Imposter Syndrome and How To Manage It

While it is normal to experience occasional feelings of doubt, the term ‘imposter syndrome’ is often used to describe the persistent feeling of being a sham, fake or fraud, and undeserving of any success or achievement. It’s often used to refer to work situations, where the value of intelligence or achievement may be emphasised, but it may also be applied to social contexts and relationships (“if you get to know me, I won’t be who you think I am”), or perfectionism more generally.

The internal experience of believing that you are not as competent as others might think you are, that you may be exposed as a fraud at any moment, that you do not deserve successes, or that you do not belong, is obviously quite anxiety provoking, and may affect many areas of your life.

Imposter syndrome can affect anyone, irrespective of gender, social or work status, or level of expertise. While not a diagnosable condition, imposter syndrome is a recognised psychological pattern. The feelings of inadequacy are typically characterised by negative thinking, self-doubt, and self-sabotage, and often include features such as:

·      Fear that you will not live up to others’ expectations.

·      Difficulty assessing your strengths, competence and skills objectively.

·      Criticising your performance and focusing on your perceived failures, instead of your successes. Worrying excessively over the smallest of ‘errors’.

·      Attributing your success to external factors or luck.

·      Sabotaging your own success, including by: 

o   Underselling your expertise.

o   Setting unrealistic goals.

·      Overachieving. 

·      Sensitivity to criticism, even if it is constructive.

·      Perceiving asking for help as a sign of weakness or incompetence.

If this sounds like you, it may seem unlikely that you could somehow believe that you belong and deserve to be where you are. But by recognising your patterns of thinking and behaviour, you can begin to change how you respond. You could start by trying some of the following ideas:

·      Consider whether your imposter thoughts and actions help or hinder you in how you would like to be. Acknowledge your thoughts, feelings and responses. Observe them rather than getting caught up in them.

·      Trust that feelings of being an imposter are quite normal. It has been estimated that around 70% of people experience these feelings at some stage. Reach out to someone you trust and share your feelings – it is likely they will recognise what you are talking about.

·      Stop ignoring positive feedback. Acknowledge your strengths, competencies, successes and accomplishments. It can be helpful to write down your positives, and use them to challenge the imposter thoughts.

·      Be kind to yourself. Have realistic expectations of yourself, just as you would for others. It’s ok not to be ‘perfect’, not know everything, and make mistakes. 

·      Try not to focus on your own situation and inner experience. Rather, focus on what someone else is saying to you, or notice if someone else appears alone or awkward, and reach out to them.

Remember that it is normal to have some doubts - the goal is to manage the imposter thoughts or feelings effectively, not eliminate them.

Apps to help take the benefits of therapy outside the consulting room

One of the benefits (but also pitfalls!) of smart phones is that they are with us everywhere we go! They have the capacity to allow us to access tools to help with many aspects of our lives at the touch of a button, regardless of where we are. Therapy and mental health support are no different. Here is a list of apps that I often recommended to clients in sessions to assist them in a variety of ways, such as emotional regulation, building awareness, managing suicidal thinking and self-harm urges, and journaling. Many of these apps help us take our therapy ‘outside the room’, and practice what we’re learning more regularly:

Thought Diary – depending on the type of therapy you’re engaging in, your psychologist is likely to recommend that you keep a thought diary. This app allows just that – easy documenting of situations and thoughts that arise, with helpful prompts to recognise thought distortions, challenge negative thinking, and develop alternative thinking patterns. You can log your mood and gratitudes here also! The app has a feature to set notifications, so that regular thought logging can occur despite forgetfulness. 

What’s Up – this app is pretty comprehensive! It includes psychoeducational resources and information about mental health diagnoses and treatment. It has a section to to log mood, keep track of habits, and add notes. It’s got a ‘coping strategies’ feature with a range of explanations regarding CBT, ACT and DBT strategies discussed in therapy. The ‘Help Right Now’ section can provide some more immediate help or techniques to assist in moments of distress or overwhelm. 

Smiling Mind and Headspace – two apps that you’ve probably heard of before! Both offer guided meditation and mindfulness practice in a variety of lengths and topics. I love how accessible and flexible these apps have made attention training and building mindfulness skills. I often tell clients that building mindfulness doesn’t have to happen in a dark room with your eyes closed – I’ve put one of these tracks on whilst walking, cooking, and driving before. They’ve also got tips to help with stress, sleep, and motivation. 

Calm Harm – this app is great for those who self-harm and want to learn alternative coping strategies. It allows you to pick from 5 activity types (comfort, distract, express yourself, release, breathe) with a random option for when you can’t choose. It then allows you to pick either a short (5 minute) or longer (15 minute) activity to help you ‘ride the wave’ to harm, with heaps of options for things to do for that length of time. This app would also be useful if you’re trying to stop or reduce another behaviour that comes with cravings or urges (such as substance use). 

Beyond Now – this app allows users to create a safety plan around suicidal thinking. Do this in session with your psychologist, or with another support person (parent, doctor, counsellor etc). In 7 easy steps, it walks you through each stage of a safety plan - from preventative self-care measures, through to emergency situations, and has helpful suggestions for things to put in the plan if you’re not sure. It allows you to have immediate access to your safety plan wherever you are. You can input photos and contact details, so that supports are accessible. 

Worry Time – this app lets you set a ‘worry time’ and add worries to think about during your set aside time. The concept of ‘worry time’ is an evidence-based technique to help manage chronic and persistent worry (often present in Generalised Anxiety Disorder). It’s a helpful way to still note the worries or concerns you’re having, whilst also working at not having them creep into all aspects of your life. It can be an easy way to ‘brain dump’ things that your worry brain is holding on to. 

Moodily– this app allows you to track your mood. It makes it super quick and easy to do so (it can take 5 seconds!), and allows you to add in the activity you were doing at the time you logged. The ‘calendar’ section can help you and your Psychologist see any patterns or triggers. A great feature is that it will send you a notification at some point during the day reminding you to log your mood

So.. Your teenager is in therapy: What's really going on?

One of the most common challenges we face as psychologists when working with teenagers is juggling the teenager’s desire for privacy with their parent’s desire to know what is going on and whether therapy is “working” for their child. 

Both of these positions make sense.

Teenagers are in a developmental phase of seeking increased independence and autonomy. They are also forming their own identities as separate from their parents. This is a complex process that often involves navigating intense feelings around their changing bodies and sexuality, their increased responsibility and need to make important decisions, and an amplified focus on peer relationships rather than parental influence. It also involves taking risks and making mistakes in order to learn the consequences of their own decisions and actions. 

It’s not possible to prevent children from experiencing the ups and downs that come with adolescence. Yet it is often very painful for parents to take a step back and acknowledge they are no longer the centre of their child’s universe in the same way they were when they were younger. This doesn’t mean parents are no longer important though - teenagers are highly sensitive to their parents’ perceptions of them, even if they don’t always show it! And as their brains are still developing, they definitely still need parental support, guidance, and boundaries as they work out the complexities of transitioning from a child to an adult.

But this frequently leads to a dilemma.

Teenagers are often navigating highly sensitive personal situations which involve things they are fearful of their parents’ judgement around. So, it makes sense that in order for them to feel safe to open up, they need to feel confident they can talk about things without worrying about their parent’s reactions. 

On the other hand, parents are often worried about their teen, concerned about some of their actions, feeling shut-out or desperate to help but not sure how, or maybe even frustrated that their teen won’t listen or take their advice on board.

So, what is a psychologist’s role in all of this? And what is it important to keep in mind throughout the process?

1.     We are bound by ethical and legal guidelines which mean we have to respect your teenager’s right to privacy and confidentiality. Depending on the age of the teen and their capacity to give informed consent, unless there is an imminent risk of harm, we often cannot tell the parents what’s going on, even if we feel it would be helpful for them to know! This is extremely complex in reality, and most psychologists spend vast amounts of supervision time discussing their decision-making around ethical issues such as these. Please rest assured we are not keeping things from you to shut you out. We are always using our clinical judgment to make decisions around what is in the best interests of your child within the framework of our professional responsibilities.

2.     We are not taking on the role of being another parent/teacher to your child. Our job is to try to understand and help them navigate the challenges and difficulties they are facing. To do this, we need to work with them on what they feel is important. It is not our job to lecture them, tell them what to do, or to automatically align ourselves with what parents or schools feel is best for them. We will absolutely take your concerns on board where possible, but our treatment plan will be a collaborative venture with them based upon their needs, and this may constantly evolve. We won’t encourage unhelpful behaviours they may be engaging in, but we also won’t condemn them from a judgmental place. Instead, we will work towards understanding what function these behaviours serve, how effective they are for them, and how they can navigate more helpful ways of coping if necessary. We can explore these things with them, but we cannot force them to act differently if they’re not ready or willing to change.

3.     Teenager’s often disclose unhappiness in their relationships with their parents. We expect this to some extent. We frequently hear they feel misunderstood, invalidated, judged, pressured, or unable to talk to their parents about things. We understand this is often part of this developmental phase and we’re not sitting back judging you. It’s natural for teens to argue with their parents and to see things differently. If we do feel it is more than typical and it is significantly impacting their wellbeing, we can discuss with them whether they would be open to involving their parent/s in treatment, but we often cannot actually do this unless they consent.

4.     Teenagers are often ambivalent about change. There can be many complex reasons for this. We can try to address this ambivalence to help them get the most out of the process, but we also need be realistic about meeting them where they’re at. Pushing them too hard too soon to try to engineer quick progress when they’re an unwilling participant is a recipe for disaster. 

5.     Teenagers often experience ups and downs. Progress is not linear. This is true for all of us, but particularly teenagers experiencing hormonal changes and frequent stressors that rise and fall in intensity such as academic pressure and challenging peer relationships. This means it might feel like one step forward, two steps back at times. 

6.     Realistic expectations are critical. Even adolescents with no mental health issues still experience mood swings, episodes of distress, anxiety around things like exams and academic performance, stress around navigating social dynamics, and increased withdrawal and desire for time alone in their bedroom. These things may be ongoing throughout the teenage years, and do not mean therapy is not “working”. Sometimes a teenager managing their mental health without getting worse is actually a significant indicator of progress as it’s very easy for things like depression and anxiety to spiral drastically in adolescents. Whilst some teens may notice rapid improvements, for others, remaining relatively stable in their functioning may actually show they’re benefitting quite significantly. 

7.     Sometimes the non-judgemental space is what the teen is really seeking. Many adolescents are reluctant to use strategies between sessions. Many believe these things to be a “chore” like extra homework or are sceptical about them working. Many half-heartedly try them once before declaring “tried that, didn’t work!”. We are constantly trying to overcome these barriers and to upskill them in various psychological strategies, but we’re also aware that one of the most evidence-based predictors of change in therapy is the relationship itself. We constantly need to balance making sure they feel heard, understood, and validated, with providing practical ways of addressing their difficulties. On the one hand if they do nothing between sessions their progress is likely to be much more gradual than if they wholeheartedly throw themselves into practicing new ways of coping. On the other hand, trying to push them to use strategies they don’t see the value in will likely just rupture the therapeutic relationship we have with them. We’re walking a fine line and continuously weighing up the best way to help them!

8.     Therapy with teenagers very rarely fits neatly into the initial Medicare referral for 6 sessions. It takes time to build rapport and for them to feel a sense of safety with an adult they’ve only just met. It often takes even longer for them to engage in using skills regularly enough to notice a benefit. Teenagers also often have multiple situations they are navigating which pop up between sessions which are really significant to them. This means therapy can take a more winding roundabout course. Trying to stick to a very structured course of CBT without giving them the space to unpack things in a flexible way is often very difficult, because to do that would mean sacrificing the relationship with them thus causing them to disengage.

9.     When teenagers are experiencing benefit from therapy, they can sometimes not want this to cease and are fearful if they appear “better” they will no longer be able to come. They can therefore be reluctant to show too much overt progress or can sometimes report new struggles or deterioration if they feel pressure to start coping independently before they feel ready. This means sometimes they have actually made more significant progress than is apparent, and also that stopping because of this progress can unfortunately reinforce them feeling they need to be “unwell” to justify support. Just as parents are navigating a fine line between forcing autonomy and fostering dependence in their teen, we are doing the same. We do not want them to become overly reliant on us or to continue when there is no benefit, but  sometimes we see parents thinking the teenager doesn’t need to come anymore, when it’s actually the ongoing extra support that’s allowing them to stay on track. If parents are able to support a continuation of therapy as “maintenance”, this can sometimes allow the teen to fully embrace recovery. Not every teen will need this, and not every family can afford this. We certainly don’t intend to create guilt for those who can’t, but often if teenagers are secure in the fact they can come fortnightly, monthly, or even just odd sessions if crises pop up, it can free them up to not worry about whether support will be withdrawn if they no longer appear so anxious or depressed.

