Damon Ashworth Psychology

Author: Dr Damon Ashworth

  • How Do You Deal With Your Problems?

    How Do You Deal With Your Problems?

    Throughout my schooling years, I was a horrible procrastinator. I would leave everything to the last minute, sometimes even having to take a day off high school to finish an assignment that was meant to be due that day.

    Once I got to university, I couldn’t do this anymore, as the due date remained the same whether I went to classes or not. So I would instead consume a lot of energy drinks the night before an assignment was due and generally do the majority of the assignment in an anxious, tense and sleep-deprived state, printing it out and submitting it 20 minutes before the deadline.

    Exams were the same. I’d miss classes, not pay attention when I was there, and then try to cram an entire semester’s contents into the last 4 days before an exam. I would lock myself in my room and study up to 12 hours a day, only leaving for toilet breaks and something to eat until I was utterly exhausted. Luckily, I have a knack for remembering vast amounts of information in short periods of time, so I always passed, but it wasn’t easy or fun.

    I sometimes tried to start early but never found this effective, as the negative consequences seemed far away. So eventually, I figured I would follow the mantra, “if you leave everything to the last minute, it only takes a minute”. This mantra actually helped me fit a lot of things into my life by being more efficient, but it did have its limitations.

    Once I got to my Doctorate of Clinical Psychology degree at Monash University, I was suddenly faced with the prospect of having to do a 70,000-word thesis that was meant to take 3.5 years to do. How could I possibly cram something so big, especially when it consisted of making a research proposal, ethics application, recruiting participants, conducting a clinical trial, collating all the results, running data analysis and writing up the thesis and journal articles? It turns out I couldn’t.

    The thesis ended up taking me 4 years to complete, and there wasn’t too much of it that I enjoyed. Moreover, it required a direct challenge of my usual defence mechanisms, which was no easy feat, especially because I didn’t know what they were. I knew that I had always procrastinated with my studies, but I was never entirely sure why.

    What Are Your Defence Mechanisms?

    Fortunately, a fun test over at personalityassessor.com on coping styles’ titled ‘How Do You Deal?’ helped me identify which defence mechanisms I typically used. So if you are interested in knowing what yours are, I definitely recommend taking it.

    It is a bit time-consuming as there are 2 parts and over 200 questions, but I like this questionnaire so much because it is tough to fudge the test to get desirable results. This is because the survey doesn’t have face validity, and therefore doesn’t appear to measure how much someone engages in a particular defence mechanism. Two examples of questions are:

    “I am bothered by stomach acid several times per week” or

    “It is annoying to listen to a lecturer who cannot seem to make up his mind as to what he really believes”.

    I’m not sure which defence mechanisms these questions are tapping into or if the correct answer is true or false. However, previous research has shown that specific patterns of responses on the questionnaire are quite good at identifying people who regularly use 10 common defence mechanisms, including repression, displacement, denial, regression, projection, reaction formation, intellectualisation, rationalisation, isolation and doubt. My results were astonishing to me.

    My Defence Mechanisms

    I first took the ‘How Do You Deal?’ questionnaire in February 2013. I had just finished a year-long practical internship at Peter MacCallum Cancer Centre, and I found supporting individuals with cancer really rewarding and meaningful, but also quite challenging as I had lost a dear friend to cancer when I was 21. In addition, I wanted to finish my thesis by July but was falling way behind, and I was also a month away from getting married and moving in with my then fiancé. So I had many big changes coming up, and I was both stressed and scared about how everything would go.

    Here are my February 2013 results, alongside the descriptions of these defence mechanisms given by the personality assessor website:

    1. Denial — 94th percentile — extremely high

    Denial is a defense mechanism where people avoid thinking about problems, or even pretend like their problems don’t exist. For example, someone might deny that they have a drug problem. Or someone might deny that they’re currently having conflict in their romantic relationship.

    Since denial can be subconscious, people who use denial might honestly believe that their problems don’t exist!

    2. Isolation — 91st percentile — extremely high

    Isolation is a defense mechanism where people compartmentalize their thoughts and feelings so that their thoughts don’t affect their feelings.

    Isolation differs from denial. Using denial, a person with a drug problem might refuse to even see that they have a drug problem. Using isolation, a person with a drug problem would acknowledge they have a problem, but would not let the fact they have a problem affect their feelings. If intellectualization is all about staying in your head to avoid your heart, isolation is about keeping your head and your heart separate.

    3. Displacement — 81st percentile — very high

    Displacement occurs when we “take out” our frustrations on someone/something else. For example, imagine that you hate your boss. It might have dire consequences if you expressed your hate toward your boss. So, if you displaced those feelings, you might go home and yell at your family.

    This is different than projection. In projection, we don’t see our own feelings — we see them in other people (e.g., I am not angry, my boss is). In displacement, however, we still “own” our feelings (e.g., I am angry) but we “take out” those feelings on the wrong target (e.g., angry at boss, but kick dog instead of boss).

    4. Regression — 73rd percentile — high

    Regression is a defense mechanism where people essentially start acting or thinking like a child. The idea is that when life feels too overwhelming or our problems feel too big, that we regress to an earlier, easier time when other people (our parents) used to take care of us. As such, regression can include:

    * desiring for other people to take care of your problems for you

    * acting dependent on other people

    * acting like a child (e.g., temper tantrums)

    * refusing to take responsibility for your actions

    5. Doubt — 72nd percentile — high

    The defense mechanism of doubt occurs when people doubt their senses or thought processes when they encounter problems. For example, imagine a good friend tells you they don’t really like you. You might utilize the defense mechanism of doubt by thinking “I must have misunderstood what they meant.”

    Doubt is kind of like a mixture of denial, intellectualization, and rationalization. Doubt lets us deny that our problems are real (or avoid making big decisions we’re afraid of) by questioning our ability to accurately see the world and make good decisions. In contrast to denial, when people use doubt, they are aware of their problems on some level.

    6. Rationalization — 68th percentile — high

    Rationalization is when people excuse their actions with usually irrational false explanations. For example, if someone binges and eats an entire large pizza, they might think “Well, the food was going to waste anyway! I might as well have eaten it.”

    Rationalization is kind of like a mixture of denial and intellectualization. Essentially, rationalization allows people to “explain away” their problems (usually bad habits, personal flaws, etc.) with a superficially valid explanation. The biggest difference between rationalization and intellectualization is that intellectualization is used to avoid feelings, whereas rationalization is used to avoid seeing our own personal flaws.

    7. Intellectualisation — 64th percentile — high

    Intellectualization occurs when people avoid painful feelings by thinking oftentimes inappropriate impersonal thoughts. For example, if someone’s pet dies, they might think, “Pets die every day. Why should I be upset?”

    Basically, the idea is that people who use intellectualization minimize their problems — or at least their feelings — and avoid the pain in their hearts by staying lodged solidly in their heads.

    8. Projection — 47th percentile — about average

    Projection occurs when we project our own thoughts and feelings onto other people. For example, you might really hate your boss. If you used the defense mechanism of projection, you might be unaware of your own feelings toward your boss, but instead think your boss hated you. This defense mechanism would allow you to deny your feelings and, in turn, believe that any conflict between you and your boss is your boss’s fault (not yours).

    Projection basically lets us believe that are problems aren’t really ours — they’re someone else’s!

    9. Repression — 37th percentile — low

    Repression occurs when people push down or block-out memories or desires that they feel are threatening. For example, someone might repress painful childhood memories and try to not think about them. As another example, someone might repress their attraction to a friend that they fear wouldn’t reciprocate their interest.

    Repression is similar to denial, but slightly different. Denial is about convincing yourself that your problems don’t exist. Repression is about blocking out part of yourself — memories or desires, usually — perhaps to avoid creating a problem!

    10. Reaction formation — 15th percentile — very low

    Reaction formation is a fascinating defense mechanism where we do the opposite of what we really want to do. For example, imagine you are very attracted to another person. If, for some reason that attraction is a problem (e.g., you are married, they are married, etc.), you might start to feel the opposite toward them — you may think they are disgusting and/or actively dislike them.

    Reaction formation allows you to avoid your problems — and also creates a buffer to ensure you avoid your problems. In the example above, you’re not merely repressing your attraction toward the other person — you’re actually feeling negative feelings toward them. These negative feelings will ensure the attraction doesn’t resurface.

    Seeing that my marriage ended up being far worse than I had predicted, I maybe should have paid attention to these results a bit more, especially my denial and doubt scores.

    It did help with the writing up of my thesis. I stopped trying to avoid the problem, started coming into the lab from 9 am — 5 pm every weekday regardless of how I felt and began making some real and consistent progress without cramming for the first time in my life. I finished a full draft of my thesis by September 2013, started working as a Psychologist in private practice shortly after that, and submitted the final copy of my thesis for examination in February 2014.

    Have My Defence Mechanisms Improved?

    I retook the ‘How Do You Deal?’ questionnaire at the end of April 2017. I now live a life that is much more consistent with the experiences I want to have rather than what society says that I should be doing. I believe that I am a lot happier and in the best place that I have ever been psychologically. But have my defence mechanisms actually changed?

    Defence Mechanisms 2013 2017
    Denial 94th percentile 75th percentile
    Isolation 91st percentile 92nd percentile
    Displacement 81st percentile 77th percentile
    Regression  73rd percentile 68th percentile
    Doubt 72nd percentile 64th percentile
    Rationalisation 68th percentile 53rd percentile
    Intellectualisation 64th percentile 18th percentile
    Projection 47th percentile 56th percentile
    Repression 37th percentile 20th percentile
    Reaction formation 15th percentile 9th percentile

    As you can see, eight of my results had improved, with denial dropping 19 percentile points and losing its position as my most used defence mechanism. This is great, as I am now more aware of my issues and can actually do something about them.

