All posts by Siobhan

How to Manage Anxiety During Lockdown

As we enter the second lockdown of the year many of us find ourselves stuck at home (again). While some are embracing the change, some of us are feeling a little frazzled and may be struggling with our mental health.

Here are six simple changes we can make to help us improve our mental health during lockdown.

1. Manage your news sources carefully. Recognise that there is a difference between being immersed and being informed. You don’t have to be plugged into your Twitter, Instagram or Facebook feed 24/7. Give yourself permission to take breaks and aim for a balanced media diet. Don’t just focus on the really bad news, gravitate towards the good news also.

2. Don’t underestimate the power of routine. The pandemic has left many people feeling adrift. Our daily routines, that were essential to us before the COVID-19 crisis have disappeared and been replaced by uncertainty and a lack of structure that can contribute to stress, anxiety and feelings of depression. Sticking to a routine helps to:

  • Create structure – A daily routine often begins with the alarm clock ringing to start our day, and the routines follow from there with showering, brushing our teeth, dressing and grabbing coffee on the school run or on the way to the (home) office.
  • Give us a sense of accomplishment – Routines typically have a beginning and an end, and we plan our day and time around being able to prioritise them and accomplish the most important tasks of the day for ourselves and our families
  • Let us know how we are doing – Even small routines like showering, brushing our teeth, and dressing are important parts of our day. Since the pandemic, many of us have taken a more liberal approach to those daily routines, such as working from home in ‘comfy clothes’ that were once reserved for weekends. Although this change is subtle, it can have a big impact, making you feel sluggish or lazy.
  • Let people around us know how we are doing – Routines also are indications to people around us of how we are doing. Before the pandemic, if you didn’t show up for work people would worry, or if you didn’t come out of your house for weeks friends would look in on you or be concerned about your well-being. With no routine, there are a lot of unknowns that can cause concern or anxiety.

3. Build activities that give you a sense of pleasure, achievement and/or comfort into your daily routine. This could be a new hobby or an activity that helps you to relax. Or maybe watching a great film, reading a book, gaming or a bit of pampering, learning a new skill, doing something creative or getting your chores done.  Personally, I like a spot of baking – it not only gives me a focus but helps me feel calmer. Bear in mind that, while it can be tempting to use ‘pleasurable quick fixes’ – such as overuse of alcohol, drugs or gambling – to cope with pain, stress, anxiety and depression, these are not viable long-term choices for maintaining good mental health.

4. Try not to worry about things that are outside of your control. When things are beyond our control, its essential to focus on what we can control no matter how small that may be – or as my clients will have heard me say many many times … control your controllables! One of the things that causes an increase in anxiety is when we worry about things that are out of our control. For example, worrying whether or not others are obeying Covid-19 restrictions. Don’t get caught up with what others are doing. Instead, try to focus on what is best for you and how you can keep yourself and your loved ones safe.

5. Stay connected. Lack of physical contact with friends and colleagues has a tendency to leave people feeling very isolated, which can increase feelings of anxiety. Consider different ways to stay in touch – a phone call, video call, text message, the ‘old fashioned’ letter. Hearing a friendly, familiar voice or reading a message from people we care about helps us to feel connected. This is so important for our mental health and especially for people living alone who may be feeling lonely, isolated and afraid about the current situation.

6. Finally, exercise! Engaging in regular exercise can help curb feelings of anxiety and depression. When you exercise your brain releases serotonin, which positively impacts your mood and helps you to feel better. It can also help to improve your appetite and sleep cycle. If you’re not self-isolating, try to get outside at least once a day. Go for a walk and get some fresh air. If you are self-isolating, walk around your garden, up and down your driveway or onto your balcony and embrace fresh air.

You don’t have to suffer in silence if you’re struggling with your mental health, reach out to a professional or contact one of the groups listed below:

CALM (Campaign Against Living Miserably) A male suicide prevention charity offering help, advice and information. Tel: 0808 802 5858 (17.00 – 00.00. 365 days a year)Web:

Childline Childline is on hand to help anyone under 19 in the UK. Call 0800 1111 or contact them online. It’s free to use and completely confidential. Tel: 0800 1111 Web:

MIND Provides advice and support to anyone experiencing a mental health problem. Tel: 0300 123 3393 (09.00 to 18.00. Monday to Friday, except bank holidays) Web:

PAPYRUS (Prevention of Young Suicide) Provides information for parents of suicidal children and supports those bereaved by suicide. Tel: 0870 170 4000 (helpline available Monday to Friday 09.00 to 22.00, Weekends 14.00 to 22.00, Bank Holidays 14.00 to 22.00) Web:

Samaritans Providing 24-hour phone support, Samaritans is a national charity aiming to reduce emotional distress. Tel: 116 123 (24 hours, 365 days a year) Web:

Stay safe!

Siobhan Graham – Accredited Cognitive Behavioural Psychotherapist –

What is the Menopause and can Cognitive Behaviour Therapy (CBT) help?

This year, World Menopause Day is the 18th October. The aim of the day is to provide support to women who are going through menopause and to raise awareness of the menopause and the support options available.

My experience of the (peri)menopause thus far is that it’s an exhausting, lonely, scary and overwhelming place to be. The menopause and perimenopause remain one of those subjects around which there is a conspiracy of silence – cloaked in a blanket of shame and embarrassment and often discussed in private using hushed voices. Mental health problems are a natural part of life, like having a cold, we should be able to talk about it.

So, let’s talk about the menopause … firstly, what is it? Well, it’s is a point in time 12 months after a woman’s last period – when the ovaries stop producing a hormone called oestrogen and no longer release eggs. The years leading up this point, when a woman’s periods may become less regular as oestrogen levels fall is known as the ‘perimenopause’. Perimenopause often begins between ages 45 and 55 and lasts, on average, about 7 years.

Menopause affects every woman differently. Some women may have no symptoms at all, or they might be brief and short lived. For other women the symptoms are severe and distressing. The hard truth about being menopausal is that it can make everyday life a challenge and not only affects a woman’s life but also impacts the lives of her family and work colleagues as well.

Unfortunately for those women who do experience symptoms, it can be a very difficult and frightening time to navigate through. Often menopausal symptoms can, incorrectly, be (and often are) explained away by many other ‘medical diagnoses’.

