Ketamine- and psychedelic-assisted psychotherapy

20th October 2023 1:23 pm Comments Off

“Pychedelics are rapidly becoming a recognised and innovative method of treatment for many mental health crises”

Psychedelics are rapidly becoming a recognised and innovative method of treatment for many mental health crises, including suicidality, refractory depressive disorder, chronic PTSD and others.

Depression is a well-recognised and all-too-common cause of problems in the workplace and domestically. A family member’s depression can have ramifications for the extended family and the children of the depressed person, especially in the case of maternal depression (Barker et al., 2012).

While many sufferers of depression improve with prescribed antidepressants, especially when combined with therapies such as CBT and talking therapies, approximately a third of patients in the UK sadly will remain refractory to treatment or only moderately improve.

The evidence

Over the last 20 years, ketamine, an antagonist of the N-methyl-D-aspartate receptor, has been described to have antidepressant properties. Nowadays, a literature search shows many publications with promising results after a single infusion of low-dose ketamine with a rapid anti-depressive effect which lasts for one to two weeks after the infusion.

For patients who cannot attend a psychedelic clinic, intranasal sprays of ketamine have been approved by the Food and Drug Administration (FDA) for the treatment of depression.

Single-dose ketamine infusion has also been used as therapy for alcohol-use disorder with success. (Dakwar et al., 2019). The authors tested whether a single sub-anaesthetic infusion of ketamine combined with motivational enhancement therapy would affect the drinking of participants in the study.

Ketamine significantly increased the likelihood of abstinence, delayed the time to relapse and reduced the likelihood of heavy drinking days compared with midazolam

Forty participants attended five weeks of once-weekly motivational enhancement therapy. During the second week of therapy, they were randomly assigned to a 52-minute intravenous infusion of ketamine at a total dose of 0.71mg/kg (N=17) or the control midazolam at 0.025mg/kg (N=23).

Alcohol use following therapy was assessed using the timeline follow-back method, with abstinence confirmed by urine ethyl glucuronide testing.

Ketamine significantly increased the likelihood of abstinence, delayed the time to relapse and reduced the likelihood of heavy drinking days compared with midazolam.

So, what are psychedelics?

Ketamine, psilocybin and MDMA are all psychedelic therapies. Traditionally, psychiatric pathologies are treated with maintenance drugs. For example, once you are prescribed an antidepressant which helps you, you take it daily until you stop, if you stop.

With psychedelics, the drug is taken only a few times or sometimes only once, alongside appropriate psychotherapy, and then that’s the end of the pharmacological side of treatment. For some patients who suffer from side effects of traditional pharmacotherapies, this will be welcome. For patients for whom therapy has been unsuccessful, this can be life-changing.

Psychedelics are a loosely grouped class of drugs that can induce altered thoughts and sensory perceptions, and some can induce hallucinations.

Ketamine

There are more and more clinics every year opening in the UK specialising in psychedelic psychotherapy. Ketamine-assisted therapy is the most commonly prescribed treatment for depression, addiction, anxiety, eating disorders and PTSD.

Psilocybin

Imperial College London (Imperial) launched the first psychedelic research centre in the world and has recently conducted trials comparing psilocybin therapy with a conventional antidepressant drug (Carhart-Harris et al., 2021).

Results were quite consistent showing that the psilocybin therapy was really quite markedly better at reducing depressive symptoms

Dr Robin Carhart-Harris, research leader, psychiatrist and neuroscientist

During the above trial, all participants received talking therapy alongside either psilocybin or escitalopram – the conventional antidepressant.

Response rates in the psilocybin group averaged at 70 percent, compared with 48 percent in the escitalopram group.

Neuroplasticity

So how do the psychedelics work?

Psychedelic drugs work on the system in the brain called the serotonin system and especially the part of the system involved in neuroplasticity: the ability of the brain to change, be shaped and adapt.

In Imperial College London’s functional MRI research, they found that psilocybin increased plasticity and opened up new communication pathways

In Imperial’s functional MRI research, they found that psilocybin increased plasticity and opened up new communication pathways. As well as psilocybin, scientists also believe you can use MDMA to access a brain state where brain plasticity increases.

MDMA

Earlier this year, the first published study of an advanced clinical trial using MDMA in the US was found to be highly effective in treating PTSD. Researchers at the Multidisciplinary Association for Psychedelic Studies (MAPS) found that after three MDMA sessions, 67 percent of participants no longer qualified for a PTSD diagnosis and 88 percent experienced a reduction in symptoms (Mitchell et al., 2021).

These articles are well worth a read for those interested in psychopathologies, and bring hope to those suffering from refractory depression, suicidality, PTSD and alcohol dependence.

Feeling ok vs feeling better

1:20 pm Comments Off

“The people who continue to feel fantastic no matter what life does or doesn’t throw at them are probably making more of an effort than the people who feel great occasionally”

Last month, I ran a seminar entitled “Embracing change” at a London-based small animal hospital that had recently been acquired by a corporate. There are so many changes when we join a group with a chain of managers and leaders – new protocols, systems of appraisal, pricing systems, and so on.

What do you enjoy doing?
One of our sessions was a contemplative session, where we pose a question and then spend some time in quiet contemplation and stillness thinking about our answers. The question I put to the group was this: “In your precious little free time, do you spend time doing what you enjoy? Or doing what will make you feel better?”

There’s obviously no right or wrong answer here.

We had already learned how to be non-judgemental that day, so there was no self-judgement or self-criticism when we were thinking about how we spend our time away from the practice.

Looking at our answers with clear fresh eyes and curiosity allows us to think factually: what activities do I spend time doing? Then, emotionally: do I enjoy them? And lastly: do they make me feel better afterwards?

Looking at our answers with clear fresh eyes and curiosity allows us to think factually: what activities do I spend time doing?

There was an amazingly lively discussion afterwards. I didn’t suggest what the nuanced differences might be between the two ways of spending time. This was an open discovery of each other’s interpretation of the question.

