the anxiety (table top) up, and the way to resolve this is to knock the legs away, and bring the anxious feelings down. Helping them to work on their anxiety The reason behind the anxiety will obviously shape what is the best way to resolve how they are feeling. However, some basic principles can be of help. Emotions : in relation to this, after they have learned a bit about how anxiety works, then helping them identify when they are feeling anxious can be really helpful. It is sometimes useful to think with them about what the anxiety looks like, for instance by drawing it, or giving it a name. This helps them to realise that they are separate from it, and gives them a sense of control over it. If they had called the worry their ‘scary monster’ for instance, you might notice them withdrawing and say ‘I wonder if you are getting that feeling in your tummy now, has the scary monster come to bother you again?’ Depending on your child’s age, you could also think with them about how much the anxiety is bothering them, from 0-10, or use sad and happy faces if they are a bit younger. Physical feelings : Activities such as breathing and relaxation can be helpful for children. For younger children, you could get them to pretend to blow up a balloon when they get the anxious feelings, or you could get them to imagine they are floppy ‘like a rag doll’ to help them relax. If they are a bit older, then doing some basic breathing strategies, or tensing and releasing type relaxation, could work for them. Please see the other articles we have written to help here. Thoughts : If you notice that they are often down on themselves, for instance if they are worried that they have to take a test and they are saying things like, ‘What if I do badly? What if I don’t know how to answer the questions?’ then it is helpful to think with them about how they can answer those thoughts back. How true is it that they will do badly? What would their friend say if they told them they were worrying? What would happen if they did do badly? This approach can also work in helping them solve situations that they are worried about, for instance helping them to work out the best way to proceed if they are not sure what to do. For instance’ helping them think about the pros and cons of different choices can help them feel more confident in making decisions. Another strategy which can be helpful is to set aside a time to talk to your child each day, if they are worried. Getting them to write down their worries in a notebook, or put them in a box, and then go through them at your assigned time can help to create some structure, so that the worries don’t take over. You could encourage them to put the worries out of their mind, unless it is the time to discuss them. Younger children may benefit from their parent keeping hold of the box, as this helps them feel like their grown up is taking care of the worries and gives the child more of a feeling of being looked after. Behavioural : This part involves thinking about what they can do differently to help fight the anxiety. For instance, is the anxiety stopping them from doing something? One way to help them with these kinds of problems is to break the issue down into manageable parts. For instance, they might be worried about performing at their school assembly. You might get them to build their confidence by initially getting them to practise on their own in their room, then in front of just you, then a small group of people, and so on. They could make use of some of the other strategies above, to get control of difficult thoughts and physical sensations and gradually build their confidence. If you know that there are difficult events coming up or changes which will impact on your child, it can be helpful to talk to them about this, so that they are prepared, and you can think with them about what they might need to be able to cope. How you manage stress matters too! Another point is about how you as a parent both manage your own anxiety, and how you show that to your child. I’ve often heard parents say to me, ‘so it’s all my fault!’ I usually respond that that’s not a helpful way to look at it, but you are a huge part of the solution. They will always look to their parents as models for their own behaviour, so it might be helpful to think about whether you are taking enough care of yourself, and managing your own stress. Could you also benefit from doing some breathing, or relaxation, or challenging yourself when you doubt yourself? Also, are you able to manage your own feelings, so that you are able to hold your child’s in mind, and help prepare them for any changes and tricky situations? This is not about being a perfect parent, but about modelling how you can manage difficult feelings and cope with challenging situations, in a way to allow you to get past them. A final note… If after trying these strategies you are still concerned about your child, please seek professional advice. By Gemma Lutwyche

