How To Discuss Screen Usage With Your Teenager

Like many people, I recently watched ‘The Social Dilemma’ – a new documentary produced by Netflix examining the way that large social media and technology companies are manipulating our behaviour. It’s a pretty challenging two hours – most of us use our phones daily, if not hourly – for work, family, friends, socialising, shopping, organising, entertainment, planning, the list goes on. But the documentary provides some compelling reasons to consider reducing our exposure to the internet, particularly social media. It’s not the first documentary of it’s kind – there’s been a couple released over the past few years providing some thought provoking, at times scary, statistics. After finishing the documentary, I spent some time reflecting on my own social media and internet use – there are so many benefits to our phones, but I found it helpful to decide on what I was happy with and what I wanted to change. 

These are questions often asked by many clients – how is my phone or social media use affecting my wellbeing? Are there things I need to, or want to, change? And it’s a common question from many parents of young people – how do I get them to use their phone less? 

It can be pretty worrying as a parent when documentaries or reports come out suggesting the darker side to social media and phone use. It’s easy to feel helpless or confused - changing our own phone habits can seem difficult, let alone encouraging young people to do so. So how should you discuss this topic with your young person?

Acknowledge Change Takes Time

First, it’s helpful to recognise that change takes time, it doesn’t happen overnight. Psychologists often refer to the ‘Stages of Change’ model, which outlines the process we go through in order to make and sustain a behavioural change. The stages are 1. Pre-Contemplation (not even thinking about it!), 2. Contemplation (possibly considering a change). 3. Preparation (deciding on what changes to make), 4. Action (taking steps to make the change), 5. Maintenance (engaging in things which sustain the change), and possibly 6. Relapse. 

What this framework shows us is there are three important stages to go through before someone is able to actually take action! Notice that your teenager might be ‘pre-contemplative’ about changing their phone use – it’s not necessarily that they’re against it, they just haven’t considered it, or don’t considered it a problem yet. 

Express Concern To Your Teenager

When trying to help someone make a change, it can be pretty easy to just suggest or even mandate the new behaviour. Maybe you want to jump straight in and set new rules or boundaries regarding social media or phone us with your young person. However, this isn’t always the most effective strategy.

Most people, but particularly young people, respond better to suggestions when they can understand why it’s being suggested. We need a rationale. And sometimes facts and logic don’t cut it. Particularly some of the facts and figures regarding the impact of phone usage don’t always connect with young people – they personally don’t feel impacted by it. Work our what your feelings are in regards to the issue – do you feel worried, anxious, confused, frustrated, guilty, powerless, lost...? Try expressing these feelings first to your teenager – beginning conversations with feelings and questions, rather than directives help reduce defensiveness and perhaps might assist with moving them through the ‘stages of change’. Approach things with a curiosity – try to understand more about their phone usage (when, why, with who, how) before trying to change it. 

Develop A Plan With Them Not For Them

Try and develop a plan for change in collaboration with them. This will have to involve some compromise – for both you and your teenager. Ask lots of questions! Ask them what they think is an appropriate amount of time they need to use their phones for each day, or when might be a good time to reduce or shift phone usage. Ask them what they might struggle with about using their phone less. Ask them what they are willing or not willing to change and why. Demonstrate your own willingness to adapt by agreeing with as much as you can, and being open about your own expectations and boundaries. 

Often I suggest a trial period for the new rules – it can be hard to commit indefinitely to change, so suggest a 1-2 day ‘experiment’ or one week of your plan, and one week of your teenager’s plan before settling on the new behaviours or rules. This can be helpful in testing out assumptions about what will be ‘too hard’ or ‘impossible’. 

Have Things To Replace The Old Behaviour

Whenever we remove an action, an activity, a behaviour, or a coping mechanism, we need to have something to take its place. Before setting the new rules or guidelines, plan what to do instead of using your phone, device, or social media site. Sometimes being active helps distract us (being outdoors, running, swimming, taking the dog for a walk). Sometimes it’s helpful to have a good morning or evening routine involving a bath, face mask, listening to music, reading a book, having a good meal which makes us less likely to engage in automatic phone use. Maybe it’s easier to still do something on your phone, but avoid social media – perhaps it’s reading the news, watching a video, looking at old photos, face-timing a friend or family member. Find something that you can do when the impulse to check your phone kicks in. 

Set And Hold Boundaries

Once the plan is set, it’s going to take some reinforcing. Remember that your young person’s brain isn’t fully developed, particularly the all important frontal cortex which deals with emotional regulation, consequences, self-reflection, and planning. 

You’re going to need to hold the boundaries for them, with both flexibility and consistency. It can take a while to set a new habit, so have some compassion for the challenges, but remember that ‘giving in’ too early often means we don’t give ourselves enough time to adjust. Be clear with your young person in the planning stages how you’ll manage setting the new rules and boundaries. 

Focus On Rewarding Good Behaviour Not Punishing Bad Behaviour

Recognising and rewarding positive behaviour is often a better way to change patterns rather than punishing negative behaviour. Be on the look out for when your young person is managing well without their phone, or has been considerate, kind, thoughtful, funny, or helpful. Perhaps plan a reward with your young person for making a positive change. Also try not to pick up on mistakes or challenges early on. 

Demonstrate Changing Your Own Behaviour With Your Teenager

If you’re asking your young person to change their phone or social media use, it might also be a good idea to reflect on your own use. Are there ways that you can demonstrate commitment by changing your own behaviours? Could you charge your phone outside your bedroom at night, remove your email notifications on weekends, put your phone on silent during meals or social time? You might even ask your young person what they wish you did differently. Modelling coping with the difficulties of changing our behaviour is a great way to engage your young person and perhaps get some more ‘buy in’ to discussions around changing their behaviours. And you might even notice you feel better for it!

Loneliness: Feeling alone in feeling lonely?

Loneliness is a powerful feeling. And just like most human emotions, it is experienced by nearly all of us at some point in time. Even prior to COVID-19, according to the Australian Psychological Society’s 2018 survey, 1 in 4 people reported experiencing a current episode of loneliness. And yet it’s something that’s rarely talked about. It’s a feeling akin to shame which seems to cut to the core and elicit immense vulnerability when truly acknowledged. People often share they feel anxious or depressed, but what’s often not spoken about is that at the heart of this there is often a feeling of being lonely, disconnected from others, different, or separate in some way. Lacking in true meaningful connections. Perhaps the reason it’s so difficult to acknowledge the feeling of being lonely is that by its very nature most of us feel very alone when we’re experiencing it. Or perhaps there is a stigma attached to loneliness; a belief that if you’re lonely there is something wrong with you, that you lack the capacity to build relationships, or that others don’t want to be around you. These beliefs are often totally unfounded! When we take a step back, most of us can recognise that loneliness is a feeling, not a measure of how many friends you have. Some people who feel lonely are genuinely socially isolated, but for many, the feeling of loneliness can be just as intense when they’re surrounded by people.

Where does loneliness come from?

There’s no definitive answer to this question. Sometimes loneliness is a deep-seated feeling which relates to our earliest childhood experiences. Many people who have experienced childhood abuse, neglect, trauma, or experiences of being unloved will carry through very painful feelings that they are unwanted, unlovable, or different to others- which often correlates to feeling very alone as a teen or an adult- no matter how many people surround them. For others, the loneliness may come from feelings of being bullied or socially rejected, or from longstanding feelings of “not fitting in”. For others, the grief of losing somebody who matters at any stage in life can precipitate the onset of intense loneliness: feeling alone in a world with pain that strong, in combination with missing someone who was an important source of connection, support, or companionship.

Loneliness can also be linked to social anxiety or depression and can be very self-perpetuating due to the withdrawal or avoidance of social interactions which often accompanies them. For many it could be precipitated by other changes in life circumstances; and those who live alone, or who experience a separation or significant relationship breakdown are at particular risk of increased loneliness. Or it can simply be a gradual process whereby one day you become aware you have become distant from those around you; mentally, physically, or emotionally. I have sat with many individuals who are in relationships, or employed, or who report having families who love them; always surrounded by people yet feeling intensely alone on an emotional level. 

What is also sometimes overlooked is how we live in a world whereby it is easier than ever to connect with others through technology. For some who live alone or away from loved ones, or who have limited capacity to see people in person, this can be beneficial. The flipside, however, is that often the connections we have online lack the genuine authenticity that is necessary for true meaningful connectedness. And social media often elicits comparisons to others and feelings that we come up short. Or a pattern whereby our self-esteem is impacted by how many likes or comments we get. Whilst the many available social media platforms may seem like they bring us together, often the reverse is true, with the pressure to present an image of our best selves or comparisons with others driving feelings of loneliness and separation rather than feelings of closeness. And often the more we communicate via technology rather than in person, the less comfortable or necessary it feels to actually spend quality time with others. 

How to respond to loneliness

The best antidote to loneliness is connection.

And it’s not about quantity, it’s about quality. Feeling truly connected is a subjective feeling, but it often requires us to feel able to reveal our true authentic selves. To feel valued and accepted for who we are as an individual. To feel safe in the relationship.

It sounds obvious, but we often lose sight of how important this fundamental human need is. Connection to others serves a powerful evolutionary purpose in ensuring we are part of tribe; surrounded by those who are willing to step-up in times of stress, illness, danger, or need. Years of infant attachment research highlights how emotional connection is just as vital to our wellbeing as having our physical needs met. The desire to be truly close and connected to others is extremely powerful. And it doesn’t ever cease to matter. Ever. Healthy connections to others can be linked to mental and physical health throughout our entire lifespan!

So, if we feel lonely, the first step is to figure out where our loneliness is coming from? Is it an external problem that needs to be solved such as not having many people in our lives we want to connect to?

Or is it more that we are choosing to isolate ourselves or are holding ourselves back in some way when we are around others? Are there thoughts or beliefs getting in the way of us relaxing and being ourselves even with an abundance of more superficial connections? Are we driven by a fear of rejection rather than a belief that others will accept us as we are and will want to build intimacy with us? Or have we simply become so busy “doing” we are spending less time simply “being with” others? 

Whatever the reason, if you’re currently experiencing loneliness, the following ideas may be a place to start:

·      Allow yourself to observe the emotions that come up when you reflect on what it’s like to feel lonely. Approach this with curiosity rather than judgment. What messages are your feelings trying to tell you about what is currently happening in your life?

·      Reflect on what your needs really are. We all have different thresholds for proximity and intimacy with others. Some of us enjoy spending time alone. This is solitude, not loneliness. Whereas others might feel very alone unless physically in the presence of others. Is your loneliness related to feeling alone physically, or does it show up more when others are around through a sense of being different, misunderstood, judged, unaccepted, or unable to relax and be yourself? What does this tell you about what would be helpful for you?

·      Work on connection to yourself first. What really matters to you in this world? Who do you want to be? How do you want to live your life? The more you understand this, the better chance of connecting to others who have similar values, or of communicating your needs to those already in your life. 

·      Practice self-compassion and letting go of self-criticism and judgment. Working on being comfortable with who you are is often fundamental in learning how to be authentic in the presence of others too. For any of us, shame around who we are is often a massive barrier to connection.

·      When you feel ready to start reaching out to others, start small. Is there someone who matters to you that you would like to become closer to? Could you start with a message, work up to a phone call, and then meet for a catch up if feasible? Or could you start with initiating conversations or replying to messages you’ve been ignoring and work your way up in terms of the depth of the conversations and vulnerability required? Have you become distant from your partner? Fallen into the trap of seeing each other every day but never really connecting on a deeper level? Could you organise a date night where you agree to rediscover each other’s interests instead of talking about mundane tasks, or instead even start with small daily acts of connection such as an extra hug or kiss, putting down your phone when talking to them, doing something small but meaningful to demonstrate you care?

·      If the issue is a lack of friendships or relationships could you brainstorm ways to get around this and take a chance on meeting new people? Join a social club or team sport? Say yes to any invites that come your way instead of automatically thinking of reasons you can’t! Reach out to old contacts you have lost touch with? Volunteer for a cause that matters to you or explore any events in your local community? If you attend school or university could you smile at someone in your class, or sit next to someone different? Or if you have young kids, could you ask a fellow parent if they would like to organise a playdate? 

·      If feasible, consider getting a pet or spending time around animals. Whilst human connection is often vital, many people report significantly lower levels of loneliness when connecting with a non-human companion as a way to bridge the gap and experience some unconditional affection!

·      Reach out to professional helplines. If you feel alone and isolated there are a number of helplines such as Lifeline (13 11 14), Kids Helpline (1800 55 1500), Mensline (1300 78 99 78) and BeyondBlue (1300 22 46 36) that have trained individuals ready to listen.

·      If you are experiencing social anxiety or depression that significantly impacts your life and limits your ability to engage in interactions with others it might be worth considering professional support. Working on the thoughts, beliefs, behaviours, and physical symptoms that compound your difficulties can help you overcome any barriers! And building a connection with your therapist in a safe space can be a great way to become more comfortable with vulnerability, authenticity, and figuring out who you are, and what kind of people you would like in your life!

·      And perhaps, most importantly, remember you are never alone in feeling lonely.

Why do psychologists always talk about breathing?

If you’ve ever spoken to a psychologist or a counsellor, you’ve probably been encouraged to try out breathing techniques as a way to manage a range of mental health concerns.