What are some of the most common symptoms associated with menopause?

Many of the symptoms associated with menopause tend to be as a result of hormone imbalance and lack of oestrogen. These symptoms can affect how you feel. You may find that you become stressed, anxious and irritable, suffer with low energy levels and experience mood swings. This change in emotions can lead to feelings of low mood and depression. All of which can be made worse if you are fatigued and experiencing symptoms such as disturbed sleep or insomnia due to night sweats.

In addition, you may experience difficulty concentrating, suffer with ‘brain fog’ and poor memory which can negatively affect your confidence. During this period, the body begins to use energy differently, fat cells change, and women may gain weight more easily.

It is likely that you will also experience some of the following physical symptoms: hot flushes, vaginal dryness, digestive problems, itchy skin, breast pain, loss of sex drive, sensitive bladder (an increase in incontinence) and headaches. Bones also become less dense, causing joint aches and pains, making women more vulnerable to fractures.

However, the menopause does not happen in isolation. Women’s lives are complex, particularly at midlife – changes in family dynamics, health problems and significant life events may coincide with menopausal symptoms. Trying to balance work life with domestic responsibilities, where women may be caring for young children, teenagers, grandchildren, ageing parents, and in some cases their partner. Maybe supporting teenagers through exams, and coping with children leaving home only to return at some stage to fill the ‘empty nest’.  Throw bereavement, chronic illness and disease, divorce, financial concerns and other factors into the mix and all this can exacerbate symptoms and add to the burden of uncertainty, anxiety and stress women often feel around the menopause.

Creating a more positive approach with CBT

Fortunately, it’s not all ‘doom and gloom’ (phew!) We have far more influence over our menopause journey than we are led to believe. Taking time for yourself, challenging negative attitudes and expectations about menopause and midlife can be helpful.

In addition to medical treatments, such as hormone therapy, many women prefer non-medical options such as Cognitive Behavioural Therapy (CBT). The National Institute for Health and Care Excellence (NICE) guidelines recognise that mental health issues can be symptoms of the menopause and have recommended CBT as an effective approach.

CBT is a well-researched and effective treatment for menopausal symptoms such as anxiety, depression, and sleep problems. More recently it has also been demonstrated to be effective in reducing the impact of hot flashes and night sweats. It is based on the concept that our thoughts, feelings, and actions are linked. Consequently, how we feel and think affects how we behave. It makes sense, therefore, that our negative thoughts and feelings can trap us in a vicious cycle of thinking and acting in a certain way. For example, if your night sweats and insomnia are keeping you up at night, you might feel irritable and angry the next day, which could negatively impact your performance at work, leading you to feel even more upset and angry by the end of the day which in turn keeps you awake with anxiety. CBT will help you to understand these links and other negative thought processes that lead to low mood or anxiety.

How might CBT help with Menopausal symptoms?

Using an educational approach, CBT will address problematic symptoms via a number of strategies and techniques. The menopause happens to every woman and it is easy to become lost in the ‘I’m menopausal’ mindset. There is light at the end of the tunnel and it is possible to feel good about yourself. Changing the way in which we think about the menopause is the first step. CBT will help you to:

  • Identify unhelpful underlying thoughts that are self-perpetuating and may negatively impact your quality of life and self-esteem.
  • Reduce ‘catastrophising’ and self-critical thinking.
  • Review and challenge unhelpful behavioural responses to anxiety and stress. For example, are you working longer hours? Are you eating or drinking too much? Are you avoiding certain people or activities? Are these healthy responses? Could you find a more appropriate response?
  • Challenge negative social images and negative attitudes about menopausal women (which can negatively impact our self-esteem) with the goal of becoming more compassionate to ourselves.
  • Address low mood by increasing activity, engaging in pleasurable activities, developing a structure to your day and reducing self-critical thinking.
  • Reduce stress which exacerbates vasomotor symptoms such as hot flushes and night sweats
  • Address sleep disorders, sexual concerns and depression by working through negative thought patterns, establishing positive behavioural changes and reframing the experience.
  • Manage sleep and night sweats by creating good habits to optimise sleep behaviour and environment

Alongside, and in addition to, the above cognitive solutions, CBT offers a number of practical behavioural steps you can take to help with problems associated with menopause. For example,

  • Relaxation and paced breathing – to calm your body’s physical and emotional reactions. Breathing from your stomach will reduce physiological arousal and allow focus to shift to neutral calming thoughts rather than on self-critical or other unhelpful thoughts. This is an important part of the CBT approach for hot flushes.
  • Good sleep hygiene – train your body’s natural rhythms to facilitate sleep. Limit light in the bedroom (including light from mobile phones and laptops). Limit caffeine and alcohol which can impact sleep onset and quality. Develop a good bedtime wind down routine to help you relax before going to bed. Maintain a regular sleep pattern.
  • Hot flushes – keep cool and avoid possible triggers such as spicy foods, caffeine, alcohol, smoking or stress. Dress in layers so you can remove items if you feel too warm.
  • Regular exercise – may help reduce hot flushes, improve sleep and lift your mood.
  • Pelvic floor exercises – squeezing and releasing the muscles that support your bowel, bladder and vagina can help strengthen your pelvic muscles and may improve your bladder control.

While CBT may not be for everyone, the benefits can certainly be worth it. CBT teaches life skills that once learned can be applied in situations long after ‘treatment’ has finished.

Don’t suffer in silence! If you’re struggling with symptoms of the menopause and think you could benefit from CBT, give me a call!

Siobhan Graham Psychotherapy – – 07863 546421


How to look after your mental health when working from home

This week, the government announced that due to coronavirus cases spiking across the UK, anyone who could work from home, should do so. The latest guidelines suggest that these new coronavirus restrictions for England could last for up to six months.

With this in mind, it is important to note that working from home for long periods of time can negatively affect our mental health. Working at home during a pandemic is slightly different to working from home pre-pandemic. I find myself in a situation where both myself and my husband are working from home at the same time. Practically this means that space and quiet is often hard to come by, stress levels increase and heated ‘negotiations’ often take place!