    My most noticeable improvement was my reduction in intellectualising things, but I also repress things much less than I used to, rationalise my actions less, and doubt myself less too. This means that I am now turning into what I feel and need more, not just remaining in my head. By understanding and accepting my emotions rather than avoiding them or explaining them away, it really does make it easier to know what action I need to take. Regular journaling, mindfulness and therapy have definitely helped me to create these changes. So has being more honest and authentic with others.

    The two defence mechanism scores that have increased are projection and isolation. The increase in projection isn’t helpful, as this means I could be externalising some problems rather than taking responsibility for my role in creating them. The high isolation score isn’t so bad, though, as separating my head and heart is something that I have worked on to make sure that I am making decisions in line with my values and not my fears going forward. If this never changes, that will be fine by me.

    Can We Change How We Deal With Problems?

    It’s not possible to completely avoid engaging in defence mechanisms. We all have different coping methods, and many of these coping styles are developed in childhood and modelled on what everyone else in our family did.

    However, some defence mechanisms are more helpful than others, and they can change in time with deliberate practice. Head researcher of the Grant longitudinal study, George Vaillant, has separated defence mechanisms into immature, intermediate and mature defences. Acting out, projection, passive-aggressive behaviour, and denial are considered immature. Reaction formation, repression and displacement are intermediate defences. Mature defences include:

    1. humour: seeing the funny side of things,
    2. sublimation: channelling difficult emotions into something prosocial and constructive,
    3. anticipation: planning for upcoming situations that might be challenging,
    4. suppression: not reacting to your feelings or letting them show if this would interfere with you achieving your goals, and
    5. altruism: deriving pleasure from helping others.

    A 2013 study by Malone and colleagues found that men who used more mature defence mechanisms between 47 and 63 years of age had better health between 70 and 80. This was mostly because the people who regularly engaged in more mature defence mechanisms had better social support and stronger interpersonal connections than individuals who used immature defence mechanisms (Malone et al., 2013).

    If you want to build up healthier coping strategies, understanding which defences you currently use is a great place to start. The best way to do this apart from taking the ‘How Do You Deal?’ questionnaire is consulting with a therapist, especially a psychologist or a psychiatrist trained in psychoanalysis or psychodynamic psychotherapy. Friends and family might be able to point out some potential defence mechanisms that you use, but I think it is better to get this feedback from professionally trained and impartial. They can then help you replace these defences with more mature and adaptive coping strategies to have more supportive relationships and better long-term health and well-being.

    Dr Damon Ashworth

    Clinical Psychologist

  • The 5 Lessons I Discovered From Being Kind

    On January 1st, 2018 we kickstarted our Deliberately Better movement.

    Along with other passionate and driven allied health professionals, we aimed to highlight the various ways that people can choose to act if they wish to scientifically improve their health and well-being.

    In January, we aimed to engage in a random act of kindness each day.

    This was a fun experiment, and I tried to make a video of my acts of kindness every second day, which I was mostly successful with:

    • On day 4, I supported a friend on a hang gliding expedition
    • On day 6, I spent some quality time with my dad and played a round of golf with him
    • On day 8, I donated some spare change to the Royal Children’s Hospital
    • On day 12, I bought a copy of the big issue to support a rough sleeper
    • On day 14, we left a big tip at a restaurant that stayed open for us
    • On day 16, I donated plasma to the red cross blood bank
    • On day 18, I topped up some stranger’s parking meters
    • On day 20, I donated some clothes to charity
    • On day 22, I supported an organisation that was trying to raise money to protect a wilderness area in Tasmania
    • On day 24, I proofread a book that my friend had written and wanted to publish
    • On day 28, I went and played a beach volleyball tournament with my sister.
    • On day 30, I handed out bottles of water to people who were homeless around Melbourne.

    Even though it was weird to film and promote the acts of kindness that I engaged in, the month really did teach me a few valuable lessons. These are:

    caleb-jones-131203

    1. Trying to be kind to others feels good

    madi-robson-113926

    2. Viewing or hearing about others acts of kindness feels great

    annie-spratt-54462

    3. Hearing about or seeing others acts of kindness encourages people to be kinder too

    zachary-nelson-192289

    4. Trying to be kind to others can improve social anxiety

    brooklyn-morgan-390

    5. Trying to be kind to others can enhance energy levels and physical health

    To assess changes in how I felt from the beginning to the end of the month of kindness, I completed the Positive and Negative Affect Scale (PANAS), as developed by Watson, Clark and Tellegen (1988). This scale has two 10-item scales; one for positive affect and one for negative affect.

    If you would like to assess your levels, please answer from 1 to 5 on the following questions for how much you have felt this way recently:

    1 = very slightly or not at all

    2 = a little

    3 = moderately

    4 = quite a bit

    5 = extremely

    Positive affect items:

    _______ active

    _______ alert

    _______ attentive

    _______ determined

    _______ enthusiastic

    _______ excited

    _______ inspired

    _______ interested

    _______ proud

    _______ strong

    Negative affect items:

    _______ afraid

    _______ scared

    _______ nervous

    _______ jittery

    _______ hostile

    _______ guilty

    _______ ashamed

    _______ upset

    _______ distressed

    If you want to compare your scores to previous norms, first add up your totals for your positive affect and negative affect.

    A 1989 study of 815 Detroit adults by Quinn found an average for positive affect of 36.0. For negative affect, the average was 18.2 (Quinn, 1989).

    In 1993, an unpublished study by Wilkinson found an average of 33.5 for positive affect in 114 adult men and 33.9 in 115 adult women. For negative affect, it was 14.2 for the men and 15.5 for the women (Wilkinson, 1993).

    What I find interesting about these findings is that US adults report both higher positive and higher negative affect, indicating that they may be more expressive (and more aware) of their emotions than Australians.

    My score for positive affect before the kindness challenge was a 32, which was below the norms for both Australian and US adults. Given that I was feeling exhausted by the end of 2017, this makes sense to me. Extraverts are more likely to experience higher levels of positive affect also, and I would consider myself more of an ambivert.

    After a month of kindness, this score had shot up to 41, which was more than one standard deviation higher than the norm for Australian men, and much higher than the average for US adults too.

    My negative affect was less impacted by my acts of kindness, however, with my score remaining at 16 at both the start and the end of the month. I was slightly less irritable by the end of the month, but I was also a little bit more afraid, and this could have been due to the videos that I was putting up.

    Either way, I seem to experience slightly more negative emotions than the average 1993 Australian, and somewhat less than the average 1989 individual from Detroit.

    My experiment with being kinder didn’t solve all of my problems, but it did help me to take a few risks, challenge myself, put myself out there more, grow as a result, and hopefully put a few smiles on some people’s faces. That is enough for me, for now.

    2018 DELIBERATELY BETTER AGENDA:


    * In February, we gave up or cut down on something that was having a negative impact on our quality of life.
    * In March, we focused on our diets and looked at what were the most effective ways to lose weight or get into the best shape of your life.
    * In April, we looked into the different habits of high performers and how they improve their skills and become as effective as they are at what they do.
    * In May, we’ll be looking at how to hijack your hormones and get in control of your sleep, metabolism and energy.
    * In June, we’ll be checking out the latest and greatest developments in health and wellness literature, and passing on the top tips from the fields of medicine, psychology, neuroscience, behavioural economics, fitness and nutrition.
    * In July, we’ll be exploring the benefits of minimalism, looking at ways to develop and stick to a budget, how to financially plan for the future, how to cut back on spending, how to create passive income streams, and the top tips for investing in or trading on the stock market.
    * In August, we’ll be getting into the gym and out onto the track to explore how to bulk up, shred down, get ripped and be the most physically capable than you have ever been in your life.
    * In September, we’ll be looking at the latest trends in health technology, and exploring the various options that you have if you want to improve your psychological and physical well-being.
    * In October, we’ll be focusing on how to stress less, and sharing the latest tips to calm down quickly if you are distressed and want to live a more relaxed lifestyle in general.
    * In November, We’ll be trying something new, and looking at the multitude of benefits that novelty can play in our lives.
    * Last, but not least, in December, we’ll be taking stock of the year, reviewing what worked and what didn’t, and cultivating gratitude for all of the fantastic things in our lives.

    Thanks,

    Dr Damon Ashworth

    Clinical Psychologist

  • Can You Improve Your Sleep By Going to a Sleep Retreat?

    Can You Improve Your Sleep By Going to a Sleep Retreat?

    Just the other week, I was featured in the Daily Telegraph and the Herald Sun on sleep retreats. It was weird because I had been planning on running some sleep retreats but hadn’t yet. Stranger still, I hadn’t told anyone about my idea yet, and it was the first article that I have been mentioned in that I am aware of without being interviewed or asked for permission first.

    In the article, the first recommended retreat was Golden Door in the Hunter Valley, NSW. From what others had told me about it, it is generally known as a well-being retreat rather than a sleep retreat.

    An excellent Sleep Physician that I work with at the Melbourne Sleep Disorders Centre, Dr David Cunnington, did inform me that he often goes up there on weekends to be a guest speaker on sleep difficulties and how to improve them. He asked if I wanted to accompany him one time. I willingly obliged.

    We flew up to Newcastle on Friday the 18th of May just after midday, drove an hour from the airport to the Hunter Valley, and settled into our rooms just before 4 pm. It was a charming private villa, with my own balcony with a view, a long couch to relax on, a nice big bathtub to relax in, and my own king bed to sleep in. And that was just the room.

    The main building where the reception was consisted of a huge golden door opening up to steps and a waterfall running through the building. A chef was on-site to prepare healthy meals for everyone for breakfast, lunch and dinner (no red meat or processed carbs, no caffeine and no alcohol). Not to mention a day spa offering five pages of treatments, an indoor pool for deep water running or lap swimming, an outdoor pool for relaxing, a steam room and spa, a yoga studio, indoor basketball court, a huge gym, two tennis courts and even a table tennis table.