Some of the delegates felt that the way they spend their time does indeed make them feel better in the long run. Others felt that their own activities and pastimes perhaps didn’t actually result in greater contentment and happiness afterwards, although they were truly enjoyable at the time.

Most delegates, including myself, enjoy the odd binge-watch of our favourite series, beer and curry in hand, followed by sprawling out on the sofa in delicious escapism from the hectic emotionally exhausting practice. Most of us also enjoyed walks in the fresh air, some of us enjoyed exercise, and others reading, cooking, and so on.

The difference was this: the delegates who felt that their activities outside of work resulted in an overall improvement in their mood were typically the people who were exercising, playing tennis, playing music, meditating, journalling, reading, etc, whereas those of us who were enjoying our binge-watching Netflix, eating ice cream and finishing off the bottle of wine knew in our hearts of hearts that it didn’t necessarily result in an improvement in our mental well-being.

True self-compassion is improving your mental well-being from low to good to fantastic, and then reinforcing that strong, unwavering contentment and joy by continuing the activities which improved it in the first place

Improving your mood doesn’t need to be reserved for when you’re feeling low or stressed. True self-compassion is improving your mental well-being from low to good to fantastic, and then reinforcing that strong, unwavering contentment and joy by continuing the activities which improved it in the first place.

Staying non-judgemental, there’s nothing wrong with slobbing out on the sofa and being entertained by streaming networks or drinking alcohol. We knew that. However, it’s a temporary “fix”, not an “improver”.

So, if it’s clear to us what makes us feel better and which activity provides a band-aid to our mood, why is it that some of us choose the latter instead of one of the options which will improve our overall well-being?

We decided it was because often those activities require effort.

What is effort?
It’s putting our mental and often physical energy into something. Sometimes it’s quite unpleasant, like that extra spin class you shoe-horned into your week, or maybe it’s getting up earlier than we want in order to meditate. It might be having water instead of beer. It may also be doing guitar practice when we desperately want to be horizontal instead.

Other times, the means is as enjoyable as the end. In other words, the effort is pleasant, such as having a bath with candles and gorgeous bath foam or sitting in the garden leaving all technology indoors and on silent.

Whether we choose to make more effort or not is our individual choice. Maybe we will only make an effort when our mood is low, and we have a wake-up call that those meditations we did last month aren’t having the same effect now as they did then.

The people who continue to feel fantastic no matter what life does or doesn’t throw at them are probably making more of an effort than the people who feel great occasionally. Maybe activities like running, meditation, piano practice and mindful reading are more enjoyable for some and more exhausting for others. After all, that’s the way life and personalities are.

Happiness is not ready-made; it comes from our own actions

The Dalai Lama
How do I do it?
It’s easy to make a list of “Things which make me feel better”, and to try to dip in and out of it regularly.

It’s important to notice how you feel prior to the activity, during it and afterwards. I usually can’t be bothered to go for a run after work. But once my trainers are on and I’m out the door, it’s “Oh my goodness this is amazing! I feel fantastic! What a treat.” Then afterwards, once the gasping for breath has settled and the muscle aches are setting in, I notice that I have done something for myself which required a hell of a lot of effort, and now I am high on endorphins and I’ll be congratulating myself on being that little bit fitter for the next few days.

Choosing different things off the list keeps it fresh and varied. We’re not going to run, cook healthy food, practise guitar and meditate every day

Choosing different things off the list keeps it fresh and varied. We’re not going to run, cook healthy food, practise guitar and meditate every day, I’m guessing. So, having plenty of activities to choose from means we never need to feel guilty for not doing everything on the list.

Conversely, if the list has only two to three things on it, we may feel obliged to do all three every day before we switch off. That’s unhelpful pressure and will probably end in our giving it up due to repetition and boredom. Most people will have 8 to 10 things that make them feel better. Getting started simply involves writing the list and noticing.

Book Release

7th September 2023 5:29 pm Comments Off

I’m so excited to share with you that my new book is now available on Amazon. All royalties are being donated to Vet Life and also to the provision of free of charge therapy for veterinary nurses in crisis.
It costs the same as half of 1 counselling session.
It is claimable as CPD, so it’s tax deductible and you can use part of your CPD allowance to buy it.
I hope you enjoy.

https://amzn.eu/d/3kJMfcz

From the Back Cover
Explore practical strategies for mental wellbeing across the veterinary professions

Mental Wellbeing and Positive Psychology for Veterinary Professionals: A Pre-emptive, Proactive and Solution-based Approach delivers a practical, hands-on guide to mental health and resilience for individual members of the veterinary professions and for those managing entire practices. Divided into 6 sections, the text offers valuable tools, including meditation, mindfulness, and positive psychology, to help readers grapple with the mental challenges presented by veterinary practice. The author has also included a series of case studies and anecdotes from her experience in counselling members of the professions, including a new-graduate vet, a specialist surgeon, and a head nurse, as they encounter issues like anxiety, compassion fatigue, fear of failure, imposter syndrome, and grief. By learning in advance about the common hurdles they will face during their careers, the reader will discover how to prepare for these in positive and proactive ways.

Readers will also find:

A thorough introduction to effective strategies for dealing with the difficulties of the veterinary professions, including mindfulness, empathy, and emotional intelligence
Comprehensive explorations of meditation, including body scan meditation, breath meditation, imagery, and mini-meditations
Practical discussions of specific challenges faced by veterinary practitioners, including moral injury, client complaints, burnout, imposter syndrome, and a loss of confidence
Fulsome case studies, including a veterinary nurse’s journey to mental wellbeing
Dr. Laura Woodward is well positioned to write on the topic, as both a working veterinary surgeon and an accredited counsellor and has crafted a text that is perfect for veterinarians, veterinary nurses, and practice managers. Mental Wellbeing and Positive Psychology for Veterinary Professionals will also benefit veterinary students, student veterinary nurses, and teaching staff seeking a comprehensive resource for veterinary mental health.

About the Author
Laura Woodward, MVB; CertVR; CertSAS; Dip Couns; MRCVS is the Founder of a counselling and mindfulness practice for veterinary professionals and also a surgical veterinarian at the Hampstead Village Vet Hospital in London in the United Kingdom. She is also mindfulness teacher, a positive psychologist, and is training to be an equine psychotherapist.

