An insight into CBT

Hi all

I obtained 50 sessions of Cognitive Behavioural Therapy (CBT) in the years 2012-13 and ultimately this set me on the road to alleviating the worst of anxiety that had frankly crippled for most of my life prior.  Yes, CBT isn't the answer to everything but for me it put my life on track to a point where today I can say that I am able to manage anxiety and do things with my life that I couldn't do previously.  I have blogged numerous times before about how I obtained this therapy and the other less successful therapy attempts I had before this.  It's a minefield, sadly, even today when a lot more is being done to tackle mental health stigma and to try and get mental health on a level playing field with physical.  Of course, we're still miles off.

I never said these images would be interesting

Naturally, the effectiveness of CBT or any other sort of therapy does become maximised by the therapist themselves.  Yes they will (hopefully) say insightful things that strike chords and that help you to get out of whatever pit you're in.  But ultimately it is down to you as the person with anxiety, depression, bipolar or any other mental health condition to do a lot of the work.  I understand that sometimes this can be difficult at best and other interventions are required for people to even begin to work at getting help, but once you're in that position, the best way to help you is to help yourself. If that makes sense.

One of the main things that my therapist advised that I did was create a toolbox of things that I could open in times of need.  This toolbox contains a series of things that I learnt from my mammoth run of CBT sessions that remind me what I need to do and how I need to act to ensure tasks I undertake do not cause anxiety to spiral out of control.  Now I'm in a much better state, it would be tempting to lock the toolbox shut and even get rid of it, but instead I routinely open it every couple of months and remind myself where I was and where and I am now and most importantly, how I got here.  The toolbox contains a series of prompts that help me to get through challenges as they get bigger now I'm nearing 30.  I talked in my last blog about my mum's early-stages of dementia, the blog before about my travels - all new challenges.  I need this toolbox to get me through it.

When I say toolbox, by the way, I mean Excel spreadsheet.  Such is the modern way of things.

The first things on this spreadsheet are things I can do to help me before and/or during an event (a trip, meal out, work conference or whatever) to prevent a major anxiety meltdown. I then 'score' them informally on how often I actively trigger this technique when required and how effective it is in helping me get through and even enjoy a situation.  Examples include:

• Planning my time when I'm alone
• Do some people watching in busy places if things feel overwhelming
• Focus on my breathing if things start to become anxious
• Plan out the logistics of events meticulously; maps, literature, materials etc.

Sound daft? Yes probably, but you have no idea how much, especially when combined, these things all help you to get through a situation. There is also a big focus on people - who can you call if things go pear shaped? Who is the first aider at the place you're visiting? Who looks friendly to you (because you're not always with your own friends!) Using people is, of course, a risk when you don't know them, but it is always better to use someone than to use no-one in times of strife, in my experience. I would put my life against this statement.

Then I have another list that is more general to life than to specific events, such as:

• Make a strong effort with my friends
• Try not compare myself with other people, positively or negatively
• Enjoy and take in the feelings of happiness and compassion
• Take criticism well by using it constructively.

This is all about putting a positive or a neutral spin on things; not always easy and probably impossible to get right all of the time. There is a danger that you strive for perfection, of course, which is not helpful either ("love your imperfections" as a multi-national online dating agency says), but this list is about recognising how to feel better and more confident about yourself and with yourself, which is hugely important when you have a mental health condition. Incidentally, I have a heck of a long way to go before my scores are anywhere near where I'd like them to be, especially in the ones more general in life. My strongest points are probably planning and organising things, focusing on my friends and others and work related goals. My weaknesses usually come from the analysis around not being in a relationship, surprise surprise. 

Talking of which, I also have a list that is called 'valued directions' which sets out where I'd like to take my future, including things like:

• I would like to be more tolerant with other people
• I would like to help young people through the job market
• I would like to travel to certain places
• I would like to help in the local community
• I would like to eat well and healthily 

I'm not into all of this "life enrichment, positive thought, you can find yourself" wishy washy bollocks that a lot of people on Twitter seem to be about.  Some of the above may sound like this, but it is not at all; these lists and techniques were brought together through grit and hard work and I'm by no means achieving them all. They are just ideas and concepts to try and model myself against so that I don't spiral back where I was five or more years ago. Having anxiety for nigh on 20 years has made me unable to do a lot of things and this is more about a list of achievements if I can do them. So to provide some annotation around the above list:

• I would like to be more tolerant with other people - I need people around me so that I feel like I'm wanted and in case I do spiral again I have people there who can help. So I don't want to piss people off.
• I would like to help young people through the job market - I know what it was like trying to get a job and work my way through university with anxiety...
• I would like to travel to certain places - I've never been able to go anywhere due to crippling anxiety!
• I would like to help in the local community - this makes me feel good and I also know how important interaction is to the elderly and lonely.
• I would like to eat well and healthily  - being physically healthy is always a good thing for your mental health.

You get the idea. 

As I said earlier, I revisit this Excel based toolbox every couple of months or so, so that I never forget it, and re-score where I need to improve or where I've done well. Overall the scores are glacially going up as I get older and I strive for this to continue. To think where I am now compared to, say, 2011 is just extraordinary and thanks in no small part to these sort of CBT techniques. 

And of course thanks to the therapist who introduced these sorts of practices to me in the first place. To her, I am forever indebted. 

Best wishes,
Al

PS - I go to Ireland for eight days on 8th May; four nights in Dublin, four in Killarney, on my own. This is possibly the biggest self-inflicted challenge I have ever presented myself with. Edinburgh went well in February, but Ireland is on a much greater scale. This trip could, ultimately, make a break the next several years in terms of what I can achieve and my general mental wellbeing. I will report back, but for now, please wish me luck.

PPS - June 15th will be the fifth anniversary of my blog. More to follow...

New challenges

Hi all

My mum has got early onset Alzheimers.

The first me and my dad noticed that something unusual was happening was about a year ago; little things were not right, mainly around her becoming easily confused about things that someone without a condition would not confuse, like not being able to process what time a bus departs a stop. There was then a further decline during November and December, a fairly sudden one, where further confusion occurred along with incidents which really started causing concern.  I think the one incident that particularly affected me was when she sent me a text saying that she didn't know where she was and that she wished she was in her own home.  Of course, she was at home at the time.

