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When I was 21 years old I started a 6 month placement on an acute mental health ward. I was inspired and enchanted by many of the people I met.

The ward manager

When I first arrived on the ward I was approached by a smartly dressed man who shook my hand and welcomed me on to the ward. He introduced himself as the ward manager and told me I could contact him if I had any questions or concerns. He seemed to know a lot about the place but his lack of an ID badge concerned me. He must have seen me looking for it because he explained that he lost his ID and they were sending out a new one.

Once he said goodbye and started to walk across the ward, I approached another member of staff to check whether he was actually manager. They explained that he was a patient with schizophrenia who had been on the ward for about a year and often had delusions of grandeur; some days he was God but most of the time he believed he was the ward manager. The staff always let him know when someone new was arriving so he could greet them. It was their version of an initiation process and thankfully I had passed.

The catatonic man

A young man was admitted to the ward in a catatonic state. He appeared to be unable to move, eat, talk or respond in any way. He was immediately put onto medication and a nutritional supplement. Staff regularly tried to engage him in conversation and support him with basic tasks, but there was little progress until they took him to the Creative Group.

The group involved drawing and painting while listening to music. Within a few minutes of being there the catatonic man began to respond to the music. His hand was tapping along to the beat and his head began to move too. With each session he responded more and more to the music, until he was moving most of his body and making eye contact with others.

At the same time his engagement outside of the group began to improve and he began to eat with support from staff. He occasionally had lapses, where he would return to his catatonic state, but on the whole he seemed to be doing well. He even got up to say goodbye to me when I finished my placement on the ward.

The football father

This was one of the first patients I noticed when I started working on the ward because of his unusual appearance. He was walking around in the garden area with about nine balls tied to his waist. They were all of varying sizes and in stretchy fabric bags, which hung down to his ankles.

When I asked the other staff about him they explained that he thought the balls were his babies and carried them with him all the time. You could always tell how ill he was by how many balls he was carrying. The bigger they got, the more concerned people became.

Towards the end of my placement I went into the garden to say goodbye to everyone and I noticed him walking around with just one football under his arm. The rest of the balls were gone and I felt relieved to know that he was making progress in his recovery.

The expectant mother

There was a woman on the ward who was several months pregnant and experiencing Puerperal Psychosis. This mostly presented in the form of paranoid delusions; she believed that people were trying to kill her.

Her medication had to be carefully monitored because of her pregnancy and she was kept under close observation to make sure that she was safe.

After about a month it emerged that the expectant mother had been forced into marriage by her aunts and that her relationship with her partner might be abusive. Staff therefore had a difficult time trying to determine which of her reports were the result of her paranoid delusions and which were actually true.

The safety of the expectant mother and her baby were discussed at great length in safeguarding meetings, involving staff from all disciplines. It was decided that she would be sent to a mother and baby unit when the baby was born, so that staff could monitor her condition, her ability to care for the baby and her relationship with her partner.

The expectant mother eventually gave birth to a baby boy. I was on duty at the time and supported her through part of the labour; this was difficult because at times her psychosis was so bad that she didn’t even realise she was pregnant. It was hard to convince her to stay in bed.

After the birth she was transferred from the acute mental health ward to the mother and baby unit. I worked a few shifts at the new unit about a month later and was pleased to see her progress. Although there were still some concerns about the nature of her relationship with her partner, she was no longer experiencing delusions and was being supported by staff to care for the baby.

The messiah

We had a very charismatic patient on the ward, who always dressed in white clothes and wore a white band around his head. He believed that he was the messiah of all the religions and went out of his way to preach to people and spread his story.

He also believed that his ex-girlfriend’s dad had implanted a device in his head, which he desperately wanted removed. He explained that he got nose bleeds a lot and that this was a side effect of the device.

One day he met two other people on the ward, who also believed that they were the Messiah. It was interesting to listen to them talk together and express surprise towards each other. After the conversation I approached him to find out if talking to the others had made him question his delusion. He simply stated ‘those other people are crazy….they all think they’re me’.

One of my favourite memories of him is when he got out his guitar and played songs in the corridor to cheer up all of the patients. Several of them joined in singing and I could tell that it was the highlight of their day.

The smoking woman

There was a small elderly woman on the ward who had been admitted because she was having a manic episode. Apparently she had spent thousands of pounds within a few days and had been smoking over 100 cigarettes in a day. She ended up collapsing on the ward after a few days because she was having difficulty breathing.

Whilst on the ward, staff encouraged her to ration her cigarettes and monitored her physical health closely. Staff also kept her credit card in the safe and supervised her when using it, because otherwise other patients would take advantage of her generosity.

After a couple of weeks her manic episode appeared to subside and she became fairly depressed. She was put on to medication to help improve and stabilise her mood and then discharged. Whilst in the community she was monitored by the Home Treatment Team and her family. Thankfully they were very supportive and kept staff informed whenever her behaviour changed.

The evil man

There was an elderly patient on the ward who used to spend most of the day in bed. He rarely spoke during the day apart from a few whispered replies. However, around 8pm every day he would start to come out of his room and approach staff. Each time he would say over and over ‘I am evil, I am evil, I am evil’. Staff would reassure him that he was a good man and then usher him back to bed. Within about 5 minutes he would be back again, saying the same thing. Sometimes it would last until the early hours of the morning. Staff tried on several occasions to determine why he thought he was evil but he never elaborated on his statement.

The Psychiatrists were continually debating his condition and whether he might have a form of dementia. By the time I left the ward they were transferring him to an older adult ward.

The homeless woman

There was a young homeless woman on the ward who had been diagnosed with Personality Disorder. She was very friendly towards me and we developed a good therapeutic relationship. However I soon realised that she was prone to ‘splitting’; she would tell each member of staff that they were her favourite and that all the other staff were mean to her, which had the effect of dividing up the team.

She also had difficulty regulating her emotions and could become very distressed over things that other people might consider insignificant. It was like she was in constant crisis and providing her with continued reassurance was sometimes very draining for staff.

On one occasion she found out that she had been prescribed medication in tablet form, rather than the liquid form she preferred. Before staff could contact the doctor to have it changed, she stormed off, shouting that she was going to leave the ward and kill herself. I followed her and attempted to calm her down but she became more and more upset. She eventually pulled out a razor blade, which she had been hiding in her bra, and started slashing her arms in front of me. She threatened to cut me if I tried to take the blade away from her.

I eventually managed to calm her down and convince her to drop the blade. She was then supported in cleaning and bandaging her arms. Staff also checked to make sure that the other patients who had witnessed the event were ok.

The next day she approached me and acted as if nothing had happened. She was very friendly and eager to talk about the possibility of her getting a house soon. Sadly, each time she was offered housing she seemed to sabotage it in some way, either by doing something self-destructive to extend her hospital stay or by finding a fault with the housing that was offered.

