Talking Therapy for Carers

Whether you’re a young carer or an older carer, you will find caring takes its toll on your mental health over time. As a carer, you are constantly putting the needs of someone else before your own needs, relegating your feelings to the bottom of the pile. Your life will run to a tight schedule of medication management and appointments, cooking, cleaning, helping with movement, shopping, money management and much more.

You may also struggle to take your own physical health seriously, as you are so focused on the physical health of the person you’re caring for; your own aches and pains seem trivial in comparison.

Though this attitude seems admirable, it can present problems, as you have no time or emotional bandwidth to value yourself. You are at risk of burning out if you don’t put things in perspective, and that’s no help to you or the person you care for.

Solution-Focused Therapy (SFT) is one type of therapy that can really help carers, because it makes sure you develop a lasting plan for change and growth.

You might also consider Cognitive Behavioural Therapy (CBT), Mindfulness-Based Cognitive Therapy (MBCT) or Psychotherapy. An initial consultation allows you and your therapist to decide which type of talking therapy is best.

Carers and the Burden of Responsibility

Here are some of the automatic thoughts that carers of all ages can have, and that therapists can help you to work through during treatment:

There’s no point asking for help when everyone else is so busy or far away.

I’d rather be there all day and all night than have a stranger looking after them.

Mum refuses to go into a home, and we can’t afford home help, so my only choice is to be her full-time carer. If I say no, I’m a bad child.

They’re in constant pain, so how can I moan about anything in my life?

I’ll just skip breakfast and lunch again today – there isn’t time to make food for me and keep an eye on them.

How can I leave someone else in charge of care when I’m the only one who knows how to do it? I’d never forgive myself if something happened when I wasn’t there.

Society puts high value on altruism; helping others is seen as a worthy act, and it wins praise from those around you, but it also wrongly puts a negative slant on choosing to step away or share the responsibility of caring. Apparently, you should just ‘Keep Calm and Carry On’, regardless of your own difficulties and the limits of only 24 hours in a day. This damaging attitude can leave you with core beliefs that you struggle to change without therapy.

Advice for Young Carers

A young carer is defined as ‘a person under 18 who provides or intends to provide care for another person (of any age, except where that care is provided for payment, pursuant to a contract or as voluntary work)’, according to the Children and Families Act 2014. Carers.org estimates there are 700,000 young carers in the UK, or one in every 12 secondary school-aged children.

Young carers are especially vulnerable to taking on too many responsibilities and feeling isolated from their non-carer peers. Being a young carer means acting like an adult when you’re not ready to be one, however hard you try, as you juggle schoolwork, hormones and growing up with the pressures of caring. Importantly, a young carer shouldn’t be taking on the same tasks and time demands as an adult carer.

Furthermore, young carers have missed an average of 48 school days to care for relatives, and 68% of young carers have been bullied because of their home situation. However, help is at hand: families can ask for a Carer’s Assessment, apply for a Carer’s Allowance and, from 2019 in Scotland, those not eligible for Carer’s Allowance can apply for a Young Carer Grant.

Talking about your feelings as a young carer can help; child psychologists offer a non-judgemental ear and can support young carers at this pivotal time in their lives, away from the turbulent settings of home and school.

Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk). 

Small Ways to Help Someone with Alzheimer’s

As the British public reels at the news that entertainment legend Dame Barbara Windsor has been living with Alzheimer’s for four years, it’s a reminder that dementia is a growing condition that can touch you, your friends and your family. Thanks to medical advances, we have an ageing population living longer and fuller than ever before, but we must also deal with conditions like Alzheimer’s inevitably affecting even more of us: currently, that means 500,000 people in the UK.

We know getting an Alzheimer’s diagnosis can be devastating for a patient and their family, as thoughts of the future seem scary and impossible. It feels cruel and upsetting for everyone involved. Yet there are many ways to support someone with Alzheimer’s in their daily life, at any stage of the condition, allowing you to do something practical.

Read up on Alzheimer’s and What it Really Means

When a person with Alzheimer’s starts talking about their diagnosis, well-meaning friends and relatives can sometimes jump in with unhelpful advice or anecdotes about someone else’s experience. This can cloud everyone’s judgement and cause the patient more distress.

Your first port of call, aside from medical support from your GP, should be registered charities like the Alzheimer’s Society, which provides a wealth of information. Age UK also has plenty of advice and can give local support, such as drop-in groups for those affected.

There is some public confusion about the difference between Alzheimer’s and dementia: Alzheimer’s disease is the most common cause of dementia, whereas dementia is a set of symptoms used to describe over 100 progressive brain syndromes affecting cognitions and emotions. Though there is no cure for Alzheimer’s, some medications can help slow its progression.

Don’t Correct Someone with Alzheimer’s – Reassure Them

Though Dame Barbara Windsor was diagnosed in 2014, her husband has spoken of the move from a condition that has good and bad days to a more advanced stage, where ‘a definite continual confusion has set in, so it’s becoming a lot more difficult for us to hide’.

