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Agoraphobia, characterized by an intense fear of situations that might cause panic or a feeling of being trapped, can significantly impact a person’s life. While professional help from a therapist is crucial, there are also steps individuals with agoraphobia can take on their own journey towards feeling empowered and regaining control. Ensuring that you feel that you have the necessary tools to be able to work through the fears that agoraphobia creates, is essential in the healing journey and in widening your life experiences in the future.

Here are some self-management techniques that can be incorporated into daily life:

Education and Understanding:

• Learn about Agoraphobia: Knowledge is power. Understanding the root causes of agoraphobia, its symptoms, and common triggers can be a starting point for self-compassion and developing coping mechanisms. Reputable mental health organizations and online resources can provide valuable information.
• Identify Triggers: Keeping a journal can help identify specific situations, places, or thoughts that trigger anxiety. Recognizing these triggers empowers individuals to prepare coping strategies in advance. It may also help in making sense of where the roots of your phobias may have originated from and doing so can frame and boundary the root of the fears, rather than feeling that they are ‘all-encompassing’.

Building a Support System:

• Connect with Loved Ones: Social isolation can worsen agoraphobia. Sharing your struggles with a trusted friend, family member, or therapist can provide invaluable emotional support and a sense of accountability.
• Consider Support Groups: Connecting with others who understand the challenges of agoraphobia can be incredibly helpful. Support groups can offer a safe space to share experiences, learn from others, and feel less alone.

Challenging Negative Thoughts:

• Cognitive Reframing: Agoraphobic thoughts often focus on potential dangers and worst-case scenarios. Practice reframing these thoughts into more realistic and empowering perspectives. For example, instead of “I can’t leave the house; I’ll have a panic attack,” reframe it as “I may feel anxious, but I have coping skills to manage it.” (Changing what we say to ourselves is a powerful tool in reducing fears).
• Challenge Catastrophizing: The fear of a situation spiralling out of control is a common trigger. Challenge these catastrophic thoughts with evidence. Ask yourself, “Has the worst-case scenario ever actually happened?”

Relaxation Techniques:

• Deep Breathing: Simple deep breathing exercises can significantly reduce anxiety in the moment. Focus on slow, deep breaths from your diaphragm, inhaling for a count of four and exhaling for a count of six. You may want to purse your lips when exhaling, like you are exhaling from a straw.
• Mindfulness Meditation: Meditation practices cultivate present-moment awareness and calmness. Techniques like focusing on your breath or a mantra can help manage anxiety symptoms.
• Progressive Muscle Relaxation: This technique involves tensing and relaxing different muscle groups, promoting relaxation throughout the body and reducing overall tension. You might also want to imagine the word ‘relax’ when you relax your muscles and this can also help to stimulate the Parasympathetic Nervous System, or what can be called the ‘brake’ of the nervous system.

Healthy Lifestyle Habits:

• Regular Exercise: Physical activity is a powerful tool for managing anxiety. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
• Healthy Diet: Eating a balanced diet rich in whole foods can improve mood and energy levels, indirectly aiding anxiety management.
• Quality Sleep: Anxiety can disrupt sleep, and poor sleep can worsen anxiety. Develop healthy sleep hygiene habits for a consistent, restful sleep schedule. This means limiting screen time on your phone and ensuring that you do not scroll on your phone in bed.
• Limit Caffeine and Alcohol: These substances can exacerbate anxiety symptoms. Consider reducing or eliminating them from your diet. Additionally, if you still want to consume caffeine, try and have your last coffee around 3 or 4 pm in the afternoon.

Gradual Exposure:

• Create an Exposure Hierarchy: List situations that trigger anxiety, ranking them from least to most anxiety-provoking. This hierarchy becomes your roadmap for gradual exposure. They key here is to then work through them at a consistent pace.
• Start Small and Celebrate Successes: Begin with the least anxiety-provoking situation on your list. Celebrate even small successes, reinforcing your progress.
• Develop a Safety Plan: Having a safety plan for situations that trigger anxiety can provide a sense of control. This might involve relaxation techniques, having a trusted person on call, or carrying a comfort item.