While working from home certainly has its benefits, you may also be experiencing some of the following feelings

  • Feeling isolated, lonely, or disconnected from other people – socially and professionally
  • Feeling stressed and overwhelmed
  • Being unable to ‘switch off from work’
  • Having difficulty staying motivated
  • Having difficulty prioritising your workload
  • Feeling uncertain about your progress, and whether you’re performing ok
  • Insomnia and sleep problems

So, how you can protect your mental health while working from home?

Set up routine and structure for your workday — create boundaries between ‘work time’ and ‘home time’

We are creatures of habit so establishing a routine and sticking to it when you are working from home is a good way to keep your motivation and productivity on track.

Define your work hours – if you find yourself staying up late or waking up early to meet deadlines, professional and personal boundaries will become blurred. Try to get up at the same time during the work week as you would if you were going to an office. Stick to predetermined break times and block out time to get up from your desk to stretch and move about.

Change out of your pyjama’s and into different clothes for working in. When the routine of getting changed into new clothes for working at home is practiced enough, psychologically you become conditioned to associate the changing of clothes with a change of mindset, preparing you for the working day ahead.

Stay consistent and ‘leave work’ when your working hours are over. It’s very tempting to ‘just answer one more email’ when you don’t have to leave to catch a train or avoid the rush hour.

This will help you switch off from work at the end of the day and minimise the possibility of work intruding into your family time.

Set up a specific ‘work’ place in your home (avoid your bedroom)

It is important (where possible) to create a designated work space that (pardon the pun) ‘works’! Try to ensure you have access to a desk, a comfortable chair and plenty of natural light.

Creating a specific work place will help you follow a disciplined work schedule when you’re at home – when you sit or stand there, you’re working and when you leave that place, you’ve left work. Because of this, it is suggested that you have “your own” work area at home (and in an ideal world in a separate room.) This may prove a little challenging if you have limited space, more than one person home working and/or a big family.

If you don’t have a specific room to work from set up a separate space (for example, in your living room), somewhere that is quiet, with good light, that allows you to focus, where you can have a comfortable table and chair to work from.

It has been well documented that working from home can interfere with sleep, especially for those who find it difficult to switch off from work. Avoid working from your bedroom if possible so that it does not become associated with being alert, awake and switched on.

Get a good night’s sleep

It may be tempting to do ditch your sleep routine while you’re working from home. Maybe you fancy grabbing a lie-in instead of your morning commute, or maybe you don’t see the need to go to bed as early. This is counterproductive if you want to continue getting consistent, high-quality sleep. Disruption to routine can cause the circadian rhythm (the sleep-wake cycle) to overcompensate, which can lead to you to being sleepy during the day, and alert when you go to bed. Try and keep the same sleeping and waking hours you did before the pandemic. It may not feel like it first thing in the morning, but it will definitely be worth it in the long run.

Maybe you’re finding it difficult to sleep due to increased feelings of worry? We’re living through anxiety provoking times where it is often difficult to detach from the very real fear we are faced with – even when you’re trying to relax. While worry can be a very natural response, it is also an unhelpful one. Try to be proactive about addressing your anxieties. For example, set aside a time before bedtime (preferably not too late in the evening) where you write down the things that are worrying you so that they’re out of your head for the night and allow you get a good night’s sleep.

Set boundaries

Treat your ‘at home office’ as you would if you were in an ‘office office’. During working hours, be clear that you are unavailable for anything outside of your job duties. If you live with other people, let them know that although you might be ‘physically at home’, you are not mentally there – you are working and not available to do chores or have random conversations at any time, (and if you live in my house, not answering the front door to take in a parcel when the postman is pressed up against the window looking at you – this really irritates my husband when he’s ordered something for delivery and I don’t answer the door!)

Think about creating an action plan to deal with distractions and help you stay organised when working from home. Consider establishing cues for other family members. Maybe a closed door means ‘do not disturb’ or if you’re wearing your headphones or sitting at your desk, it means that you’re not available to speak or answer any question, unless it is an emergency (the same type of emergency for which they would call for when you’re at the office). Whatever your plan is, communicate it to others to minimise distractions. Lastly, don’t panic if the dog barks or a child wanders into view when you are on a call – these are strange times and most people will understand the juggle act that takes place when working from home!

Stay connected

For many of us, most of our daily routine, our forms of self-care, and our general sense of safety and stability have been impacted by the pandemic.

Make a conscious effort not to become distanced from your work colleagues while working from home. Not being in the office means that spontaneous meet ups and conversations with colleagues don’t happen. Be proactive in organising meetings and social networking. Maintaining emotional connections, having clear work-life boundaries, and increasing self-care strategies are key to helping reduce stress levels, reducing feelings of isolation and staying productive.

Reduce screen time

While technology makes it easier to stay connected 24/7, the downside is that it can make it difficult to switch off, and separate work and home life. In addition, with so many people using video conferencing apps, many of us are feeling drained while working from home. So much so, the term ‘Zoom fatigue’ is being used to describe this particular feeling of exhaustion. Try to avoid back to back video calls and take regular breaks to reduce the time you spend in front of a screen. Switch off notifications for work emails at the end of your working day and give your brain a rest from ‘work time’.

Try a digital detox to help you switch off from work, and spend quality time with your family, or engage in activities that give you a sense of pleasure and/or achievement.

Take regular exercise

Engaging in regular exercise can help curb feelings of anxiety and depression. When you exercise your brain releases serotonin, which positively impacts your mood and helps you to feel better. It can also help to improve your appetite and sleep cycle. Set aside time to stay active during ‘work hours’ and break up your day with regular screen breaks. If you’re not self-isolating, try to get outside at least once a day. Go for a walk and get some fresh air. If you are self-isolating, walk around your garden, up and down your driveway or onto your balcony and embrace fresh air.

Focus on the ‘positives’

Working from home can have many benefits. It can improve productivity, reduce distractions, reduce stress, improve work satisfaction, lower the time (and cost) you spend commuting, give you greater sense of control over your workday, and can even help to avoid challenging colleagues!

