Many of us can relate to a tendency to compare ourselves to others. Our patterns of thinking can allow us to become experts in detecting our physical, social or intellectual differences with others. Social comparison theory, first proposed by Leon Festinger in 1954, is a theory which suggests there may be a powerful, biological instinct which drives us to behave the way we do. Many species have been observed to have the tendency to ‘size up competitors’. The evolutionary purpose of judging levels of attractiveness or intimidation allowed our ancestors better chances of survival in an uncompromising environment. Humans became adept at ascertaining who among them had ‘resource holding potential’ (RHP), the ability to win an all-out fight if one were to take place.

In the modern world, a person with ‘resource holding potential’ may look very different; someone who has more social capital or perhaps a good job. “Leaning in” to our instincts of comparison can lead to negative consequences for our wellbeing.  As social animals, the human instinct of comparison serves an important purpose as we develop social cues through mimicry as children. When we grow older, and continue to develop our awareness and assimilate with our surroundings, it is all too easy to become anxious about our jobs, relationships and lifestyles. 

Our environment today gives us a unique challenge. As recently as five generations ago, the average person lived in a society which provided, at most, a few hundred face-to-face interactions with different people each year. Whilst books and newspapers may have enabled some to imagine a life completely different from their own, this would have been with some significant mental effort. 

Our digital age has given us more opportunities for comparison than was ever previously thought possible. Research conducted on this subject (Nesi, 2015) found strong links between social media use and increased reassurance seeking, social comparison and feedback seeking behaviours. This is particularly heightened among young people who grow up online whilst navigating their path through education, socialisation and self-identification.

What we can do to help ourselves
​
In an environment where interaction with social media is unavoidable, our ability to protect ourselves from harmful comparison with others comes through awareness and understanding of what causes these anxieties about ourselves. Becoming aware (through self-reflection or Cognitive Behavioural Therapy) of internal sensitivities we are vulnerable to, or negative self-talk which arises when we compare ourselves to others, can be the first step to help us strengthen our resolve against the reality of the existence of those who appear infinitely ‘better’ than us. Instead, we can gain a lot more by orienting our focus towards our closest relationships. The practice of developing appreciation for what we already have, through gratitude journaling, can be very powerful. In any case, it is important to be kind to ourselves as we navigate a new and challenging environment in the online world.

Best wishes
Elsa Minns, Fernwood Clinic Team

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For lots of people, indecision is uncomfortable, as is changing your mind. Sometimes, sticking with your ‘gut instinct’, or the decision you made in the first place, is positively associated with a position of strength; whilst changing your mind may bring new feelings of anxiety.

In behavioural psychology, the phenomenon of the ‘sunk cost’ fallacy was first identified by researchers Kahneman and Tversky in 1970s. It describes the tendency for people to continue to pursue an option, once investment has been made, even if it is not beneficial to them. This phenomenon has been traced in a variety of human behaviour; from buying habits (continuing an unused gym membership), to political decisions (the fallacy is also known as the ‘Concorde’ fallacy), to relationships. 

The fallacy shows that ‘investment’ is emotionally associated with loss; the investment of time, money or resources, if proven to have ‘been for nothing’, would make the sensation of loss even greater. In reality, it is not possible to reverse decisions which have already been made in the past; investments of money, time and energy, once spent, cannot be recovered; so it may not be beneficial to hold ourselves hostage by those investments.

The ‘sunk cost’ fallacy may be particularly relevant for us as we get older. As children, we regularly have little agency over the rhythm of our daily lives; adults decide the food we eat, the clothes we wear, the school we attend, the place we call home. The process of growing up is often imagined as a process of increased personal agency. Alongside new choices however, new constraints emerge; education, opportunities, work schedule, family and financial commitments. The narratives given to us as children, by our parents and wider environment, about how the world functions, our duty to others, what a ‘good’ life looks like, often remain with us as well, which can provide an additional, internal constraint. It is all too easy to tell ourselves that choices are not available to us, and that we are obligated to continue investing in the decisions we made a long time ago, even if they no longer serve us.

Psychological therapy helps people confront their relationships with change, and with fallacies such as the sunk-cost fallacy. It can help people come to terms with losses associated with change, in sharing their concerns with a trained professional. Therapy can also help people imagine the potential future value of change, and help them make changes in a goal-oriented way.

Best wishes
Elsa Minns, Fernwood Clinic Team

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Whilst long-term physical symptoms of surviving Covid have received a lot of media and medical attention, there has been relatively little focus on the direct psychological and mental health impact (as different from the psychological effect of the quarantine itself).

Clinical research studies are still thin on the ground, however, there have now been several high-quality surveys that give a glimpse into the mental health impact of Covid.

One of the surveys conducted by the Indiana University School of Medicine received responses from over 1,500 participants. “Anxiety” was rated as the 8th most common long Covid symptom out of a list of 98. Perhaps surprisingly, lingering anxiety was a more common symptom than “classic” covid symptoms such as persistent chest pain or cough, suggesting that mental health impact should not be under-estimated.

Other psychological symptoms reported in this survey include difficulty concentrating, sleep problems, memory problems, sadness, confusion, feelings of irritability, and noticeable personality changes.

These symptoms can affect people for the first time, so are not only linked to pre-existing concerns.