Additional Tips:

• Reward Yourself: Positive reinforcement can be a powerful motivator. Celebrate your progress, big or small, with rewards you enjoy.
• Focus on Progress, Not Perfection: There will be setbacks, but setbacks are not failures. View them as learning opportunities and adjust your approach as needed.
• Be Patient with Yourself: Recovery takes time and effort. Celebrate your commitment to self-improvement and focus on gradual progress.

Remember:

• Professional Help is Essential: Self-management techniques are valuable tools, but professional therapy is crucial for long-term recovery. A therapist can provide personalized guidance, support, and address the underlying causes of agoraphobia.
• Seek Support When Needed: There’s no shame in seeking help. Don’t hesitate to reach out to your therapist, support system, or crisis hotlines if you feel overwhelmed.

By incorporating these self-management techniques, individuals with agoraphobia can empower themselves to manage their anxiety, reclaim their lives, and gradually return to the activities they once enjoyed. Remember, recovery may not be a linear process, but it is something that is achievable and within your means. It may take time in doing so, but whilst there may be setbacks, acknowledge them and continue with your plan. As they say, you may feel the fear, but do it anyway – in your therapeutic journey.

Ugh, that presentation’s looming like a social media notification you can’t escape. Your stomach’s churning like a washing machine on spin cycle, and your palms are slicker than a politician’s promises. Anxiety’s back, its unwelcome voice whispering worst-case scenarios in your ear. But hold on, there’s a secret weapon in your mental arsenal, and it doesn’t require lycra or a cape – it’s name is visualization.

Think of visualization as a mental gym for your brain. By conjuring up calming images and scenarios, you can transform your internal mental and physical environment, attuning it to a more positive place. It’s like training your brain to be a pro at handling anxiety-provoking situations by stimulating the parasympathetic nervous system. Here’s how it works:

• Evict the Worry Gremlins: Anxiety loves to play the role of the negativity troll in your head, whispering doubts and “what-ifs” like bad social media comments. Visualization tells those gremlins to hit the eject button. Instead of dwelling on those negative thoughts, rehearse the victory lap version. Picture yourself delivering a killer presentation, the audience hanging off your every word, erupting in laughter at your perfectly timed joke (because who doesn’t love a good chuckle?). By focusing on the positive, you crowd out those anxiety gremlins and replace them with empowering self-belief.

• Fast Track to Chill Town: Remember that epic weekend getaway where your stress dissolved away much like an ice cube on a hot day? Visualization lets you recreate that feeling. Close your eyes and transport yourself to your happy place. Feel the sand between your toes, hear the crashing waves (or the thumping bass at your go-to club), smell the salty air (or the aroma of freshly brewed coffee). Engage all your senses – it’s like a virtual vacation for your mind, washing away tension with each imaginary wave. The key here is to let your imagination go and really engage with it and what you like.

• Confidence Level: Boss Mode: Imagine yourself radiating the charisma of Beyonce with a dash of Steve McQueen’s coolness. Picture yourself calm, collected, and owning the situation like a total boss. The more you rehearse this inner image, the more it seeps into reality. Visualization strengthens your belief in yourself, making you feel like you can handle anything life throws your way. It’s like building a mental fortress of confidence that shields you from anxiety’s attacks.

Now, let’s get down to business. Here’s an exercise to unleash your visualization superpower:

Step 1: Identify Your Anxiety Kryptonite: What situation typically turns you into a nervous wreck? Public speaking? Job interviews? Hitting the dance floor? Everyone has their social anxiety triggers. Take a moment to identify yours.

Step 2: Craft Your Happy Place: Close your eyes and imagine a place that brings you ultimate peace and calm. Is it a secluded beach bathed in golden sunlight, a bustling music festival with your favourite band headlining, or maybe your childhood bedroom plastered with band posters that evoke happy memories? This is your personal happy escape pod. It can be real or imagined, the key is that it should be a place where you feel completely at ease.