    I wanted to get to it all but remembered that this was a perfect opportunity to switch off, relax, and unwind. So instead of participating in the afternoon activities on Friday, I decided to run myself a hot bath, listen to an audiobook, and rest until dinner time.

    Golden door seemed to attract an eclectic mix of people, from stressed executives, burned-out executive assistants, and people needing a career, family or relationship break or change. Everyone was friendly and welcoming, and most obliged with wearing their name tags across the weekend, making it easier to approach and ask people what brought them to Golden Door and what they were hoping to get out of it.

    The staff were fantastic too, often mingling with the guests at meal times and participating in as many activities as possible. After dinner, at about 7 pm, those interested went for a leisurely walk and stopped to lie back and stare up at the stars. Living in the heart of Melbourne, this is an opportunity that I don’t often get, and I relished just looking up without feeling like I had to rush off and do something else.

    After the walk, we headed back to our private villas, where I continued to try to stay away from bright screens. Instead, I did 10 minutes of meditation, listened to an audiobook while relaxing on the couch, and went off to bed once I felt sleepy.

    On Saturday morning, I was awoken by a knock on the door, and a doorbell ringing at 6 am. If you don’t want this, you can put a do not disturb sign on the outside of the door, but it is to help people get up for the 6:30 am tai chi session up on meditation hill. I didn’t want my sleep to be over yet, but I managed to get dressed and strolled up the hill just as the sun rose across the Hunter Valley.

    With 360 degree views of the valley, Meditation Hill is probably the most picturesque part of the Golden Door retreat (it’s all pretty nice, though). I’d never done tai chi before, but it wasn’t too bad, especially with the hot air balloons taking off for their flights from the valley below.

    Following that, it was straight to the pool for some deep water running. I thought it would be some light aqua aerobics for oldies, but it was much more intense. Then there was breakfast and a 10km hike. Followed by tennis after lunch, and table tennis after that. Way more exercise than I expected to do, but I didn’t regret it. I then headed off to yin yoga, another activity I’d never tried before. I may have fallen asleep a little bit during this, but power naps are healthy for you.

    A 50-minute deep tissue massage was next at the Elysium day spa. A bit pricey at $140, but it felt amazing after all of the activity I’d done, especially my calves. These treatments are optional, but quite a few guests seemed to be getting them.

    David’s talk on sleep was after dinner. Then it was off to bed again. My second night of sleep was longer but not quite as deep as the first one.

    When I compare it to how I slept two nights before the retreat and two nights after it, I can see that a wellness retreat really can improve your sleep on the nights you are there. This is because it gives you so many things that can help you to have a good night’s sleep, including:

    • Lots of physical activity during the day but not too late at night
    • A vast amount of morning sunlight helps entrain your circadian rhythms and wake you up for the day. This can also help you to fall asleep earlier that night.
    • Healthy food.
    • No caffeine.
    • No alcohol.
    • Plenty of activities to relax and unwind.
    • More time in nature with beautiful scenery and less time indoors looking at bright screens.
    • Opportunities for engaging conversation with friendly and welcoming people that are also wanting to improve their health.

    It doesn’t offer clear guidelines or individual recommendations around sleep or how to keep improving it once you go home. For example, a 6 am wake-up call is perfect for some to help them not spend too long in bed. For others, it could cause anticipatory anxiety or lead to them putting too much pressure on themselves to get to sleep early the night before.

    Dr Damon Ashworth

    Clinical Psychologist

  • Are You Living the Life That You Want?

    Are You Living the Life That You Want?

    In 2016, I decided to take on the challenge of accountability. As a Clinical Psychologist, being accountable was all about evidence-based living — engaging as much as possible in thinking patterns and behaviours that have been shown to lead to a happier, more satisfying, higher quality of life.

    The following were the five key areas that I highlighted in my ‘Do You Want to Be Deliberately Better?’ Article:

    1. Tuning in rather than tuning out

    2. Turning towards my values rather than away from my fears

    3. Maintaining an ideal work/life balance

    4. Writing things down rather than keeping things in

    5. Developing a growth rather than a fixed mindset

    I made this declaration public as I was aware that people’s desire to remain consistent meant that I would be more willing to follow through on these targets and achieve these goals. All of them were based on solid research and were expected to have a positive flow-on effect for my long-term psychological well-being in 2017 and beyond.

    While I did make some progress in being more accountable to myself, especially with numbers 2, 4 and 5, I continued to struggle with numbers 1 and 3.

    Part of the problem was that I’ve always wanted to be able to do everything, and I struggle at times to prioritise and separate what is essential to me from what is critical to others. The other part of the problem is that I was working too hard, not saying no to what I didn’t want to do enough, and not leaving adequate time for leisure and socialising or even personal growth, creativity and health.

    I was often extraordinarily drained and fatigued by the end of the workweek. I would spend most of the weekend recovering and trying to catch up on chores and paperwork to avoid falling even further behind with administrative duties than I already was. I was also financially in debt even though I was working full-time, and I was stressed out.

    Mainly, I didn’t have enough time or space to reflect on where I was or what I needed, and when I did, I still didn’t make the necessary changes to ensure that my life was consistent with how I wanted it to be.

    It’s not just me

    What seemed to help me a lot was reading the thought-provoking self-help book ‘Take time for your life’ by Cheryl Richardson. She highlights the seven common obstacles that people seem to face in living their best lives. These are:

    1. They generally have difficulty putting themselves first

    2. Their schedule does not reflect their priorities

    3. They feel drained by certain people or things

    4. They feel trapped for monetary reasons

    5. They are living on adrenalin

    6. They don’t have a supportive community in their life

    7. Their spiritual well-being comes last

    I don’t know about everyone else, but I could check yes to all of these items except for number 6. I wasn’t spending as much time as I wanted with friends, but I felt well supported by them all when I did. As for the rest, I wondered, “How does she know me so well?” but then I realised how many people there are out there that must be falling into similar traps.

    My aim for 2017 was to take time for my life.

    Here’s how I’ve gone towards creating my ideal lifestyle so far:

    • I have moved into a fantastic apartment in the city where I am within easy access by bike, foot or public transport to all of my work, sport and leisure commitments.
    • I have begun regularly using the swimming pool, spa, sauna, and gym part of this unique apartment complex. As the gym here is excellent, I have saved by cancelling my external gym membership.
    • I have sold my car to avoid having to pay $70 a week for a car spot, not to mention the registration fees, car insurance, petrol, parking fees, fines, and depreciation in the car’s value. This also has the added benefits of never getting stuck in peak hour traffic and more walking and bike riding to get to places, which reduces the amount of time I need to set aside for these activities elsewhere.
    • I have started listening to audiobooks more whenever I am walking around the city by myself. This has resulted in me getting outdoors more, reading less inside, and opened up more time for other personal growth, leisure and social activities.
    • I have finished working at Mill Park and moved into the city for all of my workdays. This means that I can get up later in the morning on workdays and ride or walk or catch public transport to work no matter where I am.
    • I have cut down the days I see clients from 5 to 4, with Mondays now dedicated to maintenance, administration, health, creativity, and well-being. Because of this reduced workload, I am less stressed and more energetic. I am currently up to date with all of my administrative duties, paperwork, and continued professional development for the first time in 3 years.
    • This has also helped me enjoy my weekends more, as instead of playing catch-up on things, I can socialise and relax and plan various adventures that I may not have had the time or energy to do in the past.
    • Even though I am working one day less per week, by buying less stuff and reducing my expenses, I am no longer in any financial debt and am saving towards buying a place of my own.
    • I have now donated plasma and platelets through the Red Cross Blood Bank three times. This can be done every two weeks and takes about 45 minutes, and really can make a huge difference for those who have leukaemia and certain autoimmune diseases.
    • I have found a new General Practitioner, Nutritionist and Dentist to ensure that my physical health is going well and made the necessary appointments to assess or fix up any of the issues that have become apparent.
    • I have had a DEXA scan to assess my bone density, lean muscle mass and fat. I will be having another one of these in 3 months to monitor my progress and ensure that I remain in the healthy range for a male my age.
    • I have resumed monthly sessions with my Psychologist to ensure that my mental health and clinical practice are as optimal as possible.
    • I have signed up for a year membership with the meditation app Calm, which will help me to continue strengthening my meditation practice. I will aim to practice this for at least 10 minutes per day to make sure that I keep trying to tune in rather than tune out.
    • I have also booked in for a 10-day Vissapana meditation retreat in April and a 12-day P&O cruise at the end of July. Both of these getaways involve switching off from all technology for the duration of my stay. They will provide me with plenty of time for rest, relaxation and reflection, essential elements for tuning in and developing greater insight.

    No Regrets?

    Now that I’ve shared the changes that I’ve started to make towards my ideal lifestyle, I want to ask you this:

    If you only have one life to live, and that life is yours, what changes do you need to make now to ensure you don’t accumulate any more regrets in the future?

    In her viral blog post and subsequent book “The Top Five Regrets of the Dying”, palliative nurse Bronnie Ware listed the top five regrets that the dying people she cared for typically had. These were:

    1. They wished they’d had the courage to live a life true to themselves, not the life others expected of them.

    2. They wish they hadn’t worked so hard.

    3. They wish they’d had the courage to express their feelings.

    4. They wish they’d made a bigger effort to stay in touch with their friends.

    5. They wish they had let themselves be happier.

    Remember, we tend to regret the things that we don’t do much more than those we do. So be brave, give it a go, and see what happens. If you’re not sure what you want or how to figure it out, booking in for a session with a Psychologist could definitely help!

    Dr Damon Ashworth

    Clinical Psychologist

  • The 10 Best Laws of Power

    The 10 Best Laws of Power

    A fascinating book that I read towards the end of 2017 was ‘The 48 Laws of Power’ by Robert Greene.