In addition to the tips listed above, don’t forget to maintain positive mental health through

  • Exercising, getting a good night’s sleep and eating well
  • Engaging in activities that give you a sense of pleasure and/or achievement
  • Staying connected and seeking out support
  • Managing stress through problem solving, relaxation and/or meditation
  • Reframe your thinking to look for the positives in a situation



How to Support Children Returning to School After Lockdown

As the new school term fast approaches, anxiety levels of students, parents and teachers are rising. Here are some straightforward suggestions from ‘Nip in the Bud’ on how to deal with any potential anxiety children may experience upon returning to school.


This is a very uncertain time and although it would be great if we could make Covid disappear – we can’t (well not yet)! Children, like us adults, must learn to tolerate some uncertainty. This skill can help us to manage anxiety.


It is normal to feel anxious about the ‘covid’ changes. Change makes most people feel a bit strange and worried. Some people find that it is harder than others though.

Difficult experiences

It’s important to remember that children have had hugely different experiences during lockdown. Some children who experience anxiety normally may have found a break from going to school, a break from triggers for their anxiety. For them going back to school is going to be very anxiety provoking. There are the children who have had a great time with families and don’t want to return to school. And then of course there are many children who have been in family situations with lots of arguing and possibly violence and neglect who will find getting back to school a refuge. Do not assume that you know how children feel.

Modelling calmness

You may be wondering whether to send your child back to school soon. You may have good reasons for wanting to keep them at home longer. Either way, just be aware of how you model your own anxiety when speaking to your child about returning to school. Speak to your child when you feel calm yourself.

Listening and validating

Listen to your child. Hear what their concerns are. Acknowledge their feelings and let them know that you know it’s tough for them.

We don’t have all the answers

Its ok not to have all the answers. In fact, its better not to pretend you know. We don’t know. Its possible we may move back to school, then to lockdown, and back. This could go on for a while.

Limit news and address misinformation

If they are worried about getting unwell or making someone else unwell, agree to investigate some facts together. For example, you may look together at the facts in the news but limit the amount viewed and address any misinformation the child has. You may want to look at what happened in previous illnesses in the past and how we got through it as a country.

Limit reassurance

Asking questions is helpful but giving excessive reassurance is not. Its very tempting to give lots of reassurance to your child as it may relieve anxiety in the short term. In the long term it keeps going. Instead listen and ask them what they think and what they think will help.

Focus on possible strategies

Help children to focus on possible strategies. Ask them how they adapted to the lockdown. What helped? What might help them now adapt to going back to school? There may be some things that immediately can be done to problem solve the concerns raised, for example, ‘I am worried that my friends won’t speak to me at school’. Agree an experiment to try this out before hand, such as try contacting a friend to speak or meet in advance of school starting.

Deferring worries

Children can also be encouraged to make a list of worries and have an agreed deferred time to worry about things on their list. For example, at 4pm spend 30 minutes worrying, this can help to contain worries and often the worry feels less distressing at this deferred time.

Preparing children for the return – routines, reconnecting with friends etc

Before returning to school, try and prepare children by getting them back into a routine. They will need to go to bed at a reasonable time, wake up early and learn to do the school walk / cycle / drive to school again. They could do some practice runs to school in the week or so beforehand. If they are not already doing so, help them to reconnect with friends to make transition easier. They could meet with a friend in a park or via zoom etc

Preparing children for changes

It might be helpful to prepare children ahead of school starting that the school may feel different. Classes may be smaller, they may have to wash their hands more, they may have less close contact with friends at school and stick to small groups of friends. All of this is to help keep them safe.

Encourage a growth mindset

Help children to recognise that building tolerance of uncertainty can help them manage their anxiety and develop their growth mindset. It is like building up ‘mind muscles’. Limit reassurances as this can maintain anxiety. Instead encourage children to ask questions, and support skills in problem solving so they can consider their own solutions.


Use rewards (in and out of school) to help children manage their anxiety about getting to school and managing at school. This should be age appropriate and not too expensive.

Taking care of self and others

Encourage children to think about their own mental health including eating healthily, exercising, doing things they enjoy, spending time with others. In addition, practice being kind to self and others. Remember it took us time to adapt to lockdown and it will take time to adapt back. Go easy on yourself.


How to Avoid Being Psychologically Destroyed by your Newsfeed

The past couple of months have been awful, in terms of what I have been seeing in my newsfeed – storms Ciara and Dennis, flooding throughout the UK, Brexit, Megxit, coverage of the Weinstein trial, the sudden death of Caroline Flack and the Coronavirus amongst others. I’ve been thinking a lot about the mental health impact of a steady stream of ‘Bad News’. Many of us deal with mental health challenges on a daily basis and being fed a steady diet of devastating world events only serves to make that harder. Here are a few strategies that will help avoid being completely overwhelmed by your newsfeed.

Recognise that there is a difference between being immersed and being informed

You don’t have to be plugged into your Twitter, Instagram or Facebook feed 24/7. Give yourself permission to take breaks and aim for a balanced media diet. Don’t just focus on the really bad news, gravitate towards the good news also.

Stick to your usual routines as much as possible

Humans are creatures of habit and we find comfort in the familiar. Make sure that you are giving your body what it needs to function at its best: healthy food, hydration, regular physical activity, time for fun, and adequate sleep.

Look for opportunities to ‘take action’

It doesn’t need to be something big (it’s likely to feel less overwhelming if it’s not). But taking positive action, however small (writing a letter, making a donation), you will be engaging the rational-logical part of your brain. This will help to slow down what could quickly escalate into feelings of anxiety and sadness. Feeling powerless fuels anxiety, whereby taking action can prevent it or at least slow it down.

Allow yourself to feel

Try not to avoid or suppress painful emotions (nor dwell on them which can result in you feeling less equipped to problem solve or connect with others). Remind yourself that feelings come and feelings go and you are not your feelings.

Maintain your sense of optimism

Focus on what you can control as opposed to fixating on what you can’t. You’ll find it easier to make this mental mind-shift if you make a conscious effort to boost your level of positive emotion by doing things you enjoy and spending time with people you love.


Reach out to others who share your concern about what’s happening in the world.  Seek professional help if you feel that you need extra support. Self-care isn’t selfish; it’s self-preservation. With all the doom and gloom surrounding us, it’s more important than ever that you need to take good care of yourself right now.

