Sam Cox
Online therapy
I’m here to listen
Getting stuck in life can feel overwhelming, and I understand that beginning therapy can feel like quite a daunting process. Together we can work at a pace which suits you, in a safe space where the relationship of counsellor and client is at the core of the therapeutic process. Our sessions together will be private, and we will work in collaboration to gain a greater understanding of your experiences, feelings, behaviours, and needs.
Humanist Integrative psychotherapist,
Adv. Dip. Reg MBACP
Book a free 15-minute consultation
I’m here to help
I work as an integrative psychotherapist, which is both person-centred, and psychodynamic. Meaning that I am able to help you understand your feelings better, by exploring your past relationships and experiences with you. I believe that a sound understanding of these, can help bring about healthy change and growth.
Mental health care has not always been readily available. Working with me online, you can work on your terms and at your own convenience. During my years of experience as a psychotherapist, I have adapted my practise to suit the needs of others, understanding that the demands of modern day living can mean that time is precious to us.
I believe that it is important for people to receive the support they need in a place where they feel comfortable and safe, and that this in itself can be theraputic. Thanks to the ease of access which online therapy offers, you can get the kind of help you need, where and when you need it. By avoiding unnecessary travel time and costs, this needn’t impact on your dayto-day priorities.
What is worrying you
Areas that I can help you to explore
What is abuse?
Abuse can happen at any stage in your life, from childhood through adulthood and during your latter years. Abuse can come in many different forms, from different people. Someone may use physical violence, the threat of violence, emotional manipulation, or cruel words to abuse you. All types of abuse can cause pain (physical and/or psychological) that takes time to heal.
Deliberately undertaking actions that are harmful, morally wrong, or are a form of misusing power to harm another person are all acts of abuse. It’s important to remember that no one ‘deserves’ or ‘asks’ to be abused. No matter how much you may be struggling, help is available.
Types of abuse
There are many different types of abuse, that can present in different ways. Knowing what to look out for could help you to recognise worrying patterns or types of behaviour you or someone you love may be experiencing.
Physical abuse
Deliberately harming or injuring someone else through physical contact, violence, or violent behaviour is called physical abuse. Anyone, of any age, gender, sexuality, or socioeconomic class can be affected by physical abuse. This type of abuse typically comes from someone within your environment, such as a member of your family, a partner, or a friend.
Physical abuse can include any (or many) of the following:
- biting
- pushing, hitting or scratching
- burning or scalding
- choking
- sexual assault
- throwing objects
- kicking
- hair pulling
The physical injury caused by physical abuse isn’t the only impact for the victim. You may feel an ongoing sense of shame or guilt about what you have experienced, which can lead to hiding what is happening to you from others.
Many victims of physical abuse experience fear, which stops them from reaching out for help. Others may be unable to let others know what is happening due to other controlling behaviours, such as restricted access to their phones, little to no contact allowed with friends or family, or being forced to stay home. These can all lead to physical abuse remaining unreported.
Emotional abuse
Leaving no visible marks or injuries for others to see the signs of, emotional abuse (also referred to as mental abuse or psychological abuse) can be difficult to identify. Those experiencing emotional abuse may fear that others won’t believe them without physical proof of their experiences or may try and downplay what they are experiencing by comparing it with other types of abuse that can leave lasting physical marks.
Emotional abuse often allows the abuser to gain power over you by using demeaning words and gestures, or deliberately scaring, humiliating, or isolating you. Threats, intimidation criticism, name-calling/insults, and undermining actions can all fall under emotional abuse.
Generally, emotional abuse can be put into three categories.
- Aggressive: This includes name-calling, blaming, accusing, making threats or using destructive criticism.
- Denying: This could be through manipulation, neglect, or the withholding of affection. Gaslighting is one such covert form of emotional abuse.
- Minimising: This could be belittling your feelings or thoughts, isolating you from friends, family, or support systems, or accusing you of exaggerating.
It’s important to remember that conflict, arguments and criticism are all healthy ways of interacting with others – but there is a clear difference between how these and emotional abuse make you feel.
Narcissistic abuse
Narcissistic abuse is a type of abuse by someone who has narcissistic personality disorder. A type of emotional abuse, typically the abuser uses words and actions to manipulate the other person’s emotional state and behaviour.
Sexual abuse
There are many different forms of sexual abuse. These include (but aren’t limited to) actions like unwanted touching or photographing, to feeling or being pressured into sexual acts without your consent. This includes acts that you don’t want, don’t agree to, or don’t fully understand. Many victims who have been sexually abused know their abuser. Often, this could be a relative, friend or partner (past or present), but it could also be a stranger.
Anyone can be a victim of sexual abuse and nobody should feel pressured into doing something they do not want to do. Those who are sexually abused may begin to change their behaviour as a result of the trauma. While everyone will react differently, the effects of being abused sexually may include intense fear, panic attacks, low-self esteem, body pains or depression.
Domestic violence
Domestic violence (also known as domestic abuse) includes any threatening behaviour, physical violence, or abuse (physical or emotional) between two people who are in (or were previously in) a relationship. This includes family members, non-romantic relationships, and individuals of any sexuality or gender.
Abuse experienced as part of domestic violence can be of any type: psychological, sexual, emotional, physical or financial. In essence, it encompasses the attempt of one person within a relationship to control and maintain power over the other person.
Research has found that domestic abuse is more common in the UK than many people think. According to the Office for National Statistics, nearly one in three women aged 16-59 will experience domestic abuse in their lifetime. Each week, two women in England and Wales are killed by a current or former partner. Between March 2020-21, police in England and Wales alone recorded 845,734 domestic abuse-related crimes, while domestic abuse helplines saw a 22% increase in use.
Individual counselling may help you assess what to do about a violent relationship and learn what steps to take next. Specialist agencies and professionals are also available for help and support.
Financial abuse
Financial abuse (also known as economic abuse) often happens alongside other forms of abuse. This type of abuse is a form of coercive control, where someone tries to use or misuse money to limit or control their partner’s current and future actions, as well as their freedom of choice.
This could include:
- using credit cards without permission
- putting contractual obligations in your name (loan repayments or phone contracts that aren’t yours)
- gambling using family assets
- taking away money or other property
- preventing or restricting you from making, using, or maintaining your own money
Those who experience financial abuse may be left without money for basic essentials such as food, clothing, or shelter. Many who escape from an abusive situation continue to experience financial control, in the form of their abuser exerting control through child maintenance.
Elder abuse
Elder abuse (also known as elder neglect) refers to the deliberate harm (physical, emotional, or financial), neglect, or exploitation of an elderly person.
Most often, elder abuse is committed by someone, such as family members, friends, carers, health care providers, who are charged with caring for an elderly person. It can take place at the elderly person’s home, in a care or nursing home, or at a family member’s house. Elder abuse can happen to elderly people of any gender. Those without other friends or family living nearby, with disabilities, dementia, or memory problems are more likely to experience elder abuse.
Child abuse
According to the NSPCC, we don’t know exactly how many children in the UK experience child abuse, due to the hidden nature of this type of abuse. Many adults in a child’s life may not recognise the signs, the child may be too young, scared or ashamed to tell anyone what is happening, or may not realise that what they are experiencing isn’t normal. We do know that every year, thousands of children are abused physically by a parent or someone they know.
Child abuse is characterised by any actions of a carer that could potentially harm a child’s mental or physical health. Research shows that many aggressors were abused themselves as children.
There are four main categories of child abuse. When anyone under the age of 18 is being deliberately harmed or not properly looked after, it is a form of child abuse. These can include (but aren’t limited to):
Physical child abuse
- hitting, shaking, slapping, throwing, pushing, or kicking
- burning or scalding
- choking, drowning, or suffocating
- restraining (inappropriately) or falsely imprisoning
- misusing medication, inducing or making up an illness or ill health
- using physical force to discipline
Emotional child abuse
- being made to feel scared, in danger, inadequate, worthless or unloved
- being unfairly blamed for things
- seeing someone else being abused (eg domestic abuse)
Sexual child abuse
- making or encouraging a child to watch or take part in sexual activities, behave in sexually inappropriate ways, look at sexual images or videos
- involving a child in the production of sexual content (images or videos)
- grooming a child online or in-person in preparation for abuse
Neglect
- persistent failure to meet a child’s basic needs (food, clothing, shelter, supervision, medical care)
- persistent failure to protect a child from physical and emotional harm
- abandonment
Some people live with the effects of an event that happened in their childhood, especially if they didn’t (or couldn’t) seek support when it happened. Childhood sexual abuse, for example, can have a huge impact on a person’s mental health and well-being. Talking about these issues with a professional can help you process past emotions and help to address issues of trust and anger that may resurface in later life.
How does abuse affect someone?
Abusive behaviour can have a significant impact on our mental health and well-being. This can happen not only at the time of the abuse but there can be lasting effects throughout a person’s life. Research has shown that abuse (in childhood or adulthood) can be a significant factor in developing depression, anxiety, and other mental health disorders.
Survivors of abuse may find that they experience:
- flashbacks
- trust issues (with themselves and/or others)
- long-lasting negative feelings
- difficulty forming relationships
- feelings of guilt or shame
- low self-esteem
- trouble feeling happy or finding happiness
- trouble sleeping
Abuse can also lead to a number of other serious issues, including self-harm, substance abuse, eating disorders, and suicide.
Why do people abuse?
The reasons why someone becomes an abuser can vary from person to person. Many abusive people believe their feelings and needs should be the priority, and they have a right to control or restrict their partner’s life. Others may enjoy exerting the power that enacting abuse gives them, while some may have difficulty handling their emotions and blame their problems on those around them.
Those who experienced abuse when growing up or who lived in a challenging family setting may have learned negative behaviours, however, it’s important to understand that past experiences do not excuse abusive behaviours.
Abuse is a learned behaviour, that may have been seen through the individual’s childhood, from friends, or even from popular culture. However, it’s important to remember that abuse is a choice that no one has to make. Many people who experience or see abuse do not continue those hurtful behaviours or harmful patterns. Abusive behaviour is never justified.
Recognising the signs of abuse
Abuse is an incredibly difficult and sensitive subject for anyone to deal with, regardless of the nature of the abuse or who the perpetrator is. If you’re worried about a loved one, spotting the signs is really important so that you can help them find the right support.
Keep in mind that people with care and support needs, such as older people or people with disabilities, are more likely to be abused or neglected. Often, they may be seen as an easy target and may also be less likely to identify abuse themselves or to report it.
Often, there is a history of abuse or violence in an abuser’s background. For instance, many abusers have often been victims themselves. But, regardless of the reasons, this does not excuse the behaviour. No one has the right to make another person feel frightened or worthless.
Abuse can surface slowly; it may not be immediately obvious. One of the main characteristics of an abusive relationship, though, is control – which can be achieved by force or manipulation. If you suspect that a relationship has become overly controlling, you start to see signs of coercive behaviour, or you notice that your loved one’s behaviour has changed, be there for them and help them find the right support.
What is coercive behaviour?
Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used by the abuser to harm, punish, or frighten their victim.
If you think your friend or family member is being abused, ask them about how they’re doing. The person may not be ready to open up to you or leave the relationship right now, but knowing that you are there to support them will be a comfort.
Taking the first steps toward seeking help can be tough – especially if you have tried speaking with someone before and haven’t had a response that has helped you. Mind share a guide to support options for abuse to help you make the next steps towards finding help.
How can counselling help?
Anyone who has experienced abuse, in any form, will need emotional support to process and recover from their experiences. But, everyone’s needs will vary. You may have a support network you can lean on but, equally, you may not feel comfortable speaking to loved ones about what has happened.
Whatever your situation, it can be helpful to speak with a trained, accredited counsellor or therapist. A therapist provides an impartial, safe space to talk about your experiences, concerns, worries, and fears without judgement. Your therapist can listen to you, help you come to terms with what has happened, and understand your options for moving forward.
Through working with a therapist, you may start to see a way out and escape from a cycle of powerlessness. You deserve to be listened to with respect and without being judged if you choose to talk about your experiences.
Counselling can help in many ways, at whatever stage you are in your life. It can act as a support if you are in the process of leaving an abusive relationship and help to restore self-esteem and re-examine healthy ways of relating following abuse.
What should I be looking for in a therapist?
Currently, there are no official rules or regulations in place that stipulate what level of training an abuse counsellor needs. However, it is recommended that you check to see if your therapist is experienced in this area.
You may wish to check if your therapist has undergone specific CPD or training in abuse and/or trauma counselling. You should also consider whether the therapist’s modality/approach is right for you, as there are lots of different types of therapy which can help people who have experienced abuse, such as psychodynamic psychotherapy and trauma processing techniques (eg. EMDR).
What is ADHD?
Attention deficit hyperactivity disorder (also known as ADHD) is a condition that makes people feel restless, impulsive and hyperactive. With symptoms typically showing up in childhood, those with ADHD often struggle to concentrate for long periods of time. While the condition is more commonly seen in younger people, it can also affect adults.
Referred to as a behaviour disorder, ADHD can make everyday life difficult, especially for those at school. Key symptoms include hyperactivity, inattentiveness and impulsiveness. These tend to be noticed at an early age, often becoming more noticeable when a child’s circumstances change (for example if there is a change in school).
The symptoms usually improve with age, however, some adults continue to struggle. Sometimes the diagnosis isn’t made and therefore learning to manage it can be difficult.
Types of ADHD
There are three types of ADHD:
- predominantly inattentive presentation
- predominantly hyperactive-impulsive
- combined hyperactive-impulsive and inattentive (when six or more signs are present, from either the inattentiveness category or the hyperactivity and impulsiveness category). This is the most common type of ADHD seen by doctors.
You may be aware of the term ‘attention-deficit disorder’ (ADD), however, this is generally no longer used. The criteria for ADHD changed to include the subtypes described above, which includes what was in place to describe ADD (predominantly inattentive presentation).
Signs of ADHD
There are two categories of ADHD symptoms, inattentiveness, and hyperactivity and impulsiveness. Most people will have a mix of the two, but this isn’t always the case. The lists below describe some of the common symptoms seen in children and teenagers.
Inattentiveness
Common signs of inattentiveness include:
- short attention span, easily distracted
- making careless mistakes
- often losing things/forgetful
- struggle to focus on tasks that take a long time
- appearing unable to listen/carry out instructions
- jumping from one task to another
- finding organising tasks difficult
Hyperactivity and impulsiveness
Common signs of hyperactivity and impulsiveness include:
- difficulty sitting still
- constant fidgeting
- unable to concentrate on tasks
- excessive talking
- excessive physical movement
- interrupting other people’s conversations
- little sense of risk or danger
- difficulty waiting their turn
In environments like school, where young people are expected to sit quietly for long periods of time concentrating on tasks, it’s easy to see why those with ADHD struggle. Receiving a diagnosis and getting the right support can help make school and other social experiences easier.
Rejection Sensitivity Dysphoria (RSD)
Rejection Sensitivity Dysphoria, commonly known as RSD, is a condition that is often seen among those living with ADHD. People with RSD are highly sensitive to criticism and often hold on to these negative comments for long periods of time – sometimes up to years later.
People with RSD might believe that they have let others down, feel that they have embarrassed themselves or have made a serious, irreversible mistake. In some cases, people living with RSD might even feel that they are deserving of the negative comments passed their way. This can lead to emotional pain, feelings of rejection and the person regularly criticising themselves.
Signs that someone is living with RSD include having low self-esteem or self-worth, becoming angry when faced with perceived rejection, feeling ashamed and, in severe cases, may think about self-harming behaviours.
Being told to “stop taking things personally” is easier said than done and can be unhelpful for people living with RSD. There are, however, some things that can make an RSD diagnosis more manageable, such as practising self-compassion and focusing on the person’s strengths.
Learn more about RSD and read Sara’s story on Happiful.
Sometimes, young people with ADHD may have other conditions or neurological differences alongside ADHD. These can include anxiety disorders, depression, sleep problems, epilepsy, Tourette’s, learning difficulties and autism. If you’re worried about any of these, be sure to tell your doctor so they can investigate and ensure your child gets any additional support needed.
Signs of adult ADHD
Symptoms in adults are less defined as currently, there is less research on adults with ADHD. Rather than developing at a later age, it’s believed that the condition will always have present in childhood, as it is thought the genes you inherit from your parents are a significant factor in developing ADHD. Symptoms may then have been missed, or they may have been diagnosed, but symptoms have persisted into adulthood.
ADHD tends to affect adults in a different way and the symptoms are often much more subtle. Some symptoms that may be seen in adults include:
- lack of attention to detail
- starting new tasks before finishing existing ones
- poor organisational skills
- difficulty focusing and prioritising
- often losing/misplacing things
- often forgetting things
- restlessness
- often interrupting other people’s conversations
- mood swings and irritability
- difficulty coping with stress
- impatience
- risky behaviour
Just like children and teenagers, adults with ADHD can develop other conditions. In adults, these often include personality disorders, bipolar disorder and obsessive-compulsive disorder.
Causes
The cause of ADHD is not yet fully understood, however, a combination of factors is thought to contribute. Genetics is considered a significant factor, specifically, the genes you inherit from your parents. There doesn’t appear to be a single genetic fault at play, however, so the way ADHD is inherited is likely to be complex.
Research has also shown that differences in the brain could contribute to ADHD. In brain scans, those with the condition are seen to have smaller areas in certain parts of the brain. Certain groups have also been suggested as at higher risk of developing ADHD. This includes those who were born prematurely (or those with a low birth weight), those with epilepsy and those with brain damage.
Getting an ADHD diagnosis
If you suspect your child has ADHD a diagnosis can be helpful in ensuring you get the right support for them. Your first step should be to see your GP. While they cannot formally diagnose ADHD, they will be able to refer you to a specialist if they feel it’s necessary.
They may initially suggest a period of ‘watchful waiting’ – a certain amount of time (usually 10 weeks) to keep an eye on symptoms and see if they improve. They may also suggest ADHD-focused parent training or education programmes. This is no reflection on your parenting, instead, its aim is to help you learn more about ADHD and how you can support your child.
If your child’s behaviour doesn’t improve and you and your doctor agree it’s affecting everyday life, they should refer you to a specialist for assessment. If you’re an adult and you think you have ADHD, your doctor will talk to you about your symptoms and may refer you for an assessment if you meet the following criteria:
- You were not diagnosed with ADHD as a child, but your symptoms started then and have never gone away.
- Your symptoms can’t be explained by another mental health condition.
- Your symptoms are affecting everyday life.
Counselling for ADHD
Treatment for ADHD usually involves medication or therapy, with a combination of the two working best for most people. Getting the right support and appropriate treatment can both help relieve symptoms and make day-to-day tasks easier.
There are several different therapy options that can be helpful for those with ADHD. These can also help with additional difficulties such as anxiety. Some therapies that may be suggested are:
Cognitive behavioural therapy (CBT)
CBT is a type of talking therapy that helps you manage problems by looking to change the way you think and behave. This can be useful if there are certain situations you/your child find difficult. CBT is also a great way to help with any associated anxiety.
Behaviour therapy
This is generally used to provide support for parents/carers of children with ADHD and may also involve teachers. This therapy aims to help with behaviour management, using a reward system to help children learn to manage behaviour.
Training and education
If your child has been diagnosed with ADHD, your doctor may recommend certain education and training programmes for both yourself and your child. These could include:
- Psychoeducation – This encourages you/your child to talk about ADHD and its effects. The aim here is to help people understand what their diagnosis means and how they can learn to cope with the symptoms.
- Parent training and education programmes – These programmes look to help parents of children with ADHD learn different ways of talking, playing and working with their child to improve attention and behaviour.
- Social skills training – Using role-play, social skills training aims to teach those with ADHD how to behave in social situations. This includes learning how their behaviour may affect other people.
Medication
There are various different types of medication that can be used to treat ADHD. While these should not be seen as a ‘cure’, they can help those with the condition concentrate better, feel calmer and be more able to practise new skills.
Addiction is the term used when someone is unable to control certain habits and behaviours, to the point where they are becoming harmful. Some examples of addiction include an addiction to alcohol, gambling addiction and smoking.
Here we will explore addictions in more detail, from the different types of addiction and how to support a loved one, to what help is available.
What is addiction?
Addictions can develop from what may be seen as fairly innocent, or at least common social habits. Drinking alcohol, gambling, eating, having sex and using the internet can all turn from what is considered a common activity, to a darker, more destructive compulsion.
Addictions may come from the way these activities and habits make people feel, both emotionally and physically. They can be pleasurable – a form of escapism for someone who is going through a difficult time. But this moment of pleasure can trigger a powerful need to continue the habit or activity, over and over, in order to feel that way again.
In many cases, people with addictions are not aware of the problem, nor are they aware of the impact it is having on their lives, or on the lives of those around them. If the addiction has stemmed from trauma – perhaps a past event, an accident or a mental health issue, they may be unable to break out of the addiction on their own, and more support will be needed.
For many, it’s not as easy as stopping the habit. Addiction recovery takes time, patience and a lot of support from loved ones. The person will need to take the steps to understand what may have caused the addiction and learn how to not only overcome it but manage their feelings for the future.
Addiction treatment, such as counselling, is crucial for helping people recognise the problem and take the steps to recovery.
What is the difference between habit and addiction?
An addiction is defined as a habit that has become out of control, to the extent that the individual is dependent on it for coping with everyday life. Addictions typically have negative effects on the person’s emotional well-being and physical health, while also affecting those around them.
The psychological link, in particular, is what separates addition from habit. A habit is something people may do for fun, to relax or as a way of socialising. People can choose to stop a habit, and while it may take some time, can stop successfully. Addiction, however, can be an overwhelming need or compulsion to complete the act regularly, regardless of the time or place, in order to achieve the high. In short, a habit can be controlled, while an addiction cannot.
Getting help for addiction
In some cases, the harm of addiction may only be recognised when the individual in question experiences a crisis – either as a result of a major life consequence or when the addictive substance or behaviour is suddenly unavailable. This is typically what motivates individuals to seek help, but there are those who will be able to kick-start their recovery long before the problem reaches crisis point.
While some people are able to recover from an addiction without help, many people will require support in the form of specialised addiction treatment. Generally, the earlier the person receives treatment, the more successful the recovery process will be.