Another charity leading the way

We haven't yet got to the stage where she is forgetting people close to her, but I fear that it is only a matter of time.  The latter symptoms of Alzheimers are frightening, frankly, and I hope it takes as long as time allows before we have to see my mum deteriorate to these levels.  At present, she's still the warm and friendly person she always has been, but with added haze and confusion. This horrible condition almost strips out all personality as it gets worse and so I want it to take as long as possible before this happens.  

People always talk about Alzheimers and other dementias are a condition that 'progresses.'  I'm sorry, this is too upbeat a term for me to get on board with.

My dad, of course, has to live with her all of the time.  He sees it day in and day out and has had to suddenly learn how to live with a person who is changing and who cannot undertake many of the tasks she used to do.  I admire how he is handling it so far.  My dad is not without flaws (we agree to disagree sort of knowingly on a lot of issues) and one of the biggest challenges is getting him to plan in advance.  I've been doing a lot of research on Alzheimers since it started to look likely that my mum had that, by reading literature, talking to people who have had experience of family members with the condition and looking at the various charity websites and NHS support pages.  My dad, on the other hand, has not and I'm concerned he is not helping the situation in some ways by, for example, taking every single job out of my mum's hands, even things that she can get wrong and it wouldn't matter, like feeding the garden birds.  I've read that ensuring that people with Alzheimers are made to feel useful is very important. 

That said, my dad is having to watch the woman he has loved for 32 years gradually change into someone unrecognisable and, moreover, watch it everyday. I can't imagine the emotional impact it is likely to be having.

My parents went to the doctors on 19 January and sadly it took until 10 March - last Friday - to get the first appointment with a specialist.  People with experience of this will probably tell me that's normal, but it is frustrating. I am also acutely aware of the situation of our NHS but naturally you feel that your case (or your family's) is the most important of all. But at least progress (I use this term more accurately here) is being made it terms of obtaining support.  The appointment on Friday was a memory test followed by a general discussion; the next stages involve a scan and another appointment with a more senior person.  Then one can look to developing a 'care plan' which involves both the carers and the professionals, which sets out exactly what support my mum will get and in what form.  This is where we need to get to.

One of my many concerns in terms of being the best carer I can be is that there are only two people who can look after my mum during this time. Me and my dad. You might ask, what about wider family? Well, I'm an only child for a start and there are four - yes, count them, four - people on my mum's side of the family.  Two are disabled (one has William's Syndrome and the other was starved of oxygen at birth and needs full time care), one is the full time carer for the latter and hasn't spoken to my mum for ten years (my Aunt) and one is my nan who is 83 and is not in a physical condition to contribute. Plus, they all live 65 miles away. Yes, there are also friends, but I believe that they should only be there for some emotional support in terms of the carer chatting things through with them from time to time. Fortunately both me and my dad have some good friends to lean on, which will still be invaluable.

But aside from that, it's just us. How on earth am I supposed to transform myself into a carer? How do I need to behave? How can I help my mum the most? What should I say? Do? What should I do with my mum when I see her? All questions racing around my head like a F1 circuit. Frequent blog viewers will know that I am not even 30 yet, so I am quite young in experiencing a parent become a victim of this condition. Most people are in their 40s and 50s from what I understand, which makes sense. But my mum is only 67, so she's quite early getting the condition and she had me when she was quite late, i.e. 37, hence why we are where we are. How can I be qualified to do this job?

At the moment, I am spending a few hours every weekend at my parents' house with my mum, so my dad can leave her and know she'll be okay. I usually go for a walk with her, but just me being around seems to help.  I haven't had to dramatically change the way I am with her, although I have been involving her in more things where possible and trying to keep her occupied. But this is doable; I am scared of what will happen when the mid-later stage symptoms start to kick in. Scared of seeing my mum go through her horrible changes. Scared of whether I am going to support her in the right way. Scared of how I might deal with it.

For of course, as is the purpose of maintaining this blog for the past nearly five years, you may have noticed that I grew up with anxiety. I am in so much better a place now, but I know that huge emotional changes could trigger something. Anxiety doesn't leave, it just lurks hidden in a box in a dark corner, waiting for a moment to materialise again. Fortunately, my box has been locked for the past couple of years or so, but it's still there and the key remains in tact and I don't necessarily have full control over when it's reopened. The problem I have is this - the emotional and logistical impact of my mum changing because of Alzheimers is going to change my life. This heightens the risk of anxiety, minimising the likelihood of me being a good carer. Knowing this is a possibility puts more pressure on me in the first place, further maximising the likelihood of this scenario playing out. If I become an anxious mess again, I will not be able to adequately support my mum.  The thoughts of both becoming an anxious mess again and not being able to support my mum frightens me. So the question is, how do I keep it together?

Then, don't forget, there is being strong for my dad, who will still have to bear the brunt of all this and who will need me to help him emotionally and logistically. So it's not just my mum who is at stake here.

This brings me back to the point I made earlier about planning.  Knowing all of the above is, in some ways, helpful.  I am aware of what may happen. Without having had anxiety, I perhaps wouldn't be aware and, therefore, able to prepare. So I have to use this knowledge to my advantage and do whatever I need to do so that I don't become an anxious mess again and, most importantly, so that I can be the best person I can be for my parents. 

One example is ensuring that I still have some time in my life to myself. I am likely to be required to support my mum more and more and if it gets to the point where all I'm doing in my life is working full-time and supporting my mum, this will just increase the likelihood of me becoming anxious. So I am fully prepared that in however many months/years time, I will probably have to drop my working hours.

Ultimately, as selfish as this may sound, I also want to live some of my life in my 30s; I spent most of my teens and 20s suffering from anxiety and being unable to do the things that people in my social bracket generally do during those years (the so-called "best years of your life") so I was hoping that my 30s at least make me able to do more of these things, like my recent trip to Edinburgh and forthcoming trip to Ireland. The implications of forming relationships with all this is obviously a negative one, but this is not important anymore. Fitting my life around what is needed to support my mum is all that matters.

But I still have to look after myself. Otherwise I'm useless and, probably overall, a hindrance. So this next however-many months/years will be a constant battle of learning, adapting and handling stuff. Something that, actually, I have gained many years' experience of thanks to anxiety - so my anxious past may just help me, if I get it right.