So, we are all stuck at home, only allowed out for limited reasons. The kids are off school, you and your partner are probably working from home. The usual stresses and responsibilities you have are somewhat reduced, you can’t shop for fun, meet friends for coffee, go and see family or go to the gym, to name a few things. What ever you are facing during this time, it is likely that your pace of life has changed. Although many are enjoying the different pace of life, for some, there are added stressors, such as trying to manage work alongside homeschooling. But in amongst all this stress, what can you do? What is the opportunity? What can you do that will make a difference in your life? This free time stuck at home gives a rare opportunity. I have heard many times in therapy, ‘I haven’t had time to think about what we discussed last session.’ This is a common and understandable barrier in our busy lives. However, you now have free time that you are unlikely to get again, EVER! So, you can either binge on Netflix, become a TV expert, or you take the time for some in depth self development, knowing that you have the time, both mentally and physically, to devote to it. Therapy involves changes in insight, being reflective, learning new patterns of thinking and behaviour. There will be elements of practical applications which might be more challenging to actually do right now, but the mental reflections, reading and exploration you could do make this a time of potentially tremendous growth and development. You will need to set aside some time each week, or even each day, if you can. You can devote some of this time to reflect on something that you have been putting off...maybe something that was niggling in the back of your mind. There are a number of books that we would recommend that have helped us during our years of being therapists. If you have a particular issues, such as OCD, an Eating Disorder or another specific issue, then the 'Overcoming' series of books are a useful read. If you are someone who is highly self-critical then Paul Gilberts work focusing on Compassion Focused Therapy is used by thousands of psychologists across the country. Other work, such as Acceptance and Commitment Therapy, is useful across the board and can help us to see our behaviours and thoughts from another angle. Russ Harris' 'The Happiness Trap' is another well used book by psychologists and clients alike. Focusing more on younger children, a book that underpins most NHS led parenting workshops is Webster-Stratton's 'The Incredible Years'. This has some good tips for all parents and not just those who are struggling. For those with older children, 'The Teenage Brain' may be of use. Although this does not provide any specific strategies for dealing with teenagers, as one mother said, it made her feel she was not the only person who got it wrong! If you feel you finally have a bit of time to develop further skills relating to your psychological health or understand something further, at DSA we are still providing therapy. We can do this over the phone or via video conferencing. Many individuals feel that therapy can not be conducted over a video call but actually we have found that it can work just as well. If you have worries about remote/online therapy, just bear in mind that if you are comfortable with video calls, then you will probably be very comfortable using this medium for therapy. So, you could either come out of this and resume your life as it was, or you could use the opportunity to learn new insights and skills, and heal any emotional wounds. This could help you to come out of the lockdown with an increased strength, able to have greater impact and success.

It can be very distressing to have an anxious child. Perhaps they are refusing to go and meet with family, complaining they have a stomach ache. Maybe they are declining invites to a friend’s house, and cannot explain why they don’t want to go. It is common to find that all the reassurance, compassion and kind words have no impact on the situation. Anxiety happens in children and teens much as it does with adults. Something feels like a threat, and our fight or flight response kicks in, with cortisol and adrenaline being produced at a rapid rate. This can make them feel dizzy, nauseous, tight-chested, hot and sweaty. They might experience hot flashes, fast breathing, and tight muscles. These feelings can impact on what your child is able to participate in, for instance finding it hard to sleep, go to school or socialise. Below are some ideas to try to help relieve your child’s physical symptoms. Please be aware that this article just focuses on the physical strategies, and there may be some other solutions which are more thought or behaviour based which they could benefit from. I would advise giving any strategy a good try, before you decide that it is not the right one for your child. Although they are broadly divided into strategies for children and teens, some of these are interchangeable, depending on their developmental level and their interests. Strategies for children Deep breathing: This is something they can practice when they are feeling calm, and can then be of use when they are feeling anxious to help calm their heart rate and manage their physical symptoms. Having a visual focus can help them learn these techniques more effectively. · Balloon Breathing Ask your child to close their eyes and imagine blowing up a balloon. They can choose the colour of the balloon, and then explain that they need to exhale slowly to inflate the balloon. You could teach them to breathe in for a count of four, hold for four, and then breathe out to inflate the balloon for a count of four. They can repeat this until the balloon is inflated. If it helps they could write a worry onto the balloon before they let it go and watch it float away. · Rainbow breathing Ask your child to lie down, and