The first step in seeking help for addiction is usually to speak to someone about how you’re feeling. If you are the person with an addiction, you may not feel comfortable speaking to friends or family, but know that there are many other resources available to you.
You may also want to consider visiting your doctor, who can answer any questions you may have about your addiction, and explain the next steps you can take.
There are several treatments said to be effective in helping people overcome their addictions. But of course, everyone is different, so treatments are tailored to the individual and their particular addiction. Typically, addiction treatment is a combination of medication and talking therapies, which are designed to promote abstinence and help individuals manage both the physical and emotional consequences of the addiction.
Treatment may also involve aftercare support in the form of self-help groups and regular check-ups, which are designed to help people cope with life after recovery and manage potential triggers.
Addiction counselling
Cognitive behavioural therapy (CBT) is common in addiction counselling as it helps individuals to identify problematic behaviours and change them into positives. CBT also helps to address any underlying problems that often co-occur with an addiction. This is important in helping the individual understand the cause and take the steps in overcoming and coping with their issues.
Essentially, by interrupting the cycle of addiction, counselling provides a new way for people with addictions to think, feel and act – removing the troubled thinking and helping them to view difficult situations in a new light.
Dialectical behavioural therapy (DBT) is a type of talking treatment based on CBT that has been adapted to help people who experience emotions very intensely. The goal of DBT is to help people learn to manage difficult emotions, by allowing them to experience, recognise and accept them. While mainly used to treat issues associated with borderline personality disorder (BPD), it is becoming more widely used to treat a number of different concerns.
Counsellor Claire Sainsbury explains more about dialectical behavioural therapy:
“The goal of DBT is to help people have increasing control over their thoughts, feelings and behaviours. Unhealthy thinking patterns can easily overwhelm someone who is battling an addiction of some sort, to the extent that they become overwhelming and over-powerful, influencing a person’s feelings and behavioural urges.
“So DBT includes the practice of mindfulness, to help you learn how to ‘quieten’ your mind and to have more control over what happens as a result of a ‘thought.’ If you can learn the skill of ‘noticing’ what thoughts you are having as if you are separate from your thoughts, then you might be able to have greater choice over what happens next.”
Spotting the signs of an addiction
There are many signs of an addiction. While these may vary depending on the substance or activity, every addiction has the capacity to greatly impact self-esteem and confidence – inducing troublesome feelings such as shame, guilt, a sense of hopelessness and failure. Everyone is different and some people may be better at hiding their addiction, or they may not be aware it has become a problem, but certain behaviour changes can indicate a problem.
Common behaviours and signs of a possible addiction include:
- withdrawing from social activities or neglecting relationships
- borrowing money or selling possessions in order to fund their addiction
- attempting to hide or lie about the habit
- exhibiting frequent mood swings
- missing work, school or social events
- losing interest in activities or hobbies they previously enjoyed
However, with addictions being so varied – from gambling to drug abuse – signs of an addiction can be more or less obvious in people.
Worried about a friend?
If you’re worried about someone you know, support is available. It’s difficult to know if someone has a problem – not all addictions are easy to detect and often, people will try to hide their behaviour from friends and family.
Remember that there are ways you can help them, as well as helping yourself. Coping with a loved one who is suffering can be overwhelming, and can put a lot of tension on your relationship, but be supportive and let them know you are there to help them.
Anxiety is used to describe feelings of worry, fear and unease. Typically, it incorporates both the emotional and physical sensations we experience when worried or nervous.
We will all experience feelings of anxiety, and it’s very common to feel tense or unsure about a potentially stressful situation, such as an exam, starting a new job, or moving home. However, some of us will be affected more than others. Despite being a normal experience, if these feelings are very strong or are lasting a long time, they can be overwhelming.
What is anxiety?
Anxiety can make you imagine things are worse than they are and prevent you from carrying out everyday tasks or even leaving the house. Whereas stress is something that will come and go, anxiety can affect a person even if the cause is unclear.
When under stress, our ‘fight or flight’ response will turn on. This acts as an internal alarm system, designed to protect us from danger in the wild. These days, we can recognise this system through the ‘butterflies in the stomach’ we feel when we’re nervous. Anxiety, however, may cause this response to be activated at inappropriate moments. You may feel this during normal, non-threatening situations.
Anxiety symptoms
While feeling anxious is a natural response, suffering from anxiety long-term can be very intense. Anxiety will affect people differently, however, there are common symptoms:
- rapid and/or irregular heartbeat
- fast breathing
- sweating
- nausea
- dizziness
- trouble sleeping
- feeling irritable
- lack of concentration
- panic attacks
Some people will know what causes their anxiety, but not always. After experiencing a traumatic event, for example, you may not have such an identifiable reason. Not knowing the cause of anxiety can often cause further distress – if we don’t know the trigger, how can we overcome it?
Anxiety disorders
There are several types of anxiety disorder – we’ve listed some of the most common ones here. For more information about each one, click the links below for specific help and advice.
Generalised anxiety disorder
If you often feel anxious or fearful, but not anxious about a specific event or experience, you may be diagnosed with GAD. Typically, these feelings are related to everyday tasks, such as stress at home or work, but other times you may not know why you’re feeling anxious.
Panic disorder
If you experience seemingly unpredictable panic attacks and are unable to identify a trigger, you may be diagnosed with panic disorder. Symptoms include shortness of breath, feeling faint and trembling.
Post-traumatic stress disorder (PTSD)
After experiencing or witnessing a traumatic event, and experiencing flashbacks or nightmares, you may be diagnosed with PTSD. These reactions can make you feel like you’re reliving the fear and anxiety over and over again.
Phobia
A phobia is an intense fear of something – no matter how dangerous or threatening it may be to you. Coming into close contact with the feared situation may cause you to feel anxious. In some cases, even the thought of said situation can trigger anxiety.
Social anxiety
Social anxiety is one example of a phobia. Some people experience this as butterflies in the stomach before a social occasion. But, for others, it’s a crippling fear of even leaving the house.
Obsessive-compulsive disorder (OCD)
OCD comprises obsessional thoughts followed by compulsive urges. Obsessions are recurring urges, thoughts or images that can cause you to feel anxious. Compulsions are the actions or thoughts that you feel the need to do or repeat. Compulsions are typically a response to ease the anxiety of an obsession.
Health anxiety
Health anxiety is a condition that is often linked with OCD and phobias. Those affected by health anxiety have an obsessional preoccupation with the idea that they are currently (or will be) experiencing a physical illness.
It’s very common to experience anxiety alongside other mental health conditions. For instance, you may be experiencing depression and anxiety at the same time. If this is the case, you may be given a mixed diagnosis.
Eco-anxiety
Eco-anxiety is a relatively new term used to describe intense worry about climate change. For some, thinking about the future of our planet takes up a lot of headspace, causing anxiety and even depression. A survey carried out for the Recycling Partnership revealed that 96% of respondents are worried about climate change, with one in four saying it was their biggest fear.
If you think you have eco-anxiety, you may benefit from talking therapies like cognitive behavioural therapy. It can also help to think about what positive change you can make to your lifestyle to reduce your impact on the planet. This may include reducing your meat intake or avoiding single-use plastic. There are many ways we can all make a difference.
Anxiety in children
Children have worries and anxieties, just as adults do. Some children are more prone to worries and anxiety than others – only you know what is normal behaviour for your child.
When is the right time to seek help?
Anxiety is a problem that can get worse if the stressors continue to build up. People may feel ashamed to ask for help or believe that it’s not ‘that big a problem’, thus covering their feelings and dealing with it alone. It’s important to know that you deserve support and, as lonely as you feel, people care.
If you’re not comfortable talking to a loved one, there are many other platforms available. Online support groups and anxiety counselling give you the opportunity to talk to people who understand you.
Treatment for anxiety
If you are experiencing anxiety, it’s important that you contact your doctor. They can assess your feelings and symptoms, and discuss a suitable treatment option. Anxiety treatment aims to reduce symptoms and teach you coping methods – so that you can manage feelings before they become too severe.
There are many treatment options available, though which one/s your GP offers will depend on your diagnosis. According to the National Institute for Health and Care Excellence (NICE), you should be offered a talking treatment before prescribing medication.
Anxiety counselling
Counselling for anxiety is one form of treatment. Talking to a counsellor can help in many ways, including helping you understand what may be causing your anxiety, and teaching you coping techniques. There are many types of talking therapies available, though the most commonly prescribed is cognitive behavioural therapy (CBT).
Cognitive behavioural therapy aims to help you manage problems by enabling you to recognise how your thoughts affect both your feeling and behaviour. CBT combines two approaches; examining your thoughts and the way you behave. This helps to break any overwhelming problems down into smaller, more manageable tasks.
Tips for managing anxiety
Self-care goes hand in hand with looking after your mental health. Learning techniques and methods to help you manage your anxiety can really make a difference. It’s important to not let the fear of your anxiety rule your life and having some self-care methods in place can help you cope with symptoms.
Talk to someone
Talking to someone you trust can ease the pressure and will often give you a sense of relief. It’s easy to keep our feelings to ourselves, but talking to a friend, family member or even a professional can be so beneficial. Whether they can offer advice or simply listen, talking to someone can remind you that people care – even when it feels like you’re on your own.
Focus on your breathing
When feeling anxious or the onset of a panic attack, it’s easy to forget simple things, like breathing. But taking a moment to focus solely on your breath can calm you and help you manage the anxiety
Keep a diary
Recording your feelings and what happens every time you feel anxious can help you become more aware of your triggers. Recording when, what, and how the anxiety attacks come on can help you understand how to cope with future situations. Be sure to record successfully managed experiences with your anxiety too, this can act as a reminder that you are in control.
Practice mindfulness
Mindfulness exercises for anxiety can help you manage symptoms. The aim of mindfulness is to develop your awareness of the present moment. It can teach you to be more appreciative, self-compassionate and non-judgemental. Mindfulness can help you gain greater clarity on your surroundings, which can help you recognise what triggers your anxiety and how to deal with them effectively.
Stimulate your vagus nerve
This nerve is part of our rest and digest system and, when we stimulate it, it can help to reduce stress and anxiety. There are several ways we can stimulate this nerve, including exposing ourselves to something cold, self-massage and even singing. Counsellor Fiona Austin explains more in her article, The vagus nerve – our biological antidote to anxiety and stress.
Stay active and eat healthily
Coffee, alcohol and cigarettes are stimulants and may cause you to feel worse, or make it difficult for you to relax. Staying active and moving your body may help you manage your anxiety as it’s an opportunity to release any stress and refocus. You don’t have to follow a strict diet or a tough workout regime, but eating healthy foods and staying active can improve overall well-being.
Consider holistic therapies
Complementary therapies such as yoga, meditation, massage and aromatherapy focus on relaxation. There are many therapies available, so if you find it difficult to relax on your own, see if one of these works for you. Improving relaxation can also improve sleep, and help you manage your symptoms more effectively.
Join a support group
Joining a support group – either online or face-to-face – can give you the opportunity to talk to people who share similar experiences. Talking about the challenges you face and sharing what you’re going through can remind you that you’re not alone, and help is available.
What should I be looking for in a therapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat anxiety. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments.
In the first instance, those suffering from anxiety should be offered access to a support group and self-help information recommendations by their doctor. If this doesn’t help, or the anxiety is more severe, psychological treatments such as cognitive behavioural therapy and/or applied relaxation are recommended. Further treatment may require medication.
If you have experienced the death of someone who was important to you, you might be finding it difficult to adjust to the changes happening in your life right now. Grief can shake everything up – your beliefs, your routines, and even your sense of normality. Counselling aims to help people find a place for their loss so they can carry on with life and eventually find acceptance.
What is bereavement?
Bereavement is the time we spend adjusting to loss. There is no right or wrong way to feel during the bereavement period – everyone copes in their own way. Grief, although normal, can manifest in unexpected ways. Some people get angry, some people withdraw into themselves and some people become completely numb. Sometimes, grief can trigger mental health conditions, like depression.
Bereavement is accepting what happened, learning to adjust to life without that person, and finding a place to keep their memory alive while you try to get along as best you can.
The stages of grief
This can be a confusing time involving a lot of powerful emotions. These emotions can grow, fade and shift as we move across the different stages of bereavement. Not everyone experiences the same stages of bereavement at the same time or in the same order, though most people generally go through the following four stages at some point:
- accepting that your loss really happened
- experiencing the pain that comes with grief
- trying to adjust to life without the person who died
- putting less energy into your grief, finding a new place to put it and moving on
Most people go through all of these stages, but not everyone moves between them smoothly. Sometimes, people get stuck on one stage and find it difficult to move on. For others, grief may not surface until later on in life, such as finding out about a lost sibling — as in the case of womb twin survivors (for more information on womb twin survivors, watch our video by psychotherapist Lisa Bodenstein).
You may have heard of other models that take you through five or seven stages of grief. You may find that one model works better for you than another, and that’s OK. The important thing is to take your time to process your feelings in a way that feels right for you.
The importance of mourning
Mourning is an important part of bereavement, which allows us to find ways to explore our loss and express our grief. Mourning involves rituals like funerals, wakes and anniversary celebrations, which help to add structure to an otherwise chaotic and confusing time. Mourning allows us to say goodbye. Seeing the body, watching the burial, or scattering the ashes is a way of affirming what has happened.
As hard as it is, sometimes we need to see evidence that a person really has died before we can truly enter into the grieving process.
Bereavement counselling
Talking about the loss often allows a person to adjust to their new life with all its changes – good and bad. Keeping things bottled up or denying the sadness could prolong the pain. Any loss has to be acknowledged for us to move forward.
Bereavement counselling is designed to help people move through the stages of grief and learn how to cope with the death of a loved one. Counselling aims to get you to the point where you can function normally – however long it takes. You will probably never stop missing the person you lost, but with enough time and the right support, a new life can be pieced together and purpose can be reclaimed.
Specifically, counselling for grief and bereavement can:
- offer an understanding of the mourning process
- explore areas that could potentially prevent you from moving on
- help resolve areas of conflict still remaining
- help you to adjust to a new sense of self
- address possible issues of depression or suicidal thoughts
How to deal with grief
Many people compare their grief to waves rolling onto a beach. Sometimes those waves are calm and gentle, and sometimes they are so big and powerful that they knock you off your feet completely. Sometimes, the wave of grief can be so powerful that it leads to:
- not wanting or feeling able to get out of bed
- neglecting yourself – not taking care of your hygiene or appearance
- not eating properly
- the feeling that you can’t carry on living without the person you’ve lost
- not feeling able to go to work
- taking your feelings out on other people
All of these reactions are normal parts of bereavement – unless they go on for a very long time. If you feel like you are no longer coping with grief very well or are recognising the following behaviours, you may need some extra help:
- you are beginning to drink a lot
- you are tempted to or starting to take illegal drugs
- you are having suicidal thoughts
- you are acting recklessly
- you are starting to behave violently
- you are withdrawing yourself from people or isolating yourself
How to tell if grief has become depression
Unlike depression, grief is not considered a mental health condition. Sorrow, anger, confusion and emptiness are natural reactions to death. However, when these low feelings last for a very long time, it may be worth seeking additional support.
Of course, there is no ‘normal’ length of time for bereavement. Loss stays under the surface of our lives and continues to permeate long after it first happened. Sometimes all it takes is a certain date, a place, or a song, for all of that grief to come surging back.
So, how do you know if grief has become depression? Grief and depression share a number of symptoms, including sadness, insomnia and change in eating habits. One of the main differences between grief and depression, however, is that grief comes in waves while depression is like a cloud that hangs over everything.
Sometimes, a grieving person is able to forget their sadness for certain lengths of time – perhaps when concentrating on something, perhaps when surrounded by people who make them feel happy. Grief is often triggered by something – a smell, a sudden memory – while depression is pervasive, cutting through everything.
If you think you, or someone close to you, is suffering from depression, it’s important to find support as soon as possible. Visit our depression fact-sheet for more information.
Disenfranchised grief
Loss and bereavement come in many shapes and forms. Some sources talk of over 20 different types of loss and reasons for grief from anticipatory (such as the death of an elderly relative) to collective (such as the grief of a nation following war or a natural disaster).
As Claire Kerby MBACP explains in her article, Bereavement doesn’t need a death, ‘disenfranchised grief’ was a term developed by American grief researcher Kenneth Doka in the 1980s. He described disenfranchised grief as, “Grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, socially sanctioned or publicly mourned”.
Disenfranchised grief can be experienced when a person is made to feel that their loss is invalidated or insignificant as a result of cultural or societal attitudes. This can occur when the circumstance of the death is stigmatised (death by suicide, overdose, HIV/AIDS, drunk driving), the relationship is seen as insignificant (an ex-spouse, co-worker, miscarriage, or a pet), or when the loss experienced is not a death (dementia, divorce, substance misuse).
Here, we will explore two common types of disenfranchised grief.
Pet bereavement
As with any bereavement, the death of a pet can be a devastating loss. To some, the pet may have become a member of the family; a companion, a friend. And, in this case, it’s normal to have the same reaction as you would with the death of a person, such as feelings of shock, anger, pain or grief.
It can sometimes be hard for others to recognise the extent to which the loss of a dog, cat or another beloved pet may affect someone. But, it’s important for you to process your feelings and allow yourself to grieve – there is no right or wrong way to feel.
Give yourself time to grieve and remember your pet in whichever way helps. You may benefit from writing your memories down, looking at photos or watching videos of your pet. It’s also helpful to have someone to talk to who understands how you’re feeling and what the loss of your pet has meant to you. This is something that a counsellor can help with.
Suicide grief
All loss is devastating. However, grief after suicide can be a particularly complex process. Family and friends left behind when someone dies by suicide often experience confusing feelings. Self-directed anger and guilt are natural reactions. It’s easy to start blaming yourself and wondering if you could have done something to help. It’s also natural to feel angry at the person themselves, asking why didn’t they tell you how they were feeling?
While we will all process grief in different ways, there are typically thought to be three common stages of grief after suicide.
1. Numbness or shock
At first, you might feel like you’ve stepped into a slightly different dimension. Everything will feel different and it’s possible that you’ll even want to distance yourself from others to avoid facing what’s happened.
2. Disorganisation
Eventually, you will come to a point where you’ll be ready to address what’s happened. You might feel lonely and deeply sad at this point. People often have trouble eating, sleeping and functioning normally. It’s during this stage that people tend to go over the days leading up to their loved one’s suicide, agonising over what they could have done and why it happened.
3. Reorganisation
Over time the initial shock and horror of the situation will begin to fade as your loss becomes a part of your life. You will begin to get back into the day-to-day swing of things and soon you will be able to focus on other things in your life.
Whatever the circumstances, know that one day, it is possible for you to find happiness again. By creating a place to keep the person you lost, and finding ways to remember them (like anniversary celebrations, or leaving flowers at a memorial site), you should be able to preserve their memory and honour the impact they had on your life, without letting their absence obscure your own future. With time, pain does settle.
We all have times when we feel sad, but depression is something that affects your daily life, making it hard to find enjoyment in day-to-day activities. We take a look at what depression is, its causes, and how counselling/therapy can help.
What is depression?
Depression is a mood disorder that can take many forms: some days you may find it impossible to get out of bed, while other days you may feel more able to go about your normal daily tasks. Living with depression can be incredibly difficult, both for those suffering and those around them. Due to the nature of the condition, however, seeking help can often be delayed.
Do I have depression?
For some, an obstacle to them seeking help is understanding whether or not they actually have depression. Before we go into the symptoms of depression, it’s important to point out that if you are struggling with your emotions and feel unable to cope, it could be worth seeking support. You are worthy of help, no matter how trivial you may perceive your problems to be.
What does depression feel like?
If you have depression, you are likely to have at least five of the following symptoms.
You may feel:
- worthless
- like life isn’t worth living
- constantly anxious, tearful and worried
- like you can’t concentrate
- indecisive
- irritable and intolerant of others
- you are not getting enough enjoyment out of life
- you have a lack of self-esteem
- you have excessive and inappropriate guilt
- you have no motivation or interest in things you used to enjoy
You may experience:
- changes in sleeping patterns – broken nights or oversleeping
- changes in eating patterns – loss of appetite or overeating
- tiredness and a loss of energy
- persistent headaches and/or stomach upsets
- chronic pain
- a slower speaking pattern than usual
- loss of libido
- changes to the menstrual cycle
You may also:
- neglect hobbies and interests
- isolate yourself from friends and family
- take part in fewer social activities
- notice your productivity falling at work
In some circumstances, you might not even notice that you have developed depression, especially if it has been a gradual process over several weeks or months. Sometimes it takes a friend, a family member or a partner to point out that you may have a problem.
Why do we become depressed?
Sometimes it’s instantly apparent what the cause is, but other times there isn’t an obvious reason why you feel so down. It could be that you’ve lost something or someone, or it could stem from disappointment or frustration. Usually, there will be more than one reason why you suffer from depression, and these reasons differ from person to person.
Common reasons behind the development of depression include:
Distressing life events
Distressing life events can take their toll on us. Divorce, family problems or losing a job are all momentous in our lives that can alter our mood.
Bereavement
Losing someone close to you can increase the risk. It’s not always just the loss that causes depression, it’s the way we deal with it. If you don’t grieve or express your feelings properly, they can build up and contribute to depression.
Childhood experiences
Your childhood experiences can affect you in adult life. If you were physically or emotionally abused, or not taught to cope with troubles that enter your life, it could lead you to have problems as you grow up.
Anger
‘Frozen anger’ is a term that’s closely related to depression. You may have gone through something that caused you to become angry, but at the time you couldn’t express your feelings properly. This type of anger becomes suppressed; it can then build up and become a cause of depression.
Circumstances
Feeling like you’re alone, stressed, physically exhausted and/or have no one to talk to can all contribute to the condition.
Alcohol
Regular heavy drinking can make you more susceptible to developing depression.
Physical illness
Some types of physical illness can make people more prone to depression:
- hormonal problems, e.g. an underactive thyroid
- viral infections, e.g. glandular fever or flu (prevalent in younger people)
- painful or lasting illnesses, e.g. arthritis
- life-threatening conditions, e.g. heart disease and cancer
- chronic conditions, e.g. diabetes and epilepsy
Types of depression
There are several different forms of depression, including:
Mild depression – When depression symptoms have a limited impact on daily life. Generally, sufferers of mild depression will experience a persistent low mood and spirit. They may find it difficult to motivate themselves to do things they normally enjoy.
