the-psych-collective

ADHD Assessment: Is it necessary?

Fri, 10 Apr 2026 03:54:35 GMT

Ever wondered if you have ADHD? Use our 2-minute self-test to find out

Family Therapy in Wollongong

Tue, 25 Nov 2025 22:12:18 GMT

Rebuilding Connection, Safety & Understanding

With Laura Marett, Accredited Mental Health Social Worker
The Psych Collective Clinic, Wollongong

Family life can be deeply rewarding, but it can also be complex, emotional, and at times overwhelming. When communication becomes strained, tensions rise, or family members feel misunderstood, even small moments can spiral into conflict.

Family therapy offers a structured, supported, evidence-based way to reconnect. At The Psych Collective, Laura uses a Gottman-informed, attachment-based, and trauma-sensitive approach to help families understand patterns, repair relationships, and build a more connected home environment.

Please note that all family members must be over the age of 18 to participate.

What Is Family Therapy?

Family therapy looks at the entire family system, not one “problem person.” It recognises that when one family member is struggling, everyone is affected.

Sessions help your family:

understand each person’s perspectives and needs
identify unhelpful communication and interaction patterns
strengthen emotional safety
develop new ways of relating, supporting, and resolving conflict

At its core, family therapy is not about blame . It’s about curiosity, compassion, and learning to work as a team again.

Our Gottman-Informed Family Therapy Process

Just like our couples therapy process, family therapy follows a four-session assessment and mapping process , adapted to work with multiple family members.

This approach gives every person a voice while giving Laura the information she needs to understand the deeper patterns shaping the family dynamic.

Session 1: The Family Conversation (90 minutes)

In the first session, Laura meets with the family together. All family members must be over 18 years to attend.
You’ll explore:

what brings you to therapy
how each member experiences the concerns
family strengths, values, and hopes
the interaction patterns that are creating disconnection
existing attempts to solve the problem and why they may not be working

This session sets the tone for safety, curiosity, and collaboration.

Cost : $350 for 90 minutes

Sessions 2 & 3: Individual or Sub-Group Sessions

To truly understand the system, each family member (or each subgroup—e.g., parents, siblings) meets individually with Laura.

These sessions allow everyone to:

speak openly in a private space
share their personal story and perspective
explore emotional needs, triggers, and stress responses
discuss their hopes for their relationships within the family

This is where attachment needs, developmental factors, neurodivergence, trauma histories, and emotional patterns come to light. Laura uses trauma-informed, attachment-based, and systemic frameworks to help each person feel understood and supported.

Cost : $220 for 60 minutes

Session 4: The Family Feedback & Plan Session

In this final assessment session, the family comes back together.

Laura shares:

a clear explanation of what’s happening beneath the surface
interactional cycles or patterns contributing to conflict
each family member’s strengths and relationship needs
Gottman-informed strategies for communication, repair, and connection
a practical, tailored plan for moving forward

Families often find this session clarifying, relieving, and motivating—it provides a roadmap for change.

Cost : $350 for 90 minutes

What Happens Next?

Following the assessment phase, families continue working together in ongoing therapy sessions, where real, lasting change takes shape.

These sessions may focus on:

improving communication and emotional expression
repairing past hurts
navigating parenting differences
supporting neurodivergent children or adolescents
rebuilding trust
reducing conflict
strengthening connection and safety
learning new ways to handle stress as a family

The pace, frequency, and structure of ongoing sessions are always tailored to your family’s needs.

When Family Therapy Can Help

Families seek support for many reasons, including:

ongoing conflict or frequent misunderstandings
parent and adult-child disconnect
neurodivergent family needs (ADHD, autism, sensory profiles)
support for LGBTQI+ family members
supporting a child or teen with emotional or behavioural challenges
mental health concerns impacting the household
grief, loss, or trauma
challenges with boundaries, roles, or communication dynamics

Family therapy can involve the whole family or different combinations of family members, depending on what is most supportive.

Why Families Choose The Psych Collective

At The Psych Collective, families are supported with:

a non-judgmental, trauma-informed environment
evidence-based frameworks including attachment-focused and Gottman-informed methods
a clinician experienced in both individual and family systems
a warm, compassionate, collaborative approach
flexible options including telehealth

When families begin to heal and reconnect, every member benefits. Home becomes calmer. Communication improves. And relationships feel safer and stronger.

Important Information

Private health rebates may apply depending on your fund.
Medicare rebates do not apply to family or relationship therapy.
Payment is required at the time of each session.
Evening sessions may be available upon request.
May be funded via Open Arms for Veterans and Families. Call 1800 011 046 to request an appointment with Laura.

Book a Family Therapy Session

You don’t have to have all the answers before reaching out. Many families come to us simply because something doesn’t feel right and they want a safe place to start understanding each other again.

�� Wollongong in-person sessions
�� Telehealth for families across Australia
�� Contact Us to Learn More or call us on 0449949181

Understanding Accredited Mental Health Social Workers (AMHSWs)

Fri, 24 Oct 2025 00:19:38 GMT

Meet Laura Marett

Accredited Mental Health Social Worker at The Psych Collective, Wollongong

When you’re searching for compassionate, evidence-based mental health support in the Illawarra, an Accredited Mental Health Social Worker (AMHSW) is a trusted professional who can help.

At The Psych Collective Clinic in Wollongong, Laura Marett is an experienced Accredited Mental Health Social Worker providing therapy for adults and couples. She integrates practical psychological strategies with a warm, holistic approach to emotional well-being.

What Is an Accredited Mental Health Social Worker?

An Accredited Mental Health Social Worker (AMHSW) is a qualified social worker who has undergone advanced training and accreditation through the Australian Association of Social Workers (AASW) .

This national accreditation is recognised by the Australian Government and ensures AMHSWs are skilled in the assessment, diagnosis, and treatment of mental health conditions.

AMHSWs are Medicare-registered providers under the Better Access initiative, meaning clients with a Mental Health Treatment Plan from their GP, psychiatrist, or paediatrician can access Medicare rebates for u p to 10 individual sessions and/or 10 group sessions per calendar year .

How Laura Marett Can Help

Laura provides counselling and psychotherapy to support people experiencing a range of mental health and relationship challenges, including:

Anxiety and panic
Depression and mood disorders
Trauma and post-traumatic stress
Relationship or communication difficulties
Stress, burnout, or adjustment issues
Low self-esteem or identity concerns
Grief, loss, and life transitions

Her approach blends evidence-based therapies such as Cognitive-Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), mindfulness, and schema-informed strategies.

Laura also brings a holistic, biopsychosocial perspective — recognising the connection between mind, body, relationships, and environment. She often incorporates the therapeutic benefits of nature and animal connection into her work, helping clients build resilience, reduce stress, and reconnect with what matters most.

Why Choose an AMHSW for Therapy

AMHSWs bring a whole-of-person approach to mental health care.
They don’t just focus on symptoms — they consider the broader social and environmental factors that influence wellbeing, such as family dynamics, workplace stress, or community connection.

Laura’s extensive clinical experience means she can tailor her support to meet you where you’re at, whether you’re seeking individual counselling, couples therapy, or guidance through a challenging life stage.

Serving the Illawarra Community

Based in Wollongong , Laura Marett offers both in-person and online sessions , providing accessible support to clients across the Illawarra region and beyond.

She welcomes adults and couples from diverse backgrounds and proudly affirms LGBTQIA+ clients, creating an inclusive space for healing and growth.

How to Access Rebates

If you have a Mental Health Treatment Plan from your GP, you can claim Medicare rebates for sessions with Laura Marett.
Other funding options include:

Private health insurance (Extras cover)
NDIS self-managed or plan-managed supports
Workers’ compensation or veteran schemes
Private (self-funded) sessions

Ready to Begin?

If you’re looking for a skilled, compassionate mental health professional in Wollongong, Laura Marett AMHSW at The Psych Collective can help you navigate life’s challenges with warmth, insight, and evidence-based care.

Book a session with Laura today
Contact us here or call 0449 949 181 to make an appointment.

Couples Counselling Wollongong

Sun, 28 Sep 2025 08:17:57 GMT

Strengthen Your Relationship with Evidence-Based Support in the Illawarra

When relationships feel strained, it can be difficult to know where to turn. Whether it’s recurring arguments, emotional distance, or challenges with communication, seeking professional couples counselling in Wollongong can provide the guidance you need to reconnect and rebuild.

At our practice, couples are supported by Laura Marett , an Accredited Mental Health Social Worker with specialised training in the Gottman Method , one of the most research-backed and practical approaches to improving relationships.

Why Choose Couples Counselling in Wollongong?

Healthy relationships are the foundation of wellbeing. Yet even strong partnerships face challenges, whether from stress, parenting demands, financial pressures, or unresolved conflicts. Many couples delay seeking help, but early intervention can prevent small issues from becoming major fractures.

In the Illawarra region , more couples are discovering the benefits of professional therapy to:

Break cycles of unhelpful arguments
Improve intimacy and emotional connection
Rebuild trust after difficulties or betrayal
Strengthen communication skills
Create shared goals and meaning in their partnership

By choosing local couples therapy in Wollongong , you can access support tailored to your unique situation in a safe, confidential, and professional environment.

About the Gottman Method

The Gottman Method is an internationally recognised framework developed from over 40 years of research into what makes relationships thrive—or fail. Training in Level 2 means your therapist is skilled in applying structured, evidence-based tools to help couples:

Build friendship and admiration
Manage conflict constructively
Develop problem-solving strategies that last
Increase intimacy and shared meaning

This method doesn’t just provide short-term solutions. It equips couples with practical skills to create lasting change and resilience.

Why Work with an Accredited Mental Health Social Worker?

An Accredited Mental Health Social Worker (AMHSW) brings a holistic, client-centred perspective to therapy. Unlike general counselling, an AMHSW has advanced expertise in both, ensuring that underlying issues such as anxiety, depression, trauma, or stress are addressed alongside relationship challenges.

This dual focus can be especially valuable when one or both partners are managing mental health concerns, as the therapist integrates individual wellbeing with couple goals.

Couples Counselling in Wollongong & Illawarra: What to Expect

When you attend relationship counselling in Wollongong , sessions are structured but flexible to your needs. Typically, you can expect:

Initial Assessment – Understanding each partner’s perspective, relationship history, and goals.
Couples Sessions – Guided conversations using Gottman tools to enhance communication, resolve conflict, and rebuild closeness.
Practical Strategies – Skills and exercises you can use at home between sessions.
Ongoing Support – A personalised plan for long-term relationship health.

Sessions are collaborative, non-judgmental, and focused on creating positive, sustainable change.

To learn more about the structure of these sessions and associated fees, click HERE .

Is Couples Therapy Right for You?

You don’t need to be in crisis to benefit from couples counselling. Many couples use therapy as a proactive way to strengthen their bond and prepare for future challenges.

If you and your partner are:

Arguing about the same issues repeatedly
Feeling disconnected or “stuck”
Unsure how to repair after trust has been broken
Wanting to improve intimacy or communication

…then relationship counselling at The Psych Collective Clinic in Wollongong could be the next step toward a healthier, more fulfilling partnership.

Local Support in Wollongong & the Illawarra

Conveniently located in Wollongong and servicing the wider Illawarra region , our couples therapy services provide accessible, professional care close to home. Whether you live in the city centre, the northern suburbs, or surrounding coastal areas, you can find expert support without needing to travel to Sydney.

Laura also offers telehealth appointments to support couples who need to stay home with the kids, manage a busy schedule or who are outside of the Illawarra region.

Take the Next Step

If you’re searching for couples counselling in the heart of Wollongong or exploring relationship therapy in the Illawarra , you’ve already taken the first step towards change.

Laura Marett , our Accredited Mental Health Social Worker, trained in Level 2 of the Gottman Method, is ready to guide you through the process of rebuilding and strengthening your relationship.

Book an appointment today and discover how therapy can help you and your partner reconnect, communicate, and grow together.

�� Contact us to make an enquiry.

When Parenting Leaves You Drained: How Couples Therapy Can Help

Thu, 11 Sep 2025 04:11:05 GMT

How to Protect Your Relationship During Parental Burnout

Parenting is rewarding, but it can also be exhausting. Parenting fatigue , sometimes called parental burnout , is a common yet often overlooked challenge. When the constant responsibilities of raising children lead to chronic stress, both mental and physical wellbeing can suffer. This stress doesn’t just affect parents individually; it often spills over into the relationship, impacting intimacy, communication, and emotional connection.

Research from Dr. John Gottman, co-founder of The Gottman Method , shows that two-thirds of couples experience a significant drop in relationship satisfaction within the first three years of becoming parents. Sleepless nights, juggling work and household responsibilities, and managing the emotional needs of children can leave parents feeling depleted. This exhaustion can inadvertently create tension between partners.

Understanding the Impact on Your Relationship

When parenting leaves you drained, small frustrations can escalate into arguments. Couples may find themselves:

Communicating less effectively
Feeling emotionally distant
Struggling to reconnect after conflict

These patterns are normal, but they don’t have to define your relationship. Understanding the impact of parenting stress on couples is the first step toward breaking the cycle.

Evidence-Based Strategies to Support Couples

The Gottman Method provides practical, research-backed tools to help couples navigate the challenges of parenting while maintaining a strong relationship. Key strategies include:

Strengthening the friendship system : Prioritising connection, appreciation, and shared laughter to keep the emotional bond alive
Emotional regulation : Learning to soothe yourself before responding during moments of tension or conflict
Turning toward each other : Responding to bids for attention or support instead of withdrawing, even when exhausted
Creating shared meaning : Building rituals, routines, and shared goals that reinforce partnership and teamwork

By practising these strategies, couples can interrupt cycles of burnout, improve communication, and feel more emotionally supported, even during the most draining periods of parenting.

Practical Tips for Parents

In addition to therapy, there are small, practical steps couples can take at home to protect their relationship:

Schedule short moments each day to check in with your partner
Share responsibilities fairly to reduce overwhelm
Recognise and appreciate each other’s contributions
Practice self-care individually to maintain energy and patience

These everyday actions, combined with evidence-based couples counselling , create a buffer against stress, helping partners stay connected and resilient through the challenges of parenting.

The Good News: Connection is Possible

Even in the midst of exhaustion, relationships can thrive. With Gottman Method couples therapy , parents learn to navigate stress without letting it erode their partnership. Therapy provides a safe space to explore challenges, develop emotional regulation skills, and rebuild intimacy.

Parenting fatigue doesn’t have to spell the end of closeness or emotional intimacy. With the right support, couples can strengthen their bond, communicate effectively, and maintain a sense of teamwork, even in the busiest seasons of family life.

If you’re searching for couples therapy, marriage counselling , or ways to navigate parenting stress together, contact Laura Marett today to take the first step toward a stronger, healthier relationship while navigating the demands of parenthood.

Call The Psych Collective Clinic in Wollongong to make an appointment.

Healing After Infidelity: How to Rebuild Trust using Couples Counselling

Thu, 11 Sep 2025 04:01:26 GMT

Recovering from Betrayal

Discovering an affair can feel like being thrown onto an emotional rollercoaster. Shock, anger, grief, and confusion often overwhelm both partners. The betrayed partner may find themselves ruminating, asking, “ How could my partner do this? ” or “ How can I ever trust them again? ” Meanwhile, the partner who strayed may struggle with guilt, shame, or fear that trust can never be restored, no matter what they do.

Infidelity is one of the most challenging events a relationship can endure. However, healing after betrayal is possible, and relationships can recover with intentional effort, patience, and support.

Understanding Trust After Betrayal

Trust is often misunderstood as simply a belief or feeling. As Dr. John Gottman explains in his book The Science of Trust , trust is built through consistent, reliable actions over time . In other words, trust isn’t restored instantly, it is earned step-by-step, day-by-day.

Rebuilding trust after an affair requires both partners to lean into the work of repair:

The betrayed partner processes their pain, communicates needs, and sets healthy boundaries.
The unfaithful partner commits to transparency, accountability, and attunement , demonstrating that they are reliable and trustworthy through consistent actions.

This mutual commitment to repair forms the foundation for emotional healing and relational growth.

Skills and Strategies for Healing

In therapy, couples learn practical, evidence-based strategies to move past mistrust and re-establish connection. Some key approaches include:

Repair Attempts – Understanding how to apologise sincerely, make amends, and respond constructively to each other’s emotional needs .
Creating Safety Through Honesty – Sharing information transparently, including rebuilding routines of check-ins, and fostering openness in difficult conversations.
Step-by-Step Rebuilding of Emotional Connection – Using structured exercises to restore intimacy, appreciation, and shared meaning.

Even when emotions run high, these strategies help couples shift from a cycle of hurt and blame toward trust, understanding, and mutual support.

Challenges and Opportunities

Healing after an affair is not linear. There will be setbacks, emotional triggers, and moments of doubt. The process can feel slow, and both partners must be willing to engage with patience and empathy.

However, research and clinical experience show that couples who commit to the process often emerge stronger than before . Many partners report deeper emotional intimacy, improved communication, and a more resilient partnership once trust has been rebuilt. Infidelity, while painful, can become an opportunity for growth when approached with intention, honesty, and professional guidance.

How We Can Help You

As a therapist trained in the Gottman Method , Laura Marett works with couples to navigate the aftermath of betrayal in a structured, compassionate way. Therapy provides:

A safe space to explore emotions, express needs, and repair relational damage
Guided exercises to restore trust, strengthen friendship, and rebuild emotional connection
Practical tools for improving transparency, accountability, and ongoing communication

With the right support, couples can move from mistrust and disconnection toward a healthier, more resilient relationship.

Need Some Help to Build Your Relationship?

If you’re seeking marriage counselling in Wollongong, couples therapy after infidelity, or guidance to rebuild trust in your relationship, evidence-based strategies like the Gottman Method can help you heal and reconnect with your partner.

Call The Psych Collective Clinic to make an appointment with Laura Marett for couples therapy.

Why Does Everything Turn into an Argument?

Thu, 11 Sep 2025 03:17:11 GMT

How to stop arguing with evidence-based couples therapy

Conflict is a normal part of any intimate relationship, but for many couples, disagreements seem to escalate quickly or repeat endlessly. Often, this happens because partners don’t have clear strategies to calm themselves during conflict , and even fewer couples intentionally practice emotional regulation when tensions rise. Without these skills, it’s easy to become emotionally overwhelmed or dysregulated.

When we are dysregulated, our emotions intensify, and it becomes difficult to truly hear our partner. Misunderstandings multiply, defensiveness grows, and healthy communication breaks down. Small disagreements can spiral into arguments, and couples may find themselves trapped in repeating patterns that leave both partners feeling frustrated, hurt, or disconnected.

The Role of Emotional Regulation in Relationships

In her work with couples, Laura emphasises the importance of practical, evidence-based tools to manage emotions before conflict escalates. At The Psych Collective, we promote a ‘ Skills Before Pills ’ approach to teach partners techniques to soothe themselves, reduce intensity, and return to constructive dialogue.

One of the most powerful approaches we use for managing conflict is teaching couples the Distress Cycle . The event itself is rarely the problem—it’s the snap judgment that follows, such as “they did that on purpose” or “they don’t care about me.” These quick interpretations trigger intense emotions, which then cascade into physical changes like a pounding heart, tense muscles, or shaky breathing. As adrenaline floods the system, logic fades, emotions escalate, and the urge to react harshly takes over. By learning to notice, question, and reframe snap judgments in the moment, partners can interrupt this cycle before it spirals out of control. This creates space for calmer responses, reduces overwhelm, and helps couples prevent regrettable actions. Over time, recognising and working through the Distress Cycle builds emotional skill, improves connection, and allows for healthier problem-solving.

Is This the End of Your Relationship…or a Turning Point?

Many couples worry that constant arguments signal the end of their relationship. The good news is that research shows relationships can often be repaired , even when they feel broken, if both partners are committed to change and willing to invest effort.

Gottman Method research highlights that escaping negative cycles requires more than quick fixes. It involves shifting mindsets, practising new behaviours, and connecting intentionally . Even small changes, like one partner taking responsibility for their part in conflict, can transform the tone and trajectory of the relationship.

Understanding Negative Cycles: The Pursue–Withdraw Pattern

A common issue in relationships is the pursue–withdraw cycle . This occurs when one partner pursues connection, expressing frustration or hurt, while the other withdraws to avoid conflict. Over time, this pattern increases emotional distance, erodes trust, and makes it harder to repair conflict.

Through Gottman-based couples therapy methods and practical DBT strategies , I help couples:

Identify repeating negative patterns in their relationship
Learn skills to self-soothe and regulate intense emotions
Stay engaged during disagreements rather than withdrawing
Communicate needs clearly and listen actively

By addressing these cycles, couples can move from emotional disconnection to healing and reconnection , transforming conflict into an opportunity for growth rather than a source of distress.

The Power of Intentional Change

The key to healthier relationships is intentional practice . Couples who learn to manage their emotional responses, take responsibility for their role in conflict, and respond with empathy instead of defensiveness often report:

Reduced frequency and intensity of arguments
Greater trust and intimacy
More consistent emotional connection.
Enhanced problem-solving and shared decision-making

Even couples who feel stuck in repetitive arguments can regain a sense of partnership, closeness, and mutual respect by applying these evidence-based strategies .

Taking the Next Step

Conflict doesn’t have to define your relationship. With professional couples therapy, couples can develop the skills to manage emotional intensity, break negative cycles, and strengthen their connection. As a therapist trained in the Gottman Method and skilled in DBT-based emotion regulation , Laura Marett helps couples navigate challenges, improve communication, and build relationships that are resilient, fulfilling, and enduring.

If you’re searching for couples therapy in Wollongong, marriage counselling , or strategies to reduce conflict and strengthen your relationship, these evidence-based approaches can help your partnership thrive. Contact us today to start transforming arguments into meaningful connections.

Couples Therapy: How does it work?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 03 Sep 2025 20:10:53 GMT

How does Couples Counselling work?

Relationships can be one of the most rewarding and, at times, challenging parts of our lives. When our relationships are in strife, our mental wellbeing can be significantly compromised.

At The Psych Collective Clinic in Wollongong , we are now offering couples therapy.

Delivered by Laura Marett , an Accredited Mental Health Social Worker , our couples counselling is grounded in the evidence-based Gottman Method . This trusted framework helps couples identify strengths, improve communication, and build lasting connection.

What is the Gottman Method?

The Gottman Method is a research-based approach to couples therapy developed by Drs. John and Julie Gottman. Built on over 40 years of scientific study of thousands of couples, the method focuses on practical strategies that help partners strengthen their relationship in three key areas:

Friendship and Intimacy – Deepening emotional connection and appreciation.
Constructive Conflict Management – Learning to manage conflict in a healthy, productive way.
Shared Meaning and Life Goals – Creating a shared sense of purpose and alignment.

Through the Gottman Method, couples learn to:

Improve communication using tools like soft start-ups and active listening.
Build rituals of connection and emotional intimacy.
Understand and honour each other's dreams.
Repair after conflict and rebuild trust.

Laura will apply these principles by assessing your unique relationship dynamics and tailoring interventions to meet your specific needs. This process is supported by the Gottman Relationship Checkup , a detailed online questionnaire that provides a roadmap for therapy.

What to Expect from Couples Therapy at The Psych Collective

We offer a structured and effective approach to couples therapy using the Gottman Method , which has helped thousands of couples across the world. Our therapy process starts with an initial commitment of four sessions designed to assess, understand, and support your relationship:

1. Joint Assessment Session (90 minutes)

In your first session together, we’ll explore your relationship history, current concerns, and what brings you to therapy. You will also be given access to a comprehensive online questionnaire to complete before your next appointment. This helps us gain deeper insight into your relationship dynamics.

Cost : $350 (includes access to the Gottman Relationship Checkup online questionnaire)

2. Individual Sessions (2 x 60 minutes)

Each partner will then attend a one-on-one session with your therapist. These sessions allow for personal perspectives to be heard in a safe and private space.

Cost : $220 per individual session ($440 total)

3. Feedback and Planning Session (90 minutes)

In this final session, we’ll come back together to discuss the insights gathered, your relationship strengths, areas for improvement, and a tailored plan for moving forward.

Cost : $350

Total Initial Commitment (4 sessions) : $1140

Subsequent Sessions

Following the initial four-session assessment process, couples are encouraged to continue therapy to work toward the specific goals identified during the feedback and planning session. These ongoing sessions are where real change begins to take shape. Whether it's improving communication, rebuilding trust, navigating conflict, or deepening emotional connection, your therapist will use targeted Gottman Method interventions tailored to your unique relationship dynamics.

Cost of ongoing couples sessions : $220 per 60-minute session

Important Information

No Medicare rebates are available for couples counselling.
Telehealth appointments are available for your convenience.
Evening appointments may be offered upon request. Please note that after-hours sessions may incur a higher fee.
May be funded via Open Arms for Veterans and Families. Call 1800 011 046 to request an appointment with Laura.

Why Choose The Psych Collective for Couples Therapy in Wollongong?

We’re a trusted private practice located in the heart of Wollongong , offering professional and compassionate support.
Laura Marett is an Accredited Mental Health Social Worker who has completed Level 2 training in the Gottman Method , which is known for its scientific foundation and practical tools.
Whether you're dealing with conflict, infidelity, parenting differences, or simply want to strengthen your relationship, we’re here to help.

Start Your Journey Together

If you're searching for couples counselling or relationship therapy in Wollongong , take the first step with The Psych Collective Clinic . We’re committed to helping couples reconnect, rebuild, and grow stronger together.

To make an enquiry or book your first session, click here to find our contact details.

Feeling Cards for Kids

jess@thepsychcollective.com (Jess O'Garr) — Wed, 11 Jun 2025 02:24:56 GMT

Helping Kids Name What They Feel:

The Story Behind the Feeling Cards for Kids

By Jess O'Garr, Clinical Psychologist

During the last school holidays, my nine-year-old daughter came up to me and said, “Hey Mama, can I go on Canva and make some posters about feelings to talk to my friends?”

As a clinical psychologist, this wasn’t just music to my ears—it lit a little creative spark. I replied, “You know what? I’ve always had this idea of making up feeling cards for kids. Do you want to do a joint project with me?”

She agreed with the kind of enthusiasm only a school-holiday project with screen time can bring. That one moment of curiosity sparked what would become the Feeling Cards for Kids —a therapeutic tool created by professionals, tested by families, and brought to life by kids.

Over the next week, my daughters and I watched Inside Out 1 and 2, read storybooks about emotions, and combed through The Psych Collective Emotion and Mood maps. Both girls helped brainstorm feeling words and grouped them into categories, not realising how much I was making them practise their spelling.

Armed with an extensive list, we turned to Canva and my girls appointed themselves as Image Directors. They had a lot of fun selecting pictures to matched the feeling words. We made the decision to avoid using facial expressions as many kids struggle with them. My girls had a lot of giggles, and have declared their favourite images as t he bored bunny and the grumpy cat.

What started as a school holiday project quickly evolved. The kids were excited to show their cards to their teachers, especially because, in their own words, “the emotion stuff we do at school is kind of boring and doesn’t really explain much.”

That’s when I knew we were onto something.

What Are the Feeling Cards for Kids?

The Feeling Cards for Kids are a full set of 78 beautifully illustrated, colour-coded cards covering the six core emotion families:

Joy (17 cards)
Anger (14 cards)
Sadness (15 cards)
Fear (13 cards)
Disgust (7 cards)
Surprise (5 cards)

Each feeling card includes:

A feeling word and synonyms.
A relatable description written in a kid’s voice
The word used in a sentence
Physical sensations and body clues
Common behaviours associated with the feeling
Helpful “watch-outs” for when they might get carried away with a feeling
Guidance on how to take care of this feeling.

Why We Made These Cards (And Why They Matter)

We created these cards because, despite the growing awareness around emotional intelligence, so many tools for kids still fall short. They’re often too basic, with just a facial expression and a label, so they don’t reflect the full emotional landscape that children experience daily.

But kids are feeling things all the time. Sometimes they don’t have the words. Sometimes they don’t have the confidence. And sometimes, they don’t even realise what they’re feeling until it bursts out of them as a tantrum, a shutdown, or an “I hate you” at the dinner table.

What they do need is:

The language to name their feelings
The skills to care for those feelings
The confidence to share those feelings with others

When kids can recognise, understand, and express their emotions, they build skills that will serve them throughout their entire lives—at home, at school, in friendships, and eventually in workplaces and relationships.

We're Teaching Skills too

We’ve also created 7 bonus “Feeling Skills” cards —regulation tools that kids can use to calm themselves down, tune into what they’re experiencing, and respond in a healthy way. These aren’t just descriptions of feelings—they're tools for emotional growth.

The skills cards give kids actionable tools like deep breathing , grounding techniques , self-validation , and cooling down —practical strategies that even adults can benefit from.

What to do with the Feelings Cards for Kids

To help parents, teachers or care givers navigate the deck of feeling cards for kids, and yes, it's a big deck, we have included an instruction sheet with some tips and ideas on how to use these cards with your kids.

You'll get a copy in each box, plus we'll attach a digital copy with your order in case it gets lost or hidden by kids who think they're funny (ask me about the letterbox keys going "missing" for 3 days. Spoiler alert - it wasn't funny).

What Emotional Literacy Actually Looks Like

In our house, emotional literacy isn’t a worksheet—it’s a conversation. It’s my daughter stomping out of the room, then returning ten minutes later with a red card in hand and saying, “I’m feeling vengeful.” (Yes. Vengeful. She got that one from the cards.) It’s my other daughter handing me a blue card and quietly saying, “I think I’m feeling lonely today.”

Sometimes they can’t name the exact emotion—but they’ll say, “I’m feeling yellow,” or “It’s a big red one.” Depending on how intense the emotion is, the card might get placed in my hand… or launched across the room. Either way, I know they’re communicating—and that’s the whole point.

The cards give them a safe, playful , and emotionally intelligent way to say: “This is what’s going on inside me.”

What Makes These Cards Different?

There are plenty of feelings charts, flashcards, and “emotion posters” out there—but what we’ve created here goes far deeper than surface-level emojis. Here’s what sets these apart:

Rich, Nuanced Language

We’ve gone well beyond happy/sad/angry to include words like:

Vulnerable,
Jealous,
Discouraged,
Hopeful,
Confident,
Appalled,
Sulky,
Ecstatic,
Paranoid…

Because kids feel complex things, too. They deserve a vocabulary that reflects that.

A little tip:

We want to expand children's vocabulary, so this deck of feeling cards is very comprehensive. Some cards may feel a little too mature for your child's age and that's ok. Just pop some cards in a ziploc bag and keep them at the back of the box so they can grow into them when they're ready.

Practical Emotion Regulation Tools

The 7 Feeling Skills Cards help kids manage big feelings in safe ways. These include:

Self-validation : “It’s okay to feel this way.”
Grounding : “What’s real and safe right now?”
Cool down : “Let’s calm the body to calm the mind.”
Deep breathing , self-soothing , LEAN , and more

These aren’t just for kids who are struggling—these are for all kids, because all kids have emotions, and all kids can learn to regulate them.

Co-designed with Kids

This wasn’t a top-down adult project. Kids were the creators and design engineers. They picked the imagery, shaped the tone, and gave feedback on the language. These cards speak to kids because they came from kids.

Dr Al's kids got involved, and they love the stressed out pigs.

Designed by Mental H ealth Professionals

As a clinical psychologist (Jess) and psychiatrist (Dr Al), we’ve brought our years of clinical knowledge into every single word. These cards are grounded in evidence-based practice but speak in a child’s voice. That’s a rare combo.

How to Use the Feeling Cards

Whether you’re a parent, teacher, psychologist or carer, these cards are flexible and easy to use:

Feeling Check-ins

Do a daily or weekly check-in:

“Pick a card that matches how you feel today.”

This is a great ritual at the dinner table, during morning circle time, or as part of therapy sessions.

Support During Big Feelings

When your child is upset, say:

“Want to go get your feelings box and find a card?”

This gives them a sense of control and invites connection rather than conflict.

Teach Emotion Regulation

Use the skills cards as teaching tools:

Practise deep breaths when everyone’s calm
Role-play using grounding techniques
Make a feelings plan with your child for what to do when they're overwhelmed

Creative Storytelling

“Pick three cards and tell a story about a character who feels these things.”

This can help kids explore emotions indirectly, especially if they’re nervous to talk about themselves.

Not Just for Kids...

While these cards were created with children in mind, we’ve been surprised (though maybe not that surprised) at how many adults have connected with them too.

Some of my patients who’ve played with the cards in therapy have said:

“I finally have the words for what I’ve felt for years.”
“I didn’t realise how often I shut my own feelings down.”

Many adults struggle with identifying or expressing feelings—a trait sometimes referred to as alexithymia . These cards gently invite people back into their emotional world, without shame or overwhelm. So yes, these are for your kids—but don’t be surprised if they end up helping you too.

Why Emotional Literacy Is a Skill for Life

We all want our kids to grow up resilient, kind, and self-aware. That journey begins with teaching them that feelings are not problems—they’re messages. They help us understand what matters, what needs attention, and when something isn’t right.

When children can name and regulate their emotions, they:

Form healthier relationships
Make better decisions
Cope more effectively with stress
Develop confidence and empathy
Grow into emotionally intelligent adults

We believe that emotional literacy is one of the greatest gifts you can give a child—and it starts with something as simple as a deck of cards.

From Our Homes to Yours

Our kids are proud of the cards they helped make. They’ve used them, argued over their favourite characters (still the bored bunny vs. the stressed pig), and are counting down the days until they can take them to school

We hope your family loves these cards as much as ours do.

We made them to fill a gap—but more than that, we made them to give kids a voice. We want every child to grow up knowing their feelings are welcome, their words are powerful, and they don’t have to figure it all out alone.

Order your set of Feeling Cards for Kids a nd help your child become a Feelings Superstar—one card, one conversation, one breath at a time.

Support kids to name what they feel, understand what it means, and choose what to do next.

Add to cart and bring emotional literacy into your home, classroom, or clinic.

Order from our Resources page here

The 6 Basic Emotions

jess@thepsychcollective.com (Jess O'Garr) — Sat, 17 May 2025 07:07:02 GMT

Why You Struggle to Name Your Feelings (And What to Do About It)

By Jess O'Garr, Clinical Psychologist

If you’ve ever found yourself saying “I don’t even know what I’m feeling right now,” you’re not alone. As a clinical psychologist, I hear this all the time — not just from children, but from intelligent, self-reflective adults. Emotional awareness isn’t innate. It’s learned. And for many people, the emotional vocabulary they needed never quite arrived.

Emotions vs. Moods: What’s the Difference?

Emotions are short-term , intense , and usually triggered by a specific event or stimulus. Emotions are the intense, short-acting feeling responses that are determined by how we appraise (judge) stimuli in our environment.

This means they are always triggered by something. It may be internal stimuli (thoughts, memories, sensations) or external stimuli (you see, hear, smell, taste or touch something).

Think of them as the body’s rapid-response system: fear when a car swerves too close, joy when a friend surprises you, anger when you're treated unfairly.

Moods , on the other hand, are longer-lasting , more diffuse states that aren’t necessarily tied to a specific event. You might feel gloomy all afternoon without knowing why. Or you might feel upbeat and talkative for no clear reason. Moods are the emotional climate; emotions are the weather.

This distinction matters because the skills are different. So often when I hear a patient tell me that their skills aren’t working, it because they are not using the correct one. Emotions need emotion-focused skills and mood need behaviour-focused skills.

How do we define an emotion?

Emotions have four specific components (which is how we can tell them apart from moods).

Location:

Emotions are felt in specific locations within your body. Anger is often felt in the jaw and fists. Fear is often felt in the gut and Surprise will take your breath away. The location of emotions are more obvious and consistent with the basic six emotions, and are less obvious with the more nuanced feelings.

Action urges:

Emotions are energy in motion, which is why they motivate us to take action. Each of the basic 6 emotions urge us towards specific actions based on the appraisal or snap judgement we have made.

We feel FEAR when we believe that we are in immediate danger, so we are urged to run away.

We feel ANGER when we believe that we have been treated unfairly or someone has created an obstacle to our goal attainment, so we are urged to overcome the obstacle by fighting for what is fair.

Expression:

The basic 6 emotions all have socio-expressive phenomena, which means we express our emotions through our facial expressions and body language in a way that is interpreted in social settings. The basic 6 emotions have universally recognised facial expressions. This means that if someone pulls a DISGUST face in Japan, it will be recognised by someone in Jamaica.

Name (and Nuance)

Emotions are subjective, so only you get to decide what you are feeling. However, this required you to have an adequate vocabulary to be able to express yourself correctly. Many adults can label feelings using the basic 6 emotions, but many will struggle with the more nuanced words and may not know the distinction between words like frustrated and annoyed.

Which raises the question of…

Why Are Emotions So Hard to Name?

Enter alexithymia — a psychological construct that describes the phenomenon of not being able to label one’s emotions.

Alexithymia literally means “no words for mood”. It comes from:

Lexi , meaning lexicon (or vocabulary)
Thymia , meaning temper or mood

And the prefix a , meaning absence or lack

It’s not a disorder, per se, but a trait or experience where a person lacks emotional literacy.

Because here's the thing: emotions are like a language . If no one ever taught you that what you’re feeling in your chest is “anxiety” or that the heat rising in your face is “embarrassment,” you won’t just “figure it out” intuitively. Emotional literacy needs modelling, repetition, and freedom to express.

Many people with trauma histories, neurodivergent conditions (like autism or ADHD), or people who were raised by emotionally illiterate parents will struggle with this.

What areThe Six Basic Emotions

There are six basic emotions:

Joy
Anger
Surprise
Disgust
Fear
Sadness

These emotions are universal and hard-wired into us from birth. These emotions then link to what we refer to as ‘feeling families’ as they can be split into more nuanced words to describe specific emotions from distinct triggers.

However, before we proceed with explaining these six emotions and sub-emotions, I want to make a point about the other literature on emotions out there.

There is no definitive list of emotions!

Many researchers can’t even agree on the basic six. Paul Ekman argues that there are seven basic emotions (he includes Contempt as its own category).

