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CBT for Depression

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CBT for Anxiety: How are Anxious Thoughts Like the Circle Line?

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Digital CBT

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 What does existing research tell us about the possible impact of the pandemic on children and young people's mental health? Dr Lucy Maddox speaks with Dr Maria Loades about Maria and colleagues' recent rapid review of the literature on isolation and mental health, and what CBT principles suggest can be helpful to head off problems, in particular with loneliness during the pandemic.  Show Notes and Transcript Maria recommended lots of helpful resources on loneliness and social isolation which we've listed here: Books Together: Loneliness, Health And What Happens when we find Connection – Vivek Murthy  https://www.amazon.co.uk/Together-Loneliness-Health-Happens-Connection/dp/1788162773 Overcoming social anxiety and shyness  https://www.amazon.co.uk/Overcoming-Social-Anxiety-Shyness-Gillian/dp/1849010005 Overcoming your children’s social anxiety and shyness  https://www.amazon.co.uk/dp/1845290879/ref=cm_sw_em_r_mt_dp_U_6p13EbZ0ER2XD Websites Mind -  https://www.mind.org.uk/information-support/tips-for-everyday-living/loneliness/about-loneliness/ How to cope with loneliness during coronavirus –  https://www.verywellmind.com/how-to-cope-with-loneliness-during-coronavirus-4799661 TEDx talk by Will Wright ‘Loneliness is literally killing us’ - https://www.youtube.com/watch?v=ruh6rN5UrME&amp;feature=youtu.be Loneliness and isolation in teenagers – a parent’s guide  https://www.bupa.co.uk/newsroom/ourviews/2019/05/teenager-loneliness As always if you want more information on BABCP check out www.babcp.com If you want to find a CBT accredited therapist check the register of BABCP accredited therapists https://www.cbtregisteruk.com/ Articles The rapid review we talked about is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267797/ Podcast That podcast episode with Shirley Reynolds on teenagers doing more of what matters to them is here:  https://letstalkaboutcbt.libsyn.com/helping-teenagers-do-more-of-what-matters-to-them   Transcript Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. In this episode brought to you by the British Association for Behavioural and Cognitive Psychotherapies, we think about the possible effects of quarantine on children and young people’s mental health. I’ll let my guest for today introduce herself.   Maria: My name is Dr Maria Loades and I’m a clinical psychologist and I work at the University of Bath as a lecturer on the doctorate and clinical psychology programme.   Lucy: Maria and her colleagues have been especially interested in the effects of the pandemic on children and young people. She co-authored a rapid review of evidence to try to understand what this effect is likely to be.   Maria: What we wanted to do was to look at two things. One is the studies that have been done that have looked at social isolation in a pandemic context in children and young people and how that’s impacted on their mental health. Secondly, we were also interested in thinking, okay, if these measures mean that young people experience this increase in loneliness, what do we know about how loneliness might be related to mental health for children and young people.   Lucy: So obviously there’s not loads of pandemics to study, but you’re trying to work out from what’s been done before, how does loneliness impact on mental health problems for children and young people? You turned the review around really quickly didn’t you, because normally it takes months to do something like this.   Maria: Yes, we really felt like it was particularly important to pull this together as quickly as we could to inform policy and practice going forward.   Lucy: And what did you find?   Maria: As we expected, there isn’t much known about the impact of pandemics specifically. There was just one study that looked at mental health in children and young people in a pandemic context and it did find that there was significantly increased rates of mental health problems for those who had experienced disease containment measures like quarantine or social isolation. And the study focused on trauma symptoms and they found really much higher rates of trauma symptoms amongst those young people who had experienced those disease containment measures. But that is only one study.   More broadly though, there were over 60 studies that looked at loneliness and mental health. And we found that there is good evidence that loneliness increases the chances of developing mental health problems, both anxiety and depression, up to nine years later.   So there’s not only a loneliness and depression and anxiety linked when we measured them at the same point in time, but there’s good evidence that being lonely now will mean an increase in risk of mental health problems at a later date.   Lucy: Maria thought one study was particularly interesting. It looked at duration of loneliness compared to intensity of loneliness.   Maria: Now what we mean by that is how long the loneliness is going on for, as compared to how strong the loneliness is. And what this study found, and it was a big study, is that actually the longer we’re lonely for, the more closely linked that is with mental health problems than how strong the loneliness is.   Lucy: What are some things that might be helpful to head off these problems?  Maria: We know that loneliness is that feeling we get when our social connections are not what we would want them to be. In the current context, of course, socially connecting in the normal ways, like at school or at college, for young people, is curtailed. But we can still connect in other ways.   Lucy: Maria emphasised how important connecting for play dates over video calls can be, as well as meeting up for play now lockdown is easing, and using more old school ways of communicating as well, like sending friends cards or letters.   Maria: The other thing we can do is more broadly to think about how we promote activities amongst young people that support wellbeing in every which way we can. As well as making sure we’re providing a listening ear for young people and being open to hearing what they might be worried about or what they might be feeling sad about and problem solving that where we can. Actually giving them permission, this is a really unusual circumstance and it’s okay and it’s normal for it not to feel very good.   Lucy: Some things that we know promote wellbeing include regular exercise, good quality sleep, healthy eating and time spent on activities that young people enjoy and feel proud of.   Maria: As one goes for a walk you see rainbows in the windows and my little one looks and points and knows that those rainbows mean that there are other children out there. And I think that’s incredibly helpful in terms of feeling a sense of community, connectedness, which also helps to overcome that loneliness.   Lucy: So although there may be an increased risk of mental health problems as a result of the pandemic, there’s also lots and lots that we can do that would be protective.   Maria: Definitely. I think it’s really important too that we make a distinction between young people who might be feeling lonely now and during this context, but who were pretty well socially connected beforehand. And of course, other young people who might have been lonely beforehand and this has maybe made things worse, or that their loneliness is ongoing at this stage.   For those young people who have maybe been feeling lonely for a much longer time, we might need to do something more individualised and more specific in terms of helping them to think about how they can make social connections going forward, as we resume life to some degree.   Lucy: I asked Maria whether she thought that as we are able to see people more, there might also be some anxiety around socialising.   Maria: You know, the reality is, we haven’t been practicing socialising nearly as much as we’d normally do. So we might well feel rusty and we might well even be worried about connecting socially with each other again. Add into that, of course we’ve had a lot of messages in recent weeks about the risk of interacting with each other because of the risk of infection. And so I think anxiety about getting physically close to each other and interacting with each other is going to be really natural in weeks going forward.   And I think again, the CBT principles can really help us to deal with those social anxieties too. So the first principle that I think is really important to remember is: The first step to tackling fear is facing it.   Lucy: CBT principles suggest breaking down a scary situation into steps and gradually building the confidence to face the fear by conquering one step at a time. So starting with a text message to a friend and working up to meeting face-to-face, for example.   Another tip to help with social anxiety is trying not to focus on how we’re coming across to someone but to focus on what someone is saying rather than getting caught up in thoughts about what they think about us. Thinking about thoughts, just as thoughts rather than facts is one thing that can help with this too, both for children and adults.   Maria: There’s certain developmental reasons why children and young people may be struggling particularly and those are about the key importance of play and of social interaction to development at those ages. But actually this is something that everybody is experiencing.   I do think the majority of children and young people, and adults more generally, will have a few wobbles, but will manage and will bounce back as we go forward. But for some, I think it will be a little more difficult and they’ll need to maybe engage in a bit of self-help using some of these CBT principles or indeed actually to go on and get some more professional help.   Lucy: Maria’s review has implications for school policy.  Maria: What we’re really encouraging, both schools but also policymakers to support is that as schools return and resume their normal activities, that they focus on allowing children and young people to reconnect rather than emphasising catching up academically. We know, again, from lots of studies and reviews that have been done that having mental health problems gets in the way of academic attainment.   We’ve got a strong rationale really for arguing, okay, let’s make sure now that we try and overcome loneliness rather than prioritising catching up with school work in the short-term because actually in the longer term that’s going to be beneficial to school work as well as to wellbeing more generally.   Lucy: I was curious to know if Maria thought any children and young people might actually have benefitted from lockdown. I see children and young people in my clinical practice and I’ve seen a real mixed bag of responses.   Maria: I do think that there are some young people who have actually found lockdown to be a real relief, particularly young people who struggled more with school and who struggled more with social interactions. Again, they’re young people who might struggle particularly with the return to school as things get restarted again.   Lucy: Another group Maria highlighted were children and young people with particular transition points at this time.   Maria: People who, for example, had exams cancelled. Whilst in the short-term that might be a real relief not to have to study and not to have to face GCSEs or A-Levels for instance, I think again, going forward, then there’s worries for those young people about what did that mean for them and how do they pick up from where they left off.   Lucy: Super hard isn’t it, because there’s such a range of experiences that will be going on in people’s homes as well. I suppose one thing that has been really on my mind is children and young people who are from backgrounds where they will be disadvantaged by being at home, or perhaps even in danger for one reason or another.   Maria: I think that’s a real problem and I do a lot of work with colleagues in South Africa, for whom lots of what we’ve been talking about as helpful strategies just don’t apply. Most children and young people don’t have access to the internet and can’t continue to keep in touch by virtual play dates, for instance. So what do you do for those kind of populations who are disadvantaged in terms of being able to remain in digital contact with one another. It’s really tricky.   I think we should all be concerned about those young people for whom home isn’t a safe place. And that’s a small minority of children, but a really big concern.   Schools often have a function of being able to do that check-in and that noticing of when children aren’t doing okay and to pick up on that and we haven’t had the ability to do that. So I think the needs of those children are going to be really important to thoroughly meet as we resume education contact and so forth.   Lucy: Maria’s overall message was one of realistic optimism.   Maria: I think parents are understandably fearful about what this is going to mean for the wellbeing of their children going forward and, what’s that phrase? Realistic optimism. I do think the vast majority are going to bounce back and a few wobbles, a bit of encouragement, a bit of a push sometimes, but they’ll manage it. And the few who get a little more stuck, we do have things that we can offer to help.   Lucy: That’s all for now. I hope you enjoyed this episode and found it useful. If you’d like to listen to more on children and young people, there’s another episode with Shirley Reynolds, talking about how to help young people do more of what matters to them at this time. There’s also loads in the back catalogue about different types of CBT and different problems it can help with. For example, compassion focused therapy or CBT for hoarding disorder.   As ever, if you have ideas for new topics, feel free to get in touch with me at lucy.maddox@BABCP.com. Take care for now.    END OF AUDIO 

