Why Bother Overcoming Fears?

Last weekend I managed to successfully complete my PADI Open Water SCUBA Diver Course:

PADI Temporary Card

Open Water Diver

Name: Damon K. Ashworth

Diver No.: 1902AA8575
Cert Date: 16-Feb-2019
Instructor Number: 305944
Store/Resort Name:Big Blue
Store Number:36279
This person has satisfactorily met the standards for this certification level as set forth by PADI.
It was a pretty big challenge for me since I don’t really like being on boats and find it scary just swimming out in the middle of the ocean. I did it though because a close friend asked me if I would be her dive buddy for the course, and I thought that there would be no better opportunity than when I am already living in Vanuatu, home to some of the best dive sites in the world.
To get your Open Water Card, you need to pass a bunch of theory about diving, and you need to complete 24 skills in a pool and then replicate these skills out in the open water across four dives. During the open water dives, we saw a shipwreck, some amazing coral and sea life, and even a few small reef sharks.
The scariest part to me was when I was up to 18 metres underwater, and knowing that I’d need to stop for 3 minutes at 5 metres on the way up and also ascend slowly to avoid decompression sickness. It meant that if for whatever reason I felt a bit anxious or panicky, I couldn’t just get out to the surface straight away and start gasping for air. I had to try to remain calm, breathe slowly and steadily using my regulator, put some confidence in my dive master who was guiding us through the training and focus on whatever was in my control instead of worrying about things that were out of it.
It’s done now, and I completed the dives and all the skills successfully. Some times were pretty cool, especially seeing the wreck and all the sea life on the coral reef. In general, though, I didn’t love it and was utterly exhausted and a little bit relieved once it was done.
So how do I know if it was worth it? Should I have bothered challenging myself to do something where I actually worried that I could have died if something went badly wrong?
backlit black candle candlelight

When Is It Worth Facing Your Fears?

The answer is it depends. It depends on:

  1. What you are afraid of?
  2. How afraid you are (on a scale from 0 = no anxiety at all to 10 = completely overwhelmed and having a panic attack)?
  3. How safe or dangerous the thing you are afraid of actually (or realistically) is? and
  4. How much of an impact it will have on your quality of life if you do not face up to your fear or try to overcome it?

If what you fear has a low risk of actually occurring AND the activity is quite safe even though it feels scary AND not doing it has a significant negative impact on your life, IT IS WORTH TRYING TO CHALLENGE YOURSELF AND FACE YOUR FEARS.

For me:

  1. I think the fear of SCUBA diving was dying.
  2. The thought of actually going SCUBA diving increased my anxiety to a 7/10, which is quite high but not quite at the panic stage.
  3. In terms of actual safety, the 2010 Diver’s Alert Network Workshop Report found that only one-in-211,864 dives end in a fatality. This makes diving more risky than flying in an aeroplane or riding a bike, but much less dangerous than driving a car, skydiving, or running a marathon. We’re even more likely to die from walking or falling down stairs than we are from SCUBA diving.

risk of death

4. If I never went SCUBA diving, I doubt that it would have reduced my quality of life in any way. I did it mostly because I wanted to spend time with my friend and I wanted to challenge myself to face my fears, as not being able to withstand my concerns would have a substantial negative impact on my quality of life.
Based on the above information, I am glad that I went and got my PADI Open Water Certificate. I’m not too sure if I will ever go again though. I could enjoy it more and become less anxious about diving over time, and that did happen even across my four open water dives. If I went again, my anxiety might be a 5 or a 6. In reality, though, I think I can enjoy snorkelling just as much without it lowering my quality of life in any way, and I’ll probably do that more than SCUBA diving in the future.

What Are the Most Common Fears?


The top ten most common specific phobias are:

  1. Arachnophobia – fear of spiders
  2. Ophidiophobia – fear of snakes
  3. Acrophobia – fear of heights
  4. Agoraphobia – fear of crowds or open spaces
  5. Cynophobia – fear of dogs
  6. Astraphobia – fear of thunder and lightning
  7. Claustrophobia – fear of small spaces
  8. Mysophobia – fear of germs
  9. Aerophobia – fear of flying
  10. Trypanophobia – fear of injections

By looking at the above common phobias, they do all have some basis for why we may become afraid of them. Some spiders and snakes can kill, as can dogs (especially if they have rabies). Planes can crash, and falling from high up can be fatal. People can become trapped and suffocate in a small space or in crowds, and lightning strikes have killed people. Germs and bacteria spread disease too, and medical mishaps are the third most significant cause of death in the US according to the latest figures from the US Center for Disease Control and Prevention. The issue is that our brain is not very good at distinguishing things that are really dangerous versus things that feel dangerous but are actually pretty safe.

accomplishment action adventure challenge

How Do We Overcome Fears?

We overcome any fear through the dual process of gradual exposure and cognitive reappraisal after the exposure:

1. We determine what fear it is we would like to master. Preferably, this is something that you are currently avoiding that is negatively impacting your life, such as not going to the doctor or dentist because you are afraid of needles.

2. We develop an exposure hierarchy on this fear. This should have at least five different tasks that are ranked from least scary to most scary (scale from 0-10) tasks that you would like to challenge yourself with. For Arachnophobia this may be a 2/10 for looking at pictures of spiders, to 4/10 for watching videos of spiders, to 6/10 for looking at spiders in a an enclosure, to 8/10 for a spider being out in the open in front of you, to 10/10 for letting a spider crawl over your hand or up your arm.

