This week I was on a call with a very special friend, the talented illustrator of Arabella and the Worry Cloud (our kids book on anxiety)- Shelley. I was speaking to her about the challenges of being a self-employed independent writer- financial and as a founder, everything being on you. She told me to believe in myself and my writing and not give up! Those kind words have meant everything during a challenging time.
Then, today, I decided to pick an affirmation from my flip chart (that another lovely friend had got me for my birthday) without looking. I flipped the chart over and not only does it have pink roses (a special flower to me that is a positive sign I asked for) but I received the message,
‘The greatest things take time so never give up.’
And so, even though being a writer, a creative can be exhausting when you aren’t famous with lots of money coming in- I remember why I wrote Arabella, the children I wrote for and who need to hear its message. And because I have had this message twice this week, I will not give up. On my writing, on my journey through life and its ups and downs. I won’t give up on my first book either.
Most people first meet cognitive behavioural therapy as a single sentence. CBT, the sentence goes, is about challenging negative thoughts. True, in the way that a driving lesson is about pressing pedals. I am a CBT therapist, so I have an obvious bias here. I also know it does not suit everybody, and it is not the only route out of anxiety. What I can do is tell you what the work actually looks like from the inside, week by week, so that if you are weighing it up you know what you would be signing up for.
Before the first session: what you want to be different ?
Therapy starts with a goal, and “I want to stop feeling anxious” is not a workable one. Anxiety is not the enemy. It is your body doing something it evolved to do, and nobody switches it off for good. The useful question is smaller and more concrete. What is the anxiety stopping you doing? Where does it show up in a normal week? Then we make the target a behaviour rather than a feeling. Getting back on the train. Going to the meal without rehearsing an exit. Speaking in the meeting without scripting it twice in the shower first. Feelings are the last thing to move. Behaviour moves first.
Session one: the map, not the lecture
A first session is not a taught lecture on the cognitive model. I ask for one recent moment when the anxiety turned up, and I ask for it in detail. Where were you? Who else was there? What went through your mind, in the words it actually used? What did you do? What did your body do? Then we draw that single episode out on paper together. It still surprises me how much of the whole difficulty is already sitting inside one moment. Nothing is general and nothing is theoretical, which matters, because vague questions get vague answers, and vague answers change nothing.
Sessions two to four: the part people don’t expect
Popular writing talks almost entirely about thoughts, because thoughts are the easiest corner to describe. But the cognitive model has three corners, and the corner that keeps anxiety topped up is behaviour. Safety behaviours are the ones I mean. They rarely look dramatic. Arriving early so you can pick a seat near the door. Checking the route three times. Preparing a story in case anyone asks what you do. Taking one drink to take the edge off. These are sensible, understandable things to do, and they work in the short term, which is exactly the trap. Every time you get through something with the crutch, you learn nothing about what would have happened without it. The frightening prediction never gets tested, so it never has to face the evidence. Safe, and stuck.That is why the beginning of the work often looks like doing, not thinking. It is the harder place to start and it is the reason the rest of it holds together.
The middle sessions: exposure, built like a ladder
If there is one active ingredient in CBT for anxiety, it is exposure. That means approaching what you are afraid of, on purpose, in a planned and graded way. It does not mean gritting your teeth and flooding yourself until something breaks. Think of a ladder. The bottom rung should feel uncomfortable, and only mildly so. Take someone frightened of driving on motorways. They do not begin by joining the M25 motorway at rush hour. They sit in the parked car and imagine the drive. Then they ride along as a passenger. Then they drive a short stretch of dual carriageway at a quiet time of day. Then further, at a busier time. Every step has to be uncomfortable enough to count and small enough that it actually gets done, and calibrating that is where most of the clinical judgement lives, because too small means nothing is learned and too big means the person is set up to fail, which teaches them something worse than they started with. Safety behaviours come out of the plan deliberately, one or two at a time, not all at once. Ladders, not leaps. That is the bit people are surprised by.
Later sessions: the therapist does less
A good course of therapy should make itself unnecessary. The aim is not to feel better for one hour a week, it is to leave with a method you can run on your own. By the later sessions I am deliberately doing less and the client is doing more. They set their own tasks. They spot their own unhelpful predictions, in their own words, before I have noticed them. When that starts happening, the work is nearly finished, and the last session feels less like an ending than a handover. Part of that handover is a relapse plan, written down, because anxiety does come back at stressful points. Coming back is not failure. It is weather. When it doesn’t work CBT is a doing therapy. Most of the change happens between sessions, and that means it asks something of you at a point when you are already tired.
