Our not so realistic reality

Not so real reality

Not so real reality

The basis of any anxiety or panic problem is a personal belief about something that in reality is not true. Whatever your individual fear may be, the chances are that it is completely illogical and not at all rooted in real facts. Living a life based entirely on thoughts and feelings which we know don’t reflect reality is one of the strangest experiences a person can have, and yet so many of us live this way every day, sometimes without even realizing they’re wrong.

Myself, I could say with total conviction that I know my anxious thoughts are incorrect. My logical brain is well aware that a panic attack will do me no harm; I’ve had more than enough to factually confirm that. However, there is still that thought, a voice so to speak, which convinces me to avoid any situation that could cause a panic attack because there is always a “what if?”. This makes my anxiety very difficult to explain to others, and I know I’m not alone. People will say “there’s nothing to worry about, you’ll be fine” and you can’t help but answer “I know I will”. They ask why you’re so scared if you know you’re going to be safe, and unfortunately you’re left with no real answer. It is simply a feeling which guides you through your day, and although this may only make up 1% of your thoughts, that 1% is stronger than all of your logical thoughts combined.

It seems mad, on paper, to allow something you know is wrong to dictate everything you do. From what you eat, to where you go, to who you go there with, this one small sensation, which tells you that maybe this time will be so much worse than all the others, is in control of your life. It doesn’t take long to collect a full repertoire of symptoms and side effects of anxiety, from heart palpitations to nausea and full panic attacks. You become familiar with each one, you’ve experienced them all at their very worst and still survived to tell the tales, but still you continue to avoid and fear situations which may cause them again, all because of one tiny voice.

Imagine a world where this voice, this feeling, is the minority. Where you consider that maybe there is a risk, a small “what if?”, but you don’t allow it to control you because you truly do believe that those anxious thoughts are nothing but lies. Simply knowing that your paranoid brain is wrong is just step one, and while it’s an excellent step, it doesn’t change the fact that there is still a part of you which refuses to commit to the belief entirely. There is so much more freedom and liberation which comes with fully accepting and internalising the idea that these thoughts you have are only there to hold you back, and in no way reflect what life is really like. You first have to realise that you’ve seen it all before, you have the wisdom and benefit that comes with experience. You have been through the worst of it and you are still standing, and that should suggest that maybe, just maybe, some part of your way of thinking is very, very wrong.

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To see ourselves as others see us

I don’t know about you but there have been times in my life when I have been acutely sensitive to the gaze of others. I am not immune even now, although I am better at managing how it makes me feel.
Which is why I found this video interesting and I thought you might also. It shows how different our own impression of ourselves can be to that of others.
It is like having a window into the subtle ways we see ourselves (not the good ways) and how that can distort everything else we feel.

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The Chaos Train

An article by Eliza Burdon.

I had a client recently (Eliza) who started to talk about the experience of panic as a seemingly uncontrollable journey. I liked that idea very much and we started to call it The Chaos Train. I asked her to write an article about it as it seemed such a useful idea.

The train stops at stations on its journey to the hub. Along the way it picks up passengers and freight, (burdens to take to the hub) as each hub is reached the burdens are delivered and the result of them expressed. In the case of this particular Chaos Train they are panic, anxiety and sadness.

I think the fascinating insight Eliza had was that it all felt really chaotic and out of control. Of course it feels like that because it is panic but it is not as chaotic as it feels. The train has to stop at the stations on the way to the hub and pick up burdens otherwise there is nothing to take to the hub and nothing to be expressed. By making choices and deliberately not stopping at the stations on the route Eliza places a structure on her sense of chaos. She fights the darkness and despair and she makes a journey she wants to make not the default journey her Chaos Train may make if left to its own devices. Here is Eliza’s article.

The Chaos Train

All aboard the Chaos Train, final destination Anxiety. All change for Sadness and Depression.