Major (clinical) depression – A more severe form that can lead to hospital admission. Symptoms will be more prominent and interfere with daily life. They can affect eating habits, sleeping, and other day-to-day activities. Some sufferers may feel suicidal and that life is no longer worth living.
Bipolar disorder – A form of manic depression characterised by extreme highs and lows. For example, a period of hyperactivity where sufferers are excited and planning overambitious tasks is followed by a period of severe depression.
Seasonal affective disorder (SAD) – A form that’s closely related to the length of days. It typically occurs in the autumn and winter months when the days are shorter. Symptoms tend to alleviate when the days get brighter and longer.
Postnatal depression – A condition that can develop in anyone who gives birth or their partner following childbirth.
When to get help for depression
If you experience depression symptoms for most of the day, every day, for more than two weeks, you should seek help from your GP. If your feelings start affecting many parts of your life, this is a sign you may need professional support. The parts of your life that depression can have a negative impact on include, but are not limited to:
- relationships
- work
- interests
- an overall sense of happiness and enjoyment
Thoughts of suicide and self-harm are also warning signs that your condition is getting worse. If you experience these, you should look to seek professional support.
For many, being treated for depression can seem an impossible task, but the sooner help is sought the better. In some cases, the illness can disappear without treatment. This is not always the case however and there is a danger that living with the condition will put significant emotional and physical strain on your health and well-being. Therefore, many people with depression opt for treatment.
In the initial stages, your GP will look to diagnose the condition by conducting tests to rule out other health problems such as an underactive thyroid. They will then ask various questions about your general health and how your feelings are affecting your mental and physical well-being. From here, the appropriate treatment options will be pursued. These will depend on the nature of depression and your personal circumstances.
Depression treatment and support
Speaking to a professional, whether that’s your GP or a counsellor, can help you understand what you need. This can range from self-help tips and breathing exercises, to psychotherapy and/or medication. Everyone is different and will need differing levels of support.
Depression is a treatable condition, even in its most severe form. A range of treatment options should be provided. The two most common forms offered are counselling and medication. These are often used in combination – particularly in more severe cases.
Depression counselling
Depression counselling is often recommended as a combination treatment plan. Talking therapy can help you identify, address and manage negative, self-defeating thoughts that may affect the way you behave with depression. The following types of counselling and psychotherapy have been proven effective in treating depression:
Cognitive behavioural therapy (CBT)
According to guidelines issued by the National Institute for Health and Care Excellence (NICE), cognitive behavioural therapy is among the recommended therapies for treating depression. This therapy is based on the premise that the way we behave and think affects the way we feel. People with depression tend to have self-defeating thoughts that can lead to negative behaviour. CBT aims to help sufferers identify and address their negative thoughts and their unhelpful behaviour patterns.
Counselling for Depression (CfD)
CfD is a model of psychological therapy recommended by NICE for the treatment of depression and approved for delivery within the Improving Access to Psychological Therapies Programme (IAPT). Counselling for Depression is one of the therapies recommended in addition to CBT.
Mindfulness-based cognitive therapy (MBCT)
This type of talking therapy is specifically designed to help those who suffer from recurring depression. Mindfulness-based cognitive therapy combines elements of cognitive therapy and mindfulness techniques (breathing exercises and meditation) to help break or change your relationship with negative thought patterns.
Interpersonal therapy (IPT)
Interpersonal therapy focuses on how our mental health affects our relationships and how our relationships affect us. The thinking behind it is that psychological symptoms, such as depression, are typically a response to the difficulty in our communication with others. The symptoms gained from this can also cause communication to deteriorate, thus causing a cycle. IPT works best with those who have identifiable problems.
Psychodynamic therapy
Psychodynamic therapy aims to find out how a person’s unconscious thoughts affect their behaviour. This type of therapy can help individuals understand and unravel their deep-rooted feelings and experiences.
Group therapy
Although the term ‘group therapy’ can be applied to many talking therapies, it’s mainly used with those that work best within a group dynamic. One of the main benefits of this type of therapy is the support network of peers going through the same sort of issues. It aims to encourage you to share your experiences and work on understanding yourself better.
Art therapy
Art therapy uses artistic mediums to help individuals explore their emotions in a new way. It uses art as a form of communication – this is especially good for those who find it difficult to verbalise their feelings.
Medication
Alongside counselling, medication may be prescribed by GPs to help sufferers who are experiencing moderate to severe depression. Antidepressants can help to ease common depression symptoms such as poor sleep, low mood, and poor concentration. They can help sufferers function better and even increase their ability to deal with difficult situations if they arise.
Such medication, however, is not effective for everybody and does not tackle the root cause alone. This is why counselling for depression is recommended in combination with medical intervention.
The important thing to remember is that you have options. Support is available and it won’t always be this way. You are not alone in this.
We all start life with a family, whether that family is blood relatives, adopted parents, or a foster family. Our families influence almost every aspect of our lives, from our first moments to our last. Families go through lots of changes throughout life, so it’s normal to experience some problems. Counselling can help you overcome these difficult times.
Will counselling help my family?
Counselling can help establish the events that have led to the family needing help. These might include life events, transitions or repeating patterns. Family problems might be mapped out to show their history and development and allow members to feel clearer about the problems and how they might have arisen, reducing blame.
There should also be an opportunity to define the relationships, as people see themselves and as others do. This can lead to greater awareness and insight to allow any necessary changes. It can also offer the opportunity to see the abilities and difficulties that are available within the family group for dealing with problems and change and how they might be used.
Counselling might clarify a new pattern of being together after a marital breakdown or remarriage. It can also help to process feelings of being excluded or rejected, such as being misunderstood, which might otherwise be acted out in disruptive behaviour. Communication might be repaired or established for the first time and family members may feel supported and encouraged to manage changes.
What does it mean to be a family?
We often think of families as people who are always there to support one another and, whilst they can be, for the majority of people, family life isn’t always perfect. Problems may not always be present but issues can arise from time to time.
Family dynamics
Our family dynamics change considerably over the course of our lifetimes. Birth, death, marriage, divorce – there are many types of transitions that families go through together. And each family is unique, even within its own culture. Every family has its own beliefs and values and, within each family, there may be differences of opinions about a wide range of issues.
Factors in our lives can affect our family relationships and, equally, our family relationships can impact the rest of our lives. Our families absorb many of the stresses and strains from the outside world – and the pressures can sometimes boil over. Personal problems can overwhelm a family, so much so that it can feel as though there is no clear way forward. Other times, changes within the family leave other members confused, angry or hurt.
Particularly as children, we spend so much time with our families, and these people have an undoubted impact on what makes us who we are; we develop our expectations of others, communication skills, outlook on life, as well as many other traits from our families. As a result of the impact our family lives have on us as people, it’s important to try to resolve problems within family life, to prevent ongoing issues.
What are family problems?
Families can be a source of support, encouragement and love but, sometimes, relationships within families are put under strain. Perhaps you’re a parent worried about your child’s behaviour or how a divorce may impact your family. You might be part of a stepfamily and need help adjusting, or you may be arguing with parents or siblings and need support communicating with each other.
Every family is different but many face similar issues. Common problems include:
- disruption as a result of separation or divorce
- problems with stepfamily life or when a new partner moves in
- money problems such as debt or redundancy
- changes in family structure, as the result of a bereavement or illness
- problem behaviour with adolescents or older children
- children leaving home
- unwanted pregnancy
It’s important to remember that there may be a number of issues that are causing family problems, and it may not be possible to ‘fix’ any of the issues. What we can do, however, is adjust our attitude to what is happening and try to find solutions to make problems easier to deal with.
Parenting issues
Parents often seek counselling because they are struggling with a child who is displaying a lot of emotional angst. For young children, feelings of sadness, disappointment, frustration, confusion and anger can feel overpowering and all-consuming.
If your child’s behaviour has changed, consider what else is happening in their life – is there anything that may have triggered their distress? Situations like moving house, divorce, bullying and bereavement can affect a child greatly, and stress can build when they don’t know how to cope.
Particularly as children get older and enter their teenage years, further problems can start to arise. And, given that 75% of mental illnesses are established by the time we turn 25, supporting young people’s mental health as they enter adolescence – a peak period of change in their lives – could make the world of difference in their long-term health.
Stepfamilies
To reach the point of the stepfamily, there has often already been a degree of change and potential emotional strain on your family. Whatever the reason parents decide to separate, it can take its toll on the family life.
If you are a stepparent, you may find it difficult to fit into an existing family dynamic. For many reasons, it can be hard to strike a connection with stepchildren. It is important to recognise that stepfamilies can present challenges from the start and that this is natural. It takes time to develop and consolidate as a family group.
Ageing parents
As our parents grow older, the relationship tends to shift towards us becoming their carers and feeling responsible for their well-being. Depending on circumstances, you may find yourself faced with numerous dilemmas relating to finances and healthcare, which can greatly impact your own well-being.
The need to make difficult decisions can cause conflict among siblings and this can impact other members of the family, such as your partner or children. You may also find yourself asking questions about your own mortality and attitude toward death.
Overcoming issues as a family
Sometimes it can feel difficult to deal with certain issues, particularly if relationships are strained within the family. But, although it’s hard, it can be useful to talk these things through with someone you trust – your partner, a family member or a close friend. Talking about the challenges you are facing as a family can allow you to understand and address problems.
In some cases, it can be beneficial to seek professional help. Speaking to a counsellor regularly for a matter of weeks or months can help you get a more comprehensive understanding of what you’re feeling and where it’s coming from.
What is family counselling?
Family counselling, also known as systemic therapy, is an approach that works with families to encourage conversation and communicate better with each other, in order to resolve issues. Issues which might be explored may relate to one incident or a repeated pattern of behaviour.
Depending on the therapist, family therapy can include techniques from various approaches, such as cognitive behavioural therapy, solution-focused therapy and person-centred therapy, and considers the thoughts of all family members. This is to clarify what the problems are and focus on solutions, rather than delving into the origins of the problems. This can help with self-reflection for the individuals and increase self-awareness of the family as a whole.
Family therapy can also help to identify and address issues around the roles within the family; those that are assigned to individuals and how they can work with others. It is common for these roles to have been ‘assigned’ without intent, and depending on the role held, this can result in various issues within the family and individual relationships.
Family counselling is flexible because every family is unique. The goal is to help families build stronger relationships, but this will mean different things to different families, as we all have unique challenges. Ultimately, the aim is for families to enjoy being together and to face life’s challenges as a team.
A family counsellor maintains neutrality at all times, to establish a platform free from blame. This allows members to explore the problem and then express their concerns for the family’s ability to change.
How does family counselling work?
Your counsellor will collect the views and thoughts of members of the family through questions, mainly about the differences that exist among the individuals. Family members are then invited to be observers, too, of the questions answered by other members and of their own behaviours and assumptions. The trained family counsellor offers the group an opportunity to think and reflect on the present situation with a view to moving towards a better way of being together.
An assessment can be difficult due to the different natures of family dynamics – defining where the problem is can mean something different to each member of the family. One person might be blamed and they, in turn, may blame someone else. If this issue gets stuck, these two members might work together for a couple of sessions.
The interconnected set of relationships within the family is central to this type of counselling. The logistics of getting all members along to participate in counselling can pose difficulties, but it can be a satisfying and rewarding means to establish a new and healthier way of relating.
Not all members have to attend every session; couples counselling, youth work or individual counselling may follow and the family may meet later to discuss changes.
Feeling down? You’re not alone. Everyone feels sad or experiences a low mood at times. Sadness is a natural human emotion and, like other emotions, sad feelings come and go; they’re normal reactions to the twists and turns of life. How sad or low you feel can depend on the situation that’s causing the sadness, and how you’re coping with it. Some sad feelings are brief, while others last much longer.
Why do I feel so sad?
People feel sad and can have a low mood for a variety of reasons – everyone is different and will deal with life events in their own way. Sadness can be triggered by an argument with a relative, a breakup, or a close friend moving to another city. You might feel disappointed about your performance at work or school, or feel discouraged if your favourite sports team can’t break its losing streak.
Sadness is sometimes circumstantial. Your feelings may be triggered by the seasons, as a result of the weather and daylight. If this sounds familiar, you may be suffering from seasonal affective disorder (SAD). Or, your sadness may have been triggered by distressing events in your life that are out of your control, such as losing a loved one. This can lead to a specific kind of sadness, grief.
It’s also possible that more than one thing is causing you to feel sad; it may be a combination of any one of the above factors, plus many more.
Feeling sad or low for no reason
It’s important to try and figure out what is causing you to feel this way. Try and notice how you feel, when, and why. But, if you can’t figure out the reason, it can be hard to take control of your feelings and overcome them.
There isn’t always an easy explanation for why you’re feeling sad or can’t seem to overcome a low mood. Sometimes it might feel like there’s no apparent reason for why you feel this way. This might be a result of biological factors and natural changes in your body, such as hormones, which can also trigger sadness.
Feeling sad or low all the time
It’s normal to feel down sometimes, but, if sad thoughts or a persistent low mood are stopping you from enjoying life, then something needs to change.
The difference between feeling sad and depression
People sometimes say they’re feeling depressed when they’re having a bad day. But depression is a mental health condition that affects sufferers every day for long periods of time. This is a key difference between feeling sad and having depression – sadness comes and goes with relative speed and ease. Depression is constant and oppressive.
A low mood that doesn’t go away can be a sign of depression, but there are also many other possible symptoms. Ask yourself if the following are true for you:
- low mood lasting for several weeks (two weeks or more)
- getting no enjoyment out of life, or feeling hopeless
- sleeping more than usual, or being unable to sleep – which makes you feel tired or lacking in energy
- unable to concentrate on everyday activities, like reading or watching television
- comfort eating or loss of appetite
- having suicidal thoughts or thoughts about harming yourself
Having meetings with a counsellor or therapist can help to overcome feelings of sadness or depression, and resolve underlying issues to prevent you from feeling like this in the future.
Talking to a professional can help you to:
- understand your emotions, by putting your feelings into words
- feel understood and supported
- build your confidence and self-esteem, to become more self-accepting
- work out the problems that you face
- change negative thinking patterns
There are many types of talking therapies, which have been proven as effective treatments for feeling sad and/or low mood. Therapies such as cognitive behavioural therapy (CBT) can help you to make sense of what can feel like an overwhelming problem, by breaking it down into more manageable parts.
Overcoming depression itself might include counselling, therapy, medication, or a combination of different treatments. A counsellor might recommend daily exercise, exposure to daylight, or better ways of eating. A therapist might also teach relaxation skills to help someone get a good night’s sleep.
Remember, there is no one treatment that will work for everyone – people respond differently to different types of treatment, so what works for one person may not be the answer for you.
How to stop feeling sad and overcome low mood
It’s OK to have sad feelings at times – as long as they don’t happen too often or last too long. Remember, sad feelings, like all emotions, are just a natural part of life.
Most of the time, we can deal with these feelings and get past them with a little patience and time. But it doesn’t feel good to stay sad and it can lead to further problems if it continues for too long. So, try to remind yourself of a few key things:
You can cope and overcome feeling like this. You’re strong and each time you get over this, you become stronger and better at coping with your feelings. Learning how to deal with these feelings can make a huge difference in your life.
There are things you can do to help you feel better and improve your mood. Try not to isolate yourself – this can make your sadness worse and can also create a sense of loneliness. Put yourself in a good mood; surround yourself with people and things that you love and do things that you enjoy.
A positive attitude is the best way forward. Life is not always happy and everyone has times in their lives when sad things happen. Thinking about happy times ahead and focusing on the positives in your life can help you through. Count down to planned events and things that make you happy and bounce back from disappointments or failures as quickly as you can. Think positively – think of solutions to what’s causing you to feel sad. Focusing on positive emotions and being with positive people can help too.
Managing sadness or feelings of low mood at home
Practising some of the following simple actions can help you to feel better, and equip you with the knowledge of what can help in future.
- Eat healthy foods, getting the balance right between foods that are good for your body, and foods that are good for your soul.
- Get the right amount of sleep and keep it regular – don’t think that four hours of sleep will be enough in the week and then sleep all weekend.
- Walk, play, or do something else to get exercise every day. Exercise can help to improve your self-image, your health and your mood.
- Take time to relax – try and do things that you enjoy, whatever that is.
- Take time to notice the good things about life, no matter how small.
Trying even just one of these could have a powerful effect on your mood; restore positive emotions and a feeling of well-being.
Generalised anxiety disorder (also referred to as GAD) is a long-term condition that causes sufferers to feel anxious about a variety of situations/issues, rather than one specific situation.
What is generalised anxiety disorder?
Those with GAD will feel anxious most days and often catastrophise situations. For example, if their partner is late home from work, someone with GAD may think that they have been in an accident, rather than any other likely scenario (e.g. stuck in traffic).
Other characteristics of GAD include an inability to focus, loss of concentration and racing thoughts. If you have GAD, your day-to-day life will be affected by your anxiety, which may impact your sleeping habits, your relationships or even your ability to hold down a job. As soon as one issue has been resolved, another one will rear its head, making it difficult for you to feel relaxed and at ease.
The condition is persistent and there may be occasions when you don’t understand why you are feeling anxious. When it comes to diagnosing GAD, it can be difficult to differentiate those with GAD and those who have a naturally nervous disposition. As a rule, however, GAD is diagnosed if the symptoms of the condition are persistent and affect your day-to-day activities.
Who is affected?
GAD is considered a relatively common condition. According to the mental health charity Mind, in any given week in England, six in 100 people are diagnosed with GAD. While the NHS claims it affects more women than men, and is found to be more common in those aged 35-55.
What causes GAD?
The cause of GAD is largely unknown, although experts agree that there is likely to be a combination of factors at play. Research into the condition has revealed the following potential contributing factors:
- overactivity in the parts of the brain associated with behaviour and emotion
- an imbalance of mood-regulating brain chemicals serotonin and noradrenaline
- genetics – if you have a close relative with GAD, you are more likely to experience it
- suffering from a long-term health condition, such as arthritis or chronic fatigue
- a history of major stress or trauma can trigger the condition
- having a history of drug or alcohol misuse
While the situations listed above may contribute to the development of GAD, many people develop the condition for no apparent reason.
GAD symptoms
Generalised anxiety disorder causes both psychological and physical symptoms. The severity of the symptoms experienced will differ from person to person – one may feel all of the listed symptoms, while another feels just one or two. Regardless of how many of the symptoms you relate to – if your symptoms are causing you distress and are affecting your everyday life, you are advised to seek professional support.
Psychological symptoms
GAD usually causes a change in the way you behave as well as the way you think and feel about things. This can result in the following symptoms:
- a sense of dread
- feeling ‘on edge’
- feeling restless or unable to relax
- difficulty concentrating
- feeling irritable
- racing thoughts
- intrusive thoughts about worrying scenarios
These symptoms may cause you to avoid certain situations in order to prevent yourself from feeling anxious. This may see you withdrawing from your friends and family or from social contact altogether. Your symptoms may also make work difficult for you as it can trigger stress and anxiety, causing you to take time off. These actions can cause further worry and a low sense of self-esteem – continuing the cycle of anxiety.
Physical symptoms
Extreme anxiety can also lead to a number of physical symptoms, including the following:
- feeling lightheaded or dizzy
- feeling lethargic
- heart palpitations
- dry mouth
- muscle aches
- shortness of breath
- tension headaches
- digestive problems
- nausea
- difficulty sleeping/insomnia
These physical manifestations of anxiety can often cause further worry in those with GAD, perpetuating the ongoing feeling of unease. If you’re worried that your physical symptoms are not related to your anxiety disorder, please contact your GP.
While other anxiety disorders, like phobias, have a specific trigger for their symptoms – those with GAD may not be clear on what it is they feel anxious about. Not knowing your trigger for anxiety can intensify the feeling and may cause you to feel as if there is no way to stop feeling anxious.
Recognising that your anxiety is negatively affecting your life is the first step to seeking help. From here you can explore your treatment options.
Treatment for GAD
Generalised anxiety disorder is a difficult condition to live with and tends to weigh heavily on the sufferer’s mind. It can feel as if you get no respite from the symptoms, especially as the anxiety is not linked to a specific trigger. GAD can cause difficulties in your relationships, job and ultimately your well-being, so seeking support and treatment is highly recommended.
There are several different treatment options available to help ease symptoms, including self-help, psychological therapies and medication, such as a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs).
Speaking to your doctor will help to determine which avenue to explore further, and it is important to understand that no one treatment option is ‘right’. Every person is unique and will respond differently to the available treatments. For some people, it is a combination of approaches that work best for them – but, as you can see, there are several options available, so don’t lose heart if you try one and it doesn’t help.
Psychological therapies
If you haven’t found self-help options useful, you may benefit from therapy.
There are many different therapies available to those with generalised anxiety. The following have been found to be the most successful in clinical trials:
Cognitive behavioural therapy (CBT)
This form of therapy has been found to be incredibly helpful for a range of concerns, including anxiety. Studies into CBT’s effect on anxiety show that the benefits last longer than those of medication.
The aim of cognitive behavioural therapy is to help you to understand how your thoughts, feelings and behaviour affect each other. Having this clarity can help you to question negative and anxious thoughts, giving you the courage to do things you may ordinarily avoid as they make you anxious.
This therapy usually involves meeting with a qualified therapist on a regular basis (normally once a week) and often requires you to carry out ‘homework’ outside of your sessions.
Applied relaxation
Applied relaxation is an alternative form of therapy that has been found to be as effective as cognitive behavioural therapy in treating GAD. The technique of applied relaxation involves relaxing muscles in a particular way when you feel anxious and is best learnt through a trained therapist. They will teach you how to:
- relax your muscles
- relax your muscles quickly
- relax your muscles when you hear a trigger word (such as “relax”)
- relax your muscles when you begin to feel anxious
Problem-solving therapies
Some forms of counselling that are solution-focused can be useful for those with extreme anxiety. These therapies will help you devise coping strategies for when you feel anxious and can be a useful tool for reducing everyday symptoms.
Mindfulness
Mindfulness therapy is gaining steam and has been shown to help people with anxiety and depression. Helping you to focus on the here and now – rather than ruminating on past events or worrying about the future – mindfulness uses meditation and breathing techniques to help ground you in the present.