What Do I Do When Someone is Suicidal?

World Mental Health Day is on October 10th and this year, the theme is Suicide Prevention.

EVERY 40 SECONDS, SOMEONE LOSES THEIR LIFE TO SUICIDE. There are more deaths from suicide than from wars and murder together! Let’s just take a moment to let that sink in …

Furthermore, for each suicide it is suggested that there are more than 20 suicide attempts.

Suicide is the leading cause of death among young people aged 20-24 years in the UK and it is considerably higher in men, with nearly four times as many men dying as a result of suicide compared to women.

You don’t need me to tell you that every suicide is a tragedy that affects families, communities and has long lasting effects on the people left behind.

When someone we know feels suicidal, we can feel an overwhelming sense of helplessness, shock and fear, especially if we don’t really know how we can support them or whether to act on what they have told us. How do we know if we will say or do the ‘right’ thing if someone reveals that they are feeling suicidal?

Let’s take a look at:

  • Some of the myths surrounding suicide
  • Some of the warning signs to look out for
  • What you can do if someone discloses that they are feeling suicidal and
  • Contact details for Organisations that can help

Let’s take a look at some of the myths surrounding suicide?

There are many common misconceptions when talking about suicide, which can be dangerous. A lack of understanding could prevent vulnerable people from getting the right help at the right time.

Myth: People who talk about suicide are attention seeking.

More often than not people who talk about the idea of killing themselves are looking for help. Whether they have made suicide plans or not, is irrespective, the fact that they’re reaching out shows that they have something they want to talk about.

What can you do? Take the opportunity to ask them more about how they feel. Showing that you care about them and value their feelings could help them see that they can cope with the right support.

Myth: People who talk about suicide won’t really do it.

Almost everyone who attempts suicide has given some clue or warning.

What can you do? Don’t ignore any references to death or suicide, however indirect they may seem. Statements such as “You’ll be sorry when I’m gone” or “I can’t see any way out,” may indicate serious suicidal intent no matter how casually or jokingly said. If you feel you need assistance or guidance, seek professional advice, and never dismiss it as attention-seeking.

Myth: Don’t talk about suicide because it might give someone the idea to do it.

Suicide can be difficult subject to talk about. If you think someone close to you is having suicidal thoughts, it’s quite ‘normal’ to feel reluctant to bring the subject up in case it gives them the idea to do it.

What can you do? Discuss suicide openly. By asking someone directly about suicide you give them permission to tell you how they feel. People who have felt suicidal will often say what a huge relief it was to be able to talk about what they were experiencing. Once someone starts talking, they’ve got a better chance of discovering other options that aren’t suicide.

Myth: If a person is serious about killing themselves then there is nothing you can do.

You may think there is very little you can do when someone appears to be overwhelmingly distressed, but it’s important to realise that their feelings are probably temporary. Feeling actively suicidal usually only lasts for a short period of time.Most people experiencing suicidal thoughts do not want death; they want the pain to stop.

What can you do? Although we are not responsible for anyone else’s actions or behaviour, let’s not assume that there is nothing that we can do to help and support someone who is feeling suicidal – even if seems like they have made up their mind that they wish to end their life. Ask them how they are feeling. Sometimes people will talk about the facts of what happened, why it happened and what actions they are thinking of taking, but never say how they actually feel. Discussing your innermost feelings can be a huge relief. It can also give clues about what the person is really most worried about.

Myth: People who die by suicide are people who were unwilling to seek help.

Studies of suicide victims have shown that more than half had sought medical help in the six months prior to their deaths.

What are some of the warning signs to look out for?

It is important to acknowledge that everyone is different, and may express and cope with suicidal feelings in a different way. However, people rarely complete suicide impulsively – even if it seems that way to the friends and family they leave behind. Often contemplation of suicide is a result of someone being overwhelmed by a variety of life circumstances. Sometimes there may be obvious signs that someone is at risk of attempting suicide. For example, if they:

  • threaten to hurt or kill themselves
  • talk or write about death, dying or suicide
  • actively look for ways to kill themselves, such as stockpiling tablets

Other warning signs that may indicate a person may be at risk of attempting suicide are if they:

  • Have episodes of sudden rage and anger
  • Appear anxious and agitated
  • Are unable to sleep or they sleep all the time
  • Noticeably gain or lose weight due to a change in their appetite
  • Talk about feeling trapped
  • Act recklessly and engage in risky activities with an apparent lack of concern about the consequences – drug taking, alcohol abuse, reckless driving and taking unnecessary risks can all be indicators that a person no longer cares whether they live or die
  • Self-harm – including misusing drugs or alcohol, or using more than they usually do
  • Become increasingly withdrawn from friends, family and society in general – stop attending social functions and become difficult to contact.
  • Lack of interest in physical appearance – not wearing makeup if they usually do, not washing, not ironing clothes or taking care of themselves can indicate a lack of care.
  • Complain of feelings of hopelessness – statements such as ‘what does it matter?’ and ‘it’s never going to get better’ demonstrate that they see no way out of their situation. Studies have found that hopelessness is a strong predictor of suicide. People who feel hopeless may talk about “unbearable” feelings, predict a bleak future, and state that they have nothing to look forward to.
  • Talking a lot about death and suicide – if someone talks frequently about death and suicide, it’s likely that they’re thinking about it too.
  • Sudden appearance of calm – if they have been very depressed for a long time and they suddenly seem calm and happy, they may have made the decision to end their lives.
  • Put their affairs in order – if they make a will, give away their favourite possessions or make certain arrangements with family members, it could be because they are preparing to die.
  • Sudden reconciliation – apologising for or admitting to things that happened a long time ago can indicate that they’re laying old feelings to rest.

So, what can you do if someone discloses they are feeling suicidal?