Living in a continuous state of anxiety is chaotic. Panic is predictably unpredictable. We seem to have no idea of when it will strike and yet somehow it is always a certainty that it will. When the panic finally loosens its grip on us, whether that means a panic attack has passed or a stressful phase has ended, we can’t find a reason for it happening in the first place. Our minds will tell us there is no reason, leading us to simply “accept” how chaotic and unpredictable our anxiety is. We lose faith in our bodies and lose sight of how we’re ever going to get better because we can’t ever establish a reason for our behaviours.

 

As you pass through the stations you pick up baggage.

As you pass through the stations you pick up baggage.

The truth is it’s not all that chaotic. Anxiety and the resulting sadness and depression comes as the final culmination of a series of bad behaviours and disordered thinking. The chaos we feel we’re living in is a symptom of our anxiety taking hold of our lives, and accepting that it is that way allows it to act up if and when it pleases. Last time you did this was a Friday and today is a Tuesday? Here’s a panic attack for you. Last time you were here you wore red and now you’re wearing blue? Panic attack for you. Nothing seems all that different? Have a panic attack anyway. Your anxious mind can sense any difference in a situation, and all the chaotic steps you’ve taken to allow anxiety into your life add together to produce what feels like a very unpredictable fear response to just about anything. Yet, in reality, it is entirely predictable, it’s going to happen because you’ve accepted the idea that it’s out of your own control.

The Chaos Train is the journey you take to those major hubs, Anxiety and Depression. At each stop on the way you collect more and more behaviours and beliefs that lead to full blown anxiety disorders and predictably unpredictable panic. Each one is an essential element, they work together to seize control of your mind and create chaos.

It looks a little like this, though each persons individual stops may differ.

Other stops could include inflexibility, a lack of willingness to try things out of your comfort zone or things which are not part of your usual routine will lead to anxiety and panic. Similarly being concerned that other people will judge you. Catastrophising is a major cause of both anxiety and sadness. Catastrophising means allowing your thoughts to run away from you, and believing in only the worst case scenarios. This could be that you won’t be able to cope and you’ll have a panic attack, or that you’ll never get better.

It’s simple to build up to the “Hubs”, a series of faulty thoughts and feelings of being out of control leads to panic fairly quickly. On the other hand, breaking it back down isn’t quite so easy. It’s a slow moving train back to where you started. The best way to approach it is to break it down, cutting one station out at a time. For example, if you can combat catastrophising, you’re less likely to believe in the worst case scenario becoming a reality. With a little more faith, seeing events more realistically instead of living in a fantasy world where everything goes wrong, you would be opened up to a whole new level of freedom. In the same way, combating each station on the Chaos Train journey one step at a time, picking up a little less baggage at each stop, your anxiety would have so much less control over you, and in that, the chaos would dissolve.

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How To Combat Anxiety

How to Combat Anxiety

In the previous video I explained how a terrible event that may have no actual connection to you can increase your sense of threat. A feeling of threat, without an obvious tangible focus for the threat can cause anxiety. If you find that after Paris you are more anxious then you may find the tool I share with you in this video helpful. I have used this with many clients and the simplicity of it comes from the fact that it uses the same processes and the same neuro-chemicals as anxiety but it transforms what they are used for. Turning fear into excitement.

You don’t have to live with anxiety you can choose to do something about it.

Stop being anxious

A link to the previous film

 

 Get the Panic Pit Stop app here

About Dr David Purves

Dr David Purves is a Reading based psychologist providing private CBT in Reading, Berkshire. Dr Purves is the clinical Director of The Berkshire psychology service and former Consultant Psychologist and Head of the NHS Berkshire Traumatic Stress Service. He treats trauma and PTSD at his clinic and writes and speaks internationally on matters of terrorist related trauma.

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After Paris does the world feel more dangerous and do you feel more anxious?

Terrible things do happen.