Ultimately, though, it is one of those situations where adapting is the only way. I love my mum and I want to do the best for her, whatever it takes. So analysing the 'what ifs' is just getting in the way. 

This is a new challenge in my life and one that I am just grateful I can even consider being able to handle.

Best wishes,
Al

Going it alone

Hi all

For the unlucky few that have been keeping up to date with my recent tweets, you may have noticed that I have just returned from a short break, two nights only, on my own.  'So what?!' you may justifiably exclaim.  Well, it is the first time I have been away since March 2011 where I both travelled on my own and then spent the time at the destination on my own.  Since then, I've either travelled on my own and then met up with someone at the destination, or both travelled with someone and spent the time away with them.  Or, in the first couple of years after March 2011, not travel anywhere, as was the easier option at the time.

Fabulous city

For what happened in March 2011 was a living hell.  I had the most severe panic attack in terms of both intensity and longevity and the nightmare carried on for months afterwards; I could barely leave the house, let alone enjoy my life to any degree. Ultimately, though, it was only after this incident that I got the help I needed and my life gradually changed for the better from there.  I have written about all of this numerous times before and frankly it is what spurred me on to set up this blog in the first place.

So this trip, nearly six years on, was bound to be a test of how far I have come.  I have never, and will never, forget what happened six years ago for all sorts of reasons, and understandably I have tried to never replicate the situation since, i.e. by going somewhere for a break on my own.  Until now.

There are two parts of this blog; one is sharing how this latest trip went from an anxiety perspective and the second is to explain why I need to travel to places on my own in the first instance.

The first difference between this trip and the 2011 one was that there was no agenda this time.  For the last trip, I was naively visiting a university campus down in Cornwall to speak to a course tutor about potentially quitting my job and doing a masters degree.  Like I was ready for that.  But the pressure of all of this going on in my head I think, ultimately, led me to have that panic attack; that and knowing I had eight hours of a train journey ahead of me which I could not escape from.  And, of course, not having any tools from CBT or any other therapy to help me when panic struck.  This trip, in 2017, was just a trip.

Except that it wasn't. I always knew it was a test and that in itself put pressure on.  It was to Edinburgh, a city that I have always admired and found interesting.  I'm not a city person but this place seemed to be my sort of place from what I'd read and heard about.  So, ahead of my eight day trip to Ireland coming this May, I thought it would be a good idea to take a pre-trip to check how I would fare under these sort of circumstances.  A four hour train journey, followed by over 48 hours in an unfamiliar, busy city on my own.  What could possibly go wrong?

Naturally, I was nervous on the journey down, with some anticipatory anxiety beforehand and several thoughts of what happened in 2011 floating through my head.  There was an hour of the journey, sort of in the middle, where I had to focus on my breathing to keep it together, to not let panic win, whilst trying to ignore physical 'tingles' that reminded me of the numbness I felt in my hands and feet back in the 2011 occurrence.  I used CBT and distracted myself using pre-prepared materials to help me get through the journey; music, reading material, people watching, sugary foods, water and, again, breathing.  I had made it.  

I should point out at this juncture that even hotels are unfamiliar to me.  I have only ever stayed in a handful of hotels and always with someone else, so checking into and staying at a hotel was daunting.  I was prepared to ask the odd stupid question, although luckily I had booked somewhere with competent and helpful staff, which was also clean and comfortable, so I didn't feel particularly on edge. 

The first big test was after this, when I went to a cafe for lunch.  Regular blog viewers will know that one of the most significant outputs of my anxious past has been difficulty eating, particularly eating out.  No-one, including myself, has ever got to the bottom of exactly why this has been the case, but chances are it has something to do with pressure.  Lately, eating out has largely been incident free and I have been able to enjoy it much more and fortunately this continued.  I deployed previously learnt CBT techniques and general things like ensuring I always ask for extra water so I have plenty of fluids to call upon if necessary.  It worked. I ate lunch on my own in a cafe in the middle of Edinburgh.  I managed to eat at restaurants and cafe's during the whole trip, and enjoy the food, something that I wouldn't have even had the guts (literally) to attempt a few years ago.  

Another big key to success - a technique of CBT also, I may add - was advanced planning.  I didn't turn up blind to what was on offer. I had planned my trip to the letter, probably far too meticulously compared to what most people would do for a two day trip away, but to say it helped would be an understatement.  I went to the restaurants that I did because I knew they would have food I'd enjoy; perhaps in an ideal world I would have liked to have tried different cuisines, but I knew that was too risky.  So I planned where to go and where they were in relation to my hotel.  I carried the Edinburgh A to Z map everywhere with me and this helped hugely.  I couldn't get lost. I didn't have to use my phone's sat-nav and thus drain my battery, leaving me to panic about "what if I need my phone in an emergency and can't use it?" I planned roughly how long it would take me to do the other things either side of lunch and dinner (various sightseeing activities; museums, walks and the like) and where to go and how to get there.  This was coupled with ensuring I had things with me at all times as 'back-ups' and useful items to minimise stress, like water, reading material, warm clothing, snacks etc. I cannot emphasise enough how being organised in this way can help. Yes, it's important to keep an element of flexibility to proceedings too, in the event of bad weather or a place happening to be closed when you visit, but having a couple of back-up options is usually enough to prevent this from resulting in a major anxiety meltdown.

My sightseeing experience also confirmed what I had read about the city; it is definitely my sort of place, as far as cities go.  I won't describe this as for the purposes of this blog it is irrelevant, but it did mean that I felt comfortable and welcomed which all helped with keeping anxiety at bay. I managed to visit numerous places and eat out five times, yes five times, without major incident, knowing I could deploy various appropriate techniques when I did feel a little edgy.

In 2011, the major panic actually happened on the journey back, somewhat ironically.  I think I was keeping a lot of anxiety bottled in and I just couldn't contain it any more on the way back.  So I knew that until I got back home unscathed the trip hadn't truly been a success.  But, again, due to the various techniques I had learnt and generally being in a 'better place,' I got through it, as per my aforementioned description, unscathed. In hindsight I knew, in 2011, that although the meltdown happened on that journey back, I was a mess beforehand too. My eating out experience there was disastrous and the lack of sustenance was probably another reason for me having the panic attack in the first place.  It was definitely a lack of general preparedness that cost me back then, too.  