It’s something that I raise with most of my clients at some point during our therapy journey.

But a common comment I hear in from many of the people I see, usually in the first session or two, is that they don’t find ‘breathing’ helpful and they aren’t keen for it to be suggested again.

And it’s totally understandable why they feel this way! Whether you’ve suffered with extreme anxiety or not, most of us have had the experience of someone telling us to ‘just breathe’ or ‘take a breath’ when we’ve shared our worries or stresses. Maybe we’ve even attempted to regulate our breathing during an anxiety or panic attack before. Being told to ‘just breathe’ can be very invalidating, and often increases our frustration and worries rather than taking them away. Attempting to change our breathing during a panic attack can also feel impossible, particularly when we’re hyperventilating, feel like we’ve lost control, or even feel like we might be dying.

So why do psychologists keep suggesting it?

Breathing techniques come in all shapes and sizes. And they have a range of purposes and aims that can help us in recovery from mental health concerns

Sometimes it’s as simple as DISTRACTION – regardless of where we are, who we’re with, and how we’re feeling we’ve always got our breath. Being able to draw our attention to our breathing (and just being mindful of it, without having to change it) can be a great way to circuit-break our cycle of negative or anxious thinking, or it might help us shift our focus from something else that’s triggering. It might help you ground or get a bit of focus whilst you wait for something else to pass.

Sometimes breathing techniques help us connect with the PRESENT MOMENT. When we draw our attention to our breathing we naturally have to be more mindful! Our mental health can often take a turn when we use too much of our ‘headspace’ on the past or on the future, so training our attention muscles to remain in (or shift back to!) the present moment is a really helpful way to improve our mental health.

But a big reason why I often work on breathing with clients is that our breath is a great way to IMPACT OUR NERVOUS SYSTEM! I often find that clients don’t understand the science behind why breathing techniques can be so effective!

Within our body we have two systems – one called the sympathetic nervous system, and one called the parasympathetic nervous system.

Our sympathetic nervous system is like the accelerator in a car – it helps everything ‘start up’. It helps us stay safe by quickly and automatically responding to threats or danger. It helps us with ‘Fight/Flight/Freeze’ responses.

Our parasympathetic nervous system is like the brake in a car – it helps everything ‘slow down’. It helps us to recover after a threat, and return back to normal. After all, it’s unsustainable to remain in a state of hypervigilance for too long. It’s responsible for what we call the ‘Rest and Digest’ response (i.e. the opposite to the Fight/Flight/Freeze response).

For those of us with mental health concerns, particularly anxiety, we’re often ‘stuck’ in our sympathetic nervous system – we feel on edge, flighty, hypervigilant, often unable to focus on certain things, and find it difficult to switch off or even sleep. We need to keeping switching back into our parasympathetic nervous system and teaching our bodies that we’re safe.

Switching between our sympathetic and parasympathetic nervous system is often outside of our control – it’s determined by the automatic part of our brain.

Thankfully, however, our breath is one bodily function that can switch us between sympathetic (accelerator) and parasympathetic (brake) nervous system. When we bring conscious awareness to our breath – to slow it down, extend our exhales, and/or deepen each breath, we give ourselves an opportunity to turn on our nervous system ‘brake’.

As proof of this, I sometimes get clients to think about how their breathing looks when they want to be running (short, sharp, shoulders lifting, chest heaving) compared to when they want to be sleeping (very slow, only our lower belly moves, very deep and even). Shifting our breathing is a sign to our bodies to ‘rest’, to ‘slow down’, that we are safe and able to relax.

Sometimes we find it hard to notice or challenge our thoughts, particularly if we know they’re illogical already. So breathing can be a handy way to manage moments of anxiety. And that’s why you might find your psychologist suggesting it (again!).

If you’ve tried breathing techniques and they haven’t been useful, if you’re frustrated when your psychologist suggests it, or if you’re keen to hear more about them or give them another go – always let your psychologist know your thoughts and feelings!

Most importantly, keep giving them a go. It’s a bit like any other skill or practice – we often need to attempt it on several occasions to get the hang of it. I often think back to when I started jogging – it took me and a friend an entire year of running every week (sometimes twice a week) to build up to running 5kms. We ran a few hundred metres at first, and slowly built up each week. It was uncomfortable and tiring the whole way, but our muscles and lungs progressively got stronger and more accustomed. It’s the same with our “brain muscles” – our ability to focus on and use or breathing will be difficult at first, but with practice will get much easier!

Self-grooming habits that harm us

Most of us have habits that we would like to change or stop, such as compulsively checking messages on our phone, or chewing the end of our pen. Luckily, for most of us our habits are simply annoying, rather than actually harmful. But for around 2-5% of the population, their habit is highly problematic, and harms their body. These habits include picking at their skin (excoriation disorder or compulsive skin picking), pulling (out) their hair (trichotillomania), biting the inside of their cheeks, and biting their nails (onychophagia).

The term body-focused repetitive behaviour (BFRB) is used to refer to this group of self- grooming behaviours that are performed with a loss of control, and harm the person’s body. While there is a wide rang of BFRB severity, most people with a BFRB cannot stop the behaviour despite multiple attempts to decrease or stop, and these disorders result in distress and interfere with daily functioning.

BFBRs often first emerge in early-mid adolescence, although they can occur at any age. Perhaps surprisingly, given the prevalence of BFRBs, these behaviours are under-researched and poorly understood. However, experts have established that BFRBs are not a form of obsessive compulsive disorder (OCD), and are not due to previous trauma or bad parenting. BFRBs are also not considered to be a form of self-mutilation or self-harm. So what may account for the onset and maintenance of these habits? It appears that some people are genetically predisposed to developing a BFRB, and it is also thought that stress may play a role for some people as their habit can be experienced as soothing or providing a relieving function. However, for others the only significant stress they experience is due to their BFRB. Overall, BFBRs are acknowledged as being highly complex behaviours.

As well as causing hair loss, skin lesions, scarring and other visible effects, BFBRs can potentially have more serious physical consequences. For example, skin picking and nail biting can result in infections if the exposed wounds are not allowed to heal. Similarly, if hair is pulled from the eyelashes or the pubic region, infections may also occur. More rarely, if people who pull their hair also eat the removed hair, this hair can build up in the gastrointestinal tract, with very serious health implications.

While BFBRs can potentially result in medical complications, they also result in significant psychological distress and impacts on the person’s quality of life. Most people struggling with a BFRB hide their disorder because they feel intense shame and embarrassment, which can prevent them from seeking medical or psychological help. These disorders often negatively impact the person's self-esteem and social relationships, contributing to them feeling hopeless and isolated. BFRBs can also affect their ability to engage effectively in education, work, or other activities that they would like to pursue.

A large part of the negative psychological impact of a BFRB can stem from the belief that the disorder is the sufferer’s fault, and that they should be able to address it on their own. They are often not aware that, contrary to common belief, BFRBs are not trivial habits that a person should be able to change with a bit of willpower – they are highly complex behaviours that result in real and significant challenges. Expecting someone to simply stop such a complex behaviour will only add to the burden of shame and confusion felt by the person struggling with the BFRB.

Most people who seek help for a BFRB, only do so when they reach a point of desperation. The shame and secrecy associated with BFRBs not only prevents timely support and treatment, but also contributes to the lack of awareness of the problem more generally. Fortunately, there is increasing awareness of BFRBs, and there are now a number of recommended psychological treatments for these disorders, which all fall into the broader approach known as Cognitive Behaviour Therapy (CBT). These CBT treatments may be applied in conjunction with other psychological approaches, such as Dialectical Behaviour Therapy (DBT) or Acceptance and Commitment Therapy (ACT). While CBT is considered the most effective treatment for BFRBs, medication may also be considered prior to, or while, engaging in CBT.

Radical Acceptance in the face of COVID-19

What is Radical Acceptance

Radical acceptance is a powerful skill taught in Dialectical Behaviour Therapy (DBT). It involves truly accepting reality as it is. This means completely accepting with your mind, your heart, and your body. It also involves letting go of the struggle, bitterness, and resentment that life is not the way you want it to be, that life is cruel or unfair, or that painful experiences shouldn’t have happened, or shouldn’t be happening right now. It is about letting go of judgments and attempts to control things you cannot control; and completely accepting things exactly the way they are in this moment.

Why is it important?

Radical acceptance is a really helpful skill in times of pain, uncertainty, loss, or grief. Without accepting reality as it is we, are essentially trapped with our pain, adding immense suffering on top of it. If we judge or deny reality, we often feel stuck and unable to let go of the idea things should be different. We cannot even begin to contemplate how to change things, or work with things, or how to manage the pain life has thrown our way.

Why is Radical Acceptance so hard?

Whilst it may sound like a good idea in theory, many people struggle with radical acceptance. This is often because there are misconceptions about what it involves. We often think of acceptance as meaning approval, or liking, or agreeing with something. When life is painful, that is understandably impossible for most of us to do! That’s why it’s important to note that that’s not what radical acceptance actually is, and that’s definitely not what we’re trying to do. It is about acknowledging the facts of the situation and accepting these facts of reality to be true: even if they are completely unwanted, and even if they cause immense pain!

People also sometimes get confused around what needs to be accepted. Whilst radical acceptance may involve non-judgmentally accepting the existence of our thoughts and feelings, it doesn’t involve accepting negative thoughts, interpretations, or beliefs to be true. For example, if you were to lose your job, you might need to radically accept the fact that you are no longer employed in that position in order to direct attention towards moving forwards, but you would NOT have to accept “I’ll never get another job” or “It’s because I’m terrible at what I do” etc. We only need to accept reality, or at least very realistic probabilities – not imagined catastrophes, judgments, or criticisms of ourselves or others as being facts.

Radical acceptance is often a journey. To get to a level of complete and total acceptance is not easy. And it rarely happen instantaneously. We can choose to turn our mind towards acceptance, but to truly feel it with every part of ourselves is often a journey of repeatedly turning towards acceptance. Many people feel a sense of peace when they truly accept things or themselves exactly as they are, but to get to that point often requires opening yourself up to experience an enormous amount of painful emotions along the way. And it’s totally natural that part of this journey may involve swinging back out of acceptance. One day acknowledging without struggle that things are the way they are, the next, noticing thoughts such as “Why me?” “This can’t be happening!” “This isn’t fair!”. When this occurs, it’s a sign you might need to turn your back mind towards acceptance once more!

So how does this apply to COVID-19?

In the space of six months, the whole world has changed. The pandemic has changed our lives in ways many of us couldn’t have imagined. For some of us it has had a bigger impact than others, but for all of us, there has been a lot of uncertainty, lack of control, and need to make changes to how we live our lives. For many there has also been a lot of fear, terror, grief, frustration, sadness, and a lot of questions no one can answer. “Will I catch it?” “Will my loved ones?” “Will I lose my job?”, “When will I be able to travel?”, “When will it end?”. It is natural there has been a lot of fighting against reality. A global pandemic is scary and for most of us it is an unprecedented event! It makes sense it wouldn’t be easy to radically accept!

What this has looked like across the world though is a lot of struggle. Struggle to accept the uncertainty, restrictions, changes, or losses that this pandemic has created. A lot of reactions driven by denying or rejecting reality, or by instead treating catastrophes as though they ARE reality, when they might not actually be very likely to occur at all. Swinging between trying to reassure ourselves or others by downplaying or dismissing the facts, through to feeling completely hopeless and helpless because our attention is hooked by worst-case scenarios. By focusing on sticking to the facts and accepting we cannot individually control or change the pandemic (or subsequent rules or restrictions!), we can refocus our energy onto living with the circumstances as they are in the most effective and meaningful way. When we let go of fighting reality and the things we cannot change, we can instead refocus on what we can still control, and how we can make the best of our situation.

Even those people who have experienced the most immense pain of losing loved ones may find radical acceptance to be beneficial. Allowing and accepting whatever emotions come up without judgment is sometimes crucial to processing a loss. Radically accepting there is no easy or “right” way to experience grief can help individuals validate their own experience and allow the process to unfold. And over time, finding a way to truly accept the loss has occurred (whilst remembering we are definitely not diminishing the pain or significance of this!) can be part of moving forward in life.

Ultimately though, working towards radical acceptance is something that can benefit us all, no matter what life has thrown at us. Here are some inspiring examples of people turning towards acceptance that I have come across over the last 6 months:

• A first-time mum facing the reality of giving birth in a world where their partner was not been allowed to support them throughout the majority of labour, and where family members have not been able to meet their newborn. Initially this realisation created a lot of painful emotions, however, instead of getting trapped by thoughts that this isn’t fair and this isn’t how they pictured their journey into motherhood, they have managed to accept that this is the way things are right now; and they’ve transitioned with acceptance and grace into doing what needs to be done, even with far less practical support then they had ever imagined!  A family experiencing extreme lockdown in another part of the world letting go of the frustration and resentment around the restrictions and instead focusing on making the most of reality as it is. Instead of complaining they can only leave the house for one hour’s exercise they have embraced that hour by going for mindful walks and breathing in fresh air, sights, and sounds of the world exactly as it is in that moment! 

• A young boy handling with astonishing acceptance the realisation that his birthday party needed to be cancelled. He didn’t have a tantrum or get stuck in how unfair it was that he’d already invited his friends, and that he had been looking forward to it for months. Instead he calmly accepted that it needed to be done; and redirected his energy to planning how to have fun at home that day instead! 