The Author has assigned a share of their Royalty to Vetlife and another to free of charge therapy for Veterinary nurses

Stress and Psychoneuroimmunology

1st July 2023 3:20 pm Comments Off

What is stress?
More importantly, what is stress to you? What is your stress at the moment?
The word ‘stress’ is such an all-encompassing word. A single word for the effects the world is having on different people in monumentally different circumstances at the same time.
These people might be working in a busy veterinary hospital, they may be the owners of the pets in that hospital, they may be crossing the channel in an inflatable dinghy, they may teachers in the US worried about gun crime, they may be hospital patients themselves.
In his book Full Catastrophe Living, Jon Kabat-Zinn tells the story of how he tried and tried to change the title of the first draft of the book over a decade ago. He just couldn’t find a name for the vast array of difficult experiences and stresses a human will come across in their life apart from ‘The Full Catastrophe’.

In Buddhist teachings, we learn about The Four Noble Truths which contain the essence of the Buddha’s teachings. It was these four principles that the Buddha came to understand during his meditation under the bodhi tree.

The truth of suffering (Dukkha)
The truth of the origin of suffering (Samudāya)
The truth of the cessation of suffering (Nirodha)
The truth of the path to the cessation of suffering (Magga).

Suffering, The Full Catastrophe and Stress, these are all words which by their nature will describe complex scenarios and emotions.
But the simplicity of at the heart of this word search is apparent: we are trying to unify a multitude of human experiences and responses in life and describe them with a single word or phrase. We’re communicating a distress.

Being stressed is neither right nor wrong. Feeling like you shouldn’t be stressed about work when others are less stressed about their life difficulties is being judgmental and self-deprecating and not helpful.

Stress can originate from a huge variety of sources and can be felt in our head, our stomach, our chest our mind. It will revisit us many times a day in all its various forms.
If we accept that life will have stressful events, we can work with it effectively rather than exhausting ourselves trying to fix it, avoid it or prevent it.
If the Buddha was able to break down the human existence into four truths, maybe we can look at stress in this way too. Most of us like flow charts, spider diagrams and spreadsheets.

Chicken and egg question
So, is stress the cause of our rapid heart rate? Or is stress our rapid heart rate in response to something that is happening?
In other words, which came first? Do I feel stressed which makes my case difficult? Or is that case a stressful case causing me distress?
In realty, the stress and the stressors are interconnected and inseparable.
So, in order to decrease the discomfort, maybe we need to identify and face the event or the fact (the stressor) and then examine our responses to it (the stress).

To make it a bit more complicated, sometimes the stressor comes from within us rather than being an external event or situation. For example, my ruminations may be causing stress. My thoughts may be rational, or irrational (based on statistics) and cause me stress.
It can take a bit of work to identify what’s what. It can take days with our eyes closed, sitting on the cushion to untangle the plethora of stressors, catastrophes and sufferings.

Using mindful curiosity, along with a willingness to explore with fresh eyes, we can untangle the stressors, the responses, the internal and the external. The untangling in itself is a valuable and fruitful exercise.
Some people, me included, find it easier to triage the stressors and identify the stressful emotions with pen and paper. The flow diagrams, strategies, pros and cons lists are some methods which can help.

If you enjoy running on adrenaline and caffeine, and many of us do, what’s the appeal of leading a less ‘stress-filled’ life when we’re happy as we are?

Psychoneuroimmunology

Hans Selye said “Between stimulus and response there is a space. In that space lies our freedom to choose our response, and therein lies our freedom”.

He also proposed that long-term exposure to stressors without our learning how to alleviate their effects on our bodies and our minds could compromise our immunity and therefore lead to decreased resistance to viruses and bacteria.
We now know so much more in the field of Psychoneuroimmunology, (PNI), but Hans Selye said it first.

The upside of this is that if we learn to adapt to the inevitable and varied stressors in our lives, if we manage to experience joy despite experiencing hassle at the same time, we will feel less daunted by the shock of the next stressor coming around the corner at us and the one after that and the next one etc.

We will also fight off viruses, SSI’s and the debilitating effects of arthritic pain better than if we don’t learn to adapt.

“We cannot stop the waves, but we can learn how to surf” Jon Kabat-Zinn

Psychoneuroimmunology (PNI) is a novel interdisciplinary scientific field that examines the relationship of the mind to the patient’s neurologic, endocrine, and immune systems by examining critical parameters such as the effects of mental stress on wound healing and infection rates. Techniques that modify a patient’s emotional and mental responses to illness and surgery have positive effects on their physiology resulting in improved recoveries and higher patient satisfaction rates.(1)

A young friend of mine was recently diagnosed with chordoma of C1-C2: a locally invasive tumour expanding rostrally into her pharynx from her upper cervical spine.
The statistics for this don’t exist, just a few case reports it’s so rare.
She was given the choice of having her upper cervical spine removed through her mouth or allowing the tumour to progress.

It would involve many teams of surgeons and anaesthetists, a day and night in theatre, fusion of her remaining cervical spine to her skull, tube feeding, maybe a tracheotomy. Heart attack, stroke and death were all possibilities.
Why was she encouraged to go through this by the surgical, oncological and anaesthetic teams?
It was because they had got to know her. This woman is strong, determined, unshakeable. They new her life story and realised that she had been surfing the waves of life her whole life. Ironically, when we swim in the sea, she prefers to stay in the shallows.
But whatever life had thrown at her, she had faced it with profound self-awareness and the ability to accept stress as part of the normal human existence without detracting from her happiness and enjoyment of life running beside the stressors in parallel.

Once she had decided to go ahead with the surgery, word of her courage and determination got around the London medical world.

The world-renowned surgeon who had written and co-written those few case-reports heard about this woman who takes on stress and challenges and surfs with them, and he decided he would cherry-pick this case for himself. He swooped in and took it from the original surgeons. He knew that attitudes like hers get results.
It’s a happy story about an amazing woman who defied all the odds, came through the most ambitious of surgeries, and stunned the medical teams with her rate of recovery.