Thus showing how such amazingly simple things can make the difference between success and failure, or indeed, total breakdown.

Me 1 Anxiety 0.

So what of the second part of this blog? Why do I need to travel to places on my own?  Why can't I go with someone?  Well, first of all, it was important I did this on my own to prove I could.  Being with someone would negate the whole point of going in the first place.  But, had I purposely sought someone to go with, I still probably wouldn't have been successful.  I have a few friends that would have been happy to come with me, but they couldn't afford either the time, money or both.  Of course, most people when they (nearly - it hasn't happened yet!) hit 30 go away for short breaks with their partners, but as this won't ever happen to me (you can quote me on that), that isn't an option for me either.  And as far as family is concerned, well there's only my parents and going away with them is neither practical nor a desire, to be frank.  Again, I'm nearly 30.  The only time you go away with your parents at 30 is if you're going away with both yours and your partner's parents on a larger family holiday which I can't do because I'M NOT IN A RELATIONSHIP. I may have mentioned this already.

The biggest challenge was seeing the numerous couples of similar age, give or take five years either direction, out and about with me on my tod.  There's no denying it's not nice, especially knowing that the reason I am on my tod is 95% because of anxiety's legacy destroying my confidence and preventing me from making that connection with a girl in the first place.  I know being single isn't all bad, indeed it has many advantages, but as I've blogged about before, it's the future that concerns me greatly. Going to a city like Edinburgh just rubbed that in my face a little.

The good thing is that I wasn't the only person I saw asking repeatedly for a 'table for one.'  Do this where I live and you get confused looks, pity or people laughing at you.  Do it in Edinburgh, in my short experience, you get welcomed and looked upon as normal.  Indeed, I saw at least three other people eating alone amidst the hubbub of the restaurants I was in.  What being alone also meant was that, in visiting a post-dinner pub on my first night there, I was able to get talking to a couple of very interesting people who were also ON THEIR OWN, enjoying the atmosphere. The fact that they were female of course was irrelevant...

The point was, I knew why I was there alone; other people will judge you but so what? Let them. They are only being human. They don't know anything about me and least of all they didn't know I was WINNING. Winning against anxiety which has held me back for nigh on 20 years.  OK, so most people at the age of 30 may not consider a lone two night trip away to a city on the same island as significant and would probably identify it as quite sad, but I saw it as a huge achievement, emphasising again one positive of anxiety - not taking the small things for granted.

Now I look forward with trepidation but excitement to my trip to Ireland in early May.  EIGHT days away this time. What could possibly go wrong?

Best wishes
Al

Mental health in schools - a plea to Government

Hi all

The topic of this blog came to mind primarily for two reasons: 1) I spent most of my school life with varying degrees of anxiety (a range between crippling and irritating and usually nearer the former) and 2) because of the recent splurge in the media about mental health especially in relation to schools, following Theresa May's pledge that more support will be going into mental healthcare in this country.

Photos like this just exacerbate the problem

I will state from the outset that this will not be a political blog (particularly), but what regarding the recent announcements I will say is this.  Positive: Mental health and its crises is being talked about more (for now) and is at least recognised.  Negative: How on earth is Mrs May going to deliver on her promises?

One of the announcements as per the aforementioned was to suggest that teachers should become trained to spot when a child is experiencing a mental health problem.  At first I thought hurrah, at last, the penny has dropped.  Since then, I have thought about this notion several times, each time with more despair than before. 

For a start, teachers are under enough pressure as it is and the statistics around the mental health of teachers themselves are hard enough to swallow.  They have far too much work to do in order to do their job well as it is, let alone undergo more training to spot signs of what could be anxiety, depression, bipolar or any other of the myriad of mental health conditions.  Training to be a mental health professional is just that - a profession. It shouldn't be a bolt-on to an existing job.

Of course, if a teacher does recognise that something is clearly wrong with a student, then yes, report it via the right channels.  But more can be done to improve these channels. Plus, and I know this from first-hand experience - even students can be damn good at hiding mental health problems.  When I was at school, I didn't even really know what was happening to me when I used to lie there at night having panic attack after panic attack. "Why does this happen to me? Is it like this for everyone?" I used to say, out loud.  Not knowing meant I was stuck between an odd emotional concoction of either thinking it's something normal and therefore not mentioning it to anyone, and thinking if it is "just me" then people will think I'm weird and laugh at me even more than they already did (unsurprisingly, I wasn't exactly popular at school).  So I said nothing to anyone, and indeed, did my level best to hide any 'symptoms' of anxiety to anyone.  I had a few panic attacks during school classes during my school career and managed to hide them with a combination of looking down at my desk and pretending I was concentrating on something work related and a bit of luck.  Had a teacher ever picked on me during a panic attack, I would have been exposed.  As it is, no-one ever knew I had crippling anxiety whilst I was at school. I only "came out" during my university years.

So back to my original point - how on earth would a teacher have identified that all was not well, unless they happened to ask me something during a panic attack, or with the help of a touch of clairvoyance?

I shudder to think of how many school children, all throughout primary school up to their late teens, suffer in this way.  It's an absolute disaster, exacerbated in 2017 I don't doubt with the domination and onslaught of social media - don't get me started on that again.

So what can be done? Well, the answer is threefold - and yes, all of them cost money and resource.  Suck it up, Government.

1) A general improvement to the whole mental health care system.  This takes me back to the hollow/firm (delete as appropriate) promises Mrs May gave last week.  An overhaul to the whole NHS is needed if you believe what you read, with mental health - still - the poor man's relation to physical health across the whole system.  This cannot continue with the increasing number of children suffering with mental health problems.  And they ARE suffering.  I was suffering, let me assure you.  Yes it's partly down to money, but also some considered thought that needs to go into the system to make it possible for a child - or anyone else - to be able to access quick, empathetic and good quality care for a mental health problem, rather than the current shambolic and dangerous "give him/her an anti-depressant and put him/her on a 12 month therapy waiting list" approach.