• Many people with fears of wearing facemasks, or anxiety that makes it hard for them to breathe. Instead of getting caught up in how they don’t want to wear one, or saying it’s too hard, they have stated they accept the recommendations are what they are, and they choose to not let it hold them back, even if it’s difficult for them. 

• Healthcare and other essential workers accepting the reality that to continue turning up to work is to accept there is a risk they will contract COVID-19, and to feel at peace with their decision. Equally, other professionals making different choices and accepting that in order to protect themselves or vulnerable family members to the best of their ability they cannot continue to work; or need to adapt and work from home; even though this creates other challenges that are so hard!

These are just a few examples of how each of us has a choice to turn towards accepting ourselves, our lives, our reality, and all that comes with it in each moment. To work on letting go of judgments that things aren’t the way they should be, that others aren’t doing what we think they “should” be doing, that by ruminating about the past we can somehow change it, or that by worrying about the future we can somehow prevent things that are out of our control. Instead, finding peace in allowing each moment to be just as it is.

This also includes radically accepting ourselves and all our “flaws”, and accepting each and every emotion we experience, even if we don’t want to feel that way. It’s not about “perfectly” handling the challenges that Covid-19 has thrown at us, it’s about accepting there is no such thing as perfection, no such thing as one right or wrong way to do things, no such thing as a pain-free existence. There is just us, as unique individuals, all experiencing the shared humanity of a world filled with things we often cannot control. “There is something wonderfully bold and liberating about saying yes to our entire imperfect and messy life” (Tara Brach).

Managing Toddler Tantrums

Toddlers are little whirlwinds of emotion, sensitivity and curiousity, and thanks to their developing brains – are totally uncontained, unregulated and unable to control their impulses. 

Think of toddlers as all accelerator (big, intense emotions) with no brake (ability to manage these emotions, consider consequences, make good choices or shift their thinking).

As a parent, your whole life, effort and existence revolves around serving this little person. So it can be so easy to take tantrums personally – “I have sacrified everything for you, serve you meals six times a day, are the reason you are still alive, clean and healthy and you repay me by kicking me for slicing your sandwich the wrong way?!”; “Have a raised a sociopath? Why would my child smile while they go ahead and do the exact thing I just politely requested they not do?!”.

To help preserve your sanity, and provide you with some tools when you are completely bewildered by the shifting moods of your toddler, I’ve put together some steps to consider:

1.     REFRAME

• Understand their stage of development, rather than react to their age-appropriate behaviour as if they are our peers. Yes it is totally unacceptable for an adult to assault a waiter if they serve their drink in the wrong cup. However, it is NORMAL and EXPECTED for a toddler to be unable to regulate their emotions and behaviour. Their little brains are just not capable of this.

• Don’t take it personally – this behaviour does NOT mean your child doesn’t love or appreciate you. They do, more than you know.

• Challenging behaviours come from discomfort. 

2.     SHIFT YOUR EXPECTATIONS 

• You don’t need to change their emotion. You don’t need to prevent tantrums. You don’t need to keep them happy all the time. When your little one is having a tantrum, your role is to keep them safe, and wait for the storm to pass. Interfering, or getting triggered yourself often just intensifies the storm. 

3.    EXPLORE THE FUNCTION 

• There are different types of tantrums:

                                               i.     System breakdown (fatigue/hunger/overstimulation/constipation/sickness)

                                             ii.     Learning (pushing limits to see what happens in order to learn what they can do and make sense of the world). 

                                            iii.     Connection (sometimes children learn that the best way to get connection is through misbehaviour).

                                            iv.     Emotional release (sometimes tantrums are just a way of discharging stress from the body. These are much more likely to occur with ‘safe’ people – like caregivers, at home).

• Try and record when and where they are happening and what the trigger was. See if you can notice a pattern. Understanding the function can help address the behaviour more effectively, and set them up to succeed.

4.     BE WITH

• Your number one job in a tantrum (and in life) is to “be with” them in their emotion. Not change it, not try and reason with them or discipline them (the time for reasoning and learning comes later). Your child needs to feel heard, seen and understood. 

• Acknowledge what you think they may be feeling – validating their emotion. You want them to know you get their message.  

  • “You’re feeling frustrated. It’s so hard when you don’t get what you want isn’t it”.

  • “You’re disappointed that we had to leave.”

  • “You’re upset because that didn’t work out the way you wanted it to.”

  • “I know you’re not happy about it, but the answer is no.”

  • “I can see that this is hard for you.”

• Normalise and provide safety:

  • “It’s okay that you feel this way”

  • “You are safe. I love you.”

  •  “I’m here to help you”.

• Accept their emotion. This is my child’s emotion, it’s not about me – I can let it be. 

5.     HAVE FIRM, CONSISTENT LIMITS

• Try and respond the same way each time. By giving in to demands in the face of a tantrum every now and then, but saying no at other times, you’re actually making the behaviour more likely to occur in the future.

6.     STAY CALM

• This is so so hard when you’re activated and emotional yourself – especially when all you want is for someone to feed you 6 meals a day, bathe you, dress you and cuddle you!! – but it is so important. Work out a way of keeping your own emotions in check when you notice you’ve been triggered by your toddler’s tantrum. A few deep breaths, an affirming mantra, leaving the room for 5 minutes until your blood cools, smelling lavender oil or sucking on a lemon are just some of the strategies that might help. By all means rant and rave in your bedroom later and scream into a pillow – but be the duck on the pond with your legs furiously paddling underneath, out of sight.

7.     MODEL HEALTHY COPING

• Toddlers are sponges, and will mimic behaviours they see in the home, seemingly more of the ones you DON’T want them to pick up! The way you respond to them and others will become the framework they use to structure their own behavioural choices. NB: my husband has to remind me of this point ALL the time when I get upset because things haven’t gone my way. 

8.    BE BIGGER, STRONGER, WISER & KIND

• This line is straight out of attachment-informed research that emphasises the importance of providing loving and firm limits for your little one. They need a secure base for exploring and making sense of the world, and a safe haven to come back to. They need a parent, not a friend. You will upset your child. I find it helpful to constantly ask myself “What I am teaching you?”. Because if you are never saying no and attending to their every request in order to prevent a tantrum, you’re teaching them that they will always get their way, and that they can’t cope with difficult emotions. By “being with” them in their emotional storms you’re teaching them that feeling a full range of emotions is normal and healthy, that they can cope with them, and that they are loved and not alone with them. This is all about building resilience which is one of the most important skills to develop.

9.     LOOK AFTER YOURSELF

• Don’t expect to navigate this extremely challenging period perfectly. It is not possible. You are constantly learning, so give yourself the space to work out how you can parent a strong-willed dictator. If you’re not attending to your own needs and looking after your own mental health, it is impossible to look after anyone else. Expect to make mistakes, expect to lose it at times, and make self-compassion a non-negotiable. Some parents find it very helpful to seek their own therapy to understand why certain behaviours within their children press their buttons so intensely. This generally takes you back to your own childhood, allowing you to process how you were parented in order to tweak your ideal parenting approach.

Key Takeaways:

·      Toddler tantrums are a wonderful sign that your little one is developing as they should.

·      When the lightning strikes – keep your child safe while you wait for the storm to pass. 

·      Be with them in their emotion – acknowledge, normalise and accept it. Your job is to keep them safe, seen and heard.

·      Be calm, bigger, stronger, wiser & kind. And work out what you need to do in order to achieve that.

Parenting is so so tough! If you’re finding there is a gap between the parent you’d like to be, and how most of your days are going, firstly you are not alone, and secondly – there is help available! Seeing your GP for a referral to see a psychologist is one way to give yourself some extra support.

What to Say When Someone is Struggling

So everyone is doing it tough right now. I think we’ve read “We’re all in this together” enough times to accept that point. 

Drought, bushfires, Covid-19, home schooling, isolation, an economic recession and rising unemployment has combined into a bubbling, messy, painful, uncertain and unpredictable mixture we’d all like to CTR+ALT+DEL.

And do you know what makes 2020 even tougher? That the regular, run-of-the-mill hard stuff that happens in life hasn’t been paused. You’d think the universe would have enough insight to say “I can see that the humans have enough to deal with this year. Let’s just hold off on the general difficulties until they can wrap their head around these mega life bombs.” Unfortunately, that hasn’t happened. We still have to deal with physical illness, mental illness, relationship conflict, relationship breakdown, loss, failure and the general gaps between our expectations/wants and reality. In fact, all these difficulties have only been heightened amidst the stress and uncertainty of our current context.

Dealing with my baby’s diagnosis of Cystic Fibrosis has been one of those bombshells for me. And I know plenty of other people who have had hardships unrelated to or directly due to coronavirus. I mean, isolation alone is stressful enough in itself, let alone a global pandemic.

Being at the receiving end of so much love and support, I was struck by how much of a difference loved ones can make. I also know that it can be SO hard to know how best to support someone going through a difficult time. You don’t want to say the wrong thing but you want to say something so you can be helpful and make a difference. It is so hard to watch loved ones in pain. You want to take the pain away. You want to wrap them up in love-scented bubble wrap so that nothing can hurt them and they are safe and happy and protected from any difficulty ever. But….. that’s not possible. Unfortunately life brings pain, and it can hurt.

So, if we can’t take away our loved ones’ pain, or protect them from hurt, what can we do? You know who answers this question really well? Guy Sebastian. His latest song – “Standing With You” articulates beautifully how you can best give your support to loved ones struggling. So, to summarise Dr Guy:

·      Be there: Don’t shy away from talking to someone or making contact for fear of saying the wrong thing.  

·      Don’t think you need to be their therapist:

o   You don’t need to change how they’re feeling (you can’t)

o   You don’t need to say the “right” thing to make them feel better (there isn’t such a thing)

·      Instead of asking “Is there anything I can do?” (Although that can be helpful, you’ll generally get a reply like “No thanks, I’m fine”), just DO:

o   Drop off a meal

o   Show up and take their kids out so they can have some alone time

o   Go over and clean their bathroom

o   Drop off (or order) a care package for them filled with things they love

·      Send regular messages without expecting a reply (and tell them you don’t expect a reply). Some of the beautiful messages I received included:

o   You are not alone and you don’t have to go through this alone, never forget that. 

o   You are so loved, so many people care about you.

o   I know it feels like your life is over but you WILL feel differently 

o   I love you no matter what you look like/do/feel like.

o   Or just go with Dr Guy and say “I’m standing with you”

·      Encourage them to get professional help – they can start with their GP or call Lifeline. There are people (like me) who have studied for YEARS to learn how to help people manage their thoughts and feelings. 

·      Do ask them if they are having thoughts of suicide (and if they are – stay with them while you seek professional help).

·      Keep checking in

·      Give yourself permission to be imperfect

·      Look after yourself first to be able to support others well

No you can’t change how someone’s feeling, or make things better with a magic wand. But walking beside someone in their season of difficulty is a pretty special gift that can be the difference between pain and suffering for someone.

When might ‘dementia’ be reversible? When it is depression.

Dementia is a broad term that refers to deficits in cognitive functioning, such as memory, language or attention, to the extent that it significantly interferes with a person's ability to function in their usual activities. We usually think of dementia as being caused by a neurodegenerative disease such as Alzheimer’s Disease, which affects brain neurons and is both progressive and irreversible. However, a number of mental health conditions, most commonly depression, can cause cognitive impairments that mimic what is seen in what we typically think of as dementia. This phenomenon has been termed pseudodementia. Note that pseudodementia is not a diagnosis.

While there is a lot of debate about the appropriateness of the term pseudodementia, it is useful in describing and highlighting the dementia-like cognitive impairments that can be caused by depression and other mental health conditions. This is of particular importance because, unlike neurodegenerative dementias, pseudodementia is often reversible with the right treatment. 

This link between depression and dementia is particularly relevant to older adults, because major depression often manifests in older adults in a way that is more likely to appear dementia-like. This also increases the risk of the depression going unnoticed, and a misdiagnosis of neurodegenerative dementia being made. 

People with pseudodementia due to depression typically experience impairments in memory, executive functioning, and speech and language, and they generally find these declines in cognitive functioning very distressing. Their deficits may be evident as impaired:

·       word finding 

·       speed and fluency of speech 

·       memory in general

·       processing speed 

·       motor response

·       focus and concentration

·       ability to complete tasks 

·       organisation

·       decision making 

In addition, people with pseudodementia may suffer from other symptoms of depression including:

·       withdrawal from activities and social interactions

·       anxiety

·       poor sleep patterns

·       appetite/weight loss or gain

·       feelings of helplessness or hopelessness

·       low energy

Importantly, older adults are more likely to experience depression without significant sadness, and may not realise they are depressed, adding to the difficulty in diagnosis. 

Clearly even a subset of these symptoms is concerning. However, people with cognitive impairments associated with underlying depression can respond to a variety of treatments targeting the depression, such as psychological therapy and antidepressant medications, or a combination of the two. Evidence-based psychological therapy approaches that can be effective in the treatment of depression include cognitive behavioural therapy (CBT), and interpersonal therapy (IPT). CBT focuses on exploring and changing thoughts and behaviours that affect how we feel, while IPT investigates and addresses patterns in relationships with others that may negatively impact mood.