    Since the book was first released in 1998, it has sold over 2 million copies worldwide and has influenced many successful people, from Will Smith to Kanye West, Jay-Z and 50 Cent, who later co-wrote a New York Times’ bestseller with Greene.

    It is also the most highly requested book in U.S. prisons due to the synthesis of Machiavelli, Sun Tzu and other famous writers’ key prescriptions for effectively managing power struggles in difficult environments.

    Some of the 48 laws do seem contradictory, and others seem a little repetitive. Still, there are some truly great bits of advice for effectively managing situations where power may play a role. This might be a corporate environment, a difficult but smaller workplace, a large social group, to really anywhere where there is a power imbalance between people or a formal or informal hierarchy.

    Here are my 10 favourite laws, including a description of each law from the following website. The parts that I especially like are bolded. Enjoy!

    Law 4: Always Say Less than Necessary

    When you are trying to impress people with words, the more you say, the more common you appear, and the less in control… Powerful people impress by saying less. The more you say, the more likely you are to say something foolish.

    Like the Danish proverb that says, “deep rivers move with silent majesty, shallow brooks are noisy”, law 4 reminds me only to say things that I believe will be of value. It also helps me stay within my circle of competence and not give advice on things that I do not know much about.

    Law 9: Win through your Actions, Never through Argument

    Any momentary triumph you think gained through argument is really a Pyrrhic victory: The resentment and ill will you stir up is stronger and lasts longer than any momentary change of opinion. It is much more powerful to get others to agree with you through your actions, without saying a word. Demonstrate, do not explicate.

    A parent who smokes but tells their children not to is unlikely to be successful at persuading their children because “actions speak louder than words”. The better option is not to smoke or quit if you want to set a good example. As Mahatma Gandhi said, “you must be the change you wish to see in the world”.

    Law 13: When Asking for Help, Appeal to People’s Self-Interest, Never to their Mercy or Gratitude

    If you need to turn to an ally for help, do not bother to remind him of your past assistance and good deeds. He will find a way to ignore you. Instead, uncover something in your request, or in your alliance with him, that will benefit him, and emphasise it… He will respond enthusiastically when he sees something to be gained for himself.

    As sad as this may appear, most people are self-motivated and want to do the right thing if it makes them look good. For example, a hybrid car such as a Toyota Prius sells well because it is known as a hybrid car. It screams out, “I care about the environment,” in a way that the Toyota Camry Hybrid does not because the hybrid version of the Camry looks almost identical to the regular Camry. The 2014 sales in the US of each car highlights this point: Prius = 194,000; Toyota Camry Hybrid = 39,500; Toyota Camry (non-hybrid) = 428,600. Figure out how what you want will benefit the other person or help them look good before you ask for a favour, and you are much more likely to get them on board.

    Law 18: Do Not Build Fortresses to Protect Yourself — Isolation is Dangerous

    The world is dangerous and enemies are everywhere — everyone has to protect themselves. A fortress seems the safest. But isolation exposes you to more dangers than it protects you from — it cuts you off from valuable information, it makes you conspicuous and an easy target. Better to circulate among people, find allies, mingle.

    Many people that I see try to protect themselves at the cost of a real sense of connection and belonging with others. This law helps by reminding me of the dangers and costs of not opening up to honest people you can trust.

    Law 23:Concentrate Your Forces

    Conserve your forces and energies by keeping them concentrated at their strongest point. You gain more by finding a rich mine and mining it deeper, than by flitting from one shallow mine to another — intensity defeats extensiveness every time.

    This reminds me of the saying, “jack of all trades; master of none”. If you want to make progress in anything, it is important to prioritise and put your energy into the activities and thought patterns that will give you the best results. Law 23 also helps me to build upon my strengths rather than worrying too much about my weaknesses.

    Law 25:Re-Create Yourself

    Do not accept the roles that society foists on you. Re-create yourself by forging a new identity, one that commands attention and never bores the audience. Be the master of your own image rather than letting others define it for you.

    I often encourage my clients to clarify their most important values and see how these differ from what their family, friends, culture, or society may want. The idea of working hard and not enjoying life until retirement is not a role that I want to accept, even though this is considered normal in many respects by society. It’s much better to create and live a sustainable life for myself, whatever that may look like. Then it won’t matter if and when I retire, especially if I keep loving what I do for work.

    Law 28: Enter Action with Boldness

    If you are unsure of a course of action, do not attempt it. Your doubts and hesitations will infect your execution. Timidity is dangerous: Better to enter with boldness. Any mistakes you commit through audacity are easily corrected with more audacity. Everyone admires the bold; no one honours the timid.

    Law 28 reminds me not to doubt myself once I have settled on a course of action and fully commit myself to it for a set period of time instead of remaining uncertain or indecisive. Once a decision is made, it is much better to give it 100% until the next decision needs to be made. Uncertainty only leads to more stress and anxiety and less satisfaction in the long run.

    Law 29: Plan All the Way to the End

    The ending is everything. Plan all the way to it, taking into account all the possible consequences, obstacles, and twists of fortune that might reverse your hard work… By planning to the end you will not be overwhelmed by circumstances and you will know when to stop. Gently guide fortune and help determine the future by thinking far ahead.

    This reminds me of the benefits of thinking into the future and clarifying how I would want my life to look. For example, if I had a 50th birthday and someone close to me stood up and spoke about the person I had been for the past 18 years, what would I want to hear them say? Based on my response to this, it is then important to see if my 1-, 5- or 10-year plan is helping me to head in that direction. If not, more planning and some big changes may be required, as long as my plans are flexible enough to change as I continue to grow with time.

    Law 35: Master the Art of Timing

    Never be in a hurry — hurrying betrays a lack of control over yourself, and over time. Always (be) patient, as if you know that everything will come to you eventually. Become a detective of the right moment; sniff out the spirit of the times, the trends that will carry you to power. Learn to stand back when the time is not yet ripe, and to strike fiercely when it has reached fruition.

    Patience is a massively underrated value, especially in today’s society. How often do you see people multitasking or telling you how busy they are? I know I sometimes do. But slowing things down and really making sure that my attention is 100% on what is most important in any given moment is a great recipe for long-term happiness and well-being. While it is important to “strike while the iron is hot”, I think it is also important not to be too reactive and make sure that the decisions you make are really consistent with your values and long-term plans. Knowing how to say no to the wrong things in life is also a crucial element of success.

    Law 45: Preach the Need for Change, but Never Reform too much at Once

    Everyone understands the need for change in the abstract, but on the day-to-day level people are creatures of habit. Too much innovation is traumatic, and will lead to revolt. If you are new to a position of power, or an outsider trying to build a power base, make a show of respecting the old way of doing things. If change is necessary, make it a gentle improvement on the past.

    Trying to change my eating habits has taught me this law better than anything else recently. As soon as I try to be too restrictive, I rebel against any prescriptions. Long-term sustainable changes are again much better than short-term dramatic changes. The 20-minute walk that you manage to do is better than the 10km run you do not, so start small and try to build up slowly. If you can do this, changes are much more likely to stick.

    If you want to see the remaining 38 laws, please click here or purchase the book. Some of the laws seem pretty ruthless, but pretending that they don’t exist in power dynamics is much more dangerous than learning how they work.

    I also recommend checking out my dealing with toxic people article for more information on successfully managing and surviving difficult interactions.

    Dr Damon Ashworth

    Clinical Psychologist

  • 10 Things You Need to Know About Adverse Childhood Experiences

    10 Things You Need to Know About Adverse Childhood Experiences

    1. There are 10 categories of experience that are considered to have adverse consequences on the later development of children

    These include:

    • Abuse:
    • Emotional
    • Physical
    • Sexual
    • Neglect:
    • Emotional
    • Physical
    • Household Dysfunction:
    • Domestic Violence
    • Substance Abuse
    • Mental Illness
    • Parental Separation/Divorce
    • Crime

    2. It is possible to determine your own Adverse Childhood Experience (ACE) score

    The ACE score is a measure that has been designed to measure the cumulative nature of childhood distress.

    If you are interested in finding out your ACE score, please answer the following questionnaire from acestudy.org:

    While you were growing up, during your first 18 years of life:

    1. Did a parent or other adult in the household often or very often…

    • Swear at you, insult you, put you down, or humiliate you? or
    • Act in a way that made you afraid that you might be physically hurt?

    Yes? No? If yes, enter 1 _____________

    2. Did a parent or other adult in the household often or very often…

    • Push, grab, slap, or throw something at you? or
    • Ever strike you that you had marks or were injured?

    Yes? No? If yes, enter 1 _____________

    3. Did an adult or person at least 5 years older than you ever…

    • Touch or fondle you, or have you sexually touch their body? or
    • Attempt or actually have oral, anal, or vaginal intercourse with you?

    Yes? No? If yes, enter 1 ____________

    4. Did you often or very often feel that…

    • No one in your family loved you or thought you were important or special? or
    • Your family didn’t look out for each other, feel close to each other, or support each other?

    Yes? No? If yes, enter 1 ___________

    5. Did you often or very often feel that…

    • You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or
    • Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

    Yes? No? If yes, enter 1 ___________

    6. Were your parents ever separated or divorced?

    Yes? No? If yes, enter 1 ___________

    7. Was your mother or stepmother:

    • Often or very often pushed, grabbed, slapped, or had something thrown at her? or
    • Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or
    • Ever repeatedly hit at least a few minutes or threatened with a gun or knife

    Yes? No? If yes, enter 1 ___________

    8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

    Yes? No? If yes, enter 1 ___________

    9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

    Yes? No? If yes enter 1 ___________

    10. Did a household member go to prison?

    Yes? No? If yes enter 1 __________

    Now add up your “Yes” answers: __________ This is your ACE Score.