Terrible things that happen without warning can make you feel more vulnerable and anxious. The media play and replay their footage, with comment and analysis. All of this can have the the effect of making the terrible event seem more likely to happen to you or the people you love. Your brain is genetically tuned to detect threats to you. Indeed it is highly sensitive to any situation that may even turn threatening. So when a threat is perceived but there is no obvious focus for the threat your brain often goes into a worry loop.

If you find that the terrible events in Paris have caused you to be more anxious but you’re not sure why then watch my video. I will explain how worry gets started and why anxiety goes up.

Are you anxious?

 

The link to the next film

About Dr David Purves

Dr David Purves is a Reading based psychologist providing private CBT in Reading, Berkshire. Dr Purves is the clinical Director of The Berkshire psychology service and former Consultant Psychologist and Head of the NHS Berkshire Traumatic Stress Service. He treats trauma and PTSD at his clinic and writes and speaks internationally on matters of terrorist related trauma.

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Vitality – Where does it go and how do you get it back?

beach-sunrise-woman

by Sarah Stiles

I am sitting her wondering, “How did I lose my ‘vitality’?” I’m not entirely sure when I lost it, but I am certain it went astray. Without vitality I felt flat. So flat that nothing excited me and I found that I derived little or no pleasure from things or activities that I once enjoyed.

I would go as far as to say that I can’t remember exactly when I lost that vavavoom, oomph, vigour and zest to get up and do things, which is fine because I was in the doldrums with a low mood. Although not ‘clinically’ depressed, just feeling glum, so why do I need it?  Saying that, I knew if I could get a little bit of bounce back into my stride and if I could find a way to add a little sparkle to my day, I might just start to feel brighter and in time, more positive about life in general.

The trouble is it became so easy to do nothing.  It is so easy to make excuses and to stay in that dark miserable rut than it was to try and get out of it.

For example, I used to be a social butterfly I enjoyed being with people and doing things, but without vitality, when I got an invitation to go out with friends, I avoided all contact. On the rare occasion, if I did go out, I made little or no effort to speak to anyone, I just couldn’t be bothered.

On a day to day basis I managed to fill my time by keeping busy doing nothing in particular. I tended to sleep until midday. I slouched around the house in my onesie and although I could see that life was slowly passing me by, I simply didn’t have the energy or the inclination to do anything about it.

Then one day, I asked myself ‘How much longer can I continue to plod on in this sorrowful state?’ There was a part of me that longed to get back to ‘normal’. I had been down in the dumps for so long that I’d forgotten what normal was. I wanted to get back to feeling excited and to doing things rather than making excuses and avoiding taking that crucial step forward towards recovering my vitality.

I wanted to re-light the fire of a desire to do things, anything, no matter how small. I lacked energy. I didn’t feel up to joining a gym, or going to a fitness class.

So I decided to start with something simple. My new daily activity was walking. I didn’t need any special equipment, nor did I need to schedule an appointment with a fitness trainer. It was a gentle walk near to home. The first couple of weeks were slow, and when I got home I felt exhausted. I persisted and set aside an hour at the same time every morning to go for a walk. It was not long before I was able to extend my walk. I found the more I did, the more I could do.

I upped the pace and I started to walk with a new found purpose and zest. This new physical activity made me feel so much brighter. It also helped to ease my mental angst. Being out in the fresh air helped to make me think clearer and my sleep improved too. I felt as though I had crossed over from a dark dismal place to somewhere lighter and more alive.  It was the beginning of my journey to get some vitality back into my life.

I started to feel physically stronger and more able to do things. I was able to take stock of where I am now. You often hear that phrase ‘Be where you are now,’ but it was not until I rediscovered some vitality that I could think and take on board what it really meant to me. For the first time in a very long time I stopped dwelling on the past. I stopped mulling over all the things that had gone wrong. I stopped thinking negative thoughts and I started to concentrate on the good and positive aspects of where I was.

It is true the more you do, the more you can do. I have added swimming to my routine. It was not easy to get out of the house and get to the local pool but once there I enjoyed it.