It is important to note, however, that while depression can lead to cognitive difficulties that look a lot like neurodegenerative dementia, dementia due to Alzheimer’s Disease can also involve low mood symptoms (particularly in the early stages). Therefore expert assessment and investigation of the underlying cause of any cognitive impairments is important in order to provide appropriate diagnosis and optimal treatment or management. Your GP is a good place to start if you have concerns, and documenting all the symptoms you have noticed will also be helpful.

Managing Well in Social Situations

For almost all people, social situations bring up an element of anxiety - for some the anxiety is as minor as pre-event jitters, for other it can be as extreme as a panic attacks and avoidance of all social situations entirely.  

Social anxiety is one of the most common forms of anxiety, and it’s something the clinicians at the practice work with people to overcome on a daily basis.

While treatment of social anxiety (however extreme) is best done in a manner that is specific to you and your situation, there are some general tips that can be helpful for all of us:

Notice your (over)thinking

When researches and clinicians have looked at what separates people who experience heightened social anxiety and those who don’t, they found that people with social anxiety tend to engage in intense thinking about the social event (or situation) both before, during, and after it. They called in ‘anticipatory rumination’ and ‘post-event processing’. These thoughts before, during, and after the event are often:

-       more negative – that is, their thoughts are are more critical, comparative, hopeless or worried in nature 

-       more self-focused - that is, their thoughts are more focussed on what they are saying, wearing, doing, or how they are acting or being perceived by others (rather than what those around them are doing)

-       and more ‘threat’ based – that is, their thinking is biased towards assuming things might (or will) go wrong

When we notice our patterns of thinking, we are more equipped to manage them.

 Identify the core worries

Spend some time thinking through what is making you anxious. Perhaps allow all your anxious thoughts to come to you and don’t push them away – just observe them as you would cars down a street, or leaves on a stream. Perhaps you might find writing down your thoughts helpful. Other people might want to discuss with a friend, family member, or therapist what is making them anxious.

For example, you might be anxious about: saying something stupid, or being asked a particular question, or not knowing who to speak to, or not dressing appropriately, or getting lost on the way there, or having a flushed or sweating face (or hands), or not knowing anyone there, or getting sick from the food, or feeling trapped and unsure how to leave, or being judged by someone for something…

By identifying the anxious voice in our brain we are better able to manage and challenge the ‘what if…’s as they arise. Perhaps use some of the skills used in therapy – cognitive challenging or cognitive defusion to minimise the impact these thoughts have on your feelings and behaviour. 

(Helpfully) plan the event

If your social anxiety is more mild, doing a bit of pre-event planning can help alleviate some of the stress.

For some people, arriving early can be less anxiety-inducing. It gives you more time to find the place you’re going to, it means you can deal with traffic or public transport delays with more patience, it means you might have a few minutes to do some mindfulness or breathing before you enter the event.

For others, extra time before the event might be more anxiety inducing. For these people, spare time might encourage that anticipatory rumination mentioned above, and it might be more helpful to arrive slightly later so that you know you won’t have time to over-think before entering. 

Maybe you want to identify some people you know who are attending the event, or do a practice drive of the route before you go, or scope out parking or public transport options. Maybe you want to think of some questions to ask prior to the event, or practise answering some likely questions. Helpfully planning the event can assist in addressing your specific worries.

However, there are ways that we can engage with or plan social situations that can make our anxiety worse (not better) – read below on Avoidance and Safety Behaviours. 

Recognise thought distortions

As mentioned above, people with social anxiety often have thinking that is more negative, self-focused, and threat-based. Identifying the ways in which our thinking might be distorted is a helpful way of correcting our thinking, and perhaps making us feel less anxious.

For example – you might spend hours planning and changing your outfit before an event, becoming increasingly anxious about what to wear and what people might think of you. But spend a moment to see if you can remember what a friend wore to an event 1 month ago – you probably can’t. So, logic follows that others probably can’t remember what you wore either. Similarly with worrying about saying something embarrassing – can you recall a situation from the last social event you were at where you judged someone for what they said, and can you remember exactly what they were saying? Most people can’t. 

Avoid avoidance

Avoidance is often short-term gain for long-term pain. Avoiding an anxiety-inducing event or situation always makes us feel immediately better in the moment. However, when researchers and clinicians looked at what makes social anxiety worse, they found that continual avoidance of social situations often just perpetuated the anxiety for individuals, not solved it.

With the help of a support person (professional or personal), set some realistic goals about how, what, and when to attend certain social events. Slowly build up from what you feel most comfortable (or least uncomfortable with) and set a slightly new challenge each time (perhaps an event with more people, or remaining longer at the event).

Remember to check your thinking after the event, and to not engage in post-event negative processing! See the section of Self-Compassion below.

Correctly label (or re-frame) the feeling

How we label the sensations in our body impacts how comfortable we are with them. For most people, anxiety is uncomfortable, whilst excitement is manageable. However, anxiety and excitement share many similar bodily sensations – shaking, tingling, sweating, flushed face, elevated heart rate, increased breathing, and feeling ‘jittery’.  Many people experience those physiological symptoms before an event, however if we’re able to label those feelings as the emotion ‘excitement’ rather than ‘anxiety’ or ‘fear’ we are better able to manage and ‘ride the wave’ of the feelings. 

Identify your safety behaviours

Another core element of social anxiety is safety behaviours. Safety behaviours are things we might do or not do to make ourselves feel safe or to take away some of our anxiety, however, in the long term, they often make us feel worse. A safety behaviour might be (but also might not be) – needing to always attend an event with a person, always needing to have drink in your hand, wearing many layers of clothing to hide sweat, drinking a lot prior to an event, standing near an exit at all times… Doing one or all of these things can have the short term benefit of reducing anxiety (e.g. you don’t have to turn up alone if you always arrive with a friend, the alcohol takes the edge off your shaking if you drink before, you don’t feel as trapped if you stand near the exit, your hide your sweat by wearing a jumper, etc.). However, over time, safety behaviours can make our anxiety worse – such as when you don’t have a friend to arrive with or they cancel last minute, or maybe you need to start drinking more alcohol to manage the anxiety or you avoid events where you can’t drink, or wearing lots of clothes makes you sweat more. 

Identify possible safety behaviours and work towards removing or reducing them (or at the very least, monitor to make sure they’re not having an adverse effect). As you remove or reduce the safety behaviours, expect that the anxious voice in your brain will make the anxiety peak – but remember that it will subside! Challenge thoughts that you might have about what will happen if you remove or reduce the safety behaviour. 

Have some self-compassion

Lastly, it’s helpful to focus a sense of compassion and gratitude towards yourself, particularly if you’re working at challenging your thoughts or avoidance. As mentioned above, those of us with social anxiety are often very self-critical. Managing and challenging our social anxiety is an effortful process! Switching your internal voice towards one that recognises your own efforts, praises your attempts, forgives yourself for setbacks, and allows failures and imperfection. Set aside 5 minutes after each event or attempt and spend some time thinking through ways you surprised yourself, or were proud of yourself. 

Effective Goal-Setting

Setting goals in life is one of those things that seems so easy on the surface yet is actually really hard to do. Especially if you don’t have the right knowledge or mindset on how to do it effectively. Many people find themselves caught in a trap of setting endless goals, working towards them for a few days or weeks, then beating themselves up for “failing” to achieve what they set out to do. Others feel like they’re doing all they can but the results never seem to eventuate. For others, it can be so overwhelming to even know where to start they keep on promising themselves they’ll get started tomorrow, or next week, or when life gets a bit easier. Yet that day never seems to come! Other people have an idea of where they want to go in life, but not enough clarity or confidence to truly set things in motion! 

All of these challenges are really common, and at the same time can be really frustrating.  Often, as humans we get stuck in a pattern of beating ourselves up for feeling like we “should be” achieving certain things, yet feel incapable or unmotivated to do so, which leads to a sense of hopelessness or decreased confidence and motivation.

If you feel stuck, it can be really helpful to take some time to reflect and ask yourself what is truly standing in the way. Yes, things like lack of clarity, motivation, energy, time, confidence etc, can all play a part. But sometimes it runs deeper than that.

Often the answer is fear.

Setting goals often comes hand in hand with change. And change is uncomfortable and scary; even if it’s something we really want! We can experience fear of the discomfort that comes with challenging ourselves. Or fear of how things might be different and whether we will actually like it. Or fear of making a “wrong decision”. Or fear of failure and not being able to handle the pain of not succeeding or of being rejected. Or even fear of success, and the increased responsibility, expectations, or lifestyle that may come with that. 

Fear often leaves us to stay exactly where we are. In our comfort zone; even if it’s miserable and not actually very comfortable at all! Or it can lead us to self-sabotage once we start working towards goals, making progress, and noticing things are starting to change. 

If you’ve ever experienced any of these things you are not alone. And you are not a failure. With all these complicating factors it is pretty amazing when any of us successfully set and achieve goals! The good news is, that with some self-reflection and guidance the process can become a whole lot easier!

Practical tips for setting effective goals:

1. Clarify your own values. Separate out what you think you “should be” achieving, and work on finding out what truly matters to you! Who do you want to be? What do you want to stand for? How do you want to live your life? Having a greater understanding of this will drive you to strive for things that clearly add value and move you towards the life you want! This will naturally increase your motivation and commitment!

2. Make sure the goal is actually within your control. There’s nothing more frustrating or demotivating than working towards goals that keep getting derailed or blocked by factors outside your control. For example, “My goal is to get a new job”. “My goal is to lose 10kg” “My goal is to be in a committed relationship”. The problem with these goals is that there are so many other things that could influence the chance of you succeeding  - perhaps it will take a while to find a job that’s suitable, or perhaps you will attend lots of interviews but will miss out to other candidates. Perhaps you will diet and exercise yet the scales won’t budge, or perhaps you will date a bunch of people but not find the connection you are hoping for. 

3. One way to ensure goals are within your control is to set behavioural goals rather than outcome-based goals. Focus on your own behaviours and how you want to act, rather than focusing on specific outcomes. For example, instead of saying “I want to be less depressed” you could try something like “I want to commit to doing one pleasant activity each day ” or “I want to go for a mindful walk during my lunch break”. Hopefully these things will have a positive impact on your mood, but that outcome is a bonus, not the measure of whether or not you’ve succeeded! Increasing healthy behaviours often brings about the change we are looking for without the pressure or expectations that we “should” feel a certain way!

4.  A concept in Acceptance and Commitment Therapy (ACT) is to avoid “dead person goals”! It’s often not that helpful for us to set goals that a dead person could do better than a living one. For example, “Argue less with my spouse about housework”, or “Eat less chocolate” or “Be less anxious”. A dead person never argues, eats chocolate, or feels anxiety! To be alive and full of vitality we often need to strive for things we DO want to do! When we set goals about things we don’t want to do or things we want to get rid of, we often struggle to achieve them because our brains are not very motivated by NOT doing things or by cutting things out of our life. Or we lack clarity around how to NOT do them! We might also be trying to get rid of things that are actually impossible to eliminate, like the feeling of anxiety, which is a normal human emotion! If you notice yourself doing this, try switching it around to think of what you would be doing instead. E.g. “ I want to make time to calmly discuss with my spouse how we can collaboratively divide chores in a way that’s fair” or “ I want to pre-prepare healthy snacks for each day this week” or “I want to learn strategies to help me cope when anxiety shows up”.

5. Turn your goals into SMART goals! Make sure they are: 

Specific (break things down, have sufficient clarity, and enough detail)

Measurable (make sure it can be evaluated and quantified)

Achievable (make sure it’s challenging but possible and within your capabilities/skill)

Realistic/Relevant (make sure it’s in-line with your resources and meaningful to you)

Time-Bound (set a specific deadline to check in and evaluate).

For example, instead of “ I want to get healthier” you might try “I want to walk for 30 minutes 3 x a week for the next 2 weeks”. Instead of “ I want to be less anxious” you might try “ I want to practice controlled breathing for 5 minutes as soon as I wake up for the next 3 days”. Instead of  “I want to get more sleep” you might try “ I want to be in bed with lights off by 10pm every night for a week”. 

Once that deadline arrives, it’s a great opportunity to evaluate how you went! If you achieved your goal, fantastic! Reflect on the accomplishment, give yourself some praise, and use it as an opportunity to decide how you want to continue moving forward. Perhaps setting a new deadline to stick with the behaviour, or even adding another behaviour or ramping it up if that seems achievable and relevant! If for any reason you didn’t meet the goal, reflect on what got in the way, and use it as a chance to problem solve before trying again! FAIL can be thoughts of as meaning “First Attempt in Learning”!

6. Working within the framework of SMART goals it is often helpful to start small. Every big goal we achieve is a result of lots of small actions. Allow yourself the best chance of succeeding by breaking things down! This can boost motivation and a sense of accomplishment, increase your confidence and self-esteem, and inspire you to believe in your capacity to change and achieve what you set out to do. This can then be used to help you gain momentum. So instead of setting a goal for months from now or 5-years-time, start with  a goal for the next 24 hours, or 7 days and make sure it is something you feel confident you can stick to! Then keep on going! And if you get stuck, come back to asking yourself “What are my values here?” “What am I afraid of?” “What unhelpful thoughts are holding me back?” “ What uncomfortable emotions or experiences am I trying to avoid?” “What barriers are getting in my way?”. Let go of judgments, re-evaluate your expectations, remind yourself of why it’s important, and then set a SMART goal you know you can achieve for the next 24 hours to get yourself back on track!