Step 3: See Yourself Slayin’ It: Now, picture yourself absolutely crushing that anxiety-provoking situation within your happy place. See yourself delivering a presentation that would make TED Talk presenters jealous . Let yourself feel the positive emotions associated with success: confidence, excitement, and maybe a sprinkle of pride. The more vivid the visualization, the more impactful it will be.

Step 4: Feel the Shift: Pay attention to the physical sensations in your body as you visualize yourself acing the situation. Does your breathing slow down? Do your muscles relax? Imagine a wave of calmness washing over you with each successful visualization. This mind-body connection is key. By associating calmness with the positive scenario you’ve created, you’re training your body to respond the same way when faced with the actual situation.

Remember: Visualization is a practice, not a magic trick. The more you use it, the more it becomes your anxiety-busting best-friend. Think of it like building a mental muscle. The first few times you try it, it might feel awkward, but with consistent practice, visualization becomes a powerful tool for managing anxiety.

Here are some bonus tips to supercharge your visualization practice:

• Set the Mood: Dim the lights, light a scented candle, or put on some calming music. Creating a relaxing atmosphere will enhance your visualization experience.
• Engage All Your Senses: The more vivid your visualization, the more impactful it will be.

Agoraphobia, often misconstrued as a fear of open spaces, is a complex anxiety disorder characterized by a fear of situations that might cause panic or a feeling of being trapped. People with agoraphobia typically avoid places or situations they believe could trigger these anxieties, leading to significant limitations in daily life. Sometimes this can include a fear of travelling on trains, planes or on the underground. So – there is a significant life limiting element to agoraphobia.

Here, I delve into agoraphobia, explore techniques to manage it, and offer self-help strategies for those affected. Agoraphobia does not have to be a life sentences of limitations on your life and there are a variety of techniques that can help. The key is to use techniques that resonate with you, help to reduce stress, make you feel more able to go through the situation or event that triggers panic and anxiety and just do it.

Understanding the Roots of Fear

Agoraphobia often develops after experiencing panic attacks in specific situations. The fear of having another panic attack becomes associated with those places, leading to avoidance. For instance, someone who has a panic attack on a bus might begin fearing all public transportation. Agoraphobia can therefore go from a fear of one situation to a more complex web of fearing other modes of travel and it is therefore essential that people with agoraphobia choose to challenge their avoidance behaviours as early as possible after a panic causing event. The longer the agoraphobia is left unchallenged, the greater the ‘spread of fear’ into other parts of a person’s life.

Agoraphobia can also arise from a general fear of being out of control or without help. This can manifest as anxiety in crowded places, open spaces, or even being alone outside the home.

Breaking Free From Avoidance

The good news is that agoraphobia is highly treatable. Therapy, particularly cognitive-behavioral therapy (CBT), plays a crucial role and it is something that I use within my practice with clients. CBT helps identify and challenge negative thought patterns associated with feared situations. Through exposure therapy, a therapist guides the individual in gradually facing avoided situations in a safe and controlled environment. This allows for a sense of mastery and reduces the fear of panic attacks. Relaxation techniques like deep breathing and mindfulness meditation can also be helpful tools for managing anxiety.

Techniques for Supporters

As a friend, family member, or therapist, you can play a vital role in supporting someone with agoraphobia. Here are some ways to help:

• Educate Yourself: Learn about agoraphobia to better understand the challenges they face.
• Offer Patience and Empathy: Agoraphobia is not a character flaw. Be patient and supportive as they confront their fears.
• Validate Their Feelings: Acknowledge the legitimacy of their anxieties without reinforcing them.
• Encourage Professional Help: Gently suggest seeking therapy from a qualified mental health professional specializing in anxiety disorders.
• Be a Partner in Progress: Offer to accompany them on gradual exposures, starting with small, manageable situations. Celebrate their successes, no matter how small.
• Focus on Open Communication: Maintain open communication, allowing them to express their fears and concerns freely.