We’re not all built like that. Her grit and determination to fight for life and to be there for her family is legendary and inspirational.
The moral of the story, however, is that, if we can allow our stressors to be recognised and acknowledged, if we can accept that they may cause us stress, suffering and the full catastrophe, we can learn to surf the waves without being shocked or surprised that they keep on coming like a good beach in Cornwall.
That will subconsciously build up our resilience and inner strength, so that when bigger stressors come along, we might be pulled under temporarily only to resurface nearer to the beach, rather than succumb to a tsunami and go under for ever.

Tagge EP, Natali EL, Lima E, Leek D, Neece CL, Randall KF. Psychoneuroimmunology and the pediatric surgeon. Semin Pediatr Surg. 2013 Aug;22(3):144-8. doi: 10.1053/j.sempedsurg.2013.05.002. PMID: 23870208.

Feeling Good vs Feeling Better

3:03 pm Comments Off

Last month I ran a seminar entitled “Embracing Change” at a London based small animal hospital which had recently been acquired by a corporate.
There are so many changes when we join a group with a chain of managers and leaders. New protocols, systems of appraisal, pricing systems, etc.

One of our sessions was a contemplative session i.e., where we pose a question and then spend some time in quiet contemplation and stillness thinking about our answers.

The question I put to the group was this: “In your precious little free time, do you spend time doing what you enjoy? Or doing what will make you feel better?”

There’s obviously no right or wrong answer here.
We had already learnt how to be non-judgmental that day, so there was no self-judgment or self-criticism when thinking about how we spend our time away from the practice.
Looking at our answers with clear fresh eyes and curiosity allows us to think factually: What activities do I spend time doing?
Then emotionally: Do I enjoy them?
And lastly: Do they make me feel better afterwards?

It was an amazingly lively discussion afterwards. I didn’t suggest what the nuanced differences might be between the two ways of spending time. This was an open discovery of each other’s interpretation of the question.

Some of the delegates felt that the way they spend their time does indeed make them feel better in the long run.
Others felt that their own activities and pastimes perhaps didn’t actually result in greater contentment and happiness afterwards although they were truly enjoyable at the time.

Most delegates including myself enjoy the odd binge watch of our favourite series, beer and curry in hand, followed by sprawling out on the sofa in delicious escapism from the hectic emotionally exhausting practice.
Most of us also enjoyed walks in the fresh air, some of us exercise and others reading, cooking etc.

The difference was this: the delegates who felt that their activities outside of work resulted in an overall improvement in their mood were typically the people who were exercising, playing tennis, playing music, meditating, journalling, reading etc. whereas those of us who were enjoying our binge watching Netflix, eating ice cream and finishing off the bottle of wine, knew in our hearts of hearts that it didn’t necessarily result in an improvement in our mental wellbeing.

Improving your mood doesn’t need to be reserved for when you’re feeling low or stressed. True self compassion is improving your mental wellbeing from low to good to fantastic, and then re-enforcing that strong, unwavering contentment and joy by continuing the activities which improved it in the first place.

Staying non-judgmental, there’s nothing wrong with slobbing out on the sofa and being entertained by streaming networks or drinking alcohol etc. We knew that. However, it’s a temporary ‘fix’ not an improver.

So, if it’s clear to us which makes us feel better and which provides a band-aid to our mood, why is it that some of us choose the latter instead of one of the options which will improve our overall wellbeing ?

We decided it was because often those activities require effort.

What is effort?
It’s putting our mental and often physical energy into something. Sometimes it’s quite unpleasant like that extra spin class you shoe-horned into your week, or maybe it’s getting up earlier than we want in order to meditate. Or it might be having water instead of beer. Or it might be doing guitar practice when we desperately want to be horizontal instead.
Other times, the means is as enjoyable as the end. In other words, the effort is pleasant. E.g. having a bath with candles and gorgeous bath foam or sitting in the garden leaving all technology indoors and on silent.
Whether we choose to make more effort or not is our individual choice. Maybe we will only make an effort when our mood is low and we have a wake-up call that those meditations we did last month aren’t having the same effect now as they did then.

The people who continue to feel fantastic no matter what life does or doesn’t throw at them are probably making more of an effort than the people who feel great occasionally, Maybe the activities like running, meditation, piano-practice, mindful reading etc. are more enjoyable for some and more exhausting for others, that’s the way life and personalities are.

How do I do it?
It’s easy to make a list of Things Which Make Me Feel Better, and to try to dip in and out of it regularly.
It’s important to notice how you feel prior to the activity, during it and afterwards. I usually can’t be bothered to go for a run after work. But once my trainers are on and I’m out the door, it’s “oh my goodness this is amazing, I feel fantastic, what a treat”, then afterwards once the gasping for breath has settled and the muscle aches are setting in, I notice, I have done something for myself which required a hell of a lot of effort, and now I am high on endorphins and I’ll be congratulating myself on being that little bit fitter for the next few days.
Choosing different things off the list keeps it fresh and varied. We’re not going to run, cook healthy food, practice guitar, and meditate every day I’m guessing. So, having plenty of activities to choose from means we never need to feel guilty for not doing everything on the list.
Conversely if the list has only 2-3 things on it, we may feel obliged to do all three every day before we switch off. That’s unhelpful pressure and will probably end in our giving it up due to repetition and boredom.
Most people will have 8-10 things which make them feel better.
Getting started simply involves writing the list and noticing.

“Happiness is not ready made; it comes from our own actions”.
The Dalai Lama

Ukraine War and How It Affects Us

30th April 2022 10:33 am Comments Off

Just as we were getting over Covid…………………… Putin messes it all up.

Most of us were affected emotionally at least on some level by the pandemic.

So much has been written about the mental health impact of it, including here.

And then, just as the world could look up, de-mask and breathe a sigh of relief filled with common humanity and the potential of connecting with our fellow humans around the globe in collective recovery………………….Putin ordered his troops into Ukraine.