Interesting side note: Paul Ekman was the consultant for Disney’s Inside Out. You might even notice that the colours of our Emotion Map looks familiar…

Robert Plutchik argues that there are 8 basic emotions (our six, plus trust and anticipation)

Who is right, who is wrong? Nobody and everybody because feelings are subjective.

That doesn’t help you does it?

Let’s just say this: The most common model is the 6 basic emotions and learning the sub-emotions will expand your vocabulary even though most of them are synonyms.

So hear are my definitions of the basic 6 emotions, including the typical trigger for each emotion, the action urge and how it is felt in the body.

JOY

Trigger: Joy is activated when we perceive that something positive has occurred, often in a way that exceeds expectations.

Felt as: Lightness, warmth, or energy, typically in the chest or face. It is often accompanied by spontaneous smiles or laughter.

Action urge: It motivates continued engagement in pleasurable activities, sharing joy with others and celebrating good moments.

Sub-Emotions for Joy : Excited, Elated, Delighted, Amused, Proud, Grateful, Relieved, Affectionate

Related Moods: Happy, Content, Confident, Hopeful, Playful, Satisfied, Loved

ANGER

Trigger: Anger often arises in response to a perceived mistreatment or injustice. It serves to protect oneself when in danger or cornered and assert boundaries.

Felt as: Tension in the jaw and fists or heat in the chest or face.

Action urge: It motivates confrontation, defence, or correction of the perceived wrong.

Sub- Emotions for Anger : Frustrated, Annoyed, Jealous, Envious, Enraged, Resentful, Vengeful, Disrespected, Offended, Impatient, Humiliated

Related Moods : Grumpy, Bitter, Hostile

FEAR

Trigger: Fear is activated when we perceive immediate danger or threat in our surrounding environment.

Felt as: A tightness in the chest, a churning stomach, or goosebumps.

Action urge: It motivates avoidance, escape, or preparation for potential harm.

Sub-Emotions for Fear : Scared, Terrified, Panicked, Embarrassed, Powerless, Humiliated

Related Moods : Nervous, Anxious, Stressed, Vulnerable, Hopeless, Dread

SADNESS

Trigger: Sadness is activated when we lose something or someone important.

Felt as: A heaviness in the chest, a lump in the throat, or tearfulness.

Action urge: It motivates withdrawal from what was lost, reflection or reminiscing, and seeking comfort from others.

Sub-Emotions for Sadness : Rejected, Disappointed, Devastated, Hurt, Defeated, Regretful, Grieving, Sulky

Related Moods : Lonely, Hopeless, Bored, Discouraged, Depressed, Gloomy, Bereaved

DISGUST

Trigger: Disgust protects from harmful substances by orienting us away noxious or toxic objects or offensive behaviours.

Felt as: Nausea, a bad taste in the mouth, or a scrunched-up face.

Action urge: It motivates rejection, distancing oneself or turning away from the offensive object or behaviour.

Sub-Emotions for Disgust : Revolted, Appalled, Guilty, Ashamed, Loathing

Related Moods : Contemptuous

SURPRISE

Trigger: Surprise helps to quickly orient our attention towards an unexpected event, preparing for a rapid response.

Felt as: A jolt or flutter in the chest or stomach.

Action urge: It motivates investigation, questioning, or immediate reaction to the new stimulus.

Sub-Emotions for Surprise : Shocked, Confused, Amazed

Related Moods : Curious, Bewildered

Emotions Are a Map — But You Need the Legend

Without the right language, emotions can feel like noise. Confusing, chaotic, even threatening. But once we build the vocabulary, these signals become navigable. They become information , not just sensation.

If you were never taught the word resentful , how would you explain that simmering anger at unfairness?
If you didn’t know discouraged , would you mistake it for laziness?
Without anxious , might you just call it "tired" or "bad"?

At The Psych Collective, we have created two types of maps - The Emotions Map and the Mood Map. Since they are categorised differently, we saw a need to split them up.

You can download these PDFs for free by clicking here !

How to Improve your Emotional Literacy

You don’t need a psychology degree to build emotional literacy. What you need is practice noticing , naming , and normalising your internal world.

To improve your emotional awareness and literacy, we ask you to LEAN into your feelings. We use a specific acronym developed by The Psych Collective to help you to label your feelings, which will help you decide how to RESPOND to your feelings.

Other things you could try to improve your emotional awareness:

Keeping a “feeling log” to track shifts in your mood
Using feeling word cards (yes, even as an adult!)
Slowing down to ask: Is this an emotion or a mood? What triggered this?

Naming your feelings is an important skill, especially for those of us who are raising the next generation.

And if no one taught you this language growing up? It’s not your fault — but it is your invitation.

Now, are you ready to improve your emotional literacy?

Download the resources you are going to need here !

Understanding the Distress Cycle

Wed, 30 Apr 2025 09:02:46 GMT

The Distress Cycle

Understanding your distress and how to manage it.

When distress hits, it can feel like complete chaos. You're overwhelmed with emotions, everything feels disordered, and it’s scary – which just adds to the distress!

At The Psych Collective, we want to help you bring order to your chaos so you don’t feel so lost and chaotic all of the time. We want you to understand what is happening as part of the process of distress because it follows the same pattern every time.

The Distress Cycle

We developed a model that we call this the Distress Cycle . This model underpins everything else that we teach about distress tolerance and using skills to prevent regrettable actions. This is a model that you should have memorised and know it so well that you could teach it to someone else.

The Stages of the Distress Cycle

Here are the seven stages of the Distress Cycle:

1. The Trigger: Where Distress Starts

Distress doesn't just come out of the blue. It’s always triggered by an event.

External triggers : seeing something distressing, hearing a noise that reminds you of something bad happening, someone saying something upsetting or triggering, even smelling something upsetting. Distress can also come from being touched in a way that you don’t like.

Internal triggers : You may feel like nothing happened to cause your distress, but inside your mind you recalled a memory. Or perhaps you had a “what if something terrible happens” thought. On the outside, there is nothing to witness, but your amygdala (your brain’s panic button) will still react to threats made up within your mind.

A very common trigger is emotional invalidation – when someone dismisses, minimizes, or challenges your emotional experience. Someone might say that what you’re feeling doesn’t matter, or you are being too sensitive or that you shouldn’t be feeling how you do. It might be that they said something hurtful, or even that they didn't say something you needed to hear. Invalidation hits on a very emotional level and is a frequent trigger for distress.

2. The Snap Judgment

Once the trigger happens, we make an almost-instant interpretation – a snap judgment . This is usually a low-resolution thought : a quick, automatic assessment that often isn't very clear or conscious. From a CBT (Cognitive Behavioral Therapy) perspective, this is called an automatic thought .

You might not even notice it happening unless you practice mindfulness or have really developed your self-awareness. But even if you miss it, the next step is usually unmistakable: you get slammed with a big emotion.

3. Intense Emotion

Emotions can be triggered by little things, but for the Distress Cycle, we're mostly talking about the ones that create real distress – things that ignite strong anger, sadness, or fear. This fires off your brain’s alarm system, leading to a surge in nervous system activity and a spike in adrenaline. This then leads to a physical reaction.

When you later fill in the distress cycle worksheet, we will ask you to identify the emotion you felt and then rate the intensity of how overwhelmed you felt on a scale of 1-10. This is similar to a SUDs scale. You can read our blog about the SUDs scale here .

4. Strong Physical Feelings

That's when you start experiencing physical symptoms – your fight-flight response might kick in. You might feel hot, tense, clench your fists or jaw, or notice your heart pounding. Breathing changes are incredibly common but often go unnoticed.

Sometimes people are not in tune with their bodies, so they may not be aware of their physical reactions, particularly the more subtle ones.

5. Feeling Overwhelmed

If you don’t find a way to exit the cycle before here, things ramp up fast. The intensity of the emotions increase and we begin to feel overwhelmed.

What started as anger becomes rage.

Sadness deepens into despair.

Fear can turn into terror.

At this point, there's usually a cognitive appraisal – a thought like "I can't handle this" or "This is too much." And that thought intensifies distress even further.

The more overwhelmed you feel, the more aroused your system becomes, producing even more adrenaline and pushing you deeper into distress.

6. The Urge to Act

Next, a strong urge to act appears. Every primary emotion has an action urge attached:

Anger urges you to defend or attack.
Sadness ideally motivates connection, but often, if you’ve had bad experiences, it pushes you to isolate.
Fear urges you to flee.

This urge feels compelling – it’s your mind’s way of trying to discharge the overwhelming emotional energy. And if you engage in these urges, it often leads to something regrettable.

7. Regrettable Actions

If you act on the urge – lashing out, fleeing, isolating, using substances, sending that angry text – you often find yourself doing something you later regret. These problem behaviours tend to have real consequences.

There are some situations where it is not a regrettable action. If the trigger is that someone is attacking you and the snap judgement is “oh my goodness, I have to get away”, then fleeing is the appropriate thing to do. So there is no regrettable action.

So when we use this model with patients who experience frequent episodes of distress who often experience negative consequences from the way that they try to handle their distress.

We ask them to fill in the worksheet (below) about the times when they engaged in a regrettable action so we can plan for more skilful ways to handle their distress the next time.

What we could consider regrettable actions (or call problem behaviours if we’re doing DBT) include:

Self harm
Over-reliance on medication or drugs or alcohol to take the distress away,
Firing off that angry text to someone
Binge eating
Online spending or gambling

Importantly, the consequences of a regrettable action can become the next trigger in your distress cycle.

For example, if you verbally attack your partner in a moment of rage, you may later be overwhelmed with sadness, guilt, or fear about the damage you've done – and that becomes your next trigger.

Breaking the Cycle

If you get to the urge to act and then choose to do something skilful - Congratulations! You have exited the cycle of distress before you engaged in a regrettable action, which is the first goal for this model.

So if you want to get better at exiting the cycle before you make some bad choices, then you will need to start by filling in the Distress Cycle worksheet for each episode of distress.

We want you to get to know your distress cycle intimately. Use our worksheet to map out:

What triggered you
What the snap judgment was (you might not know this at first)
What emotions you felt
Your physical sensations
How intense the overwhelm was (rate it from 1–10)
What the urge was
Whether there was a regrettable action

Write it out. Practice explaining it to yourself or someone you trust. The clearer you are on your own cycle, the better your chances of catching yourself earlier next time.

Every episode of distress is an opportunity to learn and become more skilful. Over time, you’ll start to spot patterns – the snap judgments, the schemas (like fear of abandonment or vulnerability to harm) that drive your distress.

For this skill to be really effective, you will need to fill in the worksheet 30-50 times. Then take your worksheets to your psychologist or mental health practitioner and get some help to look for patterns and plan alternative actions.

We have this in a fillable PDF that you can download for free, so you can use the worksheet again and again.

The Distress Cycle Worksheet

Understanding your distress and how to manage it.

This worksheet accompanies Dr Al's talk on the distress cycle. Use it to get a better understanding of the process of distress so you can do something about it before you become overwhelmed.

Download the handout from our Resources page. It's free!

Real-Life Examples

Want to hear some examples of the Distress Cycle in practise?

Watch the video below as Jess and Dr Al explain the cycle and give some examples of how to apply this model to your experience of distress.

The Distress Cycle with DBT skills.

Putting the two together.

If you have done any DBT therapy, then this video will explain which skills to use at each stage of the distress cycle.

Temperament and Neuroticism

Wed, 30 Apr 2025 05:58:45 GMT

Neuroticism and Emotional Sensitivity

Why Some People Feel More Than Others

Have you ever wondered why some people seem to breeze through life unfazed, while others feel everything deeply? Maybe you’ve thought “Why do I react so strongly to things that don’t seem to bother anyone else?” Or perhaps you’ve been on the other side — watching a partner, friend or child become overwhelmed, while you're left wondering what all the fuss is about.

This difference often comes down to sensitivity , which is closely tied to something psychologists refer to as neuroticism — a personality trait that influences how strongly you experience negative emotions like anxiety, fear, or sadness.

What Is Neuroticism?

Neuroticism refers to how prone someone is to experiencing negative emotions like anxiety, fear, sadness, or irritability. People higher in neuroticism tend to feel things more intensely and may be more easily thrown by stress. Those lower in neuroticism are often seen as more emotionally stable, laid-back, or “unflappable”.

Neuroticism is largely genetically determined , though trauma or difficult life experiences can also push someone into higher sensitivity over time. It’s not about being dramatic or attention-seeking — it’s about how your nervous system is wired.

Why Are Some People More Sensitive?

As we discuss in our online course Surviving Distress (find out more here ), some people naturally live at the higher end of the Subjective Units of Distress (SUDs) scale. It’s not always about what’s happening around them — it often comes down to temperamental sensitivity , which is closely linked to a personality trait known as neuroticism .

You’ll know this if you’ve met someone who is easily overwhelmed, emotionally intense, or often on edge — they’re probably high in neuroticism. On the flip side, you’ve likely met people who are chilled out, relaxed, and not easily rattled. They’re low in neuroticism. These are simply different ends of the emotional sensitivity spectrum.

The Orchid and Daisy Metaphor:

A Way to Understand Emotional Sensitivity

Let’s look at this with a metaphor I love:

Are you an orchid or a daisy?

A friend once explained temperament like this. Orchids are stunning but high maintenance. They need exactly the right amount of sun, the perfect amount of water, and just the right potting mix to flourish. And if you move them even slightly from their perfect spot, they can wilt.

Daisies, though? Daisies are easy. They grow anywhere — by the beach, in drought, on the roadside, in parks. Kids trample them, dogs pee on them, and they just keep blooming.

People are like this too. Some are born with a hypersensitive temperament — like an orchid. Everything needs to be just right for them to feel okay, and small disruptions can throw them completely off balance. Others are more like daisies — emotionally hardy, adaptable, and unfazed by what life throws at them.

This is where the concept of temperament comes in. It’s not something you choose. It’s something you’re born with. But if you’re an orchid, you can learn to become more tolerant of change and more skilful in how you respond to stress. And remember: orchids might be delicate, but they are stunning, unique, and — in my view — often the most emotionally insightful people around.

How Neuroticism Shapes Your SUDs Range

The level of neuroticism you sit at shapes the range of your distress. If you’re high in neuroticism — an orchid — your daily emotional range might sit between 5 and 10 on the SUDs scale. You might never really feel like a 1. Some patients even say, “I don’t know what a one feels like — I’ve never been that low.”

In contrast, someone low in neuroticism — a daisy — might be a 1 or 2 most days, only spiking higher in genuinely extreme situations. Even on a bad day, their reaction might not pass a five.

But here's the issue — in our culture, we often value daisies more. They’re seen as strong, resilient, and "low maintenance". Meanwhile, orchids can be judged as too sensitive, too emotional, or “too much”. This judgment becomes a real problem, especially in parenting. If you’ve got a highly sensitive child being raised by a less sensitive parent, you can end up with emotional invalidation. The daisy parent may not understand or accept the orchid child’s intensity — not out of malice, but simply because it’s so far removed from their own experience.

Emotional Sensitivity Isn’t Weakness — It’s Biology

To illustrate this, I often use another metaphor: peanut allergies.

Imagine you’re totally fine with peanuts. You can eat satay chicken and not feel a thing. But someone else could go into anaphylaxis just from smelling peanuts. You’d never say to that person, “Do you think you could tone down your reaction? It’s only a peanut.”

Yet we do that all the time with emotions. Someone has an intense emotional reaction — maybe a panic attack, or a meltdown — and we say things like “Calm down,” or “It’s not that bad.” But their system is just more reactive. It's not over-the-top — it’s simply the way they’re built .

And just like someone with a peanut allergy needs an EpiPen, someone with high emotional sensitivity needs skills to regulate their response. The good news? These skills can be learned.

We talk about this in great detail in our online course Surviving Distress .

Can Trauma Increase Sensitivity?

Absolutely. While neuroticism is mostly genetic, trauma — particularly chronic trauma or PTSD — can push someone higher up the sensitivity scale. A person who used to be relatively unflappable might find themselves overwhelmed by things that never used to faze them.

This is particularly true for those who grew up in invalidating environments — where their emotions weren’t recognised, understood, or were even punished. Over time, they may develop patterns of shutting down or becoming hyper-alert, which further fuels emotional dysregulation.

We call this Acquired Neuroticism and we discuss this in our book The Depression Solution .

What This Means for Your Skills Practice

If you’re someone who identifies as an orchid — with high emotional sensitivity or neuroticism — it’s even more important that you practise emotional regulation skills. Your SUDs are likely to climb quickly, and you’ll need to be able to catch that rise early and intervene before it hits a peak.

The more sensitive you are, the more essential it is to develop mastery in the skills we’ll be teaching. These might include grounding, breathing techniques, thought defusion, or mindfulness. And just like going to the gym, the more you practise, the stronger you get.

TO help you out, we have made a deck of Coping Cards this is like a therapist in your pocket. They come in a travel tin so you can carry them around with you where ever you go.

Check them our here . We offer them in hard copy and an instant digital download.

Need more?

We have a free PDF download about this topic that you can access right away.

It includes the image above of the orchid and daisies at either end of the neuroticism scale.

Get your copy here .

What are Subjective Units of Distress?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 30 Apr 2025 05:11:26 GMT

Understanding the Subjective Units of Distress (SUDs) Scale

What It Is, How to Use It, and Why It’s Sometimes Hard

By Jess O'Garr, Clinical Psychologist

What are Subjective Units of Distress?

This is a concept that comes up constantly in clinical practice — we talk about it daily with almost every patient. It’s about how you measure or rate your distress, and we do this using something called the Subjective Units of Distress Scale , or SUDs .

So what are SUDs? It’s basically a way of asking " How distressed are you, out of 10?"

Some people use a 1 to 100 scale, but it’s essentially the same.

We find this scale incredibly helpful. It not only allows patients to communicate more clearly with me, but it also gives them a language to explain how they’re feeling to friends and family — especially in those moments of high distress.

How to Use the SUDs Scale to Rate Your Distress

We typically ask, “ Where are your SUDs at ?” It’s a simple way of checking in on how intense your level of distress is. You might be surprised — someone might look okay on the outside, but when asked, they’ll say they’re a 10 out of 10. Others might appear quite distressed but rate themselves as a five. That’s the whole point — it’s subjective . It’s about your personal rating of your internal experience.

Nobody else gets to decide what your SUDs are. You might appear calm on the outside — like a swan, smooth on the surface, but paddling furiously underneath. Some people are good at masking how they feel, which means others may not pick up on their actual level of distress. So even if someone looks calm, if they say they’re an eight, then that’s what we go with.

That said, not everyone will be able to correct rate their SUDs because they don’t have the internal awareness or language to describe their subjective experience.

Part of a clinician’s role is helping people learn to rate their SUDs more accurately. We aren’t here to tell you how to are feeling, but we are here to help you express how you are feeling so you can communicate more effectively.

Why Do Some People Struggle to Describe Their SUDs?

1. Lack of Emotional Vocabulary (Alexithymia)

A lot of people rate their distress as either a zero or a ten — either completely fine or completely freaking out. They lack the in-between gradations. This is often linked to a condition called alexithymia.

Alexithymia literally means “no words for mood”. It comes from:

Lexi , meaning lexicon (or vocabulary)
Thymia , meaning temper or mood
And the prefix a , meaning absence or lack

So people with alexithymia experience emotions, but don’t have the words to describe them. They might say things like “ I’m fine ,” “ I’m bad ,” or “ I’m pissed of f,” but they struggle to express the nuance of how they’re feeling.

It’s much more common than many people think. Often, individuals were raised in environments where emotions weren’t discussed, or they were punished for expressing feelings. If parents themselves didn’t have the emotional vocabulary, how could the child possibly learn it?

2. Dissociation from Emotions Due to Trauma

Another common reason people struggle with rating distress is dissociation , especially in individuals with a trauma history.

Dissociation can affect your connection to yourself and your surroundings. For example, survivors of childhood trauma may have learned to “go inside themselves” to escape danger, disconnecting from their emotions as a protective response.

As adults, this becomes a default coping strategy. When asked “Where are your SUDs at?”, someone in a dissociative state may simply say “I don’t know” or give a blank stare. They’ve shut off from their internal world, so they’re unable to report what’s happening inside.

In therapy, we help these individuals reconnect with their body and internal experience — gently and in small steps, in a safe environment. That way, over time, they become better able to give a meaningful SUDs rating.

3. Messages from Childhood and Social Conditioning

If someone was raised in an environment where they were told things like, “Stop crying or I’ll give you something to cry about,” they may have learned that expressing emotion is dangerous. That person might tend to under-report their distress later in life.

For instance, a child falls and scrapes their knee, starts crying, and the parent says, “It wasn’t that bad. Don’t be such a sook.” The child is then getting the message: “My feelings are wrong.” So they start distrusting their own emotional instincts.

4. Occupational Training

The same is often true for people trained in high-pressure roles — like the military or police. These environments may actively train people to suppress emotional responses. So even if someone is distressed, they’ve been conditioned to ignore or override it — making it harder to report SUDs accurately.

Tips for Practising Your SUDs Ratings

If you’re new to SUDs or you’re someone who finds it difficult, a simple starting exercise is to:

Set an alarm on your phone three times a day.
When the alarm goes off, pause for a moment and ask: Where are my SUDs at right now?
Try to give a number, even if it’s rough. Start with broader strokes like 1, 3, 5, 7, 10 if finer details feel too hard.

It’s important to practise this not only when you’re highly distressed. Building awareness of your emotional state before things get intense helps you to catch the build-up — and potentially avoid a crisis.

Every episode of distress has a build-up, a peak, and a crash. Most people only notice the peak — the “freak-out” moment — and miss the earlier signs. So the goal is to help you spot the signs sooner , and then intervene more effectively.

How Do I figure out my SUDs?

Write it Down!

We offer two different worksheets for people who want to practise rating their distress.

The first option is a simple scale that asks you to write down each symptom that is present at each level of distress. For this, you need to be able to ask yourself “What symptoms do I experience at 9 that makes it different from 8?

This can be tricky, and often my patients will leave 1-3 blank because these lower levels are very unfamiliar.

The second option is included in our Distress Skills patient workbook .

Rather than writing a list yourself, we include a matrix for you to tick off which symptom you experience at each level of distress, and by accumulating ticks you will reveal which symptoms are present at each level.

This is often much easier for people who struggle to describe their SUDs.

Still need more?

Jess and Dr Al give a comprehensive overview of the SUDs scale, factors that make it harder to rate, how neuroticism and sensitivity play a part and advice on which skills to use in Lesson Two: Rating your Distress from their online course Surviving Distress .

PTSD: take back control of anger and terror

Sun, 05 Jan 2025 04:32:06 GMT

Using the Mammalian Dive Reflex to as a tactic to stop anger and overwhelm in it's tracks

Hacking Your Physiology to Take Back Control:

A Rapid Reset Tactic for PTSD RED ALERT Symptoms

PTSD can feel like being constantly on alert, as though a threat is always lurking just around the corner. This state, known as hyperarousal , primes you to detect danger at every turn. It’s hard to relax when you’re perpetually on “YELLOW ALERT,” and over time, this can become exhausting. As if that weren’t enough, PTSD frequently involves "triggers"—trauma cues or upsets that cause your emotions to escalate rapidly. In these moments, your brain perceives threat even where none exists—or where the threat is minor—and the Fight/Flight Survival Reflex kicks in hard. Your heart races, your breath quickens, and your muscles may shake, ready for instant action.

RED ALERT symptoms are both physically and emotionally draining. Fortunately, there’s a way to use your body’s built-in systems to calm the storm.

Enter the Tactical Physiology Hack : activating the Mammalian Dive Reflex .

This simple technique engages your body's natural calming mechanisms, helping you shift out of crisis mode. Let’s explore how it works.

Understanding the RED ALERT State

In PTSD, the nervous system frequently goes into overdrive, dominated by the sympathetic nervous system (SNS) . This is the part of your nervous system responsible for the fight/flight survival reflex, it's "sympathetic" to taking action, not to your feelings!

While these responses are lifesaving in genuine emergencies, PTSD primes you to overreact to minor provocations. Because you have PTSD, you now have a “hair trigger” to detect and respond to perceived threats. This constant activation wreaks havoc on your body and mind, leading to chronic emotional and physical fatigue, which is anything but "sympathetic" to your life.

The goal of this tactical physiology hack is to activate the parasympathetic nervous system (PNS) —the “rest and digest” system that counterbalances the SNS. This shift lowers your heart rate, relaxes your muscles, and brings you back to baseline.

The Physiology Hack: Tapping Into Your Body’s Natural Systems

This technique combines two methods to "hack" your autonomic nervous system and rapidly reduce distress. Here’s how it works:

1. The Ice Pack to the Face

Why It Works:
Placing a cold pack on your face, especially over the sinuses and around your eyes, triggers the Mammalian Dive Reflex . This reflex, present in all mammals, is designed to conserve oxygen when submerged in cold water.

What Happens Physiologically:
The cold sensation stimulates the trigeminal nerve , sending signals to blood vessels in the extremities to constrict, preserving oxygen for vital organs.
Critically, this slows your heart rate ( bradycardia ), which reduces the sense of panic and helps your body calm down.
The Dive Reflex initiates a calming parasympathetic response , overriding the fight-or-flight state.

How to Do It:
Place a cold pack wrapped in a cloth (or even a bag of frozen peas) on your face for 30-60 seconds.
Breathe very slowly, imagine you are conserving limited air.

2. Bending and Bearing Down

Why It Works: Bending forward and bearing down creates internal pressure changes that stimulate the vagus nerve , a key player in the parasympathetic nervous system.

What Happens Physiologically:
Vagal stimulation slows your heart rate and reduces blood pressure.
Pressure changes in your chest and abdomen put physical pressure on the organs and vessels, which signal your brain to deactivate the flight/flight survival reflex..

How to Do It:
Sit down and bend forward, hugging your knees or resting your chest on your thighs.
Bear down and hold your breath in as though pushing during constipation for 20 seconds, then repeat if necessary.

3. Combining the Effects

Using both techniques together amplifies the calming effect. The ice pack activates the Dive Reflex, while the bending or bearing down enhances vagal stimulation. Together, they reset your nervous system and bring your physiology back into balance. Secret built-in bonus hack: Slowing the breathing limits emotional overwhelm by reversing the impact of the Survival Reflex on your carbon dioxide levels.

When to Use This Tactic

This physiology hack is ideal for moments of intense distress, when your emotions feel like they’re spiralling out of control. If you feel overwhelmed with anger or terror, gracefully exit the situation and apply this technique. Practicing it regularly can help you build awareness of your body’s signals and responses.

For more awareness of impending anger/terror, see The Distress Cycle , which teaches you to recognise the signs of rising anger before it escalates into rage (more here ).

Situations Where It Might Help

Anger or rage: When you feel on the verge of snapping or have snapped and need to calm.
Panic or terror: When your heart is racing, and you’re struggling to catch your breath.
Emotional overwhelm: When distress becomes so intense that you can’t think clearly.

Why This Works for PTSD

Two hallmarks of PTSD are hypervigilance (your radar is constantly scanning for threats) and hyperarousal (your body is physiologically primed to act). These are manifestations of your subconscious sensing you are vulnerable because of it intuits an ongoing susceptibility to further trauma. That is what is keeping the survival reflex poised to activate.

Using the Mammalian Dive reflex leverages your body’s natural calming mechanisms to counteract these effects. By activating this reflex, you directly address the physical symptoms of hyperarousal. This avoids over-reliance on medications or cognitive techniques, like mindfulness, or slow breathing which can feel inaccessible during high-stress moments.

It does not address the root cause of PTSD directly, but does address a critical and troubling symptom of emotional overwhelm. By calming your body first, you create space for your mind to follow. Instead of acting regrettably because of the urge from anger, you can pause, reset, and regain control. This can be critical to saving relationships which are often damaged by the anger associated with PTSD. This tactic can be vital when it comes to doing trauma work as it can give you the capacity to deal with the distress that can arouse with trauma work. That way it can become part of the strategy to help you to address the root cause of PTSD: the intuited susceptibility to further trauma.

A Simple Way to Take Back Control

The beauty of this approach lies in its simplicity. You don’t need special training or equipment—just a cold pack and the willingness to pause and take control of your body’s responses. Over time, this technique can become an essential tool in your PTSD anger and fear regulation toolkit, helping you become more strategic in how you navigate life. It means you can tackle trauma processing work with greater confidence and resilience.

When the alarms in your body are blaring, remember: your physiology holds the key to silencing them. Try the Mammalian Dive Reflex Physiology Hack next time your red alert symptoms flare, and experience the empowerment of calming your body to calm your mind. For a compressive course on managing distress including demonstrations, see our Surviving Distress course here and an overview video of this and other critical distress skills here .

- Dr AL GRISKAITIS

DVA Mental Health Claims: How to Link Your Condition to Service (Psychiatric IL Guide)

Sat, 23 Nov 2024 10:02:03 GMT

Getting properly squared away with DVA

The Critical Importance of Linking Diagnoses to Service in DVA Initial Liability Reports

If you’re an Australian Defence Force (ADF) veteran preparing an Initial Liability (IL) claim for the Department of Veterans' Affairs (DVA), you may already know how vital it is to have a comprehensive psychiatric report . However, what you might not fully appreciate is just how critical it is that your psychiatrist explicitly links your diagnosed condition to your military service. Without this connection, your claim could be rejected, leaving you without the support and entitlements you deserve.

Navigating the complexities of the DVA framework can be daunting. While you can review the Statement of Principles (SoPs) for various conditions at the DVA website. The nuances and precise details often trip people up. The importance of accuracy and clarity cannot be overstated—especially for conditions like PTSD, where specific stressor categories and timeframes are central to the claim.

Additionally, under the Military Rehabilitation and Compensation Act (MRCA), the number of diagnoses is less significant than the psychiatrist's impairment assessment. A single mental health diagnosis can suffice for a claim, but precision and timing are paramount. If you have dependent children under 18, lodging your claim sooner could entitle you to additional benefits.

Written by Dr Al Griskaitis, Psychiatrist
Director of Trauma Treatment, South Coast Private Hospital
Focus on DVA psychiatric assessments .

Quick Answer: Why DVA Mental Health Claims Get Rejected

Most DVA mental health claims fail because:

The diagnosis is not clearly linked to service
Stressors are poorly documented
Timeframe criteria (RH vs BOP) are not met
Reports do not follow Statement of Principles (SoP) requirements

Who This Guide Is For

ADF veterans preparing a DVA claim - get it right first time
Veterans needing an Initial Liability report
Veterans whose claims were rejected - what needs to be addressed
Psychiatrists who are unfamilar with DVA report requirements

Understanding Stressors (factors): Category 1A, 1B, Category 2 and pain

A well-supported diagnosis often must be connected to recognized stressors under the DVA framework. The most common way of doing this is with stressors. Stressors are classified as Category 1A, Category 1B, and Category 2 , each requiring detailed documentation in your claim.

Category 1A Stressors

These involve life-threatening or extremely severe events, such as:

- Experiencing a life-threatening event, including combat scenarios, indirect fire, or high-risk deployments.

- Being subject to a serious physical attack or assault, such as sexual assault or molestation.

- Being threatened with a weapon, held captive, kidnapped, or tortured.

Category 1B Stressors

These involve exposure to severe trauma, including:

- Killing or maiming a person.

- Witnessing a person being killed or critically injured.

- Eyewitness to atrocities or participation in the clearance of corpses or casualties.

Category 2 Stressors

These involve chronic negative life events causing ongoing distress, such as:

- Prolonged severe work stress or tempo, e.g with sleep deprivation.

- Workplace bullying, harassment, ostracism, or humiliation.

If your stressors are exclusively Category 2, you may not qualify for PTSD but could potentially pursue claims for Adjustment Disorder or Anxiety instead. Misclassifying stressors can harm your claim if PTSD represents a significant portion of your case.

Pain (Chronic Pain as a Factor)
Chronic pain can also be linked to service and contribute to mental health conditions. For DVA purposes, pain typically needs to persist for more than 6 months.

Pain often drives:

poor sleep
irritability
reduced function
low mood

It acts as a strain multiplier, increasing vulnerability to conditions like Depression and Anxiety.

Make sure pain is:

clearly linked to service
described in duration (>6 months)
connected to its psychological impact

Pain Timing Matters
The official date of onset of pain is critical. For example, lumbar pain from 2015 may have contributed to Depression in 2016. However, if the pain condition is only formally recognised as starting in 2025, DVA may not accept it as a contributing factor to the earlier Depression.

Ensure the documented onset of pain aligns with the timing of your mental health condition.

The Format: How to Detail a Stressor in Your Report

To ensure your psychiatrist provides a strong report, each stressor you want should be detailed. I suggest using the following format:

Title: [Provide a succinct title identifying the event (e.g., "Bullying at Recruit School").]

Date: [ Specify a timeframe, even if approximate (e.g., “Between January - August 2010”).]

Role: [Your age rank, position (e.g., “Age 24, Corporal, Infantry Soldier”).]

Event: [Provide a narrative, including:

- Specific actions or words (e.g., “The Sergeant often belittled us with comments such as…”).

- Patterns of behavior (e.g., “This harassment occurred daily over six months.”).

Outcome: [Describe your immediate response, symptoms, or injuries (e.g., “I became extremely anxious, had trouble sleeping, and my mood deteriorated.”).]

Impact: [Explain the broader implications, such as:

- Development of a mental health condition.

- Career setbacks or relationship breakdowns.

- Changes in your personal outlook (e.g., “This event eroded my trust in authority figures.”).]

And repeat for each event you want considered.

It's often easier to do this in writing than it is to talk all this out with a psychiatrist who you don't know. Talking about trauma can stir people up. If you don't think you can do this then make sure you get support e.g. from a psychologist who can teach you skills to help you cope. If you can't get a psychologist there are skills to cope in this course: Surviving Distress .

A slightly easier way of getting the stressors/trauma onto paper is explained in a video here: Trauma Headlines but that relies on the psychiatrist to put it together properly.

What Does “Linking to Service” Mean?

It means demonstrating that:

A qualifying stressor occurred during service
Symptoms developed within the required timeframe
The condition meets Statement of Principles criteria

RH vs. BOP: Understanding Timeframes

For your condition to be linked to service, it must fall within specific timeframes, depending on whether your deployment was:

1. War-like ( Reasonable Hypothesis - RH): A more generous evidentiary standard.

2. Non-war-like ( Balance of Probabilities - BOP): A stricter standard with shorter timeframes and fewer inclusions.

For example:

- For a stressor to meet connection with service for Depression, symptoms must develop within:

- 5 years under RH criteria.

- 2 years under BOP criteria.

Otherwise the stressor not considered "connected to service" and the claim might not get up.

Issues such as Moral injury causing Depression are considered a valid connection to service for Depression under RH but not under BOP.

Other conditions, such as Anxiety Disorder, Chronic Insomnia, Alcohol Use Disorder, or Sexual Dysfunction, also have timeframes that must be addressed explicitly in the report.

Here are some useful links to the relevant DVA criteria (Statement of Principles SOPs) for commonly claimed mental health diagnoses:

Depressive Disorder | Standards: RH | BOP

Anxiety Disorder | Standards: RH | BOP

Alcohol Use Disorder | Standards: RH | BOP

Post Traumatic Stress Disorder Standards: RH | BOP

Don't forget Erectile Dysfunction (ED)!

Service-related mental health conditions (or medications for service related mental health conditions) can result in Erectile Dysfunction. If that applies, make sure you discuss it with your doctor in case it can form part of your claim. ED brings with it points beyond those of the mental disorder that may have causes it.

Erectile Dysfunction | Standards: RH | BOP

If you want some practical help for Erectile Dysfunction, read my popular blog post on it.

Common Pitfalls and How to Avoid Them

1. Failure to Link Diagnosis to Service

Ensure your psychiatrist draws a clear and explicit connection between your diagnosed condition and service-related stressors within the appropriate time frame. This connection is non-negotiable for a successful claim.

2. Vague or Incomplete Stressor Details

Stressors must be described, ideally in the format above, with information about dates, events, and impacts. Ambiguity or omissions can lead to rejection.

3. Overlooking Category 2 Stressors

While not qualifying for PTSD, Category 2 stressors can significantly contribute to other diagnoses like Depression and Anxiety. Ensure they are included and well-documented.

4. Neglecting Timeframes

Confirm that your condition aligns with the required timeframe under RH or BOP standards. This often-overlooked detail is crucial for claim approval.

5. Relying on well-meaning psychiatrists

Confirm your psychiatrist has expertise in writing DVA IL reports. A well-meaning psychiatrist may be happy to give it a go for you, but you may miss out on entitlements if the strict DVA criteria are not satisfied. Well-meaning is nice. Receiving your correct entitlements is nicer. At a pinch, share this blog post with your psychiatrist , hopefully they will already be across everything.

Practical Tips for Veterans

Collaborate Closely with Your Psychiatrist: Ensure they understand the DVA requirements and can articulate the connection between your condition and your service clearly.

Stressors: Use the format I provided above to articulate your stressors and their impacts.

Medical documents: Most people don't report their mental health problems while they are serving for fear of MEC downgrades, going off promotion roster etc. If you did report them while serving that strengthens your case, but generally DVA seem to accept that people often don't report while serving. If you are still serving and not travelling well, get the help you need (and get on the record).

Consider Legal Support for Complex Claims: Firms like Emanuel Solicitors specialise in veteran claims and can provide valuable guidance.

Video explainer: I explain the process I ask veterans to follow in this video .

Final Thoughts

A DVA claim is not just about a diagnosis; it’s about demonstrating a clear and service-related cause. The precision and quality of your psychiatrist’s report can make or break your claim. If you’re unsure where to start, use the recommended stressor format above and impart to your psychiatrist the criticality of connecting the diagnosis to service taking note of the timeframes.

Remember: Your sacrifice entitles you to compensation, but it’s up to you to ensure the process is done right. For more information or assistance, visit my DVA report webpage or email me directly. I help a lot of veterans with their mental health claims and I'm very familiar with the process. If you need to appeal something, then you'll need to take that to the lawyers.

Don’t let an inadequate report stand in the way of the support and entitlements you deserve.

Get it right on the first go.