Group therapy
Some people with GAD may find it helpful to speak to others who have similar issues. Group therapy offers you the opportunity to receive treatment for your anxiety alongside fellow GAD sufferers. Facilitated by a trained therapist, these sessions encourage you to share your experiences while teaching you relaxation techniques and coping strategies.
Alternatively, you may find it useful to attend a support group. In contrast to group therapy, support groups are rarely facilitated by a trained therapist – they allow you to share your experiences with attendees and discover how others with the condition manage it.
Self-help
For many people dealing with anxiety, their first port of call is to try self-help methods. In some cases, this self-help is supported by a trained therapist with whom you speak on a regular basis.
There are many different books and courses available for those with anxiety, it is worth noting that the National Institute of Health and Care Excellence (NICE) currently only recommends trying self-help treatments based on the principles of cognitive behavioural therapy (CBT).
Tips for dealing with anxiety
As well as the above treatments for anxiety, there are some things you can do yourself to help ease symptoms of GAD, mostly to do with self-care. Try the following tips during your treatments to give yourself the best possible chance of overcoming your anxiety:
1. Exercise regularly
Regular exercise has a variety of benefits for both your physical and mental health. Research shows that regular aerobic exercise can help to release tension and encourages the brain to release serotonin – the ‘feel-good’ hormone. This can improve your overall mood and make you feel less inclined to worry. Try the following exercises:
- walking or jogging
- cycling
- hiking
- swimming
- team sports such as football or rugby
- aerobics
Recommended guidelines state that you should aim to do a minimum of 150 minutes of moderate-intensity exercise a week – this intensity should raise your heart rate.
2. Make time to relax
Another key part of self-care is giving yourself time to relax and unwind. There are several ways you can do this, from breathing exercises and meditation to gentle exercises like yoga. Find something that works for you and try to dedicate some time every day to relaxation.
3. Avoid caffeine
Having too much caffeine in the system is known to disrupt sleep and speed up your heart rate. Both of these can have adverse effects on your anxiety levels. Try to cut down on your caffeine intake and try herbal teas instead.
4. Avoid drinking and smoking
Alcohol and smoking have been known to make symptoms of anxiety worse. To improve your physical health and your anxiety levels, aim to cut down on your alcohol consumption and look to quit smoking.
What should I be looking for in a counsellor or therapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat generalised anxiety disorder. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments.
In the first instance, those suffering with anxiety should be offered access to a support group and self-help information recommendations by their doctor. If this doesn’t help, or the anxiety is more severe, psychological treatments such as cognitive behavioural therapy and/or applied relaxation are recommended. Further treatment may require medication.
Our sexuality and gender can form a big part of our identity and those who don’t fit society’s heteronormative ideal can come up against more challenges. Those who identify as LGBTQ+ can be seen as ‘different’ by some, facing discrimination, bullying and a lack of understanding which can lead to mental health concerns.
While things in society are slowly moving forward in terms of acceptance, we still have a long way to go. Incredibly, the World Health Organisation only removed ‘homosexuality’ as a formal psychiatric diagnosis in 1992.
The fact is, being LGBTQ+ does not lead to mental health problems – dealing with other people’s adverse reactions does. Because of this, those who don’t identify as heterosexual are more likely to experience mental health problems. Here we’ll explore sexuality and mental health in more detail, where to find support and coming out concerns.
Sexuality and mental health
LGBTQ+ people can be at a greater risk of developing a mental health condition than those in the wider population. According to the Mental Health Foundation, a survey carried out by Stonewall found that half of LGBTQ+ people experience depression and three in five experience anxiety.
The reasons for this are complex and not entirely understood, however, most mental health problems experienced can be linked to discrimination, bullying, homophobia, biphobia or transphobia.
If you identify as LGBTQ+ and you’re struggling with your mental health, know that you’re not alone. You may be particularly prone to:
- Depression – when you experience a low mood for a long period of time.
- Anxiety – when you feel especially anxious or worried for long periods of time or at a high intensity.
- Self-harm – when you hurt yourself on purpose to cope with difficult emotions.
- Suicidal thoughts – when you feel very low and as if there is no way out.
You may experience rejection from those around you, including friends, family and work colleagues. Other factors may also complicate things, for example where you live, your ethnicity and religious background. Understandably, this can all have a big impact on your sense of self-worth and your confidence. You may feel the need to hide this part of yourself from others, and this can be damaging in itself.
Some people may find they turn to alcohol and drugs to help them cope with difficult emotions. If you’re worried about the way you’re using alcohol or drugs, your doctor, a counsellor or an addiction helpline can offer support.
LGBTQ+ counselling
Speaking to a counsellor can help with some of the difficulties you’re facing, such as:
- finding it hard to accept your sexuality
- coping with other people’s reactions
- low self-esteem and low self-confidence
- fear of violence or abuse in public places
- effects of bullying and discrimination
- feeling as if your body does not reflect your true gender (gender dysphoria)
- transitioning
If you develop a mental health condition, talking therapies can help you find new ways of coping and either overcome or manage your condition. What’s important is for you to find a counsellor who you trust and feel able to talk to openly about your experiences. For this reason, it can be helpful to check your counsellor has experience working with LGBTQ+ people and/or has had appropriate training.
If at any point you feel uncomfortable with your counsellor, remember you have every right to stop your sessions and find a more suitable counsellor for you.
Other forms of support
Aside from talking therapy and counselling, many LGBTQ+ people find it helpful to connect with others in the community. You may want to join a support group online or connect with campaigners. There are a number of organisations and charities that support and campaign for LGBTQ+ people, Mind has an excellent list of resources.
Discrimination – what’s the law?
Attitudes in the UK towards the LGBTQ+ community do slowly seem to be improving, however, there are still some people who discriminate against others based on their gender and/or sexuality. There is a law against this at work and in wider society – The Equality Act 2010.
This protects gay, lesbian, bisexual and trans people and anyone who experiences discrimination because they associate with LGBTQ+ people. You can find out more about what the Equality Act 2010 covers and includes on the gov.uk website.
Coming out
The term ‘coming out’ is often used to describe when you tell people about your sexual orientation and/or your gender identity. For some, it can take a long time to feel comfortable to do this. It’s important to know that you don’t need to come out at a certain time, you simply need to do what feels good and right for you.
Having these conversations can be difficult. You may experience unpleasant reactions and even rejection in some cases. This can make coming out an emotionally trying time. And sadly, for many, coming out isn’t a one-time thing. Every time you meet someone new or start a new job, for example, you may need to consider when or how much of your identity as an LGBTQ+ person you want to share.
Despite what may sound like negative repercussions of coming out, this doesn’t happen to everyone. Many people are supported and understood by those they’re coming out to.
Hiding who you are, however, can be an incredibly difficult thing to do and can be damaging to your mental health and well-being.
Everyone will ‘come out’ in different ways. For many, it’s a series of conversations that take place between the LGBTQ+ person and the people in their life they want to tell. It’s important for you to come out in a way that feels right for you and your circumstances.
Telling someone you trust and believe will be supportive first can be a good idea. They can then provide you with some support as you tell others in your life. Picking a time when you can talk through any concerns and worries is also recommended.
Try to keep in mind that although this is likely something you have known about yourself for a long time, for others, it may be a surprise. Initial reactions may be laced with shock, and they may change over time.
Creating a support network, whether that includes friends, family members, online communities or professional support (or all of these!) can be incredibly helpful when taking this step.
Above all, please remember you are not alone. With greater understanding, kindness and representation hopefully making its way through society – we can only push for progress.
Loneliness is something we all may experience at some point in our lives. For many, it’s a feeling that only lasts a moment, appearing in certain situations. But others may feel lonely all or most of the time.
Here, we’ll look closer at what it means to experience loneliness, who it affects, and what support is available for those wanting to escape this feeling.
What is loneliness?
Loneliness can be defined as a “subjective, unwelcome feeling of lack of companionship”. It’s the feeling we get when our want and need to have social connections and relationships is not met. There is no one set idea of what it means to be lonely, as the experience is different for everybody. What may feel like loneliness to one person may not be the same for another.
What’s the difference between loneliness and being alone?
Loneliness is not the same as being alone. Some people can experience feelings of loneliness even if they’re surrounded by close friends and family, or are in a relationship. This is especially common in people who don’t feel listened to or understood by those around them.
It’s common to mistake being alone as feeling lonely. But choosing to be alone can be a positive thing. It’s a conscious decision that can be restorative, re-energising, and calming. The feeling of loneliness isn’t a choice. It comes from a feeling of being disconnected from others.
Types of loneliness
There are two types of loneliness; emotional and social.
Emotional loneliness
This is when we miss the company of one particular person, such as a spouse, sibling, or best friend.
Social loneliness
This is when we’re lacking a wider social network (a group of friends or colleagues, for example). Loneliness can come and go in waves. It can be situational, meaning it’s only experienced at certain times, like at Christmas or bank holidays. Or it can be chronic, meaning someone feels lonely all or most of the time.
Social interaction is a part of life and it’s in our human nature to crave companionship and compassion. When this is taken away, you can feel very lonely indeed.
What causes loneliness?
There are several reasons why someone may feel lonely. Sometimes, this might not be obvious, but some of the most common causes are:
- losing a loved one
- moving away from friends and family
- loss of contentment or enjoyment in your work
- having health problems that limit your ability to socialise/leave the house
Counselling for loneliness
If you’re feeling lonely, speaking to a counsellor or therapist can help. It can help you feel connected with someone and supported. By talking to a professional, you can experience validation – it’s OK to feel this way, it’s not your fault and support is available.
Long-term loneliness can lead to mental health problems – such as anxiety and depression – and increase the risk of developing certain health conditions. Experiencing a mental health problem isn’t easy, and it’s even harder going through it alone. If you’re lonely or feel like you have nobody to talk to, reach out to a qualified professional.
Who is affected?
Loneliness can affect anyone. Experiences of loneliness can vary, but its effects can be profound and wide-ranging. Here we’ll explore how it can affect different groups in society.
Elderly loneliness
In the UK, over two million people aged 75 and over live alone. And more than half a million older people will spend a week or more without seeing another person. So, it’s no surprise that loneliness is extremely common in older people. This is typically due to becoming weaker and less able to get out to see people, as well as losing partners in older age.
Companion loneliness
Widowed and divorced people are also at risk of loneliness. Their companion, which they believed to be lifelong, has gone. For whatever reason, they’re alone and this isn’t something you expect to feel, especially if you’re a younger adult.
If you’ve moved away from your friends and family, perhaps for a new job, you’re thrust into the unknown, knowing nobody. These days, making friends can be tough. You may spend weeks meeting new people, but they’re not the companions you want.
Loneliness affects us all differently and you may be able to manage feelings easier than others, or at least for a longer period of time. Most of us need some form of social contact to maintain good mental health, but we’re all different. You may need a large group of friends to feel satisfied, or you may be content with a smaller circle.
Young person’s loneliness
Loneliness is often considered a taboo, particularly amongst young people. Perhaps because it’s generally associated with the elderly, young people experiencing loneliness often suffer in silence.
Self-harm is the leading cause of death in the UK and much of that is down to the stigma of mental health and people not knowing where to turn. Instead of talking about their troubles, some young people turn to self-harm as a way of releasing their emotional pain.
Student loneliness
When the realities of student life set in (lack of contact time, deadlines, workload, difficult housemates and fending for yourself), university can be a lonely time. A study conducted by Sodexo found that almost half of UK students (46%) admit to loneliness during their time at university – compared to 32% globally – with UK students most likely to consider dropping out compared to their worldwide counterparts.
How does it affect mental health?
While feeling lonely isn’t itself a mental health problem, chronic loneliness is closely linked with mental ill-health and unhappiness. It’s often associated with depression, sleep problems and stress.
It can be a vicious cycle. If you’re experiencing mental health problems, it can be a very isolating time. You may feel like there’s nowhere to turn or, as a result of stigma, feel too scared to talk or seek help.
We aren’t always aware of the impacts of loneliness because we don’t expect it to affect us. Usually, feelings ease after a while and we get on with our lives. Many of us fear being alone but, the reality is, you don’t expect how much it can change your life until it does.
Advice for staying connected
Whether your feelings of loneliness are fleeting or have been with you for a long time, it can be deeply emotional and overwhelming. Doing anything can seem hopeless, but trying to think positively, and taking the steps to help yourself out of loneliness can be useful. Remember, it’s not your fault you feel this way, and there is a way out.
Think about what’s making you lonely
If you’ve been feeling lonely for a while, the first step is to recognise it and try to understand what has caused it. The reason may be more clear, for example, if you’ve lost a lifelong partner, being without them will obviously have an impact.
In older age, friends and partners grow old and pass away, and your family are living their own lives – you can’t bother them with your problems. ‘You’ll be fine’, you think, but actually, you haven’t spoken to anyone in weeks and it’s starting to affect your well-being.
Think about what you would like more of – maybe you miss your family. If so, invite them to visit or call them for a conversation. When feeling lonely, it’s easy to believe people don’t want to see you, as they’re too busy. This is understandable but, often, people will accept an invitation to spend time with you.
Look after yourself
If you’re able to, go for walks and move your body regularly. Eating well and keeping active can help maintain good well-being and can help you to relax more in your own company.
Loneliness can be all-consuming and your days can blend into a never-ending, painful experience. Try to establish a routine: get up in the morning and have breakfast, spend time outside and speak to people where you can.
Make new connections
The simplest way to ease feelings of loneliness is to socialise more. This may sound obvious, but trying to reach out and meet new people can really change a life. Is there anything you’re particularly interested in? Maybe there’s an activity group or class in your area that could help you meet new, like-minded people.
Take a look at local volunteering opportunities. Volunteering is a great way to meet people and socialise, and helping others can make you feel good. Do It is a great place to start.
Take it slow
Reaching out isn’t easy and taking things into your own hands can be daunting. If you’re not ready to jump straight in, take it a little slower. Start by going to the cinema or a cafe with a book; somewhere you can be around people, but not be expected to talk to them.
If you’re interested in joining a class or a group, there’s no harm in calling whoever runs it and asking questions. Or, consider joining a class that doesn’t necessarily run on conversation – a creative event, where people are focused on what they’re doing, rather than those around them.
Open up
Do people know how you feel? You may have plenty of friends and family but, if they don’t know how you’re feeling, they may not realise how much you need them. It’s not easy, but opening up to loved ones can really help. Remember, there is no shame in feeling lonely.
If you’re not comfortable opening up to family, consider speaking to someone less involved. Perhaps a friend, through an online community or even a professional.
Get some help if needed
If it’s affecting your mental and physical health, it might be time to consider professional support. You don’t have to go through this alone. As lonely as you feel, there will always be someone to talk to.
What support is available?
When experiencing loneliness, the idea of reaching out and asking for help can seem pointless. Who can support you if there’s no one around? But the thing to remember is that there is help available.
There are charities and resources dedicated to helping those who feel lonely. They may organise events, activity groups and coffee meetings; bringing people together.
Support for the elderly
Elderly people may benefit from the Age UK befriending service. Volunteers sign up to this service as ‘befrienders’ and either carryout face-to-face visits or schedule a weekly telephone call. This provides regular, friendly conversation and companionship over a long period of time.
Befriending provides those who feel lonely with a link to the outside world and a source of regular communication. Often, befriending acts as valuable support and can even be a gateway for other services the person may be missing.
Older people can be more reluctant to seek help for mental health problems that may arise if they’re experiencing loneliness. However, it’s important to remember that you’re never ‘too old’ to seek support and, if you feel you need further help, you may benefit from counselling or therapy.
In her article, Benefits in counselling for the elderly, Helen Smith explains how “skilled listeners” can be transformative in helping older people alleviate mental health issues and feel they have someone who can validate their feelings. For more information on counselling, read our fact sheet.
Other support
Charities such as The Silver Line, and Co-op Foundation work to combat loneliness and support those in need. They have befriending services and volunteer opportunities, connecting people who feel lonely with a conversation and companion.
Students may also benefit from reaching out to Student Minds, a mental health charity there to support students in higher education.
Low self-confidence is something that many of us experience but, over time, it can have a negative impact on our mental health.
Here, we’ll explore self-confidence in more detail, discussing what can impact it, how it links to our mental health, and how counselling can help.
What is self-confidence?
Self-confidence is about trusting your own judgement and feeling comfortable with your abilities and powers: it’s the means to realise your full potential and be the person you want to be. This trait allows you to feel secure in the world and encourages others to feel comfortable around you.
Self-confidence is made up of a variety of factors, including how you present yourself physically to the world and how you relate to other people. We all differ, but possessing self-confidence can bring benefits to all areas of your life, enhancing your relationships, career, social life and state of mind.
It’s also worth noting that levels of confidence can vary depending on your environment or situation. For instance, you may be particularly confident at work but lack social confidence. Or you might have a thriving romantic relationship but lack confidence in your friendships.
How is self-confidence different from self-esteem?
Although the two terms are often used interchangeably, there are key differences between self-confidence and self-esteem. Confidence is linked with the external world, such as how others see us, how we present ourselves, and what we achieve. Self-esteem, however, is more internal. It’s about our own relationship with ourselves and how we feel deep down about who we are.
The two traits are linked but not always connected. As a result, self-confidence can evolve alongside self-esteem or independently.
Signs you have low self-confidence
Your level of self-confidence can be seen by others in many ways; in your body language, your behaviour, how you speak and how you react to different situations.
If you have low self-confidence you may feel:
- you are unsuccessful
- you have no drive or direction
- shy and uneasy
- a sense of uselessness and worthlessness
- inferior to others
- bitter about work, social and family relationships
Self-confident people are generally more positive and believe in their abilities, whereas those with low self-confidence often have negative thoughts about themselves and their abilities. Confident people build on what they can do and confront honestly what they’re lacking, accepting constructive criticism and support.
Your confidence won’t necessarily be the same across all areas of your life. It’s important to assess this to understand that learning and skills can be developed to bridge confidence. Maybe you’re confident with one or two close friends but not with big groups, or you’re confident with animals or children, but not with adults.
Causes of low self-confidence
In order to tackle low self-confidence or low self-belief, it’s important to look at where those beliefs originate from. There are many different factors that can interfere with our self-concept, and how we feel about ourselves.
Your early environment and childhood influences often have a major effect on how your confidence has developed throughout your early life, such as if you were bullied at school. Other factors include your own disposition and resilience.
Children who are encouraged to speak their minds openly usually retain that habit. Children who have been unable to make their needs understood or experience learning difficulties may feel there is no way forward or opportunities for them.
As an adult, a knock-back at work or a recent redundancy are common causes of low self-confidence, as your trust in your ability to perform a certain task has been rocked.
How to improve self-confidence
Even if you have lacked confidence your whole life, it’s important to remember that confidence is a flexible trait. Although the past may seem to have determined your current confidence level, it is never too late to start being confident.
For many people, a crisis, divorce, illness or bereavement can be a surprising springboard to finding an alternative route to building confidence. It’s always possible to improve your skills in this area at any time you choose.
Self-help
Everyone has their own strengths, abilities and skills to enhance their self-confidence and become who they want to eventually be. Doing something outside of your comfort zone – such as joining an evening class, support or interest group or undertaking training – can often be the first step to building confidence.
Self-confidence is also a skill that can be developed through realistic goal setting and planning. Be realistic about your goals and what you want to achieve: it can help to set both short-term goals and long-term goals so that you can map out small steps to achieve big things.
One common suggestion is to write a list of your strengths and what you are good at.
As counsellor Ian Stockbridge explains, this is a challenging exercise if you think everyone is better than you or you do everything poorly. But, being able to change involves identifying your negative beliefs, and challenging them. “It can help to write negative thoughts down, recognise when you started thinking that way, and write down evidence to challenge it.
“It can also be helpful to make notes of any positive comments people say about you, even if you don’t currently believe they are true.”
How can therapy help?
A counsellor can offer you a safe, inclusive and non-judgemental environment in which you can explore your feelings and experiences and how they have impacted you. They can help you to consider what is realistic and achievable for you, and to explore how you’ll navigate disappointments and setbacks.
Counselling can help you understand where any negative thoughts about yourself came from, making you better able to challenge them. Techniques and strategies can then be developed to help you build your self-confidence and change current negative thought patterns.
Over time, low self-esteem can have a negative impact on our mental health. You may also find having certain mental health conditions impacts your self-esteem. Here, we will be looking into self-esteem more, discussing what can impact it, how it links to our mental health and how counselling can help.
What is low self-esteem?
When we have low self-esteem, we can see both ourselves and the world around us in a negative light. We may feel unhappy and find it more difficult to cope with challenges when they come up.
What is self-esteem?
Self-esteem is the way we perceive and value ourselves; essentially, it’s the opinion we hold of ourselves. This can be influenced by lots of different things, from past experiences and our childhoods to life events. While these beliefs can be misplaced, they can feel very difficult to change.
If you have low self-esteem, you may struggle to value yourself. This can affect your life in a number of ways. You may find it difficult to like who you are and struggle in relationships. Low self-esteem can make it tough for you to believe in yourself, so you might struggle to try new things and take risks.
If you make a mistake, you might take it to heart and find it hard to move on. Your self-care may suffer and you may prioritise other people’s feelings and needs above your own. Self-esteem can however be built, so if this is ringing true, please know that it doesn’t have to stay this way.
When you start to accept, value and like yourself, these struggles start to ease. You may feel more confident socialising and communicating in relationships. When new opportunities present themselves, you’re more likely to push yourself to go for them. You’ll find it easier to learn from mistakes and move onwards and upwards. Self-care can become a priority, allowing you to look after yourself better and thus, be better able to support others.
What are the signs of low self-esteem?
There are a number of different signs that you could have low self-esteem. You might exhibit some or all of these. They can include (but aren’t limited to):
- saying or thinking negative things about yourself
- being self-critical
- feelings of sadness, depression, anger, anxiety, shame or worthlessness
- blaming yourself for things that go wrong (even if they are out of your control)
- repeatedly joking about yourself in a negative way
- ignoring your achievements in favour of focusing on your mistakes or self-perceived negatives
- avoiding challenges due to fear of failure
- believing others are better than you
- thinking you don’t deserve to have nice things or fun experiences
- refusing to accept compliments
- feeling overly upset by any criticism, disapproval, or negative feedback
What are the causes of low self-esteem?