Staff explained to me that she had spent most of her life on mental health wards and tried to get herself readmitted herself whenever she was discharged. It seemed like an endless cycle. I felt very sad for her and longed for her to find some stability and a life outside of the ward.

The paranoid man

There was a man on the ward who had been diagnosed with manic depressive disorder. He would go through periods of deep depression and then periods of being exceptionally friendly and talkative. He would happily discuss his past and theories about the future for hours on end. After a couple of months he was stabilised on his medication and discharged into the community.

Sadly, he returned 3 weeks later; he’d had a relapse after stopping his medication. This time he appeared to be very paranoid. He was well kept and dressed in a suit but struggling to stand or even maintain a conversation. His wife explained that he was on hunger strike as a protest because he felt that the government were watching him.

Staff repeatedly tried to convince him to eat but he refused. Sadly staff couldn’t force him to eat because he was assessed and found to have the capacity to make the decision as he understood the risks associated with his behaviour. He was able to retain all the relevant information, weigh it up, make a decision and communicate it.

All staff could do was continue to encourage him and monitor his blood pressure, pulse and other physical observations several times a day. He was eventually stabilised on his medication again and released from the ward in time to see the birth of his daughter.

The rainbow woman

Towards the end of my placement, a woman arrived with rainbow threaded dreads and a walking stick. She explained to me that she had difficulty walking after jumping off an 8 storey building. Apparently she’d had several reconstructive surgeries to put her organs back in the right place but there were still issues.

Initially she appeared to be very friendly and co-operative but over time she started to become resistant to being on the ward. She resented being watched by staff and not being able to smoke indoors. She frequently barricaded the door of her room at night by moving her cupboard in front of it.

She had been suicidal for years and stated very clearly to staff that she would attempt to kill herself again if she was released from hospital. She was therefore still on the ward when I finished my placement.

The man who proposed

There was a man on the ward who had been diagnosed with manic depressive disorder. He was very friendly and talked excessively, to the point where it was hard to interrupt him when you needed to leave. He would ask the same questions over and over and didn’t seem to notice when he invaded other people’s personal space.

At one point he was having a particularly bad episode and decided that the wanted to marry me. He repeatedly proposed even though I explained that it was inappropriate. I reported the issue to my supervisor and tried my best to keep my distance. He then switched to threatening to kill me and would hold his hand near me in the shape of a gun. I didn’t believe he actually posed any risk to me but I had to spend most of my shifts on the female section of the ward or in the staff office just in case. It lasted about 3 days and then he went back to his usual friendly self.

After 4 months of group sessions and medication, his behaviour improved and his mood stabilised. He was discharged from the ward and monitored in the community by the Home Treatment Team. They reported that he was doing well.

The dying man

This patient set fire to his flat in an attempt to commit suicide, because he believed that he was dying a slow and painful death. Thankfully he was rescued and brought to hospital. After an extensive examination he was found to be physically healthy. However, despite reassurance from staff, he continued to believe that he was dying. He would come to staff each day to complain that he had chest pain, his skin was rotting, his stomach was twisted or he had a tumour in his brain. It was heart breaking to know that he believed that he was dying, especially when nothing we could say would comfort him.

The dying man was put onto anti-psychotic medication to help manage his hypochondriacal delusions and sedatives to help him manage his anxiety. Staff also supported him with attending to his personal hygiene as, if he was not prompted, he would spend all day in bed without food, water or washing.

His distress seemed to gradually improve but he was still experiencing delusions by the time I left, about 3 months later.

The ex-boxer

There was a 6 foot tall muscular man on the ward who used to be an ex-boxer. He was fairly intimidating to be around and rarely spoke. We had been warned that he had anger management problems and had punched a patient on the previous ward.

I was often put on close observation with him, which meant that I had to be within about arms-reach of him to ensure that he didn’t harm himself. I tried to make conversation with him and treat him with respect. Thankfully he never showed any signs of aggression towards me and even seemed protective at times.

On one occasion I was approached by a patient who was very agitated and paranoid. He believed that staff had poisoned his food and had become aggressive as a result. Before I knew it the ex-boxer had appeared and was standing between us, facing the other patient. He stared intently at the patient but didn’t say a word. The patient gradually backed away and when to his room. The ex-boxer then turned to me and simply said with a smile, ‘Good morning Miss Stone’.

I found out that he’d been admitted to the ward after trying to kill himself by hanging. Apparently his girlfriend had left him and he was struggling to cope. While he was on the ward he attempted to kill himself again using his phone charger. Thankfully staff managed to stopped him. His mood gradually improved and he was released after about a month.

The Soldier

During one of my first days on the ward, a young man with brilliant blue eyes and a shaved head ran up to me and grabbed the personal alarm hanging from my belt, pulling it off the pin in the process. The alarm went off instantly throughout the ward. He threw it across the corridor, so it landed at another nurses feet, and then dived behind the reception desk. The other nurse didn’t share my surprised expression and simply smiled as she gave me back my alarm. By now 7 staff members had run towards us in response to the alarm. They reset it and explained that the man thought he was at war and alarms were grenades. He believed all the staff were enemy soldiers and he was trying to protect his comrades, the other service users.

The soldier had been diagnosed with Post Traumatic Stress Disorder after coming back from duty. Over time we managed to convince him that we were on his side and the anti-psychotic medication helped him gain insight. He gradually became aware that he was not at war and that it was safe on the ward. However, he still experienced some flashbacks and nightmares.

The matrix man

I once arrived on the ward to find a man wearing a long leather coat and sunglasses. He looked just like someone out of the matrix. As I walked past him he stopped me and said ‘dude…you’re stepping on all the little blue people’. I politely apologised and took a different route to get to the office. I found him fascinating, but sadly he was transferred to the ward next door before I had a chance to learn anything more about him.

The mute patient

The second patient I met was a young woman from the Philippians. The nurses needed help giving her medication so I went with them to her room. She was sat on the bed, clapping repeatedly. Whenever someone spoke to her she looked at them intently and changed the pattern of her clapping, as though she was trying to communicate something.

The staff repeatedly tried to communicate with her but there was no verbal response. Eventually they went to get the medication and asked me to stay with her in the room. I did my best to be polite and friendly and commented on the book next to her bed. To my amazement she stopped clapping, turned to me and said ‘yes, it really is an excellent book’.

There was a momentary pause and then she started clapping again. I tried to continue the conversation but she seemed to be responding to some hallucination or delusion. I’m not sure that she was even still aware that I was there.

About a month later I met with her again. She seemed like a completely different person and I could hardly believe how much better she was. When I asked her about that first day I had met her she explained that she had no recollection of it, or any of the other things she had done when she’d first been admitted.