What does existing research tell us about the possible impact of the pandemic on children and young people's mental health? Dr Lucy Maddox speaks with Dr Maria Loades about Maria and colleagues' recent rapid review of the literature on isolation and mental health, and what CBT principles suggest can be helpful to head off problems, in particular with loneliness during the pandemic.  Show Notes and Transcript Maria recommended lots of helpful resources on loneliness and social isolation which we've listed here: Books Together: Loneliness, Health And What Happens when we find Connection – Vivek Murthy <a href="https://www.amazon.co.uk/Together-Loneliness-Health-Happens-Connection/dp/1788162773" rel="nofollow" target="_blank"> https://www.amazon.co.uk/Together-Loneliness-Health-Happens-Connection/dp/1788162773</a> Overcoming social anxiety and shyness <a href="https://www.amazon.co.uk/Overcoming-Social-Anxiety-Shyness-Gillian/dp/1849010005" rel="nofollow" target="_blank"> https://www.amazon.co.uk/Overcoming-Social-Anxiety-Shyness-Gillian/dp/1849010005</a> Overcoming your children’s social anxiety and shyness <a href="https://www.amazon.co.uk/dp/1845290879/ref=cm_sw_em_r_mt_dp_U_6p13EbZ0ER2XD" rel="nofollow" target="_blank"> https://www.amazon.co.uk/dp/1845290879/ref=cm_sw_em_r_mt_dp_U_6p13EbZ0ER2XD</a> Websites Mind - <a href="https://www.mind.org.uk/information-support/tips-for-everyday-living/loneliness/about-loneliness/" rel="nofollow" target="_blank"> https://www.mind.org.uk/information-support/tips-for-everyday-living/loneliness/about-loneliness/</a> How to cope with loneliness during coronavirus – <a href="https://www.verywellmind.com/how-to-cope-with-loneliness-during-coronavirus-4799661" rel="nofollow" target="_blank"> https://www.verywellmind.com/how-to-cope-with-loneliness-during-coronavirus-4799661</a> TEDx talk by Will Wright ‘Loneliness is literally killing us’ - <a href="https://www.youtube.com/watch?v=ruh6rN5UrME&amp;feature=youtu.be" rel="nofollow" target="_blank">https://www.youtube.com/watch?v=ruh6rN5UrME&amp;feature=youtu.be</a> Loneliness and isolation in teenagers – a parent’s guide <a href="https://www.bupa.co.uk/newsroom/ourviews/2019/05/teenager-loneliness" rel="nofollow" target="_blank"> https://www.bupa.co.uk/newsroom/ourviews/2019/05/teenager-loneliness</a> As always if you want more information on BABCP check out <a href="http://www.babcp.com" rel="nofollow" target="_blank">www.babcp.com</a> If you want to find a CBT accredited therapist check the register of BABCP accredited therapists <a href="https://www.cbtregisteruk.com/" rel="nofollow" target="_blank">https://www.cbtregisteruk.com/</a> Articles The rapid review we talked about is here: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267797/" rel="nofollow" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267797/</a> Podcast That podcast episode with Shirley Reynolds on teenagers doing more of what matters to them is here: <a href="https://letstalkaboutcbt.libsyn.com/helping-teenagers-do-more-of-what-matters-to-them" rel="nofollow" target="_blank"> https://letstalkaboutcbt.libsyn.com/helping-teenagers-do-more-of-what-matters-to-them</a> Transcript Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. In this episode brought to you by the British Association for Behavioural and Cognitive Psychotherapies, we think about the possible effects of quarantine on children and young people’s mental health. I’ll let my guest for today introduce herself.   Maria: My name is Dr Maria Loades and I’m a clinical psychologist and I work at the University of Bath as a lecturer on the doctorate and clinical psychology programme.   Lucy: Maria and her colleagues have been especially interested in the effects of the pandemic on children and young people. She co-authored a rapid review of evidence to try to understand what this effect is likely to be.   Maria: What we wanted to do was to look at two things. One is the studies that have been done that have looked at social isolation in a pandemic context in children and young people and how that’s impacted on their mental health. Secondly, we were also interested in thinking, okay, if these measures mean that young people experience this increase in loneliness, what do we know about how loneliness might be related to mental health for children and young people.   Lucy: So obviously there’s not loads of pandemics to study, but you’re trying to work out from what’s been done before, how does loneliness impact on mental health problems for children and young people? You turned the review around really quickly didn’t you, because normally it takes months to do something like this.   Maria: Yes, we really felt like it was particularly important to pull this together as quickly as we could to inform policy and practice going forward.   Lucy: And what did you find?   Maria: As we expected, there isn’t much known about the impact of pandemics specifically. There was just one study that looked at mental health in children and young people in a pandemic context and it did find that there was significantly increased rates of mental health problems for those who had experienced disease containment measures like quarantine or social isolation. And the study focused on trauma symptoms and they found really much higher rates of trauma symptoms amongst those young people who had experienced those disease containment measures. But that is only one study.   More broadly though, there were over 60 studies that looked at loneliness and mental health. And we found that there is good evidence that loneliness increases the chances of developing mental health problems, both anxiety and depression, up to nine years later.   So there’s not only a loneliness and depression and anxiety linked when we measured them at the same point in time, but there’s good evidence that being lonely now will mean an increase in risk of mental health problems at a later date.   Lucy: Maria thought one study was particularly interesting. It looked at duration of loneliness compared to intensity of loneliness.   Maria: Now what we mean by that is how long the loneliness is going on for, as compared to how strong the loneliness is. And what this study found, and it was a big study, is that actually the longer we’re lonely for, the more closely linked that is with mental health problems than how strong the loneliness is.   Lucy: What are some things that might be helpful to head off these problems?  Maria: We know that loneliness is that feeling we get when our social connections are not what we would want them to be. In the current context, of course, socially connecting in the normal ways, like at school or at college, for young people, is curtailed. But we can still connect in other ways.   Lucy: Maria emphasised how important connecting for play dates over video calls can be, as well as meeting up for play now lockdown is easing, and using more old school ways of communicating as well, like sending friends cards or letters.   Maria: The other thing we can do is more broadly to think about how we promote activities amongst young people that support wellbeing in every which way we can. As well as making sure we’re providing a listening ear for young people and being open to hearing what they might be worried about or what they might be feeling sad about and problem solving that where we can. Actually giving them permission, this is a really unusual circumstance and it’s okay and it’s normal for it not to feel very good.   Lucy: Some things that we know promote wellbeing include regular exercise, good quality sleep, healthy eating and time spent on activities that young people enjoy and feel proud of.   Maria: As one goes for a walk you see rainbows in the windows and my little one looks and points and knows that those rainbows mean that there are other children out there. And I think that’s incredibly helpful in terms of feeling a sense of community, connectedness, which also helps to overcome that loneliness.   Lucy: So although there may be an increased risk of mental health problems as a result of the pandemic, there’s also lots and lots that we can do that would be protective.   Maria: Definitely. I think it’s really important too that we make a distinction between young people who might be feeling lonely now and during this context, but who were pretty well socially connected beforehand. And of course, other young people who might have been lonely beforehand and this has maybe made things worse, or that their loneliness is ongoing at this stage.   For those young people who have maybe been feeling lonely for a much longer time, we might need to do something more individualised and more specific in terms of helping them to think about how they can make social connections going forward, as we resume life to some degree.   Lucy: I asked Maria whether she thought that as we are able to see people more, there might also be some anxiety around socialising.   Maria: You know, the reality is, we haven’t been practicing socialising nearly as much as we’d normally do. So we might well feel rusty and we might well even be worried about connecting socially with each other again. Add into that, of course we’ve had a lot of messages in recent weeks about the risk of interacting with each other because of the risk of infection. And so I think anxiety about getting physically close to each other and interacting with each other is going to be really natural in weeks going forward.   And I think again, the CBT principles can really help us to deal with those social anxieties too. So the first principle that I think is really important to remember is: The first step to tackling fear is facing it.   Lucy: CBT principles suggest breaking down a scary situation into steps and gradually building the confidence to face the fear by conquering one step at a time. So starting with a text message to a friend and working up to meeting face-to-face, for example.   Another tip to help with social anxiety is trying not to focus on how we’re coming across to someone but to focus on what someone is saying rather than getting caught up in thoughts about what they think about us. Thinking about thoughts, just as thoughts rather than facts is one thing that can help with this too, both for children and adults.   Maria: There’s certain developmental reasons why children and young people may be struggling particularly and those are about the key importance of play and of social interaction to development at those ages. But actually this is something that everybody is experiencing.   I do think the majority of children and young people, and adults more generally, will have a few wobbles, but will manage and will bounce back as we go forward. But for some, I think it will be a little more difficult and they’ll need to maybe engage in a bit of self-help using some of these CBT principles or indeed actually to go on and get some more professional help.   Lucy: Maria’s review has implications for school policy.  Maria: What we’re really encouraging, both schools but also policymakers to support is that as schools return and resume their normal activities, that they focus on allowing children and young people to reconnect rather than emphasising catching up academically. We know, again, from lots of studies and reviews that have been done that having mental health problems gets in the way of academic attainment.   We’ve got a strong rationale really for arguing, okay, let’s make sure now that we try and overcome loneliness rather than prioritising catching up with school work in the short-term because actually in the longer term that’s going to be beneficial to school work as well as to wellbeing more generally.   Lucy: I was curious to know if Maria thought any children and young people might actually have benefitted from lockdown. I see children and young people in my clinical practice and I’ve seen a real mixed bag of responses.   Maria: I do think that there are some young people who have actually found lockdown to be a real relief, particularly young people who struggled more with school and who struggled more with social interactions. Again, they’re young people who might struggle particularly with the return to school as things get restarted again.   Lucy: Another group Maria highlighted were children and young people with particular transition points at this time.   Maria: People who, for example, had exams cancelled. Whilst in the short-term that might be a real relief not to have to study and not to have to face GCSEs or A-Levels for instance, I think again, going forward, then there’s worries for those young people about what did that mean for them and how do they pick up from where they left off.   Lucy: Super hard isn’t it, because there’s such a range of experiences that will be going on in people’s homes as well. I suppose one thing that has been really on my mind is children and young people who are from backgrounds where they will be disadvantaged by being at home, or perhaps even in danger for one reason or another.   Maria: I think that’s a real problem and I do a lot of work with colleagues in South Africa, for whom lots of what we’ve been talking about as helpful strategies just don’t apply. Most children and young people don’t have access to the internet and can’t continue to keep in touch by virtual play dates, for instance. So what do you do for those kind of populations who are disadvantaged in terms of being able to remain in digital contact with one another. It’s really tricky.   I think we should all be concerned about those young people for whom home isn’t a safe place. And that’s a small minority of children, but a really big concern.   Schools often have a function of being able to do that check-in and that noticing of when children aren’t doing okay and to pick up on that and we haven’t had the ability to do that. So I think the needs of those children are going to be really important to thoroughly meet as we resume education contact and so forth.   Lucy: Maria’s overall message was one of realistic optimism.   Maria: I think parents are understandably fearful about what this is going to mean for the wellbeing of their children going forward and, what’s that phrase? Realistic optimism. I do think the vast majority are going to bounce back and a few wobbles, a bit of encouragement, a bit of a push sometimes, but they’ll manage it. And the few who get a little more stuck, we do have things that we can offer to help.   Lucy: That’s all for now. I hope you enjoyed this episode and found it useful. If you’d like to listen to more on children and young people, there’s another episode with Shirley Reynolds, talking about how to help young people do more of what matters to them at this time. There’s also loads in the back catalogue about different types of CBT and different problems it can help with. For example, compassion focused therapy or CBT for hoarding disorder.   As ever, if you have ideas for new topics, feel free to get in touch with me at <a href="mailto:lucy.maddow@BABCP.com" rel="noopener">lucy.maddox@BABCP.com</a>. Take care for now.   END OF AUDIO