Taking Charge of Your Recovery

If you are struggling with agoraphobia, here are some self-help strategies you can employ:

• Educate Yourself: Knowledge is power. Learn about agoraphobia and understand the mechanisms of anxiety.
• Challenge Negative Thoughts: Identify and challenge negative thought patterns that fuel your anxieties.
• Practice Relaxation Techniques: Regularly practicing relaxation techniques like deep breathing and mindfulness meditation can equip you with tools to manage anxiety in the moment.
• Develop a Support System: Seek support from friends, family, or therapy groups.
• Set Realistic Goals: Start with small, achievable goals for exposure and gradually increase the difficulty as you gain confidence.
• Reward Yourself: Celebrate your achievements, no matter how small. This positive reinforcement strengthens your progress.
• Be Patient: Recovery takes time and effort. Be patient with yourself and celebrate every step forward.

Remember, agoraphobia doesn’t have to control your life. With the right support system, therapy, and self-help strategies, you can reclaim your freedom from anxiety and live a fulfilling life.

Let’s face it, panic attacks are rubbish. One minute you’re relaxing, the next you’re drowning in sweat, convinced your heart’s about to explode. If that’s happened to you, fear not! Panic attacks are super common, and there are ways to overcome them and to learn more about yourself through the process.

It is important to be aware that from negative events, positive learning can take place and taking this mental position is also important in the healing process.

What’s a Panic Attack Anyway?

Imagine your body’s alarm system going haywire. That’s basically a panic attack. Your heart races, you breathe like you’ve just sprinted a marathon, and your mind fills with terrifying thoughts. It’s horrible, but remember, it’s not dangerous. It is simply your body’s way of trying to keep you safe, with the threat (fight or flight) reactions being triggered. It is also important to remember that just because you may be having panic attacks, it is not a life sentence meaning that you will always have them. This is not the case and it may also be useful to mentally place the symptoms in the context of the specific time, place and space in which you are in. In other words. panic may be telling you that something is making you feel anxious and unsafe at that moment in your life. Exploring what that may be, is an important part of the therapeutic journey.

Calming the Panic: Top Tips

• Breathe Easy: Deep breaths are your best friend. Try the 4-4-6 technique: breathe in for 4 seconds, hold for 4, and exhale slowly (through pursed lips) for 6. Repeat until you feel calmer.
• Ground Yourself: Feeling disconnected? The “5-4-3-2-1” method can help. Name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.
• Focus on Facts: Panic attacks make you think the worst, but challenge those thoughts! Ask yourself, “Is this situation really life-threatening?” Chances are, it’s not.
• Find Your Mantra: Repeat a calming phrase like “This will pass” or “I am in control” to anchor yourself during an attack.
• Move Your Body: Light exercise can burn off adrenaline and ease anxious energy. Go for a walk, do some skipping, or dance like nobody’s watching (because, well, they probably aren’t).

Bonus Tip: Talk About It! Don’t bottle things up. Chat to a friend, family member, therapist or GP about what’s going on. Talking can be a huge weight off your shoulders. Talking also helps you to contextualise your experiences of having panic attacks.

Getting Long-Term Help

If panic attacks are a regular pain, therapy can be a game-changer. A therapist can help you understand your triggers and develop coping mechanisms. In the UK, you can talk to your GP about getting referred for Cognitive Behavioural Therapy (CBT) which is a great option for anxiety. As a therapist using CBT as part of my therapeutic practise, I’ve seen firsthand how effective it can be in helping people overcome panic attacks. CBT helps you identify negative thought patterns that contribute to anxiety and develop healthier ways of thinking. It also equips you with practical tools to manage panic attacks in the moment and reduce their frequency over time.

Remember: Panic attacks are rubbish, but they are not reflective of you or your self-worth. With the right tools and support, you can totally take back control. Lastly don’t be afraid to ask for help!

“I really think I can’t see the positive even though I know that I have good things in my life. My brain just goes to the negative and I think about problems that may be coming up. It seems that I am in a cycle”.

This was a client that I worked with some six months ago who voiced an issue that many people have. She was not clinically diagnosed with any condition and she was not on any medication. However, she said that at points she had low moods though they lifted the next day and she “got on with life”. Having asked about her medical and past social history of experiences, it was clear that this was an issue that was not impeding her life, but it was affecting her quality of life.

