Tag Archives: anxiety

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 Our daily routines, that were essential to us before the COVID-19 crisis have disappeared and been replaced by uncertainty and a lack of structure that can contribute to stress, anxiety and feelings of depression.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: www.thecalmzone.net

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: www.childline.org.uk

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: www.mind.org.uk

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: www.papyrus-uk.org

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: www.samaritans.org

Stay safe!

Siobhan Graham – Accredited Cognitive Behavioural Psychotherapist – www.SiobhanGraham.com

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 – www.siobhangraham.com – 07863 546421


Why your 8-12 year old isn’t sleeping

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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 – www.siobhangraham.com – 07863 546421