3. We start with the least scary task first and stay in the situation for at least 10 minutes if possible. This should be long enough for the anxiety to peak and then reduce substantially during the exposure exercise. Specific behavioural and thinking skills can be taught by a psychologist to help lower stress levels during the exposure if it is not reducing at all.

4. We reflect on the exposure experience afterwards and try to change our previously held beliefs about what we fear. This is called cognitive reappraisal, and is done by asking ourselves “how did it go?“, “was it as bad as I thought it would be?“, and “how would I approach a similar situation in the future?

5. Once we are comfortable with that level of the exposure hierarchy, we repeat steps 3 and 4 with the next task on the exposure hierarchy. Once we become comfortable with the next step, we repeat this process again with the next task until we are successful with all tasks on the hierarchy. This would mean the fear has been overcome or mastered.

man standing on cliff

What if What I Fear Really is Dangerous?

If you have Ophidiophobia and live in Australia, you’re probably not going to want to befriend a snake that you run into out in the bush. Australia is home to 21 out of the 25 most deadly snakes in the world. If you wanted to overcome this fear, you might want to instead learn how to distinguish between poisonous and non-poisonous snakes and get more comfortable only with deadly ones from behind solid glass panels at your local zoo. Or you could visit someone who owned a harmless pet snake so that you could get used to being around it and touching it and realising that you are safe.

If you’re afraid of heights, I wouldn’t suggest being like Alex Honnold and trying to free climb El Capitan in Yosemite, but trying out the edge experience at the Eureka tower in Melbourne or even riding on the amusement park ride The Giant Drop on the Gold Coast might be a pretty safe way to challenge your fears.

Facts can really help some people to challenge their beliefs about their fears, but nothing beats putting ourselves in a feared situation first, and then trying to challenge our beliefs afterwards.

For me, knowing that only 12 out of the 35,000 different varieties of spiders are harmful to humans makes me not worry every time I see a little one unless it is a whitetail or a redback spider.

It helps to know that flying is one of the safest forms of travel, with a one-in-12 million chance of crashing. Although I don’t try to stand in an open field with a metal pole during a storm, it does help to know that being killed by lightning is nearly as rare, with a one-in-10.5 million chance.

Even though I don’t like to watch it pierce my skin, needles don’t hurt nearly as much as I used to imagine, and the pain goes away almost immediately after the injection. Bacteria is absolutely everywhere so I couldn’t avoid germs entirely even if I tried, and getting exposed to a bit of dirt when we are young might also be good for the development of our immune system.

If I ever feel a bit trapped or panicky the next time I dive, it will help to remind myself that I have done it before. I have my open water certificate and the skills from this, and what I’m doing is actually pretty safe as long as I don’t panic and follow what I have been taught in my training.

Just because we are afraid of something, it doesn’t mean we have to avoid it for the rest of our lives. But we don’t have to face our fears every time either, especially if it is not harming our quality of life. If you determine it would be good to challenge yourself and try to overcome a fear, I hope the steps outlined above help, and I’d love to hear about any success stories in the comments below.


Dr Damon Ashworth

Clinical Psychologist

To Trust or Not to Trust?

Recently, some things have come to light that I have found personally disappointing. A few people have behaved in a self-centred way and it puts me in an awkward situation.

If given a choice, I always try to be kind, open, honest, respectful and co-operative with others. However, sometimes some people don’t play by these same rules, and the more open and honest you are, the more this information can be used against you.

These experiences have led to me doubting myself. I wonder if I am too trusting like some of my friends say. Other friends tell me that the only way to respond is by playing the game also, putting my own needs first too.

What should we do if someone is being unkind, and only considering their needs irrespective of the consequences that these actions have on us?

person s playing chess

Game Theory

Game theory looks at what is the best rational approach to take in a strategic interaction between two people or groups of people. There are many different games, including co-operative games, where the rules and consequences can be enforced, and zero-sum games, where one person’s gain is another person’s loss.

One of the most famous examples of a game is the ‘Prisoner’s Dilemma’:

Imagine that you are a member of a criminal gang and that you have been arrested alongside one of your gang associates. You are in separate rooms at the police station, and you have no way of communicating with your associate. The Police tell you that they have insufficient evidence to get either of you on a big charge, but enough to get both of you on a smaller offence. The Police give you and the other prisoner one of two options:

  1. You can betray your associate by testifying that they were the one who committed the crime, or
  2. You can co-operate with your associate by remaining silent and refusing to testify.

The possible outcomes are:

A. If you both remain silent and co-operate with each other against the Police, you both only get one year in prison.

B. If you both try to betray each other by agreeing to testify, you both get two years in prison.

C. If they betray you, but you’ve tried to co-operate, they get to walk free, and you get three years in prison.

D. If they try to co-operate by remaining silent but you betray them and agree to testify, you get to walk free while they have to go to prison for three years.

The rational approach is not to co-operate with your associate, because at worst, you will get two years in prison (B), and at best you will serve no prison time (D). This is in comparison to the worst outcome of three years in prison (C) if you remain silent, and the best result is one year in jail (A). Not betraying your associate and co-operating will only lead to a worse outcome, even if you know that your associate will co-operate with 100% certainty.

It is therefore not always rational to try to co-operate with someone who could potentially take advantage of you, and positively not sound if you know that they are deliberately trying to take advantage of you.

person with tattoo playing paper scissor and stone

What About Long-term Strategies?