Kind Regards,

Dr AL

The Biology of Distress

Fri, 08 Nov 2024 21:06:48 GMT

Manage your body's survival reflex

The Biology of Distress: Understanding and Managing the Body’s Stress Responses

In the realm of distress and anxiety management, it’s crucial to understand the body’s biological responses that shape how we feel and react under pressure. From rapid breathing to an adrenaline rush, the intricate dance between carbon dioxide levels, the nervous system, and even the influence of medications forms the foundation of how we experience and manage distress. This blog post will guide you through these essential concepts and offer practical insights for effectively managing crisis moments.

1. The Role of Carbon Dioxide in Stress and Brain Function

When most people think of carbon dioxide (CO2), they see it as a waste product to be expelled with every breath. However, CO2 plays a surprisingly vital role in maintaining brain function and emotional regulation.

Why CO2 Levels Matter

Maintaining Blood pH : CO2 helps regulate the acidity of your blood, influencing how well your brain functions. Low levels of CO2, such as those caused by hyperventilation, can lead to a condition called respiratory alkalosis. This shift in blood pH affects cognition, leading to impaired thinking, exaggerated emotional responses, and physical symptoms like lightheadedness.

Hyperventilation and Panic : Think of times when you’ve blown up a balloon too quickly or engaged in rapid breathing. This accelerates CO2 loss, leaving your brain unable to function optimally. Emotions like fear or anger can escalate to panic or rage, as your body struggles with depleted CO2 levels and impaired cognitive control.

2. The Nervous System’s Role in the Fight-or-Flight Response

Understanding the fight-or-flight response is crucial for recognising why we react the way we do when faced with real or perceived threats.

Activation of the Sympathetic Nervous System:

When danger arises —whether it’s a physical threat or an emotional trigger—your sympathetic nervous system kicks into high gear. This response increases your heart rate, dilates your airways, and releases adrenaline to prepare your body for rapid action.

This system is a survival reflex designed to help you fight or flee effectively , with muscles working hard, producing CO2, and necessitating heavy breathing for oxygen intake and CO2 expulsion.

The Importance of Action:

If the body’s response isn’t matched by physical action (e.g., running or fighting), the excess energy remains unspent, leading to heightened and prolonged distress. This is often seen in panic attacks, where the body reacts as if under threat but remains stationary. There is an accompanying hyperventilation (which can be subtle) that further depletes CO2 levels, amplifying emotional and physical discomfort.

3. The Vagal Nerve and Parasympathetic Response: Putting the Brakes on Distress

To counteract the sympathetic nervous system, we rely on the parasympathetic system. Of relevance is the vagal nerve which acts on the organs to apply the breaks on the stress response. . This nerve acts as a calming mechanism, slowing down the heart rate, reducing breathing speed, and diminishing adrenaline production.

How to Activate the Vagal Nerve:

Cold Water Immersion: The mammalian dive reflex, triggered by immersing your face in cold water, is an effective way to activate the vagal nerve and calm the body.

Pressure and Posture: Lying on your back with your legs elevated or engaging in inversion exercises can stimulate the vagal nerve.

Humming, Laughter, and Gargling: These activities can engage parts of the nerve running through the larynx, promoting relaxation.

4. Medications: When and Why They’re Used

While medications can play a role in managing distress, they often come with limitations and side effects. Understanding their pros and cons helps frame why skills should be prioritized over pills.

Medications and Their Effects:

Antidepressants: Often used to reduce sensitivity to distress, they can help patients manage symptoms in the short term but do not address the root causes of anxiety or distress.

Sedatives and Benzodiazepines: These work by dampening nervous system activity but can lead to dependency and reduced effectiveness over time.

Beta Blockers: Commonly used for performance anxiety, they block the effects of adrenaline, reducing the physical sensations of anxiety without impairing cognitive function.

Skills Before Pills Philosophy:

While medications can provide temporary relief, building a repertoire of skills—like burst physical activity, slow breathing, and vagal activation techniques—offers more sustainable, effective control over distress. These practices empower individuals to manage their reactions without relying on external substances that may lose effectiveness or carry unwanted side effects.

5. Practical Takeaways for Managing Distress

Understanding the biology of distress is a powerful tool for reclaiming control in moments of crisis. Here are some immediate-action strategies:

Burst Physical Activity: If you’re feeling fearful or panicked, engage in short, intense exercise (e.g., running up and down stairs or doing burpees) to restore CO2 balance.

Controlled Breathing: Practice slow breathing to prevent hyperventilation and allow CO2 levels to normalize gradually (not deep breathing which can exacerbate the hyperventilation issue). .

Vagal Activation Techniques: Experiment with humming, applying cold water, or engaging in calming activities to engage the parasympathetic response.

Conclusion: Mastering Distress with Skills

While medications can assist in certain cases, they should not be the primary solution for distress management. Developing and practicing skills builds confidence and resilience, allowing individuals to navigate intense emotional and physical responses effectively. By understanding and leveraging the biology of distress, anyone can learn to face challenges with greater calm and control.

The Biology of Distress video

The Surviving Distress Course

The Five Dials: A Practical Guide to Medication and Mental Health

Wed, 30 Oct 2024 06:29:49 GMT

Crutches help you get to the surgeon.

Meds can help you get to a point were you can address the root causes.

The Five Dials: A Practical Guide to Medication and Mental Health

Welcome to a deep dive into the "Five Dials" framework—a practical way to understand how different types of medication affect your mood, motivation, arousal, and overall mental health. This post is based on insights from our latest book, The Depression Solution , and is designed to provide clarity on how medications work and what they do (and don’t do) for depression and anxiety. Let’s break it down, dial by dial.

The Five Dials: A Framework for Understanding Medications

Think of your mental health as a control panel with five key dials you can adjust:

Sensitivity (Serotonin)
Mental Arousal (Noradrenaline)
Bodily Arousal (Adrenaline)
Motivation and Reward (Dopamine)
Sedation (Calming Everything Down)

Different medications work by tweaking one or more of these dials. Let’s walk through how each one works.

1. Sensitivity: The Serotonin Dial

Selective serotonin reuptake inhibitors ( SSRIs ) are among the most prescribed antidepressants. They tweak the sensitivity dial by increasing serotonin levels, reducing emotional sensitivity.

How it helps: You feel less overwhelmed by negative emotions. Life feels a bit more manageable. But too much dose and you might feel blunted or zombified.
Example Medications: Fluoxetine, Sertraline, Fluvoxamine (my favorite—it also helps reduce anxiety through the sigma receptor).
Sedatives and Sensitivity: Sedatives also reduce sensitivity but at the cost of flattening emotional responses across the board.

2. Mental Arousal: The Noradrenaline Dial

Noradrenaline (or norepinephrine in the U.S.) boosts mental arousal, helping you feel sharp and focused. However, this comes with pros and cons.

How it helps: At low doses, noradrenaline can improve alertness and cognition.
Risk: Too much can increase anxiety, especially with medications like serotonin-noradrenaline reuptake inhibitors ( SNRIs ).
Medications Used:
SNRIs: Effective but tricky—higher doses increase anxiety.
NRIs (like Reboxetine): A more targeted option when used sparingly on days you need the mojo, not on days were your on the brink of panic..
Clonidine: Reduces mental arousal and is useful for PTSD-related nightmares.

3. Bodily Arousal: The Adrenaline Dial

This dial regulates how physically revved up you feel. Elevated bodily arousal can feel like a stress response (think racing heart or sweaty palms).

How it helps: Reducing bodily arousal can make you feel calmer in situations where your body feels overwhelmed.
Medications Used:
Propranolol : A go-to for managing PTSD symptoms by blocking the physical panic response.
Seroquel for sleep: Another option to reduce physical overdrive, potentially useful for sleep issues and nighttime agitation, but weight gain and blunting of mood might be a factor.

Even caffeine affects this dial—it’s detected by the body as a toxin, triggering a mild stress response. Cutting down can help reduce overall arousal.

4. Motivation and Reward: The Dopamine Dial

Dopamine drives motivation and reward, giving you that "feel-good" sensation from success or pleasure. However, over-reliance on dopamine from medication can dull natural rewards over time.

How it works: Stimulants and some antidepressants boost dopamine, increasing motivation and energy.
Challenges: If your brain becomes too used to dopamine boosts, you may experience a “dopamine threshold” problem, making everyday pleasures feel underwhelming.
Medications Used:
Stimulants: Like those used for ADHD, which increase dopamine significantly.
Monoamine oxidase inhibitors (MAOIs): Old-school antidepressants, often a last resort.
Antipsychotics: Reduce dopamine, which can help with mania but can also flatten emotions if used long-term. Blocking dopamine can mean blocking positive emotion potentially contributing to anhedonia.

5. Sedation: Turning Everything Down

Sometimes, the body and mind just need a break. Sedatives lower arousal and sensitivity but come with trade-offs.

How it works: Sedatives turn down all the other dials, helping with agitation and insomnia, but can dull emotions and energy.
Medications Used:
Benzodiazepines: Fast-acting but addictive; best used in more dire situations.
Antihistamines: A option for occasional sleep issues.
Antipsychotics: Sometimes prescribed for sleep, but they blunt dopamine responses, which can reduce motivation and pleasure.

A Word on Medication and Root Causes

While medications can help adjust these dials, they are not the end game. They are helpful thought of as the crutches that get you to the surgeon. The goal is to address the root causes of depression and mental health struggles. Medications can provide relief , but long-term recovery comes from addressing root causes. That can entail building skills, changing habits, and finding meaning. We explore many of the root causes of Depression in our new book, The Depression Solution .

We always advocate for skills before pills, but in some cases, medications give people the confidence to practice those skills. When used correctly, they can be a powerful tool, but the focus should always be on addressing the underlying issues driving distress.

Conclusion: Adjusting the Dials is not addressing root causes

The "Five Dials" framework offers a practical way to understand how medications impact mental health. Each medication tweaks one or more dials, and finding the right balance is essential.

If you’d like to explore this topic further and learn more about addressing root causes , check out our book The Depression Solution .

Remember:

The goal isn’t just symptom relief (meds)

It’s getting to the heart of what’s really going on (root causes).

Here's the video explainer where Dr AL and Jess explain how this works.

Download our recent PDF summary of medication and mood.

Download the root cause book: The Depression Solution .

Erectile Dysfunction in military and veterans: A practical guide

Thu, 10 Oct 2024 05:15:58 GMT

Erectile Dysfunction is common in PTSD

Overcoming Erectile Dysfunction in Military Personnel:

A Practical Guide

Erectile dysfunction (ED) is a common issue among men in the military, even young men. Often stemming from psychological factors which caused a failed sexual encounter, particularly when anxiety plays a role. These episodes can create a vicious cycle where fear of further failure worsens anxiety, making future encounters feel daunting. It hits one right in one's manhood. It's demoralising. It's quite common in Depression , Anxiety and PTSD .

This guide provides practical steps for breaking this cycle and regaining confidence and your mojo.

Understanding the Vicious Cycle of ED

The first step in overcoming ED is recognising the cycle of anxiety-driven dysfunction. It often begins with one or more episodes of ED, frequently linked to high-pressure situations (e.g., excess stress), anxiety, guilt (e.g., infidelity), or substance use (e.g., alcohol). When an erection fails to occur, the individual may start to fear repeated failure, increasing anxiety about performance, which in turn can cause further episodes of ED.

Simply put: worriedly focusing on the hard-on tends to weaken it.

Initial Steps to Break the Cycle

Acknowledge the Anxiety: Recognise that performance anxiety is the problem. This is a normal reaction to the previous experiences, and understanding that is a critical first step toward overcoming the issue. For young men, it’s rarely a physical problem, which is reassuring because psychological causes can usually be remedied. That's what this blog is about!
Avoid Alcohol and Substance Use Before Sexual Encounters: While alcohol might seem to help with relaxation, it can impair sexual function ("brewer's droop"). Staying sober ensures that any issues experienced aren’t worsened by intoxication.

Proper Use of Medications: Viagra is a useful crutch

Managing Expectations with Medications: Viagra (sildenafil) works by indirectly limiting the breakdown of substance that relaxes blood vessels. The relaxing blood vessel walls to increase blood in the penis. Viagra won’t automatically induce an erection; sexual arousal is still required. Viagra-assisted erections typically come more easily, are firmer, and last longer than usual. The medication's effects last for 4-8 hours, sometimes even longer, but an erection will go away once arousal ends unless you get aroused again.
Dose matters: Getting the dosage right may require some experimentation: sometimes, just a quarter of a tablet makes a big difference. Larger doses can produce more dramatic results but may also cause headache, which could detract from arousal. It's reasonable to start small and find the minimum effective dose to avoid overusing the medication. In Australia, it comes in 25mg, 50mg, and 100mg strengths. There are only four tablets in a packet, so it can feel like you are wasting them if a sexual encounter doesn't transpire. A common starting point is ¼ of a 50mg tablet. That means you get 16 doses out of a packet of 4 tablets. They are fiddly to cut, but a pill cutter can make that easier.
Timing Matters: Take Viagra approximately 30-60 minutes before anticipated sexual activity. If you're on a date and things are looking promising, it's better to take the medication preemptively rather than waiting until the last moment, which can be demoralizing if it doesn’t have time to take effect.
Avoid Over-Reliance on Meds: While Viagra is helpful for breaking the anxiety-ED cycle, think of it as a temporary tool—like crutches for a healing leg. The goal is to build confidence with its help and eventually reduce reliance on it.
Side Effects: Viagra is generally well-tolerated, but it can cause side effects, especially at higher doses. Common side effects include headaches, flushing, and nasal congestion (caused by changes in blood flow in erectile tissue present in the nose).

Focus on Enjoyment with the Reassurance of the Viagra

Get Comfortable with the Viagra: Engage in sexual activities without the pressure to perform perfectly. This could include solo experimentation to understand the medication's effects. When with a partner, a supportive environment is ideal. Single individuals may have to navigate dating, which can add pressure, so don’t underdose. If you're prone to headaches, take some paracetamol to lessen the impact.
Set Realistic Goals: Focus on intimacy and satisfying your partner in other ways (e.g., manual or oral stimulation). Doing so tends to be arousing and takes your focus off your erection. This approach keeps your attention on your partner, rather than on your own performance. Gradually work towards full sexual activity as anxiety decreases and arousal increases. If you get soft, swap out to manual or oral stimulation.
Practice Makes Perfect: As you become more comfortable, keep practicing to create positive experiences that replace previous negative associations. Avoid porn completely and refrain from ejaculation in the days prior to a sexual encounter to stack the deck in your favor. Masturbation while refraining from ejaculation will build up more sexual tension.
Gradual Tapering of Medication: Once you’ve had successful encounters with Viagra, consider gradually reducing the dose/use. Techniques that boost nitric oxide naturally, like sunlight exposure on large areas of skin (without burning), can help maintain blood flow and support natural erections.

Alternative Therapies and Techniques

Pelvic Floor Exercises (Kegels): Strengthening the muscles involved in erections can improve erectile function. Practicing Kegels daily can increase muscle control and blood flow, leading to stronger erections. Try contracting the muscles used to stop urination, holding for five seconds, and then releasing. Aim for three sets of 10 repetitions daily.
Anxiety Alleviation Techniques: Employ tactical breathing before sexual activity to reduce anxiety. For example, inhale for a count of four, hold for four, exhale for four, and pause for four.
Natural Methods to Increase Nitric Oxide: Exposure to sunlight on large areas of skin boosts nitric oxide production, improving blood flow and supporting erections naturally. Aim for 30+ minutes of direct sunlight on your body (strip down to your shorts, no sunscreen), turning over after 15 minutes. Do this when your shadow is longer than you are tall to avoid sunburn. Supplementing with arginine may also help, as the body uses it to produce nitric oxide.
Constriction rings ("cock rings") are elastic devices placed at the base of the penis to restrict blood flow, helping to prolong an existing erection by keeping blood in the penis. They can be helpful but require practise in their use.
Circulatory Breathing ("Microcosmic breathing") This alternative practice, rooted in Taoist traditions, involves a breathing technique that alters blood pH to enhance emotional state while engaging in non-ejaculatory masturbation. The idea is that is builds and retains "sexual energy". It can heighten arousal and enhance control over sexual function, it can intensify and prolong arousal, potentially contributing to better sexual function.

Factors That Can Worsen ED

Certain medications and lifestyle factors can make ED more challenging to manage, especially for those with PTSD. If the Viagra isn’t quite doing the trick, then chat with you doctor about the issues raised below. Delaying a dose can sometimes open up a window for the function to improve.

Antidepressants: Medications like SSRIs and SNRIs, commonly prescribed for mood, anxiety or PTSD, can cause or worsen ED as a side effect. They typically delay ejaculation, often decrease libido and, but sometimes they make it harder to achieve an erection. If you notice these symptoms, speak to your doctor about adjusting the dose, switching medications, or differently timing/skipping your dose before a planned sexual encounter.
Blood Pressure Medications (e.g., Clonidine, Prazosin): These medications are sometimes used to manage PTSD symptoms, such as nightmares and hyperarousal. However, they can contribute to erectile difficulties. It’s worth discussing with your doctor whether it’s safe to skip or delay these medications in the lead-up to a sexual encounter to reduce their impact on erectile function.
Alcohol and Recreational Drugs: While alcohol might initially seem to help relax you, it can impair sexual performance. Recreational drugs, particularly depressants can also worsen ED by affecting your central nervous system.
Sedatives and Sleeping Pills: These medications can dull arousal and make it difficult to achieve or maintain an erection.

Long-Term Strategies

Professional Help: If ED persists, it may be necessary to explore deeper psychological factors. Therapy can address underlying trauma, stress, or negative thought patterns that might be contributing to the issue. Testosterone can be checked, but low testosterone is mostly associated with low libido rather than erectile function and is rare in young people.
Lifestyle Adjustments: Strength exercises, meat, hydration, and adequate sleep can positively impact overall health, which in turn enhances erectile function. Avoiding a sedentary lifestyle, excess weight, poor diet, and alcohol use will also help improve erectile function.

Conclusion

Erectile dysfunction is most often a treatable condition, especially when addressed with practical strategies. By understanding the anxiety cycle, using medication appropriately, and incorporating alternative techniques, young men in the military can overcome ED. Remember, progress is gradual, and setbacks may occur. Consulting a healthcare professional to rule out other underlying conditions and guide treatment can be an invaluable step.

Side Note: DVA claims

Making a veteran's claim for erectile dysfunction is an important way of honouring your sacrifice to service. In Australia, DVA claims for Erectile Dysfunction provide "points" which should not be left off the table. You need to address strict criteria for the claim to "get up"! So make sure the doctor who does your report addresses the linkage to service e.g.: "The veteran's Erectile Dysfunction is connected to service, as he had service-related clinically significant disorders of mental health at the time of the clinical onset of Erectile Dysfunction" .

I have helped many veterans with DVA claims and if you need a psychiatrist to help with an Australian DVA claim, take a look at my DVA report page .

Kind regards,

Dr Al Griskaitis, psychiatrist

Stubbornness may prolong suffering in PTSD

Wed, 28 Aug 2024 23:42:53 GMT

Stubbornness can keep traumatised people stuck

Flex Your Mind: How Boosting Cognitive Flexibility Can Help Overcome PTSD Rigidity

Stubbornness and Low Openness Make PTSD more likely and Harder to Treat

In my work with police and military personnel suffering from PTSD, I’ve noticed something striking: those who are stubborn or low in openness—traits that psychologists often measure—tend to have a tougher time benefiting from trauma processing treatments. I’ve long suspected that this stubbornness or rigidity, which shows up as a difficulty in seeing things from a different perspectives and a refusal to act differently gets in the way of moving forwards. After all, being stuck in one way of thinking and acting can make it harder to learn from trauma and limits post-traumatic growth. The trauma alarm remains because the lessons of the trauma are not embodied. Most high rating searches on PTSD won't even note this important risk factor.

Research Confirms That Cognitive Flexibility Reduces PTSD Symptoms

Curious to see if the science backed up my hunch, I dove into the research and found a 2018 Israeli study that really hit home. Conducted by Ziv Ben-Zion et al and published in Frontiers in Psychiatry , this study looked at whether neurocognitive training—essentially, exercises designed to boost mental flexibility—could reduce PTSD symptoms in trauma survivors. The results were compelling: people who had better cognitive flexibility ended up with significantly less severe PTSD symptoms over time. Even more encouraging, those who participated in early neurocognitive training saw a noticeable drop in their PTSD symptoms compared to those who didn’t get the training. Specifically, the intervention group experienced about a moderate to high reduction in symptom severity.

Enhancing Cognitive Flexibility Is a Practical Way to Mitigate PTSD

What does this mean in plain English? Essentially, by training your brain to be more flexible, you might be able to reduce the grip PTSD has on you. This also might explain why psychedelic treatments—known for increasing openness as a personality trait—have shown promise in some cases. In fact, if a mystical experience is induced by psilocybin this may boost openness by about 20% ( MacLean et al ., 2011). Psychedelics come with their own set of barriers and challenges and are not generally used for this purpose.

Neurocognitive Training Could Be the Key to Overcoming Rigidity

So, what can you do? The good news is that you don’t need to venture into uncharted territory to start reaping the benefits of increased cognitive flexibility. Clinically, focusing on increasing openness through cognitive flexibility training could make a real difference for those stuck in rigid thinking patterns. This approach could be particularly helpful for people who find themselves resistant to traditional PTSD treatments.

How Rigidity impacts

A common cause of accumulated trauma that leads to PTSD:

The rigid willingness to continue to stay situations that are causing one harm.

One of the biggest barriers I see to recovery from PTSD is in part a result of mental inflexibility:

The unwillingness to change.
The unwillingness to do things differently.
The unwillingness to let go of what doesn't work.

Training Boost Flexibility and Reduce PTSD Symptoms

Actionable Tip: You can start by downloading a validated cognitive training app like BrainHQ and focusing on exercises that target mental flexibility. Commit to using the app for 30 minutes a day over the course of a month, and you might see an improvement in your cognitive flexibility—and with it, some reduction in PTSD symptoms. Look for tasks like the Stroop Task (which helps you manage conflicting information) or Switching of Attention exercises (which teach your brain to shift gears smoothly). It may also improve your mental fatigue by increasing mental fitness. And it doesn’t stop there. Games like Tetris , which requires you to fit falling shapes into the right spots, or Sudoku, which challenges your logic and pattern recognition skills, can also help loosen up that rigid thinking. Clearly it's not a panacea, but Incorporating these activities into your daily routine could help you develop a more adaptable mindset, making it easier to process trauma and move toward healing. Try it for a month.

[We have no affiliation with BrainHQ or any other app]

Anger: the Family-Destroying Demon of PTSD

Sat, 17 Aug 2024 05:05:39 GMT

Emotional fatigue makes it hard to stop the demon from emerging. Upgrade your brain with an anger early warning system.

One of the hardest things about PTSD is how it changes you. Once, you were the calm, steady hand in the family. But now, your nerves are on edge, and the smallest things can set you off. Anger can be with worst part of PTSD. Things that never used to bother you—kids playing, a TV left on, a frustration about some reservations —now overwhelm you, like an assault. This isn't just about being irritable; it's about being on edge all the time, with no off switch.

You think it's bad now? It will get worse if you don't address it.

That emotional and mental fatigue you're feeling? It’s real, and it strips away your patience. The subtlety you used to have, that ability to keep a lid on things, is gone. What comes out instead are harsh words and cutting responses that can cause wounds to your relationships.

Possessed by Anger: The Demon Comes Out

When you become angered, it’s almost like you’re possessed by the spirit of the anger. You do or say things you would never do or say if you were calm. It’s like a demon comes out through your words and actions, and this demon seems hell-bent on destroying your family. While this demon cannot be exorcised completely, you can learn to control it so it doesn’t possess you. So it doesn't destroy your family.

Emotional Fatigue

PTSD puts you on a rollercoaster of negative emotions. The hyperarousal is exhausting, the anxiety is intense, and the lows are crushing. Over time, this leads to something called emotional fatigue. It’s not just about being tired; it’s about being emotionally worn out. Your capacity to keep raw emotions in check is shot. You’re more sensitive, way more irritable, and less able to give a damn about things you once cared about deeply or enjoy the thing you used to enjoy.

When you're emotionally fatigued, the smallest things can push you over the edge. You’re less agreeable, more likely to snap, and prone to empathy lapses. The result? The demon comes out easily. You become someone who’s more difficult to live with, and that takes a toll on everyone around you.

Those Horrible Moments:

The Distress Cycle Explains the Anger Process and helps you see the demon coming - An early warning system.

Here’s the thing about anger: it doesn’t just come out of nowhere. It’s part of a cycle: The Distress Cycle . This process explains why you react the way you do. It all starts with an event causing a snap judgment. A snap judgement is a subconscious shortcut your brain takes to quickly assess a situation. But when you’re emotionally fatigued, these snap judgments are more likely to be exaggerated unhelpfully .

Here’s how The Distress Cycle works (also refer to the diagram below):

First Lap

Event : Something happens—maybe something small, like a comment from your partner.
Snap Judgment : Your brain quickly interprets this event, often jumping to the worst possible conclusion.
Emotion : That judgment triggers a strong emotion—anger, frustration, which gets adrenaline going.
Physical Symptoms: Your body responds to the adrenaline—your heart races, your muscles tense up, your fists and jaw clench.
Emotion overwhelm : The adrenaline on top of the emotions leads to an intensification of the anger. Anger can intensify to rage (anger to rage, fear to terror, sadness to despair).
Urge to act : You feel an overwhelming urge to act on the emotion. Anger/rage causes an attack urge. It’s like a demon is on the verge of possessing you.
Regrettable Action : You act on that urge; it’s something you wish you hadn’t done—a verbal attack is common, but it might be worse. It’s like you were possessed for that moment.

It's not over yet.

Second Lap

Event: That verbal attack you just did is the new event. You’ve just yelled about something trivial, and now your evening has gone from bad to much worse.
Snap Judgment: Often self-recrimination—“I’m broken, I’m deeply flawed.”
Emotion : Sadness. If intense, then there’s adrenaline and despair, isolation, or even suicidal ideation because the suffering seems inescapable.
etc

Understanding this cycle is crucial because it gives you a chance to interrupt it before it spirals out of control. It helps you learn how to tame the demon (we’ll show you the way below). I don't know a more effective way out of the trap of anger than to use the Distress Cycle as the scaffold to stop being possessed by anger.

Approaches to Addressing Anger

Medications May Help for a While

SSRIs ( antidepressants ) can reduce sensitivity and irritability, but tolerance to them means that this effect is usually temporary. Chasing higher doses isn’t a sustainable solution. Tolerance usually means a break is needed, but rebound worsening of irritability can be an issue. So don’t count on it as the enduring solution. But they might help you do the work to achieve the real solution: metacognition.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is a talking therapy approaches that is helpful for many. CBT needs a psychologist who is skilled at working with PTSD and anger. Supportive therapy, the most common way CBT is employed (in Australia) is not very helpful for anger.

Mindfulness

Mindfulness is excellent for anger, but the difficulty with mindfulness approaches in PTSD is that when one attempts to still the mind, one can be flooded with trauma memories. This interferes with mindfulness practice making it impossible for many.

Metacognition: The warning that anger is about to possess you.

The Power to Stop the Demon from Possessing You.

The Distress Cycle is the best tool you can master to take control of yourself. By performing an “anger autopsy” after any episode of anger, you will get much better at recognizing anger before you act on it regrettably. Metacognition is the real-time insight into what’s happening in your head. It can help you keep the demon from coming out in that critical moment. It functions as a warning system that anger and regrettable action is immanent.

Dedicate yourself to understanding and embodying the Distress Cycle if you want to stop the demon from coming out. Memorize the Distress Cycle and do an anger autopsy using a D istress Cycle worksheet after any anger. The more you do this, the more capacity you will have to prevent the demon from coming out. Doing it once will accomplish nothing. You may need dozens of reps before it starts to impact metacognition. The install takes work to stick. Are you committed to change or just paying lip service to change? The anger autopsy that is the Distress Cycle work sheet will turn anger episodes into growth opportunities: anger becomes a means of change, rather than just a means of destruction. You will develop the capacity to gracefully exit the situation rather than letting the demon destroy your family.

There are many skills you can overlay on the Distress Cycle to lessen sensitivity and improve your predicament. If you want to do a deep dive on how all this works, you can check out our online course, Surviving Distress . It's wise to do this with your partner so you learn a common language, which will help with communication about this. This will help you both understand the processes and the skills so you can approach the issue of anger as a unified team. Such a united approach is the remedy the toxic default of "apologetic aggressor" versus "aggrieved victim". No one wants to be either of those positions, better to be a partnership: united to solve a problem.

Install the Distress Cycle into your brain by memorising the Distress Cycle and by doing the Distress Cycle worksheets.

I wish you well on this journey to subdue the demon of regrettable anger.

Bruxism and PTSD: The Teeth Keep the Score

Sat, 29 Jun 2024 07:27:18 GMT

Bruxism: The Teeth keep the Score in PTSD

How PTSD Can Lead to Bruxism and Dental Issues: The Teeth Keep the Score

By Dr Al Griskaitis, Psychiatrist

Bessel van der Kolk noted in PTSD that " The body keeps the score ".

Bruxism "the gnashing of teeth" is a literal example of that.

What is Bruxism?

Bruxism is the involuntary grinding or clenching of teeth. It can occur during waking hours (awake bruxism) or during sleep (sleep bruxism). Common signs include worn-down biting surfaces of teeth, erosion of teeth at the gumline ( abfraction ), jaw pain, headaches, and increased tooth sensitivity. While bruxism is often associated with transient stress, its common connection to PTSD highlights a bodily impact of feeling endangered. Bruxism likely relates to this chronic state of increased arousal from PTSD which can be further exacerbated by alcohol and some medications.

What is PTSD?

I posit that it is more than a reaction to trauma with a syndrome of symptoms, that's too low resolution. Post-Traumatic Stress Disorder (PTSD) occurs when a very serious adversity leads to a " alarm state" which is a chronic state of increased arousal. The alarm never stops because the subconscious perceives an ongoing susceptibility to further danger. PTSD also entails intrusive memories/nightmares which can serve as clues to resolve the susceptibility. The longer the trauma susceptibility goes on, the deeper the impacts of cumulative mental, emotional, and physical fatigue . That fatigue brings irritability, anhedonia and depression.

The Link Between PTSD and Bruxism

PTSD can contribute to the development or exacerbation of bruxism through several interconnected mechanisms:

Physiological Response: The ongoing sense of danger causes heightened physical arousal and chronic stress, leading to increased muscle tension throughout the body, including the jaw muscles involved in bruxism.
Neurological tone: The ongoing perception of danger ramps up autonomic nervous system, specifically a tonal shift to the sympathetic (arousal) system and away from the parasympathetic (calming) system.
Hypertrophy: Constant muscle tension from bruxism can lead to hypertrophy (muscle growth) of the jaw muscles. The stronger they get the more potential for wear on teeth surfaces and abfraction near the gums.
Endocrine Factors: Increased adrenaline (epinephrine) secretion because of the acute "triggers" over and above the chronic alarm state of PTSD further contributes to muscle tension and bruxism.

Clinical Implications

Chronic teeth grinding can exacerbate existing dental problems, it can cause tooth wear, fractures, jaw pain and temporomandibular joint (TMJ) dysfunction. Here's a recent study . Recognizing bruxism as a potential symptom of PTSD is crucial to prevent dental damage among people with PTSD.

Treatment Approaches

Managing bruxism in the context of PTSD requires a comprehensive approach that addresses both the psychological and physiological aspects and root cause:

Root cause Interventions: Treatment of underlying PTSD symptoms through distress tolerance skills, Eye Movement Desensitization and Reprocessing (EMDR), and trauma susceptibility work can reduce bruxism over time.
Dental Interventions: Custom-fitted occlusal splints (bite guards) can protect teeth from further damage during sleep and periods of heightened stress.
Botulinum Toxin A Injections: Injections into the masseter muscles can weaken muscle strength, reducing hypertrophy and the severity of bruxism. Initial treatments may require quarterly sessions, reducing in frequency as muscle hypertrophy resolves.
Combination of approaches are the best mitigation for dental damage.
Acceptance-Commitment Therapy (ACT Therapy) can help address the underlying psychological causes (see next section).

Patient Stories and Moral Injury

I mostly work with police and military PTSD and most of my patients have bruxism. Real-life examples underscore the connection between PTSD and bruxism, highlighting the need for integrated treatment approaches in improving symptoms and overall quality of life for individuals affected by PTSD complicated by bruxism. It's very common. Clinically there seems to be a strong relationship between Moral Injury and bruxism, which resonates with the biblical idea of one's actions/inactions leading to despair and the "weeping and gnashing of teeth". Moral Injury can benefit from moral solutions. A type of therapy called Acceptance-Commitment Therapy (ACT Therapy) can be most useful. This therapy usually entails a painful acceptance of difficult truths of the events(s), such as the revelation of self-betrayal of one's values or recognising the results of misplaced trust (another form of self-betrayal). A careful exploration of one's "gut" values so that one can crystallise them and make a commitment to follow one's values in the face of morally challenging predicaments is undertaken. Undertaking ACT therapy is an challenging act of self-compassion, forgiveness and atonement.

Preventive Measures and Self-Care

In addition to professional treatment, individuals can adopt self-care practices to manage bruxism and support overall well-being:

Tension-Release Exercises (TRE): These exercises allow the body to mimic the "post-traumatic shaking reflex" seen after acute trauma. That shaking reflex is what you observe if you've ever seen an acutely traumatised person. The reflex probably promotes parasympathetic down-regulation to alleviate jaw tension. That can give relief for several hours.
Distress and stress skills: Learning the skills to manage, prevent and recover from states of Distress can be a game-changer, here's our online course for that: Surviving Distress .
Regular Dental Check-ups: Routine visits enable early detection of bruxism-related dental issues and prompt intervention.

Conclusion

If you have PTSD, ask your ask your partner to listen out for dental grinding at night and ask your dentist to assess and monitor for signs of bruxism. If you get jaw tension during the day or wake up with jaw soreness, get checked out ASAP. People can be bruxing for years and accumulate a lot of expensive and permanent damage. Early intervention and a holistic treatment approach can mitigate the impact of bruxism on dental health and overall quality of life.

Don't let your teeth keep the score.

Exploring our Schema Therapy Resources

jess@thepsychcollective.com (Jess O'Garr) — Sun, 09 Jun 2024 02:07:22 GMT

Finding the right resource for your needs

I love Schema Therapy. It makes so much sense to me. I first attended a Schema Mode Therapy workshop in 2014, walking into it knowing nothing and walking out with resonating in my bones. The facilitators put us through our paces. We had to work on ourselves and participate in the experiential activities to get a feel of what we are asking our patients to do. I learnt, I cried and I left with a determination to share my knowledge with everyone. Fast forward to April 2022 and I finally released my first eBook on Schema Mode Therapy. Since then, we have created a stack of free and paid resources for Schema Therapy and Schema Mode Therapy. And with this plethora of resources, I often get asked which resources would be most suitable for people's needs.

What is the difference between Schema Therapy and Schema Mode Therapy?

This is probably the most important thing to sort out first. They are two related yet separate types of therapies.

Schema Therapy could be described as advanced Cognitive Behavioural Therapy (CBT). It makes the assumption that your early childhood needs were not met and therefore you developed negative beliefs about yourself and your position within the world. These negative beliefs (also known as core beliefs) were categorised into themes. These themes are the Schemas. Initially, Jeffery Young identified 18 maladaptive schemas and then Oz Yalcin did his PhD on reviewing the list of schemas and found that there are actually 20. All of our schema resources now use the revised list of 20.

So, Schema Therapy uses cognitive restructuring techniques to address the maladaptive beliefs associated with these schemas to create meaningful change. However, this can take a long time as these beliefs usually have been held since childhood. It is important to note that it is possible to have a healthy childhood with all emotional needs met and then have a traumatic incident in adulthood that shakes your belief system to its core, and then you develop maladaptive beliefs, though this is less common.

Schema Therapy will also use behavioural techniques like behavioural pattern breaking to encourage new behaviours or ways of responding when schemas are activated. This is similar to standard CBT.

However, Schema Therapy goes beyond traditional Cognitive Therapy because it incorporates experiential activities to manifest change by influencing feelings. It is common for a patient to reach the point where they know something isn't true but it still feels true. This is where schema therapy really excels because techniques like imagery rescripting and chair work can help to shift the feelings someone has about themselves in response to a memory or belief.

Let me give you an example of how I use Schema Therapy with a patient.

Sarah is a 42 year old mother of two who works as an Admin Manager. She takes her role very seriously and often stays up until 1am completing work tasks that she doesn't have time to finish whilst in the office. She is presenting for treatment of burnout.

We identify that her mother put a lot of pressure on her growing up to get good marks and be helpful to everyone. Sarah was taught to put others first and not be lazy. She has an Unrelenting Standards schema and a Self-Sacrifice schema.

After an assessment to understand why she has come to therapy and what her upbringing was like, we used the YSQ-R questionnaire to identify which schemas were strongest. Then we made a plan to tackle them.

Sarah downloaded the Schema Therapy workbook to understand more about her schemas and to complete the self-reflection worksheets for homework. We then used the Schema Awareness pages together to go through this in more detail (from the Treatment Guide eBook). Once Sarah had an understanding of her schemas, we started to use the Schema SWITCH worksheet to plan an alternative way of thinking about her perfectionism and people pleasing.

We talked about ways of setting boundaries and saying no. We also discussed ways of talking to her boss about her workload which she had been hiding for fear of getting into trouble. From this, we used the Behavioural Pattern Breaking worksheet to plan a behavioural experiment to see what would happen if she started to say no at work.

Sarah was making good progress with her self-talk and was setting some boundaries, but she still felt like she was going to disappoint someone. So we used chair work to imagine that her younger self was sitting in the chair next to her and was feeling the pressure from Mum to always perform at a high level and take care of others. With my coaching, she spoke to her younger self to reassure her that she would not be rejected for taking time out for self-care. We also brought her mother into the image and talked to her about how her expectations were unrealistic and she needed her mother to love her for being kind and loving, rather that for her output and performance. From this, Sarah was able to let go of the guilt she felt about taking time for self-care and saying no to unreasonable requests.