10.  We are not trying to take your place in your child’s inner circle. We are acutely aware of how your child is part of your family system and that the strength of your relationship is immensely powerful to their wellbeing. We do not want to become their closest ear at the expense of them turning to you. What we are trying to work on is helping them to have an additional space where they can speak to someone neutral without judgement, to make sense of their experiences without worrying about the consequences of sharing this information, and to feel validated in their feelings as they navigate their ever-evolving identities. We often spend sessions upskilling teenagers in assertiveness or helping them work out the best way to discuss things with parents, teachers, or peers. We also often encourage gentle reflection on other people’s perspectives (including parents!). These things often improve their relationships over time, as does the process of therapy itself. If we can give them a positive experience of help-seeking it can sometimes pave the way in the future for them to trust that opening up to others can serve them well should they find themselves struggling.

11.  We feel privileged to be working with your teenager and we get how hard this is for you as well as them. We understand you may not see the value in your hard-earned money being spent week after week without clear indicators of change. We are passionate about how early intervention at this stage of their lives can significantly shape their mental health futures, and are also aware of how progress can be hard to define for parents when you’re not privy to all the details about their lives. We appreciate your patience. We empathise with how stressful your role is as a parent, (particularly when faced with issues like self-harm, suicidal thoughts, depression, school-refusal, severe anxiety, disordered eating, emotional outbursts, and challenging behaviours)! We acknowledge your commitment to your child’s wellbeing in seeking help for them, and we are constantly striving to do the best we can to support this!

Teenagers and Sleep

Adequate sleep is important for mental and physical wellbeing in teenagers. Research suggests that most teens aged 12-14 years should get between 9-11 hours, while those aged 14-17 years need between 8 and 10 hours of sleep a night. While some young people may need more or a bit less, the evidence is that most teens do not get the recommended amount of sleep per night, and around 40% of teens have sleep difficulties by early high school. A teen’s sleep issues may be characterised by difficulty falling or staying asleep. 

Particularly over time, this can lead to significant negative impacts on the young person’s emotional, physical and academic functioning. For example, inadequate sleep can compromise their mental wellbeing by contributing to increased risk of depression, anxiety, suicidality, low self-esteem and difficult relationships with others.

Some factors that could contribute to reduced or poor sleep

• Hormone changes during puberty can shift a teen’s body clock forward by 1-2 hours. This means they don’t feel like sleeping until later and, because the school day doesn’t allow for sleeping in to compensate, over time they are consistently accruing a deficit of sleep.

• Increased stress and anxiety, or an over-stimulated brain can make it difficult to fall asleep. Unfortunately this may also be caused by insufficient sleep, leading to a never-ending cycle.

•  Exposure to light at night, such as from screen-based devices, can interfere with the production of melatonin (the brain chemical the helps us go to sleep) and disrupt the sleep-wake cycle.

• Over-commitment before- or after-school can result in reduced sleep time. This might be contributed to by sport, homework, extra classes/tutoring, paid work, appointments or socialising.

• Tempting or over-stimulating activities may make it difficult for the young person to go to bed or sleep. For example, television, social media and gaming or exercising late at night may make it difficult for a teen to want to go to bed or sleep.

•  Using alcohol or other drugs.

Tips for improving sleep

• Establish a regular sleep/wake routine by aiming to go to bed and get up at the same time each day, including on the weekend. Try not to nap during the day. This will help your body get into a good routine. 

• Set up a relaxing bedtime routine. At least 1 hour before bed, turn off all devices with screens, and avoid loud music and stimulating activities (such as homework). Instead, read a book, have a warm shower, meditate or do a mindfulness exercise, or do some gentle exercise such as yoga. This will help cue your body and mind for a restful night. Do this for at least 4 weeks so your brain associates the routine with going to sleep.

• Make where you sleep comfortable. If possible, your bed should be comfortable and your bedroom should be dark, quiet, cool (around 16-18°C) Consider using eye masks and/or earplugs if necessary!

• Try and keep your bed for sleep.  If practical, only use your entire bedroom for sleeping. Avoid doing homework, watching TV or being on devices in bed. This will help your brain to associate your bed/bedroom with going to sleep. 

• Exercise during the day. Tiring your body with a walk, playing sport or a workout can help you feel tired at night. But avoid vigorous exercise just before going to bed, as this may stop you from going to sleep. 

• Avoid stimulants, particularly in the evening. Stimulants like caffeine, nicotine and alcohol can disrupt your sleep, so try not to have anything with these in them for several hours (preferably after lunchtime) before your bedtime. Drinks that contain stimulants include coffee, tea, soft drinks and energy drinks.

• Avoid recreational drugs (including alcohol and tobacco) before trying to sleep. Consider seeing your GP to discuss any issues with alcohol, smoking or other drugs, and how to quit.

• Use light to regulate your natural sleep cycles. In the morning, try and get some morning sun/light by going outside or sitting at a bright window for 30 minutes. If this isn’t possible, there are also lights available that will imitate natural light.  This will help with regulating waking. Similarly, to regulate sleep onset, avoid bright lights at night (including screens). Consider dimming the lights as part of your bedtime routine. 

• Try not to worry about your sleep! While the tips above may be helpful, it’s also important to try not to focus too much on any sleep difficulties you may be having. Most people underestimate how much sleep they get, and thinking about your sleep issues can increase your anxiety. Keeping a sleep diary, or using a sleep app, might help you to also notice the nights that you do sleep well and to be optimistic about your next sleep being good. 

 

Tips for parents of sleep-deprived teens

However worried or frustrated you may be feeling, try to take the time to discuss sleep with your teen when you are both calm and have time. This way you can identify what may be contributing to their inadequate sleep and you can work together to get ideas about how best to increase their sleep. 

• Ask your teen how their life and ability to do day-to-day tasks would change if they were to get enough/better sleep.

• Encourage your teen to keep a sleep diary for a couple of weeks so you can both see what is happening (https://www.sleepfoundation.org/sleep-diary).

• Consider all aspects that may be contributing to their sleep issue: Is their bed comfortable? Are they lying awake worrying at night? Are they tempted by their phone, gaming or a favourite TV show? Are they too busy before or after school? Is their room too light or too hot/cold? 

• Agree on what might help (see tips above), and how you may be able to support your teen to implement changes (for example by limiting screen time in the evenings, removing phones from the bedroom, or helping them rationalise or restructure their before/after-school activities.

• Try to provide a calm and restful environment in the home as your teen’s bedtime approaches. When appropriate, encourage restful activities during the evening, such as reading, listening to calm or happy music (not too loudly), cooking, board games or art/craft.

When to seek support, and what is available?

If your teen has been having difficulty with sleeping for at least three nights a week for three months or longer, it may be wise to seek additional support. 

• You (or your teen) may wish to start by talking to your GP about what is happening with your teen’s sleep.

• A trained psychologist or clinical psychologist can also use cognitive behavioural therapy to help your teen (or you!) with insomnia that may be interfering with their ability to function during the day.

• You could also consider encouraging your teen to engage with an online program, such as THIS WAY UP’s free online Managing Insomnia Course (https://thiswayup.org.au/courses/managing-insomnia-course/), or to use an app to support them:

• ReachOut’s Recharge app is a 6-week program focusing on improving sleep (https://apps.apple.com/au/app/recharge-move-well-sleep-well-be-well/id878026126).

• The Black Dog Institute is developing the Sleep Ninja app to help improve sleep in young people (https://apps.apple.com/au/app/sleep-ninja/id1210214623). This app is not available to the public yet, but hopefully will be soon. 

How do I get the most out of therapy?

There’s a lot more to therapy than just booking your session and turning up. Psychological support can be time-consuming and expensive, so here’s how to get the most out of it:

1.     Come prepared

Coming prepared to a therapy session is one of the best ways to get the most out of it.  

I always tell clients to start a new note in their phone titled ‘therapy’ or ‘things to raise with psychologist’. In between each session I get them to log when they experienced a particular emotion or thought, or when their depression/anxiety/trauma/eating disorder seemed strongest, or anything that occurred during the time between sessions that they don’t want to forget – such as an argument, or skill practice, or new thought, memory, or idea. 

At the very least, write a mental list as you drive to the session or even whilst you sit in the waiting room. Ask yourself – when did I feel my best this week, why was that? When did I feel my worst this week, why was that? Did I try anything different this week in regards to my mental health? What got in the way of doing something different, what barriers presented themselves? What thought patterns did I notice most, was there a particular ‘story’ that my brain got caught up in?

However, if you can’t think of anything, or nothing comes to mind – don’t necessarily assume you have to cancel your session, or that it will be a waste of time. Let your psychologist know and ask them for what they think you still need to work on, or anything that can be picked up from previous sessions. 

2.     Be honest

Let your psychologist know how you’re feeling about therapy. If something isn’t working, share it. If you don’t understand the reason for doing something, tell them. If you think the homework they’ve set isn’t achievable, raise this. If you’re unsure if you’re making progress, or if you want to come less frequently or stop coming all together, let them know. If they tried to summarise what’s happening for you and it doesn’t fit, correct them. If they make a suggestion about your experience that feels like it missed the mark, say it. 

Don’t be afraid to be radically honest in therapy. Your psychologist can’t (always!) guess how you’re thinking or feeling, so you need to share it. 

I often tell clients to never put their psychologist’s feelings above their own – don’t be afraid to hurt your psychologist’s feelings. I guarantee that they can handle it, in fact – they want to know when they’re wrong or when it’s not working for you! 

3.     Know that most of the work happens out of the room

If you come to therapy once a week, that’s 1 hour in 168 (or .6%). If you come once a fortnight, that 1 in 336 hours (or .3%). Once a month, it’s 1 in 744 hours (or .1%). This is a tiny fraction of your life. 

Now – we know quantity doesn’t always equable quality! Just a few hours of therapy spaced over a few weeks or months can have a huge effect on someone’s life. 

However, we have to be realistic that the vast majority of your life is spent outside of the therapy room. What you do outside the room is going to have an impact. Depending on your goals for therapy, it’s probably going to be helpful if you end each session with a summary of ‘take home’ points and an achievable list of things to practice or action. 

There are also a range of self-guided therapy resources to help you continue your therapy journey outside of sessions. These are often much more affordable than psychological sessions, and help you learn about mental health concepts to raise with your psychologist. 

Ask your psychologist for recommendations of books to read or podcasts to listen to. There are also free self-paced therapy courses online (such as ‘This Way Up’ by St Vincent’s Hospital). Simple journaling can also be amazingly powerful – and there are many free prompts found online if you’re not sure where to start. Alternatively look for a ‘Thought Log’ worksheet.

4.     Be curious about your own expectations

What did you think therapy would be? Before you attend therapy, ask yourself – what do I want to get out of this? What do I imagine therapy to be? Do I want it to be structured and practical? Or do I want it to be a safe place to share my inner world? Do I expect this to be easy or hard? What type of character do I want my psychologist to have?

If you’re currently doing therapy, or have done therapy in the past – ask these questions also. Are your expectations matching reality? 

Expectations of therapy are tricky! Because therapy is always done behind closed doors, often the only knowledge we have of psychology sessions comes from television and movies. However, this isn’t always very accurate (namely – the whole ‘lying down on the couch’ thing!). So we want to acknowledge and explore our expectations, and we want to use them to guide what our needs for therapy are. However, it’s best to go into therapy with an open mind about what actually happens. 

5.     Notice ‘the process’

Some of therapy is the content. Some of therapy is the process. Content is anything that you discuss or learn – it’s the topics covered and skills learnt. The process, however, is the experience of doing this. It’s what happens in your body and your mind as you discuss the topics or skills. It’s noticing what it’s like for you to share and learn things. It’s the awareness of what happens in the therapeutic relationship between you and your psychologist as you do therapy. 

To give an example: a few years ago, a friend of mine tried to teach me to drive a manual car (after 10+ years of driving an automatic). The content I learnt was how to change the gears, and when to use the clutch, how to do a hill start, and which gear to be in when. The process was noticing that I didn’t like having thoughts that I was ‘bad’ at something, it was noticing that I felt ‘small’ around a friend I previous felt equal to as they taught me, it was finding myself reluctant to make mistakes, and frustrated at myself for not picking up things ‘quick enough’. I learnt cars, driving, and myself in this situation!

It’s the same in therapy. You’ll obviously want to pay attention to what content your learning (perhaps what triggers your mental health concerns, which skills help you regulate, how to sleep better, how to communicate more effectively, etc). But also notice the process of therapy – what thoughts and feelings and sensations arise in your mind and body when you do the work. Mindfulness or present moment awareness can help with this. As you become aware of the process, you can raise our observations with your psychologist by saying things like:

-       ‘as you said that, I noticed that I felt embarrassed and scared’

-       ‘I’m finding that I’m struggling with a mental block around this topic’

-       ‘when you suggest things like that, I’ve found it makes me less likely to speak to you about -----‘

-       ‘last session, I noticed there was a feeling in my chest I couldn’t make sense of, and it was weird’

-       ‘I think I sometimes overshare about ---- topic, because I’m trying to avoid bringing up ----‘

-       ‘one part of me felt excited to try that, and another part of me feels sceptical’

It’s never too late to begin trying to make the most of therapy. Overall, it’s a process that takes time and is always adaptable to change. 

Prioritising FUN!

Life is hard! Life is exhausting! Life is stressful! 