If two people play multiple games of Prisoner’s Dilemma and they can remember what the other player did previously, does it make it more desirable to co-operate rather than betray the other person? This is more reflective of how most relationships are in real life, whether with family, friends, co-workers, bosses or in intimate relationships. We may win more in one situation, but at what cost? This iterated version of the Prisoner’s Dilemma is sometimes known as the ‘Peace-War game’.

In 1984, Robert Axelrod organised a tournament where participants chose their strategies in an extended version of the Peace-War game, let’s say with 2000 trials. He found that greedy approaches to the game actually didn’t fare too well, and resulted in more years spent in prison by the end of the game.

One of the most straightforward strategies was also the most effective, and this was ‘tit-for-tat’. In the tit-for-tat strategy, the aim is to always co-operate in the first trial, and then do exactly what your opponent did on the previous trial for your next move. This way, you punish a betrayal with a quick betrayal back and reward co-operation with ongoing co-operation. Sometimes (in 1-5% of the trials), it is good to co-operate once even after your opponent betrays you, but generally, the most effective method is still tit-for-tat, which is interesting to know.

After the tournament ended, Axelrod studied the data and identified four main conditions for a successful strategy when negotiating with other people:

  1. We must be nice. What this means is that we should never defect or cheat before the other person does, even if we only want the best for ourselves.
  2. We must retaliate quickly and at least 95% of the time if people try to defect against or cheat us. It’s not good to be a blind optimist or always co-operate no matter what the other person does. This only leads to us being taken advantage of by greedy people.
  3. We must be forgiving, and get back to trying to co-operate once we can see that the other person is trying to co-operate reasonably again.
  4. We must not be envious and just try to beat our opponent or score more than them. Creating a win-win scenario is ideal if possible, even if it means giving up some points by co-operating when you could defect.

black and white sport fight boxer

What Relevance Does This Have For Real Life?

It may be easy to fall into the trap of thinking that screwing others over is the best way to get ahead in life. Or to not put ourselves out there so that we don’t get taken advantage of. In reality, this would only be the best approach in a world where every single other person tries to take advantage of everyone else every chance they can. This is not the case in any society on our planet as far as I know, so never trusting people and always assuming the worst from others is not the way to go.

Trust Don’t Trust
Untrustworthy Get hurt Don’t get hurt
Trustworthy More connection Less connection

By looking at the table above, the best outcome is to try and trust individuals who are reliable (and co-operate with them) and not trust or co-operate with individuals who are not. The worst results are being hurt by putting our trust in those we shouldn’t or not letting in or co-operating with others that we really could have.

Maybe I am a little too trusting. I do assume that other people are kind and good people who have good intentions unless I am proven otherwise. This is the position that I will continue to take, even if it means that sometimes I get hurt once I realise that someone is a bit more self-centred or dishonest than I had hoped.

Looking at the four elements of a successful negotiating strategy, I know that I am nice, forgiving and non-envious. The lesson that I do need to learn is that of swift and appropriate retaliation, or enforcing a certain consequence shortly after someone is nasty towards me. This would help to deter the other person from trying any more selfish tactics going forward and could put them back on the path towards co-operating and trying to achieve a win-win situation for the both of us.

I have thought previously that if I always co-operate, then at least I can be happy with the person that I am. However, sometimes being firm and assertive and standing up for ourselves in the face of unkind and selfish behaviour is the far better, and more self-respecting approach to take.

I hope this article has encouraged you to not give up on trying to trust or co-operate with others. I also hope it will encourage you to stand up for yourself if someone is trying to take advantage of you.


Dr Damon Ashworth

Clinical Psychologist

How to Cope in Times of Disaster

Vanuatu Mental Health Newsletter

February 2019

Latest Data on Mental Health in Vanuatu

In 2018, Vanuatu’s Lifestyle Disease Unit conducted 13 screening sessions for non-communicable diseases (NCDs) across the island of Efate. As part of this screening, all participants were given a Kessler Distress Scale (K10) to assess their level of psychological distress. Of the 748 participants who successfully completed a K10:

  • 135 (18%) rated their psychological distress as low
  • 213 (28%) rated their psychological distress as moderate
  • 300 (40%) rated their psychological distress as high
  • 100 (13%) rated their psychological distress as very high

More than half of the population that were screened on Efate have either high or very high psychological distress. However, when looking at the amount of people accessing services from the MindCare Clinic on Efate, only 800 out of 65,800 people saw or were seen by the clinic staff in 2018 (1.22%). This means that there are many people out there with elevated psychological distress who may benefit from assessment and treatment with the Mind Care Clinic.

If you or anyone you know has been very stressed lately and it is starting to impact how you function at work, at home, or with friends and family, please do get in contact with us, and we will try to help out where we can. We can be contacted via the Mental Health Vanuatu Facebook page, or via the contact details at the bottom of the article.

How to Cope with Trauma in Times of Disaster

The World Health Organization’s (WHO) Department of Mental Health and Substance Abuse report that exposure to extreme stressors, such as natural disasters and internal displacement, is a significant risk factor for mental health and social problems.

Both Cyclone Pam in 2015 and the evacuations and relocation from Ambae in 2017 and 2018 are two recent events that had a potentially traumatic impact on a large number of people.

Disasters trigger much mental health and long-term psychosocial challenges, as the instability of the event has shattered people’s normal routines, and can trigger stress, anxiety, fear, loss, grief, depression, ongoing adjustment difficulties and trauma. These distressing events affect entire communities, as people can lose their land, homes and belongings, become separated from family members and other close social connections, and have limited access to basic needs and services, including mental health and psychosocial support.