Everyone will have different things in their life that affect self-esteem. For some people, self-esteem changes suddenly (for example, after a stressful life event) while, for others, low self-esteem may be something they’ve lived with for a long time.
Often your opinion of yourself is built in your early years. You may have experienced authority figures who were disapproving. Being criticised a lot in childhood can lead you to form the opinion that you’re ‘not good enough’. Being bullied in childhood can also have a lasting impact on your sense of self-esteem, long after the bullying stops.
Other life events that can affect your self-esteem include:
- experiencing abuse (of any kind)
- experiencing discrimination or stigma
- having relationship problems
- ongoing stress
- difficulties at work/school
- body image worries
- problems with money or housing
- losing your job, of finding it hard to get a job
- physical health problems
- mental health problems
It’s also important to acknowledge the influence of society and the media. With social media especially, more of us than ever before have access to other people’s lives, thoughts and opinions. As no one has created a ‘truth’ filter for this information (yet), much of what we see is curated, perfected and… false.
All of the information we receive, including societal expectations, beauty ideals and gender stereotyping is presented as fact and it can be difficult for us to unhook our self-worth from these notions. The fact that more and more young people are using social media could also be a cause for concern.
While this is worrying, it’s worth noting that social media can have the power to improve both body image and self-esteem, when used in the right way. Making feeds more diverse and following inspiring and uplifting accounts can help.
Understanding the source of your low self-esteem can help you understand yourself better and start taking steps to build it up.
Self-esteem and mental health: What’s the link?
If you have low self-esteem for a long time, you may find it affects your mental health. It can lead to conditions such as depression, anxiety, self-harm and eating disorders. Some of the signs of low self-esteem, like feeling worthless and blaming yourself can also be symptoms of these conditions.
You may find low self-esteem makes it difficult to socialise which can lead to isolation. Feeling isolated and lonely can make you feel worse mentally. Some people will turn to unhelpful habits and behaviours to try and cope with low self-esteem, including drinking too much alcohol and abusing drugs.
If you have a mental health condition, you may also find that your self-esteem is affected. For example, depression can often make those with the condition feel worthless and anxiety can lead to people thinking they’re not ‘good enough’.
How a counsellor can help?
Building self-esteem and navigating the mental health implications can be difficult to do alone. Working with a trained professional such as a counsellor can help you understand where your opinion of yourself stems from and how to challenge limiting beliefs. Developing more awareness of your personal history and how this impacts who you are today can be eye-opening. Finding a counsellor who you feel comfortable with is key, it helps to be as open and honest as possible.
There are several different therapy types that can help here, including cognitive behavioural therapy (CBT) which helps you notice and change patterns of negative thinking. Compassion-focused therapy can also be very helpful for those struggling with self-esteem, helping you to let go of the self-blame that often comes with negative thoughts.
Arts therapies may be a good approach to consider if you find it difficult to articulate how you feel. These therapies use mediums like art, music and drama to help you process feelings and express yourself.
How do you fix low self-esteem?
As well as getting professional support, there are things you can do yourself to help improve self-esteem. What’s important for you to remember here is to try and not put too much pressure on yourself. Building up your self-esteem can be a long process, but small steps lead to big changes.
Here are eight ways you can try to help raise your self-esteem:
1. Reflect on your values and beliefs
Try using a journal to get to know yourself a little better. Make a list of your values and beliefs, what do you value in others? What are your beliefs?
2. Challenge your inner critic
When that voice in your head tells you something negative, for example ‘I can’t do X’, get into the habit of challenging it. Ask it ‘why not?’. Imagine what you would say to a friend who said this to themselves and try to treat yourself as you would a friend.
3. Use positive affirmations
This can be difficult at first, but many people find it helpful. Once you’ve challenged your inner critic, try telling yourself something positive, for example ‘I am perfectly capable of doing x’ and repeating it to yourself often.
4. Get out of the comparison trap
It’s natural for us to compare ourselves to others, especially those we see on social media. When you notice this happening, say ‘stop’ out loud and remind yourself that you are only seeing other people’s highlights. If it helps, try taking a break from social media and the online world from time to time.
5. Step up your self-care
Looking after yourself is something that can be pushed down the priority list when you struggle with self-esteem. Try to schedule self-care into your diary and challenge yourself to prioritise it. The act of taking care of yourself can help to reinforce that you are worthy and deserving of care which can improve self-esteem.
6. Challenge yourself
Taking small steps outside of your comfort zone can feel very hard, but once you see that you can do it, you gather evidence that will bolster your self-belief. Try something very small at first and remember to celebrate every single win. You may also find it helpful to reflect on past achievements and make a note of them somewhere.
7. Learn to accept compliments
Instead of brushing off or dismissing compliments, get into the habit of smiling and saying thank you. This will make both you and the compliment giver feel better.
8. Lean on your support system
When you’re feeling down about yourself, reach out to friends, family or your counsellor for support. You may even want to use a support group or talk to friends online. Know that you’re not alone and you have people in your life who care about you.
The journey to rebuilding and improving self-esteem can feel difficult at times, but the opinions and beliefs we have about ourselves are learnt. This means, with the right support and some self-work, we can unlearn them. Nothing is set in stone and you always have the opportunity to change your story.
What should I be looking for in a counsellor?
Choosing a therapist can be daunting, but it’s important to spend some time reviewing counsellors, their areas of specialities, their personalities and speaking to them beforehand.
Having some questions prepared for your initial consultation can be helpful in deciding whether they are right for you. Ask yourself, “What do I want from counselling? Will this person help me to explore my individuality?”
There aren’t regulations regarding the level of training a counsellor working with someone with low self-esteem needs, however, there are several accredited courses, qualifications and workshops available to counsellors to improve their knowledge of a particular area.
When researching therapists and therapies, take your time and get to know their background. Don’t be afraid to ask for more information if you need it.
When we feel anxious, we can feel uneasy and may experience physical symptoms such as chest pain and dizziness. For some people, this anxiety can become so intense that it triggers a panic attack, where you feel overwhelmed with fear and experience extreme physical symptoms.
What is a panic attack?
When you have a panic attack, your body feels a rush of fear and panic, leading to intense physical and mental symptoms. They can feel very frightening, especially if you haven’t experienced one before.
They are our body overreacting to stress and anxiety. Most attacks last between five and 20 minutes, however, some have been reported to last up to an hour. Although it doesn’t feel like it at the time, panic attacks won’t cause you any physical harm.
After having an attack, you may start avoiding certain situations in case they trigger another attack. This can become a vicious cycle, as you start avoiding more and more things and become anxious about panic attacks.
How do I know if I’m having a panic attack?
A panic attack can come on very quickly and may appear out of nowhere. Common physical symptoms include:
- a fast or irregular heartbeat
- feeling very hot or cold
- feeling dizzy and lightheaded
- chest pain
- stomach pain
- sweating and shaking
- a tight throat or feeling as if you’re unable to breathe
- feeling as if you aren’t connected to your body or mind (this is called dissociation)
Mentally, you’ll likely feel very scared and worried that you’re going to pass out, have a heart attack or even that you’re going to die.
What causes panic attacks?
Panic attacks are rooted in anxiety and, like many mental health conditions, anxiety can have many causes. Usually, conditions like this are linked to a combination of factors, including experiencing a traumatic or stressful life experience, having a close family member with the disorder and an imbalance of neurotransmitters (the chemical messengers in the brain).
You may notice that your panic attacks are triggered by certain places, situations or activities. There may be a pattern to your panic attacks (for example, before a stressful appointment or at nighttime) or you may get them for no reason in particular.
If you are having panic attacks often, you may have panic disorder.
What is panic disorder?
A type of anxiety disorder, panic disorder is when you have regular panic attacks and often without any identifiable reason. It is common for those with panic disorder to also experience agoraphobia at the same time.
Agoraphobia is when you feel anxious about being somewhere you think would be difficult to get out of, or where you think it would be hard to find help if you had a panic attack. This can lead people to avoid everyday situations such as using public transport or even leaving the house. Sometimes agoraphobia develops after you have a panic attack, as you become worried about having another attack and avoid any situation which may lead to an attack.
Panic disorder in children
Panic attacks are more common in teenagers and adults than children, however, they can affect younger children and can be particularly tough to deal with. Depending on the severity, panic disorder can affect children’s development and learning.
If you’re worried your child may be experiencing panic attacks, visit your GP for a diagnosis. We have also put together some free resources which may be helpful for anxious kids.
How are panic attacks and panic disorder diagnosed?
If you are experiencing panic attacks, it’s advised to visit your doctor. To diagnose you, they will likely ask you to describe your symptoms, how often you have panic attacks and how long you’ve experienced them. They may also carry out some physical tests to rule out any other conditions that could be causing the symptoms.
If you have been experiencing regular or unexpected panic attacks followed by at least a month of ongoing concern about having more attacks, you may be diagnosed with panic disorder. It can feel difficult speaking to someone you don’t know about how you’re feeling, but it’s important to be as honest as possible. This will ensure you get an accurate diagnosis and the right support.
Treatment for panic disorder
The aim of treatment is to help ease anxiety symptoms and reduce the frequency of panic attacks. The most common approach is talking therapy and medication. Depending on your circumstances you may benefit from either one alone or a combination of the two.
In the first instance, you’ll likely be recommended to try cognitive behavioural therapy (CBT). You may be referred by your doctor, or you can refer yourself directly. You may also want to explore private therapists if this is accessible to you.
CBT can help you understand how you react and think when you have a panic attack and how you can change these. Your therapist can teach you breathing techniques and other behavioural changes that can help with anxiety. Your doctor may also recommend antidepressant medication. It may take a little time to find the right type of medication and dose that suits you, so ensure you keep your doctor updated on how you’re feeling.
Finding support
Alongside your treatment, you may also benefit from talking to others who have anxiety. Support groups and charities can be incredibly supportive as people can share experiences and what does and doesn’t work for them.
Managing anxiety
As well as following your treatment plan, there are several lifestyle changes you can try to ease anxiety and prevent further attacks. Prioritising self-care is important, try to ensure you’re getting enough sleep and eating a well-balanced diet (what we eat can affect mood and anxiety levels). Avoid too much sugar caffeine and nicotine as these can all exacerbate anxiety symptoms.
Find ways to reduce stress and encourage more relaxation in your life. This could be through physical exercise, breathing exercises or even exploring complementary therapies like massage and aromatherapy.
Developing a mindfulness practice can help too, whether this is through meditation or activities like yoga. If you’re struggling to lower your stress levels, mindfulness-based stress reduction (MBSR) may be worth exploring.
How to stop a panic attack
If you can feel a panic attack coming on, try the following:
- Focus on your breathing, aim to breathe slowly, exhaling a little longer than you inhale.
- Try not to fight the attack and if possible, stay where you are.
- Tell yourself that this feeling will pass and remind yourself of previous attacks that you’ve lived through.
- Stamp your feet on the ground. This can help you come back to your body and control your breathing.
- Focus your attention on your senses. Try eating a mint, smelling an essential oil or touching something soft and think about how it feels/tastes/smells.
When the panic attack passes, take it easy and ask yourself what you need. You may want to sit somewhere quiet or drink some water. If you can, tell someone what’s happened and share with them ways they can help you if you have a panic attack in the future.
What should I be looking for in a counsellor or therapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat panic disorder. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments.
In the first instance, those suffering from panic disorder should be offered access to a support group and self-help information recommendations by their doctor. If this doesn’t help, or the panic disorder is more severe, psychological treatments such as cognitive behavioural therapy and/or applied relaxation are recommended. Further treatment may require medication.
When we talk about mental health, there is often a misconception about what it is and who it affects. First and foremost, mental health is not the same as a mental health issue or illness. We all have mental health – it doesn’t come and go, it’s with us throughout our lifetime.
The term mental health is often used interchangeably with emotional health and well-being. Our mental state is certainly a key part of our overall well-being. It refers to how we are aware of our abilities and how well we cope with the ups and downs of life.
If we are physically unwell, say, with a cold, it may go away on its own within a week. But, the same cannot usually be said if we are mentally unwell. Good mental health can be maintained with self-care but, if we experience a problem, it may not go away on its own. We may require further help, for example, through talking therapies such as psychotherapy and counselling.
Types of mental health conditions
Mental health issues can have a profound impact on how we think, feel and behave. They can range from worries we all have from time to time, to long-term conditions that require treatment to manage effectively.
According to the Mental Health Foundation, traditionally mental health conditions have been divided into two categories; ‘neurotic’ (which is now more frequently called ‘common mental health problems’) and ‘psychotic’ (where symptoms interfere with your perception of reality).
Labels and categories can be helpful for professionals to diagnose and treat a problem, however, there are controversies surrounding this with some believing generalisations and assumptions interfere with individual care. Some people may also experience a combination of neurosis and psychosis, therefore, distinguishing between the two may not always be useful.
Signs of a mental health problem
When you get a physical illness like a cold, you may experience symptoms such as a sore throat and a blocked nose. These signs tell you that something is wrong so you can take medication, or rest in bed for a few days. When it comes to our emotional well-being, the signs aren’t always so obvious.
One thing to remember is that there is no set list when it comes to the signs and symptoms of mental health problems. Each condition varies and, of course, each individual is different too. If you are worried about your mental health, you should visit your GP for advice on what could help.
What causes mental health issues?
Mental health conditions are complex and can have a wide range of causes. Often, it is not known exactly why someone develops symptoms. There are, however, certain factors that are thought to play a role in triggering problems. These are:
- psychological
- physical
- social and environmental
Psychological causes
A ‘psychological cause’ is something that affects the mind or emotional state.
Traumatic experiences such as the loss of a loved one or a road accident can trigger mental health issues. A traumatic event can change a person’s perception of the world, and as a way of coping, they may experience feelings of anger, helplessness, fear and guilt. Over time, and without the right support, unhealthy behaviours can emerge.
Internal triggers may also play a part in the onset of mental health concerns. Internal factors such as loneliness or social isolation, self-criticism and low self-esteem or self-worth, and long-term or severe stress can, over time, be detrimental to a person’s mental well-being.
Physical causes
A ‘physical cause’ is something that affects the body on a biological level, such as:
- Genetics. Experts believe some people are more at risk than others; they have a genetic ‘predisposition’ because of genes passed down from parents.
- Early development. Some studies suggest that a baby is at greater risk if its mother takes drugs or contracts a virus during pregnancy.
- Head injuries. Sometimes, after a serious head injury, psychotic symptoms can develop.
Social and environmental causes
The things that happen around us can have a big impact on mental health. Social and environmental causes include:
- where you live
- where you work
- the relationships you have with family and friends
- experiencing discrimination or stigma (e.g. racism, ableism, homophobia, transphobia)
Mental health support
Mental health support covers a range of things designed to manage symptoms and improve quality of life. The most common types of treatments include talking therapies and medication.
If you are concerned about yourself or someone else, it is advisable to speak to your GP. They will be able to diagnose any problems and recommend treatment options. It is important to note that all appointments and topics discussed are completely confidential.
Talking therapies
One way of managing the effects of a mental health problem is by talking about it. Whether you are living with a mental health problem, or know somebody else who is, it is important to talk about your experiences and the stigma associated.
Counselling involves talking about your problems with a trained mental health professional such as a counsellor or psychotherapist. Talking therapies allow you a space to talk freely, without fear of criticism or judgement, and help you understand what may have caused your problems and how to manage them.
There are many different types of talking therapy that can help. These include:
- Cognitive behavioural therapy (CBT)
- Cognitive analytic therapy (CAT)
- Creative therapies, such as art therapy, drama therapy and music therapy
- Family therapy
- Dialectical behaviour therapy (DBT)
- Person-centred therapy
- Psychodynamic therapy
The type of therapy that will work for you will depend on what you hope to achieve from counselling, and the counsellor themselves. It’s always worth asking questions about the therapist’s way of working and discussing any concerns you have about a particular approach – together, you can work out whether you are the right fit.
Medication
Medication is sometimes prescribed to help reduce the symptoms of mental health conditions. Sometimes medication can help to improve the quality of life and make people feel less overwhelmed by their condition.
Depending on the type of mental health problem you have, you might be prescribed:
- antipsychotics to reduce symptoms of psychosis (i.e. hallucinations)
- antidepressants to reduce the symptoms of depression (i.e. loss of emotion, low moods)
- mood stabilisers to moderate extreme changes in mood
- benzodiazepines to reduce anxiety
Self-care for mental health
Prioritising self-care is something we can all do to help maintain our mental health. This can be as simple as taking any prescribed medication and showering to setting boundaries, carving out time for yourself and doing activities that make you happy.
When we look after ourselves, we give ourselves space to become more aware of our emotional well-being, so we can notice any signs that something’s wrong.
Challenges of living with mental health issues
Mental health issues are complex. Unlike a cold or cough, symptoms do not clear up after a course of antibiotics and some people have to learn to live with their condition. They may find everyday situations, such as work and socialising, particularly difficult.
Social stigma
Unfortunately, the social stigma attached to mental health still exists. According to the Mental Health Foundation, nine out of 10 people with mental health issues are affected by discrimination of some kind. Other people’s ignorance and lack of understanding can make it hard for people with certain conditions to maintain stable relationships, and find work or suitable housing. Some may find themselves socially excluded from mainstream society.
Research and a greater understanding of some conditions have helped change views of mental health. However, sensationalised films, news articles and stories mean misconceptions still exist. In order to tackle damaging stereotypes, more needs to be done to broaden communication between people with mental illness and the wider community to help spread awareness and understanding.
Attending work and school
Statistics show that one in six workers is dealing with a mental health issue at any one time. Certain problems can be caused by work (usually stress and anxiety), while some mental health conditions can impact our ability to work productively.
Many people are reluctant to speak about mental health in the workplace because they fear they may be penalised or judged for it.
Young people in school worry they’ll face criticism, alienation or bullying if their peers know they have mental health issues. While it can be difficult to talk about their emotional well-being with peers, colleagues and bosses, keeping an open dialogue in school and the workplace is important. It could help alleviate stigma and prevent problems from escalating.
Relationships
Some mental health issues can make it difficult for people to build healthy relationships. When problems emerge after a couple has been together for some time, new challenges can lead to difficulties. Frustration and lack of understanding can cause tension and arguments.
Couples counselling is helpful for those who are keen to open up and make space for change in their relationship. This type of mental health support can help couples to learn ways of coping with mental health issues together.
Parenting
Having children can make living with mental health issues even more challenging. Having the right mental health support in place is important, with talking therapies and counselling helping families overcome the challenges together.
Getting the conversation about mental health started with your children can help them learn about looking after their health and well-being as a whole.
Relationships are a key part of our lives. They bring happiness and support, but that doesn’t mean they’re easy. When we encounter problems in our relationships, it can be difficult to know where to turn. Talking to a relationship counsellor can really make a difference.
Relationships – whether romantic or platonic – can bring us a great deal of happiness and fulfilment. Strong connections with our loved ones, friends and even our coworkers allow us to be at our happiest, healthiest and most productive.
For many, these relationships offer an important source of advice, guidance, love and support. Research has even suggested that our relationships can significantly impact our well-being, with proven links showing that relationships can lower our rates of anxiety and depression, make us more likely to experience higher self-esteem and greater empathy, and can even lead to us trusting more. A strong, healthy relationship could even help you to live a longer life.
However, fulfilling and supportive relationships don’t come automatically. They require good social skills and a great deal of work, time and energy to last and stay strong. Sometimes our most meaningful relationships can break down, and this can be due to a number of reasons. But the loss of this connection can be difficult, leaving you feeling lonely, disappointed, or even confused as to what may have gone wrong.
In some cases, our relationships may not be meeting our expectations, which can impact our happiness and life satisfaction. For others, they may crave companionship yet find it very difficult to come by. Whatever the relationship issue, there is help available.
Relationship counselling is an option you can undertake together as a couple, or as an individual. It provides a space where you can talk about your concerns and needs, as well as explore what you want from your relationships. Many relationships can be improved by counselling, even if there is no clear problem or issue.
Through speaking with a professional relationship counsellor, you can learn more about yourself, your partner, your friends, or your relationship. You can gain a better understanding of each other’s needs while receiving support and guidance that can help enhance and even strengthen your relationship.
Why do we need good relationships?
Humans are naturally very sociable. We enjoy the company of others and crave positive interactions and meaningful friendships. To some extent, good relationships are just as important for our survival as food and water, which can explain why when our relationships suffer, our health and happiness are also affected.
Having good relationships in your workplace with colleagues, as well as others within similar professional circles can boost your productivity and act as a valuable tool for developing your career. Being on good terms with your manager or boss is not only great for productivity and fostering a positive work environment, but it can also mean that you may be more likely to be considered for new opportunities such as promotions when they arise.
Good relationships can create a sense of freedom. Rather than spending time and energy overcoming obstacles that arise due to relationship issues, you are able to focus more on the task at hand, enjoying the time that you spend there.
What defines a good relationship?
What makes a good relationship varies greatly from person to person, relationship to relationship. Each individual may value different aspects of their relationship to a different degree. However, many people agree that mutual respect and emotional support, companionship, shared sexual expression, and a level of shared economic security are common, important parts of a healthy, adult relationship.
All relationships are unique, and that’s part of the beauty of them. But, there are several characteristics that generally are a sign that you have a strong, healthy connection with someone. These may include:
Trust – Relationships are built on trust, which is essential for good communication and forming strong bonds with people. Without trust, relationships are unlikely to survive.
Mindfulness – If you’re mindful of what you do and say, and of the other person’s needs, you’re more likely to maintain strong relationships. Issues can arise if you let your negative emotions affect others, or if you aren’t thinking of them. Remember, it’s a two-way street.
Mutual respect – As mentioned above, strong and supportive relationships rely heavily on mutual respect. You need a mutual understanding of each other’s needs and values, and to consider these regularly.
Good communication – Your relationships will be richer if you make an effort to keep in contact with those around you. Being honest and open with others also allows you to connect deeply and build long-lasting bonds.
Counsellors can help you to better understand where and why things may have gone wrong in your relationship, and how you can overcome these problems. Taking into consideration the above areas as well as others, a therapist helping with relationship problems can help identify specific issues, and how (if possible), the relationship can be rebuilt.