According to some psychiatrists, around 30% to 50% of people with Covid illness experience psychological impact ranging from diagnosable common mental health conditions, such as depression and anxiety, to more general symptoms such as not feeling your best or able to carry out work, academic or home responsibilities as before.

Another common symptom described by survivors is “brain fog” -- a perceived decline in overall cognitive function, such as the ability to focus, attention span, memory, and speed of learning new information. Brain fog is not unique to Covid, it also affects patients with other viruses, illnesses, and those who experienced prolonged hospital stays. The difference with Covid is that some patients report these symptoms even after a mild episode of virus and no hospital stay, leading some specialists to suggest that the virus itself could be damaging neurons. 

Because the impact of Covid on mental health is still poorly understood, some of our clients report skepticism from friends, family, or even their GPs when trying to communicate their symptoms. If you feel that your psychological health has been affected by the experience of Covid, it can be really helpful to keep a diary of your mood, feelings, and anything that is different from normal, over a course of a couple of weeks. These records are very valuable if you are trying to explain to your GP or another professional what has been going on and will help to support your narrative.

Psychological recovery after Covid is greatly assisted by lifestyle improvements, such as a gradual increase in physical activity, maintaining a healthy diet, being connected with friends and family, taking time to read books, and engaging your brain with learning new skills. At Fernwood we are here to provide tailored mental health support for symptoms such as anxiety, low mood, stress and overwhelm, helping you to process the effects of the illness and move forward. 

Best wishes
Fernwood Clinic Team

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Learned helplessness can at first seem like a loaded term. In reality, it describes an experience common among many people, who feel a loss of agency in response to adversities in life.
 
The term emerged following psychological research undertaken by M. Seligman in the 1960s. Learned helplessness is a situation that occurs after a person has repeatedly experienced something which causes them stress and disappointment. With repetition, someone may begin to feel that they are ‘unable to control’ or change the situation. With this in mind, they may no longer feel able to make attempts to adjust their circumstances, despite possible opportunities for change. 
 
It is a part of negative conditioned learning which happens subconsciously. The impacts of this learning can exacerbate existing senses of loss of agency, which is commonly associated with depression. Thoughts may include sensations such as ‘this is going to last forever’, or ‘this situation is endemic and internal to me’. Thoughts of this nature often hold immense power, as they can feel as though they are the real, rational response to the course of events.
 
For many people, the real-life application of learned helplessness occurs in workplace, family, and relationship contexts. Following the belief that agency is lost, many begin to think, feel, and act as if that agency is completely lost, even though this is not necessarily the case.
 
Cognitive Behavioural Therapy (CBT) is an evidence-based, talking therapy technique that helps people cope with difficult thoughts (including learned helplessness) by breaking them down into smaller parts and helping to break or weaken cycles of thought, or ‘un-learn’ ways of thinking in a gradual way, to support a more hopeful, holistic approach.
 
At Fernwood Clinic, all of our practitioners are chartered psychologists fully trained in CBT. For further resources: NHS on Cognitive Behavioural Therapy - here, or for more on the academic basis of this subject, see Science Direct, here.

Best wishes
​Elsa Minns, Fernwood Clinic Team

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This week we wanted to explore the link between vitamin D deficiency and mental health (depression in particular). According to national UK surveys, approximately 1 in 5 people are vitamin D deficient; this is particularly acute in winter when there is little sunshine. There is already a proven case for taking vitamin D to support musculoskeletal health, but how does vitamin D affect mood and mental health?

Vitamin D is a unique neurosteroid hormone and there is solid research evidence that links vitamin D to many brain development and functional processes, for example, neuroimmunomodulation (the connection between the nervous system and the immune function) and neuroplasticity (the ability of the brain to form new synaptic connections, for example when learning new information). 

What is more, vitamin D receptors have been found in areas of the brain associated with depression; vitamin D is also linked to serotonin production. 

Therefore, it is biologically plausible that a lack of vitamin D can contribute to depression. 

In 2018 the British Journal of Psychiatry published a meta-analysis examining 14 different studies that look at the evidence about the relationship between vitamin D deficiency and depression. The analysis showed that lower vitamin D levels were found in people with depression compared to the control group. There was also an increased odds ratio of depression for the lowest v. highest vitamin D groups. 

The analysis is consistent with the theory that low vitamin D concentration is associated with depression, however, association does not equal causation. At present, more studies are needed to explore whether vitamin D deficiency directly contributes to depression. 

Until results from further studies are available, there seems little harm in recommending that all of us follow the NHS advice to take 10 micrograms of vitamin D per day. Vitamin D is proven to be beneficial for physical health and is likely to be beneficial for mental health also.

Best wishes
Fernwood Clinic Team

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How is mental health affected in winter?

The majority of people report that their mood and energy levels are affected by the change of season. There are many ways in which our emotional health can be impacted during the colder months. Some of the main reasons winter influences us include:

Lack of daylight and sunshine
The exact mechanism by which reduced daylight affects our mood is not fully understood, however, the main theory proposes that it leads to changes in the production of two key hormones: melatonin and serotonin. Melatonin levels are increased and this leads to feelings of sleepiness. Serotonin levels are reduced and this can lead to feelings of depression.

Staying inside more
Cold weather encourages us to stay indoors, which can mean less social interaction and other enjoyable activities, which in turn may contribute to a low mood.