Many people sadly experience this type of thought process – a form of mental filtering towards the negative. It is nothing to be ashamed about and it is important to be able to voice such concerns with loved ones, or with counsellors and therapists, since shame, guilt and self-blame simply compound the issue and also add to low moods.

It is important to remember that our minds work in a certain way. They work from experiences that have happened to us, perceptions that we form over time, things that key people have said to us when we were growing up and patterns of behaviours that we exhibited early in our life as a way of ‘surviving’ or ‘fitting in’. In other words, our brains work on a daily basis through patterns that reflect these past events which have been tried and tested over time. The problem is that some of these thoughts and behaviours that we have become used and accustomed to, may not be helpful in later points in our lives. Allied to this is the fact that the limbic system which manages our long term memory, emotional and stress responses, is a key and integral ‘older’ part of our brain and has developed over millions of years to keep us safe. This also means that in keeping us safe, our brains naturally work in the background, much like an automatic virus checker in a computer, ensuring that we remain safe in a potentially unsafe world, where today there are different types of stressors.

Additionally, if we take on this perspective, our brains are therefore always subtly scanning for risk whilst we remain in the conscious world during the day. Therefore, if  someone has been through life experiences which may have been difficult or troubling, their brain may well have become hyper-sensitized to risk and thereby slants the individual towards looking at life through the lens of having to overcome obstacles or of another problem potentially coming round the corner. It is therefore understandable that my client had started to view life through that lens. It was also understandable that in thinking and feeling that there were obstacles that could come up and with these thoughts recurring in her mind, that her mood was affected. This form of mental filtering towards the negative, sometimes with catastrophising, is called a cognitive distortion.

There are a number of ways of reducing these cognitive distortions though they need time and a commitment from the individual who is affected. They need a form of positive mental and emotional self-investment, a realisation that a change in mindset can happen, is possible and achievable; that just because difficult situations happen, they do not need to be viewed as a catalogue of problems, or ‘another thing that goes bad in my life’. Difficult things happen, but life also throws up many joys in the day, with sometimes the smallest of things that can bring joy to us. It is about recognising this, embracing it, and really holding those small positive moments of joy, colour, vibrancy or company that we are blessed with. By doing so, this is also a form of acceptance, of resetting what is important to individuals and in raising their capacity to see joy and goodness in the world.

So what are the things that can help to reduce cognitive distortions like negative mental filtering? Firstly, stress reduction can really help. Anything that adds significant stress, such as smoking, drinking high quantities of coffee or caffeinated colas need to be reduced or ideally, removed from their lifestyle. Things like meditation and mindfulness can really help, by allowing the individual to have the space to realise that the brain is going through an old pattern that can be changed over time and that the person has ultimate control over this. Sometimes this basic awareness can help to reduce the strength of the emotions that may be thrown up by the negative thoughts, especially if they are self-deprecating.

Other things that can help include taking up exercise, building a circle of friends and ensuring that there is regular communication with them. This person to person connectivity is important for us as a species. Also, listing the pattern of negative thoughts and reasons and facts that challenge the negative thoughts and which resonate well with the individual, are another way of helping to chip away and reframe thinking over time. This also needs to be practised regularly. Positive visualisation can also help and this involves taking some 10-20 minutes out of the day to find a quiet space in which someone can close their eyes, and visualise a safe, warm and comfortable place that they have been to. It could be anywhere in the world that they have visited. Visualisation is another technique that helps in giving positive meaning and in strengthening positive feelings.

Lastly, therapy and counselling can really help and depending on commitment, people can see real benefits in a short period of time. Finally, it is important to remember that we are the drivers of change. This means that we can also change the way that we see the world externally, whilst also changing the way that we experience negative thoughts or feelings. We may not be able to wholly erase the latter, but therapy can certainly reduce the impact of them on daily life.

In my work with clients who have Obsessive Compulsive Disorder (OCD), there are many techniques that I use to help or assist them in their journey around understanding the condition that affects them.

