Compassion-focussed therapy

heart in handsI’ve been reminding myself of some of the basics of compassion-focussed therapy recently, and I thought I’d blog about it because we could probably all use a bit of this. Compassion-focussed therapy is a third-wave CBT approach, which means it has grown out of cognitive behavioural therapy even though it looks quite different to traditional CBT. A key part of it involves learning to show more compassion to ourselves as well as others.

Compassion-focussed therapy draws on neuroscience to explain some of its practices. It highlights three brain systems in particular (for more detail check out Mary Welford’s book Building Your Self Confidence Using Compassion-Focussed Therapy):

  • The threat system: the brain system involved in spotting threat in the environment and preparing us to run, hide, or fight. Back in the day this system helped us spot sabre-toothed tigers. Now we are more likely to experience this as we scan situations for social risks, for work terrors, or relationship frights.
  • The drive and resource acquisition system: the system involved in making us feel motivated to try for things we want and which gives us a sense of achievement when we succeed.
  • The contentment and soothing system: the system involved in attachment to caregivers and affiliation with others. A very social system, and one that kicks in when we are safe, secure and content.

Think about what day to day experiences you are having – run through which tend to activate your threat system, drive system and soothing system… Most work experiences, for example, tend to activate one of the first two.

For many people, especially people experiencing low mood, anxiety, and low self esteem, the contentment and self-soothing system in our brains tends to be less in use than would be optimal for a sense of well being. Connections in our brains get strengthened by use, so if we don’t use a system as much it is also likely to be less easily triggered than the others.

Compassion-focussed therapy helps us to balance the systems out by really focussing on the soothing system and actively practising compassion for ourselves as well as others.

Compassion is defined as a deep sympathy for suffering, alongside a desire to remove that suffering. Kristen Neff, expert in researching compassion, describes it in terms of three key components:

  • Kindness versus judgement: This means kindness in a very active sense of the word – really trying to do what we can to alleviate suffering, either of others, or of ourselves. As well as things that are more traditionally seen as kindness to ourselves (having a break, doing self soothing things) this can also include holding ourselves to account for things like preparing work in advance, doing exercise, eating well, pushing ourselves to try new things even when they feel difficult – things that might feel effortful but which set us up well.
  • Common humanity versus isolation: This is the idea which we might all know, but which is less often felt, that we are all part of a huge human population, all of whom suffer at times.
  • Mindfulness versus over-identification: Noticing how we are in the moment – right now – is vital for knowing if we are suffering and if this is related to our attitude towards ourself.

What can we do about it if we think we are less practised in soothing and self-compassion than we would like? Neff suggests some quick and easy ways to start in a 2 minute video that you can watch here:

  1. Give yourself permission to be kind to yourself. It isn’t selfish, it’s necessary.
  2. Try to notice how you speak to yourself – would I say this to a close friend?
  3. Try writing a letter to yourself as you would to a good friend.
  4. Try using soothing touch when you are feeling stress or suffering – placing your hands on your heart, or face, or clasping your hands together.
Advertisements

Not enough mental health services to go round for young people

nspccOver 100,000 children referred to local mental health services in England have been rejected for treatment in the last two years. Figures requested from NHS Trusts by the NSPCC, released today, show that an average of 150 referrals a day are turned away from NHS children’s mental health services, despite Childline reporting record numbers of calls. From a total of 652,023 cases referred to child and adolescent mental health services (CAMHS), 109,613 children were turned away. The NSPCC has called on Government to focus on early intervention to reduce numbers who reach crisis point.

These figures are very concerning, and reflect the chronic levels of underfunding which mental health services, and in particular child and adolescent mental health services, have experienced. With ever-shrinking and unprotected budgets for child and adolescent mental health and social care, services are sometimes pushed to raise the threshold for access higher in order to prioritise high-risk and crisis cases. It is mad that a system there to help young people should have to wait until they are in crisis before it can.

Not every assessment should necessarily result in access to a service – some referrals aren’t appropriate and some young people could be better helped in other ways, but these sky-high numbers suggest that the need for mental health services for young people is much greater than the provision. In addition the care received in different geographical areas of England differs, so waiting lists and access to services depends on where you live. This data is only for England but we know other areas of the UK and Ireland are also affected by stretched services, with Wales in particular suffering from having very little access to evidence-based talking therapies for children and adults.