That is a real cost and it is worth knowing before you start. It is also not the right shape of help for everyone, and it is not the right time for everyone. If the main difficulty is grief that has not been given room, or a trauma that is still too raw to approach, or a situation that is genuinely unsafe rather than misread, then the work needs to be something else first. A poor fit with the therapist does the same damage. You can do everything asked of you and get nowhere if the person in the room is not the person you can talk to.
Having CBT once and finding it didn’t help is not evidence about you. It may have been the wrong moment, the wrong shape of support, or a room where you couldn’t be honest. All three are fixable.
What to ask before you see a therapist
Four questions, and the answers tell you a lot.
How much will I be expected to do between sessions, and what does that look like in a normal week?
What would you be working on with my particular problem, specifically?
How will we both know it is working, and what happens if it isn’t?
And do they have a fixed number of sessions in mind before they have actually met you, which is the one that should make you cautious, because the work takes the time it takes.
Anxiety responds to evidence gathered in your own life, not to being told to relax. That is the whole idea. It is slower than people expect and more ordinary, and it works. Guidance for generalised anxiety usually puts a course at around 12 to 15 weekly sessions of an hour, so a number in that range is a fair planning figure. It is not a promise, and no one should be making promises before they have met you.
Peter Klein is a CBT therapist who works with anxiety and OCD, in person in Richmond, UK and through online CBT therapy across the UK.
The intrusive thoughts. The compulsions. The shame. The reality of living with OCD.
“It’s not about having all the answers. It’s about making you feel less alone.”
Rose Ellen Dix, one half of YouTube couple Rose & Rosie, is getting more personal than ever in RoseCD, a new podcast exploring her lifelong experience of living with Obsessive Compulsive Disorder (OCD).
Rose has lived with OCD throughout her life and was diagnosed aged 17. She is now exploring her experience of the condition in depth through RoseCD, sharing what it feels like to live with OCD in her own words, with honesty, humour and warmth. Now, in her first podcast dedicated entirely to her own experience, she is talking openly about the parts of OCD that are often misunderstood or left unsaid — from intrusive thoughts and compulsions to health anxiety, shame, perfectionism, panic spirals and the impact it can have on relationships.
RoseCD is a ten-episode first season .The podcast is entirely self-produced by Rose, with episodes based on her own lived experience rather than a clinical or expert perspective.
“I live with OCD. Not as an expert and not as a clinician. As someone who’s spent almost twenty years trying to understand their own brain. RoseCD isn’t about teaching people what OCD is. It’s about showing them what it feels like.”
“I wanted to make something that I would have wanted when I was younger — something that made me feel less weird, less ashamed and less alone,” says Rose. “OCD can make you think you’re the only person in the world having a particular thought. Sometimes just hearing someone else say, ‘I’ve thought that too,’ can make a huge difference.”
Rose says the aim is simple: to talk honestly about what OCD actually feels like from the inside, share what she has learned about living with it, and create a space where people can recognise thoughts they may have been too frightened, embarrassed or ashamed to say out loud.
RoseCD is available on Spotify and digital platforms. If you have been affected by anything discussed in this release, Samaritans are available free, day or night, on 116 123.
Living with bipolar 1 from the age of 16 meant living with deep depressions, of which suicidal thoughts were a part. Being able to safely share these with family and psychiatrists in the past saved my life and helped me hold on in the dark moments of bipolar episodes. I am not alone in feeling this way- millions are struggling now, today. Medication, therapy and support keep me well.
So today I read from my essay in this very special book to tell you- ‘You will feel the sun and smell the rain again, even after suicidal depressions when you lay in bed wanting to disappear. ‘
Please reach for help when you start getting these thoughts and hold on- a better day is coming. Helpline numbers includingSamaritans at 116 123 are available if you need to talk and feel in crisis.
I also know the devastation of losing a loved one to suicide and conversely, to help people through these thoughts. Their stories are not my own so I am not sharing them today but I hope that today and every day we focus on suicide prevention and support for all who are struggling.
Shana Tova U’Metuka, a happy and sweet new Jewish year to everyone celebrating and marking Rosh Hashana this weekend. Rosh Hashana is an important Jewish festival where we gather with family and friends, pray at synagogue or home and reflect on our relationship with G-d and what we need to change in the coming year ahead. It’s also time to ask for things, to dream and to plan- oh and to eat honey cake or apple and honey for a sweet year too!