In this article, I am going to look at some self-compassionate ways of thinking that can help to reduce the impacts of intrusive thoughts. I also need to point to the language that I am using and some people may use the term ‘countering negative thoughts’. This is potentially problematic in working with OCD since countering something gives the impression that it needs to be ‘challenged’ or ‘pushed back’ or countered as though there is some kind of mental ping pong between negative intrusive thoughts and positive counter-challenge thoughts. This simply may re-enforce or cycle the possibility of more intrusive thoughts affecting someone.

So the following positive cognitions are thoughts that can be placed into an acceptance framework, and internally repeated once or twice when an intrusive negative thought comes into mind. It is important not to get into a repetitive pattern of using the positive cognitions to ‘push away’ or to suppress negative intrusive thoughts and this feeds into the ‘thinking ping-pong’ that simply re-enforces and gives more weight to intrusive thoughts. Remember, it is the depth and weight of the meaning given to intrusive thoughts that makes them ‘sticky’ and impactful. This in turn generates a heightened state of anxiety that fuels ongoing OCD ruminations.

Also, when I speak of an ‘acceptance framework’, I am suggesting that people with OCD take time to accept that intrusive thoughts will come and go. Additionally, the general public all have  intrusive thoughts, though it is how quickly they disengage and move on from the thinking that separates people with OCD and those who don’t experience the condition. Accepting negative ruminations does not make the thoughts true or that they are part of your identity. They are simply thoughts and they will have a cycle of their own – they will come and go. It is how much weight, consideration and gravity an individual gives to them which fuels them. So, being an unresponsive to them as possible, will limit their hold on people.

So, here are some elements of positive ‘self-talk’ that can be used to undermine negative ruminatory thoughts. Again. they are to be repeated once or twice in relation to a specific negative rumination. Individuals should take the time to see which statements resonate within them and ensure that the negative rumination is allowed to come and pass, after the statements are repeated internally a few times. This means that individuals should in a way, retrain themselves in staying in the present and allowing any OCD related ruminations to fall away as they don’t give the thoughts credibility or strength by fearing the thoughts.

Positive Self-Thinking Statements

1. “It is ok, I recognise that this is part of my OCD and the thoughts will pass. They don’t reflect who I am”.
2. “I realise that the OCD is part of historical fears that I had and which are not relevant today. They are just resonances from history and ‘background noise’. I can switch off from them”.
3. “I know who I am and what my values are. My OCD thoughts do not reflect who I am and the core values of what I stand for”.
4. “OCD thoughts are the mirror opposite of my values. That is why I get anxious. This means that my core values are moral, open and value the world and people around me”.
5. “My brain is simply doing its thing and what it learnt it in the past. It does not mean that it is true, it is following an old pathway of thoughts”.
6. “Just because I think it, does not make it true. It simply means that there are thoughts that are not valid or true that I think of and which I can ultimately disengage from. They are not me”.

You may have heard of the word ‘cognitive defusion’ or come across it when reading something. Or someone may have used the term ‘cognitive defusion’ in a conversation because mental health is increasingly becoming a topic of real interest for many people.

The term comes from the third wave of Cognitive Behavioural therapies and Acceptance and Commitment Therapy is less about challenging and breaking down thoughts patterns in order to change them (classical CBT work), but more about accepting the thoughts, feelings, emotions and perceptions as they arise; accepting that they come and go, accepting that they may come back in the future, but that they will diminish, and accepting that you are ultimately in control of how much these thoughts diminish in the future by disengaging with them and reducing their energy. Any reduction in the ‘stickiness’ of ruminatory thoughts gives individuals the time to enjoy, engage with and be present within the moment.

Acceptance and Commitment Theory therefore includes the element of cognitive defusion within its structure as a tool that allows individuals to create some distance between the thoughts and their actions. In other words, creating the space so that the action can be adapted and amended from previous ones which re-enforced the initial negative belief or troubling thoughts and feelings.

It is also important to stress that cognitive defusion is a tool that can be practised on feelings and bodily sensations. So, for example, some people with anxiety and OCD may feel muscle tightening in their bodies associated with specific ruminatory thoughts or they may tense and twitch certain muscles. In this instance, cognitive defusion means disengaging from tensing muscles so that ruminatory thoughts do not continue to elicit actual physical reactions which add further weight to the ruminatory process.