How many times do we hear ourselves telling people some variation of this theme? I hear it from clients, I hear it from friends, I hear it from family, and I also hear it from myself. Sometimes I catch myself out loud telling loved ones of my struggles, sometimes it’s more the voice in my own head focusing on all the things I need to get done, the constant juggle of day-to-day responsibilities. Other times it’s triggered by unexpected difficulties, challenges, or really painful experiences. This is normal, understandable, and to be expected! We are all human. We cannot live a life free from pain or struggles.

Our minds are designed to keep us safe, and part of that design means looking out for danger or problems to solve. Some theories suggest our minds are even hardwired to be negative as part of this survival mechanism! Talking about it is not necessarily a problem either. Reaching out to share our experiences often connects us to others, and helps us to feel supported, loved, or understood!

And yet even though these patterns may be understandable and adaptive to some extent,  what happens to our quality of life when we find ourselves getting sucked into constantly focusing on how difficult life is? 

I’m certainly not suggesting we invalidate these feelings. It’s important to acknowledge and recognise when we are struggling, and to not dismiss these feelings. And at the same time many of us are living lives of such pressure, expectation, and demands, that we forget that whilst life can be hard, exhausting and stressful, it can also be joyous, exhilarating, exciting, and FUN!

If you feel stuck in a cycle of negative thinking, continuous venting about problems, feeling weighed down, stressed, or constantly under pressure to meet demands, it might be time to prioritise some fun!

Here are some quick tips to get you started:

1.     Understand what is stopping you from prioritising fun already! Is it the stories your mind tells you about being too busy or having more important things to do? Or that you don’t “deserve” to have fun? If so, either notice and name that process to remind yourself that these thoughts aren’t facts and may not be all that helpful; or try compassionately challenging some of those beliefs! Doesn’t a meaningful life include plenty of moments that bring you joy or vitality? And if so, what could be more important than living a meaningful life? Out of 168 hours a week are you genuinely so busy there is no way at all to carve out even a few extra minutes here and there to prioritise some light-hearted enjoyment? Is sacrificing fun for all other things in life really the life you want to choose for yourself? Or is it more just that you are so used to telling yourself this narrative that you no longer stop to question it?

2.     Reflect on the way children see the world. To them, fun is a big priority! They naturally live in the moment; and left to their own devices they are often carefree, boisterous, exhilarated, and full of vitality. Perhaps it’s only when they have been worn down by the messages we adults tell them that these things change! How often do we constantly say, “Hurry up, we don’t have time for that” or “You need to stop that and be quiet” or “Careful! Don’t do that or something bad will happen” “Work harder” “Study more” “Be more responsible” etc. Yes, we need to teach and guide them, but is it really them that needs to learn these things from us to such an extent? Or are there actually things we could learn from following their lead a little more often?

3.     Think back to what you used to enjoy when you were a child! Don’t presume you’ve outgrown them! Maybe there are things you used to love that you don’t make much time for anymore? Reading fiction? Nature walks? Playing board games? Picnics in the park? Dressing up in different outfits? Listening to music? Daydreaming? Hanging out with friends? Pamper time? Day trips to special places - museums, the zoo, aquarium, swimming pool, beach etc?

4.     Reflect on buried goals, hopes, and dreams. It’s an old cliché, but if you found out you only had a year to live, what would you want to do with that time? There could be some bigger items on your list that may not be feasible right now, but are there smaller things you’ve always wanted to try? Are you caught up in the never-ending cycle of daily demands to the point you’ve put fun on hold? Reflect on places you want to go! Hobbies you want to start! Small things you’ve told yourself you’ll do one day when you have more free time! There quite literally is no time like the present for any of us, so seize the opportunity and take action towards fun now, however small that first step is!

5.     Embrace new experiences! When we feel stuck in a rut or life has lost its spark, sometimes we struggle to see the beauty in everyday activities because we take them for granted. Practicing gratitude can definitely help, but so can shaking things up by trying new things! Explore a different park, beach, or suburb, call a different friend you haven’t spoken to in a while, watch a new movie, treat yourself to a new haircut or item of clothes, plan a trip to somewhere you’ve never been, take a class in something new, walk a different route around your neighbourhood, order  a different item on a menu etc.

6.     Be Present! There’s no point in engaging in activities if you’re going to simultaneously be preoccupied with what you still need to get done, or what happened earlier that day, or why you don’t have time for this. It’s critical you throw yourself into the activity fully. Practice mindfully focusing your attention on what you’re actually doing rather than whether you could/should be doing something else! It’s also important you don’t do fun activities with the expectation of getting rid of negative feelings, or you’ll probably be too busy analysing if its working (or more likely telling yourself it’s not!). Instead approach things with openness and curiosity and see what happens!

7.     Let go of guilt! No matter who you are or what life you are living, you matter. You deserve to feel joy in this world. You deserve to prioritise yourself sometimes. You deserve to be free to pursue things that bring you enjoyment! It may take some juggling initially to figure out the balance of how to make it work, but once you start, you’ll realise just how vital it is for your wellbeing!

8.     Understand cycles of low mood! If you’re struggling with low mood, energy, or motivation, or telling yourself you’ll start things once you feel better, it may be helpful to understand how this vicious cycle works. Withdrawing from activities often decreases mood further, and to reverse the pattern sometimes you need to push yourself to do things first, with an increase in mood often following! If you’re telling yourself you don’t deserve to have fun because you’ve been struggling to meet responsibilities, remind yourself that allowing yourself to prioritise fun might boost your mood, which in turn might make it easier to complete these tasks. Or perhaps you already are prioritising “fun” over responsibilities like study or chores but are you really allowing yourself to fully participate in and enjoy the fun activity or are you spending the whole time beating yourself up or feeling guilty about it which means it’s not actually “fun”? 

9.     Start small! If you’re tired and under pressure you don’t need to take up new hobbies, join new clubs, take big trips etc to have fun. Those things can be great if you have the capacity and resources, if not, identify small, achievable “everyday” ways to have fun! Set aside 15 mins to read a chapter of a book you enjoy each night. Prioritise watching one new movie or episode of a TV show you like. Plan one phone call or catch up with a friend. Take 10 minutes to really savour eating something special. Plan one date night with your partner. Tell one silly joke to your kids or ask them to tell you one. Identify what “fun” means for you and prioritise a small dose of it in whatever way you can!

10.  Get Help. If all the above ideas feel overwhelmingly hard for you, and trying to reflect, problem solve, or overcome barriers feels impossible, it might be worth reaching out for more support. It’s natural if your mental health is suffering everything will be so much more difficult, and if you feel you can’t do it alone, make an appointment with your GP or psychologist to explore having someone to help you navigate life’s toughest times!

Shaking the New Year Blues

While we mostly think of a new year as a time for a fresh start, full of optimism and anticipation, mid-January is also known as a time when people can feel anxious and melancholy as they experience the ‘January Blues’.  While this effect is magnified in the Northern Hemisphere, where the weather is cold and the days are short, the phenomenon is also relevant in Australia. 

Starting a new year, recovering from the financial and other excesses of the holiday season, and struggling to return to our usual routines and the face the day-to-day reality of life after a break, can all contribute to feeling down at this time of year. The uncertainties of the year ahead can leave us feeling anxious and questioning our choices and directions: Am I really happy in my job? Is my relationship right for me? Where am I headed? It’s already another year, and I haven’t been moving forward! I’ve already given up on my resolutions for this year. And, of course the last year is exceptional in that it has presented us all with higher levels of complexity, uncertainty, and anxiety than most. 

For those wrestling with the return to regular life after a much-needed break, here are some thoughts to help smooth the process and bring increased calm and enjoyment to the year ahead:

1.     Identify what made your break most precious to you, and try to bring those things into your everyday life

Plan enjoyable activities for after work and weekends that recapture elements of what you enjoyed about your break, such as eating out, walking, having a picnic, seeing a movie, reading a good book, or catching up with friends or family.

2.     Look after your health

Making an effort to eat, sleep and exercise regularly and well will support your physical and mental wellbeing, making all aspects of everyday life more manageable and enjoyable. When we’re not at work we’re likely to be more physically active, so try and maintain this when you return to your usual routines.

3.     Work on lowering your stress levels and try to bring the feelings of relaxation into daily life

Get plenty of sleep and rest when you can. Make room for calming activities such as meditation and mindfulness, practice self-care and self-compassion. Let go of judgemental thoughts – you can only do your best.

4.     Foster feelings of connectedness 

Schedule social time and time with loved-ones. Spend time with friends one-on-one, and also spend time with groups. Maybe take up a new activity that is also social, like joining a book club, taking art classes, or volunteering.

5.     Examine your work situation

Identify the positive aspects as well as the challenges. Unless you really hate your work, strive for balance in terms of workload, the degree of control you have in your job, interest level, and relationships with colleagues. If something is making you unhappy, take the time to carefully identify what it is, and plan how to effect change. Focus on achieving a good work/life balance. 

6.     Set some personal SMART goals

SMART goals are Specific, Measurable, Attainable, Relevant, and Timed. By setting simple, realistic and measurable goals that align with your values you can make the year exciting and fulfilling – it will ‘count’ rather than just ‘pass’. By having goals that you are clear about why you want to achieve them, you are more likely to succeed and enjoy the process.

7.     Spend time outside

Enjoy the longer days and warmer weather, even during the week. Look for opportunities to work in outdoor cafes or outside in a peaceful shady spot. Walk or read outside on your lunch break and after work. Spend time in nature when you can.

8.     Plan your next (mini)break

Or at least keep some of the sense of adventure and spontaneity from your break. Visit new local places, try new foods, be open to meeting new people, and consider accepting invitations that come your way. 

9 Tips for Building Positive Body Image in Your Teen

It can be scary for parents to watch their teen navigate the modern world, exposed to social media, intense marketing and ubiquitous sexualisation of the female form. Young girls are bombarded with messages that equate their sense of worth with how they look. It can be heartbreaking for parents to see their impressionable daughters start to think, talk and act negatively towards their bodies. 

Sadly, telling your daughter that they are beautiful no matter what just doesn’t cut it. Here are my top tips for building up your daughter to have the skills and knowledge they will need to value themselves in a helpful way, be critical of unhelpful cultural messaging, and nurture self-respect and self-acceptance. 

1. Model self-love. Notice how you think and talk about the way you look. Be conscious of what message you are sending to your children about your relationship with your body. Talk about what you love about your body, be proud of all it has done and can do, and focus on looking after, accepting and respecting it. 

2. Teach critical thinking. Look at instagram, watch TV and dissect ads with your teen. Ask what they think about the images. Get them thinking about the point of the image.. What are they trying to sell? What are they trying to get you to think and feel? How do they benefit from getting people to think and feel that way? What do you think about that? Do a detox of their social media together by thinking about how the different accounts in their feed make them feel. 

3. Function over form. Shift your teen to thinking about what their body can do, rather than what it looks like. Go through all the different parts of the body and reflect on the role it plays in the whole system. Get them to think about all the things their body can do that they are grateful for. 

4. Brain talk. Ask your teen what they know about how the brain works with the way they see themselves. Do they know that we see ourselves differently to how everyone else does? When we look in the mirror, the image we see is very different to how everyone else sees us. The way we think and feel about our bodies impacts the image we perceive. 

5. Family meal times. If it works in your family, try and have at least one meal a day together. Take the focus off the food, and make a calm atmosphere the goal so that the food becomes part of a positive emotional experience. 

6. Focus on health. Ask your teen what health means to them. Talk about people they know that are healthy and people they know that are not healthy. Have a discussion about what foods and activities nourish the body, and what can stress it. How do they feel after eating certain things and doing different activities? How does their body like to move? What does their body like and not like so much? Balance is an important key here too. We don’t want to cut anything out or restrict things… we want to make choices that nourish our body most of the time. 

7. Notice the stories. If your teen is open to talking about it with you, find out what stories their mind tells them about their body, their weight, their shape and food. Write the different stories down and go over them objectively, without judgment. Our minds can often be pretty cruel, especially when they have absorbed the messaging that is floating around in our culture. What is important though, is that we have a choice about the power we give to certain stories. A discussion around how the different stories make you feel, where they come from and how they impact behaviour and relationships creates a space to reflect on what place your teen would like these stories to have in their life. Often, teens can be more willing to have this conversation with someone outside their immediate family - a family friend, an aunt, a grandmother, or a psychologist.

8. Focus on diversity. Ask them what beauty means to them. Who are the people they admire and respect in their lives? What are the qualities they look for in friends? When they are 80 years old, what is going to be important to them? How do they want others to remember them? Go through the people they love and get them to identify their different strengths. What would the world be like if everyone looked the same? What do they think the value is in difference and diversity? You’re trying to help them flesh out their identity, value and worth outside of appearance. This can be really challenging if they’re smack bang in the middle of cultural messaging around image as everything. Just gently try and open up questioning that starts to open up alternative ideas and narratives. Make a point of acknowledging their own strengths and qualities independent of how they look. 

9. Get help early if you’re concerned. As a parent, your number one role is to love, love, love. To hold a non-judgemental and loving space for your child so that they feel safe expressing their thoughts and feelings in the security of your relationship. If your gut tells you they need more help than this, the earlier you seek help, the better. Once body dissatisfaction starts to show up as changes in weight and behaviour, professional help is often needed to support change.