Loneliness for Children & Young People During the Pandemic

How does doing more of what matters help teenagers with low mood and depression? And what can we all learn from this, particularly at the moment? Prof Shirley Reynolds speaks to Dr Lucy Maddox.   Show Notes and Transcript If you want to know more the following resources might be helpful. Books Shirley has written two books about depression in teenagers, one for teens and one for parents: For parents: Teenage Depression:  CBT Guide for Parents  https://www.amazon.co.uk/Teenage-Depression-CBT-Guide-Parents/dp/147211454X For adolescents: Am I Depressed and What Can I Do About It?  https://www.amazon.co.uk/Am-Depressed-What-Can-About/dp/1472114531/ref=pd_lpo_14_t_0/260-4076808-4951665?_encoding=UTF8&amp;pd_rd_i=1472114531&amp;pd_rd_r=bd1ea151-b4d3-40bc-99bc-583aa3824613&amp;pd_rd_w=xtKq9&amp;pd_rd_wg=CFBxI&amp;pf_rd_p=7b8e3b03-1439-4489-abd4-4a138cf4eca6&amp;pf_rd_r=MFANFKSAD9RE92R6XS65&amp;psc=1&amp;refRID=MFANFKSAD9RE92R6XS65 Websites BABCP website www.babcp.com Register of BABCP accredited therapists https://www.cbtregisteruk.com/ These resources about child and adolescent mental health might also be useful Young Minds https://youngminds.org.uk/ MindEd https://www.minded.org.uk/ Association for Child and Adolescent Mental Health https://www.acamh.org/ Other resources Shirley is running a course with Future Learn from 1st week in June about adolescent depression – aimed to help parents and professionals understand and help young people who struggle with low mood:  https://www.mooc-list.com/course/understanding-depression-and-low-mood-young-people-futurelearn Have you seen the BABCP animation about what CBT is? Only 1 minute long and available here: https://www.youtube.com/watch?v=ZRijYOJp5e0 Photo by Daria Tumanova on Unsplash Podcast episode produced by Dr Lucy Maddox for BABCP Transcript  Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. This podcast is all about CBT, what it is, what it’s not and how it can be useful. Today I’m speaking to Professor Shirley Reynolds from the University of Reading about how doing more of what matters can help teenagers boost their mood, and how this might be particularly helpful for all of us to remember at the current time.   Shirley: The thing I’m really mostly interested in is understanding more about adolescent depression in order to help us really develop better treatments and better ways of preventing young people from developing depression. So that we can really try and divert them away from a path that can lead into a lifetime of problems with low mood.   Lucy: Fantastic. And at this time in particular when we’re all shutting doors a bit because of the pandemic and teenagers are shutting doors as well, what can your research tell us that might be helpful at this time in particular do you think?  Shirley: I think there are some general points and some more specific points. I think the general point is that one of the things we know, not just from our own research but from many people’s research is that when you’re a teenager, most teenagers are going to be incredibly attached to and reliant on having relationships with their friends, their peers.   The family becomes a bit less important, it’s not unimportant, but the importance of it becomes a little bit less and that’s replaced by a really, really strong focus on needing to be part of a social group. Being accepted by other people, contributing to things with your friends, being part of something bigger than yourself.   And so what that tells us then is that a period like now when young people simply cannot have those relationships in the normal ways, that this is a potential point of really massive stress for them and distress for them. And we need to try and support them; to maintain any relationships they already have, in whatever way is possible.   And what most parents are currently struggling with, but I think getting a handle on, is that currently that is going to be on a computer.   It’s not just young people, we all need these things. This is a lifelong thing for most people, but it’s a particular importance at that critical development period when we’re teenagers.   Lucy: So making sure that we’re supporting the young people in our lives to maintain contact with their friends in whatever way is possible.   Shirley: In whatever way is possible, absolutely. And accepting and understanding that it’s frustrating and difficult and anxiety provoking and that that’s true for everybody, parents, children, and everybody else.   There’s a degree to which we have to kind of let our normal expectations just be shifted around a bit and learn to live with that and be okay with that.   Lucy: Actually, just you talking about teenagers in particular made me think about that tension that can happen sometimes between teenagers really wanting to be independent and maybe family really wanting to comfort teenagers during this time. And sometimes that can be a really tricky balance to walk, can’t it, if you’re a parent who wants to offer comfort and your teenager is saying, “No, leave me alone.” Is there anything, from your point of view, that you would say about that?   Shirley: I think that’s absolutely right because the other task of being an adolescent or a teenager or growing up is to learn to be independent and to learn to do things on your own. And at the moment everybody is forced to spend 24/7 with their families and that exploration and getting out there and taking a bit of a risk and learning about yourself in the world is something, it’s very hard for teenagers to do at the moment. So they are going to need time to be separate and to be on their own.   And it is fine for them to tell you to back off and it’s inevitable that people will feel a little bit pushed away and maybe left out or maybe tempers will be frayed and there’ll be a bit more irritability. But again, I think that’s one of those inevitable challenges that there’s no right answer for this.   So I think that tension between needing support and also needing to be separate is really a massive struggle, especially for people who live in very small houses, don’t have outside space. So sharing bedrooms. I think trying to find a space for young people to call their own, for at least some of the time is going to be really important, if that’s at all possible.   Lucy: Yeah, really helpful. And helpful to remember that in the midst of trying to homeschool and all the rest of it as well actually, that to be somebody’s teacher and mum and seeing them all the time is not possible.   And some of the research that you’ve done that I found really interesting has been about valued actions. I wondered if you could say a little bit more about what valued actions are?  Shirley: Yeah, so this comes from the research we’ve done with teenagers with depression and low mood. What we see when somebody has depression or beginning to become depressed is that as we feel a little bit worse, what we tend to do – this is in normal life – is to take ourselves out of our normal social activities. So young people who have got problems with depression very often, nearly always, spend more time on their own than they would have previously.   And as they do that, as they take themselves further out, they get less reward from life. So fewer of the things that would have just happened in their normal daily life, a smile from somebody or a shared joke or something that you notice outside of the house that just made you feel good about yourself, those things just are less available to you. They happen less because you take yourself out of what’s happening in life.    As you withdraw what we see is you get less reward from life, or less of what we would call the ‘feel good factor’. And when you get less of the ‘feel good factor’, that makes you feel worse. And as you feel worse, you withdraw a little bit more and you get less reward and then you get less of the ‘feel good factor’.   So you find that young people with depression and adults with depression get themselves into this very hard to escape from cycle, this vicious cycle.   Lucy: Shirley’s research looks at ways of trying to break the cycle of low mood and doing less.   Shirley: So, we want to break the cycle and the way we turn it around when we’re working with young people is we help them to do more of what matters. More of what matters are things that are important to them and we help them decide what matters to them by talking to them about their values.   Lucy: Values are guiding principles in life, the things that show us the direction we want to go in. To work out what matters sometimes takes some real reflection on what it is that’s important to us.   Shirley: Now, they’re really big questions, why am I here? What am I doing? What is the point of it all? They’re massive questions, but they’re brilliant questions and lots of teenagers are sort of playing around with them anyway. So if we can tap into that need to work out why I’m here and what I’m doing and what my values are, it becomes a really exciting, interesting conversation.   Lucy: Shirley told me about three main areas that she tends to ask young people to think about. Values to do with themselves, like health or fun, values to do with things that matter, like education or politics and values to do with people that matter, like family and friends.   Shirley: And then the idea is that once we’ve helped them think about what their values are, which we can do in a very structured way, we then help them to do a little bit more of what matters. These are the valued activities.   So tiny little, small, easy to do activities that help them get a little bit more of that ‘feel good factor’.   Lucy: By increasing time spent on things that matter, that vicious cycle Shirley talked about before can be reversed.  Shirley: And as that reward comes back, we start to reverse the cycle. They feel a little bit less bad, so they’re able to do a little bit more and that makes them feel a little bit better. Then they can do a little bit more and so on.   So we’re taking the cycle we had that was dragging them down and we’re turning it into a cycle that can help them build their life back up again.   Lucy: Shirley encourages young people to think of a wide range of things that they can to help them move towards their values. Key is to make each step as easy as possible so young people feel a sense of achieving what they want, not failing. Also key is that the things really do matter to the young person.   Shirley: Most kids are doing a whole load of stuff that other people make them do. Their lives are much more circumscribed than adults’ lives. They’re told what to do by other people. There are hundreds of things they can’t get out of. So you can be really busy doing loads of stuff, but if it doesn’t really matter, you don’t get that ‘feel good factor’.   We find even 11 year olds and 12 year olds can begin to tell you about things that really matter to them. And these don’t have to be sophisticated or complicated or smart. The importance of the value is not in its cleverness, we just care that it kind of lights you up a bit.   Lucy: Because what matters to each young person is specific to them, how the treatment looks is very individualised.   Shirley: Everybody is following a similar recipe, but what they’ll be doing and how they’ll be doing it and how we’ll help them to do it will be completely different for every young person. The way we get them into the this, we get them to keep diaries really. And that is to help us see, and for them to see what they’re currently doing and what it usually shows us is that there’s almost no reward in their daily life. And so it helps us also find times in their days and their weeks when we can pack a bit of reward in, or we can swap one activity to another.   So when we do it for ourselves and we write down our activities and then we write down our values, and we try and map across, we’ll nearly all find a huge gap between what we value and how we’re spending our time. We’re just saying, “Where’s the flex here in your life to put in more of what matters?”   Lucy: Shirley’s research has found that people are less likely to drop out of therapy when the treatment focuses on what matters to them in this way. It also helps young people move on from feeling stuck in the here and now.   Shirley: We don’t talk about the future in an explicit way, but when you talk to a 15 year old about what their values are, they’re nearly always going to connect with the future and where they want to go and what they see themselves as. And it allows them to kind of use a bit of, yeah, just a little bit of imagination about, “Oh, I don’t know…”   And if they’ve never thought about what they want or what their values are, they go, “Oh, I don’t know.” It’s actually quite an interesting question, even if it’s something you’ve never thought about.   I mean the other part of what we do is we try and get other people in the young person’s life to help them with those rewards because young people don’t have as much autonomy or as much money. They don’t have as many resources. They sometimes need practical help to get things done. Or they need encouragement, giving lifts or arranging things at home that are a little bit different to give a young person a bit more space.   Or thinking about rewards that might be shared, like deciding on somebody’s favourite meal and then going out and doing the shopping together and then cooking together. That can be quite nice because it’s a kind of value about wanting to get on with my family but it might also be learning a skill.   Lucy: I asked Shirley how we can use these same principles at the moment, even though young people, and adults too, are going to be unable to do all the things that they value at the moment.   Shirley: I don’t think there are any fundamental differences. I just think we’re looking at a different range and a different kind of repertoire that we can use.   Lucy: What Shirley said earlier about teenagers being so, so busy, but actually their time is all stuffed with things that other people want them to do made me wonder whether there’s a slight perspective shift that’s helpful for young people and for adults. From thinking about how much stuff we’re all doing to really thinking about how much of that stuff matters to us.   Shirley: And I think if we thought more a little bit about well, what are the rewards I’m going to get from this, what am I going to take away from this that’s going to make me feel good, we might make different choices about how we’re going to spend our time. For me it’s all about the search for more positive experiences. It’s not about getting rid of bad experiences because we’re all going to have bad experiences, that’s just part and parcel of life. But if we’re filling a lot of our time with positive rewarding experiences, there is, by default, less of the time to have more negative experiences.   Lucy: There’s maybe something here for all of us. At the moment when our usual schedules are for lots of us upside down, maybe it’s a chance to pay attention in a different way, to helping young people in our lives to be doing stuff that matters to them. And also to be thinking about this for ourselves.   Shirley: Learning to savour things, paying attention to those positive things that sometimes we perhaps just let them go and they’ve gone before we’ve kind of properly enjoyed them. There’s a sort of opportunity to just notice a little bit more deliberately some of the more positive aspects. And that could be something like our first cup of tea in the morning.  Lucy: Always the best one.  Shirley: Exactly! Or the cat purring on your lap or I don’t know, silly things, tiny things and they’re different, some of them are shared, but many of them are very personal. It doesn’t matter what they are, it’s just capturing them somehow.   I like my phone for that reason, I do a lot of photographs of things that make me feel good because then I kind of feel I’m carrying them in my pocket. I think it’s always about finding the thing that fits your preferences and your personal style. But I do think some sort of recording of what is happening in your life, especially when we’re living through a weird time like this, is likely to be useful.   So that could be through writing. It could be through photos. It could be through just what you email your friends. But I think some way of kind of recording what you’re doing, where you’re at in your life and spending a bit of time just thinking about that becomes a very helpful habit to have. Because it can stop you falling down into those vicious cycles that when we don’t notice we’re falling into them, it can be much harder to climb back out later.   I would just say, I think everyone needs to give themselves a bit of a break, and their kids. And we just all need to just, what’s that expression… Be kind.   Lucy: Wise words there I think, being kind to ourselves and each other goes a long way.   I hope you enjoyed that episode and can think about how both you and any young people in your lives can do more of what matters. It’s challenging at this time but there are still lots of possibilities.   I’ve put some resources that Shirley recommended in the show notes and if you want to hear more about values in particular, check out the episode on acceptance and commitment therapy. We speak about values in that as well.   That’s all for now, take care.    END OF AUDIO 