As most people do not have this sort of conversation every day you may feel uncomfortable and unsure of what to say. This is entirely normal and understandable. However, you can help by being calm, supportive and non-judgemental. If you’re worried about someone close to you, it’s important not to panic. Here are some steps you can take:

Give them space to talk about it:

  • Create a safe place – when starting difficult conversations like this, choose a time and place where the person feels comfortable, and has time to talk. Allow the person who feels suicidal to talk freely and in confidence.
  • Listen – always listen attentively. It is important to listen carefully and to be patient while they are talking, without giving ‘advice’.
  • Observe body language – watch for signs of distress to get a feel for how the person is feeling. This will allow you to make a rational decision about whether to call for further assistance. It may be that they just need someone to talk things through with, and if you alert the authorities, friends or family this could create unwelcome drama and attention thus causing more distress.
  • Ask questions – the best way to help is to ask questions, especially open questions. This will give the suicidal person the opportunity to be honest with how they are feeling and will encourage them to think about other options that might not have occurred to them before.
  • Show empathy – try to show empathy. Please note that empathy is not the same as sympathy. Sympathy is saying you can identify with what a person is saying. Empathy is saying you appreciate how they must feel, even if you have never experienced it yourself.
  • Don’t leave them alone if they are ‘critically suicidal’ (see ‘what to do in an emergency’)

Be mindful of how you respond:

Avoid addressing their problems with your own experiences. When someone tells you that they are feeling suicidal you may feel like trying to cheer them up or telling them that they have no reason to feel like that, that there are people far worse off than they are. While these responses are understandable, they are not helpful. Let them know that they are not a burden, that you chose to be there for them because you care. Someone who wants to end their life is unlikely to want:

  • to feel rejected by friends, family or colleagues
  • people to change the subject when they are talking about how they feel
  • to be told that they are wrong or silly
  • to be patronised, criticised or analysed
  • to be told to cheer up or ‘snap out of it’
  • to be told that they should be grateful for having such a good life

Don’t take it personally:

Although it is tempting to believe that we could or should do more, it is important that we don’t make the suicidal thoughts about us. We could tie ourselves up in knots thinking of ways we could offer more support or ‘fix’ the situation. What is important is being non-judgemental while being supportive and showing understanding. We may not always know the right thing to do or say but someone’s suicidal thoughts and feelings are about them, not us.

Point them in the direction of other help:

What to do in an emergency: If you think someone is urgently at risk, call 999 or take them directly to the nearest Accident and Emergency (A&E) department. At A&E, immediate health needs will be dealt with and they may be referred to a liaison psychiatry team or the local on-call mental health services, such as the crisis resolution and home treatment teams.

Do not leave someone who is critically suicidal alone. If you believe that someone you are with is about to attempt suicide

  • Take them to the nearest hospital or call for emergency help
  • Do not leave them on their own.
  • Remove any medication or anything that could cause harm
  • Keep talking to them while waiting for professional help to arrive.

Remember to look after yourself: While it is incredibly distressing to experience suicidal thoughts and feelings, let’s not under estimate the emotional impact on those who are close to someone who discloses that they are suicidal. When we are offering support to someone who is suicidal, we can feel severely impacted emotionally, mentally and physically. We may give so much time, energy and attention to them that we forget to take care of ourselves. While it’s important to respect their confidence, you may need to talk to someone else about how you’re feeling. Don’t be afraid to ask for professional help or guidance if you need it, contact one of the organisations listed below.

Helpful Organisations:

CALM (Campaign Against Living Miserably)

Tel: 0808 802 5858 (17.00 – 00.00. 365 days a year)


A male suicide prevention charity offering help, advice and information



Tel: 0800 1111


Childline is on hand to help anyone under 19 in the UK. Call 0800 1111 or contact them online. It’s free to use and completely confidential.



Tel: 0300 123 3393 (09.00 to 18.00. Monday to Friday, except bank holidays)


Provide advice and support to anyone experiencing a mental health problem


PAPYRUS (Prevention of Young Suicide)

Tel: 0870 170 4000 (helpline available Monday to Friday 09.00 to 22.00, Weekends 14.00 to 22.00, Bank Holidays 14.00 to 22.00)


Provides information for parents of suicidal children and supports those bereaved by suicide



Tel: 116 123 (24 hours, 365 days a year)


Providing 24-hour phone support, Samaritans is a national charity aiming to reduce emotional distress and reduce suicidal feelings so that fewer people die by suicide



Tel: 0300 304 7000 (16.30 to 22.30 daily)


Saneline is a national mental health helpline providing information and support to people affected by mental illness


Young Minds

Tel: 0808 802 5544 (Parents helpline. Monday to Friday. 09.30 to 16.00)

Young people: text the YoungMinds Crisis Messenger, for free 24/7 support across the UK if you are experiencing a mental health crisis – Text YM to 85258


Young Minds offer a free confidential helpline for parents worried about their child or young person, offering practical advice of where to go next.


Siobhan Graham – Accredited Cognitive Behavioural Psychotherapist –




Finding a Cognitive Behavioural Therapist and the importance of Accreditation

Over the last few years there has been an increasing demand for Cognitive Behaviour Therapy (CBT). At the time of writing, the psychotherapy profession is unregulated. What this means, is that anyone can call him or herself a Cognitive Behavioural therapist and anyone can say that they provide CBT (whether they have had appropriate training or not!) Incredibly the title ‘cognitive behavioural psychotherapist’ remains unprotected.

Furthermore, not only can anyone can give themselves the title of ‘Cognitive Behavioural Therapist’, they can also set themselves up in private practice. I find this truly horrifying. For the unsuspecting client who is often distressed and at their most vulnerable when seeking therapy, this has the potential to be incredibly damaging. Therefore, we as therapist’s have a duty of care to be clear about our skills and the services we offer.

To become an accredited Cognitive Behavioural Psychotherapist, I trained for four years to gain my Masters qualification and invested a vast amount of energy, time and money into my training – holding down a full time (high pressured) job while travelling up and down the M1 to University, completing assignments and gaining client experience while working in a Primary Care Team (PCT) and in a Community Mental Health Team (CMHT). I love my job and am extremely passionate about what I do. So, I find it incredibly frustrating to hear from clients and ‘Joe Public’ who have supposedly experienced CBT only for them to say ‘it was rubbish’ or ‘it didn’t work’ amongst other damning statements. In my experience, when questioned these clients have not experienced CBT nor have they been treated by an accredited CBT therapist. While I feel very privileged that I am able to work as a CBT therapist. The flip side is that I am tired, frustrated and incredibly sad at having to continually defend my profession largely due to the poor practice and misrepresentation of others. Unless you are part of a professional organisation that regulates your practice, it is very unfair and unethical to ‘sell’ your services as something they are not.