How do I know if my child’s anxiety is ‘normal’, or should I get them some help?

I have the distinct memory of walking around for about three days on a fractured ankle as a kid because my parents thought I had “just sprained” it and were quite surprised when a reluctant x-ray showed otherwise. Conversely, my parents dutifully took me to the optometrist after each of my yearly complaints that I needed glasses despite the assessments coming back each time that I had 20/20 vision. It can be tricky to walk the line as a parent between being caring and observant for your children and care-free and relaxed. Sometimes it’s hard to know whether under-reacting or over-reacting is worse! 

One of the benefits of the increasing dialogue around mental health conditions is that everyone appears more aware of the presence of clinical anxiety (and depression, etc.) and the impact that they can have on one’s life. The stigma around seeking mental health treatment, including talk therapy and medication, is thankfully lifting and we’re seeing more willingness from all people to reach out for help when they feel like they need it. 

However, we never want to pathologise (i.e. consider something that is normal as abnormal or a disorder) anyone, particularly children and young people in very formative years of their life. Labels applied by adults (teachers, parents, health professionals) can stick around children for years to come and can sometimes be internalised into their sense of self and personal identity.

Nervousness, anxiety, worry, and even panic are common (and useful!) feelings for children and young people. Children need to experience, feel, and learn from feeling all emotions, in particular anxiety and worry.  But how do you know if your child’s anxiety is normal, or whether it’s something to seek help for?

Here are a couple of helpful tips that might provide you with direction:

-       What does your family GP think?

Your GP is always a good starting point for anything health related. They are especially useful if they’ve cared for your child for a while (I can’t recommend enough finding a good GP and sticking with them for many years if possible!). Your GP can hopefully understand your child in the context of their temperament, your family situation, and other family history factors. They can also discuss and perhaps rule out other medical factors that may be contributing or masking as anxiety. Ultimately, they can also provide a referral to a health practitioner under Medicare should you want it.

-       Is it significantly getting in the way of life? 

How much is the anxiety or worry impacting your child? How much does it get in the way of their learning, their friendships, their relationships with family, their ability to grow and develop appropriately? Your child’s anxiety might be more mild, but be ‘triggered’ almost daily (e.g. such as a fear of speaking to others) meaning you might think about getting more support than if your child’s fear was very intense but rarely ‘triggered’ (e.g. flying in a aeroplane or riding a rollercoasters).

-       Are they very distressed by it? Are you very distressed by it?

Your child might experience feelings of worry or anxiety, but after the feared event, situation, or stimulus passes they settle quickly and aren’t bothered by what happened. They might also be able to reflect on how the anxiety was lying to them, with statements such as “that wasn’t as bad as I thought it was going to be!” or “I’m glad I gave that a go” or “can I give it another try?”. However, perhaps their worry and anxiety is very distressing to them and seems to take up a lot of their mental, emotional, and physical energy. 

A question I often get parents to think about is their own response to their child’s anxiety. Our anxiety as adults can surreptitiously fuel our kid’s anxiety. How do you cope with your child’s worry? How distressed or anxious are you about them? Do you have history with worrying, nervousness, apprehension, or avoidance? If so, then perhaps a helpful avenue is to seek your own assistance in managing your emotions. Modelling this to your child is a really powerful tool!

-       Does it not seem to be shifting after a while? 

Notice your child’s worry and anxiety. Approach your child’s anxiety with them with curiosity instead of fear. Gently help them approach (not avoid) feared situations and stimuli. However, if their anxiety and worry doesn’t seem to be shifting after a few months, or seems to be getting worse – think about reaching out. 

-       Does it seem different to peers their age? Does their worry or anxiety seem reasonable?

How much does their worry suit their age and stage? You might even want to check in with their class teacher or other parents. (Note – sometimes comparing between siblings isn’t the most helpful!). Does this seem comparable to other’s their age? For example – any transition is likely to create anxiety (e.g. a new school, new grade, starting pre-school, primary school or high-school), as are any ‘firsts’ or new experiences such as school camp, sleep overs, ‘big’ exams, family changes (e.g divorces, separations, new siblings, step-parents etc.). Does their worry seem reasonable? Discuss the “worry story” or what their “anxiety brain” is telling them? A child’s worries about being left alone is different depending on whether they are 5 or 15. Worries about failing an exam are different to worries about a ‘boogeyman’ in the closet. 

-       Do they want to speak to someone?

Ask your child what they might need or want! Adolescents and young people in particular might be interested in seeking psychological help (through school or an external service such as a private psychologist or Headspace). It can be helpful for children to have a ‘third party’ person to speak to, to explore what’s happening for them and be a sounding board  – however this doesn’t always have to be a psychologist, it could be your GP, an aunt or uncle, a Godparent, or other friend or cousin. 

Ultimately, back yourself as a parent (and a good one at that!) to understand and meet your child’s needs. You are the expert in your child! Listen to your intuition, and have an open and honest conversation (or multiple conversations over weeks and months) with your child about what’s going on for them and what you’re noticing.  

You Can’t Pour ( Or Drink!) From an Empty Cup!

The Pouring Part

Most of us have probably heard the old saying “You can’t pour from an empty cup” to highlight how necessary it is for us to take care of ourselves in order to be capable of taking care of others. This is especially true for parents, who have a huge amount of responsibility for the wellbeing of another (or multiple) humans, yet who still have separate issues, demands, ongoing stress, and other areas of life to attend to. Trying to completely self-sacrifice individual needs to meet the needs of children rarely works out well for anyone, and yet at the same time it’s not always easy as a parent to say, “I need some time for me!” and to truly do something soothing, nurturing, or beneficial with that time.

The issue is, that without taking time-out to reflect on what’s happening and to self-regulate, the demands don’t stop. Parents get more burned out, more emotionally depleted and more stressed; and the role of being a parent becomes even more challenging. Children are emotional sponges. They can sense a parent’s stress. They pick up on anxiety and they notice when a parent is not really present. They can also sense the resentment, frustration, anger, or guilt that often bubbles over when a parent is overwhelmed. And that often triggers insecurities, anxiety, or stress in the child. These things then get communicated through the child’s behaviour, and thus everyone gets trapped in a cycle whereby the more challenging the child’s behaviour is, the more stressed or frustrated the parent becomes.

And yet how do parents set aside time for themselves when they are so busy? It’s impossible right?

No. It’s not impossible, even though it may often feel that way! It’s just very very hard! Especially in today’s world where for many there is no tribe of villagers to step in. And yet it is essential. You don’t stop being a human with individual needs the moment you have a child. Your cup needs filling so that you have the emotional resources to cope with caring for someone else.

The Drinking Part

Just like we cannot pour from an empty cup, we cannot drink from one either. Children have their own cups that need filling too! And they may not have the same capacity to fill their cups independently. So, what happens when we make demands of our kids when their cup is empty? They struggle to meet our expectations! What may look like defiance, meltdowns, stubbornness, or aggression could be their way of communicating to us that they cannot “drink” from their cup right now. They need help to refill it before they are able to regulate themselves or meet our demands!

We can think of kids as having a general emotional cup that gets refilled by things like enough sleep, good nutrition, plenty of play, exercise, and fresh air, but it can sometimes also help to picture how they may have specific needs or “cups” that can get depleted, and to figure out how we can help refill them!

The Connection Cup

All children have a powerful need for connection. If this need is not met through regular quality, undivided attention, it’s likely the child will communicate this through their behaviour. The child refusing to go to bed is often a great example of this. You may be conscious of their need for sleep. You may also be tired yourself or have things you need to get done. Every parent has probably faced that challenge at some point! But if they’ve been away from you all day, or if you’ve been trying to work from home or do chores whilst they’ve been interrupting, or if you’ve been trying to divide your attention between them and their siblings, it’s possible that they are longing to reconnect! The more you push them away, the stronger that need becomes. You are their world when they’re little, and even as they grow and gain independence, they still rely on the sense of security that you being a safe base to return to gives them as they explore the world. 

If you feel your child’s connection cup needs filling, here are some ideas!

1.     Set aside 15-20 minutes to focus purely on that child in an undivided way and let them guide the activity. Ideally this will be a daily thing. If it’s only done every now and then you may find their cup is so empty, they struggle to accept when the time is up as they still need more!

2.     Try to eat at least one meal together as a family without technology. Use it as an opportunity to talk, laugh, spend quality time in each other’s company. There may be some resistance at first if no one is used to doing this, but over time it make a real difference.

3.     Notice and recognise your child’s bids for connection. When they do talk to you, wherever possible try to pause and really pay attention to them. Even if what they’re saying doesn’t seem important to you, it’s important to them in that moment. If you don’t pay attention when they communicate the small things, there’s less chance they will open up to you when it comes to the big things. Make eye-contact, turn towards them, actively listen without distraction, or if this is not possible, at least acknowledge their desire to talk to you and negotiate a time when this can happen.

4.     Connect before you correct! If your child is exhibiting challenging behaviour, recognise it is a form of communication. Try to pause and notice what’s happening before you react. Help them to label their feelings, then empathise and validate them before you try to teach them to behave differently. If they feel you understand them there is a lot more chance they will co-operate with you. Plus, when children are highly emotional the “thinking part” of their brain is often offline. When you connect you help them to regulate which makes it much easier for them to understand and remember the limits you set.

5.     Connect through affection. Frequent hugs, ruffling their hair, a kiss goodbye, or a quick snuggle before bed or on the couch are all powerful ways of keeping the connection strong!

The Power Cup

As children develop, they start to assert themselves. It’s natural for all kids to have a need for power and to feel in control of some things in their life. The younger they are the less control they have over their environment, but sometimes those meltdowns or defying your instructions are a signal their power cup is empty! These ideas may help!

1.     Give frequent age-appropriate win/win choices where possible. Instead of asking your child “what do you want for lunch?” which could evoke a response of “ice cream!” (thus resulting in you once again having to assert your power over them to say no!) you could try “what would you like in your sandwich, peanut butter or vegemite?” 

2.     Play imaginary games where they are the boss. Younger kids in particular love role-playing games where they’re the police and you’re a baddie. Or they are the mummy or daddy and you are the child. Or you could try games where you have to freeze whenever they say! Or where they direct the game and you follow their instructions!

3.     For older kids, let them take on the role of expert. Show curiosity as you ask them to tell you about things that they know more about than you such as their passions and interests, whatever those may be!

4.     Let them win. I know our society highlights the importance of teaching kids to be good losers, but sometimes if their power cup is empty, they need to feel that experience of being on top. Playing board games, sport, or anything else where you can let them win can be a way of meeting this need.

5.     Every now and then let them be in charge for a day. Set some initial ground rules that are non-negotiable for you, give them a budget, and then let them be in charge of deciding what to do that day! 

The Boundaries Cup

Just like kids need opportunities to feel in control, there are also times when they need consistent limits, structure and routine in order to feel safe. Recognising the need to balance being too strict versus too permissive, or between fostering dependence versus forcing autonomy can be really important. If you sometimes swing between being super strict to then letting them have whatever they want to keep them happy, or if you tend to let them have free reign without many rules, their boundaries cup may be empty. They may be finding it hard to co-operate if they don’t understand why the rules are always changing or they may be feeling overwhelmed at the lack of structure or consistency. If you feel like this may be the case, the following tips may be helpful.

1.     Prioritise. Choose one thing to work on rather than changing everything all at once. That will just create more chaos for everyone and make it much harder to stick to. 

2.     Be realistic and consistent. Change takes time and is often a process of adjustment for everyone. Understanding that when you give in ‘sometimes’ or if you change the rules when their behaviour is more volatile, it’s likely you’re reinforcing the very patterns of behaviour you’re trying to change. Intermittent reinforcement often teaches them to try harder, resist more, or refuse to back down those times you do try to set limits.

3.     Be prepared to negotiate and involve children in the process. Yes, they need boundaries, but they also want to be heard and understood. When they’re not meeting your expectations, it’s likely they lack the skills or capacity to do so, or there’s a barrier getting in their way. Working out a plan together that factors in their difficulties whilst also highlighting your concerns is a lot more likely to be successful. Collaborate in solving problems before they arise, rather than always trying to put out fires in the moment!

There are many other types of “cup” your child may have that may need filling. Their downtime cup. Their belonging cup. Their mastery cup etc. Most parents can notice when their child is out of sorts and it can be helpful to ask yourself “What unmet need are they trying to communicate?” And as always, remember to take a moment to pause, breathe, calm yourself, or fill your own cup too! 

8 Reasons Why Parenting In The Modern World Is So Hard

I see it with the families I work with, I experience it in my own family. Parents are exhausted, overwhelmed and burnt out. Children are struggling, needing more from their parents. But parents are so depleted, trying to juggle everything the modern world demands that even the thought of giving more brings them to tears. Parents, children and families are so stuck.. and it’s normally the parents that blame themselves and think they’re doing it wrong. But the truth is, the issue lies in a fundamental disconnect between the modern world we live in and the way as humans we are wired to operate and raise our children.