play some calming music if this helps. Teach them to inhale slowly, and then pause and breathe out, and imagine releasing a colour in the breath. You could get them to think about things which are that colour, which could be in their imagined breath. Repeat for all the colours of the rainbow. Give yourself a hug When people hug, a hormone called oxytocin is released. As well as giving your child a hug, you might want to teach them to also hug themselves. Teach them to fold their arms and squeeze their body. Dealing with nausea Feelings of nausea can make children feel that they don’t want to eat. Again, a balloon image can be helpful here. It could be useful to imagine a balloon filling the stomach, causing the nauseous feelings, and you could get your child to pop the balloon in their imagination. They might want to draw a picture of it to help them do this. Relaxation techniques To help with the sensation of tight muscles, you could use a relaxation exercise, where they imagine being ‘floppy’ like a rag doll. A good example of this is in the link below. If the rag doll doesn’t really fit with them, it could also be a teddy or other soft toy. https://www.greenchildmagazine.com/guided-relaxation-ragdoll/ Another way of getting children to relax is to get them to push against a wall, thus tightening their muscles in the process. Get them to push against a wall, with all their might, making sure that they include their arms, legs, stomach and back, hold for a count of 10, then rest, and repeat 3 times. Dancing is also a good way to help children relax. Get them to put on some of their favourite music, and you could join them in some freestyle moves! They could also sing along, too. Strategies for teens Depending on their age and interests, they might find some of the strategies in the previous section helpful. Here are some additional techniques for the older age group. Yoga Stretching muscles i.e. by doing yoga poses is a good way to help relieve some of the physical tension in their muscles and reduce their heart rate. They might want to try a class, or use a DVD at home, or look up some videos on YouTube. Progressive muscle relaxation They might feel ready to do a longer relaxation exercise. Please see the blog entitled progressive muscle relaxation, for some techniques around this. Sweat it out Exercise releases endorphins, the feel good chemicals in our bodies. Intense exercise, more intense than normal physical activity, can reduce the body’s response to anxiety. Cycling, running, hiking and climbing would all be good challenges for your teen. Having a relaxing scent Smell goes straight to the emotional centres of our brain, and a relaxing smell can therefore bring quick relief to anxious feelings. You might want to get them to find a smell which they find comforting, e.g. a favourite shower gel, perfume or soap, and get them to find a portable version of this that they can carry around with them. As already mentioned above, give all these strategies a chance to work, before you decide that they are not the best for your child. by Gemma Lutwyche

You may have heard of the idea of a 'safe place'. A safe place is a technique that psychologists use that can help to reduce down our anxiety system. If we are feeling overwhelmed by emotions, if we feel unsafe or if we are facing something that we fear - bringing out 'safe place' to mind can help. However, as with most things, this comes with some practice. We need to bring our 'safe place' to mind often and then really think about how we would feel when we are in our safe place. This reminds me of the poem by Roger Robinson called A Portable Paradise, which I think is a much more beautiful way of describing it. And if I speak of Paradise, Then I am speaking of my grandmother Who told me to always carry it on my person, concealed, so no one else would know but me. That way they can't steal it, she'd say. And if life puts you under pressure, trace its ridges in your pocket, smell its piney scent on your handkerchief, hum its anthem under your breath. And if your stresses are sustained and daily, get yourself to an empty room - be it a hotel hostel or hovel - find a lamp and empty your paradise on to a desk: your white sands, green hills and fresh fish. Shine the lamp on it like the fresh hope of morning, and keep staring at it until you sleep. By Roger Robinson We all need a Portable Paradise - what is yours? You need to think it through. Is it the memory of a favourite holiday with the sun glistening off the sea and the soft sand flowing between your toes with the sound of the gentle waves lapping on the shore in front of you? Is it a memory of your favourite place as a child...your bedroom or the space behind the tree in your back garden or local park? Is is winter with the fresh snow on the ground and you and a friend hurling snowballs to each other? It may be the woods in Autumn - the beautiful cacophony of colours raining down on you. If you have a memory you can use - remembering how wonderful you felt then. Try to remember the smell - what you saw - what you could hear. If you don't have a memory then you can make up your Portable Paradise. We have an abundant imagination. Where does yours take you? When you have your Portable Paradise clear in your mind, keep it there and hold it close by. Feel the calm it brings. And then, when you are going through a difficult time, you can bring to mind your Portable Paradise.