Disruption of the body clock
Circadian rhythm is an internal body process that regulates the sleep-wake cycle. When daylight is reduced, we naturally want to sleep more, however, modern lifestyles do not accommodate for this, for example, we are still expected to get up early to go to work and school, and this can lead to a dissonance between the body clock and the daily schedule.

What can we do to feel happier? 

Accept the biology
The first step is to acknowledge that it is completely normal to feel a bit sluggish in winter. Practicing self-compassion, kindness, and understanding during these months can go a long way towards feeling better.

Seek out natural light
Take any opportunity to be exposed to natural light. In London in November, the best hours to be out are between 8 am-3 pm, so even if you manage a quick half-hour walk during lunchtime, it will make a difference to how you feel. 

Reduce stressful events
If it is possible, consider postponing potentially stressful events, such as a house move or a job change to other months. Of course, this might not be realistic and is dependent on other life factors.

Ramp up self-care
Exercising (preferably outdoors), staying connected with friends and family, and having a healthy diet including 5-a-day are all proven to lift the mood and improve energy levels. 

Consider the useful side effects of a bad mood
There is research to show that there is an indirect link between bad weather and improved memory. One study demonstrated when the weather is bad, which makes people grumpy, they tend to correctly remember and recall previously seen items in a shop, significantly outperforming people doing the same task in the sunny weather. This improved ability can be useful both at home and at work.

Know when to seek help
A small percentage of people will develop more severe forms of Seasonal Affective Disorder (SAD). The symptoms of SAD include persistent low mood, loss of pleasure in everyday activities, irritability, and feelings of despair. If you feel that SAD is having a significant impact on your everyday life, you may consider further treatment options, which include counselling, Cognitive Behavioural Therapy (CBT), and antidepressants. 

Best wishes
Fernwood Clinic Team

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Many people feel anxiety in their lives; when they are called upon to speak at a meeting, when they are about to meet new people; or when they are about to be tested or exposed to potential judgement. A degree of anxiety in situations such as these is a part of the normal range of emotions which make up our internal lives. 

Some people suffer from a level of anxiety all the time, which can be described as ‘background anxiety’. This is a sensation of a low-level anxiety that is always present, even if nothing appears to be going wrong, and which may have the tendency to build up slowly over time. 

What does background anxiety feel like?

As with any form of worry, background anxiety can take on physical symptoms. Background anxiety can feel like a simmering sensation, a sense of being ‘on edge’, an anticipatory feeling. In your body you may feel your heartbeat flutter occasionally, or feel a funny sensation in your stomach, or find that parts of your body are shaking a little or feel tense.

Background anxiety can be characterised as markedly different from panic attacks. Where panic attacks are immediately apparent to the sufferer, background anxiety is more subtle, and can develop slowly over time. Where panic attacks are a very high level of anxiety, with dramatic physical effects, background anxiety presents as a steady feeling of unease, worry or fear.

It can be unsettling to feel a level of anxiety and to perhaps not have a clear-cut ‘reason’ for the feeling. The true causes of background anxiety can be linked to other aspects of your life. Many people with background anxiety find that they are able to function at school, home and work, even though they are feeling uncomfortable. The feelings of background anxiety may also have impacts on being able to fall asleep. 

What can help if I am experiencing background anxiety?

Talking therapy can help to alleviate some of the symptoms associated with background anxiety, as the condition may be linked to unarticulated worries, memories or feelings. Discussing emotions can create ‘room’ for worries and fears to be expressed, and Cognitive Behavioural Therapy can help to guide your thoughts towards more constructive places. Other techniques such as regular, habitual mindfulness, anxiety checklists can also be helpful.

Best wishes
Elsa Minns, Fernwood Clinic Team

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Why are we interested in coping with uncertainty? There is a lot of psychological research to suggest that poor ability to deal with uncertainty is associated with anxiety, low mood and other emotional health difficulties. So improving our skills in this area can have a very positive impact on our well-being.

So how can we become more tolerant of uncertainty?

Imagine the opposite.
Let’s do a little fantasy exercise. Imagine that you have complete certainty regarding what will happen every single day for the next, say, 40 years. You now know exactly what will happen each hour of each day of your life. You cannot change it. You are a passenger in your own life. Will this be fun? The uncertainty is eliminated, but so is the joy, the human agency, all the unexpected highs and lows, the decision making, the surprises, the feeling that you are in control of your destiny, that you can change things if you choose to. So perhaps 100% certainty is not a good thing.

Now imagine the 0% certainty scenario. You don’t know anything about your future, including where you will sleep, where your next meal is coming from and who you will be with. That’s pretty stressful. So maybe 0% certainty is not a good thing either.

So, as ever,  it looks like we are looking for balance somewhere in the middle. We want to have some comfort around the basic structures of future life, but with enough flexibility and space for decisions, individual judgement and creativity. 

Put your driver’s hat on.
Imagine you are driving a car. You have some idea of where you are going and the route to take. But you don’t know the details. You don’t know what the traffic is going to be like. You don’t know if a particular road is going to be closed and you will need to go a different way. You don’t know if a fox is going to run out on the road and you will need to slow down. But you deal with these events as they come. You react to each of those situations using your judgement as they occur. You don’t know in advance what will happen or how you will deal with it, but you trust yourself to do it in the moment.