2) For goodness sake, put learning about mental health on the syllabus and make it mandatory. Bring in specialists to help run the course. What to look out for, how you can get help and all the rest of it.  School is all about learning largely pointless tripe that no-one gives a **** about and is no use in later life.  Whilst you're at it, put other life skills (accountancy, plumbing, cooking (not cakes), PE theory etc.) on the curriculum as well.  And by the way, by putting mental health on the curriculum, you're also educating the teachers about it!!

3) Consider utilising specialists, not just for talks or lessons which could be integrated into the above, but also actually in schools.  Perhaps schools and charities could start partnering together to ensure that they have good access to quick advice, guidance and support to students who may be suffering.  They could spread literature round schools to help fellow students identify if their friends have problems (in line with point 2).  This would almost be more effective than teachers trying to identify problems in students, as students' friends would know them better and recognise if something was wrong. You could also have a mental health specialist from the NHS or privately based at a school, or across a few schools one or two days a week. 

Yes, these would all require significant resource but I don't care or agree with austerity Britain and I firmly believe that the Government should find ways of achieving outcomes like the above.

I can say this not because I am remotely qualified, but because I have the experience.  Student life for me was mostly a living hell. Half the time I didn't even know what was happening to me, let alone where I could get help from.  I was scared to tell anyone, teacher or otherwise, because I thought I'd be singled out, treated as a head case.  I simply bottled it all up and let it explode inside of me at a later date, or hour, in the form of more panic.  How many other kids are going through similar - or worse - experiences that I did and thus not just ruining their school lives but damaging their futures too?

Please can we sort this out? Doing nothing is no longer an option.

Best wishes

Al

Unhealthy anxiety

Hi all

For all the therapy I have had over the years and for all the improvements I have made with anxiety, the one thing I have found very difficult to crack in terms of solving is that of health anxiety.  

Last time I did this, I was found to be alive

Granted, much of what I have learnt is how to deal with anxious symptoms, with an overarching acceptance that I will always have anxious feelings to some degree.  But having the tools to deal with these feelings is hugely important and this is what I have learnt over the years.  Naturally, what happens if you have the tools to deal with and react more strongly to anxious symptoms is that the cause of the symptoms becomes less too.  A good example here is my experience with panic disorder, which used to prevent me from doing certain things such as presenting, socialising or eating out.  Whilst, sometimes, these things can still present challenges, having the tools to deal with any anxieties that these things throw up (no pun intended) gives you more confidence to tackle the original causes and do them anyway - and even enjoy them.  I cannot emphasise enough how much I revel in eating out with a friend and actually enjoying it.  A positive of anxiety - you don't take for granted small wins that perhaps other people don't even register as significant.  So, tackling the symptoms also helps to tackle the cause and eventually a hugely anxious and near-to impossible situation becomes doable or even enjoyable.

Sadly for the health compartment of my anxiety, the success of this cognitive behaviour change has not been realised in quite the same way.  Yes, I am now able to deal with the symptoms of health anxiety better - i.e., when I get a physical pain or discomfort and automatically associate it with immediate death or life defining illness, I am better able to rationalise and say to myself 'you're being stupid,' and come up with alternatives to the problem other than cancer, a brain hemorrhage or equivalent.  But the problem is, I still automatically associate any pain with these sort of horrendous problems - in the case of health anxiety, tackling the symptoms and dealing with them better has not really changed the way I perceive a physical discomfort in the first place.  This differs from other 'types' of anxiety, particularly panic disorder, as described above.

What this shows is how powerful sensational and unrealistic thoughts can be.  I know, KNOW, that when I get a small pain somewhere, the chance of it being anything other than a natural small pain that anyone could get at anytime is close to zero.  And I do KNOW this.  But my brain automatically sensationalises it into something absurd and, yet, believable.  Usually, the pain I feel could, theoretically, turn into something more sinister.  But the odds are so great that most people whose brains are wired with the correct circuitry are able to manage it rationally.  

Now, you may be thinking that this heightened health awareness and negative interpretation could be a good thing - after all, many people who do have the misfortune to develop a serious health problem do so because they failed to seek help for potential symptoms early enough.  With a health anxiety condition - or hypochondriasis if you'd like the medical term - the automatic thoughts of imminent death and disease surely, at least, makes early diagnosis of anything bad almost certain.  Indeed, some people with particularly severe health anxiety pay frequent visits to the doctor, almost as a form of OCD (see below!); they cannot help but get a professional opinion on whatever it is they are experiencing as a way of reassuring themselves that they are okay.  In extreme cases, people will get multiple opinions from multiple doctors.  This must be a very frustrating and time consuming practice, one that I am glad to say I don't have.

However, the down side of not being like this is that I now have a problem whereby, despite my brain tricking me into thinking I have an extreme problem even though I KNOW that I don't, means I don't go to the doctors and instead assume it is health anxiety and try and deal with it accordingly.  So far, it always has been health anxiety.  The problem is, what if I get symptoms that I put down to health anxiety but are ACTUALLY something more sinister?  Could the thing that I fear the most end up being the reason for a mis- or late diagnosis? It would be the ultimate anxiety irony.  It makes subtle symptoms very difficult to differentiate between hypochondriasis and a real health problem and due to experiencing the former for nigh on 20 years, my brain will automatically assume it is health anxiety.  How twisted is that?  I automatically think that a pain is a major health disaster, triggering a reaction that makes me assume it's health anxiety, meaning I do nothing about it and instead just deal with the symptoms of health anxiety.  What if I actually need to deal with the symptoms of a real physical health problem?

The other irony with health anxiety (anxiety generally is one big labyrinth of irony, I've discovered) is it can make you more physically ill in the first place.  For example, when I had very bad panic disorder, I was obsessed (literally) with checking my heart rate.  Checking for symptoms, generally, is one common annoyance that comes with health anxiety, showing again how it is also closely linked with OCD - one can become so fixated on checking that something is wrong that something can become wrong! So back to the panic disorder example - not surprisingly, when I had panic disorder, my heart rate was often higher than you'd expect (whatever that actually was!). Now, what health anxiety did is automatically associate this high heart rate with an imminent heart attack.  Even though I knew it was 'just' the anxiety, I still assumed that my heart was about to burst and kill me.  So, what did I do?  Keep checking my heart rate, to 'make sure I was ok.'  Naturally, almost everytime I checked it, my heart rate was high, and in realising this, checking it made it higher and higher, which led to stronger health anxiety feelings regarding a heart attack.  All of this anxiety can of course make you physically ill - imagine the strain all this nonsense is putting onto your body.  I often had pains in various places (that made the health anxiety worse, of course) which were caused by a constant state of panic.  