Coping Skills for Children: Physical and Sensory Strategies

In previous blogs I have explored some relaxation and distraction skills, which children can use in many situations when they feel anxious or afraid. There are, of course, many other strategies that children can also learn and use. These include using movement and sensory experiences to cope. Many of these skills overlap, and may fall into more than one ‘category’, but what is important to note is the wide variety of strategies that children can choose from. This makes it likely that with some exploration a child is likely to find a number of strategies that resonate with them, and that they can use in a variety of contexts (e.g. at home or school; when alone, or when with parents or friends).

Physical strategies can be very helpful for children to calm down and get rid of excess energy. This can be particularly relevant when they are feeling worried, anxious or angry, because the fight, flight or freeze mode creates adrenaline, or they may feel like lashing out at those around them. Moving is also helpful for focusing and attention, so it is helpful to always include physical activities throughout the day. Regular organised activities and sport can also be great, particularly if they’re with other people.

There are many simple physical or sensory options that children can be encouraged to use when they might need to calm down, get rid of some energy or cope with anger. Consider creating a list of appropriate activities with the child (draw them for younger children), that can serve as a ‘menu’ of options for when they feel like physical strategies would be helpful.

Here are a few suggestions:

·       Squeeze a stress ball, play dough, or putty

o   A good way to do this is to repeatedly squeeze it, hold it for a few seconds, and let go. Make sure to use each hand.

·       Fidget with a fidget toy, or another object that feels nice to hold and fiddle with. For example, a beaded bracelet, Rubik’s Cube, pipe cleaner, makeup sponge, pebble or shell, key chain, unfilled balloon, rubber band, or dice.

·       Bounce a ball

·       Pop bubble wrap - try different kinds!

·       Shred paper, such as scrap paper or newspaper

·       Punch or hit something safe and appropriate if feeling angry and like lashing out. For example a pillow or soft sofa.

·       Move parts of the body, such as wiggling toes and/or fingers, shrugging shoulders, pushing hands together

·       Dance or move to music or do gymnastics

·       Do simple exercises, such as jumping jacks, running around a circuit (e.g. in the house or garden), jog on the spot, use a skipping rope, or do stretches or yoga poses.

o   Try having a set number of repetitions or time to do the exercise for

·       Go for a walk or run

o   Even a short walk can create a break and be calming and focusing

o   Maybe ensure it is with an adult if the child is young

·       Bounce on a trampoline

·       Ride a bike, scoot or skate

·       Go to a playground

·       Swing

·       Swim

·       Use sensory options, such as:

o   Have a shower or bath (with bubbles)

o   Drink through a straw

o   Wrap up in a blanket

o   Curl up in a beanbag or comfortable chair

o   Have a hug

o   Suck on some ice

o   Use some scented cream or oil

o   Watch a lava lamp

o   Pat a pet

o   Brush hair

o   Have a warm drink

Remember to encourage children to try a few physical and sensory coping strategies at least once when they are feeling worried, anxious or angry, before deciding if they are helpful or not.  

Finally, don’t forget that many of the techniques and strategies that help children cope may also be helpful to adults in similar situations – be sure to give them a try yourself if you don’t use them already.

Some Thoughts on Feelings

As a psychologist with training in CBT (Cognitive Behaviour Therapy), a lot of time in session can be spend on Thoughts: what we’re thinking about ourselves, others, the world. However, it’s always worth spending some time on Feelings: what we notice in our body, and how we choose to label it.

I sometimes tell clients that it’s not feelings that are (necessarily) the problem, it’s our relationship with the feelings. 

What do I mean by that?

There are different types of feelings; ‘primary emotions’ and ‘secondary emotions’. Secondary emotions are the feelings that arise after an initial emotional reaction. For example – sometimes I’ve heard people describe feeling sadness or grief after a loss, and then feeling angry at themselves for feeling that sadness or grief.

Often what keeps us ‘stuck’ is the response we have to our feelings that we naturally might experience. We often respond with either suppression, or anger, or avoidance. 

Having a healthy relationship with feelings and emotions that come up is another way of functionally managing our mental health and wellbeing

Here’s some tips on how to have a healthy relationship with feelings:

Watch how we label feelings

I often hear people talk about ‘good’ feelings and ‘bad’ feelings. Usually, when we refer to ‘good’ feelings we mean things like happiness, gratitude, peace, and love. And often when we refer to ‘bad’ feelings we are talking about emotions like anger, pain, sadness, grief, regret, and shame. 

It can be quite easy to classify some feelings as either ‘good’ or ‘bad’, but some others are less clear – what do we do with anticipation, or nostalgia, or longing, or solitude?

The problem with rigidly labelling our feelings as ‘good’ or ‘bad’ is that we can begin to avoid the emotions that we call ‘bad’. And when we try to avoid certain feelings that make us feel ‘bad’, then our life might start to look a bit smaller. 

Avoidance is often a functional coping mechanism. Think about someone who just got food poisoning - it’s in their best interests in the future to avoid that the type of food they ate or the restaurant that served the food that made them sick. However, when it comes to feelings, it is a guarantee that we will feel emotions that we call ‘bad’ as we live life. It’s a ‘when not if’ situation. So avoidance of ‘bad’ feelings is very hard. It is very difficult to live a life as a human on planet Earth without experiencing loss, sadness, frustration, pain, regret, and embarrassment at some point. 

Avoidance of ‘bad’ feelings will probably feel good at first! But often these feelings catch up with us. Think about when you procrastinate for an exam for a subject that you find very stressful and challenging – by deciding that you can put off studying until tomorrow afternoon, you suddenly feel a surge of relief. But then tomorrow comes around and you might put off studying again – before you know it, the exam is today and you’ve either done nothing or crammed as much as you can in the past 24 hours, and you’re feeling stressed, overwhelmed, guilty, or angry. 

Maybe you start avoiding events with really large crowds (such as sports matches or festivals) because they make you anxious, and at first your life isn’t too impacted. However, perhaps then smaller crowds begin to seem pretty anxiety inducing, so you begin to avoid shopping centres and cinemas, then restaurants and cafes. Before you know it, you might be ordering your shopping online or declining every invitation from friends to socialise. 

Being able to tolerate and ‘sit with’ negative feelings can keep us living functional, fulfilling, and values-driven lives. 

We actually need the whole spectrum of our feelings, not just the ‘good’ ones. 

Feel feelings

Acceptance of feelings can only come if we recognise what we are feeling. Often we’re aware that we’re feeling something, but we’re not sure exactly what it is.

I sometimes work with people who find it very difficult to know what they are feeling. It’s can be surprisingly hard to do, and takes practice to get better at! Some ways to address this:

-        Use a ‘feelings chart’ or ‘feelings wheel’: There are lots that are available online after a quick google. Sometimes we don’t know what we’re feeling because our language around feelings is limited. This is particularly relevant for children! By looking at a list of feelings, sometimes we find it easier to describe what we’re feeling. Especially for children and adolescents, it can ease some of the frustration of trying to communicate what they are experiencing.

-        Think about what you know you don’t feel: When we feel really stuck with describing what we’re feeling, it can be helpful to name what we’re not feeling. For example, after a death of a friend or family member, we might know we’re not feeling the emotions of excitement and hope and playfulness. 

-        Sit for a bit: Sometimes we try to ‘rush’ feelings. Being able to identify a complex feeling immediately is not always possible, particularly when we are living very busy and hectic lives. It’s important to allow ourselves to take time to ‘check in’ with what we’re feeling in an unhurried way. This is where mindfulness or meditation can play a role. Or even just going somewhere without your phone, or giving yourself some time before bed with no work or Netflix!

-        Think about locations or sensations: if you’re not sure what emotional label to put on your feeling, use a physiological description, such as “shaky”, “cold”, “heavy”, “tingly”. If you can, locate where in your body you are feeling it such as “in my head/hands/feet/chest/stomach etc.”

Think about what they’re telling you

Think for a minute about physical pain. Physical pain is a very unpleasant experience – the more intense the pain, the more unpleasant it is. However, we need the experience of pain to learn what is safe and unsafe, to be able to take care of our body, to teach others, and stay well.

There are documented cases of people who can’t feel physical pain, and rather than life being blissful, it is actually surprisingly difficult. Think about a young child who can’t feel pain – they might  touch the oven when it’s on and won’t flinch away from the heat and so will probably burn their skin. They will trip over and break their hand but won’t realise immediately how serious the fall was, until they notice swelling or bruising. They might be dehydrated but not know it because they won’t notice a headache in the same way that we would. 

It can be similar with emotional pain. Despite how uncomfortable it is, emotional pain can teach us when a situation or event didn’t sit well with us. It can help us decide which relationships are worth pursuing or not. It can teach us to act differently in certain situations. It can remind us what things to avoid (within reason!).  

I often encourage clients to think about the ‘job’ of emotions. And to think about what their emotions are ‘telling them’. 

Love tells us when we care for someone. Excitement tells us when we are looking forward to something. Guilt tells us when we might want to make a shift in our behaviour. Shame tells us when we might need to apologise. Anger tells us when we might need to protect ourselves or someone we care for. Pain tells us that something mattered to us. Fear tells us when to be careful and cautious. 

Every emotion has a purpose, and when we tune in to our feelings and consider what they might be alerting us to, we might find that we have a better relationship with our feelings, and live more fulfilling and rich lives. Notice I say a ‘fulfilling’ life, not necessarily a ‘good’ or ‘happy’ life.

Lastly, it goes without saying that if you’re feeling consistently ‘bad’ or noticing an increase in emotions that are heavy, or get in the way of life – then definitely seek help! Whilst it’s helpful to tolerate ‘bad’ emotions, we also want to live in a way that promotes ‘good’ emotions also!

Adolescent Self-Harm - A Parent's Guide

Few things strike terror into the hearts of parents like discovering their child or adolescent is self-harming. I have sat with multiple parents who report they cannot understand why their child would do that to themselves. Does it mean they want to die? Does it mean they hate themselves? Does it mean they have a serious mental illness?

Sometimes yes, but often no. 

Self-harm is reasonably common in Australian teenagers with as many as 17% of females and 12% of males between the ages of 15-19 reporting they have self-harmed at some point. Some may become aware of it, try it once and never again; whilst others will try it once and discover it serves a function for them and then repeatedly engage in it. Some teenagers regularly self-harm whereas others report only doing it occasionally. 

Self-harm is sometimes referred to as Deliberate Self Harm (DSH), Parasuicidal behaviours,  or Non-Suicidal Self-Injury (NSSI) depending on its nature. It is a non-specific psychiatric symptom that is sometimes associated with those experiencing depression, anxiety, eating disorders, developmental disorders, and borderline personality disorder; however, it can be engaged in by those with any mental illness, or by those without.  This means that by itself, it is not an indicator of any one particular disorder. Mental health issues are certainly a risk factor for self-harm behaviours, and whilst statistics vary depending on whether individuals require medical treatment or emergency care, it is thought that as many as 50% of young people who self-harm would likely not actually meet full diagnostic criteria for a mental illness.

For many, self-harm is also not a sign that they are suicidal. In fact, it is often described as the opposite by many who engage in it: a way to actually help them live with the difficulties they are experiencing. If an individual is experiencing suicidal thoughts or plan it is crucial that they get appropriate help. Even in the absence of suicidal intent though, self-harm must still be taken seriously. It can have short and long-term medical consequences and is certainly an indication that there is something the individual is struggling with. The most common forms of self-harm include deliberately cutting, overdosing on medications, or burning oneself. Other methods including hitting or punching, hair-pulling, scratching or interfering with wound healing.

Why do teenagers self-harm?

Adolescents, and in fact many adults, self-harm for a variety of reasons. Research suggests that for many, self-harm serves as an emotion-regulation strategy. Meaning that it is a way of coping with difficult or overwhelming emotions that they are struggling to know how to manage. Similarly, others report doing it to distract from or suppress painful thoughts, memories or images. Sometimes people report doing it to feel “something” when they otherwise feel numb, whereas for others they report doing it to feel “less” or to feel something “different”. Some people say the physical pain relieves the emotional pain, whereas others say it gives them a sense of control over the pain they are in. Some teenagers try it because their friends do and they are curious or want to fit in, and for others it may serve a function of self-punishment if they are experiencing intense shame or disgust towards themselves. For others it serves as a way of communicating their pain to others. At least half of young people who self-harm do not seek help though, meaning it is often done as a private way of self-soothing or regulating distress rather than as a way of eliciting a response from others. Whatever the function for the individual, it is usually in response to painful feelings or experiences of some description, and those who self-harm require compassion and empathy, not judgment.

Adolescence is a challenging time, with many developmental, hormonal, and psychosocial stages impacting a young person’s mental health and emotion-regulation capabilities. Common experiences which can trigger a young person’s distress include bullying, academic concerns or pressure, family or parental conflict, social concerns, relationship difficulties, low self-esteem, perfectionism, sexuality, gender identity concerns, body image concerns, and trauma.

What do I do if my teenager is self-harming?