Schema Mode Therapy uses similar approaches but it conceptualises the situation in a slightly different way and is more useful with complex presentations. Schemas are the beliefs that one holds about themselves and the world. Schema Modes are the expression of those schemas when they are activated. The modes represent the emotional and behavioural responses that play out in the moment when the schema is triggered. These responses can flip rapidly and thus this therapy looks at the bigger picture and needs to consider all relevant modes at once. Our resources talk about 17 different modes. However, the labels for the modes can be personalised as long as they always include Child Modes, Maladaptive Coping Modes, Dysfunctional Parent Modes, and Healthy Modes.

Schema Mode Therapy still uses cognitive, behavioural and experiential techniques, but it has a greater emphasis on the experiential work, and incorporates more limited reparenting, which is when the therapist emulates the role of the Good Parent to give the patient the experience of being cared for by a parental figure who cares about them and teaches them how to get their emotional needs met (within the boundaries of an appropriate therapeutic relationship).

I use Schema Mode Therapy on myself. My Healthy Adult regularly has chats with my Vulnerable Child to make sure she is travelling okay and set limits on my Perfectionistic Overcompensator who always tries to overdo any project. I have to set limits with my Demanding Parent about the expectations are on my time and resources and make sure I allow time for my Happy Child to play otherwise I will burn out.

To see this in action, check out this video:

Want to learn more?

To help you with your journey through either Schema Therapy or Schema Mode Therapy, we have developed a range of resources. Some of them are written for patients, some are directed more at therapists and others are designed for both.

Schema Therapy

The Complete Set of Worksheets

This resource has been developed for patients (and therapists) who want to learn more about each of the 20 maladaptive schemas . It has a page per schema and discusses the what the schema is, how it develops, which need it relates to and what the Healthy Adult response would be. On the back of each worksheet is a self-reflection page for you to consider how this schema shows up in your life.

It also includes the 14 adaptive schemas , giving a definition and description of each, along with self-reflection questions to consider how you can strengthen these schemas.

This workbook is designed to enhance your understanding of schemas but does not include skills

Schema Mode Therapy

The Complete Set of Worksheets

This workbook focuses on the 17 schema modes . If gives a detailed description of each of the schema modes and the mode diagrams explain the maladaptive and adaptive distributions. On the back of each page is a worksheet for Mode Awareness and Mode Management. At the end is a Health Adult Mode Map for you to plan your management plan for each mode.

This workbook will give you some ideas on what needs to be done to address each mode but does not go into details of how to implement the skills.

Schema Therapy

Treatment Guide

This eBook was written for therapist who have been trained in Schema Therapy, but there is no reason that patients can't read it too.

This eBook is designed to support people who are undertaking Schema Therapy and it explains the steps involved, including assessment, education, skills, creating change and leveraging adaptive schemas . It includes patient worksheets that are only available in this eBook and scripts for the therapist on how to facilitate the experiential activities.

As a therapist, this is your road map to Schema Therapy. As a patient, this will help you develop an understanding of how your treatment is supposed to be progressing.

Schema Mode Therapy

Treatment Guide

This is the pièce de résistance.

This is the one I am most proud of.

Again, it is written for therapists, but it won't hurt a patient.

Schema Mode Therapy has so many moving parts. So this workbook includes factsheets about each mode that are different to the ones in the Complete set of Worksheets. It also includes a flowchart for every mode to teach you how to implement the skills and in what order.

There is a small amount of overlap between this and the Schema Therapy Treatment Guide, but that is because some of the techniques are similar with a different emphasis, so this eBook has the modified scripts and worksheets for the modes.

And it's huge - 134 pages.

Schema Cards

These are my favourite resources to use with patients because they bring Schema Therapy to life.

Because there are 20 maladaptive schemas, 14 adaptive schemas, 5 needs and 17 modes, that is a lot of moving parts to keep in your head at once. So these cards allow me to make Schema Therapy tangible.

They also include the skills, which makes them actionable and bite-sized, removing some of the overwhelm some people feel when facing this therapy.

Box 1 includes:

20 maladaptive Schemas

14 Adaptive Schemas

5 Needs plus an instruction sheet

Schema Modes Cards

Expansion Pack

Some people are only interested in the schemas and don't bother with the modes, hence we offer the flexibility to just get the cards you need.

However, the back of each maladaptive schema and Mode card includes a list of skills to use to manage that schema/mode. These skills are coloured either purple or pink.

The purple skills cards are in Box 1 and the pink skills cards are in Box 2 (this one), so to fully benefit from the actionable content, we suggest buying both boxes.

Box 2 includes:

19 Schema Modes

16 Healthy Adult Skills

15 Schema Skills including flashcards.

They are a physical product and can be shipped all over the world.

Check out the video below to see how I use them.

The Psychology of Doomscrolling - and how to break the habit

Sat, 01 Jun 2024 22:27:24 GMT

Guilty about over-scrolling? Try a more meaningful habit

The Psychology Behind Mindless Scrolling—and How to Break the Habit

Ever wonder why you can't stop scrolling through your phone? You're not alone. Sometimes called Doomscrolling , it eats up our lives, minute by minute. Life can slip through our fingers and that feels meaningless and is demoralising when we waste too much time.

Doomscrolling: Here's why it happens and how you can mitigate it.

1. Your Default " Seeking Mode "

Humans we are natural foragers. Just as our ancestors searched for both food and information. We mostly have plenty of food so we can now focus that drive to seek new information.

Our phones offer an endless stream of content, satisfying our evolutionary drive to explore.

2. Variable Reward Reinforcement

Scrolling is like playing a slot machine. The unpredictability of finding interesting content keeps us hooked, this is well understood and known as " variable reward reinforcement ". Each "hit" of engaging content releases dopamine, reinforcing the habit. The social media companies could just give you the content you really like, but you'd get sick of that and disengage. So instead they feed the good stuff like little prizes among the mediocre stuff.

We tire of predictable rewards, but we don't tire of unpredictable ones.

3. Soothing and Safe Foraging

Scrolling provides a safe, passive way to relax and escape daily stress. It allows us to learn and feel in control without real-world risks. Binge-watching TV shows is another common way to soothe ourselves. While it can be a valid way to recharge, it's easy to overindulge. Excessive binge-watching, like excessive scrolling, can lead to feelings of guilt and shame. These negative emotions often arise when indulgence becomes chronic, overshadowing more meaningful activities. We feel we have "wasted our day" and that time "slips through our fingers" when we don't do anything meaningful.

How to Break the Habit

Meaningful Rewards: Seek rewards that truly matter to you.

Set aside a few minutes now. Ask yourself, "What could I do instead of this that would be meaningful ?"

Close your eyes and listen to what your subconscious offers.

Engage in Fulfilling Activities: Replace mindless scrolling with activities that have deeper significance. Whether it's pursuing a hobby, learning something new, or working on a meaningful project, find what resonates with you.

Balance Soothing Activities: It's okay to use your phone for relaxation, but diversify your relaxing activities to include more enriching experiences.

Reflect on Your Screen Time: If you're embarrassed about how much time you spend on your phone, it's a sign you need a change. That guilt/shame is often a sign you're doing something against your "gut values." Replace mindless scrolling with activities that offer real value and fulfillment.

It's perfectly fine to scroll or binge-watch occasionally to relax and recharge, but are you happy with that as your primary method of coping? Have activities ready for when you feel recharged enough to switch from scrolling/binging to those that align with your "gut values" and provide lasting satisfaction and a sense of accomplishment.

Action Step: Use the Four Buckets Technique to Find Goals, Projects and Deeper stuff

To break away from mindless scrolling, use the Four Buckets Technique to categorize your thoughts and tasks. This method helps you organize your mental space and prioritize meaningful activities.

Take 10-20 minutes in a quiet space and see what thoughts bubble up.

Categorize Your Thoughts: Write each thoughts under it's 4 Buckets category

-To Do,

-Projects,

-Deeper Stuff, and

-Junk.

To Do Soon: Identify immediate, actionable tasks. Small wins should be appreciated.
Projects: Ideas, longer-term goals and projects. Each step towards to goal is a small win.
Deeper Stuff: Reflect on significant, personal tasks that require thoughtful attention.
Junk: Acknowledge trivial thoughts and let them go if they don't matter.

Attending to the ideas you generate ad hoc is fine, having a routine which incorporates scheduled time for "To do's" and "Projects" is even better. Regularly revisit the "Deeper Stuff" bucket to ensure you're addressing long-term personal goals and get help if you need it.

Conclusion

Understanding why we scroll and binge-watch can help us make better choices. By all means, recharge, but be wary of chronic overindulgence. By finding meaningful rewards and engaging in fulfilling activities, we can break the cycle of mindless indulgence and lead more enriching lives.

If you find yourself overdoing the scrolling, stop and do the 4 buckets and find something more meaningful.

We have a worksheet here if you'd like a nice neat form to use in doing the 4 buckets:

How Naltrexone Might Help with Alcohol Addiction

Wed, 24 Apr 2024 01:19:41 GMT

In the complex world of addiction, where past pain and emotional scars run deep, finding a way out can seem daunting. However, new treatments like Naltrexone provide hope by helping us understand how the brain, emotions, and substance abuse are connected.

In this blog, we’ll explore how Naltrexone works to reduce alcohol cravings and prevent relapse, shedding light on its potential to offer individuals struggling with alcohol addiction a renewed sense of control and a path towards long-term recovery.

What is Naltrexone?

Naltrexone is a medication commonly prescribed for managing alcohol and opioid dependence . It works by blocking the pleasurable effects of alcohol and opioids, which helps individuals reduce their cravings and dependence on these substances. Unlike other medications that aim to reduce cravings or withdrawal symptoms, Naltrexone takes a unique approach by targeting the very mechanism that drives addiction - the brain's reward system.

Root Cause of Alcohol Addiction

Addiction often stems from past pain and unresolved emotional struggles. Trauma, stress, and tough experiences can leave lasting marks, leading people to turn to substances like alcohol for comfort. Alcohol's numbing effect may offer temporary relief by providing a break from inner turmoil. However, reliance on alcohol or other substances as a coping mechanism can quickly spiral into addiction, as individuals seek to recreate that sense of temporary relief again and again.

Impact of Alcohol Addiction on Emotional Well-being

Alcohol's appeal lies in its ability to change emotions. It numbs pain and brings temporary pleasure by flooding the brain with dopamine , which makes us feel good. However, this temporary relief comes with a price. Over time, alcohol messes up the brain's natural balance, leaving us feeling down and struggling to find real happiness.

In the complex world of addiction, the lack of positive feelings is a big problem. Naltrexone steps in by disrupting the brain's pleasure response. While it might feel strange at first, this disruption gives us a chance to find genuine happiness again, free from the grip of addiction.

Disrupting the Cycle of Addiction with Naltrexone

Naltrexone serves as a ray of hope amid the storm of addiction. By blocking alcohol's pleasurable effects, Naltrexone interrupts the addiction cycle. Without the promise of reward, alcohol loses its hold and becomes less appealing over time.

But Naltrexone does more than just curb alcohol cravings. By removing the artificial highs , it helps individuals face the emotional wounds fueling their addiction. With alcohol's numbing effects lifted, people can confront past pain, heal emotional scars, and develop healthier ways of coping.

Takeaway

As we learn more about addiction, we're discovering better ways to treat it. Naltrexone is one such treatment that offers hope for those struggling with alcohol addiction. It works by tackling the underlying causes of addiction and breaking the cycle of dependence. By helping people deal with past pain, heal emotional wounds, and find emotional balance, Naltrexone provides a pathway to recovery, guiding individuals towards a brighter future.

Looking for free mental health resources? Visit this page .

Bully Attack Mode

Wed, 24 Apr 2024 01:15:05 GMT

Have you ever found yourself in a situation where someone's behaviour made you feel uncomfortable or threatened? Or did you witness someone else experiencing distress due to the actions of another? It can be a distressing experience, but understanding the underlying reasons behind this behaviour is key to addressing it effectively.

In this blog, we'll explore the psychological roots and effects of bully attack mode, offering insights and strategies to help readers address bullying in their lives and communities. By delving into the root causes, we can learn how to handle conflict gracefully and navigate challenging situations with confidence and dignity.

Who Are Schemers?

Schemers are individuals who resort to bully attack mode as a defence mechanism. They are the ones who want to be perceived as intimidating, threatening, and untouchable. Behind this facade lies a deep-seated insecurity , a fear of being perceived as weak or vulnerable. Rather than confronting their own issues head-on, they choose to project their insecurities onto others through acts of aggression.

Understanding the Triggers Behind Bully Attack Mode

Understanding the triggers behind bully attack mode is crucial in dissecting this complex behaviour. Often, it stems from a sense of entitlement and a distorted perception of power dynamics. These individuals think they have to control everything around them because they're afraid to be perceived as weak. As a result, they lash out at others before they themselves feel vulnerable.

Crossover: Establishing Boundaries and Respect

Boundaries show where one person's space starts and another's ends. In human interactions, respecting boundaries means not treating people badly or aggressively. However, bully attack mode crosses these boundaries as it violates the fundamental principles of respect and dignity. Hence, it is important to recognise that such behaviour is unacceptable and must be addressed.

Healthy Adult: Navigating Conflict with Grace

Contrary to bully attack mode, a healthy adult approach involves navigating conflict with grace and maturity. It acknowledges that disagreements are inevitable but emphasises the importance of resolving them through constructive dialogue and mutual respect. A graceful exit from a situation that is escalating or becoming toxic signifies emotional intelligence. It's about recognising when a situation is no longer conducive to positive outcomes and choosing to disengage before irreparable damage is done.

Making Our Own Choices

Confronting bully attack mode requires individuals to make choices. This involves deciding what behaviour they are okay with and standing up for their right to be treated well. While conflict resolution is ideal, if one is at risk of harm, they have the right to remove themselves from the situation. Feeling empowered means realising that you are in charge of your own decisions and not allowing someone else's problems to make you feel like you're helpless or a victim.

Takeaway

Bully attack mode is a manifestation of deeper psychological issues that may involve entitlement, mistrust, and abuse schemes. It reflects an inability to confront one's vulnerabilities and tends to react aggressively to protect themselves.

By understanding the motivations behind this behaviour and asserting boundaries, individuals can minimise its impact and foster healthier relationships built on mutual respect and understanding. After all, individuals who are emotionally healthy don't resort to bullying. Instead, they are open to vulnerability and handle conflicts with understanding and maturity.

To download our complete set of worksheets, click here .

Suspicious Overcontroller

Wed, 24 Apr 2024 01:08:39 GMT

Suspicious Overcontrollers have certain behaviours and ways of thinking that can be confusing and worrying. These individuals deal with a lot of problems, like PTSD, unhelpful ways of coping, wanting everything to be perfect, and feeling like they need to control everything. If we understand why they think and act this way, we can show them empathy and give them the support they need.

In this blog, we'll delve deeper into the complexities of Suspicious Overcontrollers and explore how their past experiences and fears shape their behaviour. By helping you understand how Suspicious Overcontrollers think and feel, we can offer the help they need to feel better.

Understanding Triggers and Responses

Many Suspicious Overcontrollers act the way they do because of things that happened to them in the past that made them feel scared and vulnerable. Things that remind them of those experiences, called triggers , can make them feel extremely anxious, where the need to maintain control becomes most important. It's a coping mechanism, albeit a maladaptive one, born out of a deep-seated fear of experiencing harm again.

The Constant Pursuit for Safety

At the core of the Suspicious Overcontroller's mindset is a relentless pursuit of safety. They monitor their surroundings meticulously, including their partners, children, and even themselves, convinced that only they possess the keen insight necessary to detect and prevent any potential danger. Every action they take is driven by the desire to keep themselves and their loved ones safe, even if it means sacrificing trust and autonomy in the process.

Maladaptive: The Dangers of Excessive Control

With their strong desire to stay safe, Suspicious Overcontrollers can sometimes cause problems. They try so hard to control everything that it can make their relationships difficult. Their loved ones might feel overwhelmed by the constant checking and strict rules. Plus, their lack of trust can make things even more tense and suspicious, making their fears even worse.

Suspicious Overcontroller Vs. Perfectionistic

While Suspicious Overcontrollers are focused intensely on safety, perfectionists are fixated on their performance and achieving perfection. They think that if they do everything perfectly, they can avoid failure and keep control over their lives. But trying to be perfect all the time just makes them more anxious and insecure. They worry a lot about not meeting their own high standards and feel even worse if they make a mistake.

Recognising the Healthy Adult

Breaking free from the grip of suspicious overcontrol requires the Healthy Adult approach. Adopting healthy adult perspectives involves a reality check on probability versus possibility. This helps individuals understand that while something might be possible, it may not be probable. Therapy like Exposure and Response Prevention (ERP), often used for OCD, can also help them slowly let go of behaviours that make them feel safe but actually reinforce their need for control.

Observing Boundaries and Receiving Support

Support from friends and family is crucial in the journey towards healing. However, it's essential to assert boundaries and avoid enabling their controlling behaviours . Instead, encourage them to confront their fears and uncertainties, while providing a safe space for them to express their emotions without judgement or criticism.

Takeaway

In the world of mental health, Suspicious Overcontrollers show us how deeply trauma and fear can affect someone's life. Their journey towards healing is filled with challenges, but with empathy, understanding, and the right support system in place, they can slowly let go of their need to control everything and start living a life based on trust, strength, and real relationships.

If you’re looking for free resources for your mental health, click here .

How to Improve Sensitivity and Resilience for Those with PTSD and BPD

Wed, 24 Apr 2024 00:52:24 GMT

Living with Post-Traumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) can be like trying to balance on a tightrope. Emotions are intense, things can easily set us off, and every day brings its own set of difficulties. But within these conditions, there's a unique way we experience and interact with the world.

In this guide, we'll learn some practical strategies and offer tools to manage overwhelming emotions and cope with triggering situations. By understanding ourselves better, we can improve how we handle challenges, giving ourselves the strength to thrive, even in difficult times.

Understanding One’s Temperament

Our temperament, which is like the blueprint for our personality, starts shaping up early in life and affects how we interact with the world around us. Just as orchids and daisies have distinct characteristics, individuals with PTSD and BPD also exhibit unique traits. While orchids tend to experience emotions intensely and may require more time to calm down, daisies generally remain more composed, with their emotional peaks not reaching the same heights.

Just like these flowers, people with PTSD and BPD have different reactions to things around them. While some individuals feel emotions very strongly and might need more time to calm down, others stay relatively calm even when things get intense, and their emotions don't escalate as much.

How We Respond to Situations

Our responses to life's challenges are deeply intertwined with our temperament. Those with a lower threshold may find themselves easily overwhelmed by stressors, such as unresolved trauma , lack of sleep, or feeling unwell.

'Bad' Day

For those with PTSD and BPD, a bad day can feel overwhelming due to heightened emotional sensitivity and past traumas resurfacing. This leads them to experience increased distress and difficulty in managing everyday challenges.

Feelings of Meaninglessness

People with PTSD and BPD may experience a sense of meaninglessness, often due to the emotional turmoil and trauma they endure. As a result, this makes it difficult for them to find purpose or value in their lives.

Non-Acceptance/Willfulness

Individuals with PTSD and BPD may reject accepting their life circumstances, often due to the overwhelming distress and trauma associated with their conditions, which then leads them to avoid or deny reality.

Detesting Discomfort

Individuals with PTSD and BPD may strongly dislike discomfort, often preferring to remain within their comfort zones as a means of managing their symptoms and avoiding triggers associated with their conditions.

Strategies for Building Resilience

Individuals with PTSD and BPD can greatly improve their ability to cope with and overcome challenges by following these strategies.

Working Through Things

The best way to solve problems is by addressing them directly. Talk with someone you trust, write in a journal to express yourself, or use problem-solving techniques to understand and deal with your emotions and experiences.

Moderate Exercise

Make sure to include regular physical activity in your daily schedule. It not only lifts your mood but also lowers stress levels, helping you feel better overall.

Sleep Hygiene

When you address the underlying issues in your life, you can be able to establish a calming bedtime routine and prioritise the quality of your sleep.

Skill Development

Practise distress skills, self-soothing skills and have confidence that when a situation arises, you know you’ve got a solution.

Medication

Consult with a healthcare professional about medication options, such as SSRIs , to support mood stability and manage symptoms.

Willingness to Tolerate Discomfort

Embrace discomfort as a natural part of growth and healing. Cultivate a mindset of acceptance and openness to new experiences.

Takeaway

Improving sensitivity and resilience for individuals with PTSD and BPD is a journey of self-discovery and self-compassion. By understanding our temperament and how it influences our responses to the world, we can adopt strategies to navigate challenges with greater ease.

Through perseverance, support, and a willingness to embrace discomfort, individuals with PTSD and BPD can cultivate resilience and thrive in the face of adversity. Remember, you are not alone on this journey, and each step forward is a testament to your strength and resilience.

To download these handouts, go to our Resources page. It's free!

Weight Gain and Antidepressants: Emotional Eating, Indifference and Effects on Appetite

Wed, 24 Apr 2024 00:25:16 GMT

Many people who want to improve their mental health often turn to antidepressants as part of their journey towards feeling better. These medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs) or Tricyclic Antidepressants (TCAs) like Mirtazapine , can be life-changing, as they offer significant relief from symptoms of depression and anxiety. However, alongside their therapeutic benefits, these antidepressants can also bring about unwelcome side effects, including weight gain.

In this blog, we'll delve into the intricate interplay between antidepressants, emotional eating, indifference, and their impact on appetite, shedding light on how different types of medications impact these factors.

The Link Between Antidepressants and Weight Gain

One of the primary culprits behind the weight gain associated with antidepressants lies in their mechanism of action. SSRIs, for instance, work by increasing the levels of serotonin in the brain, which can influence mood regulation and appetite.

Similarly, TCAs like Mirtazapine possess antihistamine properties that can stimulate appetite and promote weight gain. While the exact mechanisms aren't fully understood, these medications can disrupt the delicate balance of neurotransmitters involved in appetite regulation. As a result, it can lead to increased food intake and potential weight gain.

SSRIs and Emotional Indifference

Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed antidepressants that work by increasing serotonin levels in the brain helping to alleviate symptoms of depression and anxiety. However, an intriguing aspect of SSRIs is their potential to induce emotional indifference in some individuals. This emotional blunting can manifest as a reduced investment in careful food choices or a diminished inclination towards emotional eating.

For some, this indifference may mean experiencing less intense cravings or emotional triggers that lead to overeating. Conversely, others may find themselves disengaged from the pleasure of food, which may result in a decreased appetite and subsequent weight loss. While SSRIs don't guarantee weight gain in the same way as other antidepressants, their impact on emotional eating and food preferences can vary greatly among individuals.

TCAs and Mirtazapine: Weight Gain Guarantee

Tricyclic Antidepressants (TCAs) such as Mirtazapine operate through different mechanisms compared to SSRIs. Mirtazapine, in particular, acts as an antihistamine, which can stimulate appetite and promote weight gain. In addition, its sedative properties can aid in sleep, which is often disrupted in individuals experiencing depression.

One common effect of Mirtazapine and TCAs is a notable increase in cravings for carbohydrates and hunger. People might feel intense urges for calorie-rich foods high in carbs. This increased appetite, combined with decreased feelings of fullness, sets the stage for weight gain.

Strategies for Managing Weight While on Antidepressants

While weight gain on antidepressants can pose a significant challenge, there are ways individuals can take to mitigate its impact:

Nutrition Balance

Stay mindful of food choices and aim for a balanced diet rich in whole grains, lean proteins, fruits, and vegetables. Incorporating nutrient-dense foods can help counteract the effects of increased carb intake and cravings.

Regular Exercise

Engage in regular physical activity to support overall well-being and manage weight. Exercise not only helps burn calories but also boosts mood and reduces stress , complementing the effects of antidepressant therapy.

Mindful Eating Practices

Practise mindful eating by paying attention to hunger and fullness cues, rather than eating out of boredom or emotional triggers. This approach can foster a healthier relationship with food and prevent overeating.

Consult with Healthcare Providers

Maintain open communication with healthcare providers about any concerns regarding weight gain or changes in appetite. They can offer personalised guidance and may consider adjusting medication dosage or exploring alternative treatment options if necessary.

Takeaway

Weight gain on antidepressants can present a diverse challenge, influenced by emotional factors, neurochemical changes, and disruptions in appetite regulation. By understanding the complex interplay between antidepressants, emotional eating, indifference, and appetite dysregulation, individuals can adopt effective strategies to manage their weight while prioritising their mental health. Through a comprehensive approach that includes healthy eating, regular exercise, and mindful self-care, we can journey toward well-being with strength and confidence.

Are you looking for free mental health resources? Visit this page .

A Hierarchy of Mindfulness

jess@thepsychcollective.com (Jess O'Garr) — Fri, 30 Jun 2023 10:41:38 GMT

Exploring Different Levels of Mindfulness

In this follow-up blog on mindfulness, Jess and Dr Al share their perspectives on this practice. While Al discussed mindfulness of thoughts in a previous video, Jess introduces a comprehensive approach to mindfulness that acknowledges different levels of engagement. This breakdown allows individuals to find a starting point that feels accessible and gradually progress towards deeper levels of mindfulness. Join us as we explore Jess's hierarchy of mindfulness and discover how to cultivate awareness and attention in various aspects of our lives.

Level 1: Awareness of Behaviours

Jess begins by highlighting the importance of paying attention to our behaviours. This level involves choosing an activity and engaging in it with full attention. By focusing on the present moment, we can bring awareness to our actions and immerse ourselves in the experience. This level is particularly helpful for individuals who find it challenging to tune into their thoughts or are seeking a safe way to address distressing emotions.

Level 2: Physical Awareness

Moving up the hierarchy, Jess emphasises the significance of turning our attention inward to the physical sensations in our bodies. Conducting a body scan, starting from the top of the head and working downward, allows us to notice any tension, discomfort, or other sensations. By becoming familiar with our physical state, we gain a deeper understanding of our bodies and foster a sense of mastery over our well-being.

Level 3: Emotional Awareness

The next level involves bringing awareness to our emotional state. Jess suggests that after conducting a body scan, we can identify clues that connect physical sensations to emotions. For those who struggle to label or describe their emotions, she recommends using an emotions list or an emotion wheel to find the closest approximation. This practice enables us to develop a greater awareness of our emotional landscape and enhances our ability to navigate and understand our feelings.

Level 4: Cognitive Awareness

At this level, Jess encourages us to examine our thoughts and cognitive patterns. Journaling can be a helpful tool for capturing and processing our thoughts, especially when they feel overwhelming or difficult to articulate. By documenting our thoughts and reading them back, we can identify themes and gain insights into our mental processes.

Level 5: Meta-Cognitive Awareness

As we ascend the levels of mindfulness, we reach a crucial stage: metacognitive awareness, the art of thinking about our thinking. Jess emphasises the significance of cultivating this higher level of mindfulness, where we become conscious of when our thoughts wander off track and redirect our attention to the present moment. By nurturing metacognitive awareness, we gain the ability to observe our thoughts without judgment and disentangle ourselves from their grip, fostering a sense of clarity and control over our mental landscape. With practice, we can harness the power of metacognition to enhance focus, regulate emotions, and deepen our overall mindfulness practice.

Choosing the Right Starting Point

While some people will vary in their readiness to engage with different levels of mindfulness. Some may be comfortable starting at the higher levels, while others may benefit from beginning with the more accessible levels. It's important to assess your mindfulness practice and determine areas that require more attention and development. By building skills gradually, you can strengthen you capacity for attention and awareness.

Understanding the Maladaptive Schemas

jess@thepsychcollective.com (Jess O'Garr) — Wed, 28 Jun 2023 09:49:15 GMT

What is a Schema?

A schema is a framework for the way we organise information. It is like a blueprint that shows us how to understand the world. A schema looks at how we collect, store and interpret information about ourselves and the people around us. Often referred to as a 'node', schemas are interconnected memory structures that hold on to data that is collated over time.

Our early childhood experiences inform our view of the world and ourselves in it. Schemas often begin to emerge in our early years based on our experiences of getting our needs met. If our primary caregivers met our psychological needs of attachment, autonomy, play, freedom and boundaries, then we learned that we are safe, loved and important. If these needs were not met, then we learned that we are unloved, unsafe and unwanted. This leads to the development of maladaptive schemas, such as Failure, Defectiveness and Abandonment.

From the latest research, we now recognise 20 maladaptive schemas.

1. Abandonment

The belief that everyone will leave, creating a sense of loneliness as no one can offer the emotional support, connection, strength, or protection needed. This often leads to hypervigilance towards signs of perceived rejection, resulting in anxiety. This may resulting clingy behaviours, intolerance of short absences or avoidance of starting relationships due to the impending abandonment.

2. Mistrust/ Abuse

The belief that others will cause harm by lying, cheating, manipulating, hurting, shaming or abusing. People with this schema have great difficulty trusting others, believing there to be a hidden agenda. They are often guarded, suspicious and defensive towards others, even without provocation or evidence that the other person actually intends to cause harm.

3. Emotional Deprivation

The belief that the need for emotional support, attention, understanding, empathy and help will never be sufficiently met by others. It is usually based on early experiences of a lack of affection or support. People with these beliefs were often deprived of nurturance (cuddles, quality time), empathy (validation and compassion) and protection (safety, defence, guidance) when they were younger, and hence do not believe that it is possible or even that it exists as an adult.

4. Defectiveness

The belief of being flawed, worthless, bad, incapable, or useless in important aspects of life. People with this schema see themselves as entirely broken. They may avoid relationships so as to not burden others. Others may feel that they are putting on a charade and fear being 'found out'. They often make self-deprecating comments and blame themselves for things beyond their control. They are the masters of compare and despair, judging themselves to be less worthy or desirable compared to everyone else.

5. Social Isolation

The perception of being isolated from others, being different from other people, not being part of a group or having no sense of belonging. There may be a reason for not fitting in, such as appearance, race, neurodivergence, sexuality or economic status. They feel alienated within their family, community, school, or work environment. They may then isolate themselves as a protective measure to not allow further opportunities to be excluded.

6. Dependence/Incompetence

The belief that a large amount of support is required from others in order to be able to manage daily life or complete tasks. People with this schema see themselves as incapable of performing tasks independently and fear making decisions on their own. They lack confidence in their problem-solving skills so will turn to others to seek instruction or to have someone solve their problems for them.

7. Vulnerability to Harm/Illness

The belief that there is a constant risk of illness, harm or danger that cannot be prevented. People with this schema constantly fear that disaster will occur at any time and the consequences will be catastrophic. They fear that chest pain is a heart attack, a headache means a tumour, the next storm will knock a tree onto their house and their children will die in a horrible accident. They are perpetually anxious and restrict their lives to reduce their exposure to risk.

8. Enmeshment/Underdeveloped Self

The strong attachment to others and over-involvement in their lives due to the belief that one does not have any social life or interests of their own and therefore needs to be close to others. People with this schema believe that they could not survive emotionally without the particular relationship, as their identity is fused with the other person. They lack a strong sense of identity that is independent of the relationship.

9. Failure

The belief that one has failed or will always fail in areas of performance, such as work, school or sports. This schema is focused on task performance and can be quite specific (as opposed to Defectiveness which is global). People with this schema doubt their abilities or intelligence and measure their failure in domains such as career, income, marital status or aptitude. Some people with this schema actually achieve success in these domains, but think of themselves as a fraud and are fearful of being found out for 'fluking it'.

10. Entitlement/Grandiosity

The belief that one is better than others or more deserving of special treatment than others. People with this schema see themselves as above the law and consider the rules that govern the rest as unnecessary for themselves. They expect others to make exceptions for them, grant their favours and prioritise their demands over others. They are often very selfish and spoiled. It is important to differentiate between those with 'pure' entitlement and those who are overcompensating for a Defectiveness schema.

11. Insufficient Self-Control/Self-Discipline

The difficulty with controlling impulses or urges, resulting in risk-taking behaviours or expressing feelings in an extreme manner . There is often a low frustration tolerance and unwillingness to make a sustained effort to achieve something difficult. People with this schema often give up on a task when it becomes too hard. They are often disorganised, distractible and prone to developing addictive disorders. It is important to differentiate this schema from underlying ADHD.

12. Subjugation

The act of giving over control to others to allow them to make decisions due to the belief of oneself being weak and others being stronger. People with this schema may subjugate their needs by staying silent on what they want and following the lead of others, or they may subjugate their emotions by hiding them so they won't be abandoned. They often feel powerless in their situation or relationships and may have a passive-aggressive style of agreeing at the time and then resent the decisions made later.

13. Self-Sacrifice

The belief that the needs of others are more important and must be fulfilled at all costs, to the detriment of one’s own happiness or well-being. People with this schema believe that caring for themselves is selfish and feel guilty for doing so. They wish to serve others to make themselves more likeable or to prevent abandonment and rejection by others. They may take on the emotions of others, describing themselves as an 'empath'.

14. Approval-Seeking

The act of trying excessively to achieve the approval, praise, or attention of others or trying to fit in at the cost of developing one’s own true feelings or identity. People with this schema have an insatiable need for external validation and believe that without the attention of others, their achievements do not matter. They have a strong need to be liked and admired by others, conflating attention with attachment. This schema may commonly present in people with Histrionic Personality Disorder.

15. Negativity/Pessimism

The tendency to focus on the negative aspects of life and always expect the worst. People with this schema have often accumulated an extensive number of traumatic or negative events in their lifetime which creates this bias of pessimism. They always predict the worst outcome to prepare themselves for the eventuality of disaster. They discount any examples of good outcomes, attributing them to flukes or find a way to discredit them.

16. Emotional Constriction

The need to excessively inhibit spontaneous feelings, actions, or communication, usually to avoid feelings of dislike or shame, or to avoid losing control over impulses. This schema is the revised version of Emotional Inhibition. People with this schema have a tendency to excessively control their expressions, resulting in flat affect, unreadable facial expressions and a presence of aloofness. They fear being shamed or criticised for displaying their emotions, which likely developed from invalidation of their feelings as a child.

17. Fear of Losing Control

The belief that something terrible will happen if one fails to maintain control over their emotions. This is the second half of the original Emotional Inhibition schema. People with this schema are often hypervigilant of their internal environment, predicting uncontrolled bouts of dysregulation, such as in panic attacks. Others may fear their anger and believe that if they were to express it, they would lose control, become aggressive and cause harm.

18. Unrelenting Standards

The belief that one must work excessively hard to meet very high standards for behaviour and achievement to avoid criticism from oneself or others. People with this schema are often described as perfectionists, striving for unachievable results and condemning themselves when they don't achieve this. There is a constant sense of pressure towards completing their endless to-do list which lacks realistic limits, but rather focuses on what should be done instead of what can be achieved with available time and resources.

19. Punitiveness towards Others

The belief that people should be punished harshly if they make mistakes. People with this schema struggle to forgive others even for minor mistakes and may present as morally superior. They are harsh critics and highly judgemental of others. They believe that punishment will lead to improved behaviour or greater compliance in the future. They lack empathy or compassion towards others, though they may silently judge rather than vocally express their disdain.

20. Punitiveness towards Self

The belief that one should harshly punish themselves for mistakes. People with this schema are their own worst enemy. They are hypercritical towards their mistakes, flaws and perceived effectiveness. They may engage in self-harming behaviours or restrict their access to food, sleep or positive activities as punishment for not meeting their own standards. Their inner critic is very loud, constantly judging and condemning their existence.

Interested and want to learn more.

Download this 68-page PDF from our Resources page to get a full description of each maladaptive schema, plus the 14 adaptive schemas.

List of Core Emotional Needs

Tue, 30 May 2023 14:31:39 GMT

Everyone has needs. We talk about them all the time in Schema Therapy, but what do they really mean? In this 3 minute video, Jess gives a quick overview of the 5 categories of needs.

There are five core emotional needs that are necessary for healthy emotional development in children.

1. The Need for Secure Attachment

Secure attachment is vital for the healthy emotional development of children. When children form secure attachments with their primary caregivers, they develop a sense of trust, safety, and emotional stability. Securely attached children feel confident to explore the world, knowing that they have a secure base to return to. This foundation allows them to build positive relationships, regulate their emotions, and develop healthy coping strategies. Securely attached children also develop a stronger sense of self-worth and empathy, as they have experienced consistent and responsive care. The emotional security provided by a secure attachment helps children navigate challenges, manage stress, and develop resilience. Ultimately, secure attachment lays the groundwork for healthy social, emotional, and psychological well-being throughout their lives.

2. The Need for Autonomy

Autonomy plays a crucial role in promoting healthy emotional development in children. It refers to the ability to make independent choices, exercise personal agency, and develop a sense of self-identity. When children are given opportunities to make decisions and take responsibility for their actions within age-appropriate boundaries, they develop a sense of competence and self-confidence. Autonomy allows children to explore their interests, discover their strengths, and learn from their mistakes. It fosters a sense of ownership over their lives and helps them develop a healthy self-esteem. Moreover, autonomy allows children to express their individuality, preferences, and emotions, leading to a greater understanding and acceptance of themselves. By encouraging autonomy, caregivers provide a nurturing environment that supports children's emotional well-being, promotes self-regulation, and lays the foundation for their independence and resilience in adulthood.

3. The Need for Boundaries

Boundaries play a crucial role in fostering healthy emotional development in children. Establishing clear and consistent boundaries provides children with a sense of safety, predictability, and structure. Boundaries help children understand acceptable behaviour, develop self-discipline, and learn to respect the rights and boundaries of others. By setting limits, caregivers teach children about personal space, privacy, and appropriate social interactions. Boundaries also promote emotional regulation by providing a framework within which children can express their feelings in a safe and healthy manner. Additionally, boundaries teach children important life skills such as responsibility, self-control, and delayed gratification. They help children develop a strong sense of self and establish healthy relationships based on mutual respect and understanding. Ultimately, boundaries create a supportive environment that allows children to thrive emotionally, nurturing their self-esteem, independence, and emotional resilience.