I have still got a long way to go on my journey before I can say I feel exuberant or effervescent, but by recognising that my vitality was lost, and taking that first hesitant step to regaining it, has turned my life around for the better . I feel a great sense of hope for the future.

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Are you dealing with stress and depression?

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Are you dealing with stress and depression? Is there a link between the two? Can stress actually cause depression? These are the questions our visitor Colin had for me. With Colin’s permission I’m sharing his letter with you and then I’ll answer his questions.

Dear Dr Purves

In May I relocated from London to York and took a new job with a housing company. For the previous three months I’d been commuting to London and staying there for the week, away from my wife and newborn child whom I missed terribly.

The move to York was supposed to make things better but things just went from bad to worse. The person who interviewed me for the post wasn’t the person I ended up working for and he took an instant dislike to me. I put up with his bullying as best as I could but it just got worse and worse. I was constantly stressed. He undermined everything I did so that I began to believe it was me. In my previous role I’d been trusted, liked and confident with my tasks but within a couple of months I felt like a different person. It was hard to relax even at home.

Then I got a call from my mother who lives in Scotland to say she’d been diagnosed with a brain tumour and they had to carry out more tests. I’m not  sure if there’s any relationship between how I was feeling before and what happened but I sunk in to an immediate depression.

I was tired and tearful all the time. I found it hard to get out of bed in the morning. I was snappy with my wife and I didn’t want to do anything. In six weeks I put on a stone in weight and I’m not tall so it looked even more. The weight gain made me feel even worse about myself and I withdrew even more.

I recently saw my GP who diagnosed me with depression and signed me off work. I’ve been referred to a CBT therapist now and am just waiting for my appointment to come through.

Is the fact that I was stressed at work before I found out about my mother’s health the reason I sunk so quickly in to depression or are they completely unrelated?

Many thanks

Colin

Dealing with stress and depression: What is stress?

Let’s start by looking at what stress is. In a nutshell it’s physical or mental stress on your body. Colin was certainly experiencing mental stress from his situation at work and as he himself identified was feeling stressed and uptight even when he was at home.

We all need a certain amount of stress in our lives but when it’s too much it begins to negatively impact us and our body. What’s actually going on in your body is that the stress causes higher levels of hormones such as cortisol and for example the amount of serotonin decreases. When your chemical balance is out of whack you can find yourself wanting eat more as Colin did or less. You might find you’re very sleepy or can’t get to sleep. And you may find yourself feeling tense and snappy as Colin reports. If this continues you can find yourself suffering from depression.

Dealing with stress and depression: What is depression?

If you are depressed you might feel sad or empty, experience a change in appetite or sleep, tired or even worthless. Colin reports feeling tired and tearful and gaining weight which are all typical symptoms of depression. When we refer to depression what we commonly mean is clinical depression or Major Depressive Disorder to give it its full diagnostic criteria name. You can learn more about what depression is on my clinical depression page.

Dealing with stress and depression: Is there a relation between the two?

There is a relationship between stress and depression. Colin was already susceptible to depression being stressed and unhappy at work before he learned that his mother was ill.

I would ask Colin if as a result of being stressed he had been making negative lifestyle changes. I wonder if he was already eating more unhealthy foods and exercising less? Changes such as these in stressed out people can mean that they are at greater risk of experiencing depression.

Dealing with stress and depression: Getting better

So you know how you got here. Now what should you do? I’m glad Colin’s been referred to a CBT therapist as cognitive-behavioural therapy (CBT therapy) is a highly successful way to treat depression. While Colin is waiting for his appointment to come through there are plenty of free CBT exercises available which he could use to get started.

Waits to see CBT therapists can be lengthy depending on where you live.  If you find yourself on a waiting list and would prefer to get started sooner another option is to embark on a computerised CBT program such as Mood Control or Blues Begone which you can fit in to your lifestyle.

Dealing with stress and depression: Other treatments

There are lifestyle changes you can make   and natural treatments for depression which you can also try.