This year has had many blessings but also many difficult moments that I will reveal at the right time. So, I pray for a happy, healthy, sweet, prosperous, joyous New Year with all dreams manifesting if meant to be. I am grateful to still be running this blog after a decade and to be able to share my thoughts and emotions here. I am grateful for all my blessings- 2016 me who set up this blog would not quite have believed what happened in the past 10 years!
Thank you all for reading this blog and for supporting it. We are here to help people feel less alone, to promote recovery and healing and good treatment for all who live with mental illness or are in remission from episodes.
If you are struggling with your mental health this Rosh Hashana (or feeling at risk of harm)-to save your life, please reach out to mental health services or helplines like Samaritans (116 123)
Many people die every day and every hour from suicide in the UK and globally. 7000 lives lost a year on average in the UK to suicide and 75% of these are men according to research by CALM charity.
Taking their own lives is often the only way they can see to end their own deep pain and suffering- whether as a result of trauma, mental health issues and life circumstances (abuse, addiction, divorce, parenting struggles being just a few).
If you feel suicidal or very low, please tell a trusted person or if in the UK call Samaritans on 116 123.
If you’ve ever tried to get mental health support, you’ll know that it can feel like watching a game of ping-pong. You call one service, and they refer you to another. They point you to a helpline, which suggests a group. And at the end of it all is the bottom of a waiting list.
There’s a big shortage of mental health support out there. Whether you’re one of the millions struggling with a severe mental health illness, or simply going through a difficult time in your life, it’s never been harder to find care.
It’s not good enough, and everyone deserves access to the support they need – whether that’s a therapist, a diagnosis, a helpline, a support group.
But the truth is that no service, however good, can give us everything we need, all of the time. The toughest moments in life don’t wait for a therapy appointment. There will always be moments where you’re on your own with it.
That gap is what I built Tough Minds for.
Tough Minds is a completely free, online toolkit to help you go from a difficult moment into a lighter one. There are breathing exercises, guided meditations, an urge-surfing timer, and calming soundscapes to help you relax or decompress.
These are exactly the sort of exercises that a therapist or counsellor might recommend you try – but the ones that are so hard to remember at 2am when you’re in a crisis, or when you’re trying to fight off a difficult urge, or when you just need five minutes to breathe before a job interview.
That’s why Tough Minds has no sign-up, no app to download, nothing to pay for, no ads. Whenever you need it, you can just go to Tough Minds.
(image: Mediensturmer: Unsplash)
Building emotional resilience
Those in-the-moment tools are only half of the reason I created Tough Minds. The other half is about building the underlying skills that can make those difficult moments less frequent and less severe.
We are less likely to be taught how to look after our mental health in school – and that’s a problem. We only ever learn how to look after our minds once we hit a crisis point – which is a bit like taking your first driving lesson when you’re already halfway round the M25 (UK motorway).
It doesn’t have to work that way.
Building Emotional Resilience
Tough Minds also has tools, games and exercises to help you build emotional resilience – the sort of skills you might learn in therapy. There are skills that help people manage emotionally difficult moments and even help with some mental illnesses. Skills like having a wide vocabulary for your own emotions, or knowing how to catch and reframe a spiralling thought before it takes hold.
These are skills like any other – they can be built so they’re there when you need them. That’s the part of Tough Minds I’m most excited to keep building: to improve and steady mental health.
None of this is about pretending that a website or an app can do the job of real support services, or the human-to-human support that so many of us benefit from.
However, what Tough Minds can do is help all of us take care of ourselves. Not instead of support, but around it: when you’re on a waiting list, the days between sessions, the stretch of life after a course of treatment ends, and for the times life is just a little hard.
If that sounds useful to you, you can find Tough Minds at toughminds.org. It’s free, and it’s there whenever you need it.
Thanks so much to Anuj at the team at FeedSpot for listing this blog number 12 out of 30 Best Bipolar Disorder Blogs to follow on the internet here ! Delighted to be nominated amongst many wonderful blogs.
Feedspot is an RSS Reader that lets you subscribe to blogs, news sites, and any website you want to keep up with.
Stress is a normal part of life, but when it becomes persistent or overwhelming, it can have a significant impact on emotional wellbeing, physical health, relationships, and overall quality of life. Many people experience periods of increased stress due to work responsibilities, family obligations, financial concerns, health issues, or major life changes. While occasional stress is expected, chronic stress and anxiety can gradually interfere with daily functioning and make even simple tasks feel difficult.