    3. Adverse childhood experiences are common

    Of the 17,337 individuals surveyed, here is the prevalence of each possible adverse experience, from most to least, represented as a percentage:

    • Physical abuse towards the child — 28.3%
    • Substance abuse in the household — 26.9%
    • Parental separation/divorce — 23.3%
    • Sexual abuse toward the child — 20.7%
    • Mental Illness in the household — 19.4%
    • Emotional neglect towards the child — 14.8%
    • Domestic violence in the household — 12.7%
    • Emotional abuse towards the child — 10.6%
    • Physical neglect towards the child — 9.9%
    • Imprisoned household member — 4.7%

    This graph from acestoohigh.com presents these percentages visually:

    4. It is more common to have an adverse childhood experience than not to have any

    As shown in the graph from cdc.gov, 64% of the population surveyed experienced at least one adverse childhood experience(ACE), with the majority of those reporting at least one ACE reporting multiple ACEs.

    Beyond the ACEs study, at least one in four children will suffer from physical, emotional or sexual abuse at some point during their childhoods, with one-in-seven children experiencing abuse or neglect in the past 12 months (Finklehor, Turner, Shattuck & Hamby, 2015).

    5. Adverse childhood experiences are linked with a higher risk of many things in later life

    This includes:

    • Alcohol abuse and dependence
    • Early smoking initiation and current smoking status
    • Illicit drug use
    • IV drug abuse
    • Obesity
    • Suicide attempts
    • Depression
    • Anxiety
    • Hyperactivity
    • Sleep Disturbances
    • Hallucinations
    • Eating disorders
    • Suicide attempts
    • Post-traumatic stress disorder
    • Conduct disorder
    • Teen or unintended pregnancies
    • Intimate partner violence
    • Improper brain development
    • Impaired learning ability and general cognitive difficulties
    • Attention and memory difficulties
    • Visual and/or motor impairment
    • Lower language development
    • Impaired social and emotional skills
    • Poorer quality of life

    Another long-term study indicated that approximately 80% of young adults who had previously been abused qualified for at least one psychiatric diagnosis at 21 (Silverman, Reinherz & Gianconia, 1996). Neglected or abused children are also 59% more likely to be arrested during childhood, 28% more likely to engage in criminal behaviour as adults, and 30% more likely to engage in violent crime as an adult (Widom & Maxfield, 2001).

    The graph below from vetoviolence.cdc.gov shows the increased risk of many conditions in individuals who have previously had adverse childhood experiences:

    As you can see, there is a higher risk of experiencing these difficulties for individuals with ACEs. However, the prevalence rate is NOT 100% for any of the factors. The importance of this should not be understated…

    Individuals who have had negative experiences during their childhood can still grow and flourish as adults and can also be more resilient due to learning how to overcome significant challenges when they are younger.

    A major longitudinal study even found that what goes right during childhood is often more important than what goes wrong. Having even one safe, stable and nurturing figure in a child’s life can reduce the later risk of psychological and physical health problems (Vaillant, 2015).

    6. Adverse childhood experiences are linked with a higher risk of later disease and early mortality

    This includes:

    • High Blood Pressure
    • High Cholesterol
    • Obesity
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Ischemic Heart Disease (IHD)
    • Liver Disease
    • Sexually Transmitted Infections (STIs)
    • Lung Cancer
    • Death Before Age 65

    As you can see in the table below from acestoohigh.com, individuals with an ACE score of 4 or more are at a significantly higher risk of developing later physical health conditions:

    Abuse and neglect during childhood can also negatively impact the ability of individuals to efficiently establish and maintain healthy romantic adult relationships (Colman & Widom, 2004). As relationship warmth and social connection are vital protective factors for long-term health and happiness, many of these more significant risks could at least be partially explained by the higher risk of interpersonal conflict, disconnection and isolation.

    7. The more adverse childhood experiences one has, the more significant likelihood they have of experiencing difficulties with their mental and physical health and overall well-being later in life

    A “dose-response reaction” exists with most risk factors and following conditions, in that the more adverse childhood experiences one has, the higher their risk is for adverse outcomes later in life, as shown in the above graphic from cdc.gov.

    8. It is possible to conceptualise how these adverse childhood experiences lead to an early death

    The ACE Pyramid from cdc.gov suggests that adverse childhood experiences contribute to premature death via four intermediate processes that develop in a sequential nature:

    9. Reducing adverse experiences of childhood will significantly improve public health and reduce the burden that these issues have on individuals and the society

    Childhood abuse and neglect are not just damaging to the individual. They also place a substantial financial strain on society, with an estimated total lifetime economic burden of approximately $124 billion (2010 dollars) in the US in 2008 (Fang, Brown, Florence & Mercy, 2012). This is similar to the financial burden of other public health issues, such as diabetes and stroke.

    The main reasons for the increased economic burden are lost productivity, followed by increased medical costs, special education, child welfare and criminal justice costs (Fang, Brown, Florence & Mercy, 2012).

    Even though it may be expensive to develop and implement programs that aim to prevent child neglect and abuse, the benefits of these programs, if valid, are very likely to outweigh the costs in the long run.

    10. We need to do something to address and lower the prevalence of ACEs in future generations

    Creating safe, stable and nurturing environments (SSNREs) is the key to positively impacting reducing ACEs from now on.

    The five best practices to do this is shown in the graph below:

    The US Centers For Disease Control (CDC) also suggests:

    • Greater treatment for mental illness and substance abuse
    • More high-quality child care, and
    • More financial support for low-income families.

    Conclusion

    Please help to get this information out there to as many people as possible. Also, if you found something of value in this article, please share it or pass it onto whoever else may benefit too!

    Dr Damon Ashworth

    Clinical Psychologist

  • Are You Asking the Right Questions In Your Search For a Therapist?

    Are You Asking the Right Questions In Your Search For a Therapist?

    If you were searching the web as a consumer, looking for the best Psychologist, would you know what to search for?

    If you said that you would look for someone experienced, it is a good guess, but years of experience don’t seem to make too much of a difference in improving therapeutic outcomes (Minami et al., 2009).

    What may be necessary is that they are a Psychologist and not a Counsellor. In Australia, anyone can call themselves a Counsellor and open up a practice, even without training. However, if they are a Psychologist, they have to have completed at least four years of undergraduate training, plus a post-graduate degree or at least two years of formal supervision. Psychologists are also obliged to abide by the Australian Psychological Society’s (APS) code of ethics, whereas Counsellors are not.

    If you said the company they worked for or how much they charged, these are both good guesses. However, private practice Psychologists are self-employed and set their price for their service, or a company employs and sets their price for them. Therefore, it is unlikely that all Psychologists within the same practice are equally effective, even if they are charging the same amount.

    The current recommended rate for a 45–60 minute Psychological consultation in Australia is set at $238.00 by the APS, but all Psychologists have the discretion to vary this fee. For example, services in more affluent locations often charge more, whereas services in poorer areas often charge less.

    More expensive Psychologists may believe themselves to be better Psychologists too, but this doesn’t mean that they are. The self-evaluations of therapists are often not very accurate, with a largely positive bias suggesting overconfidence in their general abilities. In a 2012 study by Walfish, McAllister, O’Donnell, and Lambert (2012), they found that out of the 129 therapists surveyed, 25% estimated that their therapy results were in the top 10% compared to the other therapists. Not a single therapist believed that they were worse than the average. If this sample represents the general population, this means that at least 50% of Psychologists don’t realise how bad they are and may therefore not be aware of what they are doing wrong and what they need to do to improve.

    What is known is that some Psychologist’s do consistently outperform other Psychologists (Wampold & Brown, 2005). In a 2015 study by Brown, Simon and Minami (2015), they looked at 2,820 therapists, with a combined sample size of 162,168 cases. The researchers found that the lowest-performing therapists required three times more sessions to produce successful outcomes than the average therapist. They also needed as much as seven times the number of sessions as the highest-performing therapists. So choosing the right Psychologist is a crucial task. But,

    What characteristics do the best Psychologist’s have, and what do they do that makes them so successful?

    1. They practice a specific model of treatment that is most recommended for your condition or is a good fit for the type of therapy you are interested in

    (Model of Treatment = 15% of overall outcome variance)

    There are many different schools of Psychotherapy, such as CBT, ACT, DBT, Positive Psychology or Psychodynamic Psychotherapy. They will all have research supporting their treatments as effective, especially with specific conditions (such as DBT for Borderline Personality Disorder or CBT for Panic Disorder).

    What they won’t often advertise is that no matter what school of therapy it is:

    • None of them will help every client
    • The drop out rates can be pretty high
    • Clients who do drop out prematurely tend to fare worse than clients who can complete treatment, and
    • Other psychotherapy schools tend to produce similar results.

    So yes, therapy helps, sometimes, and for some people. However, it is perplexing to think how the research findings are all so similar in the different schools of psychotherapy (Wampold, 2001) until it is made clear that non-specific treatment factors are shared across the various schools of psychotherapy. These non-specific factors are described below and together contribute 85% of the overall outcome variance in psychotherapeutic studies (Hubble and Miller, 2004).

    Whilst one mode of therapy may not generally be more effective than another, the goodness of fit does seem to be necessary. So try to choose a Psychologist who has experience in treating your particular concern, as well as an approach or therapy model that seems to make sense or appeal to you.

    2. They help you to hope, expect and believe that you can improve

    (Expectancy of Treatment Effects = 15% of overall outcome variance)

    An individuals’ belief that they can improve has a powerful impact on their actual improvement (Bergsma, 2008). More considerable reductions in symptom severity occur post-treatment in those with higher expectations of benefit at pre-treatment (Ogles, Lambert, & Craig, 1991; Rutherford, Sneed, Devanand, Eisenstadt, & Roose, 2010).

    Greater expectations can improve hope and increase goal-directed determination, which has been shown to predict treatment completion (Geraghty, Wood, & Hyland, 2010).

    Greater expectations of treatment outcomes can also improve distress tolerance. These skills can reduce distress and depression severity across treatment (Williams, Thompson, & Andrews, 2013).