Thinking ahead and preparing ourselves for events that cause us worry, such as a work presentation or a social occasion, is completely normal. But we can also remind ourselves that our brain is an amazing tool which has evolved over millions of years to react quickly and appropriately, without any preparation, to what is going on right here, in the present. Don’t underestimate your cognitive capacity. 

Try a behavioural experiment.
Are there any situations where you are uncertain about the outcome that you tend to avoid, for example, social engagements, or going to new places? You can start small and gradually expose yourself to more settings with an element of uncertainty. The important thing is to treat this as a scientific experiment--you cannot go wrong whatever the outcome. Afterwards you can reflect on how you felt, what you did and what happened. Did things turn out ok? If things didn’t turn out ok, were you still able to cope with the negative outcome? 

Gradually embracing uncertainty through this process of exposure and habituation will allow you to build higher tolerance levels for it, increase confidence, reduce negative beliefs and shape a life you want.

Develop a healthy “anchor” structure.
It is helpful to have a broad structure around your day / week to provide a foundation to feel more in control. This can include appropriate self-care, such as eating well, exercising and getting enough sleep, maintaining social relationships, doing meaningful work and helping others.

If you feel that you have the core elements in place, it can be easier to tolerate events with an uncertain outcome. 

How can psychology help?
We work with clients to develop a tailored programme of exposure and CBT exercises, taking into account each client’s unique needs. Your psychologist will provide a safe space to explore worry and anxiety surrounding uncertainty and help you reflect on thoughts and behaviours which are not serving you well. We will monitor progress towards your goals, adjusting therapy if needed.

Best wishes
Fernwood Clinic Team

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A panic attack is a difficult and stressful experience, for both the person experiencing the episode, and for any friends or family. 

Nature of panic attacks.
Panic attacks are characterised by an extreme fear response even if there is no direct threat presented.  Attacks can vary significantly from person to person; as far as possible, talk to your loved one about how best you can support them according to their specific situation.

For someone experiencing a panic attack, sensations may include a feeling of dread, choking, a fast heartbeat, shaking, dizziness, and hyperventilation. The feeling can be overwhelming and feel as if it is dangerous to the person experiencing the attack, but it is important to try to remember that the panic attack itself isn’t dangerous. 

Pay attention to the sensation the person is feeling, and try to be empathetic; though this may be something which occurs frequently, each panic attack can feel as distressing as the one before. Try to not discount what they are feeling, avoid phrases such as ‘At least’.

Panic attacks are typically 5-10 minutes long, but for the person experiencing it they may not have a secure concept of time. 

How to behave.
As far as possible, speak in a slow, relaxed tone. This will help provide a background sensation of calm. If possible, model deep breathing and encourage the person to do the same if this is something which has been helpful for them in the past.

The way the person is behaving may be stressful to you, but try to remember that the panic attack itself isn’t dangerous. 

Depending on the person’s preferences, they may prefer to move to a quiet place where there is less background noise, or visual stimulation. As symptoms may involve nausea and dizziness, they may wish to stay still in one place, sitting on the floor or on a chair.

What to say.
You may want to ask ‘How can I help?’ but remember that the person experiencing the attack might find it hard to communicate. 

Instead, you can try providing reassuring support; ‘I’m here, I’m not going anywhere. I’ll stay with you until this is over.’ The person experiencing the attack may not be able to listen to what you are saying properly. 

Reassure them that the panic attack is not dangerous in itself - it can be hard for someone experiencing the episode to ‘rationalise’ that they are not in a dangerous situation.

Once it is over.
The person you are with may feel exhausted and wish to take a break, alone or with you. Check in with them and be mindful of their own preferences.

Sometimes people who have experienced a panic attack may feel ashamed of how their symptoms have presented themselves, due to internalised stigma (particularly if the episode occurred in a public place). Reassure them that the attack isn’t something they were able to control and mention they were brave to be able to handle it the way they did.

If you are regularly around the person, consider asking them how they can help in future, as individuals can have differing experiences of panic attacks.

How therapy can help someone experiencing panic attacks.
Therapy can help make gradual progress to understand triggers, thoughts and emotions surrounding panic disorder. The therapist can help understand the roots of issues, which for some people can be related to traumatic events. The therapist is there for support at a regular time each week, and draws on clinical experience to help provide a professional perspective.

The impact therapy can have is long-lasting and can help develop the tools necessary to manage the condition independently in day-to-day contexts and build resilience.

Best wishes
Elsa Minns, Fernwood Clinic Team

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​Sometimes when we feel anxious, it is because at some level, the perceived threat that we feel is greater than our perceived ability to cope with that threat.
 
In other words, we tend to over-estimate the danger and under-estimate our ability to successfully deal with it.
 
So the cycle of anxiety can go something like this:
 
Step 1: We imagine future scenarios which are scary, such as redundancy, health problems, unpleasant social situation etc.
 
Step 2: We (often unintentionally) underestimate the coping resources we already have in place, for example, supportive family and friends, cognitive skills, our ability to take positive action, experience in dealing with similar situations in the past, innate resilience etc
 
Step 3: We engage in safety-seeking behaviours, including avoiding and escaping any situation which may be perceived as dangerous. This helps in the short term, but does not help us break the cycle, because we believe that this behaviour was what prevented the feared event from occurring.
 