Cognitive defusion therefore means what ‘it says on the tin’. This is about disengaging, mentally ‘stepping back’ and having the mental capacity to change previous actions and in doing so, to change the outcome of negative or ruminatory thoughts on your mood and general well-being. So, ultimately, this is about using cognitive defusion to change the lens and the filter through which you may view yourself, the wider world or the people around you.

For some, using the tool of cognitive defusion has been life-changing, and underpinning this process is the following premise; that you are not your thoughts. They are a stimulus, learnt reactions to the past and from what may have  happened to you or how you may have mentally reacted to events in the past and they do not reflect the here and now, the present. Therefore, ruminatory or negative thoughts are symptoms of impacts and events that happened in the past and the automatic replaying of such thoughts does not do justice to the present and also leads people away from the values that matter to them and how they want to lead their lives.

So let us take the example of someone who has consistent ruminations that they are a ‘bad’ person. This leads to their disengagement from social discussions and withdrawal from the present moment, so they become quiet. The action of ‘being quiet’, sustains the heavy meaning of the thought and re-enforces the whole cycle. Cognitive defusion is about training yourself to accept that the thought happens, understanding that it is just a thought and that it will pass, and then making an active decision to carry on with a discussion that adds value to your day and keeps you anchored in the present.

So, what can we do to weaken and move away from the mental filter that funnels us into engagement and mental fusion with negative and ruminatory thoughts. Well, we can:

• Notice and be aware of the thought. If the thought is ‘I am bad’, then give it a name, sometimes humour works and takes the energy and oxygen out of the thought or alternatively saying, “here comes my usual thought that I am bad”, just minimises it.
• Sometimes saying the thought also takes its energy away rather than maintaining its internal pull. So, you may want to say the statement, ‘Bad’ repeatedly for about 30 seconds and notice how the word starts to become meaningless and that it is just a sound and a word.
• Remember that our minds are attuned to look at things through somewhat of a negative lens or risk funnel so that it can protect us. This behaviour has not changed and evolved from the millions of years that we have been on this earth and when we were at risk from dangerous animals on the savannahs. Our minds therefore naturally look at risk as a precautionary mechanism to protect us and in its own way, is trying to keep us safe. It is important to reflect and recognise this.
• Remember that whist you may have thoughts that highlight risk or threats to you, you are not inherently ‘different’ to many people. The key is being aware, giving yourself space to reflect to disengage from the thought and then carrying on with your engagement with the present moment.
• Anything that takes the energy out of fusing with the thought is positive. So, saying a word repeatedly that shows you that it is just a noise, a word and that it actually has no meaning without you, is one tool that you can use.
• Finally, remember that the thought will pass. The less you engage with it through cognitive defusion, the quicker it will diminish and the stronger you will feel rooted in the present moment.

Post Traumatic Stress Disorder or PTSD is a disorder that is caused by internal bodily and emotional reactions to stress situations which seem overwhelming for an individual. The threshold of what seems ‘overwhelming’ is different for each person and depends on a range of factors, including their biochemical make-up, their experiential history, their genetics and how they interpret stress. For some, stress is energising and seen through the lens of having some benefits for performance, whilst for others it is anxiety inducing and with corresponding negative impacts on their health and well-being. For those negatively affected by stress, it has the ability to narrow and limit the mental bandwith and the focus of those affected, creating the possibility of ruminatory thoughts, a sharpened and heightened focus on catastrophic thoughts and hyper-accelerated thoughts about the future or the past that focus on danger and risk. Allied to this comes a disconnection or detachment with the self and a focus on mentalisation over time. In other words, people ‘withdraw’ into their heads.

I have worked with clients who have had PTSD reactions because of accidents, the death of close family members, the loss of their careers and also from negative press articles being written about them. It is the sense of profound shock and loss, the sense of disconnection with something that is important in their lives, followed by the associated catastrophic thoughts because of the shock event which echo in PTSD related events.