It’s important these figures don’t become yet another stick to bash the NHS with.The data shows a greater need than there is capacity for, which is different from showing that the services themselves aren’t good. There is simply not enough service to go round, which is not OK.

What might help? Several things:

  • Ring-fence current funding and increase it. There has been a huge amount of rhetoric about parity of esteem between mental health and physical health problems, but until there is parity of funding it is hard to believe this. Child and adolescent mental health funding in particular has had such a chronic lack of under-funding for so long that it needs even more growth in funding to be able to provide the care that young people want and that professionals want to be able to give.
  • Getting in there early. Providing good services early on before mental health problems become severe and enduring is crucial. This doesn’t mean cutting back on specialist services – we still need them – but it does mean also making sure there is enough funding for early intervention to try to nip problems in the bud and also enough funding for the education and social care supports that need to go alongside.
  • As well as early intervention we can think about prevention: putting more effort in even earlier, perhaps in school settings, to help young people understand and negotiate powerful emotions and have the emotional literacy they need to talk about their feelings, might help head off some of these problems before they begin.
  • Thinking about why these young people are so distressed. The rise in numbers of reported mental health problems in children may be partly to do with increased knowledge of mental health issues and increased ability to speak up, but it’s also likely to have much to do with the huge pressures young people are under. There are more exams than ever before, there are new social media pressures to encounter, it’s really hard to be a young person in our society today and we should be addressing that.

50% of adult mental health problems are already present at the age 14. If we could help young people avoid this we might set them off on a different trajectory for their adult lives.

#notfunny

g2

I had a good laugh at the Guardian G2 headline the other day suggesting that the patriarchy might be dead. The cover had a load of pictures of the hashtag #metoo.

It’s really important that more people are speaking up about experiences of sexual abuse or harrassment, talking about the extent of the problem and trying to call it out for what it is – totally unacceptable. But I think difficulties we face around sex and gender, as a society, run too deep for a hashtag to overturn them.

This cover came in the wake of all the Weinstein revelations and then Gove’s crass joke on Radio 4 comparing an interview with John Humphries to sexual assault, a joke which all the men in the interview laughed along with. I’ve heard several men (and some women) since complain that it wasn’t worth pulling Gove up on this, or that it’s not possible to make a joke anymore.

Jokes about taboo subjects happen all the time, and black humour is part of human coping, but that doesn’t mean it’s not better to call it out when lots of older white men are laughing about a rape joke. I haven’t called out every person who has tsk-ed about the Gove comment – probably (and not commendably) partly because I thought they’d think I was a nag, and partly because I just felt tired at having to explain this stuff. This post is me saying how I see it.

Rape doesn’t just happen to girls and women, but it does happen much more to girls and women. Girls and women are encouraged from childhood by our society to be well behaved and compliant in nature, to dress attractively, and girls are routinely praised for prettiness over skills or accomplishments in a way that boys are not. Women are objectified and sexualised from so young that they take it for granted that part of their self-esteem is dependent on how their looks are perceived by others. Boys and young men are also socialised to see women and girls as sexual objects, and the wide availability of porn coupled with sparse sex education and very little opportunity to talk about issues of emotional relationships and active consent, mean both young men and young women are often left woefully alone with knowing how to negotiate sexual and romantic relationships.

A context which tolerates jokes about rape is a context which minimises sexual assault. When we then tsk at women who complain about this, and ignore the presence of the power imbalances which are often part of harassment situations, we create a culture where the boundaries between compliments and harassment get blurry, where power dynamics are unacknowledged, and where it is often too difficult to say #metoo. It’s all part of the same picture.

The psychological consequences of rape and sexual assault are insidious and far reaching. Rape is one of the worst things that can happen to someone. The effects on sense of identity, self-esteem and peace of mind can be so deeply devastating that they are sometimes simply unbearable. Post-traumatic stress disorder, depression, anxiety, not to mention shame, self-blame, self-harm, sometimes suicide, these are possible consequences of rape and sexual assault. Working as a clinical psychologist, I have been in the privileged position of having conversations with many young people who have experienced sexual trauma, most (although not all of them) girls and women. The experiences these young people have withstood are awful. These experiences have not happened in a bubble. The culture that these girls and women have grown up in, that we have all grown up in, has at best enabled and at worst encouraged the treatment they have experienced.