To help stop maintaining the anxiety cycle we can do two things:
 
1.    Spend some time realistically assessing the events we feel anxious about. What is the worst case scenario? Do you have any evidence that it is likely to happen? What is most likely to happen?
 
2.    List all the resources you have available to support your emotional health. Do you have strong, positive relationships with friends and family? Can you think of at least 3 examples of how you coped with hardship in the past (not necessarily the exact situation that causes you anxiety--we are looking for proof of overall resilience). Can you remember an example of a difficult situation where you didn’t think you could work through it, but you did? What specific action can you take if the worst case scenario happens? Can you visualise yourself successfully coping with the situation you feel anxious about?

The above suggestions are not about blind optimism or positive thinking, but helping us recognise the full extent of the resources we already have in place, whilst being realistic about the level of threat we face. 

If Fernwood Clinic can help you with anxiety management, please feel free to call us on 020 8673 8604.

Best wishes
Fernwood Clinic Team

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We frequently get enquiries from people who would like suggestions on how best to support their friends and relatives with low mood:

Reach out. It may be difficult for them to find energy and motivation to connect, so you can encourage engagement by sending a message, calling or visiting to see how they are doing. 

Listen. The single most supportive thing you can do is listen. Do so without judgement and without giving advice (unless specifically trained). Feeling like you are being properly heard and understood is incredibly therapeutic. It is important to acknowledge that most of us are not naturally good listeners. There are some easy ways to improve active listening skills:

-Focus on the other person, slow down and don’t worry about planning a response;
-Ask specific follow up questions about what they are telling you, this will encourage them to elaborate;
-Pay attention to non-verbal communication, such as gestures, facial expressions and tone of voice.
 
Encourage helpful activity. You can gently encourage actions that are known to underpin good mental health, such as exercise, getting enough sleep, eating well and doing things they enjoy. Physical exercise is particularly powerful at making us feel better about ourselves, less tired and able to think more clearly. There is also interesting research to show that lots of little, positive events make us happier in the long term than rare, big events, so inviting your friend for a coffee or a walk on a regular basis is likely to improve their well-being.

Organise external support. If necessary, you can research local resources and facilities, find out about appointment availability, help locate medical insurance documents and sort out practical details like parking or transport access.

Look after yourself. Try not to take on a bigger role than you can manage alongside other life commitments. Acknowledge that you may not be able to do as much as you would ideally like in the situation but that your effort is valued and appreciated.

Best wishes
Fernwood Clinic Team

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This week, let’s remind ourselves of the 5 empirically supported aspects of managing our wellbeing. You could select 2 or 3 specific things that resonate with you to work on this week.

Best wishes
Fernwood Clinic Team

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We are now in week 7 of the lockdown and you may find yourself settled into a new routine. Hopefully you have found ways to get some exercise, structure your work and reach out socially. However, you may notice that despite your best efforts, anxiety still creeps in and we wanted to share 4 evidence-based exercises to help manage it:

Acceptance exercise

Take a deep breath and give up the fight. Just give it up. Embrace your anxiety and all the other feelings that float up--boredom, frustration, fear, restlessness. Do not waste your inner energy resisting emotions which are natural, understandable and appropriate for the current situation. “Giving up” resistance is different to “giving in” though. You are still able to take thoughtful action which is in line with your goals and values.  

Breathing exercise

This is an absolutely great exercise to do any time you feel overwhelmed (Hillary Clinton in her book confessed to using this exercise to cope with the loss of the presidential election). It is called Alternate Nostril Breathing:

--Sit in a comfortable position

--Exhale completely and use the right thumb to close your right nostril

--Inhale through the left nostril

--Use the ring finger of the right hand to close the left nostril

--Exhale through the right nostril

--Inhale through the right nostril

--Close the right nostril with your right thumb

--Exhale through the left nostril

--Repeat this cycle for about 5 minutes

Anchoring exercise

This exercise involves tapping into your past positive experiences to support you now. Remember a time when you felt happy and well. Close your eyes and recall as many details as you can: where were you? Who with? What did you see? What did you hear? What did you wear? What did you do? You may find it helpful to use old photos / videos for this. This exercise can be done with any past event that brought you joy, e.g. successful graduation, relaxing holiday, time you felt cared for and supported etc. Concentrate on the good feelings as if you are feeling them now.

Journaling exercise

Transferring your thoughts and feelings onto paper has long been a helpful way to relieve anxiety and stress. You can either try unstructured writing (e.g. write for 5 minutes at the end of each day about things that worry you) or create a little daily plan, e.g.

--write down 3 things that worry you
--write down 1 practical way you can address each worry and test it over a course of 3 days
--write down what worked and what didn’t during those 3 days

We hope you are staying well and healthy. 

Best wishes
Fernwood Clinic Team

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Now that the lockdown period has been extended for at least 3 weeks, it may be a good time to reflect on how things are going for you.

So let’s check in:

• How is your structure and routine? What is working well for you? What do you want to change?
• Are you keeping physically active?
• How is your sleep? Have you got a regular wake up time?
• Is work and household tasks (and childcare) balanced with some rest and relaxation? And some fun too?
• Are you being kind to yourself? And being realistic in your expectations of yourself?
• Are you being kind to others?
• Are you finding ways to connect socially with others?