Anxiety is just one big vicious circle.

I am happy to report that, generally, the days of this utter absurdity are behind me.  Of course, I worry about jinxing it when I write this.  But that's the reality.  However, it doesn't alter the fact that I simply cannot get that original thought process to stop.  PAIN = IMMINENT DEATH.  I think it will be something that I will always have to put up with and be, as a result, called a hypochondriac.  As long as I can deal with this behaviour more sensibly and rationally, I will be satisfied.

This is not necessarily the topic for it, but I would like to wish all my readers a Merry Christmas and a Happy New Year.  May the year 2017 be better for all of us.

Best wishes
Al

Social media: I now know which side of the fence I'm on

Hi all

I've had lots of conversations with people about social media - who doesn't? - over the past few months for one reason or another, whether it be around my Twitter account, other people's usage of social media or how we use it for work.  I thought it was, therefore, timely to follow up my blog of over three years ago.  Back then, I was more or less on the fence in terms of whether social media was beneficial to those with mental health problems or indeed damaging.  I didn't really come to a firm conclusion. I have now made up my mind.

I don't count blogging as social media

I firmly believe that social media is damaging to society, overall.  Yes it has benefits, I'm not denying that.  But three key reasons stick out for me as to why, overall, it is more of a hindrance than a help to positive mental health and development.

1) Addiction and obsession.  

This is my main axe to grind.  People cannot cope if you take them away from their social media platforms for any more than a few minutes, in extreme cases.  People including myself starting setting up Facebook in about 2006, during University.  If I was 18 now, I'd have basically known no other life than a Facebook life, which worries me.  It worries me because people live their lives through Facebook.  Everything that happens in their life is on Facebook.

One of the most worrying things I think I have heard people say is "it's not official yet because it's not on Facebook," with reference to being in a relationship.  What??! So you're telling me that unless you have posted on Facebook that you're in a relationship, you're not actually in a relationship?  What sort of life is that to live?  Unless it doesn't say it on Facebook, it's not real?

That said, I'm single, so what do I know?

But that's the problem.  People have started communicating solely through their phones and their social media platforms.  Human nature's natural instinct to be nosey in other people's affairs makes it an automatic and understandable reaction to check Facebook to see what other people, or indeed, your "friends" are up to.  The problem is, Facebook is a never ending splurge of news and updates from your "friends" meaning that you could spend hours and hours on it at any one time.  The more people do this, the harder they find it to stop - like anything that you become addicted to.

I don't believe any of this is healthy.  For a start, so much of what you read on Facebook or equivalent is utter fallacy (see point 2) with people boasting and probably making up garbage about their lives.  Secondly, the art of communication is a dying one, from what I can see, and I am concerned that in 20-30 years time younger people will be so used to communicating through digital mediums that if we encounter a problem we won't have the ability to talk openly about it.  This cannot be good for mental health.  Moreover, anecdotal and increasingly scientific evidence is increasingly suggesting that being outdoors and taking in your surroundings is hugely beneficial for people with mental health problems.  How can people truly do this when their mind is constantly buried in the blue glare of a smart phone screen?  The final, most worrying point, is that young people in particular will increasingly turn to social media for mental health help.  Yes, as my last blog conveyed, there is some hugely beneficial support on social media for dealing with and finding more information out about mental health problems - but only if you know where to look.  Filtering through the endless myriad of social media nonsense is the last thing anyone needs when they are in crisis.

2) Comparing yourself to others.

Fortunately, I've managed to never fall into the trap of point 1, possibly because my entire childhood wasn't dominated by social media and so I remember life without it (although I also know people my age and older who are equally as addicted!)  However, I am open to admit that I have viewed other people's updates and 'news' on Facebook (in particular) and started to wish that my life was more like there's.  Usually, posts that make me feel this way are to do with how amazing, hot or talented their partner's are.  All such posts do is remind me that the only thing amazing, hot and talented in my life is a new smart kettle that I bought the other week*.

When you get to 29 years old, and the predominant median age of your "friends" on Facebook are similar, this is an approximate summary of what your news feed consists of:

> I've been on an amazing holiday
> I'm engaged
> I've booked my honeymoon
> I've been on another amazing holiday
> I've taken a photo of my dinner
> I'm getting married in two days
> I'm getting married tomorrow
> I'm getting married right now
> Just married
> I'm pregnant
> I'm on my honeymoon
> More honeymoon photos
> More...
> Hotdog legs
> More.......
> I'm still pregnant
> I've had my baby
> I've taken another photo of my dinner
> Here is a photo of my new baby barfing his dinner onto my shoulder
> I'm pregnant again

You get the idea.  Social media, Facebook in particular, is simply a platform for people to boast about how amazing they perceive their lives to be.  Either that, or it is a platform for attention seeking, either by raising controversial issues or spouting about how miserable their lives are.  Or indeed, it's a platform to do both.

As I've blogged about recently, I'm currently quite happy being single but I worry that in five years time I will be getting progressively lonely and cast aside from society.  As such, the last thing I need to hear is how amazing people's relationships are.  Of course, people sugar the truth on social media.  Things on Facebook may not be in reality, but that is how it is perceived.  And, especially for younger more naive people, the impact that Facebook and others can have on their self perception can be hugely damaging to their mental health.  Suicides in young people are being increasingly reported, and I have no doubt that depression in young people is often caused, or partly caused, by social pressures.  All social media does is exacerbate this by a million, because it is ALWAYS THERE.  And because of the addiction element outlined in 1), people can't help logging on, even though they usually do get upset or, in the longer term, depressed afterwards.  2) fuels 1) which fuels 2) which fuels 1) and the cycle is very hard to break.

All I know is, that I don't want to be constantly reminded how anxiety has affected my life by other people posting about how amazing theirs is.

And frankly, even when you're not comparing yourself to other people's amazing lives, the amount of utter drivel people post on social media is absurd.  I'm the opposite of someone who enjoys reading about celebrities which doesn't help, but until I deleted my Facebook account (more to come on this!) I could have told you quite a lot about people that I have absolutely no interest in BECAUSE YOU HAVE NO OPTION!