We don’t know what the orders were. Some say the Russian soldiers were told they were just in training exercises. In any case, there is now a new and horrible collective grief and horror at the suffering, death, and destruction caused by the war in Ukraine.

Some of us thrived despite the Coronavirus Pandemic. Through huge efforts and work on our mental wellbeing, we quickly learned to accept that it was a reality. Acceptance, as I have written about here before, is a key part of having emotions while not suffering because of those emotions.

So we learnt acceptance.

Accepting our emotions and allowing them to just sit there within us instead of pushing them away or shoving them into our box of ‘never to be revisited feelings’ , is way more effective than resisting them.

You know when you try not to feel something like anxiety or sadness, it just comes back bigger and stronger to get you.

Even if you assume zombie, emotion-less mode through alcohol or drugs or even just through binge-watching Netflix, once the numbness wears off, it still hurts, and sometimes it hurts even more because we haven’t accepted any of the pain.

This war is different on so many levels albeit it is still another global crisis.

For one thing, this time there is a perpetrator.

So while our minds have to deal with familiar emotions like anxiety, fear, and despair. We now have anger to add to the mix. Helplessness, hopelessness, and guilt are in there too.

The Three circles of control

There is a prayer called the Serenity Prayer which is by far one of the most famous prayers that were written in the 1800s by Reinhold Niebuhr (1892-1971).

Its popularity grew even more in the 1940s when Alcoholics Anonymous took up using a shortened version for its recovery program.

The Serenity Prayer

God grant me the serenity

To accept the things I cannot change;

Courage to change the things I can;

And wisdom to know the difference.

Living one day at a time;

Enjoying one moment at a time;

In Counselling Psychology, there is a concept called circles of control, that helps us to understand and reflect on how close things that affect us are to our influence.

The idea here is that some things – many things happen that are entirely beyond your influence, so your energy is better focused on things that you can influence.

In the central circle are things that we can control. Although it may take effort and instruction, we can make changes here for the better. This includes the most important thing of all: our mind.

With good instruction, we can change our minds. Mindfulness can rapidly move our chaotic way of thinking and reflexive way of behaving into an easy and methodical way of thinking and a way of behaving which is reflective rather the reflexive. I.e. we decide our reactions to things.

“Between every action and our reaction, there is a space. In that space lies our freedom to choose”.

– Viktor Frankl

The middle ring contains things over which we have a small amount of control. This will include many things: our friends, family, jobs, habits, and daily life. Through compassion, self-compassion, kindness, and purposeful actions, we can have an enormously beneficial effect on the people around us. Sometimes just giving off good vibes can be palpably calming for those around us. Other times, a change in our daily habits can turn our profound sadness into joy. I say this from the experience of experiencing horrific tragedy and soon afterward feeling blissful about tiny things surrounding me.

The outer ring is made up of things we cannot control.

Vladimir Putin is going to pursue his military agenda whatever you or I think, do or say, so this sits in our outer circles, beyond any kind of control we might have.

So, how can we just accept it?

We see the Ukrainian people resist and fight back with unfathomable resilience and bravery.

The public awareness thanks to Zelensky keeping Ukraine in the forefront of the minds of everyone around the globe is phenomenal.

We’re angry and want to se Putin accountable.

Acceptance is not about sitting here like a blancmange doing nothing and saying “Que sera, sera”.

It’s not about being complacent and ineffectual.

Acceptance is about feeling that anger and maybe pure unadulterated hatred for the perpetrators of human tragedy, and accepting that we feel that way.

So we can have all that anger within us, for obvious reasons, and still, be kind to those in our inner circle (ourselves) and our middle circle.

We can donate cash with gift aid, we can drive a truckload of blankets to Poland, all the time allowing ourselves to feel anger, grief, and the excitement that comes with being proactive all at the same time.

By accepting our plethora of emotions one by one, maybe we will be more effective and courageous in the long run in changing the things we can and being wise to the things we can’t.

The use of language

22nd September 2021 12:19 pm Comments Off

“Don’t mix bad words with your bad mood. You’ll have many opportunities to change a mood, but you’ll never get the opportunity to replace the words you spoke.” – Unknown

A truly eloquent friend of mine recently asked me“Have you noticed how many people describe being stuck in traffic as a ‘disaster’, or spilling a cup of coffee as a ‘mess’ or (the big one) a case going wrong as ‘devastating’? Well, how’s about being stuck in traffic is a ‘nuisance’, spilling your coffee is a ‘niggle’ and an unsuccessful case is a ‘disappointment’!

His words made me think.

If we make the effort to ensure that our internal monologue is helpful and constructive,(or at least non-damaging), then that’s one less person bringing us down, and also our external words will be helpful and constructive for others.

Internal monologue

Psychologists reckon that only about 1 in 10 of us don’t have a chatter going on in our head for most of the day. It might be a list of things to do, an email we’re composing, a conversation we want to have or wished we’d had anything.

What a fantastic opportunity, therefore, this is to speak kindly to ourselves and to choose our language carefully.

I rarely swear out loud. But internally, when I drop and smash something, or inadvertently lock myself out of the house, or spill tea on my laptop, my internal monologue is the stuff of nightmares.

However, if my friend does the same, or if my kid break plates or the cat spills a pint of water on my electronics, I use calm, reassuring words and tone of voice, because it’s a simple mistake and they may be distressed already.

So why the disparity?

We’ve talked before about treating yourself as you would treat a friend. A helpful practice is to choose the words for our internal monologue as carefully as we would choose words for a friend or our child. Before long, it becomes a habit, so choosing helpful words and phrases for our external voice becomes something we do automatically. As a massive added benefit, the less internal self-flagellation we practice, the better our self-esteem and confidence.

External words to self

There’s little benefit from being attentive to our use of language towards others and congratulating ourselves on our kindness if we call ourselves an ‘idiot’ out loud for forgetting something or if we swear at ourselves when we drop coffee on the carpet. More damaging than the coffee stain on the carpet is the effect it has on our kids and loved ones to hear us berate ourselves if we do it out loud. How can they have healthy self-esteem and feel unjudged if their role model is cursing their own simple mistakes?