Evolutionary theory points to 8 different dimensions of parenting in the modern world which raises the potential for difficulty. As always, there are benefits and risks of anything - so many of the variables that can create problems are also the source of many wonderful advantages offered to us today. Indeed, many previous generations would not have believed the resources and opportunities available to assist parents today. Understanding and awareness of context gives us the ability to make sense of our experience (so we don’t jump to self-criticism) and make more informed decisions that protect ourselves and our children, setting everyone up in a better way. What is important to acknowledge though, is that the way families are operating in the modern world, is unusual, and is quite different to how our species has lived in the past.

1. We are not meant to do this alone!

As the saying goes - “it takes a village to raise a child”. And in the past, it has been the whole community that was part of parenting. The modern set-up of one or two parents raising the children alone is unusual, and places a whole lot of pressure and ridiculous expectations on the caregivers.

2. Science is powerful

An advantage of this is that parents have heaps of evidence-based information available to them about parenting. This has not been accessible in past generations. We know about parenting approaches that can have negative impacts, and how to guide parents in a way that can create the best outcomes for the child. The SIDS ‘back is best’ campaign is a perfect example of how science has made information available that has literally saved the lives of children today. 

A disadvantage of this is that many parents today are approaching parenting from a ‘head’ vs ‘heart’ space. They’re relying on rules, experts, google and books, which leads to rigidity. We look less to our children to guide our behaviour, and make choices based on what parenting “should” look like. We can persist with an approach even if it is clearly not working, because that’s what the books tell us to do. This can take an even more dangerous turn when the ‘experts’ we are blindly following are not credible sources. Flexibility, attunement and sensitivity in parenting is so important, so over-reliance on science can lead to difficulty.

3. Limited exposure

In human history, individuals would have had lots of exposure to babies and children before having one of their own. With larger families and different social structures, experience with younger siblings, nieces and nephews would have been part of life. You would have observed others breastfeeding, had parenting modelled to you and have an established sense of what raising children looks like. Today, the first time someone might hold a baby could be their own.

4. Rapidly changing technology

Parents today are preparing children for a world that we are unsure what will look like.

We don’t know what the effects of current technology will be.

Parents are therefore sitting in uncertainty and having to guess what will be best for our children in 10-20 years.

5. Schooling system

The modern schooling system is actually an incredibly unusual environment. 

Children are grouped with same-age peers, spend a substantial amount of time with them, and are expected to sit and be still for extended periods of time. This just didn’t happen in foraging societies. 

For some children, this is just not possible. 

The way in which school and academic/cognitive outcomes and achievement dominates childhood today shifts the way parents prioritise goals. Some parents, with the best intentions, end up prioritising cognitive development at the expense of mental health and the child-parent relationships. This is a perfectly understandable adaptation when you are trying to raise offspring to survive and thrive in the modern world, however there can be significant costs in some instances. 

6. Fewer children

Throughout the evolutionary story of parenting, humans have had fewer children with greater investment. This has advanced significantly in the past 100 years, meaning there is more focus on our children. Again, in itself this is neither a good or a bad thing, but in some circumstances it can intensify the pressure and expectation for parents.

7. Connection over distance

Technology has enabled connection to parents and other caregivers all around the world, regardless of physical distance. 

There just isn’t enough research yet to understand the capacities of human babies, toddlers and children to develop and maintain psychological connections through technology, and what the short- and long-term impacts of this might be. 

8. Work and home as different spheres

Most parents today have to juggle work and home as different roles, worlds and physical spaces. 

It has always been the case that parents have done things in their lives outside of taking care of children, but in foraging and agricultural societies, a lot of the work that needed to be done happened in the same physical space that the childcare happens. 

This juggling act creates a lot of stress and pressure.

The take-home message here is that the reason that so many parents find raising children difficult in our modern society is because of the gap between how we are wired to raise our offspring, and the environment we find ourselves currently living in. You don’t need to try harder to get it right. Everyone else doesn’t have it worked out. It’s not your fault. It’s a very challenging job and you’re doing the best you can. With self-compassion, flexibility and the right support, parenting gets easier. So place your hand on your heart, take three deep breaths, and tell yourself you’re doing a great job.

The ABCs of CBT, DBT and ACT: A very brief introduction to the therapies behind the acronyms

Most people have preconceptions about what therapy means and would be like. More often than not their ideas would correspond to reality in some forms of therapy, but not in others. This is because there are many therapy approaches that vary in a multitude of ways, and are often optimised for treating particular mental health conditions. Three of the most common psychotherapy approaches that have emerged in the area of mental health treatment are Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT) and Acceptance and Commitment Therapy (ACT). While many people have heard of one or more of these modalities, their titles and acronyms make them somewhat confusing. Importantly, however, all of these approaches are evidence-based, meaning that there is research that indicates that they are effective in treating the range of psychological difficulties they are recommended for. 

Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy, or CBT, is the most well-known and widely used psychotherapy modality and, as the name suggests, it draws on both thought-based and behavioural techniques. CBT largely focuses on the connections between thoughts, feelings and behaviours. Understanding how each of these domains influence each other, and how changing patterns in one area can lead to changes in another, are central to CBT. For example, through identifying and changing maladaptive thought patterns and beliefs, negative influences on feelings and behaviour can be improved. Fundamental to CBT is the idea that the development of more helpful or realistic thought patterns will lead to improved behaviour patterns, and so to increased positivity and confidence in daily life. 

Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy, or DBT, is a form of psychotherapy that originally derived from CBT. DBT aims to help people manage their emotions, cope with distress, and improve relationship difficulties. It does this by helping recognise and regulate emotions, reactions and behaviours. Accordingly, DBT focuses on four main areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, and includes life skills training. DBT often combines individual and group therapy formats. 

Acceptance and Commitment Therapy (ACT)

Another evidence-based psychotherapy approach derived from traditional CBT is Acceptance and Commitment Therapy, or ACT. As suggested by its title, central to this technique is the ability to accept, and ‘just be’ with, difficult feelings and thoughts. In contrast to traditional CBT, the focus is on our relationship to our inner private experiences, rather than on the content of these experiences. ACT aims to change our relationship with our thoughts, feelings, memories and physical sensations so we can disentangle ourselves from them and their consequences, and actively pursue our values. This allows a more flexible and meaningful life to emerge. The six core principles of ACT are cognitive defusion, acceptance, being in the present moment, observing the self, values, and committed action. 

These are just three of the evidence-based approaches that may be used during psychotherapy. There are, of course, many more, such as Schema Therapy. Working out which type of therapy may be most suited for an individual takes many factors regarding the person and the situation into account. These factors include the individual context, treatment goals, history and personality of the person. However, many people will have a preference for a particular therapy modality, naturally gravitating towards a particular approach and strategies they feel an affinity with. Furthermore, while each of these therapy techniques has its unique approach and features, there are also commonalities between them, and many mental health professionals use a combination of these approaches to tailor treatment to each individual’s needs.

End of Year's Reflections

Before we know it, 2021 will be upon us (!!!). And along with Christmas leftovers and the cricket, the first few days of January inevitably bring talk of New Year’s Resolutions. I’ll acknowledge they can be divisive - you either love or hate the idea of a New Year’s Resolution. 

For some, they can be hard to resist – the beginning of a new calendar combined with the hope and energy of summer and a time of holidays means that we feel like we’ve been given a ‘fresh start’ and want to make some changes. ‘New Year, New Me’ is the familar adage.

However, almost everyone can reflect back on failed resolutions of years past – to lose weight, give up a vice, spend less, run a marathon, procrastinate less, pick up a hobby, sleep better etc. By February the motivation to achieve these resolutions has often well and truly faded, and many instead resolve to never kid themselves by making resolutions again. 

Personally, I fall into the former category. I love resolutions! This doesn’t mean I’ve always been successful, however – there have been many hits and even more misses. By the time December ends, I will have successfully kept up my resolution of weekly yoga for almost two years (albeit with some youtube creativity during lockdown). I’ve also read over and above my planned 12 books this year. However, I’ve been hopeless at my goal to floss regularly (apologies to my dentist), and still haven’t decluttered my wardrobe. 

However, I’d like to spend some time on another yearly ‘R’ – reflections.

Each year, but for 2020 in particular, I think it’s important to pause and reflect on the 12 months that’s passed.

December is always a very busy month – school holidays, family events, shopping, celebrations, Christmas parties, food, work, decorations, etc. It can be tempting to rush through the last few weeks of the year and pin all our hopes on the next one. 

However, reflecting on the past year can be a helpful way of gaining insight into ourselves, determining how we’d like to spend the next, and taking stock of things which impact us as individuals and those around us. Sometimes a better method of change can be starting with reflections rather than resolutions. 

What did I want to get out of this year? What did I think it was going to hold?

Whether or not you made a resolution or plan at the beginning of the year, we inevitably have expectations. Perhaps we wanted to get a certain HSC or uni mark, get a promotion, travel to a particular place, expand our family, plan a wedding or milestone birthday, move house, see more or less of certain people, pick up a new skill… Sometimes these expectations are explicit – we are able to recognise we consciously held those expectations and we’ve even voiced them to others. Sometime we don’t realise we’ve held an expectation until it isn’t met, and we feel a rise of disappointment or resentment or sadness within us as it becomes apparent it won’t happen. Life is always unpredictable, but 2020 has especially impacted everyone’s ability to feel a sense of control and agency over their own lives and activities.  

Looking back at the beginning of the year, what did you think it was going to be like? What were you planning, explicitly or implicitly? Did those things happen, why or why not? How have you managed the differences between expectation and reality? Are their things that happened or didn’t happy that you are particularly angry or sad about? Have you processed these things, or are they still impacting you?

What would I change about the past year? What would I do differently?

It’s okay to think about things we wished were different! Sometimes we feel the need to quickly move on from things which were sad, disappointing, or frustrating – after all, “keep calm and carry on” can be a pretty adaptive coping mechanism! However, letting ourselves feel these uncomfortable emotions – grief, loss, regret, shame, embarrassment, guilt, anger, pain – allows us to more fully engage in life. I think it’s totally fine to recognise the things we wished were different over the past year. 

Being able to recognise and acknowledge our own mistakes is a part of this reflection. The old ‘Serenity Prayer’ comes to mind here – it’s about recognising things we can change and the things we can’t. Often we’re not in control of anything else other than our own decisions, reactions, and behaviours. How did you handle those disappointments, rejections, frustrations, or losses? What are some values or personal pursuits you’ve neglected? What are some ways you’ve let yourself down? With the benefit of hindsight now, what would you say to yourself 1,6, or 12 months ago?

What am I grateful for?

Gratitude lists has been demonstrated to have a positive impact on mental health and wellbeing. Australia doesn’t celebrate Thanksgiving as a holiday, but finding time to reflect on the joys and blessings of life is important.

Many of us are conscious of ‘big’ gratitudes – health, family, friends, a job, food on the table. It can be helpful here to also allow yourself to think of the ‘small’ gratitudes – utilising skills of mindfulness and present-moment awareness can help us be considerate and conscious of moments that we are grateful for – even if it’s a good parking spot at the shops, a friendly waitress, a delicious meal, a good sleep, a nostalgic tune. Each time I return home in December I’m aiming to pause and appreciate the scent of my Christmas tree as a I step in the front door. 

What am I proud of? What I have done well?

This is an important question, and for many people the hardest! There’s a template I sometimes given my clients which asks them to identify their strengths, unique skills and positive attributes. Almost every client I’ve given it to finds it a very challenging experience!

Australians find reflecting on their positive skills and attributes quite difficult – I think it’s a side-effect of ‘tall poppy syndrome’. 

However, it’s important to be able to recognise our individual strengths and gifts. It’s important to reflect on moments that we’re proud of, and achievements we’ve worked hard to get. It’s important to remember challenges we’ve overcome and ways we’ve grown and adapted and changed. 

For many of us, just making it through another day or week is an achievement!

When reflecting on these questions, I always get clients to be as specific as possible. Maybe instead of saying “I am helpful” or “I did okay at school”, think about who exactly you helped, or what subjects or assessments you did well at. All of us can think back to how we made it through and adapted to lockdown – whether coping with school, work, uni, isolation, loneliness, financial stress, or family life. 

You might even ask someone else close to you how they would answer this question for you – what are they proud of you for? How have they seen you do something well?

Who has championed and celebrated me? Who I have championed and celebrated?

We all need a cheerleader! The ability for an individual of any age to have at least 1 (if not more) deep and respectful relationship is a significant contributor to wellbeing.

Who did you feel cared for by this year? Have you let them know? If not, how could you let them know (maybe do some research on Love Languages here, so that you can demonstrate your appreciation in a way they’ll ‘understand’). Who did you appreciate, admire, or even just get to know better? Who did you feel understood by – who really made you feel seen and heard?

You might also want to flip this question and think about the relationships which were hard work, or tense and fractured, or who you felt more distant from. Why was this the case? Is this the natural shifting of a relationship over time, or has something been left unsaid or unresolved? Have you spoken about this shift with that person? Is this a relationship dynamic you think is worth persevering through, or should you let the relationship go? What are you able to change? 