We are so far from the end of the patriarchy that that G2 cover made me laugh. But not because the situation we are in is remotely funny.

World Mental Health Day

blueprint coverToday is World Mental Health Day. I haven’t written on this blog for ages – I’m sorry for the radio silence – but World Mental Health Day has got me back on here. I have been working on a couple of other things which are available or nearly available to read if you’re interested. I’ve written a piece for The Guardian on trauma which you can see here. I’ve also been working on a bigger project this last year or so – a book about child development – all the juicy experiments and theories that I think would be really useful for everyone to know about – and it’s coming out in March. It’s called Blueprint: How Our Childhood Makes Us Who We Are and it’s available for pre-order on Amazon which is both exciting and terrifying.

nest

World Mental Health day is a great opportunity to pause and think about whether there are ways we could be boosting our own or other people’s mental wellbeing.

It’s easy for simple things that we know are helpful to drift when we’re busy: things like eating well, sleeping enough and being kind to ourselves. It’s easy when we’re stressed and pressurised to forget to ask how others are doing too, and to really listen to what they say when they reply.

Sometimes it can feel overwhelming if someone tells you they’re not feeling ok, and it might leave you feeling helpless – unsure of what to do to help them feel better. But sometimes just the act of asking and listening carefully to the reply is enough. I love this cartoon from Robot Hugs which captures that feeling that someone has really tried to get alongside, not got frustrated by things not getting better immediately. 

The focus of World Mental Health Day this year is mental health in the workplace. Stress at work can be a major problem, in all sorts of professions, and trying to create kinder and more compassionate workplaces is a really important thing that we can all do. It starts with making sure we’re taking care of ourselves, so I hope if you’re reading this it encourages you to think of a kindness you can do for yourself today, as well as something you might be able to do to make a colleague’s life a little easier.

cup

Current status: anticipating

img_3358Anticipation has been described as “emotional rehearsal for possible future situations”. At the moment I am emotionally rehearsing for a holiday to Iceland, getting excited by imagining floating lumps of ice in frozen lakes and exploding geysers.

Research into anticipation shows that we get more excited about picturing a future experience than anticipating a future material purchase. People feel less excited about waiting to receive a shiny thing they have bought than waiting to have an experience they have paid roughly the same amount for.

Studies also suggest that we get more intense feelings of pleasure from anticipating something than we do reminiscing about the same event. The same is also true for negative experiences: our anticipation of them is worse than our recollection of them. Van Boven and Ashworth showed just this in 2007, by devising a series of five experiments, asking people for their recollections and their anticipations of a diverse range of experiences, including a hypothetical skiing holiday, an annoying noise, and menstruation. People’s feelings before all of the events were reported as stronger than their feelings afterwards.

In a similar vein, a classic experiment from the eighties by Loewenstein showed that people were willing to pay three times as much to kiss their favourite celebrity if it was three days in the future, instead of immediately, suggesting they wanted to be able to savour the anticipation of the snog as well as the snog itself.

These studies highlight how much more fun we can get out of doing things than buying things, and they also make me think about the virtue of advance planning. If we can see a positive experience coming towards us from over the horizon then we can squeeze even more pleasure out of it than if it takes us by surprise. It might be worth booking a few more holidays in for next year.

Back to school

leavesIt smells of back to school today. There is something about the change of season from Summer to Autumn that makes me feel, even in my mid-thirties, that I should be buying a new pencil case and trying on new shoes.

Research on memory suggests that smells are very powerful cues. One study, by Willander & Larrson, gave 93 older adults one of three different types of memory cue: a word, a picture, or a smell. The researchers asked the adults to relate any event from their life to the cue. The memories triggered by the smells were older than those triggered by the words or pictures. Smell-triggered memories were mostly from the first 10 years of life, whereas word or picture-triggered memories were most from early adulthood. The older adults who took part reported more of a sense of going back in time with the smells, and also reported that the memories they recalled were ones they hadn’t thought about as much as the memories that the words or pictures brought up.

I remember the night before the new term started as being quite terrifying, even though I liked school in general. I wonder if the smell of Autumn means that there is a collective feeling of that same anticipatory anxiety for us all as grown ups at this time of year. An excuse to have a minor existential crisis and not feel bad about it, perhaps. Or at least to buy a new coat.