The abused man

There was a young man on the ward who had been diagnosed with schizophrenia when he was a teenager. He reported hearing constant derogatory voices, which had tormented him for years by called him a paedophile. He also regularly had visual hallucinations of being raped at night.

Staff could always tell when the voices were bad because he would appear to be arguing with himself and become fairly agitated. It would have been easy to misinterpret his outbursts as aggression towards others, when really they were directed at himself and the voices. Thankfully a few of the staff had developed a good relationship with him and were able to intervene quickly before his behaviour escalated. He was also generally fairly good about coming to staff to ask for PRN anti-psychotics (medication to be taken as and when needed).

Towards the end of my placement he was transferred to supported accommodation. His hallucinations hadn’t improved but he had learnt how to manage them without becoming aggressive.

The depressed nurse

I found this patient very challenging to work with. Not because she was difficult but because I identified with her. She was the same age, same characteristics, also working in healthcare, had been abused when she was younger and kept it a secret, was experiencing severe depression, had suicidal thoughts and had been self harming for years.

I could relate to everything she talked about and desperately wanted her to know that she wasn’t alone, but it would have been inappropriate to tell her anything about myself. Instead I tried to support her when she was having difficult days and always listen when she wanted to talk.

Over time she reported feeling less suicidal, although the depression didn’t seem to improve. She was given leave from the hospital, which gradually increased until she was back to living in the community, with support from community mental health teams. She was so thankful towards the staff when she left and each time I noticed her working in the hospital she was give me a small smile.

The government advisor

There was one patient who had been on the ward for a couple of years. He had severe psychosis and suffered from elaborate delusions of grandeur and paranoia. He believed that he was one of the most knowledgeable people in the world and that it was his responsibility to advise the government and solve problems like poverty. He discussed his theories at great length with other patients and staff and frequently wrote letters to MPs.

He spent most of his time pacing back and forth along the corridor, talking loudly to himself about his latest theory. He claimed that he had to take illicit drugs to counteract his anti-psychotic medication, so that he could think clearly about his theories; this meant that it was a constant battle to try and keep him stable.

At times he became paranoid that the people around him were out to get him or were going through his files. He often got worked up about this, to the point where he would shout threats but never actually act on them. Staff would always intervene and try to calm him down.

He didn’t seem to improve much during the six months that I was working on the ward and I often wonder if he’s still there now.

The woman with visions

I met a young woman on the ward who was experiencing severe psychosis. She reported having visions of people dying and angels telling her that she could save them by drinking salt water. She honestly believed that if she didn’t follow what the angels were saying, she would responsible for the deaths of hundreds of people. It was an unbearable burden for her to be carrying.

She’d been admitted to Accident and Emergency because drinking excessive amounts of salt water had made her ill. They then referred her to our ward after realising she was experiencing hallucinations and delusions.

Whilst on the ward she also expressed delusions which centered around me. She believed that I was marrying her ex-boyfriend, who was royal, and that I would be taking the throne. She repeatedly asked me about the wedding and why he’d left her. Each time she became more and more tearful. I tried so hard to reassure her that it wasn’t true but nothing I said could convince her.

She asked me again and again. Every 3 minutes for hours on end. The obsessive questions were exhausting but I knew it wasn’t her fault. Even whilst experiencing severe mental illness, she was one of the most compassionate people I have ever met. She spent most of her time caring for the other patients and making them tea.

I finished my placement a month after she arrived so I didn’t get to witness her recovery as it progressed but I visited the ward later on and she seemed to be doing much better. She was finally aware of her delusions and hallucinations and laughed at the strange things she had previously believed.


A homeless man came to the Substance Misuse Service for assessment. He reported struggling with alcohol use, depression and suicidal thoughts.

I completed the assessment, which took about an hour. We discussed why he’d come in, his substance misuse amounts and frequency, previous convictions, social issues and housing, family (especially details of any children who may be at risk), mental health, physical health, prescribed medication, etc. It also involved completing a risk assessment (eg risk of self neglect, suicide, harm to others, etc) and an initial care plan.

It was important to use Motivational Interviewing skills to during this assessment to encourage change. I’ll explain this in more detail later.

At the end of the assessment, he was asked to complete a urine drug screen and breathalyser.

His assessment indicated that he was physically dependent on alcohol. This means that if he stopped suddenly then he would be at risk of having a seizure (and in some cases people have died from this). I therefore advised him to keep drinking, especially if he was starting to experience shakes, and that he would have to reduce the alcohol gradually (generally by 10% every couple of days).

I discussed his assessment with the rest of the multi-disciplinary team (nurses, psychiatrists, social workers, occupational therapists and psychologists) at the allocation meeting. The client was assigned to the alcohol drop in service; this meant that he would come in once a week during drop in hours for motivational interviewing. After a couple of weeks I was then assigned as his keyworker and continued to work with him on a one-to-one basis.

The aim of Motivational Interviewing was to develop a discrepancy between the person’s current situation and where they want to be. By heightening their ambivalence you can encourage change.

One technique I used is the decisional matrix. This involved asking the client to identify the advantages of staying the same, the disadvantages of staying the same, the disadvantages of changing and the advantages of changing. It was helpful for the client to see that there were many more positives to changing, compared to staying the same.

Another technique was to ask the client to rate their current physical/mental health on a numerical scale and then ask them what it would take to increase that rating by 1 or 2 points. This encouraged the client to think of ways of changing. By coming up with the suggestions himself, he was more likely to accept them compared to being told by someone else. For example, he is more likely to accept his own suggestion ‘I guess I would feel better if I quit smoking’ compared to me saying ‘you should quit smoking’.

It was also important to use the elicit-provide-elicit technique when providing information in to avoid resistance. This is where you ask the person what they know about a topic, then ask permission to give them a bit more information about it, then afterwards elicit it again by asking them how they understand what you’ve just told them.

Throughout the session I used summaries to emphasised the reasons he had given me for wanting to change and encourage ‘change talk’. I also used reflections to manage any resistance. For example, when he stated ‘my family keep nagging me about my drinking’, I reframed it by reflecting ‘so you’re family care about you a lot and are concerned about you’. Or when he stated ‘I’ve tried treatment before and it hasn’t worked’, I reframed it as ‘you’re persistent because it means a lot to you’. You can also used amplified reflections, for example if a client stated ‘I don’t want to give up methadone’, you could amplify it by reflecting ‘so you want to stay on methadone for the rest of your life’, in order to get them to acknowledge ‘well, no I guess not’.

Through Motivational Interviewing I was able to support the client to gradually reduce his alcohol use, to the point where we were able to put him on the waiting list for a detox. I explained that the Detox was the easy part and the hard part would be remaining abstinent when he comes back out again, back to the same situations, places and people. It was therefore important to have some Relapse Management sessions (based on Cognitive Behavioural Therapy) before the Detox.