How does doing more of what matters help teenagers with low mood and depression? And what can we all learn from this, particularly at the moment? Prof Shirley Reynolds speaks to Dr Lucy Maddox. Show Notes and Transcript If you want to know more the following resources might be helpful. Books Shirley has written two books about depression in teenagers, one for teens and one for parents: For parents: Teenage Depression:  CBT Guide for Parents <a href="https://www.amazon.co.uk/Teenage-Depression-CBT-Guide-Parents/dp/147211454X" rel="nofollow" target="_blank"> https://www.amazon.co.uk/Teenage-Depression-CBT-Guide-Parents/dp/147211454X</a> For adolescents: Am I Depressed and What Can I Do About It? <a href="https://www.amazon.co.uk/Am-Depressed-What-Can-About/dp/1472114531/ref=pd_lpo_14_t_0/260-4076808-4951665?_encoding=UTF8&amp;pd_rd_i=1472114531&amp;pd_rd_r=bd1ea151-b4d3-40bc-99bc-583aa3824613&amp;pd_rd_w=xtKq9&amp;pd_rd_wg=CFBxI&amp;pf_rd_p=7b8e3b03-1439-4489-abd4-4a138cf4eca6&amp;pf_rd_r=MFANFKSAD9RE92R6XS65&amp;psc=1&amp;refRID=MFANFKSAD9RE92R6XS65" rel="nofollow" target="_blank"> https://www.amazon.co.uk/Am-Depressed-What-Can-About/dp/1472114531/ref=pd_lpo_14_t_0/260-4076808-4951665?_encoding=UTF8&amp;pd_rd_i=1472114531&amp;pd_rd_r=bd1ea151-b4d3-40bc-99bc-583aa3824613&amp;pd_rd_w=xtKq9&amp;pd_rd_wg=CFBxI&amp;pf_rd_p=7b8e3b03-1439-4489-abd4-4a138cf4eca6&amp;pf_rd_r=MFANFKSAD9RE92R6XS65&amp;psc=1&amp;refRID=MFANFKSAD9RE92R6XS65</a> Websites BABCP website <a href="http://www.babcp.com" rel="nofollow" target="_blank">www.babcp.com</a> Register of BABCP accredited therapists <a href="https://www.cbtregisteruk.com/" rel="nofollow" target="_blank">https://www.cbtregisteruk.com/</a> These resources about child and adolescent mental health might also be useful Young Minds <a href="https://youngminds.org.uk/" rel="nofollow" target="_blank">https://youngminds.org.uk/</a> MindEd <a href="https://www.minded.org.uk/" rel="nofollow" target="_blank">https://www.minded.org.uk/</a> Association for Child and Adolescent Mental Health <a href="https://www.acamh.org/" rel="nofollow" target="_blank">https://www.acamh.org/</a> Other resources Shirley is running a course with Future Learn from 1st week in June about adolescent depression – aimed to help parents and professionals understand and help young people who struggle with low mood: <a href="https://www.mooc-list.com/course/understanding-depression-and-low-mood-young-people-futurelearn" rel="nofollow" target="_blank"> https://www.mooc-list.com/course/understanding-depression-and-low-mood-young-people-futurelearn</a> Have you seen the BABCP animation about what CBT is? Only 1 minute long and available here: <a href="https://www.youtube.com/watch?v=ZRijYOJp5e0" rel="nofollow" target="_blank">https://www.youtube.com/watch?v=ZRijYOJp5e0</a> Photo by <a href="https://unsplash.com/@tumanova_photo?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" rel="nofollow" target="_blank">Daria Tumanova</a> on <a href="https://unsplash.com/s/photos/teenager?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" rel="nofollow" target="_blank">Unsplash</a> Podcast episode produced by Dr Lucy Maddox for BABCP Transcript  Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. This podcast is all about CBT, what it is, what it’s not and how it can be useful. Today I’m speaking to Professor Shirley Reynolds from the University of Reading about how doing more of what matters can help teenagers boost their mood, and how this might be particularly helpful for all of us to remember at the current time.   Shirley: The thing I’m really mostly interested in is understanding more about adolescent depression in order to help us really develop better treatments and better ways of preventing young people from developing depression. So that we can really try and divert them away from a path that can lead into a lifetime of problems with low mood.   Lucy: Fantastic. And at this time in particular when we’re all shutting doors a bit because of the pandemic and teenagers are shutting doors as well, what can your research tell us that might be helpful at this time in particular do you think?  Shirley: I think there are some general points and some more specific points. I think the general point is that one of the things we know, not just from our own research but from many people’s research is that when you’re a teenager, most teenagers are going to be incredibly attached to and reliant on having relationships with their friends, their peers.   The family becomes a bit less important, it’s not unimportant, but the importance of it becomes a little bit less and that’s replaced by a really, really strong focus on needing to be part of a social group. Being accepted by other people, contributing to things with your friends, being part of something bigger than yourself.   And so what that tells us then is that a period like now when young people simply cannot have those relationships in the normal ways, that this is a potential point of really massive stress for them and distress for them. And we need to try and support them; to maintain any relationships they already have, in whatever way is possible.   And what most parents are currently struggling with, but I think getting a handle on, is that currently that is going to be on a computer.   It’s not just young people, we all need these things. This is a lifelong thing for most people, but it’s a particular importance at that critical development period when we’re teenagers.   Lucy: So making sure that we’re supporting the young people in our lives to maintain contact with their friends in whatever way is possible.   Shirley: In whatever way is possible, absolutely. And accepting and understanding that it’s frustrating and difficult and anxiety provoking and that that’s true for everybody, parents, children, and everybody else.   There’s a degree to which we have to kind of let our normal expectations just be shifted around a bit and learn to live with that and be okay with that.   Lucy: Actually, just you talking about teenagers in particular made me think about that tension that can happen sometimes between teenagers really wanting to be independent and maybe family really wanting to comfort teenagers during this time. And sometimes that can be a really tricky balance to walk, can’t it, if you’re a parent who wants to offer comfort and your teenager is saying, “No, leave me alone.” Is there anything, from your point of view, that you would say about that?   Shirley: I think that’s absolutely right because the other task of being an adolescent or a teenager or growing up is to learn to be independent and to learn to do things on your own. And at the moment everybody is forced to spend 24/7 with their families and that exploration and getting out there and taking a bit of a risk and learning about yourself in the world is something, it’s very hard for teenagers to do at the moment. So they are going to need time to be separate and to be on their own.   And it is fine for them to tell you to back off and it’s inevitable that people will feel a little bit pushed away and maybe left out or maybe tempers will be frayed and there’ll be a bit more irritability. But again, I think that’s one of those inevitable challenges that there’s no right answer for this.   So I think that tension between needing support and also needing to be separate is really a massive struggle, especially for people who live in very small houses, don’t have outside space. So sharing bedrooms. I think trying to find a space for young people to call their own, for at least some of the time is going to be really important, if that’s at all possible.   Lucy: Yeah, really helpful. And helpful to remember that in the midst of trying to homeschool and all the rest of it as well actually, that to be somebody’s teacher and mum and seeing them all the time is not possible.   And some of the research that you’ve done that I found really interesting has been about valued actions. I wondered if you could say a little bit more about what valued actions are?  Shirley: Yeah, so this comes from the research we’ve done with teenagers with depression and low mood. What we see when somebody has depression or beginning to become depressed is that as we feel a little bit worse, what we tend to do – this is in normal life – is to take ourselves out of our normal social activities. So young people who have got problems with depression very often, nearly always, spend more time on their own than they would have previously.   And as they do that, as they take themselves further out, they get less reward from life. So fewer of the things that would have just happened in their normal daily life, a smile from somebody or a shared joke or something that you notice outside of the house that just made you feel good about yourself, those things just are less available to you. They happen less because you take yourself out of what’s happening in life.   As you withdraw what we see is you get less reward from life, or less of what we would call the ‘feel good factor’. And when you get less of the ‘feel good factor’, that makes you feel worse. And as you feel worse, you withdraw a little bit more and you get less reward and then you get less of the ‘feel good factor’.   So you find that young people with depression and adults with depression get themselves into this very hard to escape from cycle, this vicious cycle.   Lucy: Shirley’s research looks at ways of trying to break the cycle of low mood and doing less.   Shirley: So, we want to break the cycle and the way we turn it around when we’re working with young people is we help them to do more of what matters. More of what matters are things that are important to them and we help them decide what matters to them by talking to them about their values.   Lucy: Values are guiding principles in life, the things that show us the direction we want to go in. To work out what matters sometimes takes some real reflection on what it is that’s important to us.   Shirley: Now, they’re really big questions, why am I here? What am I doing? What is the point of it all? They’re massive questions, but they’re brilliant questions and lots of teenagers are sort of playing around with them anyway. So if we can tap into that need to work out why I’m here and what I’m doing and what my values are, it becomes a really exciting, interesting conversation.   Lucy: Shirley told me about three main areas that she tends to ask young people to think about. Values to do with themselves, like health or fun, values to do with things that matter, like education or politics and values to do with people that matter, like family and friends.   Shirley: And then the idea is that once we’ve helped them think about what their values are, which we can do in a very structured way, we then help them to do a little bit more of what matters. These are the valued activities.   So tiny little, small, easy to do activities that help them get a little bit more of that ‘feel good factor’.   Lucy: By increasing time spent on things that matter, that vicious cycle Shirley talked about before can be reversed.  Shirley: And as that reward comes back, we start to reverse the cycle. They feel a little bit less bad, so they’re able to do a little bit more and that makes them feel a little bit better. Then they can do a little bit more and so on.   So we’re taking the cycle we had that was dragging them down and we’re turning it into a cycle that can help them build their life back up again.   Lucy: Shirley encourages young people to think of a wide range of things that they can to help them move towards their values. Key is to make each step as easy as possible so young people feel a sense of achieving what they want, not failing. Also key is that the things really do matter to the young person.   Shirley: Most kids are doing a whole load of stuff that other people make them do. Their lives are much more circumscribed than adults’ lives. They’re told what to do by other people. There are hundreds of things they can’t get out of. So you can be really busy doing loads of stuff, but if it doesn’t really matter, you don’t get that ‘feel good factor’.   We find even 11 year olds and 12 year olds can begin to tell you about things that really matter to them. And these don’t have to be sophisticated or complicated or smart. The importance of the value is not in its cleverness, we just care that it kind of lights you up a bit.   Lucy: Because what matters to each young person is specific to them, how the treatment looks is very individualised.   Shirley: Everybody is following a similar recipe, but what they’ll be doing and how they’ll be doing it and how we’ll help them to do it will be completely different for every young person. The way we get them into the this, we get them to keep diaries really. And that is to help us see, and for them to see what they’re currently doing and what it usually shows us is that there’s almost no reward in their daily life. And so it helps us also find times in their days and their weeks when we can pack a bit of reward in, or we can swap one activity to another.   So when we do it for ourselves and we write down our activities and then we write down our values, and we try and map across, we’ll nearly all find a huge gap between what we value and how we’re spending our time. We’re just saying, “Where’s the flex here in your life to put in more of what matters?”   Lucy: Shirley’s research has found that people are less likely to drop out of therapy when the treatment focuses on what matters to them in this way. It also helps young people move on from feeling stuck in the here and now.   Shirley: We don’t talk about the future in an explicit way, but when you talk to a 15 year old about what their values are, they’re nearly always going to connect with the future and where they want to go and what they see themselves as. And it allows them to kind of use a bit of, yeah, just a little bit of imagination about, “Oh, I don’t know…”   And if they’ve never thought about what they want or what their values are, they go, “Oh, I don’t know.” It’s actually quite an interesting question, even if it’s something you’ve never thought about.   I mean the other part of what we do is we try and get other people in the young person’s life to help them with those rewards because young people don’t have as much autonomy or as much money. They don’t have as many resources. They sometimes need practical help to get things done. Or they need encouragement, giving lifts or arranging things at home that are a little bit different to give a young person a bit more space.   Or thinking about rewards that might be shared, like deciding on somebody’s favourite meal and then going out and doing the shopping together and then cooking together. That can be quite nice because it’s a kind of value about wanting to get on with my family but it might also be learning a skill.   Lucy: I asked Shirley how we can use these same principles at the moment, even though young people, and adults too, are going to be unable to do all the things that they value at the moment.   Shirley: I don’t think there are any fundamental differences. I just think we’re looking at a different range and a different kind of repertoire that we can use.   Lucy: What Shirley said earlier about teenagers being so, so busy, but actually their time is all stuffed with things that other people want them to do made me wonder whether there’s a slight perspective shift that’s helpful for young people and for adults. From thinking about how much stuff we’re all doing to really thinking about how much of that stuff matters to us.   Shirley: And I think if we thought more a little bit about well, what are the rewards I’m going to get from this, what am I going to take away from this that’s going to make me feel good, we might make different choices about how we’re going to spend our time. For me it’s all about the search for more positive experiences. It’s not about getting rid of bad experiences because we’re all going to have bad experiences, that’s just part and parcel of life. But if we’re filling a lot of our time with positive rewarding experiences, there is, by default, less of the time to have more negative experiences.   Lucy: There’s maybe something here for all of us. At the moment when our usual schedules are for lots of us upside down, maybe it’s a chance to pay attention in a different way, to helping young people in our lives to be doing stuff that matters to them. And also to be thinking about this for ourselves.   Shirley: Learning to savour things, paying attention to those positive things that sometimes we perhaps just let them go and they’ve gone before we’ve kind of properly enjoyed them. There’s a sort of opportunity to just notice a little bit more deliberately some of the more positive aspects. And that could be something like our first cup of tea in the morning.  Lucy: Always the best one.  Shirley: Exactly! Or the cat purring on your lap or I don’t know, silly things, tiny things and they’re different, some of them are shared, but many of them are very personal. It doesn’t matter what they are, it’s just capturing them somehow.   I like my phone for that reason, I do a lot of photographs of things that make me feel good because then I kind of feel I’m carrying them in my pocket. I think it’s always about finding the thing that fits your preferences and your personal style. But I do think some sort of recording of what is happening in your life, especially when we’re living through a weird time like this, is likely to be useful.   So that could be through writing. It could be through photos. It could be through just what you email your friends. But I think some way of kind of recording what you’re doing, where you’re at in your life and spending a bit of time just thinking about that becomes a very helpful habit to have. Because it can stop you falling down into those vicious cycles that when we don’t notice we’re falling into them, it can be much harder to climb back out later.   I would just say, I think everyone needs to give themselves a bit of a break, and their kids. And we just all need to just, what’s that expression… Be kind.   Lucy: Wise words there I think, being kind to ourselves and each other goes a long way.   I hope you enjoyed that episode and can think about how both you and any young people in your lives can do more of what matters. It’s challenging at this time but there are still lots of possibilities.   I’ve put some resources that Shirley recommended in the show notes and if you want to hear more about values in particular, check out the episode on acceptance and commitment therapy. We speak about values in that as well.   That’s all for now, take care.   END OF AUDIO