So, for example, some people who have had negative press stories about them firstly ruminate about the story and then can go into a state of detachment and ‘shut down’, or they can become hyper-anxious and intensely worried about their future, their reputations, income and the way that they will be perceived. The brain enters a stage of trying to reflect on the risk, though given the overwhelming nature of the shock, people entering this stage of shock feel a sense of narrow focus on the catastrophe ahead, rather than being able to step back and assess the reality of the risk to them. With this narrowing of focus, comes the ‘overwhelm’, the feeling and sense that what is happening to them is insurmountable.

Take the example of someone waking up to find a major news story breaking about them. They may enter into three potential states, the ‘fight, flight or freeze’ reactions. In other words they can go into a state of detachment and just sit for hours or lie down. This can be associated with wanting to sleep and with the desire to stay in bed in order to detach oneself from what has happened. Other individuals may become angry, energised with adrenaline and stress hormones and react to the story with some form of action. Others may seek to ‘pigeon-hole’ what is taking place, that they don’t really want to address it and that they find other tasks to do, minimising its impacts. Either way, feelings of overwhelm, catastrophic and ‘black and white’ thinking do creep in and slowly deplete the body’s capacity to sustain itself during this crisis, which further adds to the cycle of negative and catastrophic thinking.

It is therefore essential at times like this to undertake simple activities like walking, breathing exercises, the use of critical thinking and in realising that the body may be reverting to the patterns I have highlighted. It is also important to carry out an activity that can reduce the stress hormones and the adrenaline that becomes raised within the body and to keep connections with loved ones. We must not underestimate how important personal connections are at this time and how much these can support the rebalancing of our sympathetic nervous system that goes into overdrive when there are traumatising situations that affect us. Additionally, cold water therapy has become a form of therapy that many say helps them to overcome PTSD over time and it helps in activating the parasympathetic nervous system. This is the body’s brake system on many organs in the nervous system.

It is important for people who have suffered such traumatic incidents to seek therapeutic help and assistance and to be able to work through these high stress events. This allows them to reflect and to introduce alternative behaviour patterns that can disrupt PTSD symptoms and allow them to feel that they are resilient and able to cope. This is absolutely key to the healing process.

People with social anxiety can really benefit from counselling and therapy with the right therapist; someone that they can feel connected to and who empathises, supports, informs and accepts.

Social anxiety affects people in a wide variety of ways. Firstly, it affects the confidence of the individual involved, and its affects their belief that they can engage with people on an ongoing basis, whether that be on a personal or group level. It also affects ‘connectedness’ something that we know which maintains anxiety and which impacts on self-esteem. Social anxiety can also strengthen and maintain a core belief of feeling and ‘being weak’, of being ‘unable to cope’ and in supporting associated thoughts that the ‘world is not safe’ and is threatening. In other words, there are many maintaining factors for such fears and these include safety behaviours such as avoidance of going to small, medium or large social events, sitting near the exits in theatres and cinemas so that people feel that they can exit the room quickly if they need to and in meeting people only on a one to one basis. Sometimes this can mean repeatedly meeting only ‘safe’ people – people who they deem make them feel safe and assist them if they have a panic attack or any other perceived future catastrophic event.

We know from a variety of research reports and pieces of social research evidence that such safety behaviours maintain and keep social anxiety going. They also maintain the strength of fearful thoughts around social engagement, and they re-enforce the depth of feelings associated with the thoughts. It is therefore essential that counsellors and therapists work on getting clients to understand their safety behaviours, the core beliefs that they have carried with them and never really challenged and the associated thoughts that have developed like a web from the core beliefs. In doing this work, it allows clients to see what is at the root of their thinking and how fearful thoughts connect with each other and the types of safety behaviour that they are undertaking which are maintaining the social anxiety.

There are two other core pieces of work that counsellors must undertake and these include gentle exposure work with the individual. This is work that slowly and surely builds their trust in their capability, resilience and ability to cope with stressful and anxiety causing conditions. The other piece of work includes psycho-educational work around how and why the anxiety may have developed during early childhood and what trauma and experiential impacts exacerbated anxiety reactions. This is also essential in giving the client an understanding of the history of the issue that roots and centres them in gaining control over the issue through a personal reflection of why the social anxiety may have developed.