3) Trolling and bullying

This barely needs any further explanation.  Ironically, it is often celebrities who are victims of Twitter trolling, which, without looking up an official definition, seems to me to basically be horrible people making, at best, persistent horrible comments about someone on Twitter or, at worst, threatening them or their family.  I grant you, it's sad that this should even be an issue because there shouldn't be anyone on the planet that is nasty enough to do this.  But they do, and the reality is it would be a heck of a lot harder if social media didn't exist.

For the non-celebrities amongst us, the more conventional term of 'bullying' is likely to be more appropriate.  This happens a heck of a lot too, as far as I can tell.  Kids who perhaps don't conform to 'the norm' or who don't bow to peer pressure can now be accessed via the Internet and bullied virtually. You hear all the time of people that have been attacked on social media for not wearing the right clothes, or for having the wrong views, or for being too far.  Victims can be severely affected for a long time by this persistence harassing and because of point one, it can take a long time for young people in particular to remove their accounts or take action.  It has suddenly made it easier for people to bully others, especially out of a school environment.

So is this rant about social media all hypocritical?  In a way yes.  Earlier this year, I did delete my Facebook account after getting increasingly fed up with drivel in my news feed making me feel low. I analysed my 7,504 "friends" (I think it was more like 100) and worked out there was only one person that I was "friends" with that I didn't have any other means of contacting them if I deleted my account - so I duly sorted that out and ensured I had their email address.  

As many of you will know, I still use Twitter, but mainly 1) hopefully for the greater good by sharing my experiences of anxiety and 2) for keeping up to date with mental health news.  I follow some very interesting people and for that, I am the first to admit, it is useful.  It's just a shame that it is abused so often.  I also have LinkedIn for work but don't use it much.  I've never had Instachat or Snapgram or whatever the others are called.

I know social media can be a good thing.  The last blog that I referred to conveyed some of the ways that this can be the case.  But there is a lot of damage caused by it, in my opinion, and although mental health support can be sought widely via social media it can also be a significant cause of mental distress.  I am concerned that we, as a society, are becoming more reliant on it. 

I'm now going to Tweet about publishing this post, and I'm being serious.

Best wishes
Al

* I haven't actually bought I smart kettle.

Sustainability and Mental Health II

Hi all

My previous blog gave an overview of how the term 'sustainability' and mental health recovery are much the same thing.  In other words, things you can do to be friendly to the environment can also benefit your mental health, and there are plenty examples of this.  The conference that I referred to in the previous blog convened on Wednesday 12 October in Birmingham, and I was really pleased with the way it went.

Antony Cobley winning an award for University
Hospitals Birmingham community orchard

As I said before, nothing was groundbreaking.  The messages were fairly self explanatory and obvious, even, but to see real life examples where organisations use sustainability practices to improve patients mental health injected some real inspiration into proceedings.  All the academics tell us that sustainability and mental health can be achieved together, but seeing it actually happen is something else entirely.  The conference was successful, I thought, in showing real-life examples of how organisations that have been spurred on by individuals to create innovative mental health care ideas whilst also improving the environment.

Neil Deuchar set the scene; although he is retired from the health care scene now, he has years of experience and kicked off the conference with a passionate speech about how we need to do more as a society.  His idea that we need to not just consider the next generation, but the next seven generations in our thinking, was well received by every single delegate in the room.  This is true sustainability and got people thinking right from the outset about how positive an impact even small projects can have on people today and far into the future.

Next up was Julia Crear and Sallie Butt from Living Streets, who are trying to turn us into a walking nation, in spite of the British obsession with the car. They provided examples of how walking in groups can dramatically reduce social isolation, something I took great comfort from.  As a keen walker anyway, I was heartened to hear that walking can give such positive mental benefits.  I can feel this myself whenever I go out walking, I must admit.  Finally before the break, Caroline Hutton showed this wonderful video of the great work of Martineau Gardens and how their therapeutic horticulture programme brings people from the local community into nature, improving the environment and, again, how this can benefit recovering mental health patients.  Caroline's wish is to see these gardens exist in every area of the country allowing easy access for patients.  I really do hope this can happen!

After a refreshment break, we heard from Public Health England on how we cannot ignore the impacts of extreme weather when it comes to its impact on mental health patients.  I've been doing some research into this myself recently on behalf of Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) and found that the impacts are becoming increasingly quantified, but as Thomas Waite explained, there is still a long way to go before we understand fully the impacts of heatwaves and flooding on things like distress, domestic violence and long-term depression.

Then came more inspiration, courtesy of two local hospital trusts.  First of all, Antony Cobley with support from Chris Blythe from The Conservation Volunteers spoke about the University Hospitals Birmingham's work with their mental health patients and outdoor activities, volunteering and their community orchard, which literally acts as a form of mental health recovery.  There followed BSMHFT with Neil Cross talking more from an internal perspective; what has this Trust done to improve their sustainability?  He outlined their impressive waste, energy and transport savings in terms of both carbon and money, crucial in tough economic times.  Neil's presentation was very honest, though, and this was appreciated by the audience; he knew that he wanted to do more, particularly on the climate resilience side, to understand which of their premises and therefore their patients were most at risk from extreme weather.

The final 20 minutes of the workshop was spent with the delegates being asked to think of actions that they are going to take back to their organisation and their office afterwards.  I scribbled a spider diagram of these ideas during the session.  It struck me that people were inspired; what you have to remember is that most people attending the conference came from either a sustainability/environmental background or a mental health care background.  As such, one of the biggest successes of the event was to bring people from these two backgrounds together; this is crucial, and surely if these two different types of practitioners worked together they could achieve some excellent results and develop some inspiring projects.  Working together is, of course, crucial in times of low resources and to bring about funding opportunities.

This is the whole ethos of the organisation I work for.  I hope that, given our troubled times financially, we can carry on bringing these people and ideas together.