The Relapse Management sessions involved using Socratic dialogue; informational questioning, active listening (using reflections), summaries and analytical questioning. In analytical questioning you ask questions that will help the client come up with the answers themselves eg ‘on the one hand you say that you think alcohol will help but on the other hand you say that you feel depressed afterwards; how do you make sense of that?’ will lead the client to realise ‘I guess it actually doesn’t help’.

We also focused on identifying and adjusting his automatic thoughts, underlying assumptions and core beliefs (see previous blogs on CBT for an explanation of this). I explained to him that his thoughts and evaluative judgements mediate between stimuli and his emotions or behavioural response. It is not the event that makes him feel depressed but his evaluation of the event; for example, thinking that not being able to get him a job makes him a failure.

He was repeatedly asked to rate on continuum scales (see previous blog) and keep a positive data log as homework. We looked at goal setting and problems solving as well as how to manage high risk situation (eg if in situations with alcohol present), crisis plans (for what to do and who to contact if at risk of drinking) and lapse chains (to determine factors contributing to any lapses he has). I also explained to him the difference between lapses (one or two instances of previous behaviour) versus relapses (going completely back to the previous behaviour) and explained that lapses don’t have to lead to relapse.

Along with the one-to-one therapy sessions, I was responsible for completing continual risk assessments, focusing on the suicidal thoughts and any protective factors. I assessed if they were constant or fleeting and whether he had any intent or plans.

I was also responsible for helping him find housing by writing a letter to the council, helping him find employment by referring him to our employment specialist and liaising social services regarding his daughter. We always inform social services if a child is involved. I explained to him that, although many people worry about social services finding out, they will actually see the engagement in treatment as a good sign because you are getting help. They will always work with families to try and help them and only take children away as a last resort.

I also encouraged him to join in with the service’s groups, including the gardening group, so that he could meet other people in recovery and start engaging in pleasurable activities again (people with depression often cut these activities out of their life over time).

After a successful Detox, he went to rehab. When I left the service he had been sober for 3 months, had improved mood, no suicidal thoughts, had found housing and was completing training (to improve the likelihood of employment). I was glad that I was able to see the case through, as often I have to leave the placement half way through working with someone. It was rewarding to see how far he’d come.


I recently had a course of IAPT for depression/perfectionism. I thought I’d share the handout I was given with you incase any of you find it helpful.

Understanding depression

Symptoms of depression:
– Depressed mood: feeling hopeless/miserable/irritable/numb/empty.
– Losing interest and enjoyment in previously enjoyed activities.
– Self-criticism and guilt.
– Pessimism.
– Hopelessness.
– Loss of energy.
– Reduced activity.
– Withdrawal from social activities.
– Difficulty concentrating.
– Memory difficulties.
– Changes in sleep patterns.
– Changes in appetite and weight.
– Loss of interest in sex.
– Thoughts of death (If you are having thoughts about suicide, get professional help as soon as possible)

Myths about depression:
‘Nothing bad has happened to me, there’s no reason I should feel depressed. It must be my fault’.
Reality: It can be hard to understand why you feel depressed but a psychologist can help. Depression is not your fault.

‘Depression is biological – there’s nothing you can do about it. Only pills can make a difference’.
Reality: Depression does appear to have biological factors and medication helps many people. However, therapy can also be very beneficial by helping you make changes in the way you think and behave.

‘Other people can cope with worse things happening to them without getting depressed. I must be weak’
Reality: A lot of people may appear to be coping, when really they’re struggling too. Also, it is important to remember that feeling you cannot cope is a symptom of depression.

‘I should be able to just snap out of it’
Reality: If it were this simple, no one would ever be depressed. Vast amounts of money is poured into mental health resources because it is recognised that people can’t just snap out of it. Talking in a constructive way has been shown to help a lot of people.

‘Why should I take medication? It won’t help change the things that make me depressed’.
Reality: Medication can help improve your mood and help you cope with your problems in a different way.

Links between thoughts, emotions and behaviour

Your thoughts and evaluative judgements mediate between experiences and emotions/behaviour.

Situation: Lose job
Certain life experiences can make people more likely to develop depression. However, not all people with these problems get depressed- it depends on their evaluative judgements of the event.
Thoughts: ‘I’ve failed. I’ve let my family down. I won’t get another job now’
Even if something bad happens, there are a number of different ways of thinking about it. John could have thought ‘well, that was unfair but I’m sure I’ll find another job- maybe even something I like more’. People with depression tend to see things in a way which is harsh, self-critical, unfair and unrealistic. With thoughts like ‘I’m a failure’ it is understandable that John should feel low.
Physical changes: Can’t sleep. Poor concentration. Loss of appetite. Fatigue.
Depression has many physical symptoms, which can in turn have a big impact on people’s behaviour.
Emotions: Sad. Disappointed. Depressed.
Once people start to think in a negative way, their feelings naturally follow. Once the negative emotions start, they make it more likely that people’s thinking will become negative, leading to a vicious circle.
Behaviour: Withdraws from friends and family. Stops doing hobbies. Stays in bed.
Often people with depression are withdrawn, stop caring for themselves, have problems with everyday tasks and have less involvement in rewarding activities.

All of these are connected and influence each other, often leading to vicious circles. It can be difficult to manage but it can also mean that making positive changes in one area, can lead to changes in others.

Steps to start tackling your depression.

Get going again.

When people feel depressed they often start doing less, including stopping activities they previously enjoyed. This can then make them feel worse.
Step 1: See what you’re actually doing by keeping a diary or using an activity monitoring sheet. Rate each activity in terms of achievement and enjoyment.
Step 2: Make a list for yourself including involvement with family and friends, Self-care, Personally rewarding activities and Small duties (eg paying bills).
Step 3: Pick your goals: Pick 2 of the activities (preferably from different areas) that you listed that are the most practical for you to start doing now.
Step 4: Make SMART goals: They should be Specific, Measurable, Achieveable, Realistic and Time specific.
Eg instead of ‘I want to eat more healthily’ you could say ‘I want to eat 2 pieces of fruit every day for 2 weeks’
Step 5: Carry out your goals: Keep a record of how you’re doing and reward yourself. This can be hard because when people are depressed, they tend to focus on the things they haven’t done and ignore or downplay their achievmenets. Deliberatiely remind yourself of what you’ve done.
Step 6: Review your progress: Are these activities having a positive impact? Do you want to increase your goals slightly?
Are you struggling with them? Do they need to be more specific or manageable?

As your energy starts to come back you will be able to do more and more. The most important thing is to start moving, no matter how slowly. When you feel ready start adding another smart goal.

Negative thinking and depression.