Helping teenagers do more of what matters to them

Let's Talk About CBT is a podcast about cognitive behavioural therapy: what it is, what it's not and how it can be useful. Dr Lucy Maddox interviews experts in the field including people who have experienced CBT for themselves.  A mix of interviews, myth-busting and CBT jargon explained, this accessible podcast is brought to you by the British Association of Behavioural and Cognitive Psychotherapies.www.babcp.com

We're all living through uncertain times at the moment. What does research from CBT tell us about what tends to help people tolerate uncertainty? Dr Lucy Maddox interviews Professor Mark Freeston about what might help.   Show Notes and Transcript For more on BABCP our website is www.babcp.com For Mark's research survey follow this link:  https://www.ncl.ac.uk/who-we-are/coronavirus/research/uncertainty/ A preprint of Mark's research paper on coronavirus and uncertainty is available here:  https://www.researchgate.net/publication/340653312_Towards_a_model_of_uncertainty_distress_in_the_context_of_Coronavirus_Covid-19 If you feel like you're struggling here are some resources: https://www.nhs.uk/oneyou/every-mind-matters/ https://www.samaritans.org/  https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/  https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/how-to-access-mental-health-services/ The register of BABCP accredited CBT therapists is here:  https://www.cbtregisteruk.com/ Photo by Katie Mourn on Unsplash Episode edited and produced by Lucy Maddox Music by Gabriel Stebbing Transcript  Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. This podcast is brought to you by the British Association for Behavioural and Cognitive Psychotherapies, BABCP. It’s all about CBT, what it is, what it’s not and how it can be useful.   Today in another post-pandemic special episode I’m speaking remotely to Professor Mark Freeston from Newcastle University. Mark’s research is about how intolerance of uncertainty relates to anxiety and he spoke to me about how findings from this research can be relevant at this current, very uncertain time.   Mark was clear that feelings of anxiety and distress in response to the current pandemic are totally normal.   Mark: Anxiety problems that we see in mental health services have an element that is recognised to be excessive about them. But what we’re looking at at the moment, which is anxiety and distress in response to the coronavirus pandemic doesn’t necessarily have this excessive element about it. So it’s not a disorder, it’s just a lot of very anxious and distressed people.   Lucy: How is your research particularly relevant at the moment?   Mark: Since the early 90s, we’ve been looking at a thing called ‘intolerance of uncertainty’. This is particularly timely given the high level of uncertainty that’s going on. Some people find not knowing, the unknownness of things as particularly difficult to manage.   Lucy: It’s quite an existential problem almost, isn’t it? It’s quite a human problem that we all might have at different moments.   Mark: The evolutionary theory, so some very clever evolutionary psychologists and they say that everyone is probably born to be intolerant of uncertainty, but to greater or lesser degrees we become more able to tolerate uncertainty. So it’s not like a personality trait that is sort of stuck at the same level all your life. When different things happen your ability to tolerate the unknownness of things is likely to change, not necessarily on a day-to-day basis, but you may have periods of greater tolerance or intolerance of uncertainty.   Lucy: Is it that intolerance of uncertainty which leads us to feel very anxious?   Mark: Eventually, yes. The way we’ve been looking at it in our current research and we’ve been working on this for over a year, because we’ve been thinking about before the pandemic came along, we’d been thinking about caregivers of people with dementia or people living with chronic and fluctuating illnesses. And so we were thinking about a lot of different types of contexts where there’s both scary things happening and a lot of uncertainty going on at the same time.   If you are intolerant of uncertainty and there is real uncertainty around, you are going to probably perceive the situation as being more uncertain than it is. So you start off not liking uncertainty, then when things are uncertain, not only do you not like it, but you see the situation as even more uncertain. And you probably also look at the things that might happen, particularly the bad things that might happen as more likely. It’s that combination we think, that makes people anxious.   Lucy: And then at the moment, do the same things apply, might some of us feel more anxious in response to what’s going on with the pandemic than others?   Mark: Yes, and obviously people who have got more at stake, so people who are at greater risk, also about financial things. It’s at multiple levels that there’s lots of uncertainty going on and some people find this more difficult than others.   Lucy: Mark told me about some research which suggests that over the last 30 years we’ve all been finding uncertainty harder to tolerate.   Mark: What we found is that intolerance of uncertainty scores have been going up since the 1990s.   Lucy: Oh really?   Mark: Yeah, so essentially year on year. One of my colleagues in Canada, Nick Carlton did a very nice study where they looked at all the published North American studies of similar types, examples, and then they looked at the extent to which people had mobile phones or high speed broadband.   And so if you think from the early 90s through until the mid-2015s, then there’s been a massive increase in our degree of connectedness, the access of information. And so one of the ideas is that the more information that we have available, the less certain we are about things.   Lucy: This research suggests that sometimes too much information can be unhelpful, can make us more uncertain.   Mark categorised information about Coronavirus into three types. Information that we need to know, like the current rules that we’re all expected to follow. Information that might be interesting to know, like answers to responsible questions that are being asked about what’s happening. And then less helpful information which is unreliable or even malicious.   Even the responsible questions might sometimes be problematic because they’re often unanswerable, so they might just generate more uncertainty.   Mark: There’s a lot of people working on the assumption that the answer is out there if only I can find it. From the point of view I’ve been working from, we can’t information our way out of this, out of feeling uncertain.   Lucy: We will likely all have had other times in our lives when things have felt uncertain and when it’s felt difficult to tolerate this.   Mark: I was reflecting on my own life and I’ve emigrated three times in my life, okay? From the UK to New Zealand, from New Zealand to Quebec and Quebec back to the UK. And so obviously they tend to be very uncertain times because you don’t quite know what to expect.   So things like emigration or becoming a parent for the first time or moving in with a partner for the first time. So it’s not just bad things, but these are just things where you don’t know what it’s going to be like because you haven’t done it before.   Everyone has had experience of big changes, sometimes they’re chosen sometimes they’re imposed. And there’s only so much you can find out, the rest you have to wait and see and that’s an uncomfortable state to be in. But the belief that drives people to try and get more and more information is that the answer is there, but it probably isn’t. It would be nice to say that the information is there, but it’s not.   Lucy: What do you know about, from your research, into intolerance of uncertainty that might help people at this time?   Mark: I think there’s two main things to do at this time. I think one thing is people really thinking about their use of information and where they’re getting it from and is that being helpful or not. Those are the things you want to manage the intake.   But there might be other types of information that might be worth finding out, that might put a bit more balance back into things. Are the birds still singing? What are some of the things that people are doing to help each other out?   Rather than stories about all the things we don’t know, there’s plenty of stories about people who are actually getting on and doing things, groups of people getting organised. So being a bit more selective in what news you go looking for.   Lucy: I really like that. The birds are still singing in Bristol, happily! (Laughs)  Mark: They’re still singing here in Whitley Bay as well and as usual, as for every year, we’ve got a particularly noisy group of sparrows that have taken up residence and I’m pretty sure the starlings will be under the eaves and they’ll be making noise for the next few months. That bit hasn’t changed.   Lucy: So managing information could be about restricting input of stuff that’s not so helpful, but also looking for information that balances the picture out a bit, it’s really nice.   Mark: Yeah, certainly. And I guess that looking for information, that balances things out a bit leads onto the next point, which is the thing about intolerance of uncertainty is that we need the presence of safety rather than just the absence of threat. So if we don’t have the presence of safety, that’s when we feel uncomfortable and that’s when intolerance of uncertainty kicks in.   So it’s not just that there’s no possibility of bad things happening, it’s about the presence of signs that things are okay in very small ways. Hence are the birds still singing? That’s an example.   We know how disrupting the pandemic has been at all sorts of levels, but it’s very easy to focus on the big disruptions, right? So people cannot go out, they cannot socialise, they cannot go to school, but there’s probably lots of little disruptions that people don’t even notice as much. Small routines of everyday life.   Lucy: One of the everyday routines that Mark has made sure to keep the same is his morning cup of coffee and a new small thing he’s noticed is that he started to eat Marmite again, which he hasn’t had since he was a boy.   Mark: So I guess it was one of the signals of safety that would go back a long way. It’s these small routines that can help us feel safer, even when there’s a lot of uncertainty.   Lucy: That’s really nice because that’s something we have some control over actually isn’t it?   Mark: Yes.   Lucy: Whether we can keep some of those small routines in place.   Mark: Many, many, many people have been taken, if you like, out of their comfort zone. What are the different things that help us feel settled and safe? And then that means that if we can get those, our perception of uncertainty will go down, our perception of danger will go down a bit and we’ll be a little less distressed and anxious.   Lucy: So two things there which might help at this time based on the research that Mark has done. Number one, thinking about which information we seek out and how often. And number two, thinking about how we signal to ourselves that we’re safe. Perhaps in quite small, but still significant ways.   Mark: There’s other types of information that says the world is still as we know it and that’s sort of the link between feeling safe and information management. That’s where the two come together.   Lucy: Although we’re all experiencing uncertainty at the moment, Mark acknowledged that some people may be finding things extra hard if they have personal experiences in their past which resonate with what’s happening at the moment in some way.   Mark: There’ll be things happening, whether it’s due to isolation, whether it’s medical threat, whether it’s seeing one part of your life being disrupted. This is going to, I guess wake up or trigger things that you might not have thought about for a long time.   So I think it’s being able to recognise that it isn’t just what’s going on outside in the world, it’s what’s going on inside your own mind as there’s a degree of match between some of the things that you’re being exposed to, that we’re all being exposed to, and things that we’ve lived through in the past.   Lucy: If you feel like that’s the case for you at the moment, do please try to reach out and seek help, whether from friends and family or from professional sources of support.   I’ve put some links in the show notes to some different resources and also to the BABCP register of accredited CBT therapists. Also in the show notes is a link to the survey that Mark has been sharing and a recent journal article that he’s written.   If you liked this episode, there are loads more you can listen to at the Let’s Talk about CBT website, or wherever you get your podcast from. There’s a short episode featuring Jo Daniels about anxiety in relation to coronavirus and a new episode about CBT bipolar disorder too.   If you have ideas for other episodes, feel free to get in touch at lucy.maddox@babcp.com.   Meanwhile, stay safe and stay well. We spoke in this episode about how the birds are still singing, so I thought I’d leave you with a little bit of birdsong recorded just outside of Bristol after the theme tune plays us out.    END OF AUDIO 