As you spend time with someone whose Alzheimer’s progresses, you will notice their lucid moments become less regular, and it is more of a struggle to recognise the person you know and love. It can be tempting to correct them when they forget people, places, events or words, but you should avoid doing this where possible.

Instead of correcting them (for example, saying “You can’t go and see your Auntie Flo – she died in 1990,”), just go along with what they say (“Let’s arrange something with Auntie Flo in a few weeks,”). By avoiding further confusion and possible anger or frustration, you will keep your loved one calm. Find more tips from Dr. Marie Marley, author of books on Alzheimer’s.

Create a Welcoming and Tailored Environment

Incorporate space and materials that relate to your Alzheimer’s sufferer’s personal life or their old work life: knitting or crafting materials, perhaps, or sporting memorabilia for someone who used to work in the sports industry. This will make them feel comfortable and give them talking points. You may also need physical adaptations to their home to keep them independent in the early stages of Alzheimer’s.

The distant past will be fresh in their memory, but they may also want to help with manageable tasks around the house, such as washing up. Repetitive tasks can aid with building and maintaining a routine. Each day is different: some days they might not be able to do the task, but on other days it will give them a sense of achievement.

The patient’s physical needs and abilities will also change; some people with Alzheimer’s refuse food, change their eating habits, or can’t use cutlery. Meals should be prepared and eaten in relaxed environments to reduce stress and distractions, so try to limit noise, cluttered places and patterns. Don’t rush their eating, and don’t worry about messy eating habits: as we’ve mentioned before, keeping calm is key.

Consider Non-Medical Therapies

Music therapy is perhaps the most important occupational therapy for people with Alzheimer’s, as it’s hugely beneficial. When many other memories have been lost, songs and melodies from decades earlier will be familiar to the patient, even in late stages. Age UK has plenty of information on the impact of music for dementia.

Art therapy can be useful, too, whether painting, drawing or printmaking. In the early stages of Alzheimer’s, a patient may withdraw from activities they used to enjoy, but art is one thing they can resume or take up, regardless of ability. With adult colouring books still popular, it’s never been easier to find art materials on the high street.

Creating a record of the person’s life, either with professional help or as a self-directed project, can help you reconnect with an Alzheimer’s sufferer and build up a picture of their past. It also acts as a lasting record for friends and family as the patient’s condition worsens. Written life stories can include photos, mementoes, tickets, poems and quotes. You could also get grandchildren to help.

Give Yourself Respite and Care to Help Everyone

As Alzheimer’s progresses, some of the symptoms can be particularly upsetting for friends, family and carers: you may witness the patient hallucinating, frequently falling, or struggling to speak. This takes a toll on caregivers and loved ones, too, as it becomes harder to keep someone safe and meet all their needs.

Respite care is crucial; nobody can monitor someone 24/7. You need time to recharge your own batteries, mentally and physically. Carers’ Support groups up and down the UK will give you a sense of community and help you meet like-minded people at different stages of caring. Look out for memory cafes, which carers attend with their friends or family, and day centre sessions.

You could also benefit from talking therapy, giving you an outlet for your emotions and worries. This therapy doesn’t have to end when your loved one goes into residential care or sadly passes away – the grieving process is long, and it’s different for everyone, so you may need more time to process your feelings and cope with loss. If you’ve given up work or perhaps moved house to support someone with Alzheimer’s, there will be an adjustment period to cope with as you decide what your next step will be.

Written by guest contributor Vikram Das for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk). 

EMDR – How and Why Does It Work?

EMDR, or Eye Movement Desensitisation and Reprocessing, was developed in 1987 by psychologist Francine Shapiro. Whilst on a walk, she realised that moving her eyes backwards and forwards helped her whilst thinking about traumatic memories. By 1990, Shapiro had established the EMDR Institute, and today you will find EMDR practiced around the world.

EMDR for PTSD

When you hold onto trauma and cannot process it, for example with cases of PTSD (Post Traumatic Stress Disorder), you are stuck in a state of hyper-vigilance and waiting for the next threat or attack. EMDR allows you to move on from that hyper-vigilant state of fight or flight. It doesn’t ask you to forget what happened, but simply to take the useful parts of that experience and discard the physical reactions and beliefs that have become ingrained ever since – for example, fast breathing, sweating and a raised heart rate triggered by certain noises, smells or places that remind you of the trauma.

Many people assume PTSD only occurs in high-profile and universally threatening situations, such as a terror attack, natural disaster, war, abuse or rape. In reality, PTSD can occur in everyday incidents, like robbery, persistent workplace bullying, or complicated childbirth.

Why Does Rapid Eye Movement Help With Trauma?

By stimulating rapid eye movement from side to side, an EMDR therapist is able to mimic the rapid eye movement that happens when we are asleep and our brains process the day’s events. Instead of reflecting on recent events during the eye movement, patients are asked to recall their traumatic experiences. They don’t always have to talk in great detail for EMDR to work.