So, what do I mean by an accredited CBT therapist?

An accredited cognitive behavioural psychotherapist is someone who holds accreditation with the British Association of Behavioural and Cognitive Psychotherapies (BABCP) – the lead organisation for CBT in the UK and Ireland – or the Association for Rational Emotive Behaviour Therapy (AREBT). Both these organisations ensure that therapists are providing quality Cognitive Behavioural Therapy to the public having undertaken approved training and regular supervision. It also means that in order to maintain accreditation therapists are continually assessed to ensure that they meet the high standards set by the BABCP and that they adhere to ethical practice.

All officially accredited CBT therapists can be found on the CBT Register []. Please note that an online Accreditation Check on the CBT Register is now the only recommended means of verifying CBT Practitioner Accreditation. You can search the CBT Register to check if an individual is accredited by using the surname search. You can also search for an accredited therapist’s contact details by name, location, or language.

To further complicate the issue, being a member of the BABCP is not the same as being accredited with the BABCP; anybody with an interest in CBT can become a member of the association.

This is where it gets complicated … there is a difference between an accredited CBT therapist and an accredited therapist who offers CBT.

There are a significant number of mental health practitioners – psychotherapists, counsellors, nurses, psychologists – offering CBT who are accredited but do not hold BABCP accreditation. They may hold accreditations from organisations such as the British Association for Counselling and Psychotherapy (BACP) or the United Kingdom Council for Psychotherapy (UKCP). These organisations do not offer a lesser accreditation but they are not ‘expert’ with regards to CBT.

So, what does this mean? It is possible that mental health practitioners who work primarily with other therapeutic modalities (for example, Person-Centred counselling, Psychodynamic counselling, Gestalt counselling etc) and who have undertaken little or no training in CBT, become accredited by organisations such as the BACP or UKCP and then once accreditation is obtained start to offer ‘CBT’.

To add another level of complexity, this is where terminology can become confusing. They become accredited as counsellors or psychotherapists rather than ‘CBT therapists’. In simple terms, they may have undertaken CBT training that hasn’t been approved or accredited by the BABCP or AREBT. While they may be a fabulous counsellor or therapist, it may also be the case that their level of training specifically in CBT is lower than the training required for accreditation by the BABCP or AREBT.

As a therapist who has worked in private practice for over 12 years I still find therapist job titles and accreditation issues confusing. If it’s confusing for me then it’s likely to be confusing (and potentially misleading) for clients looking for an appropriately qualified CBT therapist!

To this end, if you are a therapist or counsellor, please ensure that you are advertising your services accurately and ethically. If you are specifically looking for an accredited CBT therapist, please look on the CBT Register to ensure the therapist has the appropriate level of training!

I welcome any comments you may have about this blog/topic.

Siobhan Graham – Accredited Cognitive Behavioural Psychotherapist –

Why your 8-12 year old isn’t sleeping

SLEEP getty_rf_photo_of_girl_fast_asleep_at_eight_oclock

Over the past couple of months I have been party to a number of ‘playground conversations’ with parents concerned about various sleep struggles their children are experiencing and the knock on effect it can have not only on their day to day functioning but also family life.

So, what can you do to help your child fall asleep easier and stay asleep throughout the night?

Firstly, it is important to acknowledge that (a) some children just have a harder time relaxing and falling asleep than other children and (b) that it is really common for 8 to 12 year olds to start struggling with sleep! Often we, as parents, find children in this age range take longer to get to bed. Maybe they are taking longer to fall asleep or showing increasing levels of fear and/or anxiety about going to bed alone.

At this age it is important for children to have adequate sleep as they are growing and becoming increasingly active both in school and at after-school activities. They need well rested minds and bodies to strengthen cognitive ability, memory, alertness and overall mood and behaviour for school and learning. It is recommended that children at this age need 10 – 11 hours of sleep per night. However, it is not uncommon for them to sleep far less.

At this point it is worth noting that while ‘Sleep Guidelines’ provide us with an idea of what is considered ‘normal’, the best guide to your child’s sleep requirements are how they feel and how they function. In general, your child is probably not getting enough sleep if:

• They are sleepy at the wrong time of day (for example, after waking in the morning)

• They have trouble paying attention during the day

• They tend to fall asleep very quickly (within a few minutes) when given the chance

• They are “wired” at the wrong time of day (for example, just before bedtime)

• They are easily frustrated and quickly irritated

• They have trouble keeping their impulses in check

So why might my child be sleeping less than they need?

Biological Changes:

The average age of puberty for girls is between 10 and 12 years of age and for boys between 12 to 16 years of age. It’s during this age group that there is a shift in their natural sleep rhythms. Melatonin (our sleep hormone) is secreted later at night. It is this hormone that signals to the body that it is time to go to sleep. While this may not happen as early as 8 years of age, when the shift does occur, it can be biologically impossible for tweens and teens to fall asleep at an earlier bedtime even if we want them to!

Poor Sleep Environment and/or a Changeable Routine:

This is the age when activities, sports and homework increase. Bedtimes become later and over-scheduling leaves children over tired and exhausted making it more difficult for them to fall asleep. In addition, technology is ever present and often finds its way into children’s bedrooms. Sleep is being traded for staying up to date on social media sites or catching up on TV shows or YouTube.

The Wrong Bedtime:

Recent research has suggested that many parents are sending their children to bed too early and long before they are ready to fall asleep. If their bodies haven’t yet produced enough melatonin (a sleep inducing hormone). Children who are put to bed too early become understandably bored, and, as they lie awake with nothing to do, may find their minds dwelling on anxieties and fears.

Anxiety and Bedtime Fears:

At this age it is common for children to have fears and anxieties about school work, social environments and family difficulties or worries about illness and death. This can keep our children’s brains very busy, making it very difficult for them to ‘switch off’ and fall asleep.

This can be problematic as when we become over-tired, we keep ourselves going by releasing stress hormones such as cortisol and adrenalin into our bloodstream. When a child is over-tired, (s)he may be swamped by those bio-chemicals, (which stay in the bloodstream for more than 24 hours), thus making it harder to fall asleep the following night.