Furthermore, the host communities that take in evacuees are also impacted by the sudden influx of new people, which can lead to changes in regular routines, increased distress and demands, a feeling of being overcrowded or overwhelmed, and reduced access to the already limited resources that are available.

Mental Health and Psychosocial Support (MHPSS) services are critical for the recovery of affected communities, as they can mitigate the effects of such potentially traumatising circumstances. Vanuatu is amongst the top five most disaster-prone countries in the World, which further highlights the crucial need for a national mechanism and sustainable support infrastructure to address mental health needs during times of emergency.

MHPSS programs following natural disasters aim at the psychological recovery of individual community members as well as the social recovery of communities. Psychological first aid (PFA) training and implementation enable friendly, supportive responses to any individuals who are suffering or are in need of support. Such programs address the various psychological issues of affected individuals and strengthen the capacity of communities for future development. Although everyone is affected in some way by events such as natural disasters or internal displacement, some people are particularly vulnerable in crisis and may need extra help.


  1. Plan ahead, that is, don’t leave things to the last moment. Think about what it is that you have to do.
  • Do you have to travel?
  • Will you have people visiting?
  • Will you have to spend more money?
  • Do you have to buy special things like more food or water or other necessities?
  1. Be realistic.
  • You cannot do everything and meet everyone’s expectation.
  • your health, personal situation and family structure, may have changed. Make sure that your expectations on yourself and others are consistent with this.
  • Your home or business may have been affected by a natural disaster or accident.

You may need to reconsider what you plan to do based on this information.

  1. Learn how to say “NO” and this could be a difficult thing to do both personally and culturally.
  • Saying NO does not mean that you do not care or that you are not respectful.
  • Sometimes we do not have the time, health or resources to say YES and then follow through.
  • Saying YES to please someone and then becoming very stressed is not good for your health.
  • Take some time to think things through before you make important decisions.
  1. Reach out for help. When you are stressed and do not have the resources or health or time, talk to someone that you trust and talk things through.
  2. Tune into your feelings. You may be going through a difficult time, so try to admit to yourself if you are sad or angry. Give yourself the time and opportunity to improve.
  3. Try to resolve issues if possible. Focus on what is in your control and what is a priority. As much as you will want to fix everything at once, this is not possible.
  4. Stay healthy. Don’t eat foods that you know cause you to feel unwell or will be bad for your health like too much sugar or fatty foods.
  5. Don’t drink too much alcohol or kava or other beverages that may make you feel better temporarily but worse in the long-run.
  6. Go for a walk with your friends or family. Talk to your friends and family about their lives and yours to keep you connected.
  7. Every day take a few moments to be alone and free from distractions. Breath slowly and deeply and try to clear your mind.
  8. If you are lonely or sad or grieving, make sure you try to mix with others or if that is too difficult try to engage in community events. A church service or watching a sporting event could be helpful.
  9. If despite your best efforts you cannot manage and feel depressed or feel that life is out of control you may need to seek help from a friend, a church pastor, another person you trust. If this is not available, please seek professional help.


For more information or advice please contact:

Mind Care Clinic

Psychiatry Department



VOIP: 1972

Namalinuan Clinic



Mental Health Clinic



Mental Health Clinic



Mental Health Clinic



D.A. MoH Port Vila December 2018


The Four Ultimate Concerns in Life

I’ve been afraid to say this for a while because of how it will be perceived, but my favourite book of all time is actually a textbook. Now before you think that makes me someone that you would never want to speak to, I’ll ask if you have ever read anything by Irvin Yalom, American Psychiatrist and Author?

Existential Psychotherapy (book).jpg

His book ‘Existential Psychotherapy’ is a true masterpiece that he worked on for 10 years, and is written as eloquently as any of his other titles, including ‘When Nietzsche Wept’, for which he won the best fiction novel award for in 1992.

What is Existential Psychotherapy?

Existentialism is the philosophical exploration of existential issues, or questions about our existence that we don’t have an easy answer for. We all suffer from anxiety, despair, grief and loneliness at times in our lives. Existential Psychotherapy tries to understand what it is about life and humanity that results in these painful experiences and feelings.

In the book, Yalom explores what he considers to be our four most significant existential issues in life:

  1. Death
  2. Freedom
  3. Isolation
  4. Meaninglessness

These existential issues or ultimate concerns are “givens of existence” or “an inescapable part” of being an alive human in our world. He shows how these concerns develop over time, and how we can run into problems with each of these issues and what they might look like in patients coming to therapy. He also talks about how we can try to live with these concerns so that they have less of a negative impact on our lives, even if we don’t have clear-cut solutions to them.

Let’s go through each of these ultimate concerns…


1. Death

Homo sapiens, or humans, as far as I know, are the only species in the animal kingdom that are aware that one day they are going to die.

The first time I heard this, it fascinated me and made me wonder if life would be more comfortable not being aware of the fact that one day we cease to exist.

Imagine it. Life is going well. Then suddenly it is no more. No worry about what the future holds. We are born. We experience life. Then suddenly we are no longer there. No fear. Just nothingness.

Being aware that we are going to die shapes and influences our lives much more than we would like to admit. A lot of our anxieties and phobias at their core are fear of some type of loss or death.

Irvin Yalom says that while the actuality of death is the end of us, the idea of death can actually energise us.

If we don’t know when we will die, being in touch with the fact that one day everything will vanish is enough to overwhelm some people and make them panic.

For others, it is enough to make them follow the maxim of carpe diem and helps them to seize the day by appreciating everything that they have so that they can make the most of the precious time that they have left on this planet. The time that is really just a bright spark of lightness between two identical and infinite periods of darkness – one before we are born, and one after.