Our evaluative judgements of an lead to low mood, rather than the event itself. For example, if someone walks past you without saying hello, the evaluative judgement ‘they must be angry with me’ would leave you feeling bad, whereas the evaluative judgement ‘they must be really busy’ wouldn’t. Either judgement could be true but people with depression tend to focus on the most negative one.
The first step is to start becoming aware of these thoughts. Try to note down the situation, negative thought and emotions (rate each one in terms of intensity).
Find alternatives: For each negative thought, try to note down a more adaptive one. Then rate your emotions again. It is important to do this repeatedly if you want to see change. It is not enough to do it once or twice if you want to start breaking the habit of negative thinking. Here are some questions that might help you come up with some more fair and realistic thoughts:
– What evidence do I have for this thought?
– Is there any alternative way of looking at this?
– How would someone else think about this situation?
– Am I thinking in all-or-nothing terms?
– Am I forgetting relevant facts?
– How will things be in X months time?
Preparing for trigger situations: There will be situations in your life which make it more likely for negative thinking to occur. Look back over your thought records and try to make a list of the top 3 situations. In future when you find yourself in these situations try to be aware of any negative thoughts and think of alternatives.

Recognising the positive

People with depression often ignore positive events and focus on negative things that happen.

Step 1: Keep track of good things that happen. Make a record of everything, no matter how small. Even if it’s just that you got out of bed today.
Step 2: Reward yourself for things you do manage. Eg go for a walk in the sunshine or spend 30 minutes watching your favourite program.
Step 3: Get a more positive view of yourself:
Make a list of as many positive characteristics you can think of.
If you’re struggling then ask friends and family to make a list for you.
Or think about what bad characteristics you don’t have eg I’m not rude.
Try to carry the list with you and look at it when you’re feeling low.

Also remember

Physical activity can help. Frequency is more important than duration. Pick activities you enjoy.
Sleep is important for mood. Try to have a set bedtime and rising time.


Identifying Over-evaluation of achieving
Most people evaluate their self-worth based on a variety of things, such as their relationships, hobbies, leisure activities, achievements at work, and other abilities. Their self worth pie chart could include 11% social life, 15% money, 21% family, 6% body shape, 8% job, 6% travel, 11% sport and fitness, 11% future goals, 6% partner and 5% community.

Perfectionists tend to judge their self-worth based almost entirely on achieving their unrelenting standards. They overvalue achieving and achievement. They may have other interests, but over time these seem to take a lesser place in their lives. This system of self-evaluation may have developed through particular life experiences and/or positive reinforcement from people around them. People who try hard and are successful are often rewarded by others so achieving can become equated with being hard-working, conscientious and intelligent- in short, being of worth.

Perfectionists come to believe that they are only of worth if they are pursuing or achieving the high standards they set for themselves. Activities involving achievement take up a very large part of their pie chart, and become overly important in their lives. They begin to judge their self-worth largely on their ability to achieve. Their self worth pie chart could include 9% sport and fitness, 9% studies, 7% friends, 11% family and 64% achieving at work.

They often focus on one area of their life giving them all of their self-worth. This is very risky as any problems in this area will then lead to the person judging themselves negatively and think they are of no value. They are therefore putting a huge amount of pressure on themselves to make sure that it works out. That’s why it’s not surprising that perfectionists tend to be very focused on achieving the high standards they set themselves. It is also not surprising that they often feel stressed, irritable, depressed, anxious and guilty, and think negatively about themselves. When a goal is achieved they may feel relieved but they don’t tend to feel happy for very long. In fact, perfectionists tend to dismiss their success (‘I was just lucky’) or conclude that the standard set was too low (‘anyone could have done that’) and re-set the standard higher for next time.

Work and education take up most of my pie chart. Try drawing your own one and see if it’s balanced or unbalanced.

To expand your self-evaluation across different life areas. For each of these areas, think ‘Who do you want to be in these areas? What do you want to do in these areas?’

My social life
My work/education
My finances
My emotional health
My relationship with my partner
My relationship with my children
My relationships with my close friends
My relationship with my parents/siblings
My contribution to the community
My spiritual life
My valued pastimes and hobbies
My fitness and physical and nutritional health

Then identify goals for some of these areas by looking at
The changes I want to make:
The most important reasons I want to make these changes are:
The steps I plan to take are:
I will know the plan is working if:
Things that might interfere with my plan and how I will overcome them are:


I have had ME/CFS since 2005. During that time I have tried various ways of managing it, including seeing specialists. I thought I would share some of their recommendations, incase it’s helpful to anyone else.

Initially I was put on a mixture of supplements designed to boost my immune system. It involved taking 90 tablets a day at specific times. The mixture was designed by Dr Petrovic (I dislike the ‘curative’ claim on his website but the link is there if you want more information).

When my Mum had ME/CFS and my Brother was ill, they both found the mixture helpful. It’s hard to know if the improvement was due to the tablets or just the natural course of their conditions.

When I tried it, it just made me feel sick. My Gran had the same experience when she tried it during her recovery from cancer. We later found out that Dr Petrovic had changed the mixture since my Mum and Brother had used it, which may be why it had a different effect on us.

After that I went to see an ME/CFS specialist/neurologist called Professor Leslie Findley, who is based in Essex/London. I think he may be retired now but I’m not sure. He put me on to NADH, which helps with the energy cycle, and weekly B12 injections, because apparently people with ME/CFS don’t use B12 very efficently. He also gave me citalopram (which is a SSRI antidepressant), which is apparently helpful for ME/CFS at low doses. It’s hard to know how helpful these were because my ME/CFS fluctuated a lot anyway.

He referred me to a physotherapist, who focused on the muscles in my neck and back. They were very tense and contributing to my headaches and migraines. I found the physiotherapy very helpful but it would only last for a couple of weeks and then my muscles would be very tight again.

He also referred me to a dietician and occupational therapist, who recommended that I eat small starchy foods every 3 hours, try to break up activities into smaller tasks, pace myself, have a regular daily routine especially bed time and avoid caffiene and alcohol. The lifestyle recommendations were helpful but hard to stick too. I’m such a perfectionist and workaholic that it’s hard to pace myself.

He also recommended CBT, but I had already had a course of it for the depression.

Someone recommended the Lightning process, but I’ve never tried it so I have no idea if it’s any good.

At University I met with student support services and had a disability assessment. They provided me with a disability allowance, posturite chair, dictaphone to record lectures, extra time in exams and allowed me to do my exams on a laptop.

Recently my parents got a wheelchair for me, which I use on days out to avoid walking too far and wearing myself out. I would definitely recommend this as it means you can still go out and be involved in family trips. The Red Cross are usually fairly helpful if you want to borrow a wheelchair.

Anyway, I think that’s all that I can remember. Good luck with your recovery and feel free to comment if you have any recommendations.

Topic - Facebook

Wonderfully brave facebook post made by one of my friends from university:

I’m not usually one for personal/emotional statuses, but here goes.