Rapid eye movement action helps to process those painful memories. It forces the brain to multi-task across its two very different sections, in a process known as bilateral stimulation. Following movement uses the logical and linear left hemisphere of the brain, whilst drawing on memories uses the right hemisphere, which deals with language, intuition and emotions.

What an EMDR Session Involves

Depending on their ‘movement’ of choice, the therapist might move their finger, deliver sounds through headphones that switch between the left and right ear, or tap the patient’s knee. You’ll notice the therapist sits much closer to the patient than in other therapy sessions, such as CBT; this may take some getting used to. However, like any other type of therapy, each session takes place in a safe environment and at a manageable pace, with the ability to stop at any time during the session.

You will have an individual treatment plan for EMDR, created during the preparation phase. Part of your treatment is to uncover the negative core beliefs you hold as a result of your trauma and the target events (when it happened): for example, that you are unsafe, worthless or bad. Uncovering core beliefs is also common with other types of therapy, like CBT. You will create a positive cognition that more accurately reflects you as a person right now, like ‘I am safe’ or ‘I am a good person’, and rank it on a scale of 1-7, known as VOC (Validity of Cognition), to demonstrate how much you believe in that statement.

Learning to Desensitise in EMDR

You also need to recall the sensations and main emotions associated with your trauma and measure them on a scale of disturbance from 0-10, known as SUD (Subjective Units of Disturbance), to demonstrate how much they affect you. The EMDR aims to get your SUD score to something between 0 (no disturbance) and 2. You may uncover new details about the trauma that had been buried in your mind; this is very normal.

Towards the end of the session, the therapist will complete a body scan, asking you to identify physical tension or sensations in your body at that moment. Coping techniques are also part of recovery, as these teach you to relax in potentially triggering situations. Your therapist will develop individual relaxation techniques with you, that can be used outside the session.

Some patients and their friends and family may be sceptical about EMDR because it doesn’t sound like a traditional talking therapy, and the connection between eye movement and trauma processing may seem strange at first. However, EMDR is recognised by the World Health Organisation as a treatment for PTSD and to process trauma, because the evidence suggests it works for both children and adults, providing a positive outcome for the patient. You can find examples of clinical EMDR studies here.

Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk), and EMDR is one of the therapies offered by her team.

The ‘Spoon Theory’ in Chronic Illness

You may have heard of the ‘spoon theory’, used by some people with chronic illnesses or disabilities to describe their day-to-day lives, and you might have wondered what they meant. Or you may have seen the hashtag ‘spoonie’ on Twitter or Instagram and been just as puzzled. In fact, the spoon theory is a very useful tool for explaining the effect a chronic condition can have.

Origins of the Spoon Theory

The spoon theory was created by Christine Miserandino, who suffers from several debilitating medical conditions, including Lupus, and runs a website called But You Don’t Look Sick. She was having dinner with a friend, when the friend asked what it’s like to live with Lupus. Struggling to explain, Christine handed her friend a bunch of spoons, and asked her to imagine she had Lupus, with each spoon representing the energy reserves she would have and the decisions she could make during the course of a day.

Each everyday thing her friend would need to do – like getting out of bed, having a shower, and making breakfast – would cost one spoon, which Christine would then remove. If her friend tried to do more than her number of spoons allowed, she could ‘borrow’ against some of the next day’s spoons, but she would start with a deficit; in real terms, this meant starting the day with even less energy and ability to move.

Christine explained that each task involved making a decision: can you afford to expend energy in this way? Will this task have a knock-on effect, causing other tasks to build up? Have you got enough spoons left to cope with increased pain, fatigue and other symptoms?

Every day is a constant balancing act, according to how many spoons you have. The number of spoons you start the day with can vary, and on some days, you may have used them all up by lunchtime.

Importantly, the spoon theory means people living with chronic illness can spend less time explaining their symptoms and justifying their actions to others (such as needing to skip a family gathering because of depleted energy, or ordering takeaway rather than cooking and washing up). Applying the spoon theory to your own condition means you reach a state of acceptance, which is crucial when living with long-term sickness of any kind.

You might even find it useful when talking to your manager at work, talking to your GP, or completing an assessment for benefits. Any way you can get through to the other person and convey your symptoms is helpful.

Spreading Awareness with the Spoon Theory and #Spoonie

Countless other sufferers of chronic illnesses, both visible and invisible, have adopted Christine’s spoon theory to explain their own conditions, and many have started referring to themselves as ‘spoonies’. Christine has since produced a video and a PDF guide that you can send to friends and family, to help them further understand what it means, and volunteer translators have begun translating the theory into other languages.

Nearly 10,000 people have added a special Twibbon (a Twitter icon on top of your profile picture) to show support for the spoon theory, either because they have a chronic illness or they know someone who does. They also post on social media channels using the hashtag #spoonie, to raise awareness and connect to like-minded people.

Here’s to the spoon theory and the spoonie online community, breaking the stigma and misunderstanding surrounding chronic illness.

Written by guest contributor Vikram Das for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk). 