Death is the ultimate equaliser, for no matter how much we have achieved or done with our time on this planet, the truth is that we will all one day die.

It is also true that we will not know exactly when death will happen. It might be with a car accident tomorrow, from cancer in ten years, motor neurone disease in twenty years, a heart attack in thirty years, a stroke in forty years, or during our sleep in fifty years.

Because our knowledge of our inevitable death is so inescapable and hard to confront and deal with directly, we instead focus on smaller and more manageable worries or concerns in our lives that we can do something about if we want to. If we successfully address all these minor concerns, however, we then come in contact with our fear of death again, and the cycle repeats itself.

ancient antique art death

Most people tend to have one of two basic defence mechanisms against their fear of death:

A. They can think that they are “special” and that death will befall others but not them, and try to be an individual and experience anxiety about life.


B. They can think they are an “ultimate rescuer“, and try to fuse with others and experience anxiety about death (their own mortality and that of their loved ones).

A breakdown of either of these defences can give rise to psychological disorders:

  • narcissism or schizoid characteristics for the “special” defence, and
  • passive, dependent or masochistic characteristics for the “ultimate rescuer” defence.

In general, trying to be an individual is a more empowering and effective defence than trying to fuse with others, but the breakdown of either can lead to pathological anxiety and/or depression.

nature laptop outside macbook

The way to feel better about death anxiety is through an exercise called “disidentification“:

  1. To begin with, ask yourself the question “Who am I?” and write down every answer that you can think of.
  2. Then, take one answer at a time, and meditate on giving up this part of yourself, asking and reflecting on what it would be like to give up this part of yourself and your identity.
  3. Repeat this with all the other answers until you have gone through all of them.
  4. You have now disidentified yourself from all parts of your identity. See how you feel, and if there isn’t still a part of you that feels separate from all the labels you give yourself. This provides comfort and reduces anxiety about death and life for a lot of people.

What I try to do to manage death anxiety is to only focus on whatever it is that is most important to me that I can do something about in any given moment. I try to appreciate and be grateful for the time that I have had with each important person in my life. I try to be as fully present in the moment and with others as I can be. I try to use every moment and meeting as an opportunity to positively rather than negatively impact someone’s life. That way, I’ll hopefully not have too many regrets and be glad for the time that I have had on this planet, no matter how long it ends up being.

man with fireworks

2. Freedom

The second ultimate concern is about freedom, responsibility and the will.

Every country in the world talks about fighting for the freedom of its citizens but also talks about taking away some people’s freedom to ensure the safety and security of all. The existential dilemma is, therefore, how much freedom do we give up to others to feel safe and secure, or how much safety and security do we give up to feel genuinely free? Are these concepts in direct opposition, or is it sometimes possible to have enough of both?

Responsibility means taking full ownership of:

one’s own self, destiny, life predicament, feelings, and if such be the case, one’s own suffering” – Irvin Yalom

In the past, one’s life was set out for them by their parents or society, and many people struggled to fight for the right to live a life that was authentic and genuine to them.

These days, most people struggle instead with the amount of choice that they have in their lives. They come to therapy because they don’t know what they want to do or how to choose given all of the options that are available to them. They also know that if no one else is telling them what to do, then it is ultimately their responsibility if things do not work out the way that they want them to. People wish to choose for themselves but fear not having someone to blame when things don’t work out.

person holding compass

There are various defenses that we engage in to avoid responsibility and shield ourselves from freedom, including:

  • compulsivity
  • displacement of responsibility to another
  • denial of responsibility (“innocent victim” or “losing control”)
  • avoidance of autonomous behaviour, and
  • decisional pathology

We can do something over and over again to relieve anxiety or stop thinking about things. This can present as OCD or hoarding or any type of addiction ranging from technology to drugs and alcohol and even dependency on others.

We can try to coerce others to make decisions for us, or seek out and find controlling partners, bosses or friends. We can also just play it safe, and try to do what we think everyone else does; focus on keeping up with the Joneses, engaging in passive activities that don’t require much effort, and feeling stuck in an unfulfilling relationship or career.

The problem with giving up the responsibility for how our lives turn out is that it creates an external rather than an internal locus of control. Depression and other forms of psychological disorders are more highly correlated with an external locus of control. It  can also lead to learned helplessness, where people no longer feel like they can do anything to change their life in a positive direction.

adventure asphalt clouds country

The way to manage the responsibility and freedom paradox is to develop an internal locus of control. This is generally more beneficial for most people’s well-being, unless we really are trying to blame ourselves or change things that are out of our control. This includes what has happened in the past, what other people do or say, and acts of nature.

The serenity prayer nicely spells out how we should approach responsibility:

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.” – Reinhold Niebuhr


Paradoxical intention is a good antidote too. This means that we try to do the opposite of what we typically do for a period of time and keep an open mind and observe how things go. We can then see if the outcome is better than what we usually do or if it has taught us something about what will be best for us going forward.

Anything that creates a double bind is potentially helpful for encouraging people to take more responsibility in their lives. One way is to remind someone who struggles to make their own decisions that by not deciding, they are still making a choice to not choose. This means that no matter what they do, it is impossible to not make a decision that impacts the direction of their lives. Even if we choose to follow what someone else wants us to do, we are still making a choice to do this. Therefore, why not take responsibility for our own lives and forge our own paths?

alone branches bridge bright

3. Isolation

There are three types of isolation:

A. Interpersonal isolation: isolation from other individuals, experienced as loneliness

B. Intrapersonal isolation: parts of oneself are partitioned off from the self, and

C. Existential isolation:an unbridgeable gap between oneself and any other being.”

A common way that people try to escape from existential isolation is to fully fuse with another. This is is a strategy for dealing with death anxiety too, with people trying to be the “ultimate rescuer” of someone else. It can lead to an individual feeling temporarily less alone. However, the less isolated we are from others, sometimes the more isolated we are from ourselves.