Two years ago today I posted a generic status about mental illness, about how anxiety and depression are not signs of weakness, but of trying to stay too strong for too long. It talked of how approximately 1 in 4 people suffer from mental health problems and made mention of the lack of support that people face due to the stigma attached to mental illness. At the time of posting it I wondered how helpful it really was to use a generic status and that surely to fight stigma, real people must share their real stories. I contemplated writing something personal but I chickened out. What I wish I’d written is this:

At any one time, 1 in 4 people are living with mental illness, and I’m one of them. I’ve had frequent episodes of major depression and anxiety for over a decade and frequently struggle with intrusive thoughts. I used to try to manage my symptoms through self-harm among other things. However, through counselling, other talking therapies and medication, I’ve become more able to handle my illness. I am not crazy, I’m not stupid, I am not dangerous, I am simply ill. And while my illness is an undeniable part of who I am, it is not all that I am.

I know what it’s like to feel hopeless and to want to hide from the world. I know what it’s like to not be able to silence the voice in your head telling you you’re worthless. I know what it’s like to truly feel you will never be happy, to believe that you will only ever feel pain, to not be able to imagine a future where you are functional, let alone happy, to not be able to imagine a future at all. I know what it’s like to wake up and immediately burst into tears because the prospect of facing another day is simply unbearable. I know what it’s like to be in such psychological pain you think your heart is going to give up and just stop beating. I know what it’s like to contemplate ending it all and to honestly think that would be the best thing for everyone, and that while it might hurt the people I love, they’ll survive and eventually see it was the right thing to do. But I also know that there is help out there for people like me, that those thoughts can be controlled and can even go away. It is possible to feel happy again, to achieve things, to have normal human relationships and to lead a normal life. It’s not easy, it’s not simple and it is not quick, but it is possible.

If you are suffering, please know that you are not alone, that there is help available and that if you want to talk to me, just get in touch and I’ll be there. Please don’t suffer in silence. You are not weak, you are not selfish, you are not stupid, you are simply ill. Being ill is nothing to be ashamed of. Please get help. Your life can be filled with happiness and people love you. You’re more loved than you could possibly imagine and you’ve touched more lives than you realise.

If you know someone who you think might be suffering, then reach out to them, offer them a sympathetic ear or a shoulder to cry on. You don’t need to offer answers or solutions, just friendship. It can make all the difference. You can make all the difference.

Two years ago today I posted a generic status about mental illness, less than a month later I lost a friend to suicide. He was not stupid, he was not selfish, he was not dangerous, he was simply ill. Even though I hadn’t known him long, his death was one of the most intensely painful things I have ever experienced. It broke my heart. Meeting his parents and seeing our friends in agony made the true devastation that suicide causes unavoidably real, it rips people apart. You can’t slip away un-noticed and people don’t just get over it. It’s been almost two years since I lost my friend and the pain has barely eased, remembering those days still floors me. I had known him for just shy of 3 months.

I know he read the generic status I posted, I know because he posted the same status minutes later. Sometimes, I can’t help but wonder, if I had been brave, if I had been honest, would he have spoken to me about it? Would he have asked for help? Could I have made a difference? Looking back, it’s just one of the many things I wish I had done differently, but I guess it’s too late now. The only thing I can do is refuse to stay silent about mental health, tell my story and encourage others to do the same. It’s time to fight stigma, it’s time to be honest, it’s time to talk about mental health.

spoon theory

I highly recommend this story for anyone who has tried to explain ME/CFS to people.

My best friend and I were in the diner, talking. As usual, it was very late and we were eating French fries with gravy. Like normal girls our age, we spent a lot of time in the diner while in college, and most of the time we spent talking about boys, music or trivial things, that seemed very important at the time. We never got serious about anything in particular and spent most of our time laughing.

As I went to take some of my medicine with a snack as I usually did, she watched me with an awkward kind of stare, instead of continuing the conversation. She then asked me out of the blue what it felt like to have Lupus and be sick. I was shocked not only because she asked the random question, but also because I assumed she knew all there was to know about Lupus. She came to doctors with me, she saw me walk with a cane, and throw up in the bathroom. She had seen me cry in pain, what else was there to know?

I started to ramble on about pills, and aches and pains, but she kept pursuing, and didn’t seem satisfied with my answers. I was a little surprised as being my roommate in college and friend for years; I thought she already knew the medical definition of Lupus. Then she looked at me with a face every sick person knows well, the face of pure curiosity about something no one healthy can truly understand. She asked what it felt like, not physically, but what it felt like to be me, to be sick.

As I tried to gain my composure, I glanced around the table for help or guidance, or at least stall for time to think. I was trying to find the right words. How do I answer a question I never was able to answer for myself? How do I explain every detail of every day being effected, and give the emotions a sick person goes through with clarity. I could have given up, cracked a joke like I usually do, and changed the subject, but I remember thinking if I don’t try to explain this, how could I ever expect her to understand. If I can’t explain this to my best friend, how could I explain my world to anyone else? I had to at least try.

At that moment, the spoon theory was born. I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said “Here you go, you have Lupus”. She looked at me slightly confused, as anyone would when they are being handed a bouquet of spoons. The cold metal spoons clanked in my hands, as I grouped them together and shoved them into her hands.

I explained that the difference in being sick and being healthy is having to make choices or to consciously think about things when the rest of the world doesn’t have to. The healthy have the luxury of a life without choices, a gift most people take for granted.

Most people start the day with unlimited amount of possibilities, and energy to do whatever they desire, especially young people. For the most part, they do not need to worry about the effects of their actions. So for my explanation, I used spoons to convey this point. I wanted something for her to actually hold, for me to then take away, since most people who get sick feel a “loss” of a life they once knew. If I was in control of taking away the spoons, then she would know what it feels like to have someone or something else, in this case Lupus, being in control.

She grabbed the spoons with excitement. She didn’t understand what I was doing, but she is always up for a good time, so I guess she thought I was cracking a joke of some kind like I usually do when talking about touchy topics. Little did she know how serious I would become?

I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of “spoons”. But when you have to now plan your day, you need to know exactly how many “spoons” you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons. She laughed and said she wanted more. I said no, and I knew right away that this little game would work, when she looked disappointed, and we hadn’t even started yet. I’ve wanted more “spoons” for years and haven’t found a way yet to get more, why should she? I also told her to always be conscious of how many she had, and not to drop them because she can never forget she has Lupus.