Best of luck dealing with stress and depression.

I hope you’ve found this post helpful.

Dr Purves

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Is there a cure against depression and low mood?

low-mood-3

Rumination and negative beliefs ruin your mental health

*** Newsflash ***

Not everyone believes there is a cure against depression and low mood. A correspondent kindly sent me this quote attributed to Stephen Fry:

“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.

“Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.”

I am a great fan of Stephen Fry and as such I have time and respect for his opinion. But I have a fundamental disagreement with the first paragraph of his statement. It just seems too fatalistic. It seems to suggest that depression is what it is and that is all there is to it!

There are three fundamental reasons I can offer to disagree with Stephen’s quote:

Cure against depression and low mood: Many people overcome depression

Firstly, I have spent a considerable number of years helping people overcome depression and I have overwhelmingly found that following face to face CBT therapy people recover from depression. Indeed, this is so common that it is my expectation that recovery will occur and if for some reason it does not then I am surprised. This will give you an indication of the rate of success generally seen in practice.

cure-against-depression-and-low-mood-success

Cure against depression and low mood: Computerized CBT cures depression

Secondly, it is even the case that computerised CBT (cCBT) programs like Blues Begone and Mood Control cure depression. It my recent posts and publications you may have seen the headline that 61% of users of Blues Begone are cured of depression without having any human therapist input.

Cure against depression and low mood: Rumination and self critical thought predicts depression

And thirdly, the BBC offered a slice of data that illustrates the role of thinking processes in the development, maintenance and relapse of depression. Collaborating with the University of Liverpool the BBC administered a questionnaire to a huge population sample of 32,827 people from 172 countries making it the biggest study of its kind ever undertaken in the UK.

Cure against depression and low mood: The BBC reported:

“We found that people who didn’t ruminate or blame themselves for their difficulties had much lower levels of depression and anxiety, even if they’d experienced many negative events in their lives”. “Dwelling on negative thoughts and self blame has previously been recognized as important when it comes to mental health, but not to the extent this study has shown.

“Rumination and self-blame have long been accepted by health professionals as part of the problems that can lead to depression and anxiety – the two most common mental health problems in the UK, according to the Mental Health Foundation.”

These findings suggest that rumination and self blame are both crucial psychological pathways to depression and anxiety. I acknowledge that rumination and self blame can become habits of thought and as such can take on a power that is hard to break. But it can be broken through challenge.

Everyone who has recovered from depression has challenged and broken free of the hold of negative thinking, self criticism and rumination. Although the habit of rumination needs to be carefully monitored and challenged whenever it rises up again.

cure-against-depression-and-low-mood-pathways
Furthermore evidence from other research has shown that one of the best predictors of relapse in depression is rumination. So a dangerous foe to be guarded against, for sure!

There is nothing inevitable about rumination. Nor is there any force on earth that states ‘you must blame yourself’. These are things that we all do but it is the quantity and the sheer self destructiveness of the rumination and self blame that seem to be the tipping point into depression and anxiety.

These are processes that we can all learn to control and in so doing gain better control over our mental health.

I understand the reasons for the more fatalistic viewpoint with respect to mental health issues and that it may help remove some of the stigma associated with mental health problems. It reduces the power of the narrative that someone who suffers from depression is simply not trying hard enough to feel better or that depression is caused but not managing your psychology well enough. But if a client were to say to me ‘I am depressed and there is nothing that can be done about it’, I would say ‘let’s agree to keep an open mind about it and see if this turns out to be the case.’  Because most of the time it doesn’t.

Cure against depression and low mood: A friend is always a good thing

I agree that steadfast friendship is a restorative that is to be welcomed wherever it is found.

cure-against-depression-and-low-mood-friends
 

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What Clinical Depression Treatments are available?