Here is a handful of selected resources for this week to keep you and your family grounded:

Mindfulness podcasts from Oxford Mindfulness Centre:

https://www.oxfordmindfulness.org/learn-mindfulness/online-sessions-podcasts/

“Hope cloud” exercise to try with your children (if you have them):

https://youngminds.org.uk/media/2900/hope-clouds-activity.pdf

How kindness during chaos keeps us in control

https://lighthouse.mq.edu.au/article/april-2020/kindness-during-chaos-keeps-us-in-control

Best wishes
Fernwood Clinic Team

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​We hope that you had a restful Easter weekend. This week we would like to focus on positivity, gratitude and hope. First, we want to acknowledge that the current situation is a disaster, so it is ok and normal to be in a survival mode. And this week’s tips are about finding small glimmers of light and hope within this. 

How can we find opportunities within the current restrictions, even if small? What have we now got a chance to do, even if small? Or not do? How can we make the most of where we are at now?

If you need some ideas, here are a few suggestions:

Family time
Now is a good opportunity to get to know our loved ones better and spend quality time with them. For many of us with busy work schedules, prioritising family can often feel like a challenge, so now we have a chance to bond over simple activities, like cooking, board games, reading and walks.

Learning
Maybe there is a skill you felt like learning for a long time, but never had a chance to do. There are a lot of online courses on practically any subject. You can start simple and small and use the basic principles of goal setting: 
https://images.app.goo.gl/qxVLTAPVEZpW22wp9

Declutter
Re-organising your sock draw at this time is a bit of a cliche, however, our environment undoubtedly affects our mood. Reducing clutter, whether physical or digital, and reorganising allows us to feel in control of our immediate surroundings, as well as removes unnecessary stressors as we go about our daily lives.

Reassess priorities
You may find this pause a useful starting point to ask if you are spending your time and energy on things which are important to you and align with your longer term goals and core values. Can you think of an action you can take right now to bring these towards alignment?

Cultivate gratitude
The practice of gratitude is well studied to have a long-term positive impact on our emotional well-being. Gratitude journaling is a popular activity, where you can write down 3-5 things you feel grateful for in the past period of time (e.g. 1 day or 1 week). Gratitude jar is another simple and effective exercise--all you need is a jar, decorated how you want it. You can then put in a paper slip with at least 1 thing per day you are grateful for. When you feel low, you can go back to your journal or a jar for a pick-me-up.

Best wishes
Fernwood Clinic Team

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​We hope you are having a good week and are able to find some enjoyment and pleasure in the small things.

As the third week of lockdown continues, it may be a good time to think about how you are responding to the current unprecedented stresses we face. Herewith a diagram that might help you to think about this. It is very natural to be responding from the fear zone, at least some of the time if not most/all of the time. We are facing an enormous, invisible threat, and significant upheaval. The fear zone is a normal and adaptive place to be for survival. None of us have been here before and we are all afraid.

There is a great collection of mental health resources on: 

http://copingwithcoronavirus.co.uk/self-help-guides.html 

Several of these may be helpful to you or others, especially if you find you are responding from the fear zone more often than you would like to.

Best wishes
Fernwood Clinic Team

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At this challenging time, we wanted to put together some suggestions which will support your mental health over the next weeks and months. We all have unique circumstances, however, we have found that below behaviour changes can help alleviate anxiety, improve low mood and boost our resilience:

1. Reduce news consumption. We are now in the 24 hour coronavirus news cycle. This is a topic that everyone knows and worries about, therefore news outlets are incentivised to produce as much as possible. We are already overwhelmed with case statistics, death statistics, global updates, political updates, human interest stories, speculations regarding vaccines and much more. This is likely to continue and no person can feel on top of it all. It therefore makes sense to limit consumption of news in all their forms, including TV, radio, online news and social media news feeds. If you are worried about missing important government updates, you can sign up to official email alerts here https://www.gov.uk/coronavirus

2. Create structure in your day. We have all experienced significant changes to our daily routine. Spending some time to purposefully create a new timetable can give us a sense of control over our lives and also reduce the cognitive resources required to plan each day from scratch. To create a structure, firstly make a list of everything you have to do now (recognising that some tasks may be new). This may include working from home, procuring food and household items, home schooling your children, exercise, virtual catch ups with friends and family, preparing meals etc. Next, prioritise complex tasks, such as work projects, to be done early in the day when your energy is high; this will also create a sense of achievement for the rest of the day. 

3. Stay connected. Quality social connections create a foundation for a healthy emotional life. However, the nuance of living under coronavirus rules means that instead of a social mix of family, friends, colleagues and acquaintances, we have ended up with two very distinct groups: (1) people we live with (perhaps family, love ones or housemates) and (2) everyone else, who we cannot see. The balance here is to recognise that group 1 we see a lot more than usual so it is important to cultivate patience and give each other personal space. With group 2 on the other hand, we need to make more effort to keep in touch through means we have available.

4. Take any opportunity for physical exercise. Exercise has been scientifically proven to have a hugely beneficial impact on mental health, including improved brain function, improved sleep, reduction in stress, depression and anxiety. Now is more important than ever to try to fit in regular, particularly aerobic, activity. As of today, we can still go outside once a day, so if you can, go for a brisk walk, run, interval run (NHS has an excellent Couch to 5k app) or a ball game with people you share your home with. You can also do exercise videos at home, work in the garden if you have one or play active games, such as hide and seek, with children.