    Essentially, the more you expect that a Psychologist can help you, the more likely it is that you will have hope, persist with treatment, and get better.

    3. They develop a warm, caring and trustworthy environment where you feel safe to explore and grow

    (Therapeutic Alliance = 30% of overall outcome variance)

    Another critical issue influencing treatment outcomes is adherence to the treatment interventions, recommendations and strategies. A positive therapeutic alliance can improve compliance with treatment recommendations, which plays a vital role in the overall success of a psychotherapy treatment (Wampold, 2001).

    A positive therapeutic alliance improves outcomes by providing professional input and ensuring effective implementation of the strategies. In addition, if a therapeutic alliance can be established, developed and maintained (Cahill et al., 2008), patients are less likely to drop out of treatment and more likely to achieve clinically significant improvements (Miller, Hubble, & Duncan, 2008).

    Regardless of the theoretical orientation or the therapist’s experience, the best outcomes happen when therapists are flexible to the needs of the patient and responsive to the feedback that patients provide. They also repair any ruptures in the therapeutic alliance as quickly as possible (Cahill et al., 2008; Miller et al., 2008).

    Other research suggests that it is crucial to meet relatedness needs, dependent upon the therapist displaying warmth and genuine involvement in the treatment. As a result, the client feels a sense of caring and connection in the relationship (Ryan & Deci, 2008).

    Essentially, the more you can relate to the Psychologist and feel that you are allies working towards a common objective, the more likely you are to improve.

    4. They make sure that therapy is the right step for you at the moment and help you to develop the skills, knowledge and motivation needed to improve successfully

    (Client’s Life-Circumstances, Personal Resources and Readiness to Change = 40% of outcome variance)

    The client is the most significant factor in determining whether or not treatment will be successful, which may be surprising to some people. However, suppose their current life circumstances are unstable, unpredictable, and emotionally or physically unsafe. In that case, it will be difficult for the one hour of therapy every week or two to be sufficient to overcome all of the adverse events that are taking place between sessions.

    Not everyone is a good candidate for therapy, and therapy isn’t everybody’s cup of tea. For example, suppose a client prefers not to question things, has significant cognitive disabilities or memory difficulties, is currently manic or severely delusional or psychotic, or is too emotionally labile or reactive in close interpersonal settings. In that case, therapy can have no effect or be potentially harmful.

    Lastly, if a client does not believe that they have a problem, then there is not too much that can be done by a Psychologist to help them, even if their family or friends or partner or the legal system believes that a problem exists. Unless the client can create intrinsic motivation for change, positive change is unlikely to occur.

    Before seeing a Psychologist, you need to be sure that:

    • You want to change or improve something about yourself
    • You are willing to put in the time and effort that it requires
    • You are eager to explore things to develop and grow, and
    • Now is a good time for you to begin the amount of treatment (both frequency and duration) recommended for you.

    If you follow these recommendations when seeking out a Psychologist, it will not guarantee a successful outcome, but it will help. I wish you the best of luck with your search and therapeutic experience!

    Dr Damon Ashworth

    Clinical Psychologist

  • The Top 20 Movies of My Lifetime (10-1)

    The Top 20 Movies of My Lifetime (10-1)

    Looking at the American Film Institute’s 100 Greatest American Films of All Time list that came out in 1998, most films are super old. For example, ‘Citizen Kane’ (1941) ranked at #1, ‘Casablanca’ (1942) ranked at #2, ‘The Godfather’ (1972) ranked at #3, ‘Gone With the Wind’ (1939) ranked at #4 and ‘Lawrence of Arabia’ (1962) ranked at #5.

    I loved ‘The Godfather’ but fell asleep in ‘Casablanca’ and ‘Lawrence of Arabia’. However, I agree with ‘Gone With the Wind’ being up there, especially seeing that it is the highest-grossing movie of all time, adjusted for inflation. I also need to see ‘Citizen Kane’ before making any judgments on it, but I tend to like modern movies more than most movie critics.

    Out of the entire top 100, only 8 came out after 1985, the year that I was born:

    • Schindler’s List (1993) — #9
    • The Silence of the Lambs (1991) — #65
    • Forrest Gump (1994) — #71
    • Dances with Wolves (1990) — #75
    • Platoon (1986) — #83
    • Fargo (1996) — #84
    • Goodfellas (1990) — #94
    • Pulp Fiction (1994) — #95

    None of these movies made my top 20 countdown either, so clearly, the movie critics and I don’t always see eye to eye.

    In 2008, the AFI came out with their 10th-anniversary list, and ‘Raging Bull’ (1980) and ‘Singing in the Rain (1952) had replaced ‘Gone With the Wind’ and ‘Lawrence of Arabia’ in the top 5. The top 100 choices were still predominantly old movies, with only 14 movies released after 1985:

    • Schindler’s List — #8
    • The Lord of the Rings: The Fellowship of the Ring (2001) — #50
    • Unforgiven (1992) — #68
    • Saving Private Ryan (1998) — #71
    • The Shawshank Redemption (1994) — #72
    • The Silence of the Lambs — #74
    • Forrest Gump — #76
    • Titanic (1997) — #83
    • Platoon — #86
    • The Sixth Sense (1999) — #89
    • Goodfellas — #92
    • Pulp Fiction — #94
    • Do the Right Thing (1989) — #96
    • Toy Story (1995) — #99

    There were two movies from my top 20 countdown in the list, which makes me feel a little better. Interestingly, ‘Fargo’ and ‘Dances With Wolves’ became less admired over time and dropped out of the list. On the other hand, ‘Unforgiven’, ‘The Shawshank Redemption, ‘Titanic’, ‘Do the Right Thing’ and ‘Toy Story’ became more admired since 1998 and made the 10th-anniversary list after missing the first countdown. I hope they come out with another list in 2018 to mark the 20th anniversary and look forward to seeing what they include.

    After seeing a movie these days, I get interested in knowing what movie critics thought of the movie. Rotten tomatoes is a great website that accumulates all of the professional movie critics reviews on a particular movie and gives an aggregate score out of 100% based on how many reviews are positive for the film. Here are the Tomatometer ratings for numbers 20 through to 11 in my top 20 movies of my lifetime countdown:

    #20 — The Conjuring (2013) — 86%

    #19 — The Castle (1999) — 88%

    #18 — Midnight in Paris (2011) — 93%

    #17 — Groundhog Day (1993) — 96%

    #16 — Donnie Darko (2001) — 86%

    #15 — Before Sunrise (1995) — 100%

    #14 — The Truman Show (1998) — 94%

    #13 — The Sixth Sense (1999) — 85%

    #12 — Inglourious Basterds (2009) — 89%

    #11 — Good Will Hunting (1997) — 97%

    To qualify for this countdown, I need to have seen the movie, enjoyed it, and found that it had an emotional impact on me somehow. Here is my top 10, with their IMDb star rating and their rotten tomatoes Tomatometer score:

    # 10 — Eternal Sunshine of the Spotless Mind (2004) — IMDb star rating: 8.3/10, rotten tomatoes Tomatometer = 93%

    The tagline for the movie says it all: “You can erase someone from your mind. But, getting them out of your heart is another story.” A strange but touching movie about a couple who keep going to a memory clinic to try and erase the memories of someone they love in the hope that they can move forward with their lives. However, without even knowing why, something keeps bringing them back together. Seeing that Jim Carrey now has 2 movies in my top 20, it seems that he should have played serious roles more often.

    # 9 — Requiem for a Dream (2000) — IMDb star rating: 8.4/10, rotten tomatoes Tomatometer = 78%

    I feel like this should be shown to anyone who thinks that drugs are cool, especially teenagers. I haven’t spoken to anyone who has watched this movie and hasn’t had a strong visceral reaction to it, either positive or negative. It may be why it has the lowest Tomatometer score out of any movie on my countdown. The director Darren Aronofsky achieved more critical acclaim for his 2010 movie ‘Black Swan’, which was also quite unsettling to watch, but this one had more of an impact on me.

    # 8 — The Lion King (1994) — IMDb star rating: 8.5/10, rotten tomatoes Tomatometer = 92%

    Drawing inspiration from William Shakespeare’s ‘Hamlet’, I was obsessed with ‘The Lion King’ when I was younger, and it first came out. The story and the music were amazing, and I bought the soundtrack on CD and the movie on VHS as soon as they were released. It’s heartbreaking, uplifting and hilarious, and my favourite Disney cartoon of all time.

    # 7 — Back to the Future (1985) — IMDb star rating: 8.5/10, rotten tomatoes Tomatometer = 96%

    A movie that nearly wasn’t made. When the writer and director first sent the script of ‘Back to the Future’ around to the Hollywood studios, nobody wanted to touch it. The studios knocked it back about 50 times, and it wasn’t until the director had success with another movie that it was greenlit for production. A movie about a hero who befriends a weird old scientist who takes him back into the past where he has to evade his biological mother, who is crushing on him, seems like a weird premise for a movie. However, it became a massive box office hit with two sequels and a huge fan base even to this day. Time travel, when done well, is another truly magical aspect of going to the movies. Being able to learn about where you have come from and what your parents were like when younger is another really fascinating thing that we will never be able to see unless they captured it on video.

    # 6 — The Usual Suspects (1995) — IMDb star rating: 8.6/10, rotten tomatoes Tomatometer = 88%

    “The smartest trick the devil ever pulled was convincing the world he didn’t exist”. A very clever movie by Bryan Singer and the best in his career, in my opinion, although some of his X-Men movies were good too. But, like ‘The Sixth Sense’, it also has a twist at the end that completely changes the viewing experience of the movie. Who is Keyser Söze? It would be best to watch to find out and then see it a second time to see what signs you missed.