We're all living through uncertain times at the moment. What does research from CBT tell us about what tends to help people tolerate uncertainty? Dr Lucy Maddox interviews Professor Mark Freeston about what might help. Show Notes and Transcript For more on BABCP our website is <a href="http://www.babcp.com" rel="nofollow" target="_blank">www.babcp.com</a> For Mark's research survey follow this link: <a href="https://www.ncl.ac.uk/who-we-are/coronavirus/research/uncertainty/" rel="nofollow" target="_blank"> https://www.ncl.ac.uk/who-we-are/coronavirus/research/uncertainty/</a> A preprint of Mark's research paper on coronavirus and uncertainty is available here: <a href="https://www.researchgate.net/publication/340653312_Towards_a_model_of_uncertainty_distress_in_the_context_of_Coronavirus_Covid-19" rel="nofollow" target="_blank"> https://www.researchgate.net/publication/340653312_Towards_a_model_of_uncertainty_distress_in_the_context_of_Coronavirus_Covid-19</a> If you feel like you're struggling here are some resources: <a href="https://www.nhs.uk/oneyou/every-mind-matters/" rel="nofollow" target="_blank">https://www.nhs.uk/oneyou/every-mind-matters/</a> <a href="https://www.samaritans.org/" rel="nofollow" target="_blank">https://www.samaritans.org/</a> <a href="https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/" rel="nofollow" target="_blank"> https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/</a> <a href="https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/how-to-access-mental-health-services/" rel="nofollow" target="_blank"> https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/how-to-access-mental-health-services/</a> The register of BABCP accredited CBT therapists is here:  <a href="https://www.cbtregisteruk.com/" rel="nofollow" target="_blank">https://www.cbtregisteruk.com/</a> Photo by Katie Mourn on Unsplash Episode edited and produced by Lucy Maddox Music by Gabriel Stebbing Transcript  Lucy: Hi and welcome to Let’s Talk About CBT with me, Dr Lucy Maddox. This podcast is brought to you by the British Association for Behavioural and Cognitive Psychotherapies, BABCP. It’s all about CBT, what it is, what it’s not and how it can be useful.   Today in another post-pandemic special episode I’m speaking remotely to Professor Mark Freeston from Newcastle University. Mark’s research is about how intolerance of uncertainty relates to anxiety and he spoke to me about how findings from this research can be relevant at this current, very uncertain time.   Mark was clear that feelings of anxiety and distress in response to the current pandemic are totally normal.   Mark: Anxiety problems that we see in mental health services have an element that is recognised to be excessive about them. But what we’re looking at at the moment, which is anxiety and distress in response to the coronavirus pandemic doesn’t necessarily have this excessive element about it. So it’s not a disorder, it’s just a lot of very anxious and distressed people.   Lucy: How is your research particularly relevant at the moment?   Mark: Since the early 90s, we’ve been looking at a thing called ‘intolerance of uncertainty’. This is particularly timely given the high level of uncertainty that’s going on. Some people find not knowing, the unknownness of things as particularly difficult to manage.   Lucy: It’s quite an existential problem almost, isn’t it? It’s quite a human problem that we all might have at different moments.   Mark: The evolutionary theory, so some very clever evolutionary psychologists and they say that everyone is probably born to be intolerant of uncertainty, but to greater or lesser degrees we become more able to tolerate uncertainty. So it’s not like a personality trait that is sort of stuck at the same level all your life. When different things happen your ability to tolerate the unknownness of things is likely to change, not necessarily on a day-to-day basis, but you may have periods of greater tolerance or intolerance of uncertainty.   Lucy: Is it that intolerance of uncertainty which leads us to feel very anxious?   Mark: Eventually, yes. The way we’ve been looking at it in our current research and we’ve been working on this for over a year, because we’ve been thinking about before the pandemic came along, we’d been thinking about caregivers of people with dementia or people living with chronic and fluctuating illnesses. And so we were thinking about a lot of different types of contexts where there’s both scary things happening and a lot of uncertainty going on at the same time.   If you are intolerant of uncertainty and there is real uncertainty around, you are going to probably perceive the situation as being more uncertain than it is. So you start off not liking uncertainty, then when things are uncertain, not only do you not like it, but you see the situation as even more uncertain. And you probably also look at the things that might happen, particularly the bad things that might happen as more likely. It’s that combination we think, that makes people anxious.   Lucy: And then at the moment, do the same things apply, might some of us feel more anxious in response to what’s going on with the pandemic than others?   Mark: Yes, and obviously people who have got more at stake, so people who are at greater risk, also about financial things. It’s at multiple levels that there’s lots of uncertainty going on and some people find this more difficult than others.   Lucy: Mark told me about some research which suggests that over the last 30 years we’ve all been finding uncertainty harder to tolerate.   Mark: What we found is that intolerance of uncertainty scores have been going up since the 1990s.   Lucy: Oh really?   Mark: Yeah, so essentially year on year. One of my colleagues in Canada, Nick Carlton did a very nice study where they looked at all the published North American studies of similar types, examples, and then they looked at the extent to which people had mobile phones or high speed broadband.   And so if you think from the early 90s through until the mid-2015s, then there’s been a massive increase in our degree of connectedness, the access of information. And so one of the ideas is that the more information that we have available, the less certain we are about things.   Lucy: This research suggests that sometimes too much information can be unhelpful, can make us more uncertain.   Mark categorised information about Coronavirus into three types. Information that we need to know, like the current rules that we’re all expected to follow. Information that might be interesting to know, like answers to responsible questions that are being asked about what’s happening. And then less helpful information which is unreliable or even malicious.   Even the responsible questions might sometimes be problematic because they’re often unanswerable, so they might just generate more uncertainty.   Mark: There’s a lot of people working on the assumption that the answer is out there if only I can find it. From the point of view I’ve been working from, we can’t information our way out of this, out of feeling uncertain.   Lucy: We will likely all have had other times in our lives when things have felt uncertain and when it’s felt difficult to tolerate this.   Mark: I was reflecting on my own life and I’ve emigrated three times in my life, okay? From the UK to New Zealand, from New Zealand to Quebec and Quebec back to the UK. And so obviously they tend to be very uncertain times because you don’t quite know what to expect.   So things like emigration or becoming a parent for the first time or moving in with a partner for the first time. So it’s not just bad things, but these are just things where you don’t know what it’s going to be like because you haven’t done it before.   Everyone has had experience of big changes, sometimes they’re chosen sometimes they’re imposed. And there’s only so much you can find out, the rest you have to wait and see and that’s an uncomfortable state to be in. But the belief that drives people to try and get more and more information is that the answer is there, but it probably isn’t. It would be nice to say that the information is there, but it’s not.   Lucy: What do you know about, from your research, into intolerance of uncertainty that might help people at this time?   Mark: I think there’s two main things to do at this time. I think one thing is people really thinking about their use of information and where they’re getting it from and is that being helpful or not. Those are the things you want to manage the intake.   But there might be other types of information that might be worth finding out, that might put a bit more balance back into things. Are the birds still singing? What are some of the things that people are doing to help each other out?   Rather than stories about all the things we don’t know, there’s plenty of stories about people who are actually getting on and doing things, groups of people getting organised. So being a bit more selective in what news you go looking for.   Lucy: I really like that. The birds are still singing in Bristol, happily! (Laughs)  Mark: They’re still singing here in Whitley Bay as well and as usual, as for every year, we’ve got a particularly noisy group of sparrows that have taken up residence and I’m pretty sure the starlings will be under the eaves and they’ll be making noise for the next few months. That bit hasn’t changed.   Lucy: So managing information could be about restricting input of stuff that’s not so helpful, but also looking for information that balances the picture out a bit, it’s really nice.   Mark: Yeah, certainly. And I guess that looking for information, that balances things out a bit leads onto the next point, which is the thing about intolerance of uncertainty is that we need the presence of safety rather than just the absence of threat. So if we don’t have the presence of safety, that’s when we feel uncomfortable and that’s when intolerance of uncertainty kicks in.   So it’s not just that there’s no possibility of bad things happening, it’s about the presence of signs that things are okay in very small ways. Hence are the birds still singing? That’s an example.   We know how disrupting the pandemic has been at all sorts of levels, but it’s very easy to focus on the big disruptions, right? So people cannot go out, they cannot socialise, they cannot go to school, but there’s probably lots of little disruptions that people don’t even notice as much. Small routines of everyday life.   Lucy: One of the everyday routines that Mark has made sure to keep the same is his morning cup of coffee and a new small thing he’s noticed is that he started to eat Marmite again, which he hasn’t had since he was a boy.   Mark: So I guess it was one of the signals of safety that would go back a long way. It’s these small routines that can help us feel safer, even when there’s a lot of uncertainty.   Lucy: That’s really nice because that’s something we have some control over actually isn’t it?   Mark: Yes.   Lucy: Whether we can keep some of those small routines in place.   Mark: Many, many, many people have been taken, if you like, out of their comfort zone. What are the different things that help us feel settled and safe? And then that means that if we can get those, our perception of uncertainty will go down, our perception of danger will go down a bit and we’ll be a little less distressed and anxious.   Lucy: So two things there which might help at this time based on the research that Mark has done. Number one, thinking about which information we seek out and how often. And number two, thinking about how we signal to ourselves that we’re safe. Perhaps in quite small, but still significant ways.   Mark: There’s other types of information that says the world is still as we know it and that’s sort of the link between feeling safe and information management. That’s where the two come together.   Lucy: Although we’re all experiencing uncertainty at the moment, Mark acknowledged that some people may be finding things extra hard if they have personal experiences in their past which resonate with what’s happening at the moment in some way.   Mark: There’ll be things happening, whether it’s due to isolation, whether it’s medical threat, whether it’s seeing one part of your life being disrupted. This is going to, I guess wake up or trigger things that you might not have thought about for a long time.   So I think it’s being able to recognise that it isn’t just what’s going on outside in the world, it’s what’s going on inside your own mind as there’s a degree of match between some of the things that you’re being exposed to, that we’re all being exposed to, and things that we’ve lived through in the past.   Lucy: If you feel like that’s the case for you at the moment, do please try to reach out and seek help, whether from friends and family or from professional sources of support.   I’ve put some links in the show notes to some different resources and also to the BABCP register of accredited CBT therapists. Also in the show notes is a link to the survey that Mark has been sharing and a recent journal article that he’s written.   If you liked this episode, there are loads more you can listen to at the Let’s Talk about CBT website, or wherever you get your podcast from. There’s a short episode featuring Jo Daniels about anxiety in relation to coronavirus and a new episode about CBT bipolar disorder too.   If you have ideas for other episodes, feel free to get in touch at <a href="mailto:lucy.maddox@babcp.com" rel="noopener">lucy.maddox@babcp.com</a>.   Meanwhile, stay safe and stay well. We spoke in this episode about how the birds are still singing, so I thought I’d leave you with a little bit of birdsong recorded just outside of Bristol after the theme tune plays us out.   END OF AUDIO