5. Adjust your expectations and be kind to yourself. We are all struggling with the pace of change at the moment. You may have had plans for this year which had to be put on hold. You may have had goals in different areas of life which are now more difficult to work towards. Give yourself permission to not be ok. Take things one day at a time. We have not chosen the external events which are taking place right now, but this period need not be all bad if we can be open to adaptation.

Best wishes
Fernwood Clinic Team

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We wanted to share with you a metaphor which is sometimes used in the beginning of therapy, particularly in third wave CBT, to set the context and the direction of work. It is adapted from the original by David Gillanders.

“Imagine that life were like sailing a small sailing boat. During your life, you have picked up the skills necessary to sail your boat and you have a sense of where you are taking this boat. At some point in your learning to sail, you have learned that from time to time, waves may wash over the bow and you will find yourself with wet feet. The usual response that people have learned is as follows: when you’ve water around your feet, use this bailer to bail out the water.

So you’ve learned about the bailer, but when its not been needed it has been put away in a locker, ready to be used if needed. And at some point along your journey you have had waves come over your boat and there is now water in the bottom of your boat. So you have started to do the thing that is sensible and logic to do: get rid of the water. You have been using that bailer a lot, sometimes bailing quickly, sometimes bailing carefully, sometimes baling wildly, sometimes baling desperately and: in your experience, have you managed to get rid of the water yet? And all this time that you have been bailing, what has been happening to the direction and progress your boat has been making? Is it fair to say that you have been bailing more than you have been sailing this boat?

Now; what if you were to one day really look at the bailer and to see that it was full of holes? What if it was a sieve? What would you have to do first?

(Most people will recognize that a sieve is not a good bailer and so will suggest using a different tool; a bucket or their hands)

Well; it may be that part of the work that we do together may be about investigating which tools are really useful to you, and some of those may well be more effective tools for bailing.

Even more that that, the implicit promise of bailing is this: once you get rid of the water – then we’ll get this boat back on track and start sailing it where you want it to go. What if our work could really be about that? About working together to let go of needing to get rid of the water, to begin to look up from the bailing and looking out in front of the boat and actually choosing a direction that you want to take this boat. What if our work could be about helping you to put a hand on the tiller and to choose to pull in the sails and getting the boat moving in whatever direction you choose? This could be very slowly at first, there is no speedometer in this work. Once we get the boat moving, then we might be able to investigate some other ways of bailing; if they prove to be useful strategies in helping you to take this boat where you want it to go.

The question to ask yourself might be something like this; if you could have this boat with only a little water in the bottom, but the boat is drifting, you are not choosing the direction you sail or the boat has water in the bottom, maybe sometimes so much water that you wonder how it is still afloat, but you are taking this boat, however slowly, in the direction that you would most want to take it….which would you choose?”

Best wishes
​Fernwood Clinic Team

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We were recently supporting a young client whose parents were in the process of going through a complex divorce. Initially, one of the parents brought the child to therapy and upon finding out about it, the other parent has written to us asking if the exact facts of the court case have been made available to the psychologist, so that she can accurately establish what events took place. 

Of course, we would never request any such documents, and in fact it does not actually matter to us what “really” happened, only the impact that it had on our client, how they feel about it and how they can move forward. 

It raises an interesting question of whether reality actually matters and what is reality anyway. We know that every person experiences events subjectively, perceiving them through a compex prism, impacted by their own background, values and a way of being in the world. Often we can live through the most harrowing ordeal and cope very well with it. And then someone’s throwaway comment in an office impacts us so much that we can’t stop thinking about it for weeks. 

Frequently we use the seemingly “objective” description of events to allow ourselves to feel a certain way about them. For example, a death of a loved one--naturally we expect to be in pieces. Stood up on a date--not so much. But there is no rule book about what should and should not touch us emotionally. Our feelings, emotions and reactions communicate valuable information to us about what matters, particularly if we can find some space to be mindful of them. 

Sometimes when clients come to us for the first time, they say things like “therapy is so indulgent”, “lots of people have it much worse” or “another person needs this slot more than me”. The question we ask is “are you suffering?” If the answer is yes, you have the right to have help.

Accepting our emotions without judging them, changing them or linking them to particular past “facts” is one of the themes of Acceptance and Commitment Therapy (ACT), which is sometimes called third-wave CBT, as it developed from the same theoretical orientation. There is a growing body of evidence for the effectiveness of ACT, particularly in improving psychological well-being, reducing stress and anxiety. 

We have found that ACT works really well for a lot of our clients, especially where other more traditional approaches have not been effective. One of our clients found it so useful that she has created a prototype app project to make the skills accessible to the wider audience.

You don’t need permission from anything or anyone to feel how you feel. Your truth is “the” truth. Nevertheless, acknowledging and respecting our own feelings, whatever these may be, does not need to paralyze us or stop us from taking committed action towards value-based life goals.

Best wishes
​Fernwood Clinic Team

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There has been a lot of debate recently, following the publication of Johann Hari’s new book, about what role medication plays in helping people recover from depression.

Few people would argue that a long-term dependency on antidepressants is a good thing. Numerous studies have shown that withdrawal symptoms can be very severe and become a major mental health risk factor in themselves. Our clients at Fernwood report that whilst antidepressants can provide a safety net during a particularly severe episode, in general they tend to numb us to the experiences of everyday life--both positive and negative.