Types of relationship problems
There are many different types of problems that can arise during a relationship. These can vary depending on your unique circumstances and relationship dynamics. A relationship therapist can work with you together as a couple, separately as individuals, or with just one of you. While we may all be different, there are some common relationship issues that people frequently seek relationship counselling for.
Common types of relationship issues include:
Affairs, betrayals and infidelity
Betraying your spouse, partner, or close friend can cause a great deal of damage to your relationship by weakening or destroying that sense of trust. Whether it’s through infidelity, financial secrets, hidden addiction, or something else, betrayal can feel heartbreaking and, in some cases, can lead to relationships ending.
Affairs don’t happen without reason. Having a safe, neutral space to talk through the issues and emotions leading up to, surrounding, and following infidelity can help you to both open up about how you are feeling, what you want to happen next, and work together to decide how that’s going to happen.
Separation and divorce
Sometimes couples will decide to separate or divorce without going through the practicalities, or considering if they may way to save the relationship. Separation counselling provides an opportunity for a breakup to be explored before a final decision is made. While not all relationships can continue, helping couples to get closure and move forward in a way that is healthy for their needs can be really beneficial in the future, particularly if children are involved.
Arguments and communication issues
Some couples may find that over time, the number of arguments they are having increases, or that their communication begins to break down. Frequent arguments over little things like taking the rubbish out or who’s turn it is to cook can be a sign of deeper issues that you may feel unable to express, or that you may not be entirely aware of, such as building resentment, anger, or sadness.
Differing communication styles can also lead to issues, as one or both people may feel like the other has stopped listening to them, which can lead to assumptions being made, or fostering negative feelings. While we all know the importance of communication, figuring out how to identify where things have gone wrong, and how to make positive, impactful and lasting changes, can be difficult.
Trauma
Traumatic life events can have a significant impact on relationships. Whether individual or shared, while some people cope by pulling together, others find themselves pushing their partner away or feeling like their relationship is being pulled apart. These can all be natural reactions to big, upsetting events. Talking things through with a therapist can help you to process things, find new ways to communicate how you are feeling with your partner, and work through your trauma together.
Sexual issues and/or lack of intimacy
Decreasing intimacy, sexual issues, or a lack of physical intimacy can lead to miscommunication and hurt feelings. One partner may feel undesirable, while another may feel shame or guilt. Any number of different problems can lead to sexual issues and a lack of intimacy within a relationship. While some issues may need to be addressed through your GP to rule out other medical problems, there are also many common psychological factors that can lead to a decreased sex drive, such as depression, stress, and even anxiety.
Can a relationship survive without intimacy is a question frequently asked by couples who fear that their physical and/or emotional intimacy has decreased. Working with a relationship counsellor can help you to better identify the root causes, and how you can foster a greater sense of intimacy.
Pre-nuptial issues
Some couples seek extra support and advice on how to prepare themselves should the relationship break down or encounter difficulties in the future. Relationships are naturally full of ups and downs (we may naturally crave companionship, but we’re also very opinionated creatures). Pre-nuptial counselling can help couples to be aware of any potential stressors that may occur during different stages of their relationship, such as the birth of a child, and learn how to cope, overcome any issues and flourish.
Family issues
Our relationships with family members form an integral part of our lives, and when these become strained, they can cause a lot of pain and disappointment. In some cases, it may be one family member that is causing a rift, or it could be a previous disagreement or a number of issues that have built up over time and have never been properly dealt with.
For couples with children, differing parenting styles, discontent with the role you have fallen into (for example, when one parent always has to play the ‘bad guy’ and one gets to be the ‘fun parent’), or even just struggling to adapt to your growing family can all cause tension and strain.
Family counselling provides a safe and supportive environment where family members can communicate openly, listen to each other and work through any disagreements.
Cross-cultural relationships
Relationships involve two people coming together from different backgrounds to build a new unit. While for many, this process is relatively straightforward and seem very natural, for others, their differences can be too prominent to come to a compromise. Counselling helps couples to better understand each other’s beliefs and values, to learn how to work with their differences and compromise, building a stronger, healthier bond.
Imbalanced responsibilities
Some couples may find that their relationship dynamic feels unequal and that the typical adult responsibilities aren’t evenly shared. If one partner has difficulty committing to or making plans, or sharing typical responsibilities, this can be a sign of Peter Pan syndrome.
If the other partner seems to try and do everything for them by taking on more or all responsibilities and decision-making, this can be a sign of what is referred to as Wendy Syndrome. While not an official diagnosis, Peter Pan and Wendy Syndrome can lead to breakdowns in communication, feelings of resentment, as well as additional stress and worry.
How can counselling help with relationship issues?
Relationship counselling can help you not only improve your relationship but also improve the way you relate to and understand those around you. Working with a relationship therapist can help you to break free from old, unhealthy patterns of behaviour, and to find new ways of expressing yourself and your feelings.
As counsellor Linda Boutet explains in their article, Relationships and our sense of self, “Counselling gives us space to be the truest version of ourselves, offering us the opportunity to look at what we, as individuals, really want from our relationships.
“It offers us the opportunity to explore our past and current experiences of being close to others, whilst working to strengthen our own sense of self, so we no longer feel bewildered by the relationships we choose. Counselling can lead us to a greater sense of ourselves in the world we live in, and a deeper understanding of our relationships”
Relationship issues can be attended to as an individual, or in the form of couples counselling, a type of counselling that utilises talking therapy in a way that is designed to help two people. It really depends on you, and what it is you want to gain from counselling.
Sometimes, a relationship can leave you feeling crowded and like you’ve lost your sense of self – you may benefit from individual sessions, to have the opportunity to talk in a safe space, free from judgement. Other times, you may both benefit from talking in a zone that is out of your usual lives – somewhere private, safe and completely neutral. It may not always be an issue in the relationship, but if one of you is struggling, it could be negatively impacting your partner and in turn, your relationship.
Trust, respect and communication are three key factors that lead to a successful, happy relationship. When something happens that changes or impacts one of these factors, the relationship can start to break down. Sometimes relationships aren’t meant to be and you separate, and that’s OK. If you want to work through it and rebuild your bond, that’s OK too.
Counselling can help you work through a breakup or separation, help you rebuild a relationship and help you better understand yourself.
Does relationship counselling work?
As with all types of therapy, relationship counselling requires you to feel ready to admit that there may be a problem, and be willing to try and work towards talking about and trying to fix any issues. Relationship counselling aims to help you to better see and understand what is happening in your relationship, to figure out what you would like to be different, and enable you to start making those changes to get your relationship to where you want it to be.
Couples counselling can help you to gain new perspectives about each other and your relationship, but it isn’t a magic cure. You will need to put in the time, be honest, open, and brave, as you will likely be discussing issues that you both feel strongly about, in ways that may feel uncomfortable as you work through them.
Almost everyone experiences stress from time to time and, while a small amount of stress can motivate us, too much or prolonged stress can be damaging to both our physical and mental health. For some people, stress causes them to adopt unhealthy coping methods such as smoking or drinking – and while this may feel like a quick fix, ultimately these are only covering the issue.
What is stress?
Stress is an innate reaction resulting from our caveman days. Humans had to deal with threatening situations, which caused our brains to release a range of ‘stress chemicals’ such as cortisol and adrenaline to provoke what is known as the fight-or-flight reaction. The fight reaction would give us a burst of energy, ready to fight for our lives, while the flight reaction would encourage us to flee from danger and protect ourselves. These days, we rarely encounter threatening situations, however, our brains continue to react in this way when we are under pressure.
Stress typically begins as pressure – from ourselves or others – and if we are unable to cope with this pressure, we feel stressed. The effects of stress will differ from person to person but, if left untreated, it can lead to illness.
When we experience pressure without an option for fight-or-flight, the stress chemicals can build up and affect our immune system and blood pressure. Over time, this build-up of stress can affect our mental health, too, leading to anxiety, depression and other mental health problems.
Causes of stress
There are many things in life that can cause stress, including work, relationships, family issues and financial problems. Many other situations can cause stress, and the causes will depend on the individual – what may induce stress for one person may not be stressful for another. Having said this, most stressful situations are associated with change or a lack of control. Even if the change is a positive one, it can still be stressful.
Some common causes of stress include:
- getting married
- moving house
- having a baby
- serious illness
- bereavement
- divorce
In some cases, the absence of change or activities in life can be a source of stress. As well as events like these, stress can also be caused by long-term circumstances, such as:
- being unemployed
- having financial issues
- relationship difficulties
- caring for a disabled family member/friend
- problems at work
Stressful events outside the norm of human experiences, such as being abused, may lead to post-traumatic stress disorder (PTSD).
Recognising what causes you stress and learning how to manage these feelings effectively, ultimately, is the healthiest and most effective way to feel good and live a happy life.
Symptoms of stress
Stress is experienced individually and some personalities find themselves more susceptible to stress than others. Having said this, there are certain symptoms that are commonly associated with stress. These can affect us both emotionally and physically.
Emotional stress symptoms
- feeling agitated, frustrated or quick to anger
- feeling overwhelmed and teary
- feeling anxious
- having a low sense of self-esteem
- avoiding other people and social situations
Physical stress symptoms
- using alcohol/drugs/food to seek comfort
- difficulty sleeping
- digestive problems and upset stomach
- feeling dizzy
- sweating excessively
- experiencing chest pains or palpitations
Why does stress affect me physically?
The physical side effects of stress occur when the body prepares to respond to a threat. This is due to the hormones that are released by your brain during the fight or flight response. These hormones can:
- make you feel more alert, so you can act faster
- make your heart beat faster to carry blood quickly to where it’s needed most
Then, when you feel the danger has passed, your body releases other hormones to help your muscles relax, which may cause you to shake. If you’re often stressed, it’s likely you are producing high levels of these hormones, which can make you feel physically unwell and could affect your health in the longer term. People’s tolerance to stress differs, meaning for some, the effects will be severe but for others, they will be manageable.
When should I seek help for stress?
The issue with stress is that it exists as a problem that feeds on itself, and over time lowers your ability to cope. Because of this – the sooner you seek help for stress, the better. As stress is often viewed as simply a ‘part of life’, it can be difficult to know when outside support is needed.
As a rule, you should look to seek help if the following is happening:
- Stress (and the effects of stress) dominate your life.
- Stress is affecting your physical health.
- You are using unhealthy coping methods to deal with stress.
- You are experiencing angry outbursts that are affecting those around you.
Counselling for stress
Recognising the negative effect stress is having on your life, and understanding that this is not OK is an important first step. Once you have admitted to yourself that you need support, you can look into the various treatments available. Your first port of call may be your GP, who will be able to assess your stress levels and suggest appropriate treatments.
One recommendation commonly offered by doctors is counselling and psychotherapy. Talking with a professional about the difficulties you’re experiencing can help you understand any underlying issues that may be causing your stress – for example, low self-esteem. Working with your counsellor, you will then be able to identify your personal stress triggers and discuss ways of coping with them.
Mindfulness
One form of therapy recommended for those struggling with stress is mindfulness. This approach comes from a Buddhist meditation technique and focuses on paying attention to the present moment, rather than worrying about past or future events. Whilst focusing on the present moment, you are encouraged to notice how your body is feeling and what thoughts come and go, without judgement.
From the theories of mindfulness, more specific therapies have been devised:
- Mindfulness-based stress reduction (MBSR)
- Mindfulness-based cognitive therapy (MBCT).
MBSR aims to help lower stress levels through meditation techniques and moment-to-moment awareness. MBCT uses similar techniques, however, it also looks to identify negative thought processes that can contribute to conditions, such as anxiety and depression. The National Institute for Health and Care Excellence (NICE) recommends MBCT for those with recurrent depression.
Tips to manage stress
As well as the above treatments for stress, there are things you can do yourself at home to help manage your stress. Mental health experts agree that the following tips can help ease everyday stress.
Know your stress triggers
If you’re not sure what it is that’s causing your stress, it might be helpful to keep a diary and note down any stressful episodes over the course of a couple of weeks. Aim to include as much information about your experience as possible, including the time and place, what you were doing, what you were thinking about, how you felt physically and a rating out of 10 for how stressed you felt.
Using this diary, you can figure out what your stress triggers are, how you cope with pressure and how you could potentially change your reactions.
Look after yourself
This means getting enough exercise, eating well and taking time to relax. Health professionals agree that exercise is a useful tool when tackling stress as it releases ‘feel-good’ endorphins, helping you to physically and mentally de-stress. Eating well is another important factor. Eating an unhealthy diet puts your body under physical stress, which can exacerbate any emotional stress you may be feeling.
Taking time to relax is a key part of self-care and is essential if you want to reduce stress. Aim to dedicate a certain amount of time every day to relax, whether that be meditating, practising yoga, reading, or simply being quiet with your own thoughts.
Avoid unhealthy habits
When we are stressed it is easy to rely on unhealthy habits to make us feel (temporarily) better. Such habits may include smoking, drinking, taking drugs or even over-eating. In the long-term, these habits will only create new problems and as they don’t directly tackle the cause of your stress, meaning you will continue to feel the effects.
Connect with others
When we are stressed it can be tempting to hide away from the outside world and avoid social contact. But, this can lead to us feeling isolated and even more stressed. Being able to talk through your difficulties with other people – friends, family, co-workers, or a qualified professional – can be a good step toward reducing your stress levels.
They might be going through something similar to you, so it can help you feel more connected and may even help you view your concerns in a different light. You may also find that you are able to swap tips and ideas about stress management – in many cases, the release of talking about your concerns can be enough to reduce stress.
Take control
One of the main reasons people feel stressed is because they feel as if they don’t have control of a situation. While it is impossible to always be in control, you can choose to control your approach to a situation. If you remain passive in your thinking (i.e. “I can’t do anything about my problem”) it is likely that your stress levels will continue to build. If however, you choose to accept your problem and look to find a solution to it (which may involve you reaching out for help), you will begin to feel more in control.
Accept what you cannot change
If a difficult situation arises and there is nothing you can do to change it, take a step back and accept this. Recognise that there are some things in life you cannot control. Instead, try to focus on what you can control.
Relaxation techniques
Relaxation is an essential part of stress management. There are many different relaxation techniques that you can try, many of which focus on relaxing your body and controlling your breathing. In preparation, look to set aside a specific time each day to relax and stick to this schedule and, if you can, choose a quiet place away from distractions.
Here is a relaxation exercise you can try:
- Have a good stretch and sit/lie in a comfortable position.
- Working from your toes up to your head, identify any areas of tension.
- Notice these areas and consciously relax your muscles.
- Breathe deeply and picture a peaceful scene.
- If you find yourself getting distracted, count your breaths.
What should I be looking for in a stress counsellor?
Currently, there are no official rules or regulations stipulating what level of training a counsellor dealing with stress needs. There are, however, several accredited courses, qualifications and workshops available to counsellors to improve their knowledge of a particular area, so for peace of mind, you may wish to check to see if they’ve had further training in issues regarding stress. The NHS recommends self-help stress management support groups and/or counselling to help cope with stress.
Psychological trauma typically occurs after a particularly distressing event or a series of enduring events. Experiencing trauma can affect your mental health, leading to you feeling unsafe and on high alert.
There are different severities of psychological trauma, some symptoms are mild and may go away with time, while others can be more severe (such as PTSD) and will require professional treatment. When it comes to trauma, the sooner you seek help the better.
Having a traumatic experience or witnessing stressful events can have a profound impact on our psychological and emotional well-being. If you’ve ever felt that your life or safety has been put at risk, it can shatter your sense of security.
The important thing to remember is that there are many different causes of trauma. It’s not the circumstance or event in itself that signals trauma, but what your emotional experience was of the event. Trauma affects people in different ways and, for some, the symptoms take weeks, months or even years to surface.
Regardless of its source, an emotional trauma contains three common elements:
- it was unexpected
- the person was unprepared
- there was nothing the person could do to prevent it from happening
What is psychological trauma?
Psychological trauma usually occurs after a particularly distressing event or a series of events. The result of this can lead you to feel overwhelmed and unable to cope. These events are typically so far outside what we expect and what we believe that our reactions can seem somewhat unusual or even disturbing. Reactions like this are normal though and should be expected after trauma.
The most common term used to describe the symptoms of psychological trauma is post-traumatic stress disorder or PTSD. Categorised as an anxiety disorder, PTSD occurs after a traumatic event and refers to ongoing, severe symptoms such as flashbacks and insomnia. Not everyone who experiences a traumatic event will go on to develop PTSD.
Causes of trauma
As previously mentioned, trauma is subjective and can have a variety of causes. The common factor for events that lead to trauma is that they are not anticipated and are outside the realms of what we deem to be acceptable – physically, emotionally or socially.
Below are some examples of events that could lead to psychological trauma.
Abuse
This can refer to physical, emotional, sexual or verbal abuse. Anything that can be described as improper treatment that leads you to feel violated in some way constitutes abuse. The traumatic event could be a one-off attack or a recurring form of abuse that takes place over long periods of time.
Accidents
Being involved in an accident can lead to a traumatic response. Examples include car accidents, a bad fall and accidentally harming someone else. Even if you were not physically harmed by the accident in question, being involved and experiencing the event can still lead to traumatic feelings.
Brain tumour and brain injury
Injuries and cancer of the brain can be catastrophic for both the person affected and those around them. In some cases, such injuries and illness can alter personalities or affect key motor skills – both of which can lead to symptoms of psychological trauma.
Catastrophic events
This can relate to natural disasters such as earthquakes, tsunamis and hurricanes as well as man-made events like war and bombings. Being involved in these kinds of events can affect you both directly and indirectly.
Physical injury
Some physical injuries can change your life forever. You may have had a limb amputated and need to learn to cope with your new disability, or you may be left with physical scarring and chronic pain. Either way, this kind of trauma often requires a great deal of emotional support alongside physical rehabilitation.
Bereavement or terminal illness
Whether it’s yourself or someone close to you who has been diagnosed with a terminal illness, traumatic symptoms are often experienced. Equally, when someone close to you passes away (whether it’s expected or unexpected) you can start to question your belief system and shut down emotionally.
Violence
Experiencing violence in any way can be traumatic. Whether you’ve been the victim of physical violence, threatened with violence or even witnessed violence – you could find yourself suffering from symptoms of psychological trauma.
Symptoms of trauma
Symptoms of trauma vary from person to person and depend on the severity of the event. These symptoms can last anywhere from a couple of days to decades if treatment isn’t sought. Some people also find that they do not notice any symptoms immediately after the event as they can often occur sometime later.
The longer your trauma symptoms go untreated, the more psychological damage they could cause. Therefore, it’s important to know when to seek professional help.
Some common symptoms of psychological trauma include:
- Flashbacks – When you re-experience the traumatic event mentally or physically.
- Insomnia – After a traumatic experience it is common to have difficulties sleeping due to nightmares or mentally going over details of the event.
- Anxiety – Feeling constantly anxious after a trauma is very common. Sometimes these feelings turn into anxiety disorders such as PTSD or panic attacks.
- Stress – Even if you handled stress very well before your experience, many people find stress harder to manage after a traumatic event.
- Anger – Feeling angry after a trauma is very common. You might be angry at the person who traumatised you, at the event itself or even at the world. This can lead to outbursts and other anger management issues.
- Depression – Many people fall into a depression after experiencing something very distressing. You can be left wondering why the event happened to you – leading to dark moods and in severe cases, suicidal thoughts.
- Loss of self-esteem – It can be easy to lack self-belief and self-confidence after you have experienced something traumatic. You can be left questioning your identity and what you have to offer the world.
- Self-medication – For some, the only way they feel they can deal with what happened is by self-medicating with alcohol or drugs. This leads to very self-destructive behaviour and can isolate you from friends and family.
- Emotional detachment – For some, the emotions brought up are so severe that they cannot deal with them at all. This can lead to emotional numbness, also known as dissociation. You may refuse to deal with any psychological issues you have and could appear cold and distant to others.
Hypervigilance
Something those who have experienced trauma may notice is hypervigilance. This is when your brain becomes highly attuned to potential danger, constantly on the lookout for something bad to happen. You may notice you jump easily at sudden sounds, have a high heart rate and even higher blood pressure. This can cause unhelpful reactions and behaviours.
Like other symptoms of trauma, hypervigilance can be reduced with the help of a professional. Working with a counsellor can help you become more aware of your hypervigilance so you can seek out alternative reactions that support your well-being.
Medical trauma
Medical trauma refers to any negative or traumatic experience that occurs in a medical setting. Trauma in this instance might be illness, pain, procedures or distressing treatments. This type of trauma can be particularly difficult to deal with as it may lead people to avoid seeking medical help. This might further heighten symptoms.
There are several causes of medical trauma. Here are a few examples:
- Birth trauma. According to the Birth Trauma Association, 4-5% of people who give birth experience PTSD. This may be due to having an emergency c-section or a baby being admitted to intensive care immediately after birth, for example.
- Heart attacks. Many people that experience a heart attack may go on to develop PTSD symptoms.
- Cancer. PTSD is common in people who have had cancer. Many worry about cancer returning.
Childhood trauma
Similarly to adults, when a child feels intensely threatened by an event, they experience trauma. This kind of trauma in childhood, otherwise known as adverse childhood experiences (ACEs), can have a severe and long-lasting effect on our well-being. Particularly when childhood trauma is not resolved, a sense of fear and helplessness carries over into adulthood, setting the stage for further trauma.
There is a range of traumatic events or trauma types to which children and adolescents can be exposed to, including:
- sexual, physical or emotional abuse
- bullying
- bereavement
- neglect
- witnessing or experiencing violence
Find specific advice and support for child-related issues on our dedicated fact sheet.
Even if your trauma happened many years ago, there are steps you can take to overcome the pain and learn to trust and connect to others again. Trauma therapy is one option that can help you regain your sense of emotional balance.
When to seek help
No matter how major or minor you think your experience was, you may benefit from professional help. As we all react differently to these types of events, it’s important not to compare yourself to other people, even if they went through the same experience.
By getting help as soon as you need it, you will be giving yourself the best chance to overcome any issues and move on with your life. If you’re experiencing any of the symptoms on this page and they are persisting for weeks or even months, be sure to seek help.
It is especially important to get help if you experience any of the following:
- You feel unable to function in day-to-day life.