What is Learned Helplessness?

Feeling helpless and hopeless can be very common with mental health issues, but when your past experiences fuel your sense of helplessness, and make you think you can never avoid certain behavioural patterns or outcomes, you may be affected by ‘learned helplessness’. So, what is learned helplessness and how can we treat it?

Learned helplessness is a phenomenon first studied in the 1960s and 70s by Martin Seligman and Steven F. Maier, who discovered it present in animals. Seligman and Maier’s experiments at the University of Pennsylvania found that dogs who’d received small electric shocks later gave up trying to jump over a fence and escape, as they believed they would be shocked again. The dogs had remembered their own helplessness and decided not to risk another shock. A comparative trial with dogs who hadn’t been shocked found that they jumped the fence.

What is Learned Helplessness in Practice?

Just as in animals, learned helplessness in humans is about applying negative past experiences to a present or future experience, even if your circumstances are different. Despite signs that you may have a positive outcome, or that you’re in a safer situation than before, you firmly believe you are powerless to seek help or change.

Related studies by clinical psychologists Abramson, Metalsky and Alloy, in 1989, established a sub-type of depression called hopelessness depression, and the hopelessness theory of suicide was publicised in 2000 by Abramson et al (if you are worried that someone is feeling so hopeless they may attempt suicide, do seek immediate help for them, through their GP, by calling 111 or talking to an organisation like the Samaritans).

We may see learned helplessness in relationship patterns: the person who believes their abusive past relationship will lead to future abusive partners; the child whose memories of neglect mean they are terrified of being abandoned, and believe abandonment is inevitable, even as an adult.

If your friend or relative shows signs of learned helplessness, you will probably feel frustrated. However much you tell them that things can get better, and that one or two bad experiences don’t make them powerless to change, your words may fall on deaf ears. People with learned helplessness may struggle with self-care and healthy habits, isolating themselves from the rest of the world. That’s when they need psychological intervention.

Treatment for Learned Helplessness

Cognitive Behavioural Therapy (CBT) is ideal for treating learned helplessness, because it involves working through your core beliefs and thought patterns. By analysing situations and automatic thoughts, you can start to believe in the future, move away from assumptions about inevitability, and trust in the power of change. Your future doesn’t have to mirror your past.

Written by guest contributor Vikram Das for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk). 

International Women’s Day: Five Female Psychologists to Know

As International Women’s Day approaches (8^th March), we felt it was only right to acknowledge some pioneering female psychologists throughout history, who so often get overlooked in favour of men.

You might not have heard of these female psychologists and psychoanalytic experts, but that’s okay – just be sure to pass on what you’ve learned, and spread the message that psychology isn’t a male-only career. There are many great women working hard, deserving of just as much credit.

Anna Freud (1895-1962)

Anna Freud’s legacy lives on with the Anna Freud National Centre for Children and Families, a charity centre where children can be psychoanalysed and given appropriate treatment. The centre began as a place for children bombed out of their homes in WWII. Since then, clinicians have been able to observe children playing and taking part in group activities, to support their development and relationship-building.

Freud’s father was Sigmund Freud, but she was the only one of his children to follow him into a psychoanalysis career. She published her first book, Introduction to the Technique of Child Analysis, in 1927 and, in the same year, she became General Secretary of the International Psychoanalytical Association – a post she held until 1934. However, in 1938 she fled from Austria to Britain to escape the Nazis.

By 1947, she was officially training fledgling child therapists. Her specialisms included children who had suffered poverty, emotional neglect, a family unit crisis, hospitalisation and other trauma; she changed the way clinicians approach separation anxiety in children. Her own childhood experience of having an appendectomy without being forewarned by her family may have played a part in this interest.

Melanie Klein (1882-1960)

‘What we learn about the child and the adult through psychoanalysis shows that all the sufferings of later life are for the most part repetitions of these earlier ones.’

Klein was born in Vienna, but it wasn’t until she began travelling around central Europe that she realised her passion for psychoanalysis. She joined the prestigious Berlin Psychoanalytical Society aged 38, and began applying Freudian teachings to analysis of children, studying them at play and using her case notes as the basis for her own theories. She later moved to London and joined the British Psychoanalytical Society, clashing with Anna Freud on aspects of child psychology.

Her caseload included studying child evacuees during WWII. Klein went on to study depression, paranoid schizophrenia and loneliness, and the Wellcome Library holds an archive of her published papers, books and notes. Her most famous books are Love, Guilt and Reparation and other works (1921-45), The Psychoanalysis of Children (1932), and Envy and Gratitude (1957).

Susan Nolen-Hoeksema (1959-2013)

As a psychology professor and chair of the psychology department at Yale University (where she obtained her undergraduate degree), Nolen-Hoeksema was known for her interest in women’s mental health, from ruminating thoughts to depression, and how they differed from the male experience. Famously, in 1987 she highlighted some of the reasons women are more prone to depression than men, and mainly analysed it from adolescence upwards.