    # 5 — The Matrix (1999) — IMDb star rating: 8.7/10, rotten tomatoes Tomatometer = 87%

    I remember the marketing campaign in Australia when it first came out — “What is the Matrix?” It gave nothing away about the movie and yet made me feel like I had to watch it or I would miss out. Once I saw it, it blew my mind. Probably the most original action movie that I have ever seen. It has been copied and emulated many times since, so it probably doesn’t seem groundbreaking these days, but the bullet-dodging and slow-motion sequences were amazing. I wish they didn’t bring out the sequels, as they took away some magic from the first movie. If you had a choice, would you take the red pill and be exposed to the truth, or would you take the blue pill and live in ignorant bliss?

    # 4 — Inception (2010) — IMDb rating: 8.7/10, rotten tomatoes Tomatometer = 86%

    Another very creative and inventive premise with great visual effects. I think Christopher Nolan is a great director, and he likes to get his audiences to think. The difference between reality and dreams is something that has come up a few times on this list. Still, Inception takes it to a whole new level, saying that we can implant an idea into the subconscious mind of someone else during their sleep to impact their behaviour when they are awake. The way that time is altered at the different levels of dreams is great. Also, the spinning top at the movie’s end leaves the interpretation of what happened wide open.

    # 3 — Fight Club (1999) — IMDb star rating: 8.8/10, rotten tomatoes Tomatometer = 79%

    David Fincher is another of my favourite directors. He has an especially great knack for turning good books into excellent films, including this, ‘Gone Girl’ and ‘Girl With a Dragon Tattoo’. The antisocial, antimaterialistic and anarchistic nature of this film really appealed to me at the time. It made me question what I thought I knew about what was important in this world. It didn’t make me want to start a fight club or punch anyone, but to live a life that was more autonomous and genuine. The surprise ending is almost as good as ‘The Sixth Sense’ and ‘The Usual Suspects’ too.

    # 2 — The Dark Knight (2008) — IMDb star rating: 9.0/10, rotten tomatoes Tomatometer = 94%

    This movie is epic in scale and is really all about Heath Ledger as the Joker. I was concerned that he wouldn’t size up to Jack Nicholson’s version, but he surpassed it in every way possible and stole the scene whenever he was on the screen. It is one of the greatest performances of all time, in my opinion, and he truly deserved the Oscar for the role, especially considering the toll that it seemed to take on his emotional and psychological well-being. It was annoying that the character of Rachel changed from Katie Holmes in ‘Batman Begins’ to Maggie Gyllenhaal. Apart from that, this is the greatest Batman movie of all time, and the car chase scene through the tunnel is also the best chase scene of all time.

    # 1 — The Shawshank Redemption (1994) — IMDb star rating: 9.2/10, rotten tomatoes Tomatometer = 91%

    The highest-rated movie of all time on IMDb and, therefore, well-deserving of the #1 movie on my list. Interestingly, this wasn’t a big hit when it first came out but continued to build an audience over time once released for home movie consumption. Morgan Freeman is always great in movies, especially when he plays the narrator, but this one is his best. The ending is exceptionally uplifting, too and would give hope to even the most cynical viewer out there.

    Thanks for checking out my list. Do let me know if you agree or disagree with any of these titles in the comments section below or if you think another title should have made the countdown!

    Dr Damon Ashworth

    Clinical Psychologist

  • The Top 20 Movies of My Lifetime (20-11)

    The Top 20 Movies of My Lifetime (20-11)

    A list like this will always be subjective, and I don’t expect others to agree with it. However, I still think it is worth highlighting the movies that have significantly impacted my life and why this is the case. If you believe something amazing is missing from the list, please let me know in the comments section below.

    I was born in 1985, so the movies on the list have been released in 1985 or later. All films on the list also have to be movies:

    • that I have personally watched,
    • that I have personally enjoyed, and
    • that have emotionally impacted me in some way.

    WHY MOVIES ARE IMPORTANT

    Unfortunately, the longer I practise psychotherapy, the more I can see its limitations. Over time, it has become easier for me to look at the traps that people consistently fall into and the logical steps people need to overcome these difficulties.

    However, people are not just logical creatures. They have emotional reactions to things based on their past experiences and beliefs. Therefore, for long-term change to occur, we need to connect and bring about change emotionally.

    This is where stories become relevant. Whether through a good fiction book or a great movie, stories can connect with us emotionally and move us more than a rational argument ever could. Without further ado, here is my list, ranked based on their IMDb star rating:

    # 20: The Conjuring (2013) — IMDb star rating: 7.5/10

    Quite simply, I have never been more scared watching a horror movie in the cinema than this one. I locked my arms between the armrests so that I didn’t jump too much, and the amount of sweat I produced by the end of the movie was intense. The sequel is almost as good, but the scene where the mother wakes up and thinks that her kids are playing a clap-clap version of hide and seek is genuinely terrifying. James Wan is a master of his craft, and his supernatural stuff is much better than the Saw series.

    I was tempted to include ‘Wake in Fright’, the Australian outback horror, instead of this as it has a higher IMDb rating and was an uncomfortable watch. However, the success of a scary movie needs to be about how scary it is, and therefore ‘The Conjuring’ is the perfect way to kickstart the list.

    # 19: The Castle (1997) — IMDb star rating: 7.7/10

    My only Australian movie on the list. I was thinking about my most quoted movie of all time, and this is a close battle with ‘Anchorman: The Legend of Ron Burgundy’ and ‘Happy Gilmore’, however ‘The Castle’ has a higher star rating and gets the nod for being an Aussie film. From “tell ’em to get stuffed” to “the vibe” to “the serenity” to “he’s an ideas man” to “we could talk for hours” and “I dug another hole”, The Castle is a truly classic Australian film. For anyone who hasn’t seen it yet, please do yourself a favour and check it out. Truly knee-slapping fun.

    # 18: Midnight in Paris (2011) — IMDb star rating: 7.7/10

    It is the best Woody Allen film by far, in my opinion. Many people might say ‘Manhattan’ or ‘Annie Hall’ or even ‘Hannah and Her Sisters’ may be better, but I tend to prefer the movies that Woody actually doesn’t appear in himself. When Owen Wilson’s character gets to go back in time and meet F. Scott Fitzgerald and Ernest Hemingway and Salvador Dali and Pablo Picasso, this is movie magic at its finest. Plus, Marion Cotillard as Adriana is magical too. I’d escape Rachel McAdams as Inez for her any day.

    # 17: Groundhog Day (1993) — IMDb star rating: 8.0/10

    Just brilliant, in my opinion, and the best Bill Murray film by far. What would you do if you were stuck living the same day over and over again in a town that you didn’t want to be in? The main character, Phil, first tries to take advantage of others. He then commits crimes, tries to kill himself, learns skills, helps others and finally finds true love. Another great example of movies teaching us something using a method that couldn’t possibly happen in real life.

    # 16: Donnie Darko (2001) — IMDb star rating: 8.1/10

    This is an example of the right movie at the right time. I was experiencing a lot of suicidal ideation when this movie came out in 2001, and the main song from the movie ‘Mad World’ by Gary Jules connected with me in a way that not much else did. It seems to be the closest depiction I’ve seen of ‘The Catcher in the Rye’, my favourite novel at the time by the author J.D. Salinger. It was a dark time for me, and Donnie Darko really helped me to feel that I wasn’t alone in my struggle. It looked to be the start of a promising career by director Richard Kelly, but he doesn’t seem to have done much since 2009’s ‘The Box’.

    # 15: Before Sunrise (1995) — IMDb star rating: 8.1/10

    I enjoyed all three films in this trilogy, but the first one was my favourite by far. Two strangers, randomly meeting each other on a train in a foreign land, spending the night together wandering around the streets of Vienna and developing a powerful connection in the process. I also really liked ‘Boyhood’ and ‘Dazed and Confused’ from Linklater, but ‘Before Sunrise’ takes the cake for why I love travelling and meeting new people and saying yes to spontaneous experiences.

    # 14: The Truman Show (1998) — IMDb star rating: 8.1/10

    This and ‘EdTV’ were really at the forefront of the reality TV movement that has taken over commercial TV these days. ‘The Truman Show’ is a much better movie, however. Who hasn’t imagined themselves as the main character in a story? I know I have. What if everything was just a set-up to create conflict and tension for the millions of viewers out there? Would you like this, knowing that you are likely to be safe and cared about for the rest of your life? Or would you rather break free and experience an authentic and genuine life experience and give yourself a chance of finding real love and happiness? We all have a choice between what is expected of us and what we would really like to do.

    # 13: The Sixth Sense (1999) — IMDb star rating: 8.1/10

    Unfortunately, one of my friends spoiled the twist at the end of this movie before I saw it, so I’ll never get to experience watching it without knowing what was actually happening. However, I still loved it, which is a true credit to how great the movie is. Early on, I would have listed M. Night Shyamalan as one of my favourite directors. How far his and Haley Joel Osment’s career fell after this gives you an indication of how fickle Hollywood can be, but it was nice to see the director return to some form with the recent ‘Split’. Hopefully, his upcoming sequel to ‘Unbreakable’ will be good too. At its essence, ‘The Sixth Sense’ is an exploration of the topic of grief. I wonder what mediums think of this movie and its most famous quote, “I see dead people”?

    # 12: Inglourious Basterds (2009) — IMDb star rating: 8.3/10

    The best Tarantino movie, in my opinion. The tension he can create through dialogue is amazing, especially with the extended scene at the beginning of the film and the even more extended scene in the basement bar. Tarantino is a movie nerd through and through, and many people will say that ‘Pulp Fiction’ is his masterpiece, but this is better than that in many ways for me. Christoph Waltz was amazing, and getting to revise history in a way that leads to Hitler being shot in the face by a machine gun would have no doubt be satisfying to many. However, it also shows that big budgets and lots of action can never make up for poor dialogue when building up suspense. It’s a pity ‘The Hateful Eight’ was so bad. Here’s hoping that Mr Tarantino makes a return to form with his next film.