Tolerating uncertainty: what helps?

CBT for Bipolar Disorder

This is an understandably stressful time and it's normal to feel worried. What can we learn from CBT for health anxiety that might help us with feelings of anxiety during the pandemic? In this short bonus episode, Dr Lucy Maddox interviews Dr Jo Daniels from Bath University, about things we know are likely to help.    Show Notes and Transcript Read an article by Dr Jo Daniels on how to stop anxiety about coronavirus spiralling out of control here:  https://theconversation.com/coronavirus-how-to-stop-the-anxiety-spiralling-out-of-control-133166 Another article about panic here: https://thepsychologist.bps.org.uk/truth-about-panic And this about how it's normal to feel worried:  https://www.ft.com/content/d6c65a50-6395-11ea-abcc-910c5b38d9ed BBC piece on protecting your mental health at this time: https://www.bbc.co.uk/news/health-51873799 BABCP: www.babcp.com Photo by  Kelly Sikkema on Unsplash Transcript Lucy: Hi, I’m Dr Lucy Maddox and this is Let’s Talk About CBT. This is a podcast brought to you by the British Association for Behavioral and Cognitive Psychotherapies.   This is a bit of an unusual episode. I’ve come to Bath University to interview Dr Jo Daniels who has experience in researching health anxiety in relation to medical conditions. There’s obviously a great deal of worry around at the moment, understandably, in relation to coronavirus.   I’ve come to ask Jo about how we can look after our psychological wellbeing as well as our physical health. The information that Jo talks about is based on cognitive behavioural therapy principles for anxiety. Obviously there’s no evidence base for this in relation to coronavirus in particular, but really health anxiety in relation to any physical illness has some very similar features, so we hope that this advice can be helpful.   Jo: My name is Jo Daniels and I’m a senior lecturer in clinical psychology and also a clinical psychologist working in health.   Lucy: Could you say a bit about the work that you’ve done that’s relevant to our reactions to the coronavirus pandemic?  Jo: The research that I’ve done so far is focused on health anxiety and distress in medical conditions. I do some work in the emergency department and think about why people keep coming back in and it’s usually to do with anxiety rather than pain. I’ve also worked in health anxiety in complex conditions such as Addison’s disease, chronic fatigue syndrome, also stroke, looking at how important anxiety is in both emotion and physical experience.   Lucy: Fab. I mean it’s really understandable that people are feeling worried at this time because there’s loads of stuff around about Covid-19 and about what we should be doing about it. What advice would you have about how we can avoid spiralling out into panic about what’s happening?  Jo: I think the first thing to say, which feels quite important, is it’s very, very normal to have a fear response, to feel anxious because this is a threat really and that’s the way that our brains are interpreting it, as a threat. Important to just accept that we’re all a little bit worried at the moment and we’re really in it together.   In terms of the things that we can do help ourselves, it’s a digital age, so a lot of people are accessing various sources of media and information at the moment. Thinking about where the notifications are essential, thinking about the sources of information that we access, where some of the new stories are designed to be alarmist.   Keeping perspective is really, really important and we can do that in a number of ways. So keeping in touch, especially if we’re moving into having to be at home, we need to be in touch with people to keep perspective and also to keep ourselves happy.   Also trying to stay calm. It’s really important that we go about our normal daily business as much as we can. Things are going to change over the next few months, but normality is really important. So ensuring that we do the same things that we normally do and don’t adapt too much because sometimes when we do that, we start to do things that are actually counterproductive.   Lucy: So like a balance between following the advice that’s out there, the sensible advice on reputable websites, but doing as much as we can to keep our routine and keep in touch digitally with people that we care about?   Jo: Exactly. It’s really important to be vigilant, but not hyper vigilant. If you look for trouble, that’s what you’ll find.   Lucy: What does hyper vigilance mean, just in case people don’t know that?   Jo: That’s when we’re really paying extra attention to things. You see that a lot in health anxiety and at the moment I think a lot of us may be doing that, looking for signs of coronavirus.   The interesting thing is, is that actually if we become quite anxious; we will product physical symptoms in our body that may mimic it. So things like chest pain, you can get a bit of chest pain or dizziness, nausea, feeling a bit hot, all of those physical sensations can be anxiety or they can be something like coronavirus, which is another reason why it’s important to stay calm. As obvious as it sounds, to keep breathing.   Lucy: I find that really interesting because if I get anxious or worried, I normally feel like I get quite short of breath. Is that quite a common symptom that you would say?   Jo: Yes, definitely. We see hyperventilating – even if it’s at moderate level you might not even notice – in anxiety. Some shallow breathing and again, that sends signals to the brain that there is a threat and it does trigger off, it can trigger off a ‘fight or flight’ response, or an anxiety response. And there is a lot that we can do to help ourselves at this time, but panicking and anxiety is not helpful.   Lucy: Could you say a bit more about ‘fight or flight’ response, I expect people would have heard about that, but just a bit more detail?  Jo: So fear is a very normal response and that fear response is ultimately designed to keep you safe, it’s a survival mechanism. We can receive incoming information that triggers off a ‘fight or flight’ response that actually isn’t a real threat to us. It’s designed to deal with threats such as seeing a scary lion chasing us in the African plain, but actually we still get an anxiety response, a ‘fight or flight’ response when we send a text message to the wrong person, for example.   What happens then is we have a lot of hormones released around our body and people might be familiar with breaking into a sweat or hyperventilating a little bit or palpitations. Many, many symptoms are essentially designed so that we can fight really hard or run really fast just to keep us safe.   Lucy: But not very helpful to run away from a mobile phone when we send a wrong text message.   Jo: No, not really, that’s where it doesn’t work very well, ‘fight or flight’ response because we haven’t evolved, if you like, to be able to distinguish between what’s a real threat and what’s being perceived as something like a social threat where a ‘fight or flight’ response actually can be quite unhelpful and actually stressful.   Lucy: It’s tricky with this isn’t it, because it is a real threat and at the same time there’s a quite a lot of panic around which might be unhelpful.   Jo: Yes, exactly and that again brings on further symptoms associated with anxiety. So it’s really important to, as much as we can, give our bodies and our brains the message that actually there is a threat, but we can deal with it in a pragmatic way.   Lucy: If someone has an existing mental health problem, any advice about how to stop that being exacerbated?  Jo: I think it’s a difficult time for people who have got anxiety already because they’re already going to be quite sensitive to anything else that can be perceived as a threat.   The same applies really, so trying to maintain distance from the difficulty, just following the sensible precautions, making sure that you’re in contact with the people who care about you, both friends and family, but also GP as well, if things are escalating a little bit and it becomes unmanageable or you become preoccupied. It’s really important to put into place strategies that you know that work.   Lucy: So still that balance between making sure you’re accessing information about what to do, but not over checking, either symptoms in yourself or over checking websites that might be showing quite scary stories.   Jo: That’s right. We know that panic breeds panic. So if we see other people panic buying, then we’re more inclined to do that as well. So just trying to, again, take a step back when we feel ourselves becoming anxious and trying to retain that perspective.   Lucy: One of the things that’s so tricky about this is that there’s a lot of uncertainty around about what’s going to happen and what we’re going to be advised.  Jo: We are mostly intolerant of uncertainty and that in itself can be problematic in the sense that this will perpetuate anxiety, that’ll keep anxiety going. Rather than the actual illness itself, or the fear of the illness, it’s the uncertainty of, “Will I catch it? Will I be able to manage it? Will I be badly affected?”  Lucy: And actually it can get us checking online news a lot more can’t it, to see what are we being advised on a moment-to-moment basis.   Jo: That’s right and that’s the problem sometimes with anxiety. Even mild anxiety, because some of us who may not be usually prone to anxiety, will feel a little bit anxious at this time, for understandable reasons. But some of those strategies we use are counterproductive. I don’t know of any good examples of where people have Googled their symptoms and come off feeling better.   So check that checking behaviour, it can make us feel better momentarily, but really serves to increase our anxiety and of course then we get stuck in a loop feeling like because that anxiety was reduced for a moment by checking, that we keep doing it. But of course, it really serves to increase our anxiety.  Lucy: What are some things that we can do that would be more helpful than checking online?   Jo: One of the things we can do, given that we are experiencing mild levels of ‘fight or flight’ response, that fear response, is to try and get rid of some of that adrenaline. Exercise is really important, not only does it get rid of that adrenaline, it also allows us to keep perspective and keep fit at the same time.   But also just making sure that we keep in touch, check reliable sources and just follow the guidance. There are a lot of busy people who have got a lot of knowledge in this area who are giving very sound advice. So just keep up to date with what the precautions are.   Lucy: And how do we know that these things are helpful?  Jo: Thankfully we know a lot about anxiety, so for many, many years there’s been lots of research, lots of empirical data-based studies which have supported the development of models of anxiety. And anxiety is the same applied in different settings.   Whilst anxiety in mathematical conditions may not present the same, it’s very, very similar. Those principles which are underpinned by cognitive behavioural approach we’ve seen work in other situations where people experience anxiety, and in that sense there’s no difference here. People tend to do the same kinds of things when they’re anxious and we know that the same kinds of things will help.   Lucy: So to sum up, follow the advice on the government websites. Try to look after yourselves and other people by managing some of the anxiety response that’s going on as well.   Jo: That’s right.   Lucy: Have you got anything that you would like to add at all?   Jo: I think what feels essential is that where we can, we respond to this in a compassionate and community focused way. We’re going to be in this together as a community, so it’s really important that we look out for our neighbours, those who are vulnerable to us and express some understanding towards those who do feel anxious, who are finding it difficult.   Lucy: I hope you found that as helpful as I did. And if by the time this podcast is out we have moved into a phase where we’re having to stay at home a bit more, I hope you can remember those tips of trying to keep a routine as much as possible, following advice, but also trying not to get too preoccupied. Jo described this as having some kind of normality within an abnormal situation.   If you’re stuck at home and you want to listen to some more podcasts, there’s plenty of episodes of Let’s Talk About CBT to keep you company.    END OF AUDIO 