4. The Need for Freedom to Express

The freedom to express oneself is of paramount importance for healthy emotional development in children. When children are encouraged and supported to express their thoughts, feelings, and ideas, they develop a strong sense of self-awareness and emotional intelligence. The ability to openly communicate their emotions fosters a deeper understanding of their own inner world, enabling them to better navigate and regulate their emotions. By being given the freedom to express, children learn to validate their own experiences and develop a sense of self-worth and confidence. It also enables them to develop effective communication skills, assertiveness, and problem-solving abilities. Furthermore, when children are allowed to express themselves freely, they feel heard, understood, and validated, which builds a foundation of trust and connection with their caregivers and peers. Embracing and honouring the freedom of expression in children creates an environment that promotes emotional well-being, authentic self-expression, and healthy relationships throughout their lives.

5. The Need for Play

Play and spontaneity are vital for healthy emotional development in children. Through play, children engage in activities that are intrinsically motivated, enjoyable, and imaginative. It allows them to explore their creativity, develop problem-solving skills, and foster their cognitive, physical, and social development. Play also provides a safe space for children to express and process their emotions. It offers an outlet for them to experiment with different roles and emotions, helping them develop empathy, emotional regulation, and resilience. Moreover, play and spontaneity promote a sense of joy, curiosity, and wonder in children's lives, fostering a positive outlook and enhancing their overall well-being. By engaging in unstructured and spontaneous play, children learn to navigate uncertainties, adapt to new situations, and develop their own interests and passions. It encourages their independence, self-confidence, and autonomy. Overall, play and spontaneity contribute significantly to the healthy emotional development of children by nurturing their creativity, emotional intelligence, and overall happiness.

To download the handout for this, go to our Resources page. It's free!

Addressing Anhedonia

jess@thepsychcollective.com (Jess O'Garr) — Sun, 02 Apr 2023 07:06:17 GMT

Anhedonia might not be what you think

Are you familiar with the term anhedonia? If you're not, it's a term used in psychology to describe the loss of interest or pleasure in activities that were previously enjoyable. However, this term is often used with a double-barrel meaning that doesn't facilitate skillful intervention. In reality, the concept of loss of interest or pleasure actually covers three different things - anhedonia, avolition, and anergia.

Avolition refers to the loss of motivation, while anergia is the lack of energy or fatigue. These two conditions are often confused with anhedonia, which is the true loss of pleasure and enjoyment in previously enjoyed activities. When we misuse words, we also run the risk of applying the incorrect intervention, which can worsen the situation.

For instance, if a person has anhedonia, behavioural activation and activity scheduling may not work as the individual simply does not enjoy the activity. However, if the problem is avolition or anergia, then behavioural activation can be helpful. The idea behind behavioural activation is that even if you don't feel like doing something, if you do it, you will experience some positive emotion, which will offset some of the negative emotion.

It's important to understand the difference between these three conditions because if we don't, we may not be able to provide the right intervention. True anhedonia doesn't seem to respond to behavioural interventions, and psychiatric interventions like medications or electroconvulsive therapy (ECT) may be required.

At the Psych Collective, we've developed a handout called "Basic Behavioral Activation" that primarily targets avolition and anergia. It's a simple guide that helps individuals propel themselves into some sort of activity by focusing on body care, achievement, socialisation, interests, and cleanliness.

The take-home message is that the term anhedonia is often being overused, and it's essential to understand the higher resolution way of thinking of it. If you're struggling with avolition or anergia, then behavioural activation can be helpful. However, for true anhedonia, psychiatric interventions may be required.

Interested in our handout? Check out our Resources page under the Mood tab.

The Dark Triad

Sun, 02 Apr 2023 01:51:41 GMT

Understanding the 3 Traits of Highly Manipulative People

Have you ever met someone who seemed charming, confident, and assertive, but later turned out to be manipulative, callous, and indifferent to your feelings? If so, you might have encountered a person with dark triad traits. In this blog post, we'll explore what the dark triad is, what its traits are, and how you can protect yourself from manipulative people.

What is the Dark Triad?

The dark triad refers to a set of three personality traits: psychopathy, narcissism, and Machiavellianism. Psychopathy is characterized by a lack of empathy and emotional depth, narcissism by excessive self-love and entitlement, and Machiavellianism by manipulation and deceit.

The Three Traits of the Dark Triad

Psychopathy

The first element of the dark triad is psychopathy, which is characterized by a lack of empathy. Psychopaths are unable to put themselves in other people's shoes and often act in ways that are harmful to others without any remorse. They are cold, calculating, and callous, and their actions are often driven by a desire for power and control.

Narcissism

The second element of the dark triad is narcissism, which is characterized by excessive self-love and entitlement. Narcissists believe that they are entitled to special treatment and often demand attention, admiration, and praise from others. They are confident, charming, and assertive, but they often lack the competence to back up their bravado. Narcissists are also prone to stealing credit from others and can be very self-centered.

Machiavellianism

The third element of the dark triad is Machiavellianism, which is characterized by manipulation and deceit. Machiavellians are willing to deceive others and often use gaslighting tactics to confuse and manipulate their victims. They are interested in power and are willing to do whatever it takes to attain it, including backstabbing and betraying others.

The Sadistic Variant

There is also a sadistic variant of the dark triad, which includes all three traits plus a desire to inflict pain and suffering on others, the dark tetrad . These individuals derive pleasure from causing others harm and are often violent and aggressive.

Protecting Yourself from the Dark Triad

Unfortunately, people with dark triad traits can be very difficult to identify, as they are often skilled at hiding their true nature. However, there are some things you can do to protect yourself from manipulative people:

Educate yourself. Learn about the dark triad and its traits so that you can recognize them when you see them.
Trust your instincts. If something seems off about a person, listen to your gut and be cautious.
Set boundaries. Be clear about what you will and won't tolerate from others, and don't be afraid to enforce your boundaries.
Surround yourself with positive people. Spend time with people who are kind, supportive, and empathetic.
Seek professional help. If you have been the victim of abuse or manipulation, seek professional help to heal and recover.

The dark triad is a set of personality traits that can make people highly manipulative, callous, and indifferent to the feelings of others. By educating yourself about the dark triad and taking steps to protect yourself from manipulative people, you can minimize your risk of being victimized. Remember to trust your instincts, set boundaries, and surround yourself with positive people who value your well-being.

Dialectics Demystified

Sun, 02 Apr 2023 01:38:26 GMT

Understanding the Power of "And"

If you've ever struggled to understand the concept of dialectics, you're not alone. Many people find this philosophical concept difficult to grasp. But dialectics is an important concept, especially in dialectical behaviour therapy (DBT), which was developed to treat borderline personality disorder. By understanding dialectics, you can learn to reduce internal conflict and increase emotional regulation.

At its core, dialectics is about holding two opposing ideas in your head at the same time. This may sound confusing or even impossible, but it's a powerful tool for managing difficult emotions. Instead of swinging back and forth between two extremes, you can find a middle ground and reduce the dissonance that comes from conflicting thoughts and feelings.

The pendulum swing is a common phenomenon for people with borderline personality disorder (BPD) and other diagnoses. They may feel overwhelmed by their emotions one moment and then shut down completely the next. This back-and-forth can be exhausting and make it difficult to function.

Dialectics proposes a synthesis between two opposing ideas, rather than a choice between them. For example, instead of saying, "I want to get better, but therapy is too hard," you can say, "I want to get better, and therapy is hard." By using the word "and" instead of "but," you acknowledge both truths at the same time. This reduces the internal conflict and makes it easier to move forward.

The power of dialectics is in the word "and." It allows you to hold two opposing ideas at the same time without negating either one. This can be a difficult concept to grasp, but it's essential for managing difficult emotions and reducing internal conflict.

Here are some common dialectics that you may encounter in DBT or in life:

Acceptance and Change

This is one of the most fundamental dialectics in DBT. It's about accepting the things you cannot change and changing the things you can. By finding a balance between acceptance and change, you can reduce stress and increase emotional regulation.

Reality and Possibility

This dialectic is about balancing the reality of the present moment with the possibility of the future. By acknowledging both, you can avoid becoming stuck in negative thinking patterns.

Control and Surrender

This dialectic is about finding a balance between control and surrender. It's important to acknowledge that there are some things you cannot control, and surrendering to this reality can reduce stress and increase emotional regulation.

Self-acceptance and Self-Improvement

Self-acceptance means accepting oneself as they are, flaws and all. Self-improvement means actively working to improve oneself. By holding both ideas, a person can find a balance between accepting themselves as they are while also striving to be the best version of themselves.

Examples of Dialectical Statements

You can feel your emotions AND make choices about how to respond skilfully.

You need to learn how to do things yourself AND you need to ask someone to teach you.

You can share some information about yourself AND keep some information private.

You can give others what they need AND ask for your needs to be met.

You can make mistakes AND still be a good person.

You can make time to do work/chores AND make time for rest/play.

You can want to recover AND want to quit therapy.

Therapists have dialectics that we have to balance too.

Offering you the answers AND letting you figure it out for yourself.

Validating your experience AND challenging you to respond skilfully.

Need More

Check out our video and free handout .

Is Seroquel for Sleep Slowly Killing You?

al@thepsychcollective.com (Al Griskaitis) — Sat, 07 Jan 2023 06:25:07 GMT

Is Seroquel Slowly Killing You?

A Closer Look at the Potential Risks and Benefits of Using this Medication as a Sleep Aid

If you struggle with insomnia or other sleep disorders, you may have been prescribed the medication Seroquel (generic name quetiapine) as a way to improve your sleep. But a recent study has raised some concerns about the long-term use of this medication, specifically in terms of its potential negative effects on cardiovascular health. So, what's the story with Seroquel and is it really a danger to your health? Here's a closer look at the potential risks and benefits of using this medication as a sleep aid.

How Seroquel Promotes Sleep

Seroquel is an atypical antipsychotic medication that is commonly used to treat schizophrenia, bipolar disorder, and other mental health conditions. It is also sometimes prescribed off-label as a sleep aid due to its sedative effects. So, how does it work to promote sleep?

One of the main ways that Seroquel helps people fall asleep is through its potent antihistamine properties. Histamine is a chemical in the body that promotes wakefulness, and by blocking the effects of histamine, Seroquel can help to reduce wakefulness and promote sleep.

Actions of Seroquel

In addition to its antihistamine effects, Seroquel also blocks the neurotransmitter dopamine, which may contribute to its sedative effects. But may also dampen the reward system which can make life feel a little dull. Some people even describe feeling like a zombie, especially at higher doses. A metabolite of Seroquel (norquetiapine) It is also thought to have effects on the neurotransmitter noradrenaline, which plays a role in the body's "fight or flight" response and can contribute to feelings of alertness and arousal. Quetiapine can also do the reverse because of it’s actions on a type of noradrenaline receptor. On one hand it promote noradrenaline and on the other is reduces it. This may be why some people feel relaxed by Seroquel and other feel edgy from it. Some people get used to the reduced wakefulness from Seroquel and need progressively higher doses.

The Potential Risks of Long-Term Use of Seroquel

While Seroquel may be effective at promoting sleep in the short term, a recent study has raised concerns about the long-term use of this medication. The study compared the long-term use of Seroquel with another class of medication known as "Z-drugs" (which are also used as sleep aids) in terms of their effects on mortality from cardiovascular causes. The results showed that those taking Seroquel had significantly worse outcomes in terms of cardiovascular disease and an increased risk of death.

It's important to note that this study is not the final word on the subject, and more research is needed to fully understand the potential risks and benefits of using Seroquel as a sleep aid. However, it is worth considering these findings and discussing them with your doctor if you are taking or considering taking Seroquel for insomnia or other sleep disorders.

Other Potential Risks and Side Effects of Seroquel

In addition to the potential risks associated with long-term use, there are other side effects and potential risks to consider when taking Seroquel. These may include:

Drowsiness and sedation: As a sedative medication, one of the main side effects of Seroquel is drowsiness and sedation. This can be helpful for promoting sleep, but it can also impair your ability to perform tasks that require alertness, such as driving or operating heavy machinery.
Feeling emotionally numbed.
Weight gain: Seroquel may cause weight gain, which can increase the risk of obesity and related health problems.
Increased risk of falls: The sedative effects of Seroquel may increase the risk of falls and related injuries, especially in older adults.
Increased risk of diabetes: Some studies have suggested that long-term use of Seroquel may increase the risk of developing diabetes.
Increased risk of death in older adults with dementia: Seroquel has a "black box" warning from the FDA stating that it should not be used to treat behavioral problems in older adults with dementia due to an increased risk of death.

Alternative Treatment Options for Insomnia and Sleep Disorders

If you are concerned about the potential risks of using Seroquel or other medications as a sleep aid, there are other treatment options to consider. Non-pharmacological approaches, such as cognitive-behavioral therapy for insomnia (CBT-I) and good sleep hygiene practices, can be highly effective in improving sleep without the use of medication.

There are many generic sleep hygiene tips which are helpful, but are seldom the solution:

Keeping a consistent sleep time and relaxing bedtime routine.
Keep the room cool, dark, and quiet, and use a comfortable mattress and pillows.
Avoiding screens before bedtime. Kept illumination dim at night time.
Avoiding caffeine, alcohol, and large meals before bedtime.
Using relaxation techniques

Address the root cause of sleep disturbance

The most common issue that can contribute to high arousal at bedtime is the presence of a lot of thoughts running through our head. These thoughts can be troubling or distracting, and they can prevent us from relaxing and falling asleep by increasing our mental arousal. To address this issue, it can be helpful to take some time to clear your head before bed by writing out your thoughts and addressing any issues that may be keeping you awake. This process can help you get your thoughts out of your head and onto paper, which can help you de-arouse and calm your mind, making it easier for sleep pressure to send you to sleep. This process involves sitting down with a sheet of paper or a worksheet, closing your eyes and allowing thoughts to come up, thinking about each thought for a while, and then writing them out in a linear way to try to clarify the issue and resolve it. This can help to prevent your mind from going in circles and allow you to fall asleep more easily:

Set aside some time to focus on your thoughts. This could be an hour or two before bed, or whenever you have some free time and a quiet place to sit.
Close your eyes and see what thoughts come up. Don't try to push any thoughts away or ignore them. Just let them come to the surface.
Think about each thought for a while and try to flesh it out. What is the root of this thought? What is it about this thought that is causing you stress or keeping you awake?
Once you feel like you've explored the thought fully, start writing it out. This can be on a sheet of paper, in a journal, or even on your computer.
Keep writing until you feel like you've gotten everything out. This may take several pages or just a few sentences, depending on the complexity of your thoughts.
Try an sum up each issue concisely and then decide if it is potentially solvable or if it is unsolvable.
Decide on a Next Action for the solvable problems. This is just the next action that you can take and will take on the matter. It might mean scheduling a meeting with someone to discuss the issue. The goal is to take action on your thoughts and find a way to address them, rather than letting them linger in your head and keep you awake.
For the unsolvable problems declare then as unsolvable by speaking aloud “this is unsolvable” (this helps with acceptance).

By following this process, you can get your thoughts out of your head and onto paper, which can help you de-arouse and calm your mind, making it easier to fall asleep. Video explainer below:

Free worksheet on Clear Your Head is here .

The Bottom Line: Is Seroquel Slowly Killing You?

While the long-term safety of using Seroquel as a sleep aid is still uncertain, there are potential risks to be aware of. If you are taking or considering taking this medication, it's important to have a discussion with your doctor about your concerns and to weigh the potential risks against the benefits. It's also worth considering alternative treatment options:

CBT-I and good sleep hygiene practices and using relaxation techniques.
Intermittent use of antihistamines or adrenaline modifiers such as clonidine may be worth considering.
Reducing your mental arousal to improve your sleep without the use of medication using the Clear Your Head Before Bed approach to sort out the issues which cause increased arousal.

Remember, it's prudent to follow your doctor's recommendations and to not make any changes to your medication regimen without consulting a medical professional.

This video explores these topics and you can download the handout HERE .

Planned Recovery

Sun, 09 Oct 2022 04:07:20 GMT

"Resilience is about how you recharge, not how you endure."

I love this quote. It comes from a really good article written by Harvard Business Review a few years ago and I keep coming back to it.

Here is the original article: https://hbr.org/2016/06/resilience-is-about-how-you-recharge-not-how-you-endure

This brings me to something really important which I talk about with my patients all the time called Planned Recovery . But first, let me explain the CRASH cycle.

The Crash Cycle

Our emphasis on productivity and achievement leads many of us to believe that we must be busy in order to be valuable. In seeking this validation from others we may push ourselves to our breaking point. Many people tell themselves that in order to get things done, we aren't allowed to stop until it is done. This insistence on perpetual motion is unsustainable and a crash is often inevitable. The crash forces us to stop but we damage our resilience in the process. We take two steps backwards.

If we crash, we may end up stuck on the couch, doing something mindless, feeling guilty and willing our bodies to bounce back for the next run at a never-ending to-do list. All the while we criticise ourselves for the crash. We often punish ourselves with guilt which sabotages our rest: so we get up too early when we are still exhausted.

The Crash Cycle looks like this:

Sound familiar?

Many people believe that in order to get everything done, they aren't allowed to stop until it is done.

But this creates feelings of resentment, burnout , guilt and shame.

People may take a break, but after hours of watching TV or having a nap, they still feel burnout because they have criticised themselves needing the break, perceiving it to be a failure.

Here is an alternative:

Not convinced?

Let's imagine that you decided to drive across the country, so you fill up the tank and start driving. Eventually your car would run out of fuel and you would need to stop.

Are you going to then yell at the car for running out of fuel? Will you criticise it and call it weak? Kick the tyres, tell it that it has failed and insist that it keep going anyway?

Chances are that you will acknowledge that cars need fuel, put more in and then keep going when you're ready.

You need fuel too. Criticising yourself for it won't change that.

The Benefits of "Planned Recovery"

A balance between productivity and recovery.
Reduced guilt and shame for taking breaks.
Recovery time is faster.
Decreased feelings of burnout.
Increased self-compassion through practising self-care without criticism.
Increased productivity which is sustainable.

Opportunities to incorporate enjoyable activities into your day.

Want more?

Watch the YouTube video below as Jess explains this topic in more detail and download the free handout from our Resources page.

The Threat Drive Soothe Systems

jess@thepsychcollective.com (Jess O'Garr) — Sat, 08 Oct 2022 20:46:03 GMT

How to Prevent Burnout

There are three systems that we have internally that influence how we regulate our emotions and respond to distress. Paul Gilbert (2009), who developed Compassion Focused Therapy, describes them as the Threat, Drive and Soothe Systems.

The Threat System

The function of the Threat System is detection and protection from threats. There are parts of our brain including our Limbic System that is vigilant for threats. It is predominately developed for physical threat, such as sabre-tooth tigers in the environment, but it's also used for psychological threat, such as perceived failure, humiliation, rejection, judgement and abandonment. When we detect a threat, we respond to it automatically by activating the Fight or Flight Response (which involves adrenaline and cortisol).

The Drive System

The Drive System is our predominant system which is seeking out resources, foraging for information, finding food and getting stuff done. Our Drive System is task-focused and productivity-based and utilises Dopamine to activate our reward systems so we stay motivated to achieve positive outcomes.

The Soothe System

The Soothe System is about caregiving and bonding with others. It is how we can care for ourselves by intentionally dearousing and down-regulating when feeling distressed or overwhelmed. It is how we engage in rest and relaxation so we can recharge our batteries between tasks and threats. In many people, this system is under-resourced or absent.

Driving yourself to burnout

Your Threat System exists to keep you safe from danger. When there is a real threat in your environment, follow your instincts and get out of there. But if it is a perceived threat, which can still activate your Fight or Flight response, you can still feel distressed and overwhelmed. No one likes to feel threatened. No one wants to remain in their Threat System. Thus people will do what they can to get out of this state. What is 'supposed' to happen is that people use their Soothe System to dearouse their Threat System once the threat has gone. But if their Soothe System is underdeveloped, people will resort to using their Drive System to fix their threat instead.

This over-use of the Drive system looks like breaking boundaries, self-sacrificing, perfectionism, and substance misuse to cope. This ultimately leads to burnout.

Here's how it looks at work:

Tuesday : "The boss has given me this huge presentation to do and it's due on Friday. I don't know how I'm going to get it done. I'm scared I will fail and get fired (threat). I'm going to have to stay late until I get this finished. I'll have to cancel the kid's soccer practise as I won't have time.

Thursday : "I still haven't got this done. I've stayed back until 10pm every night. I'm so exhausted I just can't think anymore. I'm not sleeping because I'm so worried about this. I'll just have to have more coffee today to get through it, and maybe a drink tonight to relax before bed."

Friday : "I'm just going to have to give him what I have. It's really not good enough. I'm such a failure." Do presentation, stumble over words due to fatigue and barely scrape past. Drink a bottle of wine after work.

Saturday : "I feel terrible, I'm worried about how bad that was. How can I face them on Monday? I'll call in sick."

BURNOUT

Here is an alternative:

Tuesday : "The boss has given me this huge presentation to do and it's due on Friday. It's going to be a big job so I will plan how to get this done. I will tell he boss I need to deprioritise X tasks so I have time to get this done. I will stay until 6pm and then I need to leave to take my kids to soccer. I will rest tonight so I am fresh tomorrow morning."

Thursday : "There is still a lot to go, and I am managing to work through my plan. I think I will get this done. I notice I am feeling stressed so I will have a bath tonight so I sleep well and can present well tomorrow."

Friday : "This may not be perfect and it will still be okay. The boss can see how hard I have worked."

Saturday: "I did the best I could. Now I will spend time doing things I enjoy so I am refreshed and ready for Monday."

RESILIENCE

Using your Soothe System doesn't make you soft or weak. Just like over-using your Drive System doesn't make you tough or stronger. We want you to aim for a 60/30/10 split. Spend 60% of your time in Drive and 30% of your time in Soothe, allowing 10% for Threat. You still need to be on the lookout for danger, so you don't get eaten by a sabre-tooth tiger. Soothe needs to be active and intentional. Sleep is important, but it doesn't count as Soothe.

Want more?

Click on the YouTube video below to hear Jess O'Garr and Dr Al Griskaitis talk more about this model with a Schema Therapy overlay, or click on the handout to download it for free from our Resources page.

How do you start behavioural activation?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 24 Aug 2022 10:22:57 GMT

How do you get started when all you want to do is crash?

Behavioural activation is one of the most effective ways of overcoming anergia that occurs with depression. It involves setting clear goals for completing tasks, regardless of what mood you're in. Yet many people find this challenging because of mood dependence, which is where you allow your mood to dictate your choices.

Consider this:

You wake up in the morning and feel lousy. You're still tired, you're thinking it's going to be another miserable day and you just can't bring yourself to face it. So what do you do? Stay in bed? Imagine if you did. How would you feel at the end of the day? What would you be telling yourself? Probably something like " I've spent the whole day in bed and achieve nothing. Now I feel worse ."

Consider this instead:

You wake up in the morning and feel lousy. You're still tired and you're worried it could be another miserable day. However you decide that you will get up and try to at least achieve something . Doesn't have to be big, just stick the the BASICs. You get up and have a shower. You put on clean clothes and brush your teeth. Then you manage to make toast. Maybe even some eggs. You're starting to feel slightly human. You open the curtains and eat breakfast near a window. Now you've started your day.

When you are struggling with anergia (lack of energy) then you need to keep it simple. We have developed a framework to help you covers the BASICs.

BASIC

Body care: Maintain basic hygiene. Shower and brush your teeth. If that's too hard, gargle Listerine and use baby wipes. Just commit to doing something. Feed yourself and move your body.

Achievement : Get something done. Go grocery shopping or order online. Respond to emails. Book appointments. Fix or repair something.

Social : Call someone. Go out for coffee. Meet a friend for a walk. Invite someone over.

Interests : Do something you like or at least used to enjoy. Try some craft, colouring in, work on a hobby. Research something you're interested in. Watch more of us on YouTube!!

Clean : Tidy your space. Load the dishwasher or the washing machine. Pick up the 'floordrobe'. Clean out the fridge.

This framework is to help you get started because motivation comes after activity, not before it. Once you can get the ball rolling, you'll find it easier to get to other tasks. But on the hard days, just keep it BASIC.

Ready to plan your own ideas? Download the handout from our Resources page.

Sleep Levers

jess@thepsychcollective.com (Jess O'Garr) — Wed, 24 Aug 2022 00:48:10 GMT

How to make yourself sleep

Sleep comes down to a very simple formula. If your sleep drive (the feeling of being tired and ready for sleep) is greater than your mental arousal, then you will fall asleep. If your mind to too busy and your mental arousal is greater than your sleep drive, you will stay awake.

In this post, we will talk about the four things you can control to put yourself to sleep. We call these levers, which you can pull on to modify your sleep drive and your arousal. It's pretty simple. We want your sleep drive to increase and your mental arousal to decrease.

Sleep Drive = Tiredness = Adenosine

Adenosine is the compound which accumulates in your body while you are awake. The longer you are awake, the more it builds up and the more tired you feel. While you are sleeping your body breaks it down faster than you make it, so when you wake in the morning after a good sleep you have low adenosine.

Action : Get up early so you will have accumulated more adenosine by bedtime, making you more tired.

Adenosine can also be increased through physical activity Our body stores energy in our cells in a form called Adenosine Triphosphate (ATP). When we engage in exercise, this energy breaks down, releasing some adenosine. You may have noticed this after a big day of activity, like a long run or walk, a big day or gardening or moving house. The more energy you consume, the more tired you feel. That is because of adenosine.

Action : Increase your physical activity throughout the day to make yourself feel more tired at night.

Caffeine is an adenosine-blocker. Many of us will drink caffeine when we feel tired because it perks us up. It does that by blocking the effects of adenosine in our system. This can be effective in the morning if you didn't sleep enough and have residual adenosine but it is counterproductive at bedtime. Many people may have a high tolerance to caffeine and believe they can have a cup before bedtime and not be impacted, but EEG studies show the negative impact of caffeine on sleep quality and depth.

Action : No caffeine after midday . This includes coffee, tea, chocolate, cola drinks, and energy drinks. This will allow the caffeine time to wear off and the adenosine to take over so you can fall asleep.

Sleep Drive = Readiness for Sleep = Melatonin

Melatonin is the hormone that prepares your body for sleep. It does not put you to sleep (that's adenosine). Melatonin is like the night shift coming into your brain and starting the wind-down processes so that when sleep comes, your brain is prepared. The release of melatonin is triggered by the changes in light in your environment. There is a part of your brain called the Suprachiasmatic Nucleus (SCN) situated above the optic chiasm. It works like the light sensor in cars that have auto-headlights. When the light becomes dim enough, the SCN triggers the release of melatonin from the pineal gland and the night shift gets to work. Certain cognitive processes are slowed or turned off and the body also goes through a shut-down process, preparing for other processes to engage, like immune restoration, muscle growth and taking out the trash of metabolic waste.

Action : Keep the light as dim as possible two hours before bed. Use dimmer switches or lamps with warm white globes to create a soft glow. Salt lamps and candlelight are the ideal colours for evenings.

Action : Ensure you have blue light filters on your screens , including phones, tablets and laptops to reduce blue light exposure that will confuse your SCN to think it is still daylight.

Action : To stop melatonin and start the day shift, make your room bright when you first wake up . Open all curtains and sit outside or near a window when you have breakfast or your morning coffee, so you get at least 10 minutes of sunlight right into your eyeballs so the SCN can tell the pineal gland to stop releasing melatonin.

Action : While melatonin is stored and released from the pineal gland, it is made from the foods that we eat. Melatonin (and serotonin) are both derived from protein. So to ensure that you are making enough melatonin, you need to ensure you are eating protein-rich foods , especially those high in tryptophan.

Mental Arousal = Alertness = Noradrenaline

Noradrenaline (or norepinephrine in the USA) is the arousal neurotransmitter. It is linked to the hormone of adrenaline that circulates in our body when you are stressed or on alert. Noradrenaline is released when you perceive a threat, are highly stressed or worried about something, or have a strong emotional reaction such as to a trauma cue or nightmare.

This is often experienced as tension, agitation or restlessness at night when you go to bed and you can't sleep because your mind is busy ruminating or catastrophising, keeping you awake.

Action : If you have been stressed or worried about something during the day you need to deal with your mental arousal before you go to bed. Try our worksheets on Clear Your Head Before Bed or Order Your Chaos with Four Buckets .

Action : If you had heightened physiological arousal during the day (e.g. panic attack, intrusive memory or felt 'triggered', then you need to reduce your body's arousal by using Autogenic Training , PMR , Body Scan , Breathing or Yoga.

Substances = Interference

When faced with sleep problems, many people may turn to substances. Alcohol is well-known for its sedating properties, and some people feel that it "takes the edge off" the worrying thoughts or physical agitation that is keeping them awake. There are three main problems with this. First, once you fall asleep, the alcohol is metabolised so the sedating effect wears off and a rebound effect in the second half of the night means people will wake again. Second, alcohol is a REM sleep suppressant, so it negatively impacts your sleep architecture, so you have less restorative sleep, often waking more tired. Thirdly, alcohol has a strong addictive component for many, meaning people become dependent on it to sleep and suffer from weight gain, brain health impacts, and metabolic problems and thus do not learn alternative and more skilful methods of getting to sleep.

Action : Don't rely on alcohol for sleep . If you are drinking socially, then no more than two alcoholic drinks in the evenings and have at least four days per week alcohol-free.

Sleep medications like benzodiazepines (temazepam, lorazepam or diazepam, etc.) and "Z drugs (zopiclone, zaleplon and zolpidem) disrupt sleep architecture. Benzodiazepines are a REM sleep suppressant and will reduce the amount of Stage 3 and 4 non-REM sleep, resulting in non-restorative sleep. They are used in the short-term management of insomnia and should not be taken for more than two weeks. Tolerance and dependence are common in long-term use.

Action : Talk to your doctor about reducing medications and start implementing better sleep hygiene strategies so you can get to sleep without relying on your medication. Especially by dealing with the thoughts that are keeping you awake. Once you are confident in your skills, then consult your doctor to stop taking sleep medications altogether. Remember #SkillsBeforePills.

Like what we have to say here? Download the free handout from our Resources Page .

Also you can watch this video to hear us talk about Sleep Levers in more detail.

PTSD from cumulative trauma in the services

al@thepsychcollective.com (Al Griskaitis) — Mon, 04 Jul 2022 03:33:50 GMT

Understanding cumulative trauma & PTSD in traumatic workplaces

What’s traumatic for one person is not traumatic for another: Whether we are traumatised depends on whether one is vulnerable to traumatisation from a potentially traumatic event.

In some occupations such as police, emergency services and the military, exposure to potentially traumatising events is part of the job. But SOME people can do these jobs for decades without suffering the effects of traumatisation. The notion we present is that traumatic events accumulate behind a wall of resilience. The wall of resilience has hidden cracks. Those cracks are our hidden vulnerabilities. Events which traumatise us get through these cracks.

What traumatises us depends upon our innate resilience and our unique vulnerabilities, that's why a given event will traumatise one person, but not another.

As we accumulate trauma, a “pressure” accumulates which increases our sense of tension and makes us more irritable and fragile - until something smashes our wall of resilience. When the wall is smashed, we are no longer resilient and are overwhelmed with symptoms of traumatisation. With that loss of resilience comes a painful loss of identity which accompanies the flood of PTSD symptoms.

The wall cannot be easily rebuilt.

Overcoming trauma entails skills to deal with the distressing PTSD symptoms. Then these skills can be utilised to face and “process” the trauma, to resolve it. Resolving the trauma entails figuring out what made us vulnerable to traumatisation and addressing that vulnerability so we can’t be traumatised that way again.

Steps to resolving traumatisation:

1. Understanding exactly what happened . This entails fully recalling and unjumbling a trauma memory. This requires distress management skills and courage. It’s usually done by recounting the trauma narrative repeatedly until all the details emerge and make sense.

2. Once one completely recalls what happened, one can then understand the meaning of what happened. The event will be complex there will be elements within the event. Each element has meanings. Types of meaning include: External factors like randomness, malevolence, neglect (eg incompetence) and negligence. And Internal factors (vulnerabilities) like self-neglect (eg naivety), self-negligence (eg recklessness) and moral injury (action or inaction against one’s moral values). Usually there are both external factors and internal factors at play in PTSD. Everyone puts the emphasis on the external factors, but these are mostly unchangeable, and little is to be gained from focussing on these. Indeed, denial about the nature of external factors keeps people stuck (“It shouldn’t be like that…”, “they shouldn’t be able to…”, etc. is mostly pointless). Hence the need to accept the reality: “I can’t change that people like that exist, but I can act in a way that means I can see the danger and act wisely to preserve myself”. The internal factors are critical to address. People do not like to even endorse the internal factors that led to their traumatisation. A common protestation is “are you saying it’s my fault?”. To which the answer is: “no, but being traumatised is your problem and you need to address the bits you can address, otherwise you will stay stuck and remain vulnerable”. Denying one’s role in the trauma keeps people stuck. If one was naïve, one needs to understand how they were naïve (eg too trusting “they would never”). If one recklessly put oneself in a dangerous situation this need to be acknowledged (too confident “I can handle it”). Figure out the meanings and vulnerabilities, so you can address them.

3. Having understood the meaning one can then understand why one was vulnerable to that trauma. Your hidden vulnerability needs to be addressed, that’s why the memory screams at you. It’s like your body “knows” you are still vulnerable, hence you are unsafe until you have addressed the vulnerability. It like your body doesn’t trust you anymore so it’s on high alert in case you find yourself in the same situation again. Understanding the hidden vulnerability is learning the lesson of the trauma and patching our vulnerability is how to silence the alarm that is PTSD. Patching the vulnerability: If recklessness was a factor, then that must be addressed. If being too trusting was a factor, that must be addressed. If being obedient was a factor, then that must be addressed. If thinking you’re invincible was a factor, then that must be addressed. Addressing the trauma means understanding ones vulnerability in high resolution, it means being on the lookout for a situation where that vulnerability may trip you up and most critically acting in a manner that would mean you are no longer vulnerable. It means acting differently in the face of the danger. It doesn’t mean hiding away from the danger. Hiding away keeps people “safe” but it also keeps them sacred. Addressing the vulnerability that caused the trauma event to be traumatising is the way forward.

How do you deal with a panic attack?

Wed, 29 Jun 2022 08:09:42 GMT

Dealing With Panic

DON'T PANIC until you check this out

To terminate a panic attack one needs to stop/reverse the physiological cascade of panic.

The cascade is:

A. the emotion of severe anxiety (fear) results in

B. activation of the flight/flight response which triggers hyperventilation and increased heart rate (helpful if you’re running for your life, a problem if you’re just sitting there).

C. The hyperventilation and high heart rate results in changes in blood gases and an impairment in brain function ensues, a delirium (we lose too much CO2 which results in something called respiratory alkalosis) and the fear becomes terror. That’s a panic attack.

To reverse the panic cascade we need to correct the respiratory alkalosis by safely reaccumulating blood CO2.

There’s two ways to do that:

1. Move. The more intense the better. I’ve taken patients up and down the stairs in my hospital. This terminates the panic attack in about a minute. (The muscles generate CO2 which corrects the alkalosis).

Or:

2. Slow the breathing down. The slower the better. I aim for 4 breaths per minute for 2–3 minutes. This allows CO2 to reaccumulate and corrects the alkalosis that way. But it takes longer and needs practise.

In my experience people need to practice controlled SLOW (NOT DEEP!) breathing when calm in order to effectively utilise it when panicked.

Burst activity like climbing stairs, exercise bike sprints, burpees or even star jumps stop the panic and don’t need practise. It works in about a minute - and shows people that they can get control. Once you see you can get control you are more inclined to practise slow breathing.

Deep breathing can exacerbate the alkalosis, because it can cause you to get rid of even more CO2. Breathing needs to be SLOWED to reaccumilate the CO2.

Then they need exposure therapy to get mastery over the cues/fears which have come to trigger their panic.

Social Anxiety

Wed, 29 Jun 2022 08:09:42 GMT

What is the best advice to overcome social anxiety?

Social anxiety is no picnic. When you’re socially anxious, the party is a monster. It feels like they are judging you and making you small and inferior. It feels like any interaction will probably degenerate into mortal embarrassment. That will confirm your feeling of inferiority and while you bleed shame your blood imbues disgust. No picnic.

The only real solution is exposure therapy. SSRIs might help the process out. But without some deliberate exposure work you’re probably going to be a little stuck.

You need to really want to do something about it, you need to light the fire inside. Be determined. You can’t just go through the motions begrudgingly. Well you can, but it won’t help.

That’s not simply going to the party and hiding, although that’s where you might need to start- getting there might be the first challenge.

Having some practice at controlled slow breathing will help you from panicking (slow not deep!). For public speaking some people benefit from deliberate 10 second pauses where they stop breathing to reaccumilate the CO2 which we lose when if start to panic.

Competency might entail going to the party, having an agenda, executing that agenda and then simply leaving. Then increasing the scope of your agenda at the next social situation and executing that . Having a safety behaviour like some talking points is fine. Using deliberate slow breathing is fine and discrete. Execute the agenda then leave with that win. Repeat, it will get easier.

The steps are:

Talk to doc about SSRI
Prepare agenda for party
Practise discrete SLOW breathing
Have talking points prepared before hand
Go to the party
Execute the agenda
Use slow breathing/talking points if needed
Leave early with a win
Repeat to increase courage

If you do that, you’ve turned the social situation from being your predator to being your prey.

- Dr Al

Exercise for Mental Health

Wed, 29 Jun 2022 05:07:18 GMT

What are exercises that boost your mental health?

The mind and body are deeply connected.

Regarding physical exercises there are four broad types of exercise which can undertake

Intense exercise

When we breathe normally, there is an ideal amount of carbon dioxide in our blood, but when we panic breathe, this balance goes out of whack and we enter respiratory alkalosis. This is caused by a change in the pH of our blood which can cause an experience of mild delirium, making it difficult to think clearly when you are panicking. One of the fastest methods of resolving this is using intense burst exercise. Doing an activity that has you “huffing and puffing” will help correct your blood pH for acute distress relief. A minute or two can make all the difference.