What can I do to help my child fall asleep easier?

The first step towards healthier sleep for anyone (regardless of age) is to promote healthy sleep hygiene:

  • Practice consistent sleep patterns. Aim for a bedtime between 20.30 and 21.30 and have a consistent wake up time in the morning (even at the weekend)
  • Ensure the run up to bedtime is calm with no electronic devices at least an hour before bedtime. The light from devices such as televisions, iPads, computers and mobile phones keeps the body from making melatonin. Use this time to decrease any stimulation, connect with your child and prepare them for sleep (see below). Try to avoid exercise 1 to 2 hours before bedtime (although you might be tempted to wear your child down with exercise, research suggests that exercise keeps people alert for at least two hours after it’s over).
  • Be mindful of what they eat before bedtime and avoid anything with caffeine (which stays in the body for 8 to 14 hours). Have a drink of warm milk and eat a carbohydrate rich snack beforehand to improve the efficacy of the milk’s tryptophan. Abanana (carbohydrate) is a good source of both potassium and magnesium which are natural muscle relaxants and has been known to help release serotonin, which can be sleep inducing.
  • Ensure your child’s sleep environment is conducive to sleep:

o   The room is dark, signalling to your child’s brain that it’s time to release melatonin
o   The room is not too cold or too hot
o   Remove all technology from the bedroom

Address childhood anxieties and fears before bedtime through communication and relaxation techniques. Be mindful to remove the pressure of sleep off both of you – it can become a stressful cycle. Your child will stress before bedtime because (s)he knows (s)he’ll have a hard time falling asleep, you and (s)he may argue about it which will stress you both out so no one will fall asleep any time soon! Children often feel the pressure when just being told to go to bed. Remain calm and explain why it is important to sleep, supported by various techniques that can help him/her get there!

  • Think about swapping bedtime stories for colouring. With the increase of adult colouring the calming benefits of this activity is being proven. Colouring with your child is not only relaxing but also provides the opportunity to ask open-ended questions that may help you to find out more about their day and what may be causing some of their anxieties.
  • Think about suggesting your child creates a journal which (s)he is happy to share with you. Use the journal as a safe place where your child can write down any worries or concerns that they want you to know about (with the understanding that you will read it). Sometimes it is difficult for children of this age to admit their fears out loud even when they want to share them with us, the journal can act as a bridge for communication between you.
  • Think about listening to a ’talking book’ (but be mindful of the content)
  • Teach your child to relax before bedtime through mindfulness, yoga and breathing techniques. These strategies will help relax their body and quiet their mind making it easier for them to fall asleep.
  • Ensure that you both have a clear understanding of the bedtime routine so that your child is clear on the expectations at bedtime and throughout the night.

Finally, avoid ‘band aid’ solutions such as medication. The first and most effective route to take before any sleep aid supplements should be modifications to the child’s behaviour and emotional state. Good Luck!

Siobhan Graham Psychotherapy – – 07863 546421


When Mother’s Day Hurts

Mothers-day-flowersMother’s Day is observed by many as a joyful occasion, a time when hardworking mothers have a chance to put their feet up, relax, be treated to breakfast in bed or special lunches and dinners. We might receive gifts lovingly chosen or perhaps handmade by our children and partners. We may put time aside for visiting or talking to our mothers, perhaps making up for time we have spent apart, while busy with our lives.

In the weeks preceding Mother’s Day we are faced with a barrage of Mother’s Day commercials and emails created to tug at our heart strings. However, for many, Mother’s Day can be a painful and difficult day. Women who have lost a child, women experiencing infertility, women who have had miscarriages, men, women and children whose mothers are no longer with us – for these and others, Mother’s Day can be a day of sadness and loss.

Mother’s Day grief can bring up feelings of sadness, loneliness, depression, anger, alienation and despair. For many the day becomes about just getting through. For everyone, childless mothers and motherless children, planning a way to remember loved ones is important. While there is no replacement for your mother this Mother’s Day, below are some constructive ways to deal with the day that may help you feel closer to her memory. Remember to be flexible and do what feels right for you at the time.

Have some quiet time to reflect on the good times you’ve shared – You may want to have a quiet day on your own or you may feel it is important to mark the day in a special way. What did you enjoy doing together? Maybe you’d like to visit somewhere special the two of you used to go, look through a photo album, watch a favourite film or go out with friends.

Talk about your favourite memories – Take the opportunity to talk about your mother with family and friends.

Write a letter to your mother and update her on all that’s happened since her death – Writing to deceased loved ones can be therapeutic and help to continue your bond with them.

Remember her with a card, gifts or flowers – If it feels right for you, mark the day with a Mother’s Day card. Write in it what you would like to say to your mother. You may want to put it up at home or take it to the cemetery or crematorium. Likewise you may wish to mark the day with flowers or gifts in memory of your mother.

Have a simple act of memorial – Light a candle, plant a flower in the garden, organise a memorial gathering, visit the grave or final resting place of your mother.

Create new traditions – Light a candle, say a prayer, visit somewhere new or wear a flower.

Do something that would have made your mother smile – Bake one of her favourite recipes, eat cake, dance around the kitchen, do some gardening or read a book. Doing something your mother enjoyed doing is a way for you to bring her into your day. Whatever you do, allow yourself to enjoy it just as your mother would have.

Don’t feel guilty if you have moments of enjoyment – Allow yourself to enjoy moments of respite if they happen and don’t feel bad when they do.

Plan a self-care day – Take a walk. Rest. Listen to your favourite music (music can have a positive impact on both our physical and emotional health, from reducing the perceived intensity of pain to relieving symptoms of depression). Look through old photographs. Watch a film. Have a bubble bath. Treat yourself to a massage or manicure. Phone a friend. Write in a journal.

If you need support ask for it – If you are worried that no one will do anything for you on Mother’s Day, be pro-active and tell your loved ones what you would like to do to observe the day.

Seek professional support – Sometimes it can help to talk to someone apart from family and friends who may also be grieving, you could call CRUSE Bereavement Care (Freephone helpline) 0808 808 1677.

Give yourself permission to do what you need to do to take care of yourself!