External words to others

If you have high levels of Emotional Intelligence, what you say can be profoundly powerful to those around you and to yourself.

Emotional intelligence has five key elements: self-awareness, self-regulation, motivation, empathy, and social skills.

We should ideally be putting all of these into practice each and every time we open our mouths.

With practice, you can run through all these in a few milliseconds.

Self-awareness: how do I feel?

Self-regulation: Am I going to speak to myself or to someone else reactively or after some thought?

Motivation: What do I want to achieve out of this situation?

Empathy: Am I aware of how the other person feels? What type of language will resonate with them? Cognitive empathy is, after all, all about using the language of the other person rather than our own.

Social skills: What tone and volume do I need to use in order to achieve my goal? Is my body language going to reflect what I want to say and how I want to say it?

Let’s take a (potentially unhelpful) everyday situation and apply Emotional Intelligent use of language to it.

So, driving to work in London traffic, can be many different things to different people. For some, it’s a daily, boring, time-wasting source of stress which always takes longer than expected. For others, it’s a chilled alternative to the tube, with music or guided meditation playing, a good coffee sitting in the holder, and a chance to take deep, mask-free breaths.

Someone cuts in front of me from the lane that was for turning right only, then stop while they catch up on their phone.

Self-awareness: I feel angry? Enraged? Vengeful? Non-plussed? Amused?

(or can I take it to the next level and say, “Thank you,” to this driver “for helping me to exercise my patience”? Seriously, every time I try this, I smile).

No emotion is right or wrong. You don’t need to justify why you are feeling it. The exercise is to notice the emotion and put a name on it rather than be carried away by it.

Self-regulation: I could swear internally or externally. I can sit on the horn. I can tailgate that driver for the next mile. I can shrug. I can smile. I can use any words reactively ranging from “bloody idiot” to “meh, Whatever”.

“Between action and reaction, there is a space. In that space lies our freedom to choose”

– Hans Selye

Motivation: here’s the thing. I do want to get to work as smoothly and as quickly as possible (and probably in as stress-free a way as possible).

So, in my experience, shouting and tailgating rarely result in a driver like that moving faster for me or letting me go in front of them because they can sense that I’m in a hurry.

Also, while it may feel that expressing anger and rage will make the stress go away, basic physiology tells us that that’s a fallacy.

So, our internal monologue can be littered with expletives. Try it and monitor your heart rate.

Or you can really thank them for helping you to exercise your patience, notice the breath, lower your shoulders and see if you can lower your heart rate through deep breaths alone.

In reality, if you get to your destination one car length slower than intended, that’s probably “just fine”. Your stress levels are going to be way more significant than the time at the end of the journey.

Empathy: Cognitive empathy, we know, is about communication. Whereas emotional empathy is about relating to how the other person is feeling. So, tailgating this individual will resonate with them because that’s the language they speak, and will effectively communicate that you’re up for this game of caffeine-fueled aggression.

The converse is also true: by not engaging, and not communicating via words or otherwise, your goal of getting to work in a chilled state is more likely to happen. Using your internal monologue of “no problem”, “meh”, “thank you” etc. can help you to achieve this state.

Social skills:

Body language is not just for the benefit of the onlooker.

It goes without saying that aggressive gestures out the window are unhelpful. Also unhelpful is colorful internal monologue describing the characteristics of this driver

A quick body scan where you sit up straight, lower your shoulders, relax your face and jaw, and breathe, calms you while communicating to road hogs that your intentions are different from theirs. An inner monologue of “yeah, okay, whatever” might fit the bill.

“But if thought corrupts language, language can also corrupt thought.”

– George Orwell

Re-Entry Anxiety Post COVID

21st September 2021 12:25 pm Comments Off

ACT or Acceptance and Commitment Therapy is a form of psychotherapy that invites people to open up to unpleasant feelings, and learn not to overreact to them, and not avoid situations where they are invoked.

So, what’s the point of knowing that? You may ask.

Well, the restrictions of the last 12 months have been gruelling for many of us. The loneliness and anxiety felt by the halting of our usual basic liberties have caused a tsunami of mental health concerns. Unfortunately, many of the same people who have been suffering the most with these restrictions and finally succumbed to (or accepted) them, are now experiencing anxiety during the transition from social isolation to a packed diary again (the re-entry phase).

We worked so hard at accepting that it is what it is, taking one mindful day at a time. We focussed on only the present moment rather than worrying about, or even planning for, the future. We got used to not planning anything to avoid the feelings of disappointment when plans were cancelled.

We re-programmed ourselves to enjoy this cosy bubble of the home where every day is Groundhog Day, and the diary is empty. So now, we’re throwing the doors wide open and rushing back to normality as fast as the statistics will allow. All good right? Not necessarily.

ACT is widely used by therapists for the anxiety that cancer survivors experience on re-entry. Cancer survivors may experience an uncertainty about the meaning and purpose of their lives following cancer, triggering anxiety. Additionally, they may worry: ‘Does this symptom mean that my cancer is back?’, ‘How can I live knowing that my cancer might return?’, and ‘Now that treatment is over, why I am not back to normal?’ Fear of cancer recurrence figures prominently, yet the focus of anxiety extends beyond just that.

Moreover, anxiety often persists for a decade or more after cancer treatment, representing the largest mental health difference between long-term cancer survivors and community controls.

Firstly, very, importantly, I do NOT equate restrictions on our freedom in any way, shape or form with having cancer.

Nor do I think that the wonderful liberation unfolding for us over these next few months is like returning to normal life after surviving cancer.

That’s especially true because, while a person is enduring the godawful process of cancer treatment, the rest of the world is going on about their usual business without them ‘as if nothing untoward is happening’.

Covid and lockdown have affected every human on earth and so is a completely different scenario.

What I AM saying though is that we can learn from the re-entry anxiety cancer survivors experience as we begin to understand the there-antianxiety, we are feeling on coming out of lockdown.