Nolen-Hoeksema earned her Ph.D. at Pennsylvania University and worked at the universities of Stanford and Michigan before returning to Yale. Her books included Sex Differences in Depression (1990), Women Who Think Too Much (2003), and Women Conquering Depression (2010), plus she edited an academic journal, the Annual Review of Clinical Psychology, from 2003.

She was passionate about identifying early indicators of mood disorders, eating disorders and addiction in young girls: primarily, the danger of unregulated ruminating thoughts, which not only distress patients, but discourage them from seeking help. Nolen-Hoeksema warned that, despite growing freedom and moves towards gender equality around the world, women can still fall victim to an ‘epidemic of overthinking’.

Rosie Phillips Bingham (1949-)

‘To deem my ideas as ordinary on Monday, but the same idea is brilliant when my white male colleagues delivers the idea on Wednesday is discouraging; in the classroom, to overlook the raised hands of students of colour is demoralizing.’

Currently President of the American Psychological Association (APA), Phillips Bingham has dedicated her career to counselling psychology, particularly for men and women of colour, who face conscious or unconscious prejudice. In 1996, she was given the Pioneering African American Women Award.

Phillips Bingham gained her Ph.D. in Counselling Psychology from Ohio State University in 1977 and then balanced teaching and practice in both the University of Florida and the University of Memphis. Her published papers tend to focus on career counselling, racial equality, and the importance of college (university) education. We know attending university is a challenging and formative experience, and Phillips Bingham’s work ensures that students in need of emotional support or guidance will be helped to thrive.

Bluma Zeigarnik (1901-1988)

Lithuanian Jewish Zeigarnik became one of the first Russian women to attend university, and obtaining a doctorate from the University of Berlin in 1927. Yet she faced political and ideological obstacles throughout her life. Even in 1983, when she was given the Lewin Memorial Award for her psychological research, she was unable to collect it, and died before she could receive the award – particularly galling, as she had spent years working with her friend and colleague, Kurt Lewin, who the award was named after.

She worked at the Psychiatric Research Institute and the All-Union Institute of Experimental Medicine in Moscow, but was made to leave the latter in the 1950s due to anti-Semitism. Many of her scientific papers were suppressed under government restrictions. She also raised her two children single-handedly when her husband was sentenced to 10 years in a Russian prison for allegedly spying for the Germans.

The Zeigarnik effect (discovered in 1927) demonstrates that people remember incomplete or interrupted tasks better than completed ones. Zeigarnik undertook her research with adults and then children, but found the effect was obvious in both, and it made a huge contribution to gestalt psychology.

If you know someone who should have been on this list, do tweet us their name (we are @CT_Psychology on Twitter).

Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk). 

What is a Panic Attack, and How Can You Treat It?

In 2013, people in the UK experienced 8.2 million cases of anxiety; whilst anxiety is upsetting and debilitating in itself, a panic attack sees this anxiety come to a head. Panic attacks are an intense and sudden onset of anxiety, lasting minutes at a time and leaving the sufferer debilitated. Many celebrities, including presenter Fearne Cotton, are now speaking out about their experience of having a panic attack.

But how do you know what a panic attack symptom is, and how can you cope with an attack?

Symptoms of a Panic Attack

You may feel as though you’re having a heart attack – that’s because a lot of the physical symptoms are similar to those of people experiencing a cardiac arrest. If you later realise what you actually went through was a panic attack, don’t be embarrassed by the confusion. Whilst panic attacks aren’t life-threatening, your body reacts as though you’re in a life-and-death situation. That ‘fight or flight’ mode has been activated, and you feel threatened.

Key symptoms include:

• · Feeling dizzy, faint, shaky or light-headed
• · A racing pulse, possibly with chest pain
• · Difficulty breathing
• · Tightness in your throat
• · Nausea
• · Sweating and feeling very hot, or the opposite: feeling too cold
• · Sudden terror and dread
• · Numbness or tingling in your hands and fingers
• · Feeling detached from reality, or as if you are floating

What to Do if You Have a Panic Attack

Most panic attacks last from five to ten minutes, though some can be longer. Once you’ve had a panic attack, it doesn’t necessarily mean you’ll have another one, but it does increase the likelihood.

If your panic attack happens in a large public space, such as a shopping mall or a concert venue, be reassured that many staff are now trained to deal with these kinds of incidents. Should you be somewhere on your own, or with someone who doesn’t know how to help, you can still get through it.