So all in all it was a successful, enjoyable and inspiring event.  I think the gap that remains, though, is a significant one.  When a person is in crisis, at their lowest ebb, what are the chances of them coming across an initiative like Martineau Gardens, or trying out a walking club, or using their community orchard?  Do they even know such things exist, and if so, would they be aware that they aid mental health recovery?  Even if they did, when you're at your lowest point, you can't possibly fathom such actions making any difference to your living nightmare.  So what we need is two things: 1) Better signposting and use of such initiatives.  But most importantly 2), a recognition that these schemes are not replacements for receiving adequate mental health treatment, whether it be talking therapy, medication or hypnotherapy. They can be complementary methods, of course, but not replacements. Sadly, mental health care in the UK is in meltdown and the sooner the government get their fingers out from their profit making materialistic backsides the better.  

You can find all of the outputs from the workshop on this webpage.

Best wishes
Al

Sustainability and Mental Health I

You may have seen on Twitter that I am lucky enough to be running a Sustainability and Mental Health Conference as part of my job on 12 October.  I will write part II of this blog after the conference to reflect on the event and the speakers and discussion that I pick up on during the day.  Of course, had resources allowed I would like to have done more than just run a half-day conference, but it's still better than nothing and allows people to understand the links between what sustainability is perceived as, and mental health care and recovery.

Martineau Gardens near Birmingham

My conclusion prior to the event - after which I suspect this conclusion will be reinforced - is that sustainability and mental health recovery, in particular, are part of the same thing.

First of all, what do we mean by 'sustainability?'  It's such a broad term, a bit like 'environment' or 'resilience.'  I'm not going to bore you by providing a series of definitions that exist on sustainability, such as 'living within our means both now and in the future,' but this is the general premise.  One issue I still have to grapple with as part of my day job is that when people say the word 'sustainability' they instantly think of 'climate change,' or at the very least 'the environment.'  I think in most cases by 'environment' we're referring to things like nature - trees, forests, animals etc.

This isn't wrong, and indeed climate change and the natural environment are hugely important components of a 'sustainable' future.  Incidentally, both of these aspects are being hugely neglected at present, I believe. 

However, sustainability is also about addressing health inequalities, improving economic productivity and achieving social justice.  Ensuring that this country can overcome its current NHS crisis, for example, is hugely important for sustainability, otherwise millions of vulnerable people and those with health - physical and mental - problems will be at risk, which of course is not remotely sustainable for our future.  Sustainability is about everything and everyone - which is why the term isn't too helpful in many ways.

Indeed, the vision of the organisation I work for is: "By 2020 businesses and communities are thriving in a West Midlands that is environmentally sustainable and socially just." Businesses suggests economy, social justice suggests fairness and wellbeing. 'Environmental' is just one part of it.

So, with all this in mind, ensuring that our mental health care is 'sustainable' is massively important in terms of us achieving this vision, but also for the country as a whole.  Like the NHS, it isn't inaccurate to say that mental health care is currently in crisis; I recently attend North Staffs Mind's 40th anniversary lecture which focused on this very issue. So looking at how you can combine different aspects of sustainability to improve mental health care and the livelihoods of patients, without relying as heavily on the NHS, is crucial.  Indeed, to call the forthcoming conference 'Sustainability and Mental Health Conference' is almost inaccurate - as they are part of the same thing.

But there are small things that individuals with mental health problems can do themselves to help in their recovery and make it less likely of their need to be a burden on the NHS. Because let's face it - every single one of us is a burden on our NHS at the moment as we collectively abuse such a wonderful system.  There are various academic studies and practical examples that provide the evidence for the benefits of undertaking these 'small things,' which I won't quote here as there are too many, and because the Conference on 12 October will do a lot of this for me.  However, in summary, some of the brief examples are:

- Walking, especially in the countryside. Those who have followed my blog for the past four or so years will understand my passion around this and how it has benefited me over the years.  Walking is not only good environmentally - getting out of the car - and for your physical health, but there is strong evidence to support the mental health benefits too. That's why I'm delighted that Living Streets will be speaking at the Conference on 12th.

- Cycling - much the same as walking.  It is more vigorous and physically stimulating and may not be beneficial for those, like myself, who suffered badly from health anxiety (heart rate increase = thoughts of a heart attack = panic attack... etc) but over time it can be equally as beneficial.  Indeed, I have started cycling in the past few months and I'm reaping the benefits.  Sadly in both the cases of walking and cycling, our country is wedded to and has been designed for the car - hence why there is an obesity epidemic and public transport provision and infrastructure is being slashed.

- Gardening/horticulture. Now this isn't something I know much about so I'm keen to listen to the Director of Martineau Gardens at the conference. They offer something called 'horticultural therapy' which in simplistic terms allows people in mental health recovery to help in the Gardens.  It can be relaxing and rewarding and of course, gardening and improving green spaces more generally is good for the environment.  Far too much of our land is being paved on at present, damaging wildlife and causing more flash flooding, to name but two examples.  There is also the wonderful NHS Forests initiative; some hospitals that have taken up this programme have effectively developed a forest within their grounds that offers a calming place for recovery of patients of both physical and mental health issues.

Negative consequences of our environment can also cause mental distress. One key example of this is flooding, which, if severe or frequent enough, can cause significant levels of anxiety and depression in people whose homes get washed out.  People with pre-existing mental health conditions are also less likely to be prepared or aware of extreme weather events, such as a heatwave, leading to a greater risk of physical problems and, lo and behold, an even more negative impact on mental health.  Such cycles are only likely to worsen in future.  I'm pleased that Public Health England, who are supporting the conference, will be talking about this very issue.

I could go on, as there will be numerous other examples where sustainability refers to both improving the environment and people's mental health as part of the same thing. The two agendas should be worked on together, as almost always something that improves our struggling environment will also have a positive impact on people's mental health and wellbeing, thus alleviating pressure on our creaking NHS.

I'm so pleased that I am in a job that allows me to run this conference.  It won't be groundbreaking, that's for sure, but what it will do is showcase some excellent examples of local action that benefits 'sustainability' - in all of its forms.  That, combined with attendance from a passionate and compassionate bunch of delegates, from the NHS, local authorities and elsewhere, who strive every day to do their best for the world and their patients.

I will blog again after the conference and share my thoughts from the day.  Before then, I'm off to Wales (as it now tradition - fifth year running!) on Tuesday to Saturday for a break filled with sustainable walking.  

Best wishes
Al