- You are unable to form or maintain relationships.
- You are self-medicating with drugs and/or alcohol.
- You are experiencing severe flashbacks.
- You feel emotionally numb.
- You are suffering from an anxiety/stress disorder due to trauma.
Treatments for trauma
There are many different treatment options for those going through psychological trauma – the key is finding a treatment that works best for you.
Treatments generally involve acknowledging and processing trauma-related memories while releasing any pent-up fight or flight energy. Learning how to regulate strong emotions and building an ability to trust again is also essential.
The type of treatment you receive will depend on a number of factors, including the kind of trauma you experienced, your personality and your counsellor.
Cognitive behavioural therapy (CBT)
One of the most popular therapies used by counsellors today, CBT looks at changing the way individuals think and how they react to these thoughts. Trauma-focused cognitive behavioural therapy (CBT) helps to process and evaluate thoughts and feelings about the trauma. This treatment is often paired with other physiological therapies, such as Somatic Experiencing, to ensure all elements of the trauma are addressed.
Eye movement desensitisation and reprocessing (EMDR)
EMDR is a type of therapy that incorporates side-to-side eye movements, hand tapping and auditory tones to help you recall and ‘unfreeze’ traumatic memories. It isn’t possible to erase traumatic memories entirely but the process of EMDR can alter the way these memories are stored within the brain – making them easier to manage.
Particularly helpful for those who have repressed any traumatic memories, EMDR addresses both psychological and physiological issues.
Somatic experiencing
This approach taps into the body’s ability to hold emotions, including trauma. The therapy looks at what’s happening in the body by getting in touch with trauma-related tension. At this point, your therapist can help you tune into your body’s reactions and help you process the trauma physically.
Counselling for children struggling with their mental health provides a safe, confidential space that can help them express and understand their emotions.
Just like adults, children have worries and anxieties. There are many things that can affect a child, and at different ages. While these are a normal part of growing up, if it’s starting to affect their overall health and well-being, extra support may be needed.
When worried about something, like an exam or presentation, most of us will calm down and feel better after the event is over. But for some people, this feeling doesn’t go away. When the panic stays or grows even stronger, anxiety can become a problem. For children, this can be very scary and confusing. According to Young Minds, one in six young people will experience anxiety.
More than just feeling sad, depression is a mental health condition that leads to low mood and loss of enjoyment in things that used to bring joy. Growing up can be tough and, for some young people, the stressors they face can lead to depression. There are also genetic components at play, so if other members of the family have depression there may be more chance of a young person developing it.
Anxiety in children
Anxiety in children becomes a problem when it affects their daily life. Because it’s a normal reaction, a parent may not know what their child is feeling, and so the severity of the anxiety is not always clear. Also, there are many times a child will experience anxious feelings throughout their childhood. For example, between eight months to three years, separation anxiety is common. This is, however, a normal stage in a child’s development, and tends to ease off at around two years. It’s when the feelings don’t go away that further steps need to be considered.
Young children experiencing anxiety may not understand their feelings, or know how to express them, so it’s important you know the signs to spot.
What are the signs of anxiety in a child?
Common signs include:
- irritable, clingy or tearful behaviour
- difficulty sleeping or waking in the night
- nightmares
- lack of confidence
- lack of concentration
- loss of appetite
- avoiding everyday activities, like socialising or going to school
Depression in children
Depression is a mood disorder that often develops alongside anxiety. While it’s normal to feel down some of the time, when sad thoughts are lasting a long time or stopping someone from enjoying life, it can help to talk to someone – like a professional.
Depression is one of the most common mood disorders. In fact, the NHS suggests that almost one in four young people will experience depression before the age of 19.
Many signs of depression are similar to when a person feels sad, so it can be difficult to know when there is a problem. But if you think your child is depressed, it’s important to seek help as early as possible.
What are the signs of depression in a child?
Common signs include:
- sadness, or low mood lasting a long time
- being irritable or grumpy
- they’re always tired
- having trouble sleeping
- isolating themselves from friends and family
- low confidence
- talking about feeling worthless or guilty
A child may also show physical signs, such as feeling sick or having headaches.
Other mental health problems
It’s common for those experiencing depression to be experiencing another mental health problem. Coping with a mental health problem can be extremely difficult and affect a person’s life greatly, so it’s often thought this can trigger depression. Mental health problems linked to depression and anxiety may include:
Eating disorders
Some people have problems with eating and may use food as a way to deal with difficult emotions. Eating disorders are different. They are complex mental illnesses that require specialist treatment. Young women (aged 12 to 20) are more likely to develop an eating disorder, but anyone, regardless of age or gender, can develop one. While serious, eating disorders are treatable and full recovery is possible.
Self-harm
Self-harm is purposely causing yourself harm, usually as a way to cope with difficult emotions. It’s said that the majority of those who self-harm are aged between 11 and 25, but anyone can be affected. While the cycle of self-harming can be difficult to stop, help is available.
Obsessive-compulsive disorder (OCD)
OCD is an anxiety-related condition, where people have obsessional thoughts, followed by compulsive urges. People can experience OCD differently, and at varying severity. It can leave you feeling helpless, and as if it’s taking over your life. However, treatment is available and there are methods you can learn to help you cope.
What can you do to help your child?
If you think your child may be depressed, or experiencing anxiety, it’s important you talk to them. They may not understand what they’re feeling or know how to talk about it, but reassure them that you’re there and that they can talk to you when they’re ready.
Don’t judge what they say, or make it seem like it’s not important. Whatever is causing the problem is affecting them, so take it seriously. Then, together you can talk about overcoming the problem. Reassure them that it’s OK and they won’t feel like this forever.
If they don’t want to speak to you, let them know you’re there if they need you, but encourage talking to someone else. Speaking to someone they trust – outside of their immediate family – can be just as beneficial. Suggest talking to a friend, a grandparent, or a teacher. If you’re worried about their health, make an appointment with your GP. They can access the situation, speak to your child and if necessary, refer your child for specialist help.
For younger children, look at how they’re playing. Children may find it difficult to express themselves verbally, but they’re masters at expressing themselves through play. If they’re particularly stressed or upset for example, you may notice lots of fighting with their toys. Ask them about this – observing their play and commenting on the fights can help your child to open up and help you understand what’s bothering them.
Counselling and further support
Sometimes, talking about how they feel is enough to make someone feel less overwhelmed. But if your child’s health is being affected – both mentally and physically – then further support may be needed. As a parent or caregiver, it’s difficult to accept that extra support is needed, but it’s OK. Reaching out for support is admirable and nothing to be ashamed of. If you’re worried about your child, you will take the necessary steps to help them enjoy life again – sometimes, this means talking to a counsellor.
A counsellor is someone who can listen to how your child feels. They can help them understand their emotions and teach them the steps to cope.
Free resources for anxious kids
We’ve created some free resources for parents, teachers and of course kids themselves to get a handle on anxiety. Take a look through our guides, activities and articles which all aim to support children struggling with worries and anxiety.
Activities
- How to use the worry tree – an explanation for kids
- Worry tree activity
- Worry tree activity (coloured)
- Mindful colouring bookmarks
Resources
- Anxiety in children – a factsheet for parents
- Anxiety in children – a factsheet for teachers
- Worries and anxiety – a factsheet for kids
- Happiful kids YouTube – anxiety playlist
- Explaining anxiety (comic)
- Let your worries fly free (comic)
- Relax with mindful colouring (comic)
Articles
- Can mindful colouring help calm anxious kids? (article)
- Five must-read books for anxious kids (article)
Videos
In the UK, there are over 14.1 million people with a disability, impairment or limiting long-term illness. On this page, we will look further into the types of disability. We will explore the options available to help people cope with and better manage their condition, including disability counselling.
What is a disability?
The World Health Organisation (WHO) describes ‘disability’ as a term that refers to a huge spectrum of impairments, activity limitations and participation restrictions. Around 15% of the world’s population (over 1 billion people) currently experience disability at some point during their life according to WHO, with numbers increasing due to ageing populations and non-communicable diseases.
Disability is the result of an interaction between an individual with a health condition (e.g. depression, anxiety, cerebral palsy), personal and environmental factors (e.g. public transport that is inaccessible, negative attitudes or perceptions from themselves or others), and limited social support. Environment can have a huge impact on the experience and extent of disability, as an inaccessible environment creates barriers that stop individuals from accessing parts of society that others can.
An impairment is classed as a problem in body function or structure. An activity limitation is something that causes difficulties when undertaking a task or action. While participation restriction causes difficulties when undertaking day-to-day tasks.
An impairment doesn’t have to necessarily be a diagnosed medical condition, but it needs to have a substantial, long-term adverse effect on your ability to carry out day-to-day activities. For example, stress could lead to mental impairments such as difficulty concentrating, extreme tiredness, or sleep issues. An impairment may not stop you from doing something completely, but it will make things harder by, for example, causing pain or taking longer.
Equality Act 2010
The Equality Act replaced the Disability Discrimination Act (DDA) in October 2010. The Act compiles a number of different discrimination laws into one. It enforces laws that protect disabled people from being treated unfairly and applies in many situations, including:
- education
- employment
- access of facilities
- goods
- transport
- services
Under the Equality Act 2010, you are disabled if you have a physical or mental impairment that has a substantial or long-term effect on your ability to carry out daily activities. If you have a progressive condition (a condition that worsens over time) you can be classed as disabled. However, you will automatically meet the disability definition from the day you are diagnosed with cancer, multiple sclerosis (MS) or HIV.
If you are in Northern Ireland, the Equality Act 2010 does not apply. If you would like to find out more information on the Equality Act, take a look at this article on the Disability Rights UK website.
When is the right time to seek help?
Whether a disability develops early or later in life, there are many avenues of support available, both for the individual and the family.
For those who are unable to work, there are several kinds of benefits available, as well as people on hand to help claim for them. The NHS also provides a range of support services to help manage disabilities. For those studying, universities often offer a student services team. This can help the individual get the right support throughout their studies, whether that is accommodation help or learning support.
There is also support available for those caring for someone with a disability. Particularly in the case of severe disabilities, it is important that the carer is able to have a break. There are centres all over the country, where carers can go to meet other carers and take some time out. Many charities provide support for carers, as well as people with disabilities.
Disability counselling
There are a number of avenues that you can explore to help manage your situation. Disability counselling in particular can provide support to people with disabilities, as well as their partners, family and carers.
Living with a disability can be a long journey, both mentally and physically. It can be just as tough for those who live with or care for a disabled person. Friends and family may too find it difficult to come to terms with the condition, as well as adapting to a lifestyle that involves new challenges. You may find disability counselling beneficial if you are suddenly classed as disabled as a result of an accident. Similarly, if you have a serious health condition, such as cancer, it can provide some of the support you may need.
It can often lead to low social support and financial hardship. These experiences can then be linked to mental health problems, such as depression and anxiety. Counselling can help to address these issues, as well as helping you cope better with the disability and adapting to the changes it brings. The aim of disability counselling is to provide a safe and supportive space for you to discuss your concerns and fears. A trusted professional will be there to help you explore ways of making these more manageable.
Types of disability
A disability can be any physical, cognitive, sensory, emotional or developmental condition that hampers or reduces a person’s ability to carry out everyday tasks. In some cases, people may have a combination of some, or all of those mentioned above. A disability can be present at birth or occur later in life, depending on the nature of the condition.
Physical
A physical disability can either temporarily or permanently affect an individual’s mobility and/or physical capacity. Such disabilities include muscular dystrophy, epilepsy, ME, spina bifida, a spinal cord or brain injury or cerebral palsy.
Sensory
A sensory disability can affect one or more of an individual’s senses, such as touch, taste, smell, sight, hearing and spatial awareness. Hearing loss, blindness and autism all fall under the ‘sensory disability’ category.
Mental health
Disabilities that affect an individual’s mental health include obsessive-compulsive disorder (OCD), depression, bipolar disorder and schizophrenia. These fall under the Equality Act 2010 as they can affect the way a person thinks and behaves and can restrict their ability to carry out daily tasks.
Learn more about mental health and disabilities.
Learning
A learning disability is a disorder of an individual’s central nervous system, which affects their learning process. People with a learning disability may need support to develop new skills and understand complicated information. But, it doesn’t mean that the individual is incapable of learning, it just means they learn in a different way.
Chronic
The Equality Act 2010 states that for a person to meet the definition of ‘disability’, the impairment will have had a substantial and long-term effect on the person’s ability to carry out everyday tasks. For the purpose of deciding whether a person is disabled, a long-term effect is one that has lasted at least 12 months; the total period it’s due to last is likely to be at least 12 months, or the effect is likely to last for the rest of the person’s lifetime.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat someone with a disability. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines, including:
- For patients with initial presentation of moderate depression and a chronic physical health problem, professionals must offer a choice of high-intensity psychological interventions, such as group-based CBT, individual CBT or behavioural couples therapy.
- Patients with depression and a chronic physical health problem should be informed about the national resource, self-help groups and support groups available.
Read the NICE guidelines on depression and disability
The NHS also provides information on living with a disability. This includes what care and support are available, working with a disability and caring for older relatives.
Domestic abuse (also known as domestic violence) can involve physical, emotional, mental, financial and/or sexual abuse. Usually, it happens with someone you are close to, either within a romantic relationship or family setting. Abuse can affect anyone, regardless of age, gender or social background.
According to Her Majesty’s Inspectorate of Constabulary (HMIC), the police in England and Wales receive over 100 domestic abuse calls every hour. But, because domestic violence tends to happen behind closed doors, it’s hard to know exactly how many people are living in a domestically violent environment.
Here we’ll take a deeper look into the subject of domestic abuse, including how to recognise the signs, deciding to leave, and moving on. Whether you’re reading this because you believe you may be in an abusive relationship or you’re worried about someone else – know that support is available.
What is domestic abuse?
Domestic abuse charity Women’s Aid define this type of abuse as “an incident or pattern of incidents of controlling, coercive, threatening, degrading and violent behaviour, including sexual violence, in the majority of cases by a partner or ex-partner, but also by a family member or carer.”
There can be many forms of abuse used within a domestically violent relationship, including physical abuse, emotional abuse, mental abuse, sexual abuse and financial abuse.
Physical abuse
Physical abuse is when the perpetrator uses physical violence to hurt you. This may include hitting, kicking, pulling hair, controlling medication and/or destroying personal property. This is the type of abuse most commonly associated with domestic violence, likely because it can be the easiest to notice.
Emotional abuse
This is when someone consistently uses manipulative techniques to make you feel a certain way and ultimately control you. This could involve someone putting you down, calling you names, blaming you for the abuse, controlling what you do and who you see and/or intimidating you. Over time this wears down a person’s sense of self, making it difficult to know how/when to reach out for support.
Mental abuse
Also known as psychological abuse, mental abuse is when the perpetrator seeks to distort your sense of reality. This may include gaslighting, making you think you’ve said/done things when you haven’t, and gradually eroding your sense of self-trust.
Sexual abuse
This is any form of sexual activity that happens without your full or informed consent. This includes rape, sexual assault and sexual exploitation. In some cases this can involve someone withholding their partner’s contraception or forcing them into sexual practices they find degrading.
Financial abuse
This is when someone controls your money, including the way you acquire it, manage it and use it. Someone might spend or take your money without consent, stop you from working to earn money, build up debts in your name and/or damage your possessions or property.
The common thread running through all of these is the element of control and power that’s held by the abuser. Often an abuser will use these tactics to control you and keep you within the relationship.
One of the most important things for you to do is to recognise that what you’re experiencing is abuse and that you deserve help.
Recognising signs of abuse
Educating yourself on the different ways abuse can manifest is an important first step in changing your situation. You don’t have to live like this. Abuse can take many different forms and every situation is unique, however, there are some common signs of abuse you may well recognise:
- verbal abuse and criticism (shouting, name-calling, threatening, mocking)
- guilt/pressuring tactics (threatening self-harm or suicide, taking away your phone/laptop, threatening to call the authorities on you, lying to friends and family about you)
- putting you down (disrespecting you in front of others, not listening or responding to you when you talk)
- isolation (monitoring or blocking your connection with others, stopping you from leaving the house, telling you where you can and cannot go)
- lying to you (breaking promises, having affairs, often blaming you)
- threats (physically or verbally threatening you)
- sexual violence (using force, threatening you to perform sexual acts, forcing you to have sex with other people)
- physical violence (hitting, kicking, pushing, restraining you)
- denial (making you think you’re imagining the abuse, saying they can’t control their anger, appearing charming/calm in front of others, begging for forgiveness)
Domestic abuse against men
Statistically, it is more common for women to be affected by domestic violence, but it’s important to note that men can be victims too. We don’t truly know how many men are affected as, with any form of abuse, it can be difficult to talk about.
The situation is awful for both women and men, however, men may face the additional stigma of not wanting to appear as a ‘victim’ or even worrying that no one will believe them. Whatever your gender identity, it’s important to know that abuse is never OK and is never your fault.
Barriers to leaving an abusive relationship
When talking about domestic violence, a question can often hang in the air: Why don’t they leave the relationship? This seemingly innocent question implies that deciding to leave an abusive relationship is easy when nothing could be further from the truth. This question also leans towards victim-blaming, when the victim, rather than the abuser, is blamed for the situation they’re in.
Here we look at some of the barriers that can hold people back from leaving relationships to acknowledge that it is not easy but also discuss how it can be done.
Shame or denial of abuse
Your abuser may be well-liked in the community and make you feel like you cause the abuse. This can lead to feelings of shame and embarrassment. Your abuser may even minimise or deny that the abuse is happening, making you feel like you’re making a fuss over nothing.
Fear of further violence
Leaving an abusive relationship can be dangerous. You might be worried that your abuser will become more violent towards you and even that your life is at risk.
Fear of being alone
Abusers often isolate their victims, cutting off contact between them and friends and family. You might worry that you have no one to turn to when you decide to leave or that you’ve become too reliant on your abuser.
Low confidence
Abusers are experts at chipping away at self-worth. This can lead you to feel incredibly low in confidence and unable to make decisions. You may be suffering from trauma too, clouding your judgement and ability to cope.
Practical reasons
If an abuser controls every aspect of their victim’s life, leaving can be practically very hard. You may not have financial independence. You may have children you are worried about or, if you have an unsecured immigration status, fear you’ll be deported.
Lack of support
A running thread through all of these barriers is a lack of support. You may feel as though you have no one who can help you, or perhaps you’ve tried to get support before but had a bad experience.
It’s helpful to understand these different barriers and show yourself some compassion. You are in an incredibly difficult position and you should not blame yourself for your circumstances. Asking for help isn’t always easy, but it’s the best way to find the support you need to make your decision.
Leaving an abusive relationship
If you decide you want to leave, know that you are not alone in this and that it is not your fault. An excellent first step is to get advice from a dedicated domestic abuse organisation such as Women’s Aid or Refuge for women, or the Men’s Advice Line for men.
When making plans to leave, take care of who you tell to ensure your abuser doesn’t find out. Women’s Aid has put together some helpful advice for anyone looking to leave a domestic violence environment (whatever your gender).
Rebuilding life after abuse
Once you have left your relationship, it’s understandable for there to be mixed emotions. You may feel a sense of loss and sadness, guilt, overwhelm and/or anger. You may blame yourself and think you could have ‘worked harder’ to make the relationship succeed or feel as if you are ‘weak’. Of course, the truth is, you have been exceptionally courageous and strong.
Rebuilding life again after relationships like this can be hard. The traumatic nature of abuse can lead you to experience flashbacks and you may even develop post-traumatic stress disorder (PTSD). Your sense of self-worth and confidence may be in tatters, leaving you feeling overwhelmed and afraid to move forward.
Counselling for domestic abuse
The reactions and emotions following abuse can be overwhelming and difficult to navigate. To gain some support through this, many people are recommended to have counselling. Remember, a counsellor can work with you at any stage of your journey, whether you’re out of the relationship or still in it.
Counsellors can work with you to help you recognise signs of abuse and help you understand your own behaviours/way of thinking. There are many different techniques and approaches that may be able to support you, from assertiveness and grounding techniques to CBT to improve self-esteem.
You have all the strength and courage within you to move forward with your life, but there is no shame in asking for a helping hand to get there.
What should I be looking for in a counsellor or therapist?
Currently, there are no official rules or regulations in place that stipulate what level of training a counsellor dealing with domestic abuse needs. However, it is recommended that you check to see if your therapist is experienced in this area. A Diploma level qualification (or equivalent) in abuse counselling or a related topic will provide assurance and peace of mind that your counsellor has developed the necessary skills.
Another way to assure they have undergone this type of specialist training is to check if they belong to a relevant professional organisation representing counsellors dealing with domestic abuse.
We all worry about our health from time to time. However, when it’s when these worries start to take over your life that things become problematic.
What is health anxiety?
Being concerned about your general health and well-being is normal. In fact, worrying about our health can sometimes even be helpful. It can lead to us living a healthier lifestyle, such as trying to give up smoking or eating a healthier, balanced diet.
For the purpose of diagnosis, health anxiety can be split into two different disorders:
- Somatic symptom disorder (SSD)
- Illness anxiety disorder (IAD) – formally known as Hypochondriasis
The difference between these conditions is subtle and, sometimes, both may be present. For this reason, health anxiety is a common term used to discuss a range of symptoms.
Somatic symptom disorder
If someone experiences somatic symptom disorder, they may mistake normal bodily functions as a symptom of illness. This is not to say that their symptoms are not real. For example, commonly experienced symptoms may include tiredness or pain – but the person’s reaction to the symptoms is extreme.
Illness anxiety disorder
If someone experiences an illness anxiety disorder, they may be overly preoccupied with a specific disease or illness. They may have no physical symptoms whatsoever. Instead, they may confuse normal bodily processes such as sweating or bloating, as a sign of the onset of the illness they are most fearful of.
Hypochondria
Another common term used synonymously with health anxiety is hypochondria. You may have heard of the term ‘hypochondriac’ commonly used as an insult to people who worry about their health.
The trouble is, these negative connotations can often mean that many people do not see health anxiety as a debilitating illness. Instead, the person is seen to be dramatic or ‘overreacting’ about their health. However, this is not the case.
Cyberchondria
Cyberchondria is not an official diagnosis but is a term branching from hypochondria. It refers to excessive searching on the internet to self-diagnose medical problems. This has been on the rise in recent years as more and more information becomes accessible online.