Feel free to work through these questions on your own, with a close friend, or even with your Psychologist. And perhaps after all of that, you may (or may not!) want to resolve for something different in 2021!

The Impact of Traditions on Creating Meaning

As we enter into the festive season I have been reflecting on the past year and how different things are for so many people around the world, myself included. Currently in the midst of a global pandemic, most of us could not have predicted or even imagined what was in store this time last year. Every year brings about change, and this year is no different. Life requires constant adaptation and reminds us that we can at any point be thrust into unforeseen circumstances outside of our control!

Traditions and rituals can ground us, return us to a space of comfort and familiarity, and can help us to feel safe and loved. This is especially important for children, and a reason why so many kids love Christmas in a way that on the surface may appear to be related to presents and toys, but which often runs far deeper than that. Traditions and rituals signify belonging, purpose, love, and connection. And even as adults, the meaning we create can last a lifetime; transporting us back in time or being passed down to future generations.

We all have different feelings towards Christmas and the New Year. For some people, the holidays are a time of excitement, joy, and celebration; for others it may be a time of grief, loneliness, or stress. I’m acutely aware that my own feelings towards Christmas come from a place of enormous privilege. My parents gave me the gift of memories of a magical time which have stayed with me throughout my whole life. And with this in mind I wanted to add a disclaimer that the topic for today’s blog is certainly not meant to invalidate those who are currently suffering, or for whom Christmas is either not celebrated or is a time of pain or a reminder of unhappy times. It is instead intended to help create reflection on how no matter what life throws at us there is something incredibly powerful about having a clear sense of meaning in our lives: with traditions and rituals being a way of helping to create this. 

Research by Dr John Gottman, a world-renowned relationship expert, suggests that when we have rituals or traditions as a couple or a family, these create a sense of belonging and connection and can strengthen our relationships. There is something so comforting and stabilising to all of us about familiarity, but re-enacting traditions or familiar rituals is about more than the repetition - it can also make us feel part of a team or group whereby we’re included and have shared experiences of joy, humour, excitement, responsibility, or love. Perhaps we have thoughts like “This is what we do in our family”, “This is what matters to us”, and at times like Christmas “This is how we celebrate”! Even if you are alone, there may still be the opportunity to create meaning through individual traditions and rituals that feel special or important to you. Perhaps these connect you to others in the wider world, or perhaps they honour memories of loved ones with whom you’re no longer able to celebrate. Many people with religious beliefs believe the meaning of Christmas is to celebrate the birth of Jesus. For each of us that celebrates it though, regardless of our spirituality it is usually also tied up in multiple layers of what it also means for us individually, in the context of our own lives. We create our own meaning through the choices we make, the things we focus on, the sense of purpose we feel through acting in accordance with our values; and through the gifts of love, kindness, or service to others or to ourselves that we can offer. 

For me, Christmas has always been my favourite time of the year. Because it carries enormous meaning to me that relates to a sense of connection, belonging, anticipation and joy at re-living rituals and traditions. Some of these feel unique and special to my family and give me a sense of being part of that. Others feel shared with the wider community of my culture growing up in the UK and my now-adopted home of Australia. Others are more global and help me to feel connected to humanity as a whole.

What I know for sure though is that whilst I loved receiving presents as a child, I loved giving them more. The memories I have that fill me with such warmth don’t relate to material gifts but are instead intrinsically tied to the specific acts we carried out together as a family this time of year. I remember times it snowed when we tobogganed down the hill near my Grandparent’s house on black bin bags! I remember the tradition of attending local school fetes and being filled with joy at winning a tombola prize I thought would make a good gift for a family member (even if one year it was a bottle of gin that needed a parent to collect!). I remember waking up in the night with my younger brother every year to sneak a peek at the presents under the tree and try to guess what was in our stockings knowing we couldn’t open them until the whole family was awake. I remember the thrill of checking the doorstep in the morning to see if Father Christmas and his reindeer had eaten our offerings. I remember the whole family attending church, singing my favourite carols, and feeling so much gratitude for my life and loved ones. I remember being allowed to open one present from under the tree and needing to wait until after the Queen’s speech for the rest (which had to be watched in complete silence – an excruciating test of patience but simultaneously a critical part of the tradition that made the day so special!). I remember helping peel Brussel sprouts for Christmas dinner, and all sitting together pulling crackers, telling jokes, and wearing paper hats before tucking into the most delicious feast on earth! I remember playing board games as a family, watching old James Bond films and BBC Christmas specials together, and passing around boxes of chocolate, knowing we had to save the caramel ones for my Dad. It’s not just the big details like rules around presents or all attending church together which created meaning, it’s the smaller details that added to the sense of being part of our family with our own unique way of celebrating. The fact that there was always a satsuma and apple at the bottom of the stockings each year, the way my mum always made homemade mince pies with a star on top, the way me and my brothers always tried to choose presents for my Dad that would make him laugh (a battery-operated farting gnome was a definite highlight for him I’m sure!).

Traditions can be established any time. Honouring and cherishing them can bring enormous joy to all who are a part of them but can also create shared memories to reflect on, laugh at, or look back on. They can evolve throughout time; and can be something which spontaneously becomes part of the way things are done, or which is a carefully planned activity. 

Reflecting on the rituals and traditions you already have can be a valuable gift to yourself and others this time of year. Perhaps seeing them through the lens of a cherished activity that creates purpose and magic for those around you and yourself. Maybe reflecting on any new traditions you would like to introduce, or rituals you used to do that had been forgotten about in the chaos and exhaustion of what has been a tough year for many. Even small acts can have significance! Perhaps spend time reminiscing about things you used to do or sharing ideas with friends or family members about your experiences and most treasured memories. Or if you are a parent yourself, reflecting on how you can or already do create a little magic for your kids. Sometimes we get caught up in the big picture. We feel our life lacks meaning because we’re too busy focusing on the overall year, relationship, or life we have, rather than noticing the individual moments that shape our existence. One of my favourite quotes comes from Victor Frankl’s Man’s Search for Meaning and it goes as follows: “The meaning of life differs from man to man, from day to day, and from hour to hour. What matters, therefore, is not the meaning of life in general, but the specific meaning of a person’s life at a given moment.” I feel like the meaning that our own traditions and rituals can signify in each moment is equally personal; and may also change in time as our circumstances do.

We can choose to engage in acts that create or connect us to a sense of personal meaning. This can be done anytime, in any situation. It is not just what happens in our life that gives us a sense of meaning, but the way we interpret or make sense of it. One family’s traditions may be meaningless to another. One person’s most poignant memories may relate to the smallest act that signified something of great value to them. Each moment in time is what shapes our experiences and memories, and filling this season with traditions and rituals, however small, can enable us to strengthen the meaning from each individual act as it is repeated over time. For me, at Christmas, this means introducing some lightness, spark, humour, fun, excitement, anticipation, joy, and vitality through a conscious effort to connect and continue familiar activities which relate to a purpose tied into my sense of family, love, connection, gratitude, fun, kindness, and belonging. It’s not about creating extra pressure to do things in what is often already a stressful time, but instead about noticing the small things that matter to me; the feelings that come up when I honour them, and making sure they don’t get swept aside or lost in the chaos!

Why We Worry So Much About What Others Think & What To Do About It

Personally and professionally I have experienced and seen firsthand how much we worry about what others think. 

Unfortunately this is a necessary part of being human! I so wish I could tell you the secret to eliminating this fear, so that you could stop worrying about what other people think. To offer you a way of deleting the fears about how others are judging you and what you do in your life.

But it is just not possible.

Way back in our human history, this wiring in our brain was an important and in fact necessary part of our survival. Our brains have developed to become expert judging machines, in order to make sense of the huge amounts of information we are bombarded with on a daily basis. To sort through pieces of information, to categorise it, to remember what’s important, to shortcut mental effort and make living more automatic. 

We are also wired to care about what others think.. because belonging and acceptance are important for us to survive. If your clan judged you, your behaviour and your contribution positively, then it ensured that you had access to the clan’s resources - like food, shelter, information and protection. Positive judgment meant that you belonged and were safe. If the clan judged you or your behaviour as negative, that meant that there was a risk you could be banished or even killed. A negative judgment back then meant rejection, which would deprive you of access to the clan’s resources, threatening your future survival. So there is a very good reason why it is wired into our DNA to judge (ourselves and others) and care about the judgment of others.

Add on to this the fact that experiences in our past that have involved negative judgment are stored entirely differently in the brain. This is our brain’s way of trying to protect us, to help us avoid any situation in the future that might cause us physical or emotional pain. What this can mean is that there is a red flag attached to any situation, any experience that has the potential to elicit judgment. This kind of supercharges our propensity to avoid risk, to stay stuck, to stop us stepping out of our comfort zone.

This means that not only does judgment hurt, but it can hurt A LOT. It can not only cripple us with distress, but it can alter what we do moving forwards… it can have a huge impact on how we show up, on our life decisions, and therefore the very architecture of how we choose to spend our time on this earth. 

So, if we can’t stop our brains from judging, and if we can’t delete the fear of judgment, what can we do about it?

First of all it’s important to work out if there is a need to do anything about it. Fear of judgment only becomes an issue when it is getting in the way of stuff for you. When it is stopping you from being the kind of person you’d ultimately like to be, from working towards goals that are important to you, and from showing up in your life in a way that you’re going to be satisfied with when you’re 80 years old. It becomes a problem when fear is the one controlling your decisions and actions, rather than your true self, the person underneath the worry and emotions that has big dreams and a rich vision of what your life could look like.

Ask yourself this question: “If I could get rid of all fear, just delete it from my brain, along with all the worries about what other people would think…. What would I do differently?”

Any answer to that question apart from “nothing”, means you may benefit from learning how to respond differently when fear surfaces. 

Here are some tips to get you started:

1. Be Aware

   Bringing our conscious awareness to fear, to worries about judgment is an extraordinarily powerful step. To label something, to acknowledge it, means it is separate to us. It means that space, distance and choice become part of the picture - and places power back in our hands. Try to not only notice when your worries about what others think show up, but also when you are drawn into judging others (and yourself) too. 

2. Helpful or Unhelpful?

   Ask yourself - if I give my attention to this worry or judgment, if I spend time and energy focused on it.. Where does it get me? Does it help me towards my goals? Does it take me closer to or away from the things that matter from me? How will I feel?

3. Use Mindfulness

   Mindfulness is one of the most powerful tools to help ‘unhook’ your mind from unhelpful places. With practice and time, you can get better at learning to let go of those thoughts, stories and fears so that they don’t control your behaviour.

4. Compassion, Compassion, Compassion

   For yourself, and for others. You’re doing the best you can, other people are doing the best they can (even if it is entirely unworkable). Be patient with yourself and others, and hold the hand of the part of you that is wounded, that is scared, that is hurt. In fact, those people that are critical and judgmental of others are generally the ones that struggle the most. Tearing down others is a way of trying to make themselves feel better, an attempt to manage their own pain and sense of inferiority. 

5. Take Action

   Action is the best antidote to anxiety. Notice the fear, label the judgments, and make room for them as you continue to do those things that matter to you. Take your power back and walk towards the person you want to be and the life you want to build. You will be scared. You will be judged. But when the reward is the richness, depth and fulfillment of living your life on your terms, it can give you the courage to hold the inevitable difficulty and keep going. 

Our judgment and the judgment of others is part of the human condition. And sadly, decisions and actions to try and avoid judgment lead us to a small life, a life that doesn’t even work to escape judgment. And if we pretend we don’t care about what others think, we end up becoming guarded. We end up putting our walls up, which prevents us from being vulnerable, from inviting true connection, authenticity and fulfillment. We can’t stop the pain associated with judgment, and as much as it hurts, that’s OK. It’s a sign that we’re human and that we care. Where we do have agency, is learning how to respond to it.. Choosing whether we let it assign us to the sidelines of our own life or bravely face it as we take the field. 

Depression in Young People: Impacts on Learning

As we move towards the end of the school year, we often reflect on the year that has passed. And what a unique year it has been! It is also a time when many parents and students notice the effects of mental health challenges on the school year that has been. This is obviously difficult to quantify, and varies from person to person. But awareness of the potential impacts of conditions such as depression on well-being and education can help both the student, and those around them, to recognise, validate, normalise, and address educational difficulties as they arise.  Recognising possible signs of depression at school can also help in identifying depression early, and facilitating timely support and treatment.

Unfortunately, depression in young people is under-diagnosed and so can be left untreated, leading to compounding difficulties. Some reasons why depression in younger people is not picked up are that they may have difficulty explaining how they are feeling, the symptoms of depression can be dismissed as ‘normal’ in the context of adolescence, or the symptoms may be masked by anger or other negative behaviours. 

It is important to note that depression is more than feeling sad. Depression affects all areas of an individual’s wellbeing, including sleep, diet, physical health, self-esteem, social activities, interests, family life and learning. Depression affects the way an individual thinks, how they see themselves and how they view their future. 

Of course, depression exists on a continuum, from mild to severe, and the symptoms will similarly vary. However, the main symptoms of depression are to do with feeling sad or irritable, mood changes, and feeling that nothing is worthwhile and that things will never get better. These signs of depression are particularly notable if they occur together, or are not typical of the young person.