We recently received this letter from one of our visitors who’s looking for clinical depression treatments and we  felt it offered a good opportunity to talk about depression treatments in general:

clinical-depression-treatments-storm
 

Dear Dr Purves

 I’m 25 years old and today when I saw my doctor he told me I have clinical depression. I wasn’t exactly surprised as I’ve had bouts of depression lasting a few months at a time over the past few years.

 I often feel anxious as well as depressed and don’t want to leave the house and this often makes me late for work. I hate my job but the pay is good and I can’t afford to leave.  I haven’t the energy to put any effort in to friendships and many have fallen by the wayside. I just don’t enjoy anything anymore. I feel flat all the time.

 My doctor talked to me about different clinical depression treatments. He said he wanted to put me on antidepressants and arrange for me to see a therapist. I’ve had antidepressants before and they didn’t work. I also had a couple of sessions with a counsellor a long time ago but found them a complete waste of time. Is there anything else I could try that might actually work?

 John

 

Clinical depression treatments: Antidepressants

Research has shown that antidepressants aren’t that helpful in cases of mild to moderate depression and the latest guidance from the National institute for Health and Clinical excellence (NICE) is that doctors should only prescribe them for the more serious cases. Some GPs adhere to this but some are giving them out for the mild cases.

From what you’ve said you sound as if you have a moderate case of depression. However, I would suggest that you talk this over with your doctor as he will fully understand your case. If you do have a severe case of depression then antidepressants do have their place as part of your treatment plan. Your doctor is in the best place to advise you.

Clinical depression treatments: Cognitive-behavioural therapy (CBT Therapy)

I’m sorry that you didn’t get on well with your counselling. Counselling can be very helpful if you have a problem that you need help solving. Counsellors don’t tell you what to do but provide you with practical advice.

clinical depression treatments - therapy
Treatments which include cognitive-behavioural therapy techniques tend to be really successful and NICE recommends that therapy is offered to patients with depression. It’s likely this is what your doctor has in mind when he says he wants you to see a therapist and I’d encourage you to give it a try.

In a nutshell CBT therapy is a talking therapy which helps you to make sense of your thoughts and behaviours. It will teach you how to go about replacing your negative thoughts with positive ones and change your actions.

If you don’t like the idea of having face to face therapy you could try computerised CBT (cCBT) which is just as successful. Basically you undertake a course of treatment in the comfort of your own home on your own computer. Blues Begone and Mood Control are two such treatments.

Clinical depression treatments: Lifestyle changes

As part of your treatment plan you might like to consider introducing regular exercise. I’m sure you know about the general health benefits of exercise but it’s also a great mood booster. It doesn’t matter what you do as long as you get moving.

Clinical depression treatments - exercise
I have clients who walk and others who have become involved in team sports such as five-a-side football. The key is to do something you enjoy. I know you’re feeling flat at the moment so enjoy might be a strong word but choose something you can tolerate and go from there. If it’s a 15 minute walk then start there. Try to build exercise in to your daily routine.

Clinical depression treatments: Self help support groups

Depression can be isolating. As you mentioned you don’t feel you have the energy to put in to friendships at the moment and as a result have lost friends. Some of my clients have felt that their friends didn’t understand what they were going through and others have deliberately distanced themselves feeling they were no fun to be around anymore.

If this is how you’re feeling then you might benefit from joining a support group for people with depression and talking to people who understand where you’re coming from.

There is a list of self help groups on the Depression Alliance website

clinical-depression-treatment-self-help-group

Clinical depression treatments: Other treatments

If depression is severe and you haven’t responded to any of the above treatments there are some other options available which your doctor may suggest.

Electroconvulsive therapy (ECT) is one. It passes electrical currents through your brain.

Another option for severe depression is Vagus nerve stimulation which involves having an implant to control the brain’s mood centre.

And there’s Transcranial magnetic stimulation which involves holding an electromagnetic coil to your head.

Clinical depression treatments: Conclusion

As your depression appears to be moderate I hope that you will respond well to treatment. All depression is treatable to some extent and most of it to a great extent. I would urge you to participate actively in your own recovery.

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