• · Firstly, you need to regulate your breathing, which will help to lower your heart rate. Breathing exercises don’t have to be complicated: breathe in through your nose, then breathe out slower and longer through your mouth.
• · Try to draw breath from your diaphragm, as shallow breathing isn’t helpful here. Imagine the breath going down into your chest.
• · Repeat a short phrase or mantra to remind yourself this will pass – for example: ‘I’m not in danger, I am having a panic attack’, or ‘The slower I breathe, the calmer I feel’.
• · Try to focus on the sensations around you, as long as they’re not triggering: what can you hear? What can you smell? Can you feel the chair you’re sitting on?
• · Alternatively, focus on an object you can see. Zone out on everything else but that object; this practice is called ‘grounding’ and should help you refocus, rather than leaving your mind racing as fast as your pulse.
• · Release muscle tension you might be carrying, like hunched shoulders or clenched fists. Do a ‘body scan’ and work your way around your body, imagining the tension in each part easing.
• · Once a panic attack has subsided (and it will, even though it doesn’t seem possible at the time), you will probably feel drained and upset – this is normal. Get plenty of rest where possible, and don’t throw yourself head-first into a hectic routine.
• · Caffeine, alcohol and cigarettes can all worsen panic attacks, so try to avoid them. Instead, stay hydrated and eat regularly to avoid low blood sugar levels.

How to Help Someone Having a Panic Attack

• · Stay as calm as possible and try to take charge of the situation – talk in a calm voice and don’t dismiss the person as overreacting or attention-seeking.
• · Help them focus on their breathing, taking slow and deep breaths together: in through the nose, out through the mouth, as mentioned above.
• · Follow the other panic attack tips previously listed, and don’t worry if something doesn’t calm them down. Different people respond in different ways. The main thing is to find what does work to take away that panic – maybe a mantra with breathing exercises, or a body scan with breathing exercises – and guide them through it.
• · It may help if they close their eyes as they breathe. If crowds and noise are definitely making things worse during the attack, gently move with them to a quieter area, but otherwise try to ride out the attack where you are.
• · Remind them the attack will be over soon, and it is nothing to feel bad about. Tell them everything will be okay.
• · Encourage someone who has regular or prolonged panic attacks to seek professional help, especially if they start regulating their behaviour to try and combat the panic (for example, they stop using public transport because they worry about having a panic attack whilst on the bus or the train).

Therapy for Panic Attacks

A therapist would look for the underlying cause of panic attacks by exploring possible triggers and associated memories with the patient. Reliving those memories will be distressing, but talking to a psychologist means you are in a safe and confidential space where you can develop strategies to deal with the difficult emotions and thoughts that come hand in hand with the panic and anxiety. You may be asked to keep a panic diary, logging your symptoms and potential triggers.

Cognitive Behavioural Therapy (CBT) can help with panic disorders, where someone has repeated panic attacks and may end up avoiding certain places or situations to try and cope. Through CBT, you can learn to overcome your fears and regain control.

You may find it also helps to get peer support from other people living with panic attacks, through charities like No Panic or Anxiety UK, but therapeutic intervention and, if a doctor suggests it, medication, is also worth exploring for panic disorders.

Written by guest contributor Vikram Das for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk). 

Terror Levels and Anxiety in Children

The results of a recent YouGov survey have revealed that a third of children in the South East aged 5 to 18 worry about a possible terror attack. 35% of parents interviewed have said this fear is causing anxiety in their children. The YouGov survey, which saw more than 1800 parents included nationally, was commissioned by the Mental Health Foundation to uncover the impact that world events were having on children.

Worrying about unpredictable events is very understandable. Reassuringly, it is easy for parents to reduce this fear to manageable levels. Children fear the things that they can’t fully understand; that said, they are also resilient.

It is really important to be able to reduce a child’s fear before it interferes with their mood. Anxiety left unchecked tends to get worse, rather than the old and false belief of ‘ignore it and it will go away’.

Helpful Tips to Reduce Anxiety about Terror Levels

1. Talk in an age-appropriate way to your children about the unlikely probability of a terror attack in their immediate world.

This will quickly reduce their distress. Simple maths and probability with older children works well, demonstrating that the likelihood of a terror attack happening to them is very small. Last year, a Maryland University study found that, across Europe, you were more likely to be a victim of terrorism in the 1970s and 1980s than you are now. Remind your child that you lived through these times.

Fables, myths and made up stories work with younger children. For instance, a young child quickly grasps that Father Christmas only visits in certain circumstances and at certain times: if they are good, and only at Christmas. Young children don’t need to understand time and frequency to hold this in mind, as they know Father Christmas doesn’t visit every day.   

2. Teach your teenager about some sensible precautions they can take to remain vigilant about their surroundings.

Be careful not to swamp them with too much information, and stick to practical things they can do that make sense in everyday life. For instance, to always have their mobile charged when going out (perhaps carrying a charging cable or lightweight emergency power pack) and being very aware of emergency exits.

In contrast, a younger child is greatly reassured by being told that parents and teachers are there to look after them. This frees them from the burden of worry. Older children feel safer when they feel involved and in control, but younger children need to know that parents and carers are in control.

3. Reassure them that it’s okay to speak to an adult or teacher at any time that they feel a genuine fear.

Do not make fun of them when they do confide in you. If they can’t tell you for fear of ridicule, the anxiety simply stays inside and grows. Should your child be bottling things up unnecessarily, and you’re struggling to get them talking, they might wish to express themselves through drawing, writing or similar activities.