Other people try to overcompensate for their feelings of isolation by never relying on anyone and trying to be fully independent. Both extremes can have negative consequences.

The main thing we can do to manage our feelings of isolation is to realise and accept that we are social creatures and we have always relied on others to survive. This drive creates a desire to feel closer to, more understood by and more connected to people than we can ever really achieve and sustain.

Growing up, many people feel loved and comforted in a relationship that is unbalanced towards their needs being met over their parents.  They then try to reenact this within their adult relationships and usually end up feeling resentful, angry and disappointed as a result.

Yalom believes that a good relationship involves “needs-free love”, which is about loving someone else for their sake. This is opposed to “deficiency love”, which is a selfish love where we only think about how useful the other person may be to us. Trying to create a relationship where you want the best for the other person is a healthier way to manage interpersonal isolation than demanding for them to meet every need for you.

Some of the best solutions to intrapersonal isolation are to have time to get to know ourselves through practices such as journaling, therapy and meditation. Introverts may need to have more of this time than extroverts, so it’s important to tune into to how you agitated or lonely you feel to know if you have found the right balance or not.

Unfortunately, existential isolation cannot be fully breached, and therefore needs to be accepted, as it is out of our control. To feel the pain that comes with this isolation as well as our desire to not have it is challenging, but it can help to reduce the intensity of the feeling. Being grateful for the meaningful connections we have in our lives and trying to strengthen them without losing our sense of self is another way to lessen the intensity of the feeling.

photo of person walking on deserted island

4. Meaninglessness

According to Yalom and many non-religious philosophers, humans are meaning-seeking creatures in a world without a universal sense of meaning. As a result of this, the majority of the world turn to a religious or spiritual belief system of one type or another that clearly lays out the meaning of the world and our purpose in it. For people who truly believe these systems, they often provide a lot of clarity, reassurance and guidance. The tricky part is that these belief systems can vary widely, and it is hard to know which one is more correct or right than another, or if some of them are even harmful.

What we do know is that most belief systems tend to agree that

it is good to immerse oneself in the stream of life“.

People can try to find meaning through:

A. Hedonism: Seeking out pleasure and positive experiences and trying to avoid pain,

B. Altruism: Dedication towards a cause that helps other people, and

C. Creativity: Transcending oneself through art.

Many philosophers believe that both the search for pleasure and the search for meaning are paradoxical. By this, they mean that happiness and meaning or purpose in life are tough to achieve when they are aimed at directly, but possible if they are aimed at indirectly.

So if you or someone that you know is complaining about a lack of meaning in life, try to see if there are other issues too. If there are, address these other issues first if possible, and see if your worry about meaninglessness has lessened or gone away.

The best indirect way to increase a sense of purpose and meaning in life is to build up kindness, curiosity and concern for others. This is often best done by helping out with a charity, joining a club, fighting for a cause, or attending a group activity or group therapy.

photo of train on rails

Yalom strongly believes that a desire to engage in life and satisfying relationships, work, spiritual and creative pursuits always exists within a person. The key to managing meaninglessness is therefore to remove the obstacles that prevent the individual from wholeheartedly engaging in the regular activities of life.

We may never be able to find the absolute meaning of life. However, what we can do is work at creating a life that is personally meaningful to us.


Dr Damon Ashworth

Clinical Psychologist


Why Do Some People Cheat in Relationships and Others Remain Faithful?

With the development of the internet, dating websites, social media, smartphones and dating apps, it is now easier than ever for someone to cheat on their partner or spouse.

This same technology can also make it easier to get caught too, due to the potential digital trail that is created with each of these unscrupulous liaisons.

The Ashley Maddison hack and subsequent scandal was one such example of technology helping people to have extramarital affairs, but also leading to them getting caught. The hackers tried to blackmail the company and many of the users, and then released all of their details in a massive data leak when their demands were not met. Families were broken up; reputations and even lives were ruined in the aftermath.

The consequences of infidelity continue to have a devastating impact on individuals, partners, children and society. Yet it remains an issue that is prevalent in every country and culture. Maybe even more so today with the advent of technology.

Given the massive changes that we have gone through in the past 30 years, I am interested to find out what the prevalence rates of cheating are, if our attitudes towards infidelity have changed, and if there is anything that we can do about it.

adult blur bouquet boy

What is Cheating?

The definition of cheating is actually quite hard to specify and depends on who you are talking to and what their expectations are for the relationship that they are in. The stereotype is that males tend to perceive cheating to be exclusive to physical encounters or actions, whereas females also see emotional infidelity as cheating, which is sharing something with someone that you wouldn’t typically feel comfortable saying to your partner. Many people also believe that relationships that exist purely over the internet or phone can also be considered cheating, especially if there are explicit words, photos or sexual acts exchanged using these devices.

Infidelity has been defined by Weeks, Gambescia and Jenkins (2003) to be a violation of emotional or sexual exclusivity. The boundaries of what is meant to be exclusive are different in each couple, and sometimes these boundaries are explicitly stated, but most of the time they are merely assumed. This means that each partner can have different assumed limits, making it difficult for both partner’s exclusivity expectations to be met (Barta & Kiene, 2005).