I asked her to list off the tasks of her day, including the most simple. As, she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon. When she jumped right into getting ready for work as her first task of the morning, I cut her off and took away a spoon. I practically jumped down her throat. I said ” No! You don’t just get up. You have to crack open your eyes, and then realize you are late. You didn’t sleep well the night before. You have to crawl out of bed, and then you have to make your self something to eat before you can do anything else, because if you don’t, you can’t take your medicine, and if you don’t take your medicine you might as well give up all your spoons for today and tomorrow too.” I quickly took away a spoon and she realized she hasn’t even gotten dressed yet. Showering cost her spoon, just for washing her hair and shaving her legs. Reaching high and low that early in the morning could actually cost more than one spoon, but I figured I would give her a break; I didn’t want to scare her right away. Getting dressed was worth another spoon. I stopped her and broke down every task to show her how every little detail needs to be thought about. You cannot simply just throw clothes on when you are sick. I explained that I have to see what clothes I can physically put on, if my hands hurt that day buttons are out of the question. If I have bruises that day, I need to wear long sleeves, and if I have a fever I need a sweater to stay warm and so on. If my hair is falling out I need to spend more time to look presentable, and then you need to factor in another 5 minutes for feeling badly that it took you 2 hours to do all this.

I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your “spoons” are gone, they are gone. Sometimes you can borrow against tomorrow’s “spoons”, but just think how hard tomorrow will be with less “spoons”. I also needed to explain that a person who is sick always lives with the looming thought that tomorrow may be the day that a cold comes, or an infection, or any number of things that could be very dangerous. So you do not want to run low on “spoons”, because you never know when you truly will need them. I didn’t want to depress her, but I needed to be realistic, and unfortunately being prepared for the worst is part of a real day for me.

We went through the rest of the day, and she slowly learned that skipping lunch would cost her a spoon, as well as standing on a train, or even typing at her computer too long. She was forced to make choices and think about things differently. Hypothetically, she had to choose not to run errands, so that she could eat dinner that night.

When we got to the end of her pretend day, she said she was hungry. I summarized that she had to eat dinner but she only had one spoon left. If she cooked, she wouldn’t have enough energy to clean the pots. If she went out for dinner, she might be too tired to drive home safely. Then I also explained, that I didn’t even bother to add into this game, that she was so nauseous, that cooking was probably out of the question anyway. So she decided to make soup, it was easy. I then said it is only 7pm, you have the rest of the night but maybe end up with one spoon, so you can do something fun, or clean your apartment, or do chores, but you can’t do it all.

I rarely see her emotional, so when I saw her upset I knew maybe I was getting through to her. I didn’t want my friend to be upset, but at the same time I was happy to think finally maybe someone understood me a little bit. She had tears in her eyes and asked quietly “Christine, How do you do it? Do you really do this everyday?” I explained that some days were worse then others; some days I have more spoons then most. But I can never make it go away and I can’t forget about it, I always have to think about it. I handed her a spoon I had been holding in reserve. I said simply, “I have learned to live life with an extra spoon in my pocket, in reserve. You need to always be prepared.”

Its hard, the hardest thing I ever had to learn is to slow down, and not do everything. I fight this to this day. I hate feeling left out, having to choose to stay home, or to not get things done that I want to. I wanted her to feel that frustration. I wanted her to understand, that everything everyone else does comes so easy, but for me it is one hundred little jobs in one. I need to think about the weather, my temperature that day, and the whole day’s plans before I can attack any one given thing. When other people can simply do things, I have to attack it and make a plan like I am strategizing a war. It is in that lifestyle, the difference between being sick and healthy. It is the beautiful ability to not think and just do. I miss that freedom. I miss never having to count “spoons”.

After we were emotional and talked about this for a little while longer, I sensed she was sad. Maybe she finally understood. Maybe she realized that she never could truly and honestly say she understands. But at least now she might not complain so much when I can’t go out for dinner some nights, or when I never seem to make it to her house and she always has to drive to mine. I gave her a hug when we walked out of the diner. I had the one spoon in my hand and I said “Don’t worry. I see this as a blessing. I have been forced to think about everything I do. Do you know how many spoons people waste everyday? I don’t have room for wasted time, or wasted “spoons” and I chose to spend this time with you.”

Ever since this night, I have used the spoon theory to explain my life to many people. In fact, my family and friends refer to spoons all the time. It has been a code word for what I can and cannot do. Once people understand the spoon theory they seem to understand me better, but I also think they live their life a little differently too. I think it isn’t just good for understanding Lupus, but anyone dealing with any disability or illness. Hopefully, they don’t take so much for granted or their life in general. I give a piece of myself, in every sense of the word when I do anything. It has become an inside joke. I have become famous for saying to people jokingly that they should feel special when I spend time with them, because they have one of my “spoons”.

Click here for the original


If you like the spoon theory, you might also be intersted in this blog about CFS/ME and Fibromyalgia:

Open Letter to Normals.


Whilst working in Mental Health Services I have come across many misconceptions, so I though I’d address a few of them here:

Schizophrenics have split personalities

No. People with Multiple Personality Disorder have different personalities. People with schizophrenia don’t. They may hear voices in their head (auditory hallucinations) but they generally don’t feel that these voices belong to them. They also may see things which don’t exist (visual hallucinations) or have disordered thinking (delusions).

All mental health patients are violent and dangerous

The huge majority of people with mental health problems are at much higher risk of hurting themselves than others. Most of the patients I’ve worked with have been wonderfully compassionate towards others.

People with depression can snap out of it

Trust me- if we could we would. Depression isn’t just sadness. It’s not ‘my boyfriend dumped me now I’m depressed’. It’s seemingly endless pain, suffering, numbness and guilt to the point were you feel that the only way out is death. We don’t choose to be depressed, the same way other people don’t choose to have cancer.

People with manic depression enjoy their ‘highs’

Some do, but a lot of them hate the negative after effects. For example, I’ve worked with a lot of patients who smoke excessively (100+ cigarettes a day) when they are having a manic episode, to the point where they end up in hospital. Others spend hundreds of pounds in one manic epsiode and are then faced with huge debts afterwards.

All self harmers are attention-seeking

There are self harmers who have hurt themselves for years without telling anyone. Most go to extreme lengths to avoid others finding out.

People who commit suicide are weak

People who commit suicide have often been struggling with debilitating disorders for years and have endured a lot of pain and suffering. They have had to be strong for too long.

If someone survived suicide they obviously didn’t actually want to die

I’ve worked with someone who overdosed on three different types of medication, cut her wrists and then jumped off a 30 storey building. She somehow survived. Sometimes people survive suicide, it doesn’t mean that they were hoping they would. All suicide attempts should be taken seriously.

Mental wards are filled with people wearing straight jackets

No straight jackets. All of the laws regarding mental health emphasise ‘the least restrictive alternative’, which means that we will observe patients closely rather than strapping them down. Restraining a patient (eg holding their arms if they are trying to hurt themselves) is always used as a last resort after trying to reason with them verbally. Restraints are used for the minimum amount of time necessary.

You’re a psychologist so you must be reading my mind

Er no. I really wish I could read minds but they don’t teach us that at University.