·      Firstly, take a deep breath and calm yourself before reacting. It is totally understandable you may be feeling shocked, scared, angry, sad or confused… and at the same time there’s a much greater chance you’ll be able to manage the situation effectively by being contagious with your own calm. If your teenager is already in emotional pain, adding your own intense emotions on top of whatever they are already feeling is unlikely to be helpful.

·      This doesn’t mean you can’t share your concern; but try to do it with empathy and a non-judgmental approach to convey to them that you care about them and want to find a way to help. Many teenagers are very worried about their parents finding out about their self-harm for fear of judgment, criticism, invalidation, punishment, or shame. 

·      Approach it with compassionate curiosity and empathy rather than judgment. To you it may seem irrational to be hurting yourself when you’re already suffering, but to a lot of young people they perceive the self-harm to be helpful rather then harmful. Or at least that it provides immediate short-term benefits which outweigh any consequences or risk. Try to understand what function it serves for them rather than making assumptions.

·      Remember, for most of us, whatever occurs in life we are doing the best we can at any given point in time. This doesn’t mean we can’t learn to do better or get help to do better if we’re struggling, but it does mean that if your teenager is self-harming, it is likely that it is the most effective way they currently have to help themselves cope.

·      Many teenagers want to stop or reduce self-harming. What often holds them back is not knowing how to do this without giving up their most valuable coping-strategy. To take away their way of managing their distress without replacing it with something else can often increase their distress significantly. Once you understand the function, it’s possible you can help them try some alternative ways to meet the need they have.

·      On the other hand, your teenager may not be ready or motivated to stop self-harming immediately. Or they may try to stop and yet be unable to cease it straight away. Try not to panic, blame, or shame them if this occurs. If it has been happening for a while it may take time to change these behaviours.

·      Get support for yourself. Whether it’s a partner, friend, family member, or even professional help, this can be an extremely stressful situation to try to navigate. Ensuring you have people to support you whilst you try to support them can be invaluable.

·      Get professional help for your teenager if you are concerned. For some teenagers, their parents knowing about either the self-harm itself, or the underlying pain they are in, can bring about a sense of relief they are no longer alone or needing to hide it. For others, their parents knowing fills them with dread, shame, or guilt which exacerbates their struggles. Your teenager may open up to you once they know you know, or alternatively they may clam up and refuse to talk about it. If you believe your teenager is experiencing mental health concerns or trouble coping in some way, it may be beneficial to get them professional assistance to help them work through their issues or learn healthier coping tools.

·      Finally, try not to allow your mind to spiral you into panic. Self-harm is generally very treatable. Whilst it seems scary and naturally elicits a lot of concern, we deal with people on a daily basis that engage in self-harm. We have a number of evidence-based treatments we can discuss with you and your teenager that can help.

Talking to Children about Coronavirus (COVID-19)

Many parents are reporting finding it difficult to know how to have a conversation with their children about the Coronavirus, and how to help minimise their children’s anxiety about themselves, their parents, and other people they care about. By talking openly about COVID- 19, you will help your child to feel informed, heard, that they know what to do to stay safe, and that they able to bring up any concerns they may have in the future. Here are some tips for talking to children about COVID-19:

Don’t Let Your Own Fear Be In Charge

• Many people are understandably anxious about the coronavirus, so it is important to be aware of your own anxiety levels. 

• Children often become worried when they observe their parents’ anxiety and fear. This might come about through noticing constant focus on the topic, overhearing conversations, or noticing expressions or actions that convey fear.  

•  It is important for parents to manage their own emotional responses and model how to cope through calm behaviour and sensible actions. You might start on this by identifying and naming your emotions, talking to other adults about how you are feeling, and checking you are focusing on facts. 

• Also check out earlier blogs that focus on how to manage your anxiety and worry in the context of COVID-19. Seek professional support if you do not feel like you are coping.

Bring Up the Topic

While it might feel uncomfortable or confronting to talk about COVID-19, as many parents instinctually want to shield their children, nearly all children will be aware of some information (factual or not) and will have picked up on stress in the family.  

By bringing up the topic, parents can:·       

• demonstrate a sense of control

• model and encourage honesty and trust

• provide factual information

• reassure children that they can talk about the topic, and will be heard

• reassure children that they can address worries

How To Start - What Do They Know?

• Start by asking your child what they know, or have heard, about COVID-19 (or Coronovirus - use the term they are most familiar with). Let them know that you are interested in everything they have heard or come across, even if they are not sure if it is true.

• Validate fears and worries

  • One of the most important aspects of discussing COVID-19 with a child of any age is to listen. When you ask them about what they know and think about Coronavirus, listen carefully to what they are afraid of or confused about, and be careful not to dismiss their fears, interrupt or interrogate them. 

  • Some of your child’s fears may not seem correct or relevant to you, but remember they are still real fears for your child.

  • Not only will understanding their feelings and fears help you to work out how best to go about talking to them, but your child will feel heard, understood and supported. 

  • If your child’s fears are based on wrong or inadequate information, this can be addressed by providing facts and helpful information.

  • If your child’s fears are valid, you can help support your child and talk about ways of staying safe and managing difficult feelings.

  • Also check out the earlier blog by Stephanie Hill on the role of validation in parenting. 

Once you understand what your child knows and is concerned about, you can work out where best to start when addressing the facts and alleviating some of their concerns.

Keep It Simple, Age-Appropriate and Factual

When talking to children about COVID-19:

• Check that your language and tone of voice are positive

• Stick to the essential facts and avoid over-explaining or interpreting. Do not over-burden young people with too much information. 

• Make sure that you only rely on information from credible, accurate sources (and teach your children to as well if they are old enough). For example, the Australian Government or World Health Organisation (WHO). This is your opportunity to let your child know accurate information, and to diminish the effects of their imagination or misleading information that they may have acquired.

• Give practical advice about how to stay healthy. This allows your child to feel proactive and able to protect themselves and those around them.

• Make space for your child to ask questions, and answer these as honestly as possible (bearing in mind their age). It is also ok to say that you don’t know. You can talk about how people are trying to answer many questions.

• For younger children, sit close to them, maintain physical contact, and try to be at eye-level

• Younger children will learn and understand best if you model behaviour such as washing hands thoroughly with soap and water (while singing a song for 20 seconds), avoid touching your face, and cough into your elbow. You can also demonstrate social distancing. 

• There are many good resources available to help younger (and older) children, but check that they are reliable and accurate. For example, online videos (e.g. YouTube) can help to help demonstrate to younger children behaviours such as washing their hands properly, and explain why it is important, and how to do it. Also, have a look at the ABC’s Play School episode on Coronavirus, and other resources: https://www.abc.net.au/abckids/shows/play-school/covid-19/12114308

Adapting to Change and Problem-Solving

As children and their families are experiencing many changes in their lives as a consequence of COVID-19, it is important for parents to address the need for change in as calm and positive a manner as possible. This will help children to also respond more calmly.

• Keeping to usual routines and schedules as much as possible helps children (and adults) feel safe and in control. When changes need to be made, parents can calmly establish new routines to adapt to the circumstances.

• School closures and social distancing have created particular challenges for children, and it is important to listen for the difficulties children might be experiencing with these (and other) changes. Parents can help by:

  • Letting children know why the changes are necessary and helpful, and that the changes are not forever.

  • Identifying what emotions and particular problems are being felt, and working on how to solve these problems together. For example, if children are missing seeing their friends or some family members face-to-face, help them to find other ways to stay connected via telephone, online channels, or creating gifts or cards/letters. Also see the earlier blog on problem solving approaches.

Ongoing Monitoring

• Provide regular opportunities to continue the conversation, and check-in with how children are feeling. Try and be mentally present when your child is talking to you, so that you don’t miss a cue that they want to talk about something.

• Children often find it hard to talk about their difficult feelings and worries, and so parents might notice changes in behaviour instead. These changes might include becoming angry and frustrated more quickly, or withdrawing from the family.

• Headaches, stomach-aches, or difficulty sleeping may also indicate that children are worried.

• Children should be encouraged to tell an adult if they are not feeling well.

How To Readjust To Life After Covid Restrictions Using ACT

As restrictions start to slowly lift in regards to social distancing, it’s important to think about how we re-adjust to a different way of life yet again. We’re hearing a lot of talk about things returning to “normal”, however it’s more likely that we will all be forging a “new normal” from here on out. Adjusting into social distancing and self-quarantining restrictions was probably quite difficult. However, adjusting back out of restrictions and into a more busy, social, and active again can be equally as challenging.

Some things are starting to look similar to before the shut down – school children are back in uniforms, in playgrounds, and on buses. Cafes now have places to sit down and order at the table. Sport events are beginning to run again. Supermarket shelves are always fully stocked. You may have been seeing small groups of friends and family again. 

However, there are still things that haven’t changed (and many won’t for a while). Many of us are still working and doing therapy from home. It’s acceptable (even welcomed!) to wear face masks in public. We are (hopefully) all still washing our hands frequently and carrying hand sanitiser with us. Domestic and international borders are still closed, and overseas holidays seem far away. It may be challenging to visit older parents or grandparents, and the presence of a cough or sniffle is still threatening. 

As restrictions begin to lift further, we might notice ourselves feeling the impact of re-adjusting yet again. And this is totally normal! In the same way we might have noticed a variety of unpleasant or uncomfortable experiences when restrictions began, we may experience these symptoms as things are lifting, even if we are pleased or excited about the easing social distancing!

It’s totally okay to perhaps feel more nervous, on edge, or irritable. To be ruminating or having disrupted sleep. You might notice your mood shift, or you preferred style of distorted thinking flare up. Definitely speak about this with someone – perhaps a close friend or family member, or maybe your GP or Psychologist if you’re particularly concerned. 

ACT is a mode of therapy with the goal of psychological flexibility. As we move through different stages of restrictions, being able to stay ‘psychologically flexible’ is a great way to move through life and adjust to the world after COVID.

ACT was developed by Steven Hayes, and it centres around 6 core processes, to address an individual’s concerns with their life, their feelings, thinking, and/or behaviour. Each process has a helpful perspective on how to increase our psychological flexibility, and deal with “life on life’s terms”, as the saying goes.

1. Acceptance

Acceptance is not necessarily approval of something, such as an experience or emotion or event. We don’t need to like or enjoy something to accept it. To accept is to move out of a place of denial or avoidance, and ‘sit with’ what whatever is going on. You might want to read Stephanie’s previous blog post on Willingness, which was published last month, and I think is particularly relevant here. As we adjust to post-COVID life changes, acceptance can look like acknowledging the wide variety of thoughts and feelings that we are experiencing (or acknowledging, not denying or avoiding, those experiences in others!). 

2. Contact with the present moment

You’ve probably heard it explained before that depression is a tendency to ‘live’ in the past, and anxiety is a tendency to ‘live’ in the future. ACT encourages us to make contact with the present moment. By doing so we allow ourselves to cope with and manage and enjoy what is happening in (and only in) the here and now. There are many ways to do this, perhaps through forms of mindfulness meditation. But even types of journaling, gratitudes, breathwork, and exercise can help us create present moment awareness. Particularly as restrictions begin to lift, we might find ourselves spending more time in the future (“what could happen?”) or maybe in the past.. When you notice yourself doing that, try and find one way to connect yourself with your present moment (using one of your five senses is helpful!). 

3. Values

What have you learnt about yourself during this time? When we experience change, we often get a chance to re-evaluate our values. Perhaps you’ve realised how much you’ve loved having quiet, unhurried weekends, maybe you’ve surprised yourself with how you’ve adapted to take care of your kids and do homeschooling, maybe you’ve enjoyed picking up some craft or cooking, or maybe you’ve enjoyed spending more time with the people you live with. What have you enjoyed? What have you missed? How have these restrictions revealed to you what you VALUE? This part if particularly important for Step 6, below. Without creating conscious awareness of our values, we’re often more likely to live in a way which is automatic and perhaps not authentic. Before life becomes busy again, think about what you might want to change to do more of what’s important to you (and less of what isn’t). 

4. Cognitive Defusion

Cognitive defusion is to, as the name suggests, “de-fuse” from our thoughts. We can often become attached to our thoughts, and they can play a big role in how we feel and how we act or behave, and what decisions we make. We aren’t our thoughts though. Separating ourselves from what we think can be helpful in many ways – it can help us think clearer, particularly when experiencing ‘brain fog’ due to depression or anxiety. It can also help us become less impacted by the emotions that these thoughts bring. I often encourage clients to say “I’m having the thought that I’m not good enough”, rather than “I’m not good enough” as a way to begin defusion. As we move back into a different way of living, perhaps try labelling your thoughts in this way (e.g. “I’m having the thought that I won’t be able to cope at school”, or “I’m noticing the feeling of anxiety rise in my chest”). 

5. Self-as-context

‘Self as context’ is a tricky concept, but in essence, is to understand that we are not our thoughts or feelings, but we are the being that can observe these thoughts or feelings. Self as context involves creating an “observer self”. It’s why I often like to invite clients to start writing in a journal, as it encourages observation of our internal processes. When we connect with our ‘observer self’ we can also begin to see other “parts” of our self – label them and work with them (such as a scared, fearful self, or our bold, courageous self, or our creative, playful self). When we have an observer self, we might also find it easier to be compassionate and kind to the parts of ourself that we don’t like. As we move out of some restrictions, take some time to notice your reactions to things. ‘Self as context’ is not necessarily about trying to change reactions or thoughts, it’s simply about observing them. Maybe if you’ve got some extra time in the morning because there’s no commute, take some time out to journal or reflect. 