Leeker and Carlozzi (2012) believe that when someone has a subjective feeling that their partner has violated the rules around infidelity, feelings of sexual jealousy and rivalry naturally arise. If an act of adultery has occurred, the consequence is often psychological damage, including feelings of betrayal and anger, impaired self-image for the person cheated on, and a loss of personal and sexual confidence (Leeker & Carlozzi, 2012).

man and woman holding hand walking beside body of water during sunset

Prevalence of Infidelity

Like my previous article How Have Intimate Relationships Changed Over the Years, and Where Does It Leave Us Now?, the majority of the research presented in this post comes from the surprising and entertaining book ‘Modern Romance’ by Aziz Anzari (the actor and comedian) and Eric Klinenberg (a Sociologist).

Unfortunately, people who are suspicious when it comes to infidelity sometimes have a reason to be. More than half of all men (60%) and women (53%) confess to having tried to mate-poach before. This means that they attempted to seduce a person out of a committed relationship so that they could be with them instead. I can’t believe that these figures are so high.

I also can’t believe that in “committed relationships”, where the partners are not married to each other, the incidence rate of cheating has been found to be as high as 70%.

It gets a little bit better for married couples, with only 2-4% of married individuals admitting to having an extramarital affair over the past year in the USA. However, this increases to 30% of heterosexual men and 25% of heterosexual women who will have at least one extramarital affair at some point during their marriage. It’s scary to think that somewhere between a quarter to a third of all married individuals have affairs, but good to know that two-thirds of all married people stay faithful to their partner all their lives too.

adult bride celebration ceremony

Attitudes Towards Extramarital Affairs

In ‘Modern Romance’, they share results from an international study that looks at people’s views on extramarital affairs across 40 countries.

In the USA, 84% of people strongly agreed that cheating was “morally unacceptable”. In Australia, 79% view extramarital affairs as morally unacceptable. Canada, the U.K., South America and African countries all have similar rates of cheating disapproval as Australia. Areas that have the highest disapproval rates are typically Islamic countries, with 93% of those surveyed in Turkey stating that marital infidelity is morally unacceptable, second only to Palestinian territories with 94%.

France is the most tolerant country for extramarital affairs, with only 47% saying that cheating is unacceptable. They also happen to be the country with the most extramarital affairs, with the latest data indicating that 55% of men and 32% of French married women admit to having committed infidelity on their spouse at least once. The second most tolerant nation is Germany with 60% finding extramarital affairs to be morally unacceptable. Italy and Spain are equal third, with 64% each.

Expectations vs Reality

When you compare the level of disapproval towards infidelity with the data on the actual prevalence of extramarital affairs, the numbers don’t quite add up. In the USA especially, it seems that a large number of people who cheat themselves still condemn the practice at large and would not be okay with being cheated on themselves.

A Gallup poll on cheating even found that infidelity is disapproved of at a higher rate than animal cloning, suicide and even polygamy. Although it is against the law, being married to two people is seen as less offensive than being married to one and breaching the honesty, trust and connection that you share with your partner.

People also differ between their beliefs and their practices when it comes to whether or not to confess an affair or infidelity once it has occurred.

A Match.com nation-wide survey in the US found that 80% of men and 76% of women would prefer their partner to “confess their mistake… and suffer the consequences,” rather than “take their secret to the grave”. However, the excuse given by most people who have cheated and haven’t told their partner is that they didn’t want to hurt their partner. It’s interesting that they only worry about the impact that their actions may have on their partner after the unfaithful act has already occurred and not beforehand.

Unfortunately, most people try to keep their own affairs to themselves and make excuses for their behaviour while demanding at the same time that their partners own up to their indiscretions if they stray.  If their partner does own up, they are likely to treat them harshly for it, because after all, cheating is considered morally unacceptable by most.

man and woman holding hands walking on seashore during sunrise

Why Do People Cheat?

Dr Selterman from the University of Maryland looked into why 562 adults cheated while they were in a “committed” romantic relationship. He found eight main reasons given for why the infidelity occurred:

  1. Anger: seeking revenge following a perceived betrayal
  2. Lack of love: falling “out of love” with a partner, or not enough passion or interest in the partner anymore
  3. Neglect: not receiving enough attention, respect or love (#1 reason for women)
  4. Esteem: seeking to boost one’s sense of self-worth by being desired by or having sex with multiple partners
  5. Sexual desire: not wanting sex with their partner or wanting to have sex more with others (a common reason for men)
  6. Low commitment: Not clearly defining the relationship as exclusive or not wanting a future with their partner or anything too serious
  7. Variety: Want to have as more sexual partners or experiences in their lifetime (a common reason for men)
  8. Situation: Being in an unusual scenario, such as under high stress, under the influence of alcohol or a substance, or on vacation or a working holiday (a common reason for men)

Interestingly, not all of these factors suggest that infidelity is a direct reflection of how healthy a relationship is. Often it says much more about the person who commits the infidelity and their personality or impulse control than anything else.

Ways to Reduce the Likelihood of Infidelity


In ‘Modern Romance’, the authors explain that passionate love inevitably fades within every relationship. A loss of passionate love could lead to infidelity if people don’t realise that this may just be an indication of how long they have been together, not an issue with their relationship.

Companionate love, or that sense of building a life and a legacy with a partner, is different to passionate love. It can continue to grow across a relationship and a lifetime rather than decline with time. Couples in their 60s and 70s often rate their relationship satisfaction as much better than when they were younger and trying to raise children together and work full-time too.