Many may question the meaning and purpose of their lives after covid following this chance to stop, pause and re-evaluate. Others may have no choice but to pursue other career paths due to redundancy. Each triggering anxiety.

We may worry that this cough or headache is the start of a covid infection. We may continue to worry about our aged or susceptible loved ones developing the disease despite vaccinations.

We may wonder how, now that life is returning to normal, why we don’t feel normal.

And we might judge ourselves as ‘wrong’ for feeling all of the above.

We have discussed Acceptance before.

Acceptance is, in a nutshell, allowing ourselves to feel any emotion we are feeling non-judgmentally. One at a time so you can identify what that emotion is, give it a name, feel the physical effects of that emotion, look it in the eye and notice that it’s present. That’s the opposite of shutting those feelings in a box only for them to come back another day and grab us unawares.

Commitment is like deciding what we want to do as a result of each emotion we are feeling. Internally, that might be deciding to live with it and even ‘befriend’ it. Alternatively, it may be deciding to let it go for now or for longer. Neither is ‘right’ nor ‘wrong’. Externally we may decide on physical actionsE.g., do I want to shout? Do I want to convey a loud sigh? Do I want to run away? Do I want to just not reply to messages?do I want to make plans to go to the pub and then cancel at the last minute because I just can’t face it?

Making these decisions consciously is helpful because it means that each reaction is not just us running on autopilot, it’s us being self-regulated. The spin-off of good self-regulation is happier, more content people with positive interactions with others.

ACT promotes forms of coping that predict positive psychosocial outcomes among cancer survivors: actively accepting cancer-related distress, reducing cancer-related avoidance, clarifying personal values, and committing to meaningful behavioural change.

ACT allows for, rather than minimizes, the distress of cancer and fear of recurrence—an approach that may authentically validate the fears of re-entry phase survivors, many of whom live with the real possibility of relapse and early mortality. Thus, ACT may help cancer survivors increase their capacity to live meaningfully and effectively even with persistent side effects and uncertainty about the future.

I, for one, am in awe of cancer survivors who show any indication that they are accepting of these anxieties. Often, society and even the closest of family members, are so joyful for the cancer survivor when they come to the end of their treatment and are given a clean bill of health, that the survivor themselves feels totally alienated from those they feel closest to. At a venue where I counsel cancer survivors and cancer patients, time and time again I hear that the survivor with the discharge note from their oncologist emerges from the rigorous schedule of years of appointments. The champagne corks are popping, balloons are everywhere, and the survivor feels more alone than ever. Their family is celebrating but their support network has just evaporated as they are discharged from the only group of people who can truly understand how they feel. Some clients have said that they would choose to not be in remission or cured of their cancer rather than face this re-entry.

Being aware that the jaw-dropping strength of cancer survivors getting back to normality is far greater than the strength we will need to get back to the pub is respectful and, perhaps, not something we had thought of before now.

Telling yourself that there are people far worse off than you who have cancer or who have had loved ones die due to covid, while it is of course very true and not to be trivialised, rarely helps to relieve anxiety.

Self-shaming is of benefit to no one.

Some of us may have an underlying worry that, just as we get used to going to the pub again, it will all be ‘taken ‘from us. It may be the fear of disappointment that stops us from booking a holiday even though we’re allowed to do so.

Accepting this plethora of feelings and identifying them one by one is a start.

Giving ourselves permission to feel these emotions is helpful.

Knowing that there are vast numbers of people feeling exactly as we are helping because we realise that it’s the nature of being human in 2021.

The nature of Impermanence, attachment, and positive psychology.

19th September 2021 12:29 pm Comments Off

“Nothing is permanent— not even our troubles.”

– Charlie Chaplin

Impermanence is constant change, and it’s woven into the very fabric of our existence. Moments come and they go. Years go by. Kids grow up too fast. Holidays take ages to arrive and seemingly minutes to pass. Time flies when you’re having fun. The breath you took five minutes ago is long gone.

Intellectually, we understand that our pet will be born, age, and die, that a car will break down, that the traffic jam will eventually move. Our work is to move that understanding from our intellect and nestle it deep in our hearts. But how does that benefit us? Sounds miserable, right?

There’s a beauty to impermanence. You know, in Japan, people flock to the hillsides to see the spring blossoming of cherry blossoms. The festival is over after a few days as are the blooms. Tiny blue flax flowers in North America last for just a day. Glastonbury is amazing. But it has to end because it’s impossible to party that ardij

Impermanence isn’t a good or a bad thing. It’s just a fact. We rely on constant change; we rely on impermanence.

Ancient trees will burn in great forests so new ones can be born. Evil dictatorships crumble.

Winter days can be cold, wet, and dark. Some people love winter. Others of us prefer sunshine, long warm evenings and swimming in the sea. How many Winters have you seen pass and give way to Spring and Summer? We need Winters to be impermanent

So how does really understanding impermanence benefit our wellbeing?

If you’re having a great day, enjoy it to its fullest, it won’t last.

And if your day is feeling like a disaster, hang in there, it won’t last.

No matter how long that ops list is. It will eventually all get done. That’s also the nature of impermanence.

If you’re dreading the root canal treatment you’re having next week, have faith that that day will come. And it will go. And the root canal procedure will be done.

So, how can I claim that Impermanence is a path to fulfillment and an antidote to regret? Accepting the nature of impermanence is a key Buddhist teaching. It also leads neatly into relinquishing attachments which, according to Buddhist teachings, are one cause of suffering.

Impermanence versus attachment

So, if I can accept that I am impermanent, as is my cat, my job, this good or bad day, my holiday, then I can hold myself back from becoming so attached to the necessity of it being permanent that I can relax a little. Instead of fearing and dreading the end of my holiday, I can enjoy it even more mindfully and embrace every tiny joyous thing about it even though I know that it will pass.

With time, I can accept that everything, even all humans on earth including me are fleeting in some way. That is acceptance and letting go of my attachment and desperate need. And that’s ok.