Depression affects young people in many ways. These are some of the key signs that the person might show:

• Low motivation and loss of interest in activities they usually enjoy

  They may be very difficult to motivate to engage in anything and lose interest in hobbies or activities they previously enjoyed. Disinterest in pursuing passions, learning new things and planning for the future may also be evident.

• Have difficulty listening, concentrating on tasks and remembering things

  Decreased ability to focus and make decisions, and poor working memory. Depression can leave people feeling confused, vague, overwhelmed and frustrated. Even basic everyday tasks can seem difficult.

• Low self esteem

  Make negative comments about themselves. Thinking they cannot do things, and so it is not worth trying.

• Focusing on the negatives

  Look for what’s wrong, rather than seeing the positives in situations

• Social withdrawal

  Withdrawing from social situations and not want to spend time with friends or others.

• Irritability and anger

  May appear agitated, easily annoyed or upset. May lash out at those around them. May be very difficult to please.

• Sadness 

  Seems sad and cries easily. Can be difficult to reassure or calm.

• Eating 

  May either have no interest in food, or overeat.

• Poor sleep and low energy

  Has difficulty with going to sleep, staying asleep, waking early, or sleeping excessively. Even after a good night’s sleep, they can feel tired. 

• Physical symptoms

  Headache, fatigue, nausea and unexplained illness are common. 

These symptoms of depression will clearly cause problems in many areas of a young person’s life, including social and family relationships, and engaging in activities. Depression may also have a major impact on a young person at school and in their learning.

The following describes some ways in which the symptoms of depression can impact a young person at school and in their learning

• Difficulty with tasks and assessments

  Commencing tasks/staying on task or even attempting tasks can be impacted due to factors such as decreased ability to attend, concentrate or make decisions.  In addition, compromised memory function makes it challenging to retain new information and recall previously learned information. Cognitive function may be further impacted by physiological effects such as being sleepy or very tired if sleep affected, or by decreases in blood sugar levels and energy if food intake is inadequate. 

• Change in interest in school work and activities, and poor motivation to engage

  Reduced motivation or disinterest may be noticed earlier at school than other areas of life because of the lower priority of school work for many students, and leads to poor engagement.

• Lowered self esteem 

  Focus on negative and worrisome thoughts can be distracting, exhausting and demotivating.  Feelings of hopelessness or low self-esteem can lead the student to believe they are not capable of learning and that they shouldn’t bother trying. 

• Reduced social interaction and isolation

  The young person may have problems sustaining friendships, and difficulty relating to classmates and teachers because of social withdrawal. They may feel unable to engage in class activities or seek learning assistance as needed. Depression can leave some individuals feeling irritable, agitated, and anxious. They may also become uncharacteristically defiant, disruptive, or aggressive towards others. These factors can result in the student feeling lonely and unsupported.

• Lateness to school, frequent absences and/or truancy

  This may be due to poor motivation, avoidance of school, or physical symptoms (including fatigue or excessive sleep). 

So a young person’s school engagement and ability to learn may suffer due to a range of factors stemming from depressive symptoms. However, it is also important to note that inconsistent academic results are often associated with depression, with students producing great work at times, and seemingly unable to engage or complete a single task at other times. Nonetheless, overall depression will likely negatively influence their academic progress and result in under-achievement and falling behind, leading to exacerbation of the depression.

Identifying depressive symptoms early, including through impacts at school, is important for engaging with effective treatment and minimising longer-term consequences and higher risk.

A Healthy Digital 'Diet'

There’s been a lot going on online and in the news recently – the daily suspense of COVID cases, new and harsher lockdowns overseas, the chaotic and emotive US presidential election, multiple government inquiries and royal commissions, the compelling but pressing new David Attenborough documentary, the ongoing coverage of the Black Lives Matter movement, protests and unrest, attacks and beheadings, it goes on and on. 

The internet can feel pretty overwhelming at times – the content we are exposed to on a daily basis is serious, and global, and never ending. 

It can be helpful to think about what you digitally and virtually consume in the same way that you think about the things that we literally consume, what we eat and drink. Most of us know the general principles of a healthy diet – think the ‘food pyramid’, and sayings such as ‘everything in moderation’. These principles, with a little adapting, can be applied to the way we use and consume digital content. 

Consume variety

The best meals and the best diets are those that have variety! Think about what you digitally consume on a daily or weekly basis – is it mostly Instagram, TikTok, youtube, gaming, news, or Netflix? And even within those formats, think about what types of content you consume, and how you do it. Is it lifestyle, exercise, clothing, makeup, mental health, sports, news, decorations, craft, school or work related? Is it on your tablet, phone, television, or laptop. Try not to spend too much time on one type of content – get a variety of input in your digital diet! This is a recommendation to adddigital content from other forms, but a warning against spending too much time on one form of digital ‘food’.  

It’s important to let ourselves consume a variety of things. If you find yourself getting anxious at the news, let yourself watch something fun or light-hearted. If you notice yourself following a lot of health and fitness accounts, perhaps seek out some body positivity ones. 

Take a break

Much life ‘meat free Mondays’ or ‘Dry July’ – it can be helpful to, at times, challenge ourself to mix up how much we consume. We may want to change our consumption of digital content perhaps by having a screen free evening once a week, or a digital detox once a month. Or perhaps even just leaving your phone at home when you go for a walk. This gives us the opportunity to see how we go when our usual routine of consumption is different – do I feel anxious away from my phone? Do I feel happier when not reading the news? Do I feel more content when not searching online shopping sites? Do I feel more disconnected when not online gaming? Our reactions to shifting up our consumption can be a helpful signal of how things are or aren’t impacting us. 

Some things are better than others… but everything in moderation

It’s true to say that different forms of digital content have different impacts on us. Each of us as individuals can work out what parts of our digital diet ‘agrees’ with us, and what doesn’t. Staying attuned to your own mental and emotional health whilst using our digital devices is so important. Everyone has a different capacity for what they can tolerate, particularly when it comes to the news. 

However, just like making drastic changes and cutting out entire food groups for good isn’t usually a healthy move – we don’t necessarily have to cut out our digitial content all together! There are many aspects of our life that require digital consuming – work, school, uni, shopping, travel, etc. But also, allowing ourselves to consume ‘guilty pleasures’ such as re-watching an old sitcom or movie on sick days, or scrolling Instagram after work to switch off, or sharing TikTok videos with friends – all of these things aren’t too harmful in moderation!

Try to focus on one change at a time

If I tried to focus on all the possible ways I could improve my diet at once, I would probably be unsuccessful. If I attempted to eat less refined sugar, more vegetables and whole grains, less salt, less meat, more calcium, and reduce my food spending whilst buying locally sourced food – I’d struggle!

So many of the teenagers and young people I meet with are so switched on – they are intelligent and aware people who consider it important to be informed about a variety of social and political movements and events. However, as noted in the opening paragraph of this blog – the list of things to be concerned or invested can be endless. There may be many things we want to know about or be involved in, but trying to do all of them can be tiring! Working out which social or political concern(s) are most important to us, and then focusing on those whilst accepting that we can ‘let go’ of the others for the moment can be a helpful way to free up our energy to really invest in those areas, whilst also maintaining our own good mental headspace. 

Know what you’re consuming 

It can be helpful to recognise the biases and distortions of what we’re consuming. In the same way you might check the ingredients list of the food you eat, it’s helpful to be aware of some of the factors behind the digital content we see.

And we’re getting better at this – most of us know that the Instagram influencers we follow use editing software, the newspapers can sometimes sensationalise what they write, ‘good news’ stories of hope and change rarely make the front page, so called ‘reality television’ is often highly scripted and produced, and Facebook is using an algorithm to curate our newsfeed. Reminding ourself of these factors can be helpful when we feel disheartened or overwhelmed, or notice our own internal critic showing up.

Whatever you do, most of all be mindful of the way that digital content impacts you on a day to day basis. Don’t forget that small changes can make a big difference! Consider small ways that little tweaks to your ‘digital diet’ might impact your wellness. 

Making Mindfulness Fun

A lot of people are becoming more and more aware of the benefits of incorporating mindfulness into their lives. There is a wide body of research now demonstrating that mindfulness can promote a greater sense of wellbeing, reduce psychological suffering, improve attention, decrease emotional reactivity, and increase behavioural control. For those experiencing anxiety, depression, or other mental health challenges it can be particularly important- because a lot of distress can be linked to worrying about the future or ruminating on the past; which is kind of the opposite of mindfulness!

What is often not clear though, is what exactly mindfulness is. Whenever I ask people what their understanding of mindfulness is, they usually say something along the lines of meditation, breathing exercises, or using a guided app. And these can certainly be one way to practice it! There are many fantastic apps around, but some that I often recommend to clients include Smiling Mind and Insight Timer.

What sometimes happens though is that people have preconceived ideas that these guided exercises or meditations are “boring”, “a chore” or that they “don’t work”. And this is where it can sometimes help to be mindful of how we understand what mindfulness is, and flexible with how we practice it!

What Exactly is Mindfulness?

Let’s start with a definition. Mindfulness can be thought of as a conscious, non-judgemental, moment-by-moment awareness of the present moment. This means it is a state of being, not a trait that is permanently fixed or a part of who we are. The goal of mindfulness is simply to be fully present in the moment. Aware of information arising from our senses or non-judgmentally noticing our internal experiences!

When we do experience a sense of calm or relaxation, that’s great, but this is not the primary goal of mindfulness! If we go into mindfulness with the expectation it “should” make us feel a certain way, we will be too busy analysing or judging whether that is happening to actually be present in what is occurring moment-by-moment! And this is often what people mean when they say mindfulness “didn’t work”. They mean it didn’t work to change their emotional state in that exact moment. And the irony is that by letting go of the agenda of trying to alter their emotional state, that is often the very thing that happens. And even if it doesn’t, by noticing and being mindful of it without judgement they can often feel more able to respond to it effectively, rather than automatically reacting without any conscious awareness!

When people report mindfulness is “too hard”, it is often because they hold unrealistic expectations that they “should” be able to control their mind without it wandering. Once again, letting go of these judgments and expectations can be really helpful. And at the same time, we can also be aware of how over time, the more we practice, the more we can increase our ability to stay focused for longer periods or to catch ourselves when we do get distracted!

Fun Ideas to Try!

Having said all of that though, if you have tried meditations or guided apps, or genuinely feel they are not helpful or workable in your life right now, that’s ok too! The good news is that there are a million ways we can practice mindfulness. So, here’s some ideas to get you started!

1.     Music! Choose your favourite song, or one that resonates with you, and instead of it playing in the background whilst you multi-task or do other things, try pausing and focusing completely on the experience. You can choose to focus your attention on one aspect of it – the lyrics, the instruments, the bass, the tempo etc, or you can choose to just mindfully let the music wash over you and notice the feelings and sensations you experience internally as you listen. Each time your mind wanders and you start thinking about other things, just gently bring your focus back to the song.

2.     Mindful dancing! We’ve all heard the old saying “dance like no one is watching”. Why not give it a try when nobody actually is watching! Try to go with the flow, moving your body in whatever way the urge arises! Practice letting go of self-consciousness and just being in the moment!

3.     Mindful Art! Experiment with painting, drawing, colouring, flower arranging, sculpting with clay or play-doh, and once again try to really be present in the activity. Notice the colours you create, the textures or patterns arising, the feel of the pencil, paintbrush or material in your hands. You could try getting an adult colouring book, or experimenting with mandala circles, or practicing still-life drawing; or just go with the flow of creating something abstract!

4.     Mindful appreciation of a loved one.  This can be a really beautiful activity to do with a child, pet, or partner. Just spend a few minutes silently observing what you notice as you focus your full attention on them. With a child you might like to pause and watch them immersed in play: noticing their expressions of joy or concentration, the way they move, or the way their eyes light up when they look at you. Or you might like to snuggle them and inhale their scent or notice how soft their skin is or the way their body softens as they relax. With a pet you might like to softly stroke them and notice the sensation of their skin, fur or feathers, or spend time observing the different colours or patterns. With a partner you could try observing them as they go about everyday activities, noticing things about them you have taken for granted or stopped seeing in the everyday familiarity, or you could consciously spend a minute or two looking into each other’s eyes. Noticing what emotions arise as you engage in this silent intimacy.

5.     Mindful Eating. Buy or prepare the most delicious food you can think of and consciously savour the experience. Use as many of your senses as you can- inhaling the scent, observing the colours or textures, really noticing how the flavours change. Slowly savouring each step in the process of tasting, chewing, swallowing. How is this different to eating the same food mindlessly whilst watching tv or multi-tasking? A similar thing can be done by pausing as you drink your coffee, tea, or juice in the morning: devote a minute (or even just one sip!) to savour the experience whilst letting go of everything else!

6.     Mindful Pampering. Take a shower with the conscious intent to be as present in the activity as you can. Notice the feel of the water, the temperature on your skin, the scent of your shampoo, soap, or shower gel, the noise of the water beating down. How does this differ from a quick shower whilst mentally running through a to-do-list of all the things you need to complete. Or try luxuriating in a bubble bath, or spending a few minutes gently rubbing in hand cream or body lotion and noticing the sensations, really observing your skin with fresh eyes and noticing what it’s like to consciously nurture your body.