Most people only really know about a couple of Anxiety Disorders, so I thought I’ll share some (very brief) information about them including types that you might be less aware of.

Specific Phobias: Fear of a specific stimulus to the point where people will avoid it or endure it with dread. Apparently more common in women. There are common ones like fear of spiders and then rare ones like ‘Anatidaephobia’ (the fear that you are being watched by a duck).

Agoraphobia: Inter-related phobia cluster. Eg fear of public situations, going out doors or speaking in front of crowds. Generally cope by avoiding the situations altogether. Most common in adolescents.

Social Phobias: Fear of social situations to the point of avoiding them. Often associated with low self esteem. Most commonly starts in adolescence.

Panic Disorder: Episodic recurrent unpredictable panic attacks not restricted to specific situations. Must be present for more than 1 month for diagnosis.


Obsessive Compulsive Disorder: Repeatedly completing certain rituals for fear of something awful happening and feeling distressed if something stops you from completing them. Eg turning the lights on and off 30 times because you have you fear that something will happen to your Dad if you don’t. The behaviours are generally not useful or enjoyable. Must be present for more than 2 weeks for diagnosis. I have ‘Obsessive Compulsive Tendencies’ because I tend to organise and clean to an excessive extent when I’m anxious but it doesn’t affect my life enough to be classed as a ‘disorder’.

Acute Stress Reaction: Immediate response to acute stress. Initially in a daze. Will last a few hours if able to get away from the situation or 1-2 days if not.

Post Traumatic Stress DIsorder: I was diagnosed with this when I was 17 years old, after being raped. I experienced nightmares and flashbacks of the event, especially when in stressful situations like exams. It always felt so realistic, to the point where I would have panic attacks.

Adjustment Disorder: Occurs when someone is unable to cope with a change in their life. Often feel depressed and anxious. Some people may show reckless behaviours like fighting, driving carelessly, not caring about their responsibilites, skipping school, etc.

Dissociative Conversion Disorder: A lack of integration between memories, identity, movement and sensations. May vary hour to hour. Often a sudden onset. Generally occurs within a few weeks of a stressful situation.

Dissociative Amnesia: I met someone with this once. It’s amnesia which is generally associated with a trauma. It’s necessary to rule out intoxication, head trauma, etc before diagnosing.

Dissociative Fugue: One of the most interesting (in my oppinion). Dissociative Amnesia accompanied by suddenly travelling away from home/work. Sometimes they establish new identities in new places with little memory of how things were before. They are able to maintain their self care and interact with others.

Dissociative Stupor: Lack of voluntary movement, speech or normal responses to external stimuli. Generally associated with trauma.

Somatoform Disorders: Recurrent presentations of symptoms and requests for examination despite negative tests and reassurance from others. Hypochondriacal delusions would need to be ruled out before diagnosis.

Somatitisation Disorder: More than 2 years of multiple, recurrent, frequently-changing presentations of symptoms despite negative tests. Affects day-to-day functioning. Most common in adolescent women. They generally want treatment whereas someone with hypochondriacal disorder often just wants confirmation that they are ill.

Generalised Anxiety Disorder: I’m pretty sure my friend Hannah has this, though she’s never actually been diagnosed. It’s persistent free-floating worry and fear of the future. Often associated with chronic stress. For example, Hannah worries about everything and, if she doesn’t have anything specific to worry about, she worries that she should be worrying about something.

There are more detailed definitions on websites like Wiki or you can have a look at the ICD 10 (classification guide) for the actual diagnostic criteria. Please speak to a doctor before diagnosing yourself with anything though.


There are many unhelpful thinking styles, which can contribute to mental health problems or maintain them. These are a few examples. I’ve never met anyone who didn’t relate to at least one of these…

Mental filter: Only paying attention to certain types of evidence eg only noticing our failures and not our successes.

Over generalising: Drawing overly broad conclusions based on one or two events eg I’m always rubbish at maths’ after one failed test.

Emotional reasoning: Assuming that our emotions prove our thoughts are right eg I’m embarrassed so I must be stupid.

All or nothing thinking: Seeing everything in black and white eg either I’m perfect or a failure’.

Jumping to conclusions: Either mind reading (assuming we know what someone else is thinking) or fortune telling (predicting the future).

Disqualifying the positive: Discounting anything good that happens eg I got a good mark but it’s just because I had a good teacher.

Magnification/catastrophising and minimisation: blowing things out of proportion or making something seem less important than it is.

Shoulds and Musts (featured in my previous blog because I do this a lot): Using critical words like ‘should’ or ‘must’ which makes us feel guilty when we haven’t done something.

Labelling: Assigning labels to ourselves or others eg I’m an idiot.

Personalisation: Blaming ourselves for things when we weren’t actually at fault eg blaming yourself for being late when there was an accident on the road.

Noticing these thinking errors is the first step to changing them. If you can become aware of what you’re doing then you can try to correct it, but it does take time and a conscious effort to change these thinking errors.

This blog has been fairly negative recently so I thought I’d share something positive with you for a change. I wanted to tell you about some of my Random Acts of Kindness and hopefully inspire you to come up with some of your own.

I don’t normally tell people about this because generally I feel that Random Acts of Kindness should remain anonymous. That’s the whole reason why my friend Freya and I used to do them under a pseudonym.

Penguin CakeThe penguin cake: We had a friend who loved penguins, so we made her a little penguin cake. It was such fun to make and it looked really cute in the end. We then got Freya’s dad to deliver it to the friend’s house while we were at a party with her (ensuring we had an alibi).

The kinder eggs: We bought six kinder eggs, cut them in half, filled them with little presents and then resealed and re-wrapped them. We anonymously delivered them in a cardboard egg box to one of our friend’s houses.


Passing on books: Whenever I finish a good book I leave it somewhere public like the london underground with a little message inside asking people to read it and pass it on.


The treasure hunt: This one was probably the most work but also the most fun. We made a treasure hunt for our friend, which went all around her village. The clues were things like duck feathers (showing she should go to the duck pond) and ‘Read Me’ with a random list of numbers (directing her to certain books in the library. She managed to complete the treasure hunt and collect her prize (which the librarian gave to her) and still isn’t sure who created the treasure hunt for her.

Passing on the Random Acts of Kindness: I sent an anonymous email to the treasure hunt friend and the kinder egg friend asking them to do a Random Act of Kindness for Freya. I told them that they would need to use pseudonyms to keep their identity secret. I think in the end they posted her lots of  lovely little parcels.

Free hugs: This one wasn’t anonymous. We stood in the street with big ‘Free Hugs’ signs and hugged random strangers who came up to us. It was wonderful to see how much it made people smile.

Anyway, these are just a few examples, but hopefully they will inspire you to come up with some of your own.

Practice Random Acts of Kindness and Senseless Acts of Beauty.



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