6. Committed Action

Like the name suggested, ACT is about taking committed action. Particularly in a values-drive direction (which is why Step 3 is so important!). We can spend a lot of time thinking, planning, ruminating, or procrastinating – but a core feature of ACT is doing. After reflecting on your values, perhaps come up with some concrete ways to take action in line with your values. Maybe you want to drop an extra-curricular, or pick one up. Perhaps you want to walk outside more, or be more thankful, or commit to spending more time with your family or housemates. I often encourage clients to consider Dr. Nicole LePera’s (@theholisticpsychologist) approach, and to make one small promise to yourself each day – keep it really, really small (no big resolutions here!) and get into the habit of doing something values-driven each day. 

The Importance of Self-Compassion

Research into the importance of self-compassion has gained a lot of momentum in recent years. With very good reason! A lot of the clients we see report that they experience a lot of self-judgment and self-criticism. Experiencing really painful thoughts that they’re failing, they can’t do anything right, or that they’re not good enough. Or they report being so stressed and overwhelmed, and yet they struggle to take a break from their busy lives. instead they tell themselves they need to do more, achieve more, be more, in order to feel worthy. It’s so hard for all of us when life feels this way! Similarly, when it all gets too much “taking a break” often means numbing ourselves with an activity that ultimately makes us feel worse; such as disengaging from life and those who care about us; or engaging in unhelpful behaviours. These things often give instant relief but ultimately take us further away from the meaningful life we want to live.

If any of this sounds familiar, there may be an alternative. A gift you can give yourself! The gift of self-compassion.

What is Self Compassion?

Dr Kristen Neff, one of the world’s foremost researchers in self-compassion explains that self-compassion has 3 components.

1. Self-Kindness vs. Self-Judgment

   In order to be compassionate to ourselves we need to respond to our mistakes and perceived inadequacies with warmth and understanding. Life doesn’t always go the way we plan. We can’t always do or achieve what we want. It’s important that when we experience pain or setbacks we work on accepting the reality that this is part of life. We cannot always be perfect or achieve perfection. Holding those unrealistic standards often leads to self-criticism, frustration, and increased suffering.

2. Common Humanity rather than Isolation

   When we are in pain or we make a mistake, we often feel very alone. We feel like we are the only person experiencing this and nobody else has the same troubles or perceived flaws. Whilst it is true that we are unique individuals with our own special place in this world, ultimately pain and imperfection are part of being human. Everywhere in the world others are experiencing their own journey with mistakes they wish they could undo, and parts of life they wish weren’t the way they are right now. Recognising this can help us realise we are not alone in our suffering, we are not unique in our feelings of inadequacy, loss, shame, or regret. Feeling these uncomfortable feelings is part of the very essence of humanity.

3. Mindfulness versus Over-Identification

   Mindfulness is a state of non-judgmental awareness of the present moment. We cannot be compassionate towards ourselves if we ignore or suppress our emotions or painful thoughts and don’t recognise what we’re experiencing. And at the same time, we can’t be compassionate towards ourselves if we over-identify with our unhelpful thoughts and treat them as facts. Or if we allow ourselves to become completely consumed by painful emotions, reacting rather than responding effectively to them. Mindfulness helps us to become more aware of our reality, our thoughts, our feelings, and to accept them without judgment. Being mindful allows us to recognise when we need to be kind and gentle with ourselves, and to also be present with those around us in order to connect to the shared humanity that binds us all.

Self-Compassion in Action

There are many ways to embody these qualities of self-compassion that have been developed by Neff and other experts in the field. Here are some simple ideas you might like to follow:

1. Self-Compassion break

   This involves taking a few moments to draw your awareness to something in life that is difficult for you. Notice what it feels like, where in your body that discomfort is. Then say to yourself “This is a moment of suffering”, “it hurts right now,” or “this is really painful”. Next, draw on common humanity by saying “Suffering is a part of life” or “others feel this way too” or  “I’m not alone”! Finally, say to yourself “May I be kind to myself” or “May I forgive myself” or “May I learn to accept myself as I am”. Taking a few minutes to do this can be a way of acknowledging your pain and supporting yourself through it.

2. What would I say to a friend?

   This is a powerful exercise for those that place higher expectations on themselves than others, or that struggle to treat themselves with the same kindness they offer others. Next time you are experiencing a difficult situation and notice yourself thinking self-critical thoughts, try to think about what you would say to a friend or loved one experiencing the same challenge. It can be easier to think of how we would be encouraging or supportive to those we cherish rather than ourselves sometimes, so use this ability, and then turn it towards yourself.

3. Be your own best friend

   Building upon that idea, it can be helpful to remind yourself that you spend more time with yourself than any other human on the planet. What might it be like if instead of walking around judging and berating yourself, you worked to become your own best friend? To pick yourself up with encouraging words when you’re having a hard time, to be gentle with yourself, or to let yourself know that you love and value yourself and it’s ok to make mistakes sometimes?

4. Self-compassion touch

   There are many ways of doing this exercise, but the idea is to embrace the comfort of physical touch we often offer to others who are in pain. You could give yourself a hug. Gently massage your body with a special lotion or stroke the skin on your arm or face. Or you could place your hand on your heart, or any part of your body where you feel pain, and picture a warm, soothing touch radiating out offering support and comfort.

We all have the capacity to be kind and compassionate to ourselves. Even if its unfamiliar at first, or you are so used to taking care of others you forget to prioritise your own needs. It may take some practice, but prioritising self-compassion on a daily basis could be one of the greatest gifts you could give yourself to enrich your life in a meaningful way.

Remember, self-compassion is not about self-pity, or self-indulgence, or even self-esteem (which is often tied to evaluations of ourselves in comparison to others). Instead it is simply about creating more awareness of your thoughts, emotions, and experiences as a unique individual, who is part of a shared humanity. Recognising you are not alone in feeling this way, and then responding with kindness and acceptance of your flaws. We are all striving to survive, to thrive, to build lives which matter to us, and we all stumble, fall down, and make mistakes sometimes. That’s ok, we’re human. Each time we notice we’re experiencing a challenging time , it’s an opportunity to strengthen our capacity to be accepting of ourselves and acknowledge we are doing the best we can in each moment. The times we perceive ourselves to “deserve it” the least, are often the times we need love and care the most. And who better to treat us with the kindness and compassion that can shift our world than ourselves.

Coping Skills for Children: Using Distraction

I have previously explored some relaxation skills, such as calm breathing, grounding and visualisation, which children can use in many situations when they feel anxious or afraid. While these skills are very important and helpful, there are other strategies that children can also learn and use. One of these is learning to use distraction in helpful ways. 

Importantly, distraction strategies are not a way of teaching children to ignore or push away difficult thoughts, feelings or problems. It is still important to encourage children to identify and consider their thoughts and feelings, and solve their problems, at some point. So why teach a child distraction skills? Well, they can be particularly helpful in a couple of situations:

1. When a child is feeling worried or anxious they are often in fight, flight or freeze mode. They can feel emotionally overwhelmed and not be able to deal with their anxiety or stress immediately. This inability to cope can show in many ways, including outbursts of anger or distress, or withdrawal. The child may need to take some time out before being able to processing things. In this instance, distraction can provide the necessary break, giving the child’s system time to calm down, and their brain the opportunity to move from an emotional state to a thinking state.

2. Sometimes a child is faced with a stressful or worrying situation where they can’t control or solve the problem. Mostly a child can do something to try and make a situation better (e.g. talk to a parent or teacher about a problem in their class), but sometimes there is nothing they can do about the situation (e.g. their puppy is sick and at the vet).  When this happens, children may find it impossible to stop thinking or worrying about the situation, and it will often stop them from being able to focus or functioning well. When this happens, it can be very helpful to use a distraction to take their mind off their stress. By focusing on something else, the child can deal better with stressful situations that can’t be controlled or made better.

Distraction Strategies

There are many simple distraction strategies that children can be encouraged to use when they might need a break or something else to focus on. The possibilities for distracting activities are endless, and it is important to choose activities that will work for each child. Creating a list of appropriate activities with the child (draw them for younger children) can provide a ‘menu’ of options for when they feel like distraction would be helpful. 

Here are a few suggestions:

Play

Play is a great way of helping kids take a break and relieve their stress. Play can take many forms and can include activities like: 

·       Board or card games

·       Play with a pet

·       Play with a friend or family member

Creativity

Creative activities can provide distraction, but can sometimes also provide a way of expressing or exploring feelings and thoughts. Some creative distraction strategies include: 

·       Drawing

·       Painting

·       Writing a story

·       Finger knitting

·       Making a comic book

·       Making a friendship bracelet or beaded jewellery

·       Designing/making a paper plane

·       Origami

·       Make a card for someone

Other suggestions

·       Reading

·       Watch a movie

·       Baking or cooking

·       Planning something fun to do

·       Do a jigsaw puzzle

·       Listen to music

Don’t forget that distraction strategies can also be helpful to adults in similar situations – give them a try yourself!

Window of Tolerance

What is it?

The ‘Window of Tolerance’ is a concept developed by Dr. Dan Siegel. It’s a way of understanding our reactions to and ways of managing stress. He describes three ‘zones’ that we might be functioning in at any one time.

The first zone is when we’re ‘in’ our Window of Tolerance, this is also called our ‘comfort zone’ or when things are fairly normal. When ‘we’re in the zone’ (so to speak) we’re able to function fully. This includes:

-       Being able to see choices, understand options, predict consequences and make decisions

-       Notice our thoughts and feelings 

-       Regulate our thoughts and feelings appropriately, including self-soothing

-       Plan and think deeply 

-       Feel a range of emotions appropriately and comfortably – excited, concerned, happy, relaxed, disappointed. It’s completely normal of have ups and downs within this zone. 

Certain situations or events can push us out of our Window of Tolerance. 

We can be ‘out’ of the Window in two ways – in states of hyperarousal or hypoarousal. ‘Arousal’ is a psychological term which often just means how ‘activated’ we are. To put it simply, one is ‘up’ and one is ‘down’. 

Hyperarousal describes the ‘too much’ zone, this is when we are in ‘Fight or Flight’ mode:

-       We react to situations, we aren’t able to respond

-       Instincts and split-section reactions are more common

-       We notice physical sensations of stress: sweating, heavy breathing, shaking, restlessness, flushed face, racing heart, agitation 

-       It’s hard to notice our thoughts (perhaps they’re spinning really fast) and feelings (maybe their changing quickly)

-       It’s difficult to moderate our thoughts and feelings – it takes a lot of time and effort to calm down again, or they feel out of control

When we’re in this zone, it’s often more difficult to function – concentration and memory might be impacted, so working or doing school is hard. We might not be sleeping or eating as well. Relationships might also be more difficult because we feel stressed or irritated.

Hypoarousal describes the “too little” zone. This is when we are in ‘Freeze’ mode:

-       We feel numb or disconnected from ourselves and others

-       We feel ‘stuck’ or ‘shut down’

-       Thoughts, feelings, sensations might be dulled or hard to access

-       We might find it hard to make decisions or know what to do or take action towards certain goals

Similar to when we’re in “too much”, when we’re in this zone, concentration and memory might be also impacted, as might be our sleeping or eating. Relationships may also be more difficult because we are less responsive or seem very flat. 

It’s important to note that:

-       Everyone’s window looks different! Things that might stress you out, and push you ‘out’ of your window might not be that stressful to your partner or your child. Some people respond to stress or triggers by going ‘up’, some people respond by going ‘down’ and sometimes we don’t know which way it will go

-       Trauma or chronic stress can narrow our window – you might find that smaller and smaller things begin to make you anxious or angry or flat. Perhaps you used to spend a lot of time ‘in’ your Window of Tolerance, but now often things are “too much” or “too little”

We’re going to look at 4 tips on how to use the Window of Tolerance – three things to do, and 1 thing to avoid.

What to do

(1)  Be aware

It’s so important to be aware of where we are (and where our loved ones are) in relation to the window.

I sometimes suggest to families to have a print out of the Window of Tolerance of the fridge, and have a small magnet for each family member – start each day with placing the magnet where you’re feeling at that morning, and feel free to move throughout the day.

Spend some time checking in regularly with yourself. Perhaps rank yourself on a scale of 0-10, and create a range of zones (e.g. hypoarousal is 0-3, normal is 4-7, hyperarousal is 8-10), or begin journal each morning, or spend some time in mindful body scans. 

Know your ‘warning signs’ – what does being ‘in the zone’ feel like, how will you know? What does being in hyperarousal feeling like, how will you know? What does being in hypoarousal feel like, how will you know? For some people, noticing physical sensations is easiest to flag what zone they’re in, for others it’s their feelings, or the speed of their thoughts, or their productivity. 

(2)  Get back into the window

When you notice yourself out of the window, either up or down, work out how to get back into the window.

There’s a whole range of ‘distress tolerance’ or ‘emotional regulation’ skills out there – pick and choose ones which work for you.