One of the most common signs that stress is becoming problematic is when it begins affecting sleep. People may struggle to fall asleep, wake frequently throughout the night, or wake up feeling exhausted despite getting several hours of rest. Poor sleep often contributes to increased irritability, difficulty concentrating, memory problems, and reduced productivity during the day. Over time, this cycle can become difficult to break without addressing the underlying causes.
Anxiety can also present itself in many different ways. Some individuals experience constant worrying or racing thoughts that are difficult to control. Others notice physical symptoms such as muscle tension, headaches, rapid heartbeat, stomach discomfort, sweating, or feelings of restlessness. These physical symptoms are real and can significantly impact daily life, even when there is no immediate danger or threat present.
Another important sign of ongoing anxiety is avoiding situations that once felt comfortable. Someone may begin declining social invitations, avoiding public places, postponing important decisions, or putting off responsibilities because they feel overwhelmed. While avoidance may provide temporary relief, it often strengthens anxiety over time and makes returning to normal activities increasingly difficult.
Stress and anxiety frequently affect workplace performance as well. Individuals may find themselves struggling to stay focused during meetings, completing projects more slowly than usual, or feeling mentally exhausted by routine responsibilities. Decision-making may become more difficult, and confidence can gradually decrease. These challenges are common and should not be viewed as personal weaknesses but rather as potential indicators that additional support could be beneficial.
Relationships can also be impacted. Increased stress may cause someone to become more withdrawn, impatient, or emotionally reactive. Misunderstandings with spouses, family members, friends, or coworkers may occur more frequently. Loved ones often notice changes in mood before the individual fully recognizes them. Open communication and early intervention can help prevent these difficulties from becoming more serious.
(image: Unsplash)
Healthy coping strategies play an important role in managing everyday stress. Regular physical activity has consistently been shown to improve mood and reduce anxiety symptoms by releasing natural chemicals that promote emotional well-being. Even moderate activities such as walking, cycling, or yoga can provide meaningful benefits when performed consistently.
Maintaining healthy sleep habits is equally important. Going to bed and waking up at consistent times, limiting caffeine later in the day, reducing screen time before bedtime, and creating a relaxing evening routine may improve sleep quality. Nutrition also contributes to mental wellness, as balanced meals help support stable energy levels and brain function throughout the day.
Mindfulness techniques, deep breathing exercises, meditation, and progressive muscle relaxation can help reduce the body’s stress response. Many individuals also benefit from journaling, spending time outdoors, engaging in hobbies, or maintaining meaningful social connections with supportive friends and family members.
However, self care alone is not always enough. When symptoms persist for several weeks, interfere with work or relationships, or significantly reduce quality of life, speaking with a qualified mental health professional can be an important next step. A comprehensive psychiatric evaluation helps identify contributing factors and allows treatment recommendations to be tailored to each individual’s unique circumstances.
Modern psychiatric care often includes a combination of approaches. Depending on a person’s needs, treatment may involve psychotherapy, medication management, lifestyle recommendations, or collaboration with therapists and primary care physicians. Every treatment plan should be individualized, with ongoing monitoring to ensure that progress continues and adjustments are made when necessary.
Seeking help early can often prevent symptoms from becoming more severe. Mental health conditions are highly treatable, and many individuals experience substantial improvement with appropriate care. Reaching out for professional guidance demonstrates strength and a commitment to long-term health rather than weakness.
If you or someone you care about has been struggling with persistent anxiety, chronic stress, mood changes, difficulty sleeping, or emotional challenges that interfere with daily life, consulting aCarmel IN psychiatrist can provide valuable guidance, accurate diagnosis, and personalised treatment options designed to help restore emotional wellness and improve overall quality of life.
One year and a half after my bipolar 1 diagnosis and after a hospitalisation.
On holiday with friends in Spain and already on medication to stabilise my mental health. So many children now are on waiting lists for NHS CAMHS to even get to see a psychiatrist.
It is my hope and prayer that the government fund mental health services and improve access to healthcare. Or people will die from suicide or become hugely unwell.
I support the work of Mind and Rethink Mental Illness in highlighting and campaigning for this.
I was in the Priory North London adolescent unit in 2004 which was funded by the NHS and I had so much help after a mixed bipolar episode became psychosis. The psychiatrists were so caring.
We need more support for the next generation. Please to the UK government- fund CAMHS NHS services!