Their school may also be able to encourage them to open up, either as part of PSHE lessons or in school assemblies, perhaps using the Red Cross’ resources for teachers on how to discuss disasters and emergencies. Schools will be aware of the need to teach pupils not to judge other children because of their race or religion, especially in the wake of terrorist incidents, when intolerant opinions can often be voiced louder than ever before.

4. Remind children that it is okay to trust their judgment – if a situation looks suspicious, it may be suspicious.

They need to get away from the situation, if it is safe to do so, and alert an adult who can take the necessary action. If these steps are taken, fear will reduce.

The ongoing public transport campaign, ‘See it. Say it. Sorted‘ (launched in 2016) can also be reassuring, as children will realise the British Transport Police takes reports of suspicious activity seriously and that you can simply send a text message to 61016 to report something suspicious.

5. Images of terror surround us, but it is important not to produce a false picture by blacking out all media representations.

Children will always find out about life events, either through friends, family members or at school, and we shouldn’t expect them to stay ignorant.

We cannot pretend terror attacks never happen, but we can reassure children of any age that they are still rare. What’s more, when they do happen, many people will be on hand to help and, just as the unfolding coverage can upset us, there will also be stories about acts of kindness and bravery from the public during and after an upsetting event.

Talking About Terror Threats if Your Child Has Autism

If your child has autism, there are a range of very specific tools that can be used to reduce their fear. At our psychology clinic, we often use Social Stories: a concept developed by teacher Carol Gray in 1990 to help her autistic pupils.

The use of Social Stories is a very specific way of teaching, via the use of stories with your child, which introduces the concept of anxiety about terrorism in a character or subject in a made-up story. Using this technique, the child is able to understand the concept through the eyes of the character. This is really important when a child is unable to make sense of simple explanation.

Written by a guest contributor for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

Why is Happiness Fleeting?

At the weekend, I was listening to James Rhodes’s brilliant new album, ‘Fire on all sides’ – what a masterpiece. To say he has talent is the understatement of the decade.  Almost at the same time, I saw his recent BBC Breakfast interview, which you can watch below, where he discusses happiness and what it means to pursue feeling happy.

Rhodes makes some interesting observations about the state of happiness, but this one statement in particular resonates:  ‘We are not meant to be happy all the time’.  Actually, his thoughts fit like a glove with major schools of spiritual wellbeing, ancient myths and archetypal psychology: Heraclitus to Graves, to Bly and Samuels, to name a few.

The Pursuit of Happiness

Rhodes says more on the pursuit of happiness; his view is that we are not meant to be happy all the time and that the pursuit of happiness at all costs is causing us pain. Wise words indeed.

Ancient wisdom tells us that ‘happiness is a fleeting state, not an arrival at a destination’. What, then, if we think about it in different terms ? How about ‘happiness comes and goes’, just like the tides?

At best, happiness is a fleeting emotion: a sensation to be enjoyed while it is here, however short the visit.  Sadness, happiness’ ugly twin, has the same fleeting visiting pattern. When sadness visits, we have to endure despite wanting rid of it. Jung aptly named sadness  ‘nigredo’, or dark night of the soul. Sadness is a fleeting emotion, too; just like other feelings, it will pass.

More often, sadness teaches – it enables us to grow spiritually and emotionally. How would we appreciate or even know happiness if sadness didn’t exist? If happiness were the permanent condition, or even much wrestled for a sense of balance, where would meaning be found? How would the green shoots of personal growth burst forth?

Understanding Sadness in Relation to Happiness

A permanent state of bliss could be likened to the Sisyphus myth (where Sisyphus must roll a stone up a hill, only for it to roll back down again every time he succeeds). It would be meaningless and eventually boring. Could too much happiness be no more than an ecstatic death sentence? It takes a bit of thought to consider sadness from this standpoint.

Self-help books certainly do have their rightful place, but the pursuit of happiness per se is both illogical and a fallacy. Depression, too, at times is a necessary position, and it has a purpose. We can’t always be happy, just as we can’t be continually sad. James Rhodes is making a wise observation that happiness and sadness are part of a continuum. They can be normalized as part of the experience of living.

Severe or prolonged depression is a different matter. It is not normal sadness at all. These symptoms are not part of normal sadness:

• To really want to kill yourself
• To not have the energy to wash or wear clean clothes
• To want to scratch, burn or harm yourself
• To not be able to think clearly
• To not be able to make simple decisions

These depression symptoms need expert psychological or psychiatric help. These symptoms are not a progression of normal sadness, but a sign that help is needed.

However, if your sad feelings are fleeting, and part of a normal life with its ups and downs, rather than clinical depression, it’s important to put them in perspective, and Rhodes’ words can help with that process.

Written by Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

 

Understanding Trauma and its Effects: Holocaust Memorial Day

27^th January is Holocaust Memorial Day – a chance to remember the estimated 11 million people (six million of them Jews) who lost their lives in the Holocaust, and future genocides. In understanding trauma that survivors live with, we as a society demand history doesn’t repeat itself, and we acknowledge those affected.