So, if we accept that generally it would be preferable not to rely on antidepressants for too long, the next decision is when to take them and for what period.

To provide some context, it is important to understand how antidepressants are prescribed in the UK. Generally, antidepressants are prescribed by GPs, and in the minority of cases--by psychiatrists. In 2016, there was a record number of antidepressants prescribed through the NHS. From our experience of interacting with GPs from our local area, we have observed the following. GPs only have 10 minutes to see each patient. In that time they need to assess their concerns, develop an appropriate treatment plan, prescribe medication or provide a referral etc. It is a very limited time frame to properly assess risk level for someone presenting with low mood and, considering a long waiting list for NHS talking therapy, antidepressants are frequently the only practically available option. 

With this in mind, it would probably not be an overstatement to say that the majority of people who ask their GPs for antidepressants will get them, which makes it even more important that we try to make an informed choice.

Are antidepressants clinically effective? This is a very big question. It is probably best addressed in the context of “compared to what”. Compared to doing nothing? Yes. Compared to placebo? Yes (at least for short term acute depression in adults). Compared to talking therapy? And this is where it gets interesting. Most studies find no statistically significant difference in recovery for antidepressants versus talking therapy. However, these studies tend to measure recovery straight after treatment, rather than look at the longer-term outcomes, i.e. whether progress has actually been maintained. 

The NICE (National Institute of Clinical Excellence) recommendation is that both medication and talking therapy should be made available to clients with low mood and anxiety, and it is a personal choice which one you would prefer. However, the two approaches are very different. The way we address the problem is indicative of the way we view the problem. So if we take medication, naturally this means that we think the issue is the chemical imbalance in the brain. If we choose to talk, we acknowledge that our life’s context must be taken into account.

In our experience, our clients’ concerns tend to stem from external circumstances (whether past or present), combined with a way that they react and deal with those circumstances--the two often reinforcing each other through time. Each person has a unique and valuable story, which must be respected and untangled with great care to discover a way forward.

We hope our clients and readers feel empowered to make a mindful and informed choice when it comes to medication, therapy or both. 

Best wishes
Fernwood Clinic Team

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So here we are at the end of August. You may have recently come back from Greece / Florida / Glamping / Cornish Coast and now it is time to go back to work and get the kids ready for school. Lots of us believe that we often feel low at this time because of this transition back into the “real world”. However, it is worth reflecting of what happens during the holidays themselves.

During the summer we often have a lot more of “unstructured” time—longer evenings, time away, long weekends and school holidays. Most of us are creatures of habit and crave routine, so as soon as we have all this time on our hands, things can start to become a bit more volatile. With fewer commitments to occupy ourselves with, we may start reflecting on things we are unhappy with in our lives, or ruminate on any underlying worries.

​Also, the holidays themselves require a lot of organisation and we often have high expectations of the experience we want to achieve. We hope for picture-perfect days and moments and if those do not materialize, it could leave us feeling disappointed.

It is well known that relationships can become strained during the time away—being constantly together with your partners, family or parents in an unfamiliar environment can lead to tension or disagreements, which is completely normal.

So what can we do now? The first step could be to do a bit of mindfulness practice. Imagine that today you are separated from the past and future by giant heavy metal doors, like a compartmentalized ship in a storm. Focus on the everyday tasks at hand, no matter how mundane. Allocate some time in the day to do a few minutes of breathing and relaxation, acknowledging any thoughts and feelings as they appear.

Secondly, you can reconnect with friends, family and colleagues, share memories and plan things to look forward to throughout the year. 

Lastly, try transferring some of the behaviour during the holiday into the everyday life. For example, if you crammed it full of sightseeing, why not try to do more cultural activities at home on the weekend. You may have discovered some new activities you enjoy and can now use the post-holiday energy to incorporate them into your life. 

Oh and almost forgot, you can also book the next holiday:)

Best wishes
Fernwood Clinic Team

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I was talking to a friend today. She told me that she went through her whole day without speaking to anyone. She called her bank, gone through a recorded line to get her account balance. She ordered her groceries on the internet. She did some freelance work online and via email. She chatted to a friend on whatsapp.
 
Without wanting to sound excessively nostalgic, I couldn’t help but compare it to the world just 30 or 40 years ago.  Throughout the day we would have had little interactions with, perhaps, a postman, local shop assistant, neighbours and colleagues. Our phone calls and post would have been answered by real people. Even the most antisocial of us would have been known by the local community.

The world has certainly moved on and technological advances have made practical things a lot easier for us and also allowed many people to work flexibly from anywhere. And yet our emotional health needs have not really changed that much. There is a lot of academic evidence that social support structures like family, friends and community are a key to maintaining our mental health. Human beings are fundamentally social animals—from the moment we are born we seek connections with others to survive and thrive in the world.
 
This is why at Fernwood we aim to provide a service which recognises every one of our clients as individuals. We answer most of our emails within an hour. You can call us for a chat. You are welcome to drop by and talk to us. When you tell us something, we will try our best to remember it—whether it is the type of tea you drink, when you go on holiday next time or your preference for a particular type of theoretical orientation. And of course our therapists consider the bond they develop with you absolutely critical to the success of the work you do together.
 
If you think our team at Fernwood can help you with emotional concerns or difficult life events, please feel free to reach out to us.
 
Best wishes
Fernwood Clinic Team

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