Rather than finding relief or visiting a doctor, for example, the person believes that they have a serious condition. This results in increased anxiety and leaves many people stuck in a cycle of anxiousness.
For a person experiencing health anxiety, the fear is real and can consume their thoughts and feelings constantly. Intrusive thoughts can be unpleasant, regardless of their nature. But, if they lead you to believe that you are seriously unwell or are at risk of dying, this can be particularly distressing. Health anxiety can have a severe impact on a person’s quality of life.
What are the symptoms of health anxiety?
Everyone is different. You may be generally worried about your health and look out for a wide range of symptoms, or you may be concerned about one illness in particular.
Signs and symptoms of health anxiety
Common signs of health anxiety can include:
- constant or ongoing fear that you are sick, despite having no symptoms
- frequently checking for signs of illness (e.g. searching for lumps or tingling)
- reassurances or negative test results from a doctor don’t relieve your nerves
- continually seeking reassurance from others that you aren’t ill
- if you read about a disease, you worry that you have it
- your worries about your health are interfering with your life, family, work, or hobbies and activities
- avoidance of medical tv programmes or anything to do with serious illness
- you change your habits to act as though you are ill (such as avoiding physical activity or resting more)
Can health anxiety give you physical symptoms?
The important thing to remember is that health anxiety is not all in a person’s mind. Anxiety can cause physical symptoms, such as headaches, dizziness, fatigue and nausea. Of the more extreme symptoms, health anxiety can also trigger panic attacks. So, if, for example, a person is afraid of having a heart attack, the symptoms experienced can be truly terrifying.
Anxiety or OCD?
Although it is an anxiety-based condition, health anxiety is often linked with obsessive-compulsive disorder (OCD), on account of the compulsive behaviours that accompany symptoms. Seeking reassurance from doctors or the internet may, in some cases, provide relief. But, just like with OCD, such compulsions only offer relief temporarily – before the fear of illness returns once again.
What causes health anxiety?
There can be many reasons why someone starts to worry too much about their health. Perhaps you’ve had a bad experience with your health in the past or as a child, or maybe you have a loved one who worries about their health excessively. Just like many other mental health problems, there can be a wide variety of causes or triggers. These can include:
- stressful life events or situations
- health scares that turned out to be not serious or ‘false alarms’
- being abused as a child
- experiencing serious childhood illness or parental illness
But, unlike some other mental health problems, health anxiety isn’t always an internalised problem – it doesn’t always mean that people are worried about their own health. Some people become preoccupied with the health of others. This can be the case, particularly for parents, who worry about the health of their children.
Who is affected by health anxiety?
It is thought that women experience health anxiety more commonly than men. Although children can experience health anxiety, it typically begins in adulthood.
Having a medical disease, condition or diagnosis does not necessarily exclude health anxiety – many people have both. In fact, for people that have their health anxiety realised, being given the diagnosis that they most feared can present a new set of challenges.
How can I stop my health anxiety?
There are a number of different options you can try to decrease or stop your health anxiety. How effective each one is can vary from person to person. Trying different methods until you find one that is right for you is key.
Many treatments for health anxiety are similar to those for OCD. One of the most effective forms of treatment is thought to be talking therapy, specifically cognitive behavioural therapy (CBT). However, some people may find that they need additional support, in the form of medication or complementary therapies, such as hypnotherapy.
Self-help for health anxiety can also be a helpful tool to help you get started. The NHS recommends a number of different self-help tools to help you better understand the extent to which health anxiety is affecting you and to try and take back control. These include:
- Keeping a diary. Track how often you seek reassurance, look up health information or check yourself for injuries. Gradually try to reduce how often you do these things over the course of a week.
- Challenging unhelpful thoughts. Writing down your thoughts can help you to spot unhelpful thoughts or thought processes. Try writing your health worries on one side of the page, then on the other side, write out a more balanced explanation. For example: ‘I’m worried I’m having headaches and it might be something serious’ vs ‘Headaches are often a sign of stress’.
- Undertake normal activities. If you have been avoiding things like exercising, going out with friends, or doing household chores due to health worries, try to gradually start doing these again. This can also help to provide a distraction when you feel the urge to look up health information or check yourself for potential ailments. Other simple activities, like going for a walk or catching up with a friend, can also help.
- Try relaxation exercises. Simple breathing exercises and mindfulness techniques can provide a positive way of managing feelings of stress, anxiety, and overwhelm. Psychotherapist, Anne-Marie Alger, shares five breathing exercises to reduce anxiety.
Who do I talk to about health anxiety?
If you are worried health anxiety is affecting your ability to do normal daily activities or is stopping you from doing things you used to do and self-help isn’t working, speaking with your GP can be a great next step. If you are diagnosed with health anxiety, you might be referred for a kind of talking therapy like CBT or offered medicine to help you manage your anxiety.
Does counselling help with health anxiety?
Many people find that working with a professional, experienced counsellor or psychotherapist can be helpful. Together, you can explore what you are feeling, the reasons behind why you are feeling this way, and how it is affecting your life.
A therapist may be able to suggest coping mechanisms, provide an external sounding board to help you better understand unhelpful or distressing thought processes and behaviours, and help you to find a more balanced or rational point of view.
Which therapy is best for health anxiety?
While cognitive behavioural therapy (CBT) is thought to be an effective way of treating health anxiety, there is no single ‘best’ method. Finding a therapist you feel comfortable working with can be a positive step towards discovering the best way for you to manage your symptoms, challenge unhelpful thoughts, and discover more positive ways to handle anxiety.
How does CBT work for health anxiety?
Cognitive behavioural therapy can be really helpful in enabling us to take notice of our thoughts about a particular situation and recognise how those thoughts make us feel.
CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviours. By acquiring a certain mindset, you can learn to approach anxious situations differently and learn to tolerate discomfort and uncertainty.
For instance, a therapist can help you to understand why your fear of illness makes you feel anxious and notice when and why your behaviour changes, in order to break this negative cycle. This can help you to notice that it’s not the presence of a symptom of ill health that is causing your anxiety, but the meaning you apply to the symptom.
Post-traumatic stress disorder, also known as PTSD, is an anxiety disorder that some people develop after being involved in (or witnessing) something traumatic.
The condition was first seen in war veterans and has been given various names, such as shell shock. While those involved in combat can develop the condition, we’ve since learned that it can affect anyone who experiences a traumatic event.
What is PTSD?
When something traumatic happens to you, your body and mind can react in different ways. For some people, post-traumatic stress disorder develops. This often involves the person reliving the event through flashbacks and nightmares. These flashbacks can be triggered by everyday items and scenarios, making day-to-day life difficult.
After a traumatic event, some people will experience initial symptoms that are associated with PTSD, such as difficulty sleeping or feeling numb. For many, these symptoms will naturally disappear after a few weeks. If the symptoms last longer than a month, however, someone may be diagnosed with PTSD.
Speaking to your doctor is the best way to get a diagnosis if you suspect you have PTSD. You may be given a diagnosis of mild, moderate or severe PTSD. This has nothing to do with how upsetting/frightening your experience was, but how strongly the symptoms are affecting you.
Some other terms that may be used by your medical team include delayed-onset PTSD (if you start experiencing symptoms more than six months after the event), complex PTSD (if the trauma happened at an early age or if you experienced it for a long time) and birth trauma.
Covid-PTSD
The Covid-19 pandemic brought about events unlike anything we had seen or experienced before. Thought to have the single greatest impact on mental health in England since the second world war, the true scale of how Covid-PTSD is affecting us has yet to be fully understood.
During the first wave, it has since been revealed that two in five intensive care staff in England reported experiencing symptoms of PTSD. By the time the second wave hit, more evidence began to emerge that, not only frontline workers, but others have experienced trauma symptoms. According to the latest NHS forecasts, there will be an expected rise of 77,000 new cases of PTSD in England alone, bringing the total new referrals to an expected 230,000 between 2020/21 and 2022/23.
Who is most likely to experience Covid-PTSD?
While anyone can show signs or symptoms of Covid-related post-traumatic stress disorder, there are a number of people more likely to be diagnosed. These include:
- frontline workers
- victims of domestic or sexual abuse
- care workers
- those who have experienced covid-related bereavement
- those who were put on a ventilator due to Covid-19
- children and young people
- those who experienced childbirth during the pandemic
Studies have shown that 35% of those who experienced severe symptoms of covid-19 resulting in the use of a ventilator will go on to experience extensive PTSD symptoms.
With record numbers of people seeking support from mental health services, the NHS is facing its biggest backlog of patients waiting for mental health support. Early intervention is key to speeding up recovery. Seeking support through your GP to access local services is recommended.
Birth trauma
Birth trauma – a shorthand term for PTSD after birth – can occur if the experience of birth has been frightening or traumatic in some way. Perhaps the person giving birth experienced a difficult labour with a long, painful delivery, or the baby’s heart rate dipped, leading to an emergency C-section. Maybe the parent or the baby suffered injuries during birth.
Birth trauma can also develop if someone feels they were poorly looked after during birth, or if they believe they were misinformed. Birth trauma and the impact of the experience are often underestimated. While it is known that pregnancy and birth are often unexpected, nothing can prepare you for a traumatic birth. Birth trauma, as well as the recognised PTSD symptoms, can impair the relationship between partners and the parent and child. It can also prevent someone from wanting another baby.
Complex PTSD
Complex PTSD (sometimes shortened to CPTSD) can occur in children or adults who have experienced traumatic events repeatedly, such as abuse, neglect or violence. Someone is more likely to develop complex PTSD if:
- The event happened at a young age.
- The trauma was caused by someone they trusted (like a parent or carer).
- The trauma happened over a long period of time.
- The person was alone during the trauma.
- The person has experienced multiple traumas.
- The person is still in contact with the person who caused the trauma.
Children’s development can get affected by this, especially if the condition isn’t diagnosed. This can affect behaviour, confidence and their ability to trust people.
If you have complex PTSD you may be more likely to experience ‘emotional flashbacks’. These are when you feel the intense feelings you felt at the time of the trauma. You may react as if it is happening again, not realising you are having a flashback. Treatment for complex PTSD often involves rebuilding feelings of trust, something that can be helped by developing a trusting relationship with a therapist.
Going through trauma and living with PTSD in any form is incredibly difficult. With support, you can learn how to manage your symptoms, take control and live a full life with PTSD.
PTSD symptoms
Everyone who develops PTSD will have a unique experience of the condition. These differences will be according to the person, not the traumatic event. For example, two people who are involved in the same traumatic event and go on to develop PTSD may experience the condition in different ways.
However, there are some common symptoms associated with PTSD, including:
Flashbacks
Flashbacks to the trauma can make you feel as if it is happening to you again, at this very moment. It may also feel like you’re watching a video of what happened, from another point of view. You may see images/partial images from the event, hear noises or feel sensations/emotions you felt at the time.
Sometimes these are triggered by something you come across in your day, sometimes they come from nowhere as intrusive thoughts or images. For many, sleep is affected and you may find you have distressing nightmares. Physical symptoms like nausea, shaking and even pain may also be experienced.
Feeling on edge and hypervigilance
Feeling constantly on edge is common for those with PTSD. This may make you easily startled and easily upset or angry. You might struggle to concentrate or even have panic attacks and anxiety symptoms.
You may become more aware of your surroundings, feeling incredibly alert. This is called hypervigilance. Studies have shown that those with PTSD produce higher levels of stress hormones than those without PTSD, which may explain this symptom.
Avoiding certain feelings/memories
If you have PTSD, you might try to keep yourself busy to stop yourself from thinking about the traumatic event. You may avoid anything that reminds you of the event and feel emotionally detached from your feelings. You may feel physically numb and as if you aren’t in your body.
Some people may struggle to show affection, finding it difficult to trust people. Alcohol and drugs may also be used as a way to avoid certain memories or feelings.
Guilt and isolation
Some people experience guilt after a traumatic experience, blaming themselves for what happened. You may feel difficult emotions like shame and anger. If you struggle to trust people, you may believe it’s better to isolate yourself. If you feel unsafe in many situations, you may choose to stay where you feel safe, which can further isolate you.
If you have PTSD and you drive, you may need to tell the DVLA. If you’re unsure whether you need to, speak to your doctor, who can advise you further.
It’s quite common for people with PTSD to struggle with other mental health problems too. These can include depression, dissociative disorders, suicidal thoughts, self-harm and other anxiety disorders. If you feel you’re struggling with these, be sure to tell your doctor or counsellor so they can help.
Causes of PTSD
Post-traumatic stress disorder develops after an event or situation that has been very frightening or distressing, whether you were directly affected or a witness. It can also occur if you’ve experienced prolonged trauma.
Here are some examples of events/scenarios that can result in PTSD:
- road accidents
- being physically assaulted or mugged
- being sexually assaulted
- witnessing violent death/murder/suicide
- terrorist attacks
- military combat
- natural disasters
- an unexpected death/serious injury of someone close to you
- being held hostage
- severe neglect
- being diagnosed with a life-threatening illness
- any event where you fear for your life
Not everyone who experiences something traumatic will develop PTSD. While it’s not fully understood why some people develop the condition and others don’t, there are certain factors that may make a person more likely to develop the condition.
If you’ve suffered from anxiety or depression, or if you don’t tend to get much support from those around you, you may be at a higher risk of developing PTSD. Genetics may also be a factor, if a parent has a mental health condition, you may be more likely to develop PTSD. In some cases, the condition will develop immediately after the event, in other cases, it will develop weeks, months or even years later.
While it’s not known exactly why PTSD develops, suggestions have been made by the medical community. These include:
Survival mechanism
One theory is that PTSD symptoms come from an instinctive mechanism designed to keep us safe from further traumas. The flashbacks and hyperarousal could have been to help us be better ‘prepared’ should something similar happen again.
Brain changes
Looking at brain scans, those with PTSD have a different-looking hippocampus (appearing smaller). This part of the brain is related to anxiety, memory problems and flashbacks. If it isn’t processing the trauma properly it could explain why people experience anxiety long after the event. PTSD treatment allows these memories to be processed effectively, allowing this anxiety to reduce over time.
PTSD treatment
If you recognise symptoms of PTSD, going to your GP in the first instance for diagnosis is recommended. If you’ve had symptoms for under four weeks since the event, or your symptoms are mild, they may suggest ‘watchful waiting’. This means keeping a close eye on your symptoms and seeing if things improve by themselves. You should be offered a follow-up appointment within a month to check in and see how you’re doing.
If you are diagnosed with PTSD, you may be offered the following treatments:
Trauma-focused cognitive behavioural therapy (TF-CBT)
Cognitive behavioural therapy looks at the way our thoughts and behaviours interact, with the aim of helping you to change them to be more positive for your mental health. Trauma-focused cognitive behavioural therapy is a specially adapted form of therapy, designed to specifically help those with PTSD.
Young people will usually be recommended trauma-focused CBT. This will likely last eight to 12 sessions and may, where necessary, involve the child’s family.
Eye movement desensitisation and reprocessing (EMDR)
EMDR involves making rapid eye movements while thinking about the traumatic experience, under the instruction and guidance of your therapist. It’s thought that the eye movements create a similar effect to the way your brain processes experiences when you sleep. By processing the memories and the trauma, the aim is for symptoms like flashbacks and anxiety to reduce.
Medication
Those with PTSD are not typically offered medication. Your doctor may recommend it however if you are struggling with depression, have difficulty sleeping or are unable/unwilling to try talking therapies. The medication you may be offered will likely be antidepressants, your doctor will be able to talk this through with you.
Other therapies that some people with PTSD find helpful include group therapy, art therapy and dialectical behaviour therapy (DBT). Guidelines from the National Institute of Health and Care Excellence (NICE), however, highlight that these have not been designed for those with PTSD so should not be used alone.
What should I be looking for in a counsellor?
At present, there are no regulations that stipulate what level of training or qualifications a counsellor needs for treating post-traumatic stress disorder. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- There are a number of treatments for PTSD that are helpful. Most involve psychological treatment, but medication can also be helpful for adults.
- Many PTSD sufferers have had the symptoms for many months and sometimes years, but treatment can still be helpful. You should be offered treatment regardless of when the traumatic event happened. If you have developed symptoms recently you may get better with little or no treatment.
- Depending on what your symptoms are and when you developed PTSD, you may be offered psychological treatments that are specific for PTSD sufferers. These are: trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR).
Read the full NICE guidelines: Post-traumatic stress disorder (PTSD)
At Counselling Directory, our members are required to give proof of registration with a professional body, with each having minimum training standards, so you can be sure you’re receiving help from a qualified and experienced professional.
Self-harm is when someone harms themselves on purpose, usually as a way of coping with difficult emotions. Here we will look further into self-harming, including why someone might self-harm, how to find support and how someone struggling can help themselves.
What is self-harm?
Self-harming often begins when a person feels overwhelmed with upsetting thoughts and feelings. Harming themselves physically can feel like a release, almost giving them a sense of relief from the emotional pain they’re feeling.
This relief is only temporary though and is often followed by feelings of guilt and even shame. As the emotional pain is still present, the person may continue to rely on self-harming in an attempt to cope, continuing the cycle.
Why do people self-harm?
There are no simple answers as to why someone might hurt themselves as every individual is different. Many people who self-harm say it is a way for them to express something they can’t put into words. This may be emotional pain, loneliness or low self-esteem.
For some, there is a particular event or experience that triggers them to start self-harming. This could include:
- being bullied
- feeling overwhelmed with school/work
- losing a loved one
- the end of a relationship
- losing a job
- having an illness (mental or physical)
- feeling stressed
- having a poor sense of self-worth
- dealing with discrimination
- experiencing abuse (sexual, physical or emotional)
- having difficulties at home
For others, there seems to be no direct cause. If you self-harm but don’t know why, you are not alone and you can still reach out for support.
There may be certain situations or times that make self-harm more likely, for example after drinking alcohol or at night time. Every person experiences self-harm differently and one person’s reasons will be different to another person’s.
Is it just attention seeking?
Some people might talk about self-harming being an ‘attention-seeking’ act. The truth is, many people keep their self-harming private and feel alienated and upset to hear people misunderstanding their behaviour in this way.
For some, there is an element of wanting, or needing attention. They may want people to see how upset they are and offer help. Either way, self-harming should never be brushed off in this way.
What self-harming can involve
The stereotypical image of someone who self-harms tends to involve cutting. While this is a common form of self-harm, it isn’t the only way people hurt themselves.
Self-harm covers any form of hurting yourself. This can include under or over-eating, overdosing/self-poisoning and even getting into fights when you know you’ll get hurt. In some cases, self-harm can be mental/emotional. This means purposefully doing things that you know will make you feel upset.
Who does self-harming affect?
According to one recent study published in the BMJ in 2019, the prevalence of non-suicidal self-harm in England has nearly tripled over the past 10 years. As study author Sally McManus explains, “Non-suicidal self-harm is increasingly being reported as a way of coping. We need to help people, especially young people, learn more appropriate and effective ways of dealing with emotional stress.”
Self-harm doesn’t discriminate and can affect anybody, at any age. Reports show however that the majority are aged between 11 and 25. Social pressures, discrimination and stigma can all lead to high levels of stress, making it more likely for a person to self-harm.
Getting help for self-harming
Once you get into a cycle of self-harming, it can be difficult to stop. Getting professional support can help you make changes. There are different ways to go about getting help and for many, a combination of self-help techniques and professional support is key.
It is OK to feel nervous about asking for help. It takes a lot of bravery to speak up, but remember you are worthy of support and have the right to receive help.
When asking for help, try to be as honest as you can. It may be tempting to downplay the extent of your self-harming, but speaking honestly about the way you’re feeling is the best way to get the right support.
Below we look at some of the different options for getting help:
Speak to your doctor
Visiting your doctor and telling them you want help is a great first step. They can talk through treatment options and, if appropriate, offer medication for related anxiety/depression.
Join a support group
Talking to other people who self-harm in a supportive setting can be comforting. Understanding that you are not alone and sharing your experience with others who ‘get it’ can help you feel lighter.
If you’re worried about going to a support group, you can explore online support forums. Be cautious when searching, as there are some sites that promote self-harm and these can make you feel worse.
Try talking therapies
Counselling and psychotherapy have been shown to be very helpful for people who self-harm. Counselling offers you space and time to talk about your feelings in a safe, non-judgmental and confidential setting.
How to help yourself when you want to self-harm
The urge to self-harm can be intense, making it difficult to know what to do instead. If you’re struggling with this, there are a few things you can try to help yourself.
Recognise your triggers
Try to keep a diary of when you self-harm. Note down what you were doing, how you were feeling and/or what you were thinking before you self-harm to see if you can spot any patterns.
Recognising what triggers you and how you feel before you self-harm can help you anticipate the urge and distract yourself.
Distracting yourself
Distracting yourself when you feel the urge to self-harm can help you change your behaviour. Everyone is different so be sure to try different distraction techniques to see what works best for you. Here are some ideas you could try:
- hitting cushions
- going for a walk
- exercising
- talking to someone
- tidying your room
- listening to music
- writing about how you feel
- drawing
- trying relaxation techniques
If you find distraction doesn’t work, you could also try delaying. This means waiting for five minutes before you self-harm and see if the urge is as strong. Try to build up the amount of time you can put it off.
These self-help techniques are useful for the short term, but in order to recover for the long term, you may need professional support. A professional can help you learn to understand and accept your feelings and help you build self-esteem.
Recovery from self-harm
Recovering from self-harm is totally possible with the right support. This will involve you gaining a better understanding of why you self-harm, recognising your triggers and developing new ways of coping. You may experience relapses when you fall back into old habits, but don’t be discouraged by this if it happens. You are stronger than you know.
What should I be looking for in a counsellor or psychotherapist?
Currently, there are no laws that stipulate what level of training or qualifications a counsellor dealing with self-harm needs. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- If you have harmed yourself, you should be offered a full assessment of your needs. This may be by a specialist mental health professional, for example, a psychiatrist or psychiatric nurse.
- After the first full assessment, you may be offered a further assessment or further treatment.
- Psychological treatment has the best evidence for helping people who have self-harmed in the longer term.
Read the full NICE guidelines:
The NHS recommends psychological treatments such as cognitive behavioural therapy (CBT).