    # 11: Good Will Hunting (1997) — IMDb star rating: 8.3/10

    My favourite movie on therapy and the benefits that it can bring. It’s great to see Robin Williams in some of his more serious roles, too, including this one, ‘What Dreams May Come’ and ‘Dead Poets Society’. The scene where Robin Williams character Sean says to Matt Damon’s character Will that it’s not his fault for the prior abuses that have taken place in his life is compelling, as it finally leads to a breaking down of the barriers that Will puts up to defend himself. This is all too obvious with many of the clients that I see who have had abusive pasts. Many of them continue to treat themselves as harshly as their perpetrators once treated them. It is heartbreaking to see it time and time again, and I wish that they too could truly grasp and genuinely feel that they were not responsible for the abuses that they have suffered.

    Stay tuned for #10 through to #1…

  • Trauma – What is it and what can we do about it?

    Trauma – What is it and what can we do about it?

    What is Trauma?

    The Diagnostic and Statistical Manual for Mental Disorders (DSM-V) describes a traumatic experience as exposure to an event that involves death, serious injury (actual or threatened), or sexual violence (actual or threatened). It usually creates intense feelings of helplessness, horror, or fear in the individual. It is direct exposure to an event that causes trauma but can also be caused by witnessing an incident that happened to someone else. Other forms of trauma include indirect exposure by hearing about a close friend or family member undergoing trauma, or through extreme or repeated exposure to aversive details of an event, typically through professional duties, such as first responders to a fatal crash site, or repeated exposure to information of child abuse.

    Trauma can create long-standing changes in the brain. For example, imaging studies have shown heightened brain-stem activity, which controls the fight-or-flight (or freeze) system. It is the brain’s inbuilt survival mechanism. Imaging studies also show increased amygdala activation, which floods the body with feelings of fear. These changes can be pretty effective in keeping people safe in times of imminent danger. They allow individuals to scan the environment and react quickly to anything perceived as dangerous.

    The problem is that once these areas of the brain become overreactive, they will respond to anything that is potentially similar to a traumatic experience from the past without first trying to assess the actual level of threat accurately. As a result, it makes it more difficult to respond calmly and rationally in an individual’s everyday life.

    The hippocampus, an area of the brain responsible for memory, can also be severely affected by traumatic events. The more extreme, unexpected, and inconsistent an event is with previously held beliefs about themselves, the world or other people, the harder it is for the brain to fully process and integrate this experience. As a result, some of it remains unprocessed or “stuck”, which reduces the capacity to move on from the traumatic event and process and integrate following information taken in by the senses.

    Re-experiencing symptoms, such as flashbacks and nightmares, are thought to be the brain’s attempt to process and integrate the traumatic experience. As scary as this can be, it generally does help in healing and resolving trauma symptoms over time. Unfortunately, with Post-traumatic stress disorder (PTSD), the brain continues to be unable to process and integrate what has taken place. As a result, it can lead to devastating consequences and severe functional impairment for the individual suffering from the condition, especially if they don’t understand the symptoms or what to do with them when they occur.

    How to Best Respond to Each Cluster of Trauma Symptoms:

    Four clusters of symptoms indicate that a person suffers from an acute stress reaction or post-traumatic stress disorder after exposure to a traumatic event. Even if you do not have all of these symptoms, it can still be helpful to know what is occurring when you experience these symptoms after trauma and what you can do about it.

    A: Intrusion symptoms — This includes intrusive memories, traumatic nightmares, dissociative reactions, such as flashbacks, and marked physiological reactivity and intense or prolonged distress after exposure to trauma-related stimuli or reminders.

    When these intrusive symptoms occur, our brain rushes back to the past and starts to think and feel the same way it did when the traumatic event occurred. The mind feels in imminent danger, and the initial feelings of intense helplessness, horror or fear come rushing back in.

    I have found a grounding process to be most effective when this occurs, as it helps me reconnect with my senses at the moment and brings my brain back from the past to the present.

    Next time an intrusive symptom occurs, ask yourself the following:

    1. What are five things that I can see right now?
    2. What are four things that I can touch/feel right now?
    3. What are three things that I can hear right now?
    4. What are two things that I can smell right now?
    5. What is one thing that I can taste right now?

    Once you are present, ask yourself, “Am I safe right now?” If you are in danger, remove yourself from the situation. If not, you are not at risk of harm and instead need to focus on reducing your distress and physiologic reactivity through self-soothing activities.

    The more that these activities can engage you and your senses at the moment, the better, as it will help you to continue to feel present and safe. Grounding must occur first, though, or the brain will want to stay in a hypervigilant state to protect you from the perceived threat, even if the danger is only a memory in your head.

    B: Avoidance — Persistent avoidance of distressing external (people, places, conversations, activities, objects or situations) or internal (thoughts or feelings) reminders of the trauma

    Avoiding any reminders of the trauma in the first month after the incident is a good thing, as it can lower your arousal levels and reactivity, assisting your recovery.

    Ongoing avoidance of these reminders, particularly after a month, is not recommended, however, and may prevent a full recovery. Chronic avoidance prevents processing and integration of the traumatic event. Moreover, it sometimes means that people begin to avoid more and more things that may seem dangerous when they are logically relatively safe.

    Gradual exposure to the things you fear (as long as they are relatively safe) is essential in treating an anxiety disorder, including PTSD. I have gone through the steps of doing this in my first article titled “Feel the Fear and Do It Anyway”. I followed these steps to challenge myself to get outside at night and stop hiding when cars came past. It did get more comfortable with each time as I realised that my fear of being attacked was much higher than the actual probability of it occurring (it’s never happened again).

    Also, remember that we cannot entirely run away from our thoughts and feelings. Acceptance and Commitment Therapy teaches Defusion and Expansion skills to help us better manage our thoughts and emotions. Research shows that these are more effective long-term strategies than continually avoiding internal reminders of trauma through drugs and alcohol, emotional eating, meaningless distractions, or keeping busy all the time.

    C: Negative alterations in cognitions and mood — including the inability to recall critical components of the trauma, persistent and distorted negative beliefs and expectations about oneself, others or the world, or blame of self or others for causing the traumatic event or its consequences, persistent negative emotions, including anger, fear, horror, impending doom, guilt and shame, diminished ability to experience positive emotions, as well as loss of interest and engagement in previously important activities, and feeling isolated, alienated, detached or estranged from others.

    Exposure-based treatments, particularly cognitive processing therapy, are essential for addressing the extreme shifts in cognition and beliefs that can occur after trauma, particularly if they prevent you from doing the things you used to enjoy.

    If you are feeling detached or physically or emotionally numb, movement can help a lot. It doesn’t matter what type of movement, but there’s a bonus if you enjoy it. So the next time you feel this way, go for a walk or run, stretch or try yoga, play a sport or even twist and dance. They all may help bring you back into your body more and feel a bit less distant and more connected.

    Writing about how your beliefs and feelings have changed or explaining these changes to a friend that you can trust can help you feel more connected and better in time, but it should be done in collaboration with a therapist if you are concerned about how you may react.

    If I ever felt disconnected, which happened occasionally, I found any movement to be the best strategy to reconnect. It could be playing a sport, doing yoga or Pilates, weight lifting, walking or running outside, or even dancing. Anything that helps you get out of your head and into your body or the world around you.

    D: Alterations in arousal and reactivity — trouble falling asleep or staying asleep, difficulty concentrating, feeling jumpy or easily startled, and being super alert or watchful.

    Learning emotional regulation and distress tolerance skills are critical to managing arousal levels, which diminishes reactivity.

    Emotional regulation skills include adequate rest, recovery, leisure and socialising, or ensuring that things are in the right balance. For example, too much work and stress without sufficient breaks will slowly increase our arousal levels over time. Ensuring that we minimise caffeine and alcohol intake, eat a healthy, well-balanced diet and get a consistent 7 hours of sleep each night also help us to lower our arousal levels and better regulate our emotions.

    Distress tolerance skills include relaxation and mindfulness skills, as well as a distraction at times. Practising these regularly when you feel calmer makes them easier to implement when you are most distressed so that things do not become too overwhelming for too long and you can calm yourself down.

    Diagnosis of PTSD and Recommended Treatments

    All four symptom clusters must be present to a significant degree and cause significant distress or functional impairment to warrant a diagnosis of PTSD.

    If you are concerned that you may have PTSD from a trauma that you experienced more than a month ago, please complete the Post-traumatic Checklist for the DSM-V (PCL-5) questionnaire, which you can access for free online. If you score above 38 on this checklist, I encourage you to visit your GP or primary care physician to discuss the matter further and collaboratively decide on which treatment path you would like to go down.

    Sometimes a referral to a Psychologist or Psychiatrist will be essential to give you the best chance of making a full recovery.

    It is vital to realise that the most effective psychological therapies for trauma all include exposure (imaginal or in vivo) to parts of the traumatic experience or the impact it has had on you. For example, it could be trauma-focused cognitive behavioural therapy (CBT), Cognitive Processing Therapy (CPT), or Eye Movement Desensitisation and Reprocessing (EMDR) Therapy. All are considered first-line approaches for treating PTSD in Australia (NHMRC, 2007) and should be recommended before pharmacological interventions or alongside antidepressants (SSRIs) if sufficient benefits have not occurred through psychotherapy alone.

    Even 8–12 sessions of 60–90 minutes of therapy are usually sufficient in treating PTSD. You can then address any co-morbid issues in further treatment once the PTSD symptoms have subsided.

    Traumatic events can change the brain and the way that we respond to situations afterwards. Often the brain can heal itself over time, especially if we are engaging in the right strategies. However, if it doesn’t, practical psychological help is available, and it can make a big difference in helping you heal and grow.

    You can also check out my new podcast ‘Deliberately Better’, which discusses PTSD and how to manage it.