Examples:

Running up and down flights of stairs
Using an exercise bike vigorously
Running sprints

Strength-based exercise

Strength training in the form of weight training or resistance training has been shown to have an effect on mood. It causes the secretion of growth factors in the brain which can help increase resilience for stress and improve mood. Increased strength is associated with more confidence and better mood.

Examples:

Weights training
Resistance training

Endurance type exercise

Endurance exercise can decrease sensitivity by building tolerance of discomfort. Any form of exercise that takes a long time puts a strain on the body. The skills that you would implement to learn to tolerate this can then be applied to emotional discomfort. With physical endurance come mental endurance.

Examples:

A run for 20-30 minutes at a pace which means you can’t hold a conversation easily.
A fast hill walk

Restorative exercise

Restorative exercise can offer improved reserve and decreased sensitivity by using movement to take care of your body. Exercise that involves stretching, breathing and holding poses can increase flexibility and strengthen the mind/body connection.

Examples:

Yoga
Tai Chi

Some forms of exercise will achieve several of these modalities. For example, Yoga combines endurance, strength and flexibility. CrossFit combines endurance, strength and intense exercise.

You may wish to consider where you have a deficit:

Mental stamina?
Mental strength?
Mental flexibility?
Mental sensitivity?
Lack of mental discipline?

Now go use your body to do something to address it.

What is the one skill that will completely change your life?

Wed, 29 Jun 2022 01:37:27 GMT

The secret skill that underpins recovery. Every time.

Discipline.

Start to be disciplined in whichever way you can. Self-discipline is the path to mental strength.

Start where you can: with a commitment. Eg walk every morning OR cut out sugar OR cut out coffee OR daily meditation OR just start wherever you think you can.

Make the starting commitment doable but not so easy that it doesn’t require any discipline. It should ideally be a daily thing. Don’t cheat or make any excuse clauses.

Be deliberate about continuing to be disciplined about your starting commitment and keep going.

Don’t moan about it, don’t make an excuse not to do it. Just keep doing it. That’s the discipline.

As you maintain this starting commitment it will become easier. Then become disciplined about other things too. Then eventually you can apply self discipline to whatever you choose.

That’s maturity and mental toughness…

… or just make an excuse to not cultivate discipline.

How to become disciplined

One needs some rules to cultivate discipline:

Set routines and stick to them: eg “I get up at 5:30am on weekdays and go to a gym class”.
Stick to the routine especially when you don't feel like it. Then it becomes part of who you are- that’s your identity.
Be explicit about your identity : “I’m someone who gets going early in the morning” vs “I’m someone who lazes around and sleeps in”. A good interim identity is “I’m someone on a journey of becoming more disciplined about [whatever you’re trying to achieve]”.
Don’t bail out of a planned routine task. When you bail out, it becomes increasingly okay to bail out. Bailing out gets easier, until it’s the default. If that happens, forgive yourself AND urgently reset.
Don’t wait for motivation. Motivation comes and goes, but discipline will make you get things done despite the absence of motivation. Make a plan. Set a date to start (like today!) Some people like to make themselves accountable (e.g. to a partner or trainer). Just start. Then continue.
Embrace discomfort . Comfort is for sleep, recovery and consolidation. Discomfort is where growth lays. Do things that are difficult. Lean into discomfort and recover in comfort. Earn the comfort. Don’t live your entire life in unearned constant comfort.
Start being disciplined somewhere then expand your use of discipline beyond that start place . It’s good to start with exercise, as once your mental/physical strength increases you’ll have more stamina to apply discipline to other parts of your life.
One can run low on discipline as one becomes tired. Look for holes in your daily discipline pattern and work around them. E.g. If you drink at night while watching TV because your resolve is eroded after work: then go for a walk and go to bed early instead. That will pay a dividend tomorrow rather than the guilt/hangover.
Be reasonable with yourself: don’t simultaneously be a tyrant and a slave to yourself. Negotiate with yourself . E.g. “if I go to the gym every day as I said I would, I’ll treat myself to [something positive]”. If you just jam yourself into things you don’t want without a pay off it’s very hard to sustain.

Think about the people you admire. Are they undisciplined?

The comfortable path calls us to be weak, unhealthy, lazy and undisciplined. The discomfort of discipline helps us to achieve our goals and realise our potential .

The disciplined get things done.

What can I do to reduce anxiety?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 29 Jun 2022 00:56:24 GMT

What are some methods to deal with anxiety?

There are numerous approaches:

Behaviour therapy, cognitive therapy, removing things which induce anxiety, reducing stress burden and increasing stress tolerance.

Behaviour therapy is a psychological therapy where one approaches ones fears in a voluntary and deliberate manner. It’s done in a graduated way, starting with tackling something hard but do-able. Eg if the anxiety is about taking an elevator, then start by pressing the button and peering in when the door opens. Repeat that until it’s easy, say ten times a day for a few days. Then when the elevator comes, go in and come back out without actually riding it. Repeat that until easier. Then ride one floor. Repeat that. Add more floors and keep repeating.

In the case of generalised anxiety, behaviour therapy can entail writing a narrative of your worst fears, a “worry story”. Where you end up alone, broke, homeless or whatever your ultimate fear is and how you got there. Then repeatedly read/rewrite it. This can really put things into perspective. And reduce that fear and make things more realistic and make you more courageous.

Cognitive therapy gets people to question the logic of the anxiety and identify faulty and unhelpful thinking patterns or thought traps, which can be habits of mind.

Reduce the stress burden . In addition to sedative/stimulants and difficult people/relationship/news cycle what else in your life is both stressful and meaningless? Could be comparing yourself to others in social media, could be a job you hate, could be the mess in your home. Look out for stressful things. Get rid of what you can.

Increase stress tolerance . Ever met an anxious Buddhist? Meditation may not sound like your cup of tea, but it’s clear than everyone can learn to do it and it both improves tolerance to stress and reduces anxiety. Meditation is NOT clearing your mind. Meditation is practicing deliberate awareness of your thoughts and acts to kind of elevate you above them. So you're not immersed in the automatic negative thoughts/automatic emotions. One can become observant of thoughts rather than being trapped under the weight of them. The PRO section of the Headspace app has 60 days of instruction. The PRO section is buried in there. It’s worth finding (I have no affiliation).

Other practices to improve stress tolerance include things which proactively focus on improving you. Exercise, eating well, a hobby, learning a skill (start with meditation!), travel/exploration, doing meaningful things like helping those who you love or helping others. Doing meaningful things will give you a meaningful life. Doing meaningless things feels meaningless and demoralising.

Other approaches. Functional/integrative medicine practitioners often point to inflammation and gut processes as contributing to mood/anxiety. Sometimes these approaches are helpful, it usually entails elimination diets etc. These can be very powerful if there are underlying problems such as autoimmunity playing a role.

Medications . Most people don’t do the above so their doctors point them to pills. They generally seem to help by making people more indifferent. When you’re more indifferent you’re less anxious. When the meds stop things often go back. Sometimes stopping meds can be a nightmare. I avoid commencing the noradrenaline affecting ones (eg venlafaxine) which at higher doses seem to make some anxiety worse and can be hard to stop. And I avoid regular sedatives like benzodiazepines.

Schema Questionnaires

jess@thepsychcollective.com (Jess O'Garr) — Wed, 29 Jun 2022 00:21:54 GMT

How do you measure schemas and modes?

Schema Therapy, and in particular Schema Mode Therapy, is full of many moving parts. There are 20 maladaptive schemas, 14 positive schemas and at least 17 schema modes. Getting a handle on all of this can be tricky so I'm going to give you the heads up on how to get started.

Young Schema Questionnaire - Long Form 3rd edition (YSQ-L3)

Developed by Jeffery Young, this questionnaire uses 232 questions to measure the original 18 maladaptive schemas. The third edition was published in 2005. If you want a copy of this one you need to purchase it from https://www.schematherapy.org/

Young Schema Questionnaire - Short Form 3rd edition (YSQ-S3)

In 2005, a shorter schema questionnaire was developed by Jeffery Young and Gary Brown. Based on the third edition of the YSQ-L, the short form uses only 90 questions to measure the original 18 maladaptive schemas. You'll get this from https://www.schematherapy.org/ as well. Though in all honesty, I think this website is confusing and I don't use these questionnaires anymore. I use the revised and free version below.

Young Schema Questionnaire-Revised (YSQ-R)

While the original Young questionnaires have been our only option for many years, I was thrilled to discover that there is now a revised version and it's free! Following further analysis of the 'fit' of the items, Yalcin, Marais, Lee and Correia (2022) revised the YSQ-L down to 116 items with a few changes to the original 18 maladaptive schemas. It now lists 20 schemas, as the Emotional Inhibition schema was split into 'Emotional Constriction' and 'Fear of Losing Control', and the Punitiveness schema was split into 'Punitiveness-Other' and 'Punitive-Self'. This questionnaire is a more robust measure of maladaptive schemas and clinically it makes much more sense.

To use the online version of the YSQ-R with an excellent output (thanks to Jason Wessel), head to Unpack Psychology:

https://www.unpackpsychology.com.au/assessments/young-schema-questionnaire-revised

To download the questionnaire and Excel scoring spreadsheet (built by Oz Yalcon), head to :

https://www.anima.com.au/schema

Young Positive Schema Questionnaire (YPSQ)

To complement the YSQ-S3, which only measures maladaptive schemas, another team of researchers (Louis, Wood, Lockwood, Ho, & Ferguson, 2018) created a questionnaire to measure adaptive schemas. This 56 item questionnaire measures 14 adaptive schemas that help to operationalise what a Healthy Adult would believe about themselves.

Unfortunately, this questionnaire is not easily available. I contacted the lead author and was advised that he would be happy to share a copy of the questionnaire and scoring sheet but only if people contact him directly to ask. So he gave me permission to publish his email address so you can ask him for a free copy.

So here is his email: johnphiliplouis@gmail.com

Now, Dr Louis has asked that when you email him, you include in your request for a copy of the YPSQ your full name, which country you are from and the reason that you want a copy (clinical, personal, or research use or you plan to translate it into another language).

While you're waiting for a reply, here is the reference for his article.

Louis, J. P., Wood, A. M., Lockwood, G., Ho, M.-H. R., & Ferguson, E. (2018, April 19). Positive Clinical Psychology and Schema Therapy (ST): The Development of the Young Positive Schema Questionnaire (YPSQ) to Complement the Young Schema Questionnaire 3 Short Form (YSQ-S3). Psychological Assessment. Advance online publication. http://dx.doi.org/10.1037/pas0000567

Schema Mode Inventory (SMI)

Developed in 2008 and revised in 2009, Jeffery Young and his team created a questionnaire for measuring the strength of Schema Modes. Using 124 questions, it measures 14 modes, including Child Modes, Maladaptive Coping Modes, Dysfunctional Parent Modes and Healthy Adult.

It is important to note that in my schema mode therapy overview (the video with the rainbow arches) I reference 17 modes. This questionnaire does not cover them all.

Also note that this questionnaire refers to some other modes that I don't use, like Enraged Child, Impulsive Child and Undisciplined Child. Personally, I don't like these labels because it feeds into the messages that the child was the problem, instead of remembering that the child is Vulnerable and the problem is with the dysfunctional parents.

To download the questionnaire and Excel scoring spreadsheet head to :

https://www.anima.com.au/schema

Schema Mode Overview

Tue, 31 May 2022 14:31:41 GMT

I am a schema therapist at heart. I was lucky enough to attend a training workshop with Ida Shaw and Joan Farrell in 2014 and immediately fell in love with schema mode therapy. It offers a unique way of conceptualising early childhood experiences and explaining how they influence our emotions, behaviours and coping styles as an adult. Here I have tried to briefly explain how the modes fit together. There is a handout of the modes if you click on the button at the top of the page.

And yes, we know that we accidentally cut off the top of the board. My Healthy Adult is telling my Perfectionistic Overcompensator to sit with it. The handout should help fill in the blanks.

Following the presentation by Jess about how the schema modes fit together, Dr Al asked Jess to explain a few more things for him.

Schema Therapy Modes Model

A diagram of the schema modes and how they interact.

This worksheet accompanies Jess's talk on Schema Therapy Modes (Part 1) and shows how the different types of schema modes fit together.

There is also a full page version of the model in case you need a closer look.

To download these documents, log in to our Resources page. It's free!

Order your mental chaos

jess@thepsychcollective.com (Jess O'Garr) — Fri, 27 May 2022 21:04:42 GMT

Stop the cyclone in your mind

You know that feeling of when the thoughts inside your mind keep swirling around on a continuous loop? As if your brain is wanting to constantly remind you of important things so you don't forget? Your mind is occupied with all that chaos, so you can't sleep?

Yet in all that chaos, you can't sort out your thoughts so nothing productive actually comes of it?

That is the reason that Dr Al came up with the four buckets technique.

We often get the sense that my head is really full of thousands of things that need to be done, and yet when I make the time to sit and write it out the list is actually shorter than expected. The swirling mess in my mind creates the illusion of the problem being so much bigger than it actually is. Getting it down on paper allows me to see what I am really dealing with, and thus make a plan to tackle it.

However, a disorganised to-do list is not helpful. That is why we offer the Four Buckets technique to structure the way you go about this. A schedule of tasks is way more helpful that a list because a schedule will help you to allocate the time to get the task done. A to-do list will just nag you until the list is finished, and I know in my case I am very good at adding to that list faster than crossing stuff off.

So here is the four buckets technique.

Divide a sheet of paper into 4 sections "To do", "Projects", "Deeper stuff" and "Junk" (or download the "Order Your Chaos with Four Buckets " handout). Sit at an uncluttered table with that paper and a pen. Close your eyes. Pay attention to the thoughts that bubble up. As the thoughts bubble up: write the thoughts down in their appropriate bucket. Spend at least 10 minutes or as long as you need to declutter your mind.

Here's what goes into each bucket:

To Do

This stuff is the urgent or easy stuff that needs your attention soon so you can knock it off your list.

This might include things like paying bills, signing kids permission slips, writing your grocery list, etc.

Projects

The less urgent yet still important tasks that need your attention that perhaps are big jobs that need planning. This might include things like organising the garage, renovations, finishing a big project at work or school, planning your next holiday, etc.

Deeper Stuff

This may include anything that is not urgent, yet may also be harder to action. We may not see the way forward on our deep stuff. This could be things like wishing you could fix your relationship with your mother, or wanting to spend more time playing with the kids. Or a past trauma memory that keeps intruding on your thoughts. This is probably the bucket you need to share with your therapist.

Junk

This one is for the random stuff that your mind generates that doesn't really need any action. The fact that the public transportion timetables need work. This stuff isn't ours to action so we can work on letting it go by declaring it as "junk".

Order mental chaos - declutter the mind

If you often feel that your head is full, then get into the regular habit of using the four buckets. Over time, you may relabel the buckets to suit your needs and that's fine. Either way, it is important for you to take control of your mental chaos so you can sort your chaos out.

Need more?

Watch this video of Dr Al explaining and using this technique and then jump to our Resources page to download the handout.

The Revised List of Schemas

jess@thepsychcollective.com (Jess O'Garr) — Thu, 31 Mar 2022 00:00:30 GMT

Back to the drawing board

The original list of 18 maladaptive schemas was published by Jeffery Young in 2003 and he subsequently developed the Young Schema Questionnaire to assess these schemas within patients. However, Yalcin, Marais, Lee and Correia (2022) completed further analysis of the questionnaire and identified that the questionnaires fit better by reducing the number of items and changing a few of the schema subsets. Hence, this list shows the revised list of 20 maladaptive schemas.

These extra schemas come from changes to the Emotional Inhibition schema, which was split into 'Emotional Constriction" and 'Fear of Losing Control'. The Punitiveness schema was also split into 'Punitive-Self' and 'Punitiveness- Others'.

While there is nothing wrong with the original list of schemas or using the YSQ-L3 or YSQ-S3, this latest review of the data would support swapping out the old for the new and using the YSQ-R as it is more statistically robust and the changes to the aforementioned schemas are more clinically relevant.

Reference :

Ozgur Yalcin, Ida Marais, Christopher Lee & Helen Correia (2022) Revisions to the Young Schema Questionnaire using Rasch analysis: the YSQ-R, Australian Psychologist, 57:1, 8-20, DOI: 10.1080/00050067.2021.1979885

A List of Positive Schemas

jess@thepsychcollective.com (Jess O'Garr) — Thu, 31 Mar 2022 00:00:05 GMT

Finally, a list for the Healthy Adult

So much of early Schema Therapy simply focused on the maladaptive schemas. We have the list of them here . Schema Therapy was developed for patients who had Borderline Personality Disorder (BPD), severe depression or complex trauma. So of course the starting assumption was that you didn't get your early needs met, and thus you developed all of these negative schemas and core beliefs about yourself. Hence, we only focused on changing what was unhelpful.

If you combine Schema Therapy with Schema Mode Therapy, then we get an approach that recommends addressing Maladaptive Schemas by increasing the strength of the Healthy Adult Mode and reduce the Maladaptive Coping Modes.

Yet so many of my patients ask "what does a Healthy Adult look like?" or "How do I become a Healthy Adult?" And generally I list things like Self-Care, setting boundaries and regulating your emotions. And to be honest, perhaps that answer falls a little short. So imagine how excited I was when I discovered that someone did the research and made a list of Early Adaptive Schemas!

Early Adaptive Schemas

Developed by Louis, Wood, Lockwood, Ho & Ferguson (2018), this research team looked at the Young Schema Questionnaire (Short Version) and effectively wrote the questions in the opposite way to 'mirror' the maladaptive items. Hence " I haven’t had someone to nurture me, share him/herself with me, or care deeply about everything that happens to me " became " For the most part, I have had someone who really listens to me, understands me, or is tuned into my true needs and feelings ". Then they used some complicated statistical analysis that I won't bore you with (although if you want to read the article the link is at the bottom) and refined the list down to 56 questions that measure 14 adaptive schemas which makes up the Young Positive Schema Questionnaire (YPSQ).

1. Stable Attachment

The belief that your relationships are stable and enduring.

People with this adaptive schema have a strong sense of confidence and security in their close relationships. They do not cling to the people they are close to because they have trust and belief that those individuals will not leave them. This trust in the loyalty and reliability of their close relationships provides a sense of security and peace of mind and allows them to maintain a sense of independence and self-assurance, even in the face of potential loss or separation. In situations where they sense someone they care about pulling away, they do not react with panic or desperation. Their confidence and trust allow them to approach such situations with composure and understanding, recognising that people have their own individual needs and dynamics within relationships.

2. Emotional Fulfilment

The belief that you have someone in your life who meets your emotional needs of attachment, connection and safety.

People who have this adaptive schema were likely fortunate enough to experience a nurturing environment where they consistently had someone who cared deeply about them. Whether it was a parent, guardian, or a close mentor, there was always a person who invested their time and energy to nurture and support them. They wholeheartedly shared their experiences, wisdom, and affection, ensuring that the individual felt valued and cherished. The warmth provided by these caring individuals was a constant presence, creating a sense of security and belonging that shaped their journey.

3. Social Belonging

The belief that you belong and are accepted within groups.

People with this adaptive schema have confidence in their ability to fit in and connect with others. They find common ground and have shared interests with the people they encounter, allowing them to integrate smoothly into various social contexts. They experience a genuine sense of belonging and acceptance among others, feeling a deep connection and inclusion in groups. They do not encounter significant barriers or feelings of exclusion in social settings. They feel satisfied with the level of connection they have with others. They have a sufficient number of friends and do not desire or require additional companionship. They are able to form meaningful connections and foster relationships that contribute to their overall sense of fulfilment and connection.

4. Competence

The belief that you are capable of managing daily tasks and problems.

People with this adaptive schema possess a strong sense of independence and self-reliance in their everyday life. They feel capable and confident in their ability to handle various situations and navigate through daily challenges. They trust their own instincts and rely on their own assessment of situations, demonstrating a belief in their ability to make sound decisions and confidence in their problem-solving skills. They view themselves as independent, emphasizing their self-reliance when it comes to everyday functioning. They trust in their own capabilities and do not heavily rely on others for assistance or guidance.

5. Developed Self

The belief that you have matured independently from your parents and can function in everyday life and maintain appropriate boundaries.

People with this adaptive schema have successfully achieved a level of independence from their parents comparable to most others their age. They have been able to separate themselves and establish their own life, maintaining a healthy level of autonomy. They do not find themselves overly involved in their parent's problems, recognizing the importance of maintaining personal boundaries and prioritizing their own well-being and individual growth. This encourages the development of their own unique experiences, goals, and sense of self. Thus, their sense of identity is not defined by external influences, allowing them to pursue their own aspirations and forge their own path.

6. Success

The belief of being capable and competent at work or school tasks.

People with this adaptive schema consider themselves to consistently perform at a high level, perhaps surpassing the achievements of their peers. Their track record demonstrates a consistent ability to excel in various tasks and endeavours. They strongly believe in their competence, recognising their capacity for accomplishment and set high standards for themselves. With a keen sense of their capabilities, they confidently navigate the realms of work and achievement, matching or even surpassing the talents and intelligence of others in their field. Their commitment to excellence and their belief in their own abilities drive their success and propel them towards continued growth

7. Empathic Consideration

The belief that others are worthy of respect even when their opinions are different to your own and the capacity to tolerate not always getting your own way.

People with this adaptive schema possess a strong belief in fairness and equality, acknowledging that they should abide by the same rules and limitations as everyone else. They do not seek or expect special treatment, and value the importance of following established norms and regulations. This mindset allows them to gracefully accept situations where they are unable to pursue their desired course of action and instead go along with the decisions made by others. They possess a genuine respect for the conventions and guidelines that govern social interactions. They exhibit a humble and inclusive outlook, consistently recognising and appreciating the worth of what other people have to offer.

8. Healthy Self-Discipline

The ability to maintain routines and persist on difficult goals.

People with this adaptive schema demonstrate a strong ability to discipline themselves when it comes to completing routine or mundane tasks. They possess the necessary self-control to stay focused and committed, allowing them to effectively accomplish such responsibilities. When faced with challenges in reaching their goals, these people exhibit persistence and resilience. They do not easily give up and are determined to overcome obstacles in order to achieve what they set out to do. Their tenacity drives them forward, even in the face of setbacks or difficulties. They display a remarkable capacity to delay immediate gratification or pleasure in favour of achieving long-term goals. They understand the importance of sacrifice and are willing to forgo immediate satisfaction to pursue their larger aspirations.

9. Healthy Self-Care

The willingness to set aside time for self-care and prioritise your own needs.

People with this adaptive schema have a balanced approach to caregiving and receiving care within their close relationships. They actively take care of the people they are close to, demonstrating a nurturing approach. However, they are also comfortable allowing others to reciprocate and provide care for them when needed. They maintain a belief that they can be a good person while considering their own needs to be equally important as those of others. They understand the value of personal time and self-care, avoiding neglecting their own needs in the process of caring for others. They also make it known that they expect others to consider their own needs. They maintain healthy boundaries when they give and help others while expecting their needs to be taken into account also.

10. Self-Directedness

The belief that your own opinion of yourself is more important than needing to impress others.

People with this adaptive schema possess a strong sense of self-worth and importance, independent of the attention or recognition they receive from others. They value their own worth and feel important to people, even when they aren't the centre of attention. Their self-esteem is not reliant on external validation or praise from others, and they do not seek recognition or admiration in social or professional settings. Their sense of self-worth is self-generated and not dependent on external factors such as wealth or social connections.

11. Optimism

The belief that things will generally turn out for the best.

People with this adaptive schema will focus on positive moments and favourable circumstances in their life. They tend to feel a genuine sense of happiness and optimism for the future. They are able to fully embrace and enjoy positive events without succumbing to pessimistic expectations of impending disaster. They hold a belief that things generally work out well and there is no need for constant worry, as catastrophising does not lead to constructive outcomes so they maintain a relaxed perspective. This optimistic outlook allows them to savour and appreciate the present, fostering a positive mindset that extends into their expectations for what lies ahead.

12. Emotional Openness

The willingness to express your feelings and show affection towards people with whom you are comfortable.

People with this adaptive schema demonstrate a high level of comfort in expressing their positive emotions and feelings to others. They are at ease with showing physical affection, such as hugs or other forms of touch, as well as verbally expressing care and affection towards the people they value. They prioritize authenticity and genuine emotional expression, allowing them to freely and comfortably share their feelings when they desire to do so. Their ability to convey their emotions contributes to their authentic and meaningful connections with others.

13. Realistic Expectations

The belief that you can set achievable goals and accept yourself as 'good enough'. People with this adaptive schema maintain a realistic and grounded approach when it comes to their expectations for themselves. They find satisfaction in their accomplishments without feeling the need to be among the best. They embrace the concept of "good enough" and accept imperfections, avoiding undue stress or pressure. They strike a balance between responsibility and letting go, understanding that it is important to prioritise relaxation and not overly worry about unfinished tasks. They allocate time for both productivity and leisure, avoiding excessive concern over things left undone. When mistakes are made, they practice self-compassion and give themselves the benefit of the doubt, fostering a mindset of growth and acceptance.

14. Self-Compassion

The belief that you deserve to treat yourself with kindness and forgiveness.

People with this adaptive schema hold a compassionate view towards themselves, understanding that mistakes are a natural part of life and do not define their worth or character. They do not dwell on self-blame or harsh self-criticism, instead they exhibit a remarkable ability to forgive themselves, recognizing that they do not deserve punishment for their errors.They possess a healthy self-perception that allows them to accept their efforts and outcomes with a sense of peace and contentment. They hold a fundamental belief in their own goodness and have a positive self-image. They embrace their intrinsic worth and maintain a sense of self-assurance, which contributes to their overall well-being and resilience in the face of challenges.

Want this list in a handout?

You'll find a two page handout explaining this in The Complete Set of Schema Therapy Worksheets available on our Resources page .

The Good Parent

jess@thepsychcollective.com (Jess O'Garr) — Wed, 23 Mar 2022 23:12:06 GMT

The Good Parent raises a Healthy Adult

A Good Parent is an instructive role model for the development of the Healthy Adult Mode.

In Schema Mode Therapy, the therapist takes on the role of the Good Parent to coach the client on how to respond differently to challenging or distressing situations. The Schema Mode therapist (Good Parent) always responds to the Vulnerable Child with validation and empathy. The therapist allows the Angry child to be heard. The therapist supports the patient to make choices about which coping modes they still need and (preferably) which ones they can stand down. The therapist teaches the client how to stand up to their Punitive Parent and negotiate with their Demanding Parent. The therapist encourages and praises the client when they exhibit Healthy Adult choices and the therapist promotes fun and play for the Happy Child.

As in childhood, the need for the Good Parent exists only until the client learns to internalise the messages and teachings from the Good Parent (therapist) to be able to manage their modes themselves. So when clients "hear" the voice of their therapist in their head, its a good thing, as the Healthy Adult is manifesting.

Here is a script of things a Good Parent would say. These are the words you deserve to hear.

The Healthy Adult Mode

jess@thepsychcollective.com (Jess O'Garr) — Wed, 23 Mar 2022 23:04:35 GMT

The Healthy Adult Mode directs the rest of the modes.

The Healthy Adult Mode is like a stage director in charge of coordinating the modes. The Healthy Adult places the Vulnerable Child centre stage, as it is the most important player. The Angry Child is placed close by. But the bad actor Maladaptive Coping Modes which have been running the show need to be moved off to the side of stage as the Healthy Adult employs new methods of coping. The Punitive Parent is banished from the theatre and the Demanding Parent is put in the corner, only to speak when spoken to. The Happy Child is free to skip along the stage and do chalk drawings on the floor.

Early in therapy, the Maladaptive Coping Modes will sneak back in the limelight. So it's critical that the directing Healthy Adult stays vigilant to signs of old habits creeping in and deliberately uses healthy skills and its new understanding of how to make changes.

In the early stages of treatment, this is exhausting and it may not even notice when it slips up. Yet perseverance of this adaptive state is the only way to create meaningful change over time and eventually their old modes will learn their place.

The Happy Child Mode

jess@thepsychcollective.com (Jess O'Garr) — Wed, 23 Mar 2022 22:55:04 GMT

The Happy Child Mode plays and has fun.

Children need play. The Happy Child Mode is the part of our inner child that helps us meet the need to play and to have fun. Play is an integral part of healthy child development, and (in case you hadn't noticed) all adults are just grown-up children, so that need for play never leaves us. But it's often subconsciously inhibited.

Through play, children can explore their creativity, curiosity and connection with others. They can put their ideas into imaginative play. The need for play does not disappear in adulthood, but the form of the play may mature. It is crucial that adults find time for play, including novelty, exploration and fun. This healthy mode warrants just as much attention in the process of schema therapy as does the Vulnerable Child Mode.

When we are deprived of play, we miss out on opportunities for positive emotion. Lack of play can lead to pervasive low mood, feelings of burnout and resentment, and deeply impacts our identity.

Schema Coping Modes: FREEZE

Wed, 23 Mar 2022 13:31:33 GMT

Have you tried logging off?

When you are at the point of giving in, when you just don't have any more fight left in you, when you can't even run away from it any more, then your only option is to freeze.

In Schema speak, we call this the Compliant Surrenderer mode. What this means is that you surrender to your schema.

For example, let's imagine that you have the Failure schema.

The FIGHT response says "I have to prove that I am not a failure by doing everything perfectly"

The FLIGHT response says "I won't go to the meeting because I know I screwed up and I'm just going to get in trouble"

The FREEZE response says "Yeah, I'm a failure. I fail all the time. I'm not even going to bother trying."

The Four Ingredients for Emotional Wellbeing

jess@thepsychcollective.com (Jess O'Garr) — Wed, 17 Nov 2021 00:20:09 GMT

Why do you need emotions?

So often I hear “I hate my emotions, they’re stupid, can’t I just turn them off?”

Well you can, AND you’ll pay for it later.

Humans are hard-wired for emotions. Every child is born with a set of six distinct emotions: joy, anger, fear, sadness, surprise and disgust. They are universal and necessary for healthy development.

And though some of my patients have figured out how to turn their emotions off, numb themselves, detach or dissociate, I make it pretty clear that we won’t make any real progress until they learn to turn them back on again.

There are some things that will make it a lot harder to tolerate your emotions. Hypersensitive temperament, negative past experiences and lack of skills are the biggest. If you feel things deeply, and didn’t get the support you needed for this as a child, then you are going to struggle with this. But I can assure you, if you don’t figure out how to RESPOND to your emotions skilfully, you’ll spend the rest of your life running from them. And that’s exhausting.

Learning to turn towards your emotions, instead of away from them, will involve specific cognitive and behavioural tasks. We present this in a hierarchy from simplest to hardest, but if you have never done it before, then it will all be hard.

That’s okay, just keep trying.

Self-Care

Self-care is about looking after the basics. This involves behavioural tasks that are about taking care of your body each day. It includes Sleep, Exercise, Light, Food, Clean, Avoiding your kryptonite, Routine and rest and Engagement. Some of these skills will be more habitual than others already. When your body is taken care of, then your emotions get easier to handle.

Self-Validation

This is a cognitive technique because it is about the way that you talk to yourself about your emotions. Self-validation involves acknowledging and accepting your inner experiences as real for you. It is not asking you to like them, or even to want them. You just have to accept that they are there. Self-validation sounds like: “My feelings are real for me. I am struggling. I am in distress. I feel scared.” To self-validate you need to Acknowledge the feeling, Accept that the feeling is happening and Allow it to be there without trying to push it away.

Self-Soothing

Self-soothing is both behavioural and experiential. It is about looking after yourself while you feel distressed. It is about the actions that you take to care for yourself, with the aim of reducing the intensity of the distress. We often use the five senses for this, so think about what is soothing to look at (photos, scenery, TV), to listen to (music, nature sounds, binaural beats), to smell (candles, flowers, body cream), to taste (tea, mints, juice) and touch (weighted blanket, warm shower, oodie). These self-soothing behaviours need to be familiar, comfortable and authentic.

Self-Compassion

Self-compassion is the willingness to look after yourself with kindness while you experience your feelings. It says “I deserve to look after myself while I am feeling distressed”. Self-compassion says “That was a really hard day, I struggled with that, and now I am going to take care of myself while I recover from my day and let my big feelings pass.” It is empowering to know that you can look after yourself while you’re having these feelings, talking to yourself with kindness, not pretending the threat is not happening, but holding yourself with compassion, having the skills to look after yourself.

To practise self-compassion you need to be KIND . Start with a Kind approach to yourself and Identify your struggle and notice what is difficult about this experience. Then you need to Nurture your inner child (or vulnerable child) and Decide to be a healthy adult and take the appropriate steps to use whichever skills are needed in this moment.

Some of this will be really uncomfortable at first. And when our brain is presented with novel or unfamiliar experiences it can be suspicious and try to warn us away from danger. However, I want you to be really clear that there is no danger in what we are suggesting that you do here. And the more you practise looking after your emotions, the more familiar it gets, and the less scary it becomes.

What is Self-Care?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 03 Nov 2021 00:45:55 GMT

Why is self-care important?

Have you ever been around a two-year-old who missed nap time? Or was too busy playing to stop and eat? Or when they are teething or have a cold? When they have been stuck inside all day because it was raining? Which emotions do you see in them? How well can they regulate their emotions?

It is so obvious to us as an adult that small children will have bigger emotional responses when their basic needs for food, sleep, movement and comfort aren’t met. But allow us to let you in on a little secret - adults are just grown-up children. At no point do we grow out of our need for food, sleep, movement and comfort. So it is really no surprise to us when we see people having big emotions when self-care has been neglected.

There are many reasons (and excuses) why self-care gets ignored. Some people never learnt it growing up, or they had such crappy childhoods that they still believe they are not worthy of self-care. Some adults prioritise other people and tasks over their own self-care, so they tell themselves they don’t have time. Others are ruled by their mental health conditions and let their moods dictate how they care for themselves.

Regardless of the reason, self-care has to be the starting point for making changes if you want to improve the way you tolerate and manage your emotions. The components of self-care involve behavioural tasks that need to be undertaken to maintain basic functioning.

Sleep

Without it, you don’t function well, just like a toddler. But you know this already. If you’re getting less than 6 hours of sleep, or having problems with broken sleep or nightmares, head over to our Sleep page.

Exercise

Your body needs movement in whatever format you can tolerate. Whether that is a walk around the block, chasing after kids, vacuuming the house or joining the crossfit craze, you need to move every day.

Light

Exposure to sunlight, especially in the morning, is important for regulating your circadian rhythm and sleep cycle. The light sensor in your brain works like the thing that controls auto-headlights on a car. When the sun is bright, your wake cycle is activated, when the environment is dim, your brain prepares for sleep. For more information, check out our page on Sleep and Light .

Food

Your body needs food for fuel. Duh! But the food choices you make can have an impact on your emotions. Foods with high carbs or sugar will cause glucose spikes and crashes that can cause similar spikes and crashes in your mood. If you’re hankering for a snack, choose a protein option. Read more on our page about Nutritional Psychiatry .

Clean

Wash your body, brush your teeth and try to run a brush through your hair at least daily. When the grips of melancholy make this feel impossible, go for baby wipes, listerine and dry shampoo. Remember that your skin is an organ and needs cleaning. Your teeth are the only exposed parts of your skeleton and need cleaning. Don’t allow your mood to dictate your choices on this one. Push yourself to do it anyway.

Avoid your kryptonite

How is your mood when you are hungover? How jittery do you get when you’ve had too much caffeine? What is the crash like when you’ve been using benzos? How do you feel when the sugar wears off? You need to know what your kryptonite is and reduce or avoid it. If you are struggling with mood swings, remember that you feel what you eat and drink. Also remember that sometimes your kryptonite can be your phone, watching TV or spending time with toxic people. So choose what you need to change.

Routine and rest

Humans need a balance between consistency and novelty. That’s called a dialectic. Ironically, scheduling in time for novelty works well. Maintaining a healthy level of self-care takes effort and discipline. There will be days when you don’t feel like moving or eating well, and those are probably the days when you need it the most. So set yourself a routine for getting these activities done across the week, and make sure your routine includes rest. Rest is just as important as productivity. Figure out what rest activity feels restorative for you and schedule it into your routine.

Engage

Humans are social creatures. We don’t survive well in isolation (or lockdown). We need contact with other creatures to maintain our wellbeing. So make time for connection each day, whether that is talking, texting, sharing memes or just cuddling your pet.

This list might seem a bit hefty if you’re not used to it. But with practise, it will become more automatic. Also remember that you are allowed to have flexibility with this. If you need a rest day, then maybe exercise gets dropped that day, but do your best to pick it up the next day. If you have a treat, pay attention to how it affects your mood a few hours later, then adjust your next food choice accordingly.

Find the dialectic of balancing self-denial with self-indulgence. Too much of either is bad for you, so aim for the middle ground.

What is Self-Validation?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 03 Nov 2021 00:45:53 GMT

Why do we need to validate ourselves?

Self-validation is the skill of being able to notice what you are feeling with non-judgemental awareness and acceptance. It is about creating space within yourself for all of your feelings, emotions, moods and sensations without trying to dismiss them.

Your capacity to respond skilfully to your feelings will largely depend on your early childhood experiences and what messages you heard from your parents. Invalidation occurs when someone is told that what they are feeling is incorrect, inappropriate or unwanted. Children who hear messages like “stop crying or I will give you something to cry about”, “stop being a drama queen”, or “stop being so sensitive” will learn that if they show emotion they will be rejected or punished.

Those sorts of messages set up a belief for the child where they think “Okay, well, Mum and Dad are telling me I'm not supposed to feel this way, so there must be something wrong with me and my feelings.” The child then tries to repress or shut down or detach from their feelings. Which is an unachievable task. Because they cannot succeed in always repressing their emotions, they experience shame. The child starts to think “there must be something wrong with me”, which then becomes the next emotional event that triggers the cycle around again. The invalidating messages they hear from their parents, grandparents, teachers, coaches or older siblings or peers become the internal messages that they keep telling themselves as they grow up.