One way to reduce the likelihood of committing infidelity then is to focus on building companionate love and a shared life and legacy together, rather than just equating real love with passion.


In his classic book ‘On Love’, philosopher Alain de Botton said that:

“Perhaps the easiest people to fall in love with are those about whom we know nothing…we fall in love because we long to escape from ourselves with someone as beautiful, intelligent and witty as we are ugly, stupid and dull.”

It’s much easier to idealise or become infatuated with someone that you don’t know that well. To imagine that they are perfect or have none of the flaws that your current partner (or you) possess.

The quickest cure for infatuation is to actually get to know the person a bit more (without breaching the infidelity norms of your relationship) and realise that they are just as flawed as the rest of us. Once you understand this, leaving one flawed relationship for another but having to start all over again carries much less appeal.


In another of his excellent books, ‘The Course of Love’, de Botton states:

“When we run up against the reasonable limits of our lovers’ capacity for understanding, we musn’t blame them for dereliction. They were not tragically inept. They couldn’t fully fathom who we were – and we could do no better. No one properly gets, or can fully sympathize with anyone else… there cannot be better options out there. Everyone is always impossible.”

This isn’t to say that we shouldn’t leave abusive and neglectful partners. It just means that we need to avoid imagining that there is “a lover (out there) who will anticipate (all) our needs, read our hearts, act selflessly and (always) make everything better. (This) is a blueprint for disaster.” No one is perfect, and being grateful for what we do have with our current relationship and trying to make it as good as possible is much healthier than imagining that “the one” is probably just around the corner, if only we could find them.


Unfortunately, we still have the issue of love and sexual desire typically being separated in our society. Esther Perel, couples therapist and author, points this out better than anyone in her groundbreaking book ‘Mating in Captivity: Reconciling the Erotic and the Domestic’:

“Today, we turn to one person to provide what an entire village once did: a sense of grounding, meaning, and continuity. At the same time, we expect our committed relationships to be romantic as well as emotionally and sexually fulfilling… our need for togetherness exists alongside our need for separateness… (but) it’s hard to feel attracted to someone who has abandoned (their) sense of autonomy… Is it any wonder that so many relationships crumble under the weight of it all?”

Another way to keep the spark of desire alive then is to make sure that even though you do a lot of things together with your partner, you must also do some things individually.

Fortunately, Perel also agrees that both love and desire can be maintained or grown over time with effort and a specific way of looking at things:

“For [erotically intelligent couples], love is a vessel that contains both security and adventure, and commitment offers one of the great luxuries of life: time. Marriage is not the end of romance, it is the beginning. They know that they have years in which to deepen their connection, to experiment, to regress, and even to fail. They see their relationship as something alive and ongoing, not a fait accompli. It’s a story that they are writing together, one with many chapters, and neither partner knows how it will end. There’s always a place they haven’t gone yet, always something about the other still to be discovered.”

What About If Infidelity Has Already Occurred?

If cheating has already taken place, many people say that too much pain has occurred, trust has been breached and broken, and leaving is the best thing to do to maintain a sense of self-worth and self-respect. In other cases, going may not be the easiest, most practical, or best solution. For individuals in these cases, I would recommend reading Perel’s more recent book ‘The State of Affairs: Rethinking Infidelity’.


In this book, Perel says that:

“Once divorce carried all the stigma. Now, choosing to stay when you can leave is the new shame.”

Perel warns against merely passing judgment about the act of infidelity, as this shuts down all further conversation about what happened and why and where to go from there. Perel believes that it is much better to see an affair as a symptom of a troubled relationship or a troubled person.

If it is the person who is troubled, and they are remorseful for what they have done and willing to try to make amends and not cheat again, it is essential that they get help to address whatever issue led to the infidelity in the first place. If they are not willing to get help and work on themselves but merely say it won’t happen again, be wary.

If it is the relationship that was in trouble, relationship counselling may be able to help too. Perel says that:

“Infidelity hurts. But when we grant it a special status in the hierarchy of marital misdemeanors, we risk allowing it to overshadow the egregious behaviors that may have preceded it or even led to it.”

If both people in a relationship can take ownership for the behaviours that they engaged in that caused pain and hurt to the other and are willing to start again to build a stronger relationship, it is possible to have a healthy relationship going forward. It’s just never going to be the same as things were before the infidelity took place.

cold frozen ice journey

My Personal Opinion

Monogamy is sometimes hard, as is continuing to work at having a healthy relationship, but it is a choice. We may not always have full control over what we initially think or feel, but we do have the capacity to think things through properly before acting.

My favourite relationship researcher, John Gottman, found that couples who turn towards each other when there is an issue in their life are much more likely to stay together than couples who turn away from or against each other. In one study, he found that newlyweds who remained married 6 years later turned towards each other 86% of the time when issues arose. Newlyweds who were divorced six years later only turned towards each other 33% of the time. Turning towards your partner when a problem occurs is the key to a close and connected relationship, and is much less likely to result in infidelity.

For me, it comes down to personal values. I want to have a relationship that is close and connected, with openness, honesty and trust. I don’t want to feel like I have to hide anything, and I don’t want to do anything that I am not personally okay with or that I know that the people who mean the most to me would not be proud of.

Anything that we hide from our partners tends to lead to greater distance and a feeling of disconnection. This is especially the case with stuff that we may know is dishonest, not respectful or something that we feel ashamed of. Our body language, microexpressions and tone of voice also tend to leak out how we genuinely feel over time