7.     Mindful Exercise. Some forms of exercise like Yoga, Tai Chi, or Pilates naturally lend themselves to a mind-body connection and present-moment awareness. But get creative and find out what works for you! A mindful walk where you notice the nature around you, focusing your attention on your senses instead of walking whilst your mind is elsewhere? Or perhaps a team sport or kick-about with the family! Immerse yourself fully in the activity and just go with the flow!

8.     Mindful Games. Any kind of game can be turned into a mindfulness activity simply by focusing your attention on what is happening in the moment -  Have you ever played a family board game and noticed everyone is fully present, participating, and connected? Living in that exact moment instead of pre-occupied with earlier events of the day or worries of tomorrow? That’s mindfulness! 

If you do want to try some specific fun activities to practice though, here are some ideas that are great for kids, but that teens, and grown-ups can enjoy too:

·      Create a story together. Take turns to say one word or one sentence before the next person has to follow it up. “Once” “There” “Was” “A” etc. It requires focused attention without being able to predict or jump too far ahead! Let go of judgments about what you say and just go with it!

·      The Alphabet game – Similar to the one above, take turns to say an animal that starts with the last letter of the word before. Eg “Alligator” “Rhino” “Orang-Utan” etc.

·      Simon Says – An old classic, but so good for helping kids focus their attention in the moment!

·      Balancing Egg- This was one of my favourite mindfulness activities from a group therapy program I co-facilitated. Give everyone a raw egg and sit at a table – Get everyone to practice balancing their egg upright. It requires focused attention and patience and can be lots of fun! But it often elicits frustration and judgments which can be a great chance to practicing noticing this and non-judgmentally coming back to the activity.

9.     Mindful nature: Spend some time at the beach, near a lake, in a park, or a forest. Try to focus on just observing all the information coming through your senses in that moment. Noticing the sound of the waves or of birds chirping, the leaves moving in the wind, the clouds in the sky, sunlight reflecting off the water etc. You can try embracing a still presence where you simply sit back and notice the nature surrounding you, or you could try an active form of mindfulness where you throw yourself fully into an outdoors activity in that moment: swimming, hiking, horse-riding, running, bike-riding, rock climbing, or anything else that takes your fancy! To embrace mindfulness the only thing you need to do is be present! Observe any worries or distractions or self-judgments as they arise, and simply practice letting them go through redirecting your attention to exactly what you’re doing in that moment!

Hopefully by now you have a few ideas for other ways to embrace mindfulness, but the wonderful thing about it being a state of being we can cultivate is that we can make any moment in our lives a mindful one! Mindfulness doesn’t have to mean planning extra time in your schedule to practice. Sometimes it’s just about noticing what’s already happening!

When A Psychologist Sees A Psychologist

Following the birth of my second baby, I was not in a good place. Jack was so different from my first baby - he seemed to feed every 1-2 hours day and night, he wouldn’t settle, I was constantly changing his nappies and he would just cry, and cry, and cry. I would find out when he was 5 weeks old that this was because he has cystic fibrosis, and the poor little guy couldn’t absorb the goodness of the breastmilk, so he was just hungry! Of course he couldn’t settle, of course he couldn’t sleep. 

Meanwhile I spent 5 weeks blaming myself, breastfeeding and expressing around the clock, wondering how I could be doing this so wrong.. Especially as I’d already done it before!

Throw in epic sleep deprivation, the arrival of Covid-19 and an avalanche of negative thoughts that I’d ruined my first child’s life forever as I had no time or space to give her - I was a ball of tears, exhaustion and overwhelm.

The navy colour-coordination was accidental, and that smile is forced!

As a psychologist, I knew how important the early weeks, months and years are for a child’s development, so I knew that if I didn’t get myself right, not only would I suffer, but so would my relationship with my children, and ultimately their future selves. 

So thankfully with the Medicare-funded Telehealth sessions in place, I reached out and found someone who specialised in the difficulties I was facing. 

Ohhh being on the other side of the couch! I was nervous! I was skeptical. I felt guilty - shouldn’t I know all this stuff already?

Thank goodness I overcame my own ego and started therapy. Here are the main things I have learned from my journey so far:

• It is actually helpful

  • This was almost a relief to arrive at this one. I mean, after 8 years of education and pouring my heart and soul into my work for 10 years, it feels good to realise that therapy works!

• You need someone objective

  • I’d spoken openly to my husband, my friends and my family about how I was feeling, and they were amazing. But you need somebody outside of your circle, somebody you doesn’t know you as a wife/daughter/sister/friend. Who can be totally objective - not only in making sense of what’s going on for you, but also someone who you can listen to and potentially accept what they’re offering in a different way. Many things that my psychologist said to me I’m sure my husband had already tried to say… but it was much easier taking it on board from her! Maybe that’s a reflection of my stubbornness. 

• Emotions shut down your brain

  • Some of the things my psychologist pointed out seemed blindingly obvious once she’d shone a light on them. But given the state I was in, my brain was flooded with cortisol, my fight-flight response had taken over and I was absolutely depleted. I was not seeing things rationally, and I was not utilising the brain capacity I normally have available to navigate my life and the lives and paths of my clients. 

• It is worth the money

  • As with a lot of people throughout Covid, and being on maternity leave, my financial situation was not one of abundance. So I was hesitant to spend the money on therapy, and thought of all the other ways the money could potentially be better used. This was a very unnecessary barrier. Every session was worth every dollar. 

• It is worth the time

  • Between feeding, expressing, sterilising, washing, settling, burping, changing the nappies and playing with two under two as well as running my own business, I hardly had time to have a shower. And in fact that was not a daily event during this period. And oh yeah I also have a husband that has needs too! So trying to find the space to schedule an appointment in between all the demands placed on me was a challenge in itself. And of course there were the thoughts of what else I could be doing in that one hour that may be better value - sleeping? Meal preparation to get ahead? Cleaning? Nothing could have been better value. It was definitely worth the time, and, in fact, I should have had sessions more frequently. 

• Leaning on others makes you stronger not weaker

  • I carry this longstanding and entirely unhelpful belief that I should be able to cope with everything by myself. Not only is it actually counterproductive, but it is so false! We are not designed to be solo creatures! We have evolved to live within a community, to rely on and be supported by those around us. Every time I was able to loosen a grip on this belief and take a step towards support it helped me breathe easier and move forward faster. 

• Everyone should have therapy

  • I truly believe this. The power in objective reflection, in someone holding a mirror up to you and your life and your behaviours, and supporting you with the skills to make changes if your life is out of alignment is invaluable. And this doesn’t have to be formally with sessions with a psychologist (although this is an excellent way to acheive this goal). It can be through reflection, through some form of meditation or mindfulness practice, or whatever space you can access to connect with yourself in a deeper way. But whichever way you choose to do it - you must. As Plato said, “An unexamined life is not worth living”.

When concern for your health becomes anxiety

While having some concern about our health is normal and generally helpful, some people are excessively and obsessively preoccupied with their health, to the point where it interferes with their life, including work, study, relationships and daily life, resulting in significant distress. 

This is preoccupation with health and illness, and particularly that they have symptoms of a serious illness, is the hallmark of ‘illness anxiety disorder’ or health anxiety. Health anxiety can develop in people that are ‘healthy’, as well as those who have a real medical condition with physical symptoms that are excessively distressing to them (the latter is termed ‘somatic symptom disorder’). However, I will be focusing illness anxiety disorder here.

Of course, with the symptoms of COVID-19 constantly in the media and in the forefront of many people’s minds, anxiety and distress about health has been amplified, and this is particularly so for those who were already preoccupied with their bodily sensations and health.

Some of the main symptoms of illness anxiety disorder include:

·      Excessive preoccupation with having or coming down with a serious illness 

·      There are no, or mild, physical symptoms

·      Anxiety persists despite receiving negative results on medical tests and reassurance from medical professionals

·      Health-related behaviours such as:

o   Repeatedly checking your body for signs of illness 

o   Either avoiding, or frequently seeking reassurance from, medical professionals 

o   Searches for information about illness symptoms

o   Avoiding situations or stimuli that are perceived as anxiety-provoking

What keeps illness anxiety disorder going?

There are a number of factors that can contribute to keeping us stuck in a health anxiety state. These include cognitive factors, including interpretation of bodily sensations, or worry), and behavioural factors such as checking, avoidance and reassurance-seeking.

Unhelpful thoughts and beliefs

·      Misinterpreting harmless bodily sensations as a threat (indicating serious illness) can lead us to pay more attention to those sensations, which can amplify their intensity. This increases anxiety, and then the symptoms of anxiety (e.g. breathlessness, chest tightness/pain, faintness) are interpreted as a further threat and worried about. 

·      Worry and repetitive thoughts keep the fears ever-present. Intrusive thoughts and images can be upsetting.

·      Trying to dismiss or get rid of unwanted thoughts and doubts can make them come back stronger.

·      Thoughts about perceived symptoms become distorted or inaccurate, leading to overestimation of the probability of having or developing a serious illness, and underestimation of ability to cope with illness.

Avoidance, reassurance and checking behaviours

·      These are things that you do to help you cope when you feel anxious, or to try and prevent feelings of anxiety from occurring. 

·      For example, 

o   Avoiding hospitals, medical appointments, sick people, or reminders of illness such as TV or newspapers. Or avoiding anything that gives you bodily sensations that make you anxious, such as exercise, coffee, or specific foods

o   Keeping a mobile phone or companion with you, or staying close to hospitals, in case you have a health emergency, 

o   Information and reassurance seeking, such as repeated medical consultations and tests, searches for information

o   Checking. For example, of your body or memory. Checking is unhelpful in that it keeps your focus on your worries, can lead you to see a problem where there isn’t one, increases uncertainty or doubt (leading to more checking!), and can actually lead to symptoms (e.g. constantly feeling an area of the body leads to tenderness or redness).

·      Avoidance, reassurance and checking behaviours can feel good and provide relief initially, but in the longer-term they stop you from learning that you can survive without them or whether your fears are real, and they often lead to needing more reassurance and not being able to cope with anxiety symptoms and uncertainty.

Tips for if you find yourself preoccupied with bodily sensations 

A core feature of illness anxiety disorder is that harmless bodily sensations are misinterpreted as dangerous and threatening and become a focus of attention. This misinterpretation of sensations is key. 

Tip #1: Explore the relationship between your bodily sensation and your focus and anxiety. Notice if your experience of the bodily sensation changes as your anxiety rises and falls, or if your focus on the physical symptom is triggered by anxiety thoughts (e.g triggered by something in the news or hearing about someone else’s illness). Try focusing on your stomach for a minute and noticing any physical sensations (e.g. gurgling, tightness). Had you been aware of these sensations before you focused your attention on them? Did the sensations appear to increase over the time you focused on them? By observing and understanding how attention and your anxiety may impact your experience of physical sensations, you can start to change this relationship.

Tip #2: To further test the connection between bodily sensations, anxiety and attention, try focusing on how a ‘safe’ part of your body feels (e.g. your left thumb), and notice how your attention wanders when the sensations are interpreted as unimportant and ‘safe’.

Tip #3: Learn and practice mindfulness in everyday tasks to learn how to focus your attention on the here and now. Move your attention from your body and its sensations, and focus on whatever everyday task you are doing (e.g. doing the dishes, eating, vacuuming, having a shower). Focus on your senses (what can you see, hear, feel, smell, and taste? notice the details), and gently bring your attention back to the task whenever you notice that your mind has wandered (which is perfectly natural!). 

Tip #4: Set aside time to worry. Focusing on worries, including trying to stop worrying, can create more worries and symptoms. One strategy for tackling worries is to postpone them. To do this, decide on a set time, place and length of time (no more than half an hour and not just before bed) that will be your ‘worry time’. Then, when you notice a worry or focus on a symptom, write it down (briefly) to worry about later, and then bring your attention back to whatever you are busy with. Remind yourself that you will be able to come back to your concerns later. When you get to your ‘worry time’, only think about the worries on your list that still seem really important at that time (some things might seem less important or no longer relevant), and do not worry for longer than the time set (you can carry items over to the next day’s worry time if necessary).

Tip #5: Remind yourself that while any anxiety symptoms may feel unpleasant, they cannot not hurt you, and will pass. Try using distress tolerance strategies to get you through the wave of anxiety. For example, use relaxation (e.g. calm breathing) or mindfulness strategies, engage in distracting or soothing activities, or use your senses to ground you in the world around you (what can you see, hear, feel, smell, and taste?).

Of course, while the above tips can be helpful in starting to address illness anxiety disorder, you should still speak with your doctor about any concerning symptoms. If you need guidance as to wen it is appropriate to seek medical attention, it may be helpful to agree on some guidelines with your doctor.

These tips start to address some aspects of health anxiety – the focus on, and misinterpretation of, bodily sensations that often occur. However, the many unique factors experienced by those affected by health anxiety can be addressed successfully and more fully through individualised psychotherapy approaches, such as Cognitive Behavioural Therapy (CBT).