This sets up a process of mistrusting internal experiences, judging feelings to be wrong or dangerous and ultimately a fear of emotions. People who don’t learn to tolerate their feelings will constantly be on the lookout for distress. Once they Detect distress, they make an appraisal that these feelings are bad, so they Detest the distress. This leads to them choosing to Dodge the distress so they don’t have to feel it. Problem is, it comes back later.

Therefore, in order to practise self-validation there needs to be a willingness to turn towards the feelings and approach them with curiosity. To do this, it starts with an Acknowledgement of the feeling. A simple awareness of what is going on inside your body. Then comes the choice to Accept that this feeling is happening without fighting it. Finally, there is the choice to make space for the emotion. Simply Allowing it to be there for a little while. Sure, it doesn’t have to stay forever and there are skills you can use to move it along later. But first, just let it be there.

What is Self-Soothing?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 03 Nov 2021 00:45:51 GMT

How do you calm yourself down?

Self-Soothing is when you engage in activities designed to help you reduce your distress or overwhelm by using the five senses to calm yourself down.

Think about when a baby is overtired and gets worked up. What do we do for it? Swaddle it, feed it, sit in a dark room and cuddle it while we rock it to sleep with shushing noises. We reduce the stimulation and use strategies designed to calm the senses so the baby can settle and sleep. For adults, we use modified strategies, like a weighted blanket instead of a swaddle (though if you want to turn yourself into a burrito, go right ahead).

Self-Soothing needs to be carefully used so that it doesn’t turn into Detached Self-Soothing. This skill is not permission to eat a tub of ice cream and watch TV for 12 hours, but it is permission to stop and engage your Soothe System so you can unwind and destress.

To do this, we use the five senses.

Here are some examples:

Sight

Scroll through your camera reel on your phone
Look at family albums
Find images of holiday destinations on the internet
Watch out your window
Watch the clouds go by
Scroll through pinterest to plan your dream house
Watch your favourite tv show or movie
Hang up pictures around the house
Draw, paint or colour in
Watch videos on YouTube. We made a playlist for you to try.
Tidy up the space around you

Sound

Listen to your favourite music
Listen to new music by searching for playlists based on the mood you want to get into.
Listen to the birds outside
Listen to binaural beats
Listen for kids laughing, the breeze in the trees
Play songs that you will sing along to
Use an app to listen to rain sounds or white noise

Smell

Light a candle
Spray air freshener
Put on perfume
Use an oil defuser
Open the windows and let in fresh air
Put some fresh flowers in a vase
Go to the beach and smell the salt air
Cook something with garlic and chilli

Taste

Make a cup of tea
Suck on some strong mints
Drink some really cold water

Touch

Wrap yourself in a weighted blanket
Get a massage from someone else
Play with a popper
Use a spiky massage ball
Put clean sheets on your bed
Use your favourite moisturiser or body oil
Have a warm shower
Play with play-dough, putty, slime or kinetic sand
Lay in the sun

It will be easier for you to use this skill if you have everything you need ready to go before you need it.

To help with this, we have made some Self-Soothe kits for you to purchase that include some of the items we mentioned above. Head over to our Resources page to check them out.

What is Self-Compassion?

jess@thepsychcollective.com (Jess O'Garr) — Wed, 03 Nov 2021 00:45:48 GMT

Why is self-compassion important?

Self-Compassion is the ability to respond to yourself with kindness when you are struggling with something difficult. It is about the way that you talk to yourself when the chips are down. It is the opposite of self-criticism, self-condemnation and self-deprecation. It is the path forward for recovery and healing.

And if you are repelled by the idea of this, then you really need it.

Self-compassion doesn't take away your suffering,

but holds you with kindness while you experience the distress.

People with low self-esteem often believe that they don't deserve self-compassion so they criticise themselves strongly. Some people believe that by being hard on themselves, they can push themselves to be better or stronger. The reality is that when people lack self-compassion their self-criticism or judgement leads to burn out or breakdown. They suffer more than they need to.

The truth is, if you don't feel that you deserve self-compassion, then you are making things unnecessarily harder for yourself: you are contributing directly to your suffering.

If you want to overcome distress then self-compassion isn't optional.

Self-compassion requires a Kind approach. If you hear yourself telling yourself that you need to toughen up, get over it or stop being so sensitive, then you are not being kind. Think about how you would talk to a friend who is suffering. What tone would you use? What words would you say? Would you offer them understanding, care and kindness? That's compassion.

We use self-compassion when we are struggling with something, so you need to Identify the struggle. What is it that is bothering you? Which part of this is hard for you? Do you notice that this situation is triggering some old memories or urges to engage in regrettable actions? This part will require you to use some of your self-validation skills.

Once you know your struggle, then you need to Nurture yourself. This works best if it is targeted towards your inner child (or Vulnerable Child ), because this is the part of you that feels the intensity of emotions like sadness, fear, anger and loneliness. Nurturing yourself can include self-soothing skills.

Ultimately, you need to decide to be a Healthy Adult. This means making skilful choices about how to respond to your struggle. This may include setting boundaries, saying no to requests, using Planned Recovery, ignoring your Inner Critic (or Punitive Parent ) and using skills before pills.

This can be one of the hardest skills to master if you grew up in an invalidating environment. However, it is also one of the most important skills if you want to create a life you are happy with.

Self-compassion exercise

Write a letter to yourself as though you were writing to someone whom you care about that was in your situation. If they are suffering would you harshly focus on their shortcomings, inadequacies, and failings? Be kind in your tone and write what you'd say if you were being compassionate to your friend. It can shift your perspective in an important and helpful way. It can give you a glimpse of what it is to be self-compassionate.

Without self-compassion, you crucify or sacrifice yourself until there is nothing left but a burned-out shell. That's what happens. Has that already happened to you?

Be kind and gentle with yourself, the suffering is real.

Do the self-compassion exercise.

Sleep and Light

Thu, 12 Aug 2021 09:02:34 GMT

Sleep and Light

Preparing your body for sleep.

Melatonin is a hormone produced only in low/warm light that signals to the brain that it is time to prepare for sleep. Melatonin reduces wakefulness. Reduce your exposure to light at night to reduce your wakefulness.

Want to read more? Check out our handout. It is free to download from our Members Resources page.

Sleep and Light

How your light exposure effects your sleep

There is a part of your brain called the SuperChiasmatic Nucleus (SCN) and it is connected to your optic nerve. It's job is to pay attention to how much light you are exposed to, and tell the brain when it is time for sleep by kickstarting your melatonin production. The trigger for this call to sleep is from the absence of light, specifically blue light.

If you are exposed to too much bright or blue light in the evening, your brain doesn't get enough warning to start preparing for sleep until you finally shut off your laptop or turn off your phone. From when the SCN pulls the trigger on preparing for sleep, to when you actually fall asleep can be a difference of 30-90 minutes. And if you happen to be lying in bed for that time, you'll be tossing and turning and probably getting frustrated.

So give your brain some warning that it needs to start preparing for sleep by reducing your blue light exposure.

ACTION: dim the lights at sunset and turning off screens at least 30 minutes before bed.

Image Source: https://www.howsleepworks.com/how_circadian.html

Dark Therapy for Bipolar Disorder

How to manage manic episodes and preserve sleep

For people who have Bipolar Disorder, sleep is a crucial element of maintaining stability. Disrupted sleep can trigger a manic episode, and visa versa. One of the questions we get asked often is how to promote sleep during an episode, as usually people rely on drugs to sedate them while they ride out the episode.

However, I recently stumbled across this article that talks about using dark therapy for Bipolar Disorder. A research team in Norway subjected a group of patients to 14 hours of darkness (6pm-8am) while they were experiencing manic symptoms, and found that this reduced the severity of their symptoms much faster than the control group. Now, this is new information to me, so honestly I haven't tried it with a patient yet, but the research is compelling.

And for those of you that shudder at the thought of that much time in darkness, a cheat option was offered of wearing amber glasses for the same amount of time.

Read more about this from the links below.

Psych Education.org

Research Article

Amber Glasses

What is a Schema?

Tue, 20 Jul 2021 14:31:41 GMT

Schemas often develop in childhood. We learn about ourselves and our world from our early experiences. If we have positive experiences and get our needs met, then we learn that we are safe, loved and important. If we have negative experiences and our needs are not met, then we learn that we are unloved, unsafe and unwanted.

How do schemas develop?

A child’s temperament plays a big role in the development of maladaptive schemas. Some children are born with a hypersensitive temperament, meaning they feel things more intensely and have bigger reactions when triggered. These children often have a greater need for emotional support from their primary caregivers and can be more impacted by unmet needs or emotional invalidation.

If a schema is repeatedly activated by a continuation of unmet needs, it will strengthen over time. This makes the schema more rigid and our reactions less flexible. It can create harmful patterns of responding to cues by acting in ways that are unhealthy or self-defeating.

Maladaptive schemas are the problem areas that people struggle with. It is similar to a theme for core beliefs. For example, if you have a schema of Failure, then your core beliefs will sound like " I fail at everything " or " There is no point in even trying because I always screw up ". Schemas are not active all of the time but are triggered by interactions with someone or something. Once a schema has been triggered, it activates a state of intense feelings, thoughts and behaviours. These states are called Schema Modes.

The goal of Schema Therapy is first to help people to identify their maladaptive schemas underlying long-term problems. Then support the person to challenge or overcome their negative schemas and associated behaviours and coping mechanisms, replacing them with adaptive or positive schemas to promote healthy ways of coping.

To download the handout for this, go to our Resources page. It's free!

Vulnerable Child Mode

Tue, 20 Jul 2021 14:31:38 GMT

The Vulnerable Child Mode (VCM) is at the core of everything in Schema Mode Therapy, This is because the VCM is where we hold our memories of painful experiences, distressing emotions and often intense sensations. Thus, the VCM is where we hold our trauma. It is understandable that most people want to detach from their VCM by ignoring it, shutting it down or trying to get rid of it, as they don't want to reconnect with these feelings.

The problem with this is that the way people try to get rid of their feelings involves unhelpful coping strategies which often cause more difficulties later, hence we call them Maladaptive Coping Modes (MCM).

Thus, the whole point of Schema Mode Therapy is to heal the Vulnerable Child using healthy coping strategies from the Healthy Adult Mode and reduce the impact of the MCM and the Dysfunctional Parent Modes (Punitive and Demanding).

This creates space for the VCM to heal from past memories, learn to tolerate intense emotions and experience feelings of safety and comfort as adults.

Read more on our Vulnerable Child Mode handout. Download it for free from our Resources page.

How to Soothe your Vulnerable Child

One of my favourite techniques for soothing the Vulnerable Child is with a Blanket Hug.

You can do this with any blanket, or you can purchase one of ours which has a Good Parent script printed on it.

Check out this video for a demonstration on how to give yourself a blanket hug.

Angry Child Mode

Tue, 20 Jul 2021 14:31:38 GMT

Angry Child Mode

Understanding why anger is a useful emotion for change

Anger is a powerful emotion that motivates us to create change when we perceive injustice. Think about a time when you last felt angry. What was the cause? Was it because you felt disrespected? Was something unfair? Was someone that you cared about being hurt? Were you being hurt?

Ultimately, anger comes out when we feel our needs are unmet. This means that more often than not, anger is a secondary emotion, and the primary emotion is vulnerability. Feelings of being unsafe, mistreated, disrespected or hurt trigger our Vulnerable Child mode. Therefore, the Angry Child Mode is activated to draw attention to the unmet needs for the benefit of the Vulnerable Child.

However, this often causes more problems than it solves. Think of a child who didn’t get what they wanted, so they stamp their feet and yell at a parent to try to insist on getting their wants or needs met. Often tantrums are responded to with threats, punishment or neglect, and the child’s needs remain unmet. When adults throw tantrums, they can also be punished, shamed or abandoned, which exacerbates the vulnerability.

Download the handout from our Resources page. It's free!

Dysfunctional Parent Modes

Tue, 20 Jul 2021 14:31:37 GMT

Punitive Parent

The critical voice that puts us down, berates us, and tells us we are worthless, unloveable or a failure. It is based on previous experiences of being criticised, abused, bullied or neglected. We hear it so often that it feels true even when there is evidence to the contrary.

Demanding Parent

The voice in our head that is pushing us to do better, try harder, be perfect and never fail. It has a whip and a megaphone and it can be relentless in flogging us.

Schema Coping Modes: FIGHT

Tue, 20 Jul 2021 14:31:34 GMT

Perfectionistic Overcompensator Mode

The Perfectionistic Overcompensator is a FIGHT Maladaptive Coping Mode (MCM). It operates from the belief that "If I get everything perfect then no one will doubt me or see my weaknesses". Unfortunately, this leads to burnout and increases feelings of shame and worthlessness.

In this video, Jess explains more about this mode. Download our handout below for more information.

Suspicious Overcontroller Mode

The Suspicious Overcontroller is a FIGHT Maladaptive Coping Mode (MCM) within Schema Therapy. It believes that no one can be trusted so you better do everything for yourself.

In this video, Jess explains more about this mode.

Bully Attack Mode

The Bully Attack is a FIGHT Maladaptive Coping Mode (MCM) within Schema Therapy. It aims to attack others and push them down so that other people don't discover the underlying vulnerability of the bully.

In this video, Jess explains more about this mode. Download our handout from our Resources page.

Self-Aggrandiser Mode

The Self-Aggrandiser is a FIGHT Maladaptive Coping Mode (MCM) within Schema Therapy. It is a defense mechanism that uses showing off and presenting a facade of grandeur to hide the underlying vulnerability., Sometimes people know that it is all an act, other people may be more in denial.

In this video, Jess explains more about this mode. Download our handout from our Resources page.

Schema Coping Modes: FLIGHT

Tue, 20 Jul 2021 14:31:33 GMT

Detached Protector Mode

This FLIGHT mode allows for avoidance of feelings by psychologically detaching to reduce emotional overwhelm.

Avoidant Protector Mode

This FLIGHT mode allows for avoidance of feelings by avoiding situations or relationships where there is a risk of feeling distressed or anxious.

Angry Protector Mode

This FLIGHT mode uses a wall of anger to push people away to avoid people getting close. It can also look like silent hostility, stonewalling or sulking.

Detached Self-Soother Mode

This FLIGHT mode avoids feeling vulnerability by using 'stuff' to take the feelings away, such as alcohol, pills, food, shopping or sex. These behaviours are often engaged in mindlessly, leading to overuse and regrettable actions.

Complaining Protector

This FLIGHT mode avoids feeling vulnerability by pushing blame on to other people. In this video, we discuss the difference between complaining and venting and how you need to use radical responsibility to engage your Healthy Adult.

To download our handouts, go to the Resources page.

Borderline Personality Disorder

Tue, 20 Jul 2021 05:58:46 GMT

What is Borderline Personality Disorder?

It's a maladaptive survival strategy that gets set up in childhood or adolescence. It mostly results from unmet childhood needs or trauma. There’s also impact from things like rejection (real or implied) by a caregiver or neglect of emotions. Those things result in a vulnerability to future abandonment cues. Childhood trauma has a related effect, it implies that care was not as protective as it needed to be. Childhood trauma is also damaging to self-view.

Temperament plays a major role. The more sensitive the temperament, the more likely Borderline Personality may manifest in the context of trauma or unmet emotional needs.

The diagnostic criteria for Borderline Personality aren’t very integrated, just like those with the disorder! I’ll try and integrate it for you to make sense of it better; I’ve simplified and rearranged the order of the criteria so it makes sense and I’ve added my commentary in italics. Here’s the ‘background’ criteria, which result from the childhood difficulties:

Frantic efforts to avoid abandonment
Fluctuating sense of self-identity
Chronic emptiness

Whichever of these are present they are typically always present in the background. When a stress, such as an invalidation occurs we may observe one or more of these ‘reactive’ 5 features:

Unstable mood
Impulsivity
Anger
Suicidal behaviour or threats
Stress related paranoia or dissociation

In other words an invalidation (or other cue) causes Emotional Distress, this can look like one or more of the above or other maladaptive coping strategies such as spending, emotional eating, drinking, drugs, enacting the urges of emotions etc may ensue. Emotional Distress is the central feature of BPD. Emotional Distress happens a lot in BPD and it doesn’t always seem to make sense to loved ones, so it tends to be rough on relationships and the result is:

Unstable interpersonal relationships

That relationship instability feeds the abandonment fear, perpetuates the emptiness and the unstable sense of self. That’s it.

So that puts the diagnostic criteria into a framework which makes sense.

So it’s helpful to think of what’s called “Borderline Personality” as a response to either early trauma or unmet childhood needs (a different type of trauma). It’s complicated and the terms Complex Trauma, Complex PTSD may fit, but commonly it’s a Child Temperament/Parental Style Mismatch or Perceived Parental Rejection. Those ways of defining things are aetiological and I think, a little more comprehensible to people.

It was thought that in Borderline Personality people were on “Borderline” between psychosis and neurosis. Few practitioners subscribe to that formulation anymore, but that unfortunate label remains.

On a practical level the problem is a sensitivity to invalidation and a tendency to make biased reflex judgements. This tendency stems from temperament and childhood experiences, especially experiences of persistent invalidation from caregivers during childhood. But trauma, chaos and uncertainty can be major factors.

In adulthood, the combination of sensitive temperament and reflexive (often biased) judgements manifests as becoming easily emotionally overwhelmed. Emotional distress. Emotional Distress is the most obvious feature of BPD. When overwhelmed, physiological changes mean that logic goes out the window. Anger becomes rage, fear becomes terror, sadness becomes despair. The emotions come with urges to act them out: rage/attack, terror/cling or flee, despair/self-harm.

The affect and anger dysregulation is the manifestation of the emotional distress, as is dissociation, self-harm and suicidality. This is the basis of “The Distress Cycle” (see below).

In terms of “cure” it’s about improving sensitivity, reducing and noticing the proclivity to make reflex judgements and being aware of the particular biases that predispose a person with BPD to their reflexive judgements. That can be learned. It’s also about having an approach to overwhelm and the urge to act out overwhelming emotions. These are critical skills. Psychotherapy might help people understand themselves broadly. But we need to start by understanding what happens as we become distressed and what to do about that.

The “Distress Cycle” provides a framework which can help with that process. People can learn how to become less reactive. Once people get insight into their biases and snap judgements they don’t tend to become distressed, then relationships improve. Life starts getting better. But it’s work. Important work. This clip has more on that framework, if this resonates with you.

Loved ones are often perplexed by the way which people with BPD sometimes dramatically respond to seemingly innocuous things we may say. It’s because persons with BPD find meanings and invalidations where none were intended. This occurs because they have biases you can’t understand and often neither do they. But their reflexive judgements lead to overwhelming emotions. That may be mild hurt or it may manifest with profound Emotional Distress. The Distress Cycle worksheets helps people make sense of their Distress and helps people get insight into their reflex judgements and their biases which lead to those judgements and emotions.

Abandonment

Tue, 20 Jul 2021 05:58:45 GMT

Fear of Abandonment and Negative self view in BPD

Children may view their role in things that happen as central and children tend to blame themselves. If mum and dad are fighting, the child often thinks it’s their fault. If parents separate the child concludes that it’s about them. The child often believes they were abandoned when parental separation happens. A mother (and her child) leaving a difficult marriage situation can be misinterpreted by the child as the father abandoning. This can leave a child with a self view that they are disposable and likely to be abandoned again by another loved one. That can set up the central fear of abandonment in BPD.

When trauma befalls a child, sometimes they erroneously conclude that they deserved it. How could they possibly deserve it: they figure they must be bad. There’s a notion that being bad deserves punishment. The trauma is like a punishment. Being punished means they must have been bad. That’s the child’s conclusion. That’s the child’s way of making sense of it. They can’t comprehend the real causes of trauma: neglect, negligence, randomness and malevolence.

Children understand “bad” and they’re biased to believe they play causal roles. Children can carry that feeling of being bad into their future. It may become part of their identity. It has a childlike texture because one was a child when one embodied it.

The Big Five

Tue, 20 Jul 2021 05:58:44 GMT

We talk a lot about personality disorders within the mental health sphere, but what actually contributes to personality in the first place?

The Big Five inventory, sometimes known as the OCEAN inventory looks at different components of personality. While most psychology students learn it in uni and then never use it again, we dredged it up from the memory banks to explore the utility in therapy. By understanding where you sit across these five factors, you can learn to play to your strengths and make skilful changes where necessary.

OCEAN includes:

Openness

This measures how open you are to new experiences, how much you enjoy novelty, and how imaginative or creative you are.

Too much Openness can lead to impulsivity, risk-taking and thrill seeking.

Too little Openness can be lead to people being close-minded, struggle with creativity and declining new opportunities.

Conscientiousness

This measures how disciplined or controlled you are, how diligent you are on completing tasks and how reliable you are.

Too much Conscientiousness can make people rigid, rule-bound and perfectionistic.

Too little Conscientiousness can lead to people being unreliable, forgetful and disorganised.

Extraversion

This measures how outgoing you are in social situations, Extraverts get their energy from being with people, are happy being the centre of attention and are often assertive people who like to take action.

Too much Extraversion can lead to people dominating others, struggle with isolation and needing external validation

Too little Extraversion (called Introversion) can lead to people being withdrawn, needing a lot of alone time to recharge as they become exhausted or drained by social situations.

Agreeableness

This measures how easily you get along with people, how much you value harmony and how much you care for the needs of others.

Too much Agreeableness can lead to people becoming doormats, feeling scared to rock the boat and struggle with leadership roles.

Too little Agreeableness can lead to people presenting as disgruntled, argumentative and selfish.

Neuroticism

This measures how big your feelings are. Neurotic people feel things more intensely (sensitive temperament) and can have bigger reactions where their emotions are triggered.

Too much Neuroticism will lead to intense feelings that are highly changeable (emotional instability).

Too little Neuroticism can lead to a calm disposition, but perhaps an unhealthy detachment from feelings.

If you are interested in learning more about your personality style, you can complete our Online Assessment which has a mini OCEAN assessment, or click the link below for a more comprehensive assessment of the Big Five Factors.

https://bigfive-test.com/

Alternatively, you can download our handout that explores the Big Five Factors as continuums which may help you to identify your personality characteristics, and also your strengths.

Click on our Resources page to download this free handout.

Identity

Tue, 20 Jul 2021 05:58:43 GMT

Do you ever have those days when you feel like you don't know who you are? Maybe you fit in differently with different social groups and it leaves you feeling confused?

Try our Identity Matrix worksheet to identify all of the different aspects of you.

You can download this handout from our Resources page.

Do start to get a grip on your personality traits and on how you can capitalise on them you should check out our Personality and Character Traits worksheet.

Self-Authoring

Need to get to know yourself better?

Jordan Peterson and his colleagues have developed an online program which can help people untangle the chaos of their past and present and form an achievable vision for their future. The results some people achieve are extraordinary. It helps people to reconcile the difficulties of their past. It helps people make sense of themselves. It is a tool which can help those who don't have a cohesive sense of their identity. Be warned, it can be transformative.

Just a heads up - it's not free. It's about $30 USD, but that's for 2 users, so you can give the program away to someone once you've signed yourself up.

Understanding PTSD

Tue, 20 Jul 2021 05:32:18 GMT

PTSD: How, What and Why? (Part 1)

PTSD is a beast of an illness. It can invade all parts of your life and turn your world upside down. In this video, we explore the factors that contributed to the development of PTSD, explore the factors that maintain PTSD and reorganise the symptom clusters of PTSD.

Why do some people get PTSD?

A trauma event is often something deeply threatening that overwhelms your psychological resources.

When that happens (most of the time) we eventually process what happened. If we can’t then PTSD is much more likely. Sooner or later.

Processing entails:

achieving safety ASAP
releasing/expressing the emotions relevant to the trauma
connecting with someone
Being able to recall the entire sequence of events
Making sense of the entire sequence of events
Getting adequate sleep.
Deriving the meaning of what happened
Learning what lessons there are to be learned from the trauma to reduce the chance of it repeating.

Mostly if people can do this, they don’t get PTSD.

If they can’t do this they’re more likely to get PTSD. The more often they experience trauma which they can’t process, the more likely PTSD becomes. We can accumulate traumas by jamming them into the cracks of our minds. An emergency services worker may incur many trauma events without processing the trauma and not manifesting PTSD until one day they do. When that happens they lose much of their resilience. Then many past unprocessed traumas come out from those hidden cracks and overwhelm the person.

Technically, PTSD entails a fragmentation of the sequence of events leading to the formation of a dysfunctional “Trauma Memory”. “Trauma Memories” are often recalled out of sequence and with gaps. The fragments evoke powerful emotions and one feels as though the trauma just happened. So people feel very unsafe and hypervigilant.

The treatment of PTSD entails working through the steps which they did not achieve (as above). Most commonly this entails working with a therapist to unpack the whole sequence of events so as to make sense of everything. Then find the meanings and then extract the lessons.

Extracting the lessons seems critical as if we feel that we can learn a lesson from the trauma we may be less likely to be traumatised in that way again. With that comes less hypervigilance and fear.

Stages of Treatment for PTSD

Tue, 20 Jul 2021 05:32:17 GMT

Recovery from PTSD happens in four stages, once you actually get the proper treatment.

PTSD entails the presence of ‘trauma-type memories’. These are unlike normal narrative memories in that they are fragmented, often incomplete, they evoke powerful emotions and have the feeling of recency. ‘Trauma-type memories’ are toxic and they are the primary issue in PTSD; other PTSD symptoms (hypervigilance, reexperiencing/nightmares, hyperarousal/insomnia) are all manifestations of ‘trauma-type memories’.

A key goal is the transformation of toxic ‘trauma-type memories’ into less toxic narrative-type memories. This is what skilful Prolonged Exposure Therapy with Integration work can achieve.

Without skills to tackle the arousal, it’s very tough to get on top of PTSD.

Skills are critical before embarking on this journey. Becoming an expert in PTSD means you feel less chaos.

There are discrete stages to the treatment of PTSD. The stages are:

Stage 0: Pretreatment or undertreatment of PTSD.
Stage 1: Understanding PTSD and understanding PTSD treatment.
Stage 2: Acquiring the skills needed to cope with Distress of PTSD and the distress of recalling PTSD Trauma-type memories.
Stage 3: Tolerance of their trauma narrative so that people can start to make sense of their trauma experience.
Stage 4: understanding the meaning of the trauma episode and finding the lesson of their trauma experience.

Reconciling the meaning and learning the lessons of the traumatic experience are major components to resolving trauma.

Root Causes of Trauma

Tue, 20 Jul 2021 05:32:16 GMT

In order to recover from trauma, you need to be able to integrate the story. Part of this involves finding the meaning of the event.

May people get stuck with this part, as they keep asking themselves "Why me?" or "Why did this happen?"

We have found that in order for people to understand the meaning of the trauma, it helps to recognise why it happened. Often we find that the trauma is multi-modal, as there are the actions taken by the self (e.g. Randomness: wrong place at the wrong time) and the actions taken by others (E.g. Negligence: someone knew there was a problem but didn't act to resolve the danger).

Below is our matrix for the root causes of trauma.

There's an app for that

Tue, 20 Jul 2021 05:32:15 GMT

Some days technology drives us nuts, other days it helps us cure it.

Here is what we found to help with trauma. Found something else? Then send us an email and we'll share it around.

PTSD Coach Australia App

Developed by the Australian Government, this app offers education and resources for people experiencing PTSD. It has information and signs and symptoms, a self-assessment symptoms checker, scheduling tools and resources to help with distress, such as breathing, distraction or imagery scripts.

Free to download from your favourite app store.

Trauma in the Body

Tue, 20 Jul 2021 05:32:14 GMT

The Insula

Dr Jennifer Sweeton

After attending a training workshop with Dr Sweeton, we learnt about this little known area of the brain that seems to control the relationship between the brain-body connection. The implications in trauma treatment are becoming more apparent, and we have introduced this in our own clinical practise.

Tension Release Exercises

TRE Australia

Have you ever been so freaked out that you started shaking? Well the people at TRE Australia says that shaking motion is our way of trying to release trauma from the body. And they think that if you can create the tremors deliberately then you can shake it out.

Coping with COVID

Tue, 20 Jul 2021 05:07:26 GMT

Coping with COVID at home

Responding effectively to the COVID crisis

An approach to keeping important elements of life on track during a difficult time. Being deliberate will help you cope with COVID. Make your own version of the Wellness Wheel with the elements that are important to you.

Wellness Wheel

A quick check in on self care

This worksheet accompanies the video from Jess and Dr Al about coping with COVID-19 and remembering to keep an eye on your self-care, even in isolation or lockdown.

Our approach matters

A 'Warrior' versus 'Worrier' approach

Dr Al suggests that if you catch yourself acting in 'worrier' mode, gently try to nudge that behaviour into a 'warrior' approach. Doing so will make things more tolerable, not doing so may erode resilience.

Russ Harris

Responding effectively to the COVID crisis

Some helpful ideas on coping in these crazy circumstances

Nutritional Psychiatry

Tue, 20 Jul 2021 05:07:24 GMT

What is Nutritional Psychiatry?

At The Psych Collective, we define nutritional psychiatry as “the manipulation/optimisation of diet and/or nutritional supplementation with the aim of improving mental health outcomes”.

To some a nutritional approach is an alternative to conventional psychiatric treatment, to others it’s used in addition to standard treatments, to others it’s seen as rubbish. I’ve been surprised to find trials of various supplements to be advantageous in some conditions. Usually the numbers of people in these trials are quite low, so the quality of the evidence is generally not great.

Some specifics:

Dietary excesses: some posit that sugars, simple carbs, grains and in some cases dairy are potentially problematic for some people. Usually the mechanisms are thought to involve gut permeability or inflammation or both. Some people have issues with lectins, some with glutens, etc. an elimination diet is probably a reasonable way to get to the bottom of this, if it applies. See below for the link to our video on this.

Ketosis: there is increasing understanding that ketosis might be helpful in some cases of bipolar disorder and schizophrenia. See below: Is the ketogenic diet new therapy some type of schizophrenia?

Gut Biome: Some feel that various foods may detrimentally (or beneficially) affect gut flora. The literature on this is very messy. Some advocate probiotics/prebiotics. It seems it’s mostly trial and error, but trial and error is common with meds too.

Dietary deficiencies: some posit that the modern diet is low in essential nutrients such as omega 3 fatty acids & zinc and they suggest repletion with supplements. Some feel that the reference ranges used in blood testing don’t reflect the ideal ranges. The evidence is mostly anecdotal, there are cases of severe B12 deficiency correction resolving depression.

Some supplements like Magnesium Diglycinate seem clinically to be very helpful for some people with sleep problems even without obvious deficiency.

Metabolic issues: processes such as methylation are thought to be affected by common gene polymorphisms and supplements such as SAMe, creatinine or various methylated B vitamins are sometimes suggested. Again it seems to be largely trial and error.

Chronic inflammation: inflammation in acute situation is usually helpful. But chronic inflammation is often harmful and might even drive some autoimmune issues to be worse than they might be otherwise. Elimination diets might help reveal if someone has a sensitivity from foods. Others recommend supplements like Theracurmin for their purported anti-inflammatory effect. Targeted and safe interventions which reduce chronic inflammation are probably helpful for anyone with chronic inflammation.

Drug issues: some are intolerant to medications or simply favour alternative treatments. Some feel that some drugs deplete some nutrients and recommend supplementation in that basis (eg. CoQ10 with statins, controversial).

If people have severe mental illness which is stable on medications, then stopping meds might be a nightmare, no matter what the nutritional changes are. If a nutrition intervention helps, that’s great. Any adjustments to medications would require great caution and input from a professional, especially in severe mental illness as a relapse of a major illness can be a disaster.

Mostly improving nutrition will be helpful for everyone’s health, in some cases it might be very impactful but it’s not a panacea.

Sugar and Mental Health

Sugar and foods that cause elevations in blood sugar can affect our sensitivity and even make anxiety and panic symptoms worse. Persistently elevated blood sugar in the long term results in insulin resistance which can affect concentration, memory and enjoyment.

Is the ketogenic diet new therapy some type of schizophrenia?

Not yet, but it might prove to be. Understand that the normal brain can burn two fuels, either glucose (a process called glycolysis) or ketones. In diets with >40g of sugar/carbs a day (most people) ketone blood levels are negligible in most circumstances. Ketogenic diets and ketone supplements greatly increase blood ketone levels (ketosis).

So, the brain can be fuelled with glucose or with ketones. Ketones are usually only available if there is a short supply of glucose (from sugars or carbs).

The rationale for the therapeutic use of ketosis comes from some studies that suggest a road block to glucose utilisation in some schizophrenic brains (and possibly some bipolar brains too). For the nerds among us: Evidence in schizophrenia, such as their dorsolateral prefrontal cortex (DLPFC) having reduced expression of enzymes/systems involved in glucose metabolism in the brain in schizophrenia (eg the glycolysis enzymes including hexokinase & phosphofructokinase and other glucose relevant systems such as the transporters GLUT1 and GLUT3). Further evidence of glycolytic problems in schizophrenia is suggested by reduced presence of pyruvate and NADPH (glycolysis end products) in the thalamus of schizophrenic patients and from the greater levels of lactate in DLPFC. Taken together these suggest problems with glucose brain energy metabolism (glycolysis) might play a role in some cases of schizophrenia.

If a glucose energetic roadblock contributes to some cases of schizophrenia, can ketosis bypass these energetic roadblocks? Ketosis essentially bypasses glycolysis. So if glycolysis is impaired, then ketone utilisation might serve as an alternate fuel source. We only have case study data (about a dozen people), but it’s very suggestive that sustained ketosis for at least two weeks can improve symptoms in some people. Those patients who benefit relapse when they drop out of ketosis (by eating carbs). The downsides are difficulty sticking to such a low carb approach and the main side effects is body fat loss.

Ketosis is helpful in other neurological conditions including epilepsy, ALS and Alzheimer’s disease.

Could ketosis prove to be a viable treatment for some cases of schizophrenia? Time will tell. There seems to be no harm in trialling nutritional ketosis and potentially a lot to gain. A month or two in nutritional ketosis should clarify if it’s going to help. This raises the question about the therapeutic use of exogenous ketones (ketone containing supplements) in schizophrenia.

The above is condensed/simplified from a review by Sarnyai et al (2019) in Current Opinion in Psychiatry.

Click for the link to the original source: Ketogenic diet for schizophrenia: clinical implication.

Nutritional Psychiatry

Mental Horizons: Episode 27

Nutritional Psychiatry is an emerging field where the focus is on understanding the link between food and mental health. Gut health and inflammation influence symptoms of mental illness. This podcast interviews Dr Georgia Ede, Nutritional Psychiatrist from Harvard University who explains how to change your diet for better mental wellness.

Addiction

Tue, 20 Jul 2021 05:07:22 GMT

So often, it is a coping strategy that got out of hand

Addictions come in all shapes and sizes. Drugs, alcohol and gambling probably receive the most attention, particularly in the field of mental health, but emerging addictions, such as phone addictions, sugar addictions or social media addictions are creating a lot of distress for both the users and their families.

Addiction starts off as numbing the inner pain

Addiction is a means of alleviating inner tension, either by numbing or distracting. The inner tension may be a result of trauma, current problems or a life of chaos.

Addiction perpetuates the inner tensions and typically adds to the problem load. The addictive substance/behaviour alleviates the inner tension and activates the reward pathway. Furthermore, the addiction can also cause physiological or neurological changes which are hard work to overcome.

How naltrexone might help with alcohol addiction

Naltrexone blocks the mu opioid receptor. By blocking that receptor, people don't get reward pathway activation from alcohol. As a result, people don't enjoy alcohol as much when they take naltrexone. That might lessen alcohol intake in some people.

Addiction is usually the result of people's difficult past. Whether the difficulties were trauma or some other mismatch of needs/environment; some people end up with the predicament of needing to numb their pain with alcohol. Naltrexone doesn't affect the alcohol's capacity to numb. So if someone is out to numb themselves naltrexone is not likely to be the solution. But if someone drinks more than they intend to because of the subtle effect of reward activation then naltrexone might be very helpful.

Johann Hari

Everything you think you know about addiction is wrong

Johann Hari talks about his exploration into the depths of addiction as he tried to understand this issue, particularly as he had a few family members suffering from it.

He suggests that addiction is not about the drug, but about your cage, and proposes that the opposite to addiction is not sobriety, but connection.

Lessons from a Mental Hospital

Glennis Doyle Melton

A raw and honest account of what it takes to recover from an addiction and an eating disorder. Peeling off the layers to uncover the reality of feelings helped Glennis to discover that life is not only brutal, it is beautiful, or rather 'brutiful'.

Drug Information

Got any questions about drugs?

The Alcohol and Drug Federation has a very comprehensive list of drugs and associated information.

Click on the button below to check out their website

Hormones

Tue, 20 Jul 2021 05:07:21 GMT

Ladies, you know those days when your mood tanks, your irritability skyrockets and your craving for chocolate is so intense that you'd consider selling a kid to buy more?

No? Lucky you!

Yes, then read on...

For some women, their PMS gets so severe that it begins to have a significant impact on their mental health.

A little known disorder called Pre-Menstrual Dysphoric Disorder may be to blame. PMDD is a cyclical hormone-based mental health disorder that creates intense mood swings, sleep problems, cognitive fog and even suicidal ideation.

If affects 2-10% of women of reproductive age and is an adverse reaction to the hormonal changes that occur within menstrual cycles.

Want to know more?

Check out these websites for more info:

https://iapmd.org

https://www.viciouscyclepmdd.com/

ADHD

Tue, 20 Jul 2021 05:07:20 GMT

“ADHD” is the normal state for toddlers, but not so for older kids and adults. We’ll look at several helpful approaches for older kids and adults.

I think it’s helpful to understand that “ADHD” is the normal state of early childhood, but most develop out of it: All toddlers are hyperactive and inattentive - that’s normal. What happens for most kids is hyperactivity noticeably reduces from about the ages of 6–9 years (It’s very variable). And children’s capacity to maintain attention starts to markedly improve from the ages of 7–14 (again, it’s very variable). Inattention can also be thought of as marked distractibility. The improvement “hyperactivity” and “attention” happen slowly and subtly, but the differences become more obvious when kids are compared across kids of the same ages. So different kids in a given class will be at different stages of development.