This date was picked as the official memorial day back in 2000, by governments from around the world, stating that ‘we value the sacrifices of those who have risked their lives to protect or rescue victims, as a touchstone of the human capacity for good in the face of evil’.

But how did Holocaust survivors deal with the psychological trauma in 1945, and how do we begin understanding trauma like this in 2018?

Being told to forget

When most survivors returned home, or began new lives in other cities or countries after liberation, they faced negative reactions from neighbours, friends and colleagues. Hostility, silence and indifference were all common, because nothing like the Holocaust had ever happened before, where certain groups (including Jewish and Polish people, gypsies and gay men and women) were systematically targeted. Though camp conditions were reported worldwide before and after liberation, trials were delayed and took a long time, and many perpetrators escaped punishment. Every time war criminals were brought to justice – some only in the last decade – survivors faced trauma triggers.

Victims were either told to forget about their experiences, or they decided to repress the memories as a coping strategy, ploughing their attention into normal life and trying not to think about the past. This is not something psychologists, or indeed psychiatrists, would suggest today. In order to recover from trauma, and process it, patients use talking therapy with psychologists, and treatments such as EMDR would be recommended for those suffering from PTSD (Post-Traumatic Stress Disorder).

Early studies of Holocaust survivors

In 1950, survivors in Israeli refugee camps were found by sociologist Judith Shuval to be more ‘pessimistic’ than control subjects, and also ‘hard’: hardened to the setbacks they encountered. By the late 1960s, more research emerged on the psychological impact of surviving the Holocaust, and terms like ‘survivor syndrome’ were coined (by psychiatrist William G. Niederland, who studied 800 cases in 1964). For many survivors, symptoms of what we’d now call PTSD didn’t emerge until years afterwards; technically, when symptoms emerge at least six months after the traumatic event, this is late-onset PTSD.

Jewish people in Nazi-occupied Europe who weren’t in concentration camps but were hidden in plain sight (in children’s homes, convents or strangers’ homes), became resistance fighters, or fled abroad – perhaps on Kindertransport – had different experiences, but still faced emotional distress. We still call them Holocaust survivors, because they are. They lost many relatives, friends and neighbours, and had no community to return to after the war. Anti-Semitism didn’t die with the Nazis, either; the remaining Jews scattered across Europe faced stigma in the decades afterwards. Despite the distress those in hiding suffered, it wasn’t until 1983 that any researchers (Shanan and Shahar) included them in scientific studies, and we began understanding trauma for those who survived in different circumstances.

Understanding trauma in a second generation

Helen Epstein, the daughter of two Holocaust survivors, published a ground-breaking book in 1979. Children of the Holocaust: Conversations with Sons and Daughters of Survivors suggested that these children had inherited fears and anxiety because of their parents’ suffering. A mixture of learned behaviour in the family unit, and having no outlet to discuss their concerns, meant survivors’ children faced their own specific challenges. Epstein’s book struck a chord with people all over the world. It reminds us that trauma doesn’t end with the patient, but can affect those around them.

Furthermore, there’s science to back up her theory. Scientific American reported in 2015 that children of Holocaust survivors have different stress hormone profiles to their peers. The survivors themselves had lower levels of cortisol, and younger survivors had less of an enzyme that processes cortisol, freeing their bodies to focus on storing glucose (essential during starvation); this seems fairly logical. But the stress hormone profile of their children features high levels of cortisol – perhaps compensating for their parents – and a greater predisposition to PTSD than their peers.

Long-lasting effects of trauma

In 2010, the American Psychological Association summarised decades of research which showed that Holocaust survivors still had symptoms of PTSD and that they reported poorer wellbeing than peers who hadn’t been Holocaust victims. Many of these survivors won’t have had early psychological intervention; as we discussed earlier, they may have been discouraged from talking about what happened, or they may have tried to repress their memories and refused to reflect on the past, as a coping mechanism, not understanding trauma within themselves. Whatever their family circumstances, they often battle loneliness and isolation, but meeting fellow survivors can help increase their sense of community.

Sadly, other genocides followed the Holocaust. In the decades since, we’ve seen groups persecuted across the world – for example, in Bosnia, Cambodia, Rwanda, Sudan, and the current actions against Rohingya Muslims in Myanmar. That’s sadly why Holocaust Memorial Day doesn’t just remember past horrors, but what’s going on right now in the world, affecting vulnerable men, women and children. Understanding trauma in 2018 is much easier than in 1945, but survivors of more modern atrocities won’t necessarily have access to better treatment, or any therapy at all. Here in the UK, we are also fighting for Syrian refugees to be given trauma assessments and treatment to process the horrors they’ve seen (the war in Syria is on the verge of being categorised as genocide), as they adjust to starting again thousands of miles from home.

This Holocaust Memorial Day, we pay tribute to all those who’ve experienced the trauma of genocide, and their families, and wish them well in their ongoing recovery.

Written by guest contributor and mental health campaigner Polly Allen, for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).