Attachment :

According to Buddhism, attachment is the root of suffering, and it is usually the reason why impermanence is difficult to fathom for many people. Rationally accepting that everyone and everything is temporary is a refreshing concept, and whether you want to believe it or not, it’s true.

Positive Psychology :

While clinical psychology has largely focused on diagnosing and treating mental illness and diseases, positive psychology is concerned with cultivating positive well-being, which is very different from merely eliminating negative mental states.

We already know that external factors don’t determine one’s happiness. Certainly, positive external factors compound and complement one’s overall contentment, but internal factors are required to achieve an authentically joyous life. True happiness comes from within.

So, although a fortnight in the Maldives would be fantastic right now, it would come, and then it would be over. i.e., impermanent. Then you are still the same person (although a bit more rested), left with your mental state which only you can cultivate

It is also important to understand that grasping for positive thoughts, emotions, and occurrences in life is not what positive psychology suggests. If you accept the notion of impermanence but still attempt to force happiness and joy into your life, you are missing the point.

This quote from Paul T.P. Wong (2007), a positive psychologist sums up the concept of impermanence and attachment :

“Craving for happiness necessarily causes us to fear or reject anything that causes unhappiness or pain.

Attachment to possession and achievement invariably leads to disappointment and disillusionment because everything is impermanent.

Thus, the positive psychology of pursuing positive experiences and avoiding negative experiences is counterproductive, because the very focus on happiness contains the seed of unhappiness and suffering.

Failure to embrace life’s experience in its entirety is at the root of suffering.” References: Wong, Paul T.P. (2007). Chinese Positive Psychology. International Network on Personal Meaning. Retrieved from http://www.meaning.ca/archives/archive/art_Chinese-PP_P_Wong.htm

Staying mindful in a pandemic

22nd January 2021 6:46 am Comments Off

What can we learn from our patients and our pets during the pandemic?

Have you noticed how so many people have got a new puppy, a kitten, or a pair of guinea pigs since the pandemic started? While this raises many questions about morals and ethics, it also shows how the human-animal bond can be a lifeline during difficult times.

Looking at the ever-increasing number of puppy-poodle crosses among my friends and coming through the door at work, I can be either judgemental about pet breeding, grumpy about the fact that work is busier than ever and I’m suffocating behind this mask-visor combo, or I can choose to celebrate the human-animal bond which has helped me as a pet owner and many others to cope with potentially overwhelming emotions related to the pandemic. It’s a choice.

During mindfulness meditations, we can consciously train our brain to notice things, such as how a puppy has brought joy to a locked-down family, how the lack of traffic noise gives us a chance to hear more birdsongs than ever, or how concentrating on a good coffee makes its aroma, taste, and temperature so much more prominent than normal.

You can choose to rejoice in the good things about increasing pet ownership while also being aware of the drawbacks. It is about noticing both, and then choosing which one has the most influence on you. I can see how pets can have a profoundly positive effect on us during difficult times. With that in mind, what can we learn from our patients and our pets?

The importance of a good routine

When we were kids, most of us had routines provided for us. We had a wake-up time, school time, dinner time, and bedtime. These routines kept us on a productive path.

The pandemic has caused us to have amounts of time to fill that we probably aren’t used to having.

The pandemic has caused us to have amounts of time to fill that we probably aren’t used to having. And yet, for a lot of it, we are running on autopilot like news-jaded zombies. At the other extreme are very productive people learning new jam-making skills while teaching their kids to crochet their own wall hangings in five different languages. But this is a global pandemic, not a productivity contest. Somewhere in the middle are the dogs and cats: super chilled bundles of joy who love a routine of walkies – food – nap – repeat.

We can learn from our pets in many ways, and one way is by having an easy routine to add a bit of structure to the days when our default mode is to doom scroll endlessly through the news and social media. A simple routine (eg mindful meditation – mindful shower – slow coffee) can bring some normality to an incredibly abnormal situation.

Feel what I need to feel when I need to feel it

This pandemic is impacting more than just our physical health, it is taxing our mental health as well. Fear is at an extremely high level. The non-stop media coverage and prolonged uncertainty can lead to intense feelings of stress, anxiety, and depression. Now more than ever, it’s essential for us to create awareness of our feelings and to learn to manage them. With animals it’s easy: hunger, eat, done. Separation anxiety, owner returns, done. We, however, need to put a lot more effort into “notice, feel, let go” of difficult emotions.

We need to take time out to sit, breathe, and allow ourselves to feel what we feel. It’s hard to know what we’re feeling when it’s jumbled up in our minds like a bundle of intertwined wires behind the TV. The very simple act of untangling those wires and sorting them out is so satisfying. As is the act of identifying our feelings, one at a time, and giving each one a name. By naming them, we are identifying each feeling and allowing ourselves to feel it. It’s not weak to feel overwhelmed. It’s not selfish to feel sad when others may be worse off. It’s not shameful to feel joy mid pandemic. Feeling overwhelmed doesn’t stop you from feeling happy to stroke the guinea pigs, play with the kittens or walk the dog.

You are allowed to feel all of those emotions. You need to give yourself permission to feel each of those feelings, all the while recognizing each individual feeling and emotion separately, rather than as a plethora of intertwined emotions causing anxiety.

How to truly be present

Just as animals can teach us to let go of difficult emotions, they can also show us how to be truly present. What dog is yearning for life to return to the way it was pre-COVID while they’re out for a walk? The simplicity of their minds allows them to notice the present moment wholeheartedly.

When times are hard, it’s impossible to be anywhere else other than totally consumed in the moment of awful grief and desolation. So, when times are pleasant enough, or even really gorgeous, why does it take such effort to remain in that moment and glean all the happiness possible out of it to provide future resilience? It just does. Because we have hard-wired ourselves to ignore things that don’t need “fixing”. It takes training to change. It takes practice. And it’s so incredibly rewarding.

So, if we are going to achieve anything during this pandemic, maybe it could be to (1) develop a simple routine; (2) allow ourselves the time to feel what we feel, and (3) be totally present in the moment we’re in. Because the past has passed and cannot be changed or undone, and the future is overwhelmingly uncertain.

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