When the normal traits of hyperactivity or inattention haven’t improved as kids get older, that’s when kids might be said to have “ADHD” (relative to their class mates).

Schooling is an environment where kids are expected to sit still and pay attention for long periods of time. One could argue that it is a crazy expectation to make of any young child, especially one with hyperactivity and distractibility.

Most kids will eventually grow out of the hyperactivity, but not all grow out of the poor attention. If the inattention continues into adulthood, then it’s said to be “adult ADHD”. So one doesn’t just develop ADHD as an adult, there’s usually signs of it throughout development/schooling. Hyperactivity can persist into adulthood, but it’s less common than inattention persisting.

Effect on self-view: Standard schooling is not very friendly to those with ADHD. Getting into trouble for their hyperactivity/impulse control coupled with poor grades often sets kids up for a negative self-view. These kids might leave the education system believing they are not intelligent and end up in roles which are menial as they don’t act to fulfil their potential. Thankfully, some stay bold and find roles where ADHD can be an asset and do very well.

So what can one do about it? In childhood:

Rough-and-tumble play: Schooling which had more time for kids to run around and burn off their hyperactivity would also help with distractibility. More time playing especially “rough-and-tumble play” often settles ADHD kids down. But that is often frowned upon in schools, so kids are often medicated. Rough-and-tumble play also helps kids wire up their brains in a coordinated way. Wrestling with friends/siblings is an instinct in young boys and should not be discouraged. Martial arts, dance and gymnastics are also helpful formal approaches.

Foods and additives: Parents often notice some foods and additives may worsen ADHD type symptoms and there is merit in figuring out if that applies to your kids if they have what looks like ADHD. There are many online forums which explore this. If you do try eliminating some foods or additives it can be helpful to work through this with a doctor or nutritionist so you don’t inadvertently leave out some important nutrient. No harm in ditching artificial/processed foods with industrial chemicals in favour of real foods: meats and plants.

Medications: Medications are sometimes used so kids can learn their school work, so they don’t fall behind. The medications are stimulants of the central nervous system (methylphenidate, dexamphetamine, etc). They work by boosting everything, including the frontal lobe so that one is better able to inhibit the normal impulses which result in the hyperactivity and distractibility. There are potential massive benefits to medications, but there are potential massive downsides too (we can leave that for another day, but inhibiting play is not good).

Aside from medications there are some skills that can be of great benefit to improving concentration and learning. These are especially helpful to kids in their teens and for young adults doing further study.

In adulthood these skills can be game changers:

Skill 1: Multimodal Encoding and Recall Rehearsal. When learning a new fact, most students simply write the fact as a short note e.g. “Captain Cook came to Australia in 1770”. Whilst this entails some processing, it is an easily forgotten fact. Reviewing notes later is almost useless as one just skims the notes and registers the recollection of their writing, there’s no way to practice recalling the actual information. Until test day. Multimodal processing entails manipulating the information as they acquire it, e.g. by writing it as a question/answer pair during a class. So:

“Q: In what year did the first British explorer arrive in Australia and what is his name?

A: Captain Cook came to Australia in 1770. “

In the above example, one has had to more deeply process the information to formulate the question. There’s not much more writing, but there’s much more processing. The information gets in more. Then, when reviewing one’s notes the student reads aloud the question (covering the answer). This help further process the information as one is using speech. Trying to recall the information as prompted by the question allows one to practice recollection of the information from memory. Then the information can be more readily accessed when needed.

When reviewing notes which are written as questions, it’s immediately obvious if the fact is recalled or not, so it’s more engaging as well as much more useful than skimming notes.

Skill 2: Noticing Inattention and Attention Practice. Noticing Inattention and Attention Practice involves improving the skill of attention to non-stimulating information. It begins with brief sessions where one sets a goal of noticing when one becomes distracted by internal thoughts or by external stimuli.

The Attention Practice task involves setting a timer for say a 2 minutes (to begin with) and sitting down with paper and pen. In that 2 minutes the persons task is to focus their attention on something non engaging (e.g. on the tip of the pen). The task is then to notice when one’s attention shifts and make a tally mark on the page. Then repeat that: focussing again on the pen tip and making another tally when one notices the attention drift. The tally mark is a way of keeping score. As one practices this, one gets better at noticing that one’s attention has drifted. The more tally marks you score: the better you are at noticing your attention drift. This is repeated a few times a day and the duration of the session is gradually increased. Doing this, one starts to notice more readily when one’s attention has drifted. Quickly noticing attention drift is the key to regaining focus for those with attention difficulties. This practices that skill.

When people first do this they might only score a few tally marks to begin with. With practice, as people get better at noticing their attention drift, they will score more tally marks in a given session. With enough practice, people can get better at maintaining attention and then they end up scoring fewer tally marks. So one starts with low scores and then with practice, the scores start getting higher, with mastery the scores start getting lower again.

If ADHD is a problem for you, you may prefer to see the skills explained in video form, if so you may wish to google my talk on this on my youtube channel: thepsychcollective (no commercial content, just free info)

Inflammation

Tue, 20 Jul 2021 05:07:19 GMT

How can inflammation effect mood and mental well being?

Inflammation has a deep impact on mood.

It’s helpful to understand what we are talking about with the term inflammation:

Consider the situation if you’ve injured your arm. Processes take place which result in pain, redness and swelling. These processes are in place to help fight potential infection from broken skin and to begin the orchestrated process which eventually leads to healing. That’s called acute, localised inflammation. It serves a valuable purpose. A similar process occurs if you get sick. Here the inflammation is more widespread. Again to fight infection. The chemicals which the body deploys (namely cytokines) to do this have unwanted side effects. That situation is acute generalised inflammation. The process helps with dealing with the infection, but the side effects: we feel terrible, sad, low energy, foggy thinking, etc. Often it’s not the infection, but it’s the inflammation which causes that.

So it’s normal to feel mood problems whilst there is acute systemic inflammation going on. In the treatment of viral Hepatitis a molecule equivalent to our bodies own inflammatory molecule interferon is given and it typically causes Depression.

Some people have a long-term (chronic) low grade, generalised inflammation. This is like a milder version of what you get when you feel acutely sick, but it hangs around. People describe low energy/motivation, brain fog, poor mood, etc. Often associated flare ups of sore joints/tendonitis, fibromyalgia flares, autoimmune problems (often Hashimoto’s thyroiditis) etc. It can wax and wane for decades.

Sometimes the presence of inflammation can be detected by blood tests. But you're less likely for that to be picked up in pathology tests because the values that are considered normal have been creeping up. One should have low numbers for liver markers like ALP AST ALP GGT and fibrinogen. Same for more general markers like HS-CRP and ESR. One should have negligible levels of RF and ANA. But these numbers are creeping higher in Western populations. What’s now considered normal was 30 years ago considered high. This suggests that we are more inflamed than we used to be. Why?

Possible cause 1: High sugar/high carb diets can promote inflammation. Diets today are much higher in processed carbohydrate and sugar. This modern diet is more frequently associated with obesity and increasingly NAFLD (fat infiltration in the liver). Both of these factors promote inflammation.

Possible cause 2: Some foods can contribute to inflammation. When I trained in medicine, the concept of gut permeability was downplayed. But it is increasingly understood that some foods can cause increases in gut permeability and there are tests that can measure that (not commonly available, the lactulose:mannitol (LM) test).

So how can diet play a role? We know that some foods can cause an allergic reaction on contact which can vary from mild to severe. We know that some foods modulate intestinal permeability in some people. The most extreme case of this is coeliac disease. This is where gluten induced inflammation can devastate the intestinal barrier. The inflammation is severe. But it’s becoming increasingly apparent that various foods can affect intestinal permeability in more subtle ways. Things which aren’t supposed to get into the circulation may leak in. This results in low grade inflammation and some think that it contributes to autoimmunity in some people.

Which foods? It’s different for different people. Gluten is commonly blamed, but there are many who are sceptical, the doctor might say “the test says you don’t have coeliac, so no need to go gluten-free”. No harm in trying gluten free either. Some believe dairy is an issue, others posit chemicals in some plant families (eg nightshades). The only way to figure out what’s an issue is to try an elimination diet.

But which elimination diet and and for how long? It's difficult to say as there might be more than one food culprit and the gut can potentially take days to weeks to establish its integrity. The most extreme elimination diet is a meat-only diet, the least extreme is to eliminate a single food chemical at a time e.g. gluten free diet. I’m not making any recommendations, just this is what people do to try and get to the bottom of things. Sometimes it’s transformative, sometimes it turns out not to be helpful.

There is a tendency for holistic practitioners to blame lifestyle/inflammation, for some psychiatrists to blame “chemical imbalances”, for some psychologists to blame errors of thinking or avoidance, for some psychotherapists to blame past trauma or parental relationships. In the real world, people are complex and there are multiple issues at play. Here we considered the role of inflammation, but note that it is not usually the only thing leading to mood problems. One should consider multiple root causes and then do what it takes to correct the problems to feel better.

Note that mood problems can have a variety of root causes, there’s a video here which unpacks that: What are the root cause of mental illness such as anxiety and depression .

Comfort

Tue, 20 Jul 2021 05:07:18 GMT

What are the advantages of living outside the comfort zone?

The role of comfort: Comfort is a place to go to when you need some refuge or are overly taxed or need some recovery or to sleep. And that’s fine.

Constant Comfort: In the modern Western world, constant states of comfort are more accessible and some people act to avoid all discomfort as much as they possibly can. And that’s not fine.

The spectrum and outcomes of Comfort/Discomfort:

Comfort is for recovery and for the consolidation of the gains that stem from situations of Tolerable Discomfort. If you exercise a muscle (tolerable discomfort) it needs a period of recovery (comfort) in order to grow. But, constant comfort (inactivity) results in regression: the muscle shrinks. If you overdo it (severe/injurious discomfort) you may damage the muscle and the muscle shrinks.

Let’s consider another physical example:

Avoiding exercise makes activity feel harder. People become weaker and feel weaker and become less energetic. People are then prone to remain sedentary. Becoming overweight becomes likely, especially factoring in other effort comfort factors like “easy” meals and comfort eating. So constant physical comforts are often detrimental.

Let’s considers some psychological examples:

Anxieties may lead to avoidance, because facing anxiety is uncomfortable. Avoidance robs us of the opportunity to overcome anxieties because we don't get the opportunity to act courageously and consequently our capacity to be courageous diminishes. Then our proclivity to anxiety grows. This also means our world starts to shrink.
Some sensitive people are very prone to Distress and sometimes they use alcohol or sedatives to numb those uncomfortable feelings, rather than learning skills to deal with the feelings. The substances numb the emotional pain, so rapid comfort reestablished. But the substance can cause harm and we pay interest on the sedation by being more sensitive when the sedation wears off. So we don't learn how to manage the feelings and instead intensify our sensitivity to experience difficult emotions when the substances wear off.

There’s another major downside to seeking constant comfort: the erosion of self-discipline. Discipline is how we get things done. Persons who tend to indulge in constant comfort don’t get the opportunity to practice being disciplined.

People often talk about not feeling motivated, “I’ll do xxx when I feel motivated”. Motivation comes and goes, but discipline will make you get things done despite the absence of comfort. If you only act when motivated (comfortable to act) you sacrifice the future for the present. Discipline is a state of Tolerable Discomfort.

Seeing constant comfort / forsaking discipline will impede personal growth and restrict potential. Getting out of your comfort zone and leaning into discomfort will potentiate your capacity for discipline, expand your strength, your potential and your outcomes.

The effect of leaning into discomfort and becoming disciplined comes with an important shift of self-identity to “I am someone who can do difficult things and can get things done”. Then you will get things done and you will grow in capability.

Root Causes of Depression

Tue, 20 Jul 2021 04:26:05 GMT

When you are experiencing low mood, it can be very tempting to just take a pill and hope the feeling will go away.

Unfortunately, anti-depressants are no substitute for getting to the root cause of what is causing your depression in the first place. In this video, Dr Al talks about different factors that contribute to depression.

We've created a handout for this below, which integrates the information from Dr Al's talk into 6 categories. You can download it from our Resources page.

The Role of Anti-Depressants

Tue, 20 Jul 2021 04:26:03 GMT

Many people believe that anti-depressants increase the amount of neurotransmitters in the brain that helps to improve mood because there was a shortage of neurotransmitters to begin with. We're not actually sure if this is true.

Anti depressants, particularly those such as Selective Serotonin Reuptake Inhibitors (SSRI) increase the amount of available serotonin in the brain which can decrease sensitivity and increase indifference. This means that things don't get under your skin so badly, which reduces irritability. Decreased sensitivity can also reduce anxiety, as you are less inclined to worry about stuff, but there’s a spectrum of effect:

Reduced sensitivity (Usually desirable)
Increased indifference (sometimes helpful)
Emotional numbing (usually undesirable)
Zombified (undesirable)

Where you land in that spectrum depends on dose, duration, type of medication and your individual neurochemistry.

When sensitivity is reduced, things don’t feel so bad. Things don’t feel so irksome. Things don’t feel so difficult. The chaos is more tolerable. One feels less defeated. Irritability is improved and thereby relationships can improve. But when one is too numbed out, life feels dreary and joyless.

Other type of anti-depressants, called Selective Noradrenaline Reuptake Inhibitors (SNRI) work by increasing energy to help with motivation, However, if you have an agitated depression it can make things worse.

In the video above, Dr Al explains this in more detail

Sometimes the drugs make things worse

Not all drugs are created equal. SSRIs work differently to SNRIs. While both work on mood, some SNRIs (like Effexor) can make anxiety worse, creating new problems.

Dr Al explains how in this video.

Mood Dependence

Tue, 20 Jul 2021 04:26:02 GMT

What is Mood Dependence?

Being dependent on your mood means that you let your mood dictate your choices. Suffering from depression means you experience a lot of negative feelings such as sadness, fatigue, lethargy, no motivation and hopelessness. Take a moment to reflect on how often you make decisions based on how you feel at the time, or how you think you will feel later.

Do you ever notice yourself saying things like:

“I can’t go to the gym because I have no motivation”
“I won’t make plans because I’m not sure I’ll be up for it later”
“I’ll only go out to dinner if I feel like it”
“I can’t socialise with my family or friends when I feel this depressed”
“There is no point setting goals because I feel sad all of the time”
“I can’t go for a walk because I’m too tired”

These kinds of thoughts actually perpetuate depression, because it makes you think that you have to wait until you have more motivation or are feeling less depressed before you can do something. When you only focus on the negative feelings, or predict the negative feelings, you stop yourself from creating opportunities to experience something other than what you are currently feeling. One of the most effective ways of changing your depression is to participate in activities or pursue goals regardless of what mood you are in.

Imagine if…

Imagine that one of your friends invited you to do a fun run with them. A 5km walk/run that is happening in four weeks. Your initial response is “no way”, and you tell your friend that you couldn’t possibly walk that far, that you are always so tired and you wouldn’t enjoy it. The more you think about how you would feel if you had to do it, the less you want to go.

Imagine that your friend then says they will pay you $100,000 to do the walk with them. Would you do it then, even if your mood told you not to?

It may seem like a silly question, but it raises the idea that you can act independently from your mood if you choose to. Yet this is something we seem to forget when we feel depressed. We tell ourselves that we can’t do something because we are depressed. This thought becomes a belief, which then becomes a self-fulfilling prophecy. Over time, we lose sight of the fact that we are capable of doing something in spite of our mood.

Rumination

Tue, 20 Jul 2021 04:26:02 GMT

How often do you find yourself thinking about the same thing over and over? Most people who suffer from depression report doing this all the time. It’s called ruminating. The name for this process of thinking about all the bad stuff that has ever happened, and continuing to dwell on it comes from the Latin word ruminatus and is the same word used to describe cows chewing their cud.

Rumination is actually a behaviour, because it describes the process of thinking, rather than just looking at what you are thinking about (content). It can also include brooding, worrying, obsessing and overanalysing.

Many people seem to believe that rumination is helpful. They will argue that thinking deeply about a problem helps them to understand it better, or that uncovering the hidden meaning helps them understand their true feelings. Some even think that this is the way to get rid of depression. Others will say that if they think about every possible scenario, they will be better prepared. But take a moment to think about how you feel after you have been ruminating for some time, and ask yourself “Is this working?”

The Problems with Rumination

There are three main problems that occur with rumination. Firstly, it doesn’t achieve anything. Ruminating is not the same thing as problem solving. Ruminating about a past mistake or current problem does not change the outcome. Secondly, it makes your depression worse. The continued dwelling on negative thoughts or memories has a negative impact on your mood. Thirdly, it gives you tunnel vision. When you are so focused on the problem, you forget to look at the bigger picture, and therefore struggle to find an alternative way to deal with the issue. When you spend so much time thinking that you are an idiot, you focus on the failure and don’t see the solutions available to you.

How Rumination Perpetuates Depression

Painful things will always happen. From simple things like stubbing your toe to major things like a relationship breakup. However, the way we respond to and process pain will have a significant impact on your experience of depression. We can view pain as coming in two forms: clean and dirty.

Clean pain occurs when we experience something hurtful or stressful, such as an injury, illness, loss or bereavement. These situations create a natural pain response, so naturally we feel bad for a while. There is a clear cause and effect, and then the pain subsides over time.

Dirty pain is something we create for ourselves. It is the suffering that comes from the thoughts that we have about the pain. When rather than allowing the pain to naturally subside, we dwell, ruminate, and obsess over the cause of the pain.

For example, imagine you are sitting on the couch one night watching a movie and you get a call from the black sheep of the family. This person is someone that you don’t really get along with. You have never been close and they don’t quite seem to fit in. When you answer the phone, they start yelling at you. They are accusing you of something you didn’t do and you have no idea what they are talking about. The call ends with them swearing at you then abruptly hanging up. You try to call them back to talk about it, but they won’t answer their call.

What do you do?

Clean pain response: you have the right to be upset. They were abusive and accusing you of something you didn’t do. But, they are someone you have never really gotten along with anyway and you decide that they are just being weird and you go back to watching your movie. Your anger at their behaviour subsides as you refocus on the film.

Dirty pain response: Oh My God how dare they talk to me like that!! You call your mum to tell her about the phone call. You go to bed that night and toss and turn, thinking about how badly you have been treated, how angry you are and how unfair this all is. The next morning when you go to brunch with your friends, it is all you can talk about. It plays on your minds for the rest of the day, resulting in you feeling grumpy and tired.

How to Manage Rumination

Catch Yourself

Before you can begin to change your ruminating behaviours, you need to become aware of when you are doing it. Some clues might be when you are doing something that you think should be enjoyable but you aren’t feeling good about it, or noticing that you feel worse when you spend time alone, or knowing that it takes you ages to get to sleep at night because your brain won’t shut down.

Notice Your Triggers

Start to keep a record of the times when you are ruminating and the effect that it has on you. Notice the situation, the topics of rumination and the consequences of this. There is a monitoring form in the homework section. You may find that you actually have a habit of ruminating at certain times or in certain places.

Set a Time Limit

If you are not sure if you are ruminating or problem solving, give yourself a two minute time limit to think about this. Set a timer on your phone, and at the end of this ask yourself:

Have I made progress in solving the problem?
Do I have a better understanding of the problem or my feelings?
Do I feel less critical or less depressed?

Unless there is a clear yes, then you are ruminating.

Label it

Once you have recognised that you are ruminating, acknowledge it out loud. Say “This is ruminating and this is unhelpful”. Use that to create momentum to make a change.

Cue to Action

Once you have noticed that you are ruminating, you can use this to cue an alternative action. If you notice that you often ruminate in the car, then create a playlist of music that you can sing along to for distraction. If you find that you get stuck on the couch throughout the day ruminating in front of the TV, then plan activities that get you moving or engaging with other people. Break the habit of ruminating by changing your routine.

Mindful Participation

Mindfulness is more than just breathing. If you are struggling to stay focused, and find yourself slipping back into rumination, then use your mindfulness skills to help you concentrate. Engage your five senses and become fully aware of one specific activity, like having a shower, knitting, making a cup of tea, colouring in, going for a walk, driving, or even doing the dishes.

Thought Defusion

Using a script like “leaves on a stream” can help you to learn to tolerate the negative thoughts you are experiencing, without the need to engage with the thought.

Suicidal Ideation

Tue, 20 Jul 2021 04:26:00 GMT

Is it normal to think about suicide as a relief whenever you feel depressed?

Thinking about suicide seems to be very common in states of high stress, in states of Distress, in depression: typically when one feels trapped. The phenomenon is called suicidal ideation. Suicidal ideation is not the same as suicidal intention. For some people fantasy about suicide can bring relief, for others thinking about suicide is unwanted and painful.

Suicidal ideation is a sign that people feel trapped in some way.

Suicidal ideation may sometimes precede suicidal intention, but commonly people with suicidal ideation do not also have suicidal intention. That knowledge can be a great relief to some people with suicidal ideation.

Suicidal ideation is a sign that people feel trapped in some way: when it feels like there is no answer to one’s predicament, the idea of suicide bubbles up as a notional way of escaping the trap.

Those that do have true suicidal intention are the ones that suicide or make a serious attempt to suicide. Suicidal intention is an imminent desire to leave life. It may be associated with making arrangements for ones estate etc or it may be impulsive, especially in the context of intoxication.

Experiencing suicidal ideation is a sign that help is needed. Help to solve the feeling of being trapped.

Experiencing suicidal intention is an emergency.

What runs in the mind of a person who is attempting a suicide?

When someone is at the point of attempting suicide, one or more of the following factors have become overwhelming:

they feel trapped in a difficult predicament.
They are overwhelmed with powerful emotion or the opposite, they feel completely numb.
They believe they are a burden to those they care about.
they have not realised the distinction between suicidal ideation and suicidal intention, and conclude that one leads to the other.
they are depressed and can only see the negative and may also believe their preoccupation is unsolvable.
they are deeply ashamed.
they are intoxicated.
they are acting on impulse.
they are executing a long held plan and one or more of the above.

Need Help Now?

If you are experiencing suicidal intention, please contact your treating health professional, mental health line or emergency service

Australia

If you are in an emergency, call 000

Lifeline: 13 11 14

Canada

Suicide Prevention Hotline: 1-833-456-4566

Kids Helpline (under 20s): 1-800-668-6868

India

AASRA: +91-22-2754-6669

United Kingdom

Samaritans: 116 123

United States

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Need More?

Check out Befrienders.org for a list of international helplines

Mindset Matters

Tue, 13 Jul 2021 03:06:17 GMT

Are you a lion or a bunny rabbit?

If you're avoiding something because of fear, the only way to resolve this is with exposure. Start approaching it. Start somewhere, it's okay to start small, but do it several times a day. Exposure work takes a lot of courage and your success is largely determined by your mindset.

Here are your two options:

Bunny Mode (Prey):

"My therapist says I have to do this exposure task, but I don't want to. It's going to be horrible. I'm just going to grit my teeth and get through this as quickly as I can (and be freaking out the whole time)."

Most people resort to using grit when doing exposure work. Grit is when people just endure the feared thing. It's painful and grit is not as effective as courage.

Lion Mode (Predator)

"This is going to be difficult but it is important. I understand that I need to face my fears to overcome them so I am going to be courageous and use my skills to manage my anxiety as I complete my exposure task. I'm a bit scared but I can do this anyway."

If the anxiety is about your thoughts, face the thoughts head on. If it’s a phobia, face it. You will need to break it whatever it is down into manageable pieces -but attack it in earnest. A psychologist may help you with an approach to this.

It's definitely not easy. Exposure therapy requires you to summon up all your courage. Humans have survived vicissitudes for our entire history. So there's more to you than you think. You need to tap into the lion within. Being a comfy bunny rabbit and not facing anxiety is what perpetuates anxiety.

Adopt a courageous stance when you are facing your anxieties. A courageous stance will help you feel more courageous. If you are hunched over making yourself small, you will feel less courageous. Start where you can and stand courageously. Clench your fists. Take up a stern countenance. Try to feel as formidable as you can. Embody courageousness.

Most people think exposure therapy is all about habituation. But there's two factors at play in exposure therapy, there's 'habituation' whereby it's thought we get used to the feared thing by repeated approach. But more importantly, if we use courage we learn to become courageous. We can then apply courageousness in our lives beyond our anxieties.

Skills Before Pills

Mon, 12 Jul 2021 09:02:43 GMT

Save PRN Medications for Emergencies

PRN comes from the Latin term Pro Re Nata which means 'when the circumstance requires it'. Some find it easier to remember it as Per Required Need. These medications are sedating which will reduce arousal to “take the edge off” the feeling of distress. They can be very tempting to reach for when you are feeling overwhelmed. While these medications serve their purpose, a reliance on them long term can cause more problems later on. They disempower you and rob you of an opportunity to be courageous.

It is way more beneficial to learn skills to manage your distress to create meaningful change for your future. Knowing that you have the ability to manage any emotion or feeling that you experience will increase your confidence and reduce your dependence on PRN medication.

This handout has a list of skills you can use BEFORE you reach for PRN medication.

This 16 page mini guide has a comprehensive list of skills and tactics for surviving distress.

To download this handout or Mini Guide, go to our Resources page. It's free!

Mindfulness of the Dot

Mon, 12 Jul 2021 09:02:43 GMT

The Truth about Mindfulness

Less hippy dippy crap - more practical tips

Most patients I meet don't like mindfulness and it is usually because they believe like they can't do it. Most of the time, it is because they weren't correctly instructed and think they're hopeless at it.

In the first video, Dr Al explains the real purpose of mindfulness and it's not about breathing.

And then Jess explains about practising mindfulness at different levels with her hierarchy of mindfulness.

A Fresh Approach to Mindfulness: Embracing the Power of Automatic Thinking

In this blog post, we will explore a unique perspective on mindfulness that aims to address the common challenges and misconceptions associated with traditional mindfulness practices. Many individuals find it difficult to engage with mindfulness techniques due to a lack of interest or the belief that it only involves focusing on the breath. However, we will present an alternative approach that emphasises the importance of automatic thinking and its impact on our emotional well-being. By understanding and redirecting our automatic thoughts, we can cultivate a more palatable version of mindfulness that fosters personal growth and emotional regulation.

Unveiling the Misunderstandings:

Mindfulness has become a buzzword often thrown around without a clear understanding of its true essence. When introducing mindfulness to others, it is not uncommon to encounter eye-rolls and skepticism. This response is rooted in the widespread misconceptions surrounding mindfulness. To overcome these barriers, it is crucial to demystify mindfulness and present a more comprehensive perspective that extends beyond mere breath-focused exercises.

The Power of Automatic Thinking

To illustrate the significance of automatic thinking, let's consider an example. Imagine being asked to focus on a dot while being left alone in a room. Initially, you may direct your attention to the dot, but soon your mind starts to wander involuntarily. It may drift to neutral thoughts or concerns, such as work or daily chores. However, it can also delve into negative thought patterns, causing distress and anxiety. These automatic thoughts arise without conscious choice and result in corresponding emotions, amplifying arousal and anxiety.

The Flawed Exercise of Focusing on the Dot

The traditional instruction of focusing on the dot fails to provide a helpful framework for mindful awareness. Many individuals struggle to sustain their focus on the breath or any other point of attention. As a result, they may feel discouraged and believe that mindfulness is not suitable for them. This inadequate instruction does not effectively address the underlying issue of automatic thinking and its impact on emotional states.

The Correct Instruction: Noticing Automatic Thoughts

The true essence of mindfulness lies in developing a habit of mind through focused attention. Instead of solely fixating on the dot or the breath, the key instruction is to notice when the mind deviates from the point of focus. When your mind wanders, you are encouraged to acknowledge this diversion and give yourself credit for recognising it. This practice cultivates mindfulness by increasing awareness of when you are not being mindful.

Embracing Non-Judgmental Awareness

Once you become aware of your wandering thoughts, it is crucial to approach them with non-judgmental awareness. Avoid criticizing yourself for losing focus or indulging in negative thinking. Instead, congratulate yourself for catching the moment of distraction. This positive reinforcement strengthens your ability to notice when your mind wanders and paves the way for constructive choices.

Repetition and Improvement

Mindfulness is a practice that improves with repetition. With each session, you engage in multiple cycles of focusing, wandering thoughts, and noticing. Each time you bring your attention back to the point of focus, you earn a metaphorical "tick" or a moment of success. Over time, the frequency and duration of wandering thoughts decrease as you become more adept at catching them early on.

The Transformative Potential of Mindfulness

By consistently applying this mindful awareness practice for a few minutes each day over a span of three months, you can witness remarkable changes in your capacity to redirect your thoughts. As you become proficient at catching automatic thinking, you gain more control over your emotional responses. Instead of spending prolonged periods immersed in negative thinking, you can intervene at an early stage and choose to shift your focus or engage in problem-solving.

TIP Your Temperature

Mon, 12 Jul 2021 09:02:40 GMT

A fast-acting technique for reducing distress

This technique activates the human dive reflex to reduce our physiological distress by emulating diving into cold water. It uses an in-built mechanism of slowing down our heart rate to reduce oxygen consumption. We can hack this reflex to stop a panic attack in its tracks by submerging our face in cold water or applying an ice pack across our sinuses and holding our breath with our head between our knees. That calms our distress down, fast.

To download the handout for this, go to our Resources page. It's free!

Three States of Mind

Mon, 12 Jul 2021 09:02:40 GMT

The three states of mind: Emotional Mind, Rational Mind and Wise Mind was a concept developed by Marsha Linehan when she first created DBT. We often talk to our patients about the benefit of using your Wise Mind, but so often people don't know how to access it. Here Jess gives an example of an imagery exercise designed to help you connect with and visualise your wise mind.

Below is the three room image Jess refers to in the video.

Dearousal Audio

Mon, 12 Jul 2021 09:02:38 GMT

A collection of audio tracks for you to practise calming your distress.

Autogenic Training

Mon, 12 Jul 2021 09:02:37 GMT

Autogenic Training is a form of self-hypnosis that uses body imagery to induce sensations of heaviness and warmth in your body parts. It is similar to Progressive Muscle Relaxation, but instead of clenching and releasing muscles, you simply imagine creating feelings. It can be really helpful for preparing for sleep.

Here is the script for Autogenic Training:

Start by lying down somewhere comfortable, with your legs uncrossed and your arms by your sides. Bring your attention to your breath, and begin to engage diaphragmatic breathing. Ensure that your belly is inflating with each breath, and try to lengthen your exhale.

Now bring your attention to your attention to your feet, and say to yourself 4 times “my feet are heavy” and then say 4 times “my feet are warm” and finish by saying “and I am relaxed and calm”.

Next, move your attention to your legs, focusing on your whole leg through your calves, knees and thighs. Say to yourself 4 times “my legs are heavy” and then say 4 times “my legs are warm” and finish by saying “and I am relaxed and calm”.

Focus on your hips and “my hips are heavy” (x4) and “my hips are warm” (x4) “and I am relaxed and calm”.

Then your abdomen “my stomach is heavy” (x4) and “my stomach is warm” (x4) “and I am relaxed and calm”.

Next, your lower back “my back is heavy” (x4) and “my back is warm” (x4) “and I am relaxed and calm”.

Move you attention to your chest “my chest is heavy” (x4) and “my chest is warm” (x4) “and I am relaxed and calm”.

Then arms, “my arms are heavy” (x4) and “my arms are warm” (x4) “and I am relaxed and calm”.

Next, focus on your shoulders, “my shoulders are heavy” (x4) and “my shoulders are warm” (x4) “and I am relaxed and calm”.

Then neck “my neck is heavy” (x4) and “my neck is warm” (x4) “and I am relaxed and calm”.

Finally your forehead “my forehead is heavy” (x4) and “my forehead is warm” (x4) “and I am relaxed and calm”.

After completing all of the body parts, bring your attention to your heart rate. Say to yourself 4 times “my heartbeat is slow and calm” and then finally “my breath is slow and calm”.

Once you have finished, continue to focus on your belly breathing until you are ready to finish or you fall asleep.

Sleep Drive vs. Arousal

Mon, 12 Jul 2021 09:02:35 GMT

Sleep occurs when sleep drive exceeds psychological arousal. Sleep drive refers to the biological processes that make us feel sleepy, and involves adenosine, melatonin and our circadian rhythm. Arousal refers to everything else that keeps us awake. If your arousal exceeds your sleep drive, then you won’t get to sleep.

To download this handout, go to our Resources page.

Wired and Tired

Mon, 12 Jul 2021 09:02:34 GMT

Clear Your Head Before Bed

Can't sleep, are you "Wired and Tired"?

Your busy mind is keeping you awake

The most common reason people can't sleep is there's too many thoughts going on which keeps people awake. You can try and meditate the thoughts away, but they'll come back tomorrow. Or you can tackle the thoughts.

It works! Here's how this works: see the clip.

To download the handout for this, go to our Resources page. It's free!

Bed Restriction Therapy

Mon, 12 Jul 2021 09:02:31 GMT

Bed Restriction Therapy, also known as Sleep Restriction Therapy, is an effective treatment for people who experience difficulty falling asleep or staying asleep.

Spending a lot of time in bed awake can actually be quite harmful to your sleep hygiene, as it sets up the association as your bed being the place for activities (phone, TV, reading, worrying) rather than the place for sleep.

Furthermore, people who use things to get them to sleep, such as listening to the TV or a podcast, also develop a reliance on that thing, which means if they wake in the night then they need that thing to get back to sleep.

If you take a long time to fall asleep, or you have lengthy awakenings at night, then BRT might be the solution for you.

Download the handout from our Resources page to get the instructions on how to start this.

Sleep Diary Card

Mon, 12 Jul 2021 09:02:31 GMT

If you are having trouble with your sleep, be it from nightmares, awakenings, or just taking forever to fall asleep, then this one is for you. We recommend that you track your sleep and habits for at least two weeks to see where the problem areas are, and then take it to your psychologist or health professional who can help you figure out where to make changes.

Download the diary card from our Resources page. It's free!

Over-Control of Emotions

Mon, 12 Jul 2021 09:02:29 GMT

What is Over-Control of Emotions

Here we provide a brief description of the characteristics of someone who is over-controlled in their emotional expression and how Radically Open Dialectical Behavioural Therapy proposes to treat it.

Are your emotions over-controlled?

An overview of the theory and therapy for overcontrol.

This concept, which has gained attention in the field of psychology, explores how individuals inhibit and suppress their emotions to an extreme degree. By examining the bell curve analogy, Jessica helps us understand the two ends of the spectrum: under control of emotions and overcontrol of emotions. While the former group is characterized by expressive behavior, the latter group struggles with limited emotional expression, often leading to loneliness and relationship difficulties. In this blog post, we will delve deeper into the concept of emotional overcontrol, its effects, and potential coping strategies.

The Spectrum of Emotional Control

Emotional control exists on a spectrum, with most individuals falling in the middle. On one end, we have individuals who display under control of emotions. They express their feelings openly, exhibit excitability, impulsivity, and enjoy attention. Conversely, those with overcontrol of emotions tend to inhibit and suppress their emotions, appearing stoic and unresponsive. This extreme form of emotional control stems from a desire for safety and protection but can result in challenges in interpersonal relationships.

Understanding Overcontrol of Emotions

Emotional overcontrol is a relatively new concept that has gained recognition in the literature. It was first introduced by Thomas Lynch, a UK-based psychologist, who developed "radically open DBT" (Dialectical Behavior Therapy). People with emotional overcontrol exhibit perfectionistic tendencies, are highly driven, detail-oriented, and excel in delayed gratification. They often struggle to express their emotions to others, leading to difficulties in communication. Commonly referred to as having a "flat face," they have limited emotional responsiveness, making it challenging for others to connect with them. Consequently, they often feel excluded and struggle with loneliness and envy.

Factors Contributing to Overcontrol

Emotional overcontrol is influenced by a combination of nature and nurture factors, as well as coping mechanisms. The individual's temperament, such as high reward sensitivity and heightened sensitivity to negative experiences, can predispose them to overcontrol. Parenting styles that emphasize constant control, avoidance of emotional expression, and focus on task performance further contribute to the development of emotional overcontrol. Coping mechanisms like masking inner feelings, compulsive striving, and avoiding risks play a role in reinforcing the need for control and perpetuating loneliness.

Challenges and Reinforcement

Unlike those with under control of emotions, individuals with overcontrol often struggle to improve over time. Their controlled demeanor is often praised and reinforced in society, particularly in specific professions such as the military or emergency services. Consequently, their coping strategy of tolerating distress and suppressing emotions becomes further entrenched, leading to persistent loneliness and difficulty in building meaningful connections.

Addressing Emotional Overcontrol

Recognizing the challenges associated with emotional overcontrol, clinicians have developed approaches to facilitate change. Radically Open DBT focuses on three core areas for creating change: self-inquiry, social signaling, and social connectedness. Self-inquiry involves developing awareness of internal emotional experiences and identifying the mismatch between internal and external expressions. Social signaling aims to teach individuals how to communicate their emotions effectively through facial expressions and body language. Lastly, social connectedness emphasizes allowing oneself to experience and express emotions to foster genuine connections with others.

Emotional overcontrol is a complex struggle that can lead to isolation and relationship difficulties. Understanding the factors contributing to overcontrol, including both innate traits and learned coping mechanisms, is crucial for individuals to seek support and develop healthier ways of expressing emotions. By embracing self-inquiry, learning effective social signaling, and fostering social connectedness, individuals with emotional overcontrol can work towards a more balanced emotional expression and improved well-being.

If you resonate with the concept of emotional overcontrol or wish to learn more, feel free to visit CollectiveTop.com for additional resources and support. You can also engage with the community by leaving comments on the YouTube channel, sharing the video on social media, or connecting via Instagram. Remember, acknowledging and addressing emotional overcontrol is a crucial step toward personal growth and healthier relationships.

Styles of Coping Word Pairs

If you are interested in checking your own level of control, this list of coping styles asks you to tick which word most suits you from each pair. Then add up the number from each column. More from column A suggests Undercontrol, whereas column B shows Overcontrol.

To download our handout on Over-Control of Emotions, go to our Resources page. It's free!

To download the Styles of Coping Word Pairs, just click on it.

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