This is an understandably stressful time and it's normal to feel worried. What can we learn from CBT for health anxiety that might help us with feelings of anxiety during the pandemic? In this short bonus episode, Dr Lucy Maddox interviews Dr Jo Daniels from Bath University, about things we know are likely to help.  Show Notes and Transcript Read an article by Dr Jo Daniels on how to stop anxiety about coronavirus spiralling out of control here: <a href="https://theconversation.com/coronavirus-how-to-stop-the-anxiety-spiralling-out-of-control-133166" rel="nofollow" target="_blank"> https://theconversation.com/coronavirus-how-to-stop-the-anxiety-spiralling-out-of-control-133166</a> Another article about panic here: <a href="https://thepsychologist.bps.org.uk/truth-about-panic" rel="nofollow" target="_blank">https://thepsychologist.bps.org.uk/truth-about-panic</a> And this about how it's normal to feel worried:  <a href="https://www.ft.com/content/d6c65a50-6395-11ea-abcc-910c5b38d9ed" rel="nofollow" target="_blank">https://www.ft.com/content/d6c65a50-6395-11ea-abcc-910c5b38d9ed</a> BBC piece on protecting your mental health at this time: <a href="https://www.bbc.co.uk/news/health-51873799" rel="nofollow" target="_blank">https://www.bbc.co.uk/news/health-51873799</a> BABCP: <a href="http://www.babcp.com" rel="nofollow" target="_blank">www.babcp.com</a> Photo by <a href="https://unsplash.com/@kellysikkema?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" rel="nofollow" target="_blank"> Kelly Sikkema</a> on <a href="https://unsplash.com/s/photos/covid?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText" rel="nofollow" target="_blank">Unsplash</a> Transcript Lucy: Hi, I’m Dr Lucy Maddox and this is Let’s Talk About CBT. This is a podcast brought to you by the British Association for Behavioral and Cognitive Psychotherapies.   This is a bit of an unusual episode. I’ve come to Bath University to interview Dr Jo Daniels who has experience in researching health anxiety in relation to medical conditions. There’s obviously a great deal of worry around at the moment, understandably, in relation to coronavirus.   I’ve come to ask Jo about how we can look after our psychological wellbeing as well as our physical health. The information that Jo talks about is based on cognitive behavioural therapy principles for anxiety. Obviously there’s no evidence base for this in relation to coronavirus in particular, but really health anxiety in relation to any physical illness has some very similar features, so we hope that this advice can be helpful.   Jo: My name is Jo Daniels and I’m a senior lecturer in clinical psychology and also a clinical psychologist working in health.   Lucy: Could you say a bit about the work that you’ve done that’s relevant to our reactions to the coronavirus pandemic?  Jo: The research that I’ve done so far is focused on health anxiety and distress in medical conditions. I do some work in the emergency department and think about why people keep coming back in and it’s usually to do with anxiety rather than pain. I’ve also worked in health anxiety in complex conditions such as Addison’s disease, chronic fatigue syndrome, also stroke, looking at how important anxiety is in both emotion and physical experience.   Lucy: Fab. I mean it’s really understandable that people are feeling worried at this time because there’s loads of stuff around about Covid-19 and about what we should be doing about it. What advice would you have about how we can avoid spiralling out into panic about what’s happening?  Jo: I think the first thing to say, which feels quite important, is it’s very, very normal to have a fear response, to feel anxious because this is a threat really and that’s the way that our brains are interpreting it, as a threat. Important to just accept that we’re all a little bit worried at the moment and we’re really in it together.   In terms of the things that we can do help ourselves, it’s a digital age, so a lot of people are accessing various sources of media and information at the moment. Thinking about where the notifications are essential, thinking about the sources of information that we access, where some of the new stories are designed to be alarmist.   Keeping perspective is really, really important and we can do that in a number of ways. So keeping in touch, especially if we’re moving into having to be at home, we need to be in touch with people to keep perspective and also to keep ourselves happy.   Also trying to stay calm. It’s really important that we go about our normal daily business as much as we can. Things are going to change over the next few months, but normality is really important. So ensuring that we do the same things that we normally do and don’t adapt too much because sometimes when we do that, we start to do things that are actually counterproductive.   Lucy: So like a balance between following the advice that’s out there, the sensible advice on reputable websites, but doing as much as we can to keep our routine and keep in touch digitally with people that we care about?   Jo: Exactly. It’s really important to be vigilant, but not hyper vigilant. If you look for trouble, that’s what you’ll find.   Lucy: What does hyper vigilance mean, just in case people don’t know that?   Jo: That’s when we’re really paying extra attention to things. You see that a lot in health anxiety and at the moment I think a lot of us may be doing that, looking for signs of coronavirus.   The interesting thing is, is that actually if we become quite anxious; we will product physical symptoms in our body that may mimic it. So things like chest pain, you can get a bit of chest pain or dizziness, nausea, feeling a bit hot, all of those physical sensations can be anxiety or they can be something like coronavirus, which is another reason why it’s important to stay calm. As obvious as it sounds, to keep breathing.   Lucy: I find that really interesting because if I get anxious or worried, I normally feel like I get quite short of breath. Is that quite a common symptom that you would say?   Jo: Yes, definitely. We see hyperventilating – even if it’s at moderate level you might not even notice – in anxiety. Some shallow breathing and again, that sends signals to the brain that there is a threat and it does trigger off, it can trigger off a ‘fight or flight’ response, or an anxiety response. And there is a lot that we can do to help ourselves at this time, but panicking and anxiety is not helpful.   Lucy: Could you say a bit more about ‘fight or flight’ response, I expect people would have heard about that, but just a bit more detail?  Jo: So fear is a very normal response and that fear response is ultimately designed to keep you safe, it’s a survival mechanism. We can receive incoming information that triggers off a ‘fight or flight’ response that actually isn’t a real threat to us. It’s designed to deal with threats such as seeing a scary lion chasing us in the African plain, but actually we still get an anxiety response, a ‘fight or flight’ response when we send a text message to the wrong person, for example.   What happens then is we have a lot of hormones released around our body and people might be familiar with breaking into a sweat or hyperventilating a little bit or palpitations. Many, many symptoms are essentially designed so that we can fight really hard or run really fast just to keep us safe.   Lucy: But not very helpful to run away from a mobile phone when we send a wrong text message.   Jo: No, not really, that’s where it doesn’t work very well, ‘fight or flight’ response because we haven’t evolved, if you like, to be able to distinguish between what’s a real threat and what’s being perceived as something like a social threat where a ‘fight or flight’ response actually can be quite unhelpful and actually stressful.   Lucy: It’s tricky with this isn’t it, because it is a real threat and at the same time there’s a quite a lot of panic around which might be unhelpful.   Jo: Yes, exactly and that again brings on further symptoms associated with anxiety. So it’s really important to, as much as we can, give our bodies and our brains the message that actually there is a threat, but we can deal with it in a pragmatic way.   Lucy: If someone has an existing mental health problem, any advice about how to stop that being exacerbated?  Jo: I think it’s a difficult time for people who have got anxiety already because they’re already going to be quite sensitive to anything else that can be perceived as a threat.   The same applies really, so trying to maintain distance from the difficulty, just following the sensible precautions, making sure that you’re in contact with the people who care about you, both friends and family, but also GP as well, if things are escalating a little bit and it becomes unmanageable or you become preoccupied. It’s really important to put into place strategies that you know that work.   Lucy: So still that balance between making sure you’re accessing information about what to do, but not over checking, either symptoms in yourself or over checking websites that might be showing quite scary stories.   Jo: That’s right. We know that panic breeds panic. So if we see other people panic buying, then we’re more inclined to do that as well. So just trying to, again, take a step back when we feel ourselves becoming anxious and trying to retain that perspective.   Lucy: One of the things that’s so tricky about this is that there’s a lot of uncertainty around about what’s going to happen and what we’re going to be advised.  Jo: We are mostly intolerant of uncertainty and that in itself can be problematic in the sense that this will perpetuate anxiety, that’ll keep anxiety going. Rather than the actual illness itself, or the fear of the illness, it’s the uncertainty of, “Will I catch it? Will I be able to manage it? Will I be badly affected?”  Lucy: And actually it can get us checking online news a lot more can’t it, to see what are we being advised on a moment-to-moment basis.   Jo: That’s right and that’s the problem sometimes with anxiety. Even mild anxiety, because some of us who may not be usually prone to anxiety, will feel a little bit anxious at this time, for understandable reasons. But some of those strategies we use are counterproductive. I don’t know of any good examples of where people have Googled their symptoms and come off feeling better.   So check that checking behaviour, it can make us feel better momentarily, but really serves to increase our anxiety and of course then we get stuck in a loop feeling like because that anxiety was reduced for a moment by checking, that we keep doing it. But of course, it really serves to increase our anxiety.  Lucy: What are some things that we can do that would be more helpful than checking online?   Jo: One of the things we can do, given that we are experiencing mild levels of ‘fight or flight’ response, that fear response, is to try and get rid of some of that adrenaline. Exercise is really important, not only does it get rid of that adrenaline, it also allows us to keep perspective and keep fit at the same time.   But also just making sure that we keep in touch, check reliable sources and just follow the guidance. There are a lot of busy people who have got a lot of knowledge in this area who are giving very sound advice. So just keep up to date with what the precautions are.   Lucy: And how do we know that these things are helpful?  Jo: Thankfully we know a lot about anxiety, so for many, many years there’s been lots of research, lots of empirical data-based studies which have supported the development of models of anxiety. And anxiety is the same applied in different settings.   Whilst anxiety in mathematical conditions may not present the same, it’s very, very similar. Those principles which are underpinned by cognitive behavioural approach we’ve seen work in other situations where people experience anxiety, and in that sense there’s no difference here. People tend to do the same kinds of things when they’re anxious and we know that the same kinds of things will help.   Lucy: So to sum up, follow the advice on the government websites. Try to look after yourselves and other people by managing some of the anxiety response that’s going on as well.   Jo: That’s right.   Lucy: Have you got anything that you would like to add at all?   Jo: I think what feels essential is that where we can, we respond to this in a compassionate and community focused way. We’re going to be in this together as a community, so it’s really important that we look out for our neighbours, those who are vulnerable to us and express some understanding towards those who do feel anxious, who are finding it difficult.   Lucy: I hope you found that as helpful as I did. And if by the time this podcast is out we have moved into a phase where we’re having to stay at home a bit more, I hope you can remember those tips of trying to keep a routine as much as possible, following advice, but also trying not to get too preoccupied. Jo described this as having some kind of normality within an abnormal situation.   If you’re stuck at home and you want to listen to some more podcasts, there’s plenty of episodes of Let’s Talk About CBT to keep you company.   END OF AUDIO

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Let's Talk About CBT is a podcast about cognitive behavioural therapy: what it is, what it's not and how it can be useful. Dr Lucy Maddox interviews experts in the field including people who have experienced CBT for themselves.  A mix of interviews, myth-busting and CBT jargon explained, this accessible podcast is brought to you by the British Association of Behavioural and Cognitive Psychotherapies. <a href="http://www.babcp.com" rel="nofollow" target="_blank">www.babcp.com</a>

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