They might include: fast or gentle exercising, mindful breathing, guided meditation, taking a shower, making a cup of tea, speaking to someone you care about, spending time in nature, distracting yourself with a funny video, listening to music, lighting a candle. 

Sometimes the same techniques can be helpful regardless of whether things are ‘too much’ or ‘too little. 

(3)  Widen the window

When you’re back in the Window, work out ways to stay there and perhaps even ‘widen’ the window. When we’re feeling regulated and settled we’re in a much better position to help ourselves remain there. 

Strategies might include processing the stressful event, journaling about it, or doing some cognitive challenging to work through beliefs or assumptions which contributed to the stress. 

Practice good self-care, and create a good routine. Prevention is better than cure! Perhaps set a 10-minute window each day (or week) to do something for yourself. Maybe plan out your week or your semester or your day to notice when stress points might occur, and plan accordingly. 

Practice distress tolerance techniques when feeling calm! There’s no point trying to try out a new breathing technique when you’re in the middle of a panic attack – we should be trying out emotional regulation strategies (particularly things like mindfulness or breathing strategies) when we’re settled, it is a great way for your body to get used to them. 

What not to do: 

(4)  Push yourself – add stress to stress

When you notice yourself outside of the window, adding extra stress or pushing yourself can often make matters worse.

This might look like continuing to engage in the argument with your partner or child, or remaining in the presence of the stress trigger (maybe an assignment or email), or pushing yourself to work harder or calm down right away. 

Often what we need to do is ‘step away’. To take a physical or emotional break from the trigger, and practice a bit of self-compassion. 

The same principle applies when caring for those we love – perhaps a friend, partner, or child. When we notice them outside the window, it’s often time to ‘take a break’ and enable each other to breathe and re-set. Try not to re-engage (with the trigger or situation or stress-point) until you’re both back in the window. 

I’ve found the ‘window of tolerance’ an incredibly helpful guide for increasing awareness of ourselves and our stress responses. Self-awareness, particularly of our activation levels, can often be an amazing tool in beginning to self-regulate and also care for ourselves, and those we love.  

Willingness in Therapy... and life!

Various dictionary definitions of willingness includes “the state of preparedness to do something that is necessary” or “readiness to do something”. Willingness is perhaps one of the most important factors in determining therapeutic progress, and yet it’s not necessarily something that is explicitly discussed unless there is an obvious reluctance to engage. Booking an appointment is certainly demonstrating some level of willingness to seek help or achieve insight…and that is fantastic. Truly! A lot of people don’t have the courage to take that step. If turning up is all you are capable of right now, that’s ok. It is a journey, and you’re doing the best you can. We will support you in that! And at the same time, without a deeper level of willingness moving forward, simply turning up may not be enough to truly bring about the change you desire.

We as psychologists are driven to help our clients. We genuinely care, and at the same time, much as we often find ourselves trying, we cannot do the real work that’s needed to truly change your life. Often clients picture us to be experts that can “fix them” or “fix their issues”, however, therapists are not like mechanics, and people are not like cars. We have training and experience and knowledge of many evidence-based strategies to share with you, and we always strive to create a supportive space where you can reflect and be yourself…but we are not able to change your lives for you. You need to be there for you too!

Willingness as a Therapeutic Aid

CBT

Cognitive Behavioural Therapy requires a willingness to work on changing thoughts or behaviours. For example, exposure therapy to overcome fear or anxiety requires willingness to expose yourself to the things that make you afraid. If a client is not willing, and instead continues to avoid things that make them anxious, it’s likely fear-reduction will be limited. Behavioural activation to conquer depression requires a willingness to do things even when you don’t feel motivated. If a client continues to isolate and withdraw and does not follow through with increasing their activity levels, it is likely that they will continue to feel flat and disinterested in things that used to give them pleasure. CBT also requires a willingness to acknowledge the negative thoughts or beliefs that hold you back, and then a further willingness to actually work towards challenging them. This is really hard if you’ve been thinking them for so long that they feel like facts! Or it may involve working on breathing or relaxation skills to increase your ability to regulate your own physiological arousal so that you feel in control of managing your distress. Without practicing these strategies between sessions, it is unlikely you will feel that confident using them at times they could really help.

DBT

Dialectical Behaviour Therapy explicitly teaches willingness as a skill to be learned and practiced in all areas of life. Willingness is described as a willingness to respond to life’s situations wisely, as needed, voluntarily, and without grudge. Essentially it is to accept each situation as it is and do what is needed to respond effectively. Fully participating in each moment mindfully, wholeheartedly, and without reservation. It is described as the opposite of wilfulness, which is where we refuse to accept facts or reality as they are, try to control events or those around us, sit on our hands doing nothing, or refusing to truly participate in our lives or do what is needed.  Often clients say things like “That won’t work” or “I tried it and nothing changed”. Those are often clues that wilfulness has shown up! There is a big difference between grudgingly going through the motions of trying something new, or perhaps trying it once and giving up; versus actually fully committing all the way to doing what is needed. A common metaphor used is that life is like playing a game of cards. The most skilful players are those that play the hand they’ve been given. Not the one they wish they had! If they get dealt a bad hand they don’t throw their cards down and storm off, they don’t give up and just fling any old card down, and they don’t ruminate on the hand before, or worry about being dealt another bad hand afterwards. They willingly and wholeheartedly focus on the hand they have now, and what will be the most effective way to play it! Willingness in DBT is a big component of therapy in the sense that it requires being willing to learn new skills, practice them in session, and then go home and generalise them to other areas of life. However, it is more than that. Willingness is a way of living, of facing every challenge that arises, of accepting the experiences of life, both good and bad, and recognising we each have the capacity to either struggle against reality, give up and do nothing, or instead wisely figure out what to do that is likely to be most effective.

ACT
Acceptance and Commitment Therapy (ACT) frames willingness in two ways. Firstly, as an acceptance of all internal experiences: thoughts, images, feelings, and memories; and secondly, as a willingness to do what it takes to live a rich and meaningful life in accordance with our values. So, with regards to the first one, willingness involves opening up, making room for, or allowing painful or unwanted thoughts or feelings to be there. Truly accepting, rather than just tolerating their presence. Instead of spending everyday trying not to feel anxious, or not to be sad, or trying desperately to avoid or shut down or distract from our painful thoughts or memories, ACT teaches us that living a meaningful life can be done even with these in our life. We can never “get rid of” anxiety, fear, sadness, grief, shame, or guilt because to be alive is to experience a full range of emotions, both painful and joyous. To try to deny those that are painful only leaves us hooked by the very thoughts and feelings we are desperately trying to avoid. The second part of how ACT frames willingness is that to allow these thoughts or feelings does not mean to become fixated on them or controlled by them. It instead means to observe them without judgement as they arise and to make room for them to be there whilst we move forward in valued living. We choose to willingly do things that matter to us, even if it means those painful thoughts and feelings will show up! 

Therapy and life in general

Whilst CBT, DBT and ACT are some of the most common evidence-based approaches that we practice, there are many other forms of therapy that do not include components around teaching skills or strategies to practice outside of session. But no matter what therapeutic framework is used, therapeutic change requires willingness in some capacity. Perhaps it’s a willingness to be vulnerable and share with us what is really on your mind. Perhaps it’s a willingness to put scepticism or fear aside and try new things. Perhaps it’s a willingness to reflect upon your life, your experiences, your deepest fears, shame, or guilt. Or perhaps it’s a willingness to let yourself truly be seen. To believe us when we say you don’t need fixing because you are not broken. You are human. And to be human is to be full of complexities, to experience pain, to live in a world where we cannot control the things or people we desperately want to control. These things are hard! It makes sense that not everyone will be ready to engage in therapy in this way immediately. These things require a lot more willingness than simply showing up!

The same is true for life. Living a meaningful life requires more than simply showing up. More than going through the motions and wishing things were different or waiting for things to change. So, take a minute to pause. Really pause, and ask yourself: “Are you willing to give life your best shot?”

COVID-19 Uncertainty: Some strategies for managing worry

At the moment we are all being confronted by constantly shifting uncertainties associated with the worldwide health situation. It is important to acknowledge that it is very natural to have worries at the moment - what we are experiencing is unfamiliar, constantly changing, ongoing and unpredictable. These are all elements that, understandably, strongly trigger fear and worry in many people. 

Although worrying can make people feel like they are doing something useful in an uncertain situation, this is generally misleading. Most worrying is not helpful. It does not protect us, or those we care about, and it does not change the situation. Furthermore, our worries can become excessive, or feel like they are making us struggle in daily life. If this happens, it is important to try and reduce our worries and manage our anxiety levels. Here are some ideas that might be helpful in doing this:

1. Is it a ’real’ problem or a ‘what if…’ worry?

a)    Identify what you are worrying about.

b)    Decide if it is

·       a ‘real’ problem that you can do something about, or 

·       a ‘what if…’ worry (something that could potentially happen, but is not currently real and cannot be accurately predicted). These worries may be harder to identify.

c)    If it is a real problem that you can do something about, work out what you can do to improve or solve the problem, either immediately or at a specified time. In the current health situation, where isolation is increasingly common, this may involve planning to manage your mental health by setting up and maintaining routines, identifying how to reach out to help others, working out ways to stay connected with friends and family, and deciding how to get enough exercise.

d)    If it is a ‘what if…’ worry, you can 

·       notice your thoughts and respond to them (see below), then let them go and remind yourself not to engage with them every next time they come up. 

·       choose to postpone ‘what if…’ worries until later (see below).

Then change your focus to something that you can do, that is important or meaningful to you, and do it.

2. Notice your thoughts

‘What if...’ worry usually involves ‘catastrophic’ thoughts about negative outcomes of situations. When we are worried we typically overestimate:

·       The likelihood that something bad will happen (e.g. ‘I’ll be the one to get corona virus if I go out’)

·       How bad it would be if it did happen (e.g. ‘I will need to be in intensive care’)

·       How we would cope (e.g. ‘I would be too frightened to cope’; ‘I could go crazy’)

As these types of thoughts are generally overestimates, they are often not accurate or true. When you catch yourself having thoughts like these, do some reality checking, and respond to your thoughts. In doing this, remember to be kind to yourself, and be understanding about your fears. 

·       What would you say to a friend expressing the same worry thoughts? 

·       Can you find trustworthy information about the thought (e.g. the rate of people who get no/few/mild symptoms of corona virus)? 

·       What can you do to lessen the extremity of the thought (e.g. consider factors under your control, such as your ability to practice good hygiene, social distance or self-isolate; protective factors such as your ability to access healthcare, or your health and age status)? 

·       What could you do to make yourself feel better (do an activity you enjoy; do some relaxation or mindfulness)? 

Note: This approach is aimed at reducing catastrophic thinking about negative outcomes. It is still very important that we take reliably informed action to stay safe. Read advice from the Australian government or WHO about what is sensible to do, decide what you will implement (e.g. good hygiene practices and social distancing), and put other thoughts about this aside.

3. Postpone your worries

You can also choose to postpone ‘what if…’ worries until later. Although you might feel an urgency to focus on yourworries, and that they are uncontrollable, you can choose not to get caught up in them. 

In order to do this, set aside a quiet time later in each day to worry (around 15-30 minutes), and every time you catch yourself caught up in a ‘what if...’ worry, choose to let go of it until your worry time. Now redirect your attention to something else. 

This may feel odd at first, and can take some practice, but it will limit the amount of time you worry each day. You may also find that your worries are less urgent and uncontrollable than you thought, or that by the time you get to worry time, the worries no longer seem that important.

4. Accepting uncertainty

Much of our worry can be driven by a need to manage uncertainty. This is particularly so with the level of uncertainty of the current unfolding health situation. If you cannot do anything right now to change whatever is the focus of your worry, try to accept that uncertainty and unpredictability. It can be helpful to stop and focus on how the uncertainty makes you feel – then, accept that feeling. It may be uncomfortable, but it will not hurt you. Just allow that feeling to be there and notice the wish for more certainty. Now choose an action that you can do, that you feel is important to you in that moment, and do it.

5. Identify and manage worry triggers

Try to identify the things that trigger your worry, and limit these. Is it…

·       Watching the news constantly?

·       Getting alerts at unpredictable times?

·       Checking social media every few minutes?

·       Talking to someone who focuses on negative events, or catastrophises?

Try to limit the time that you are exposed to your worry triggers each day. You could limit the time you spend on social media checking news, only engage with the news at a particular time each day, or limit your contact with someone who triggers your worry. 

6. Notice and appreciate the good

With so much uncertainty it is easy to focus on what is difficult or unsettling. Make time to stop and notice things that are good, or went well, each day. Appreciate the small things (e.g. the kindness of others, a funny moment, the beauty of nature or music, peaceful or relaxing moments). You could write these down at the end of each day, or share with family members.

7. Self care

Remember to care for yourself, so as to buffer yourself against the stress and worry of what surrounds you: exercise (safely), engage in relaxation activities, spend time in nature, eat well, get plenty of sleep, connect with friends and family, watch a film, listen to music, do something creative…add your own specific ideas to this list and keep it handy. 

Do not hesitate to reach out and seek professional support if you feel like you are not coping. Speak to your GP, or a qualified psychologist. Alternatively, contact a helpline such as Lifeline, Beyond Blue, Kids Helpline (https://www.healthdirect.gov.au/mental-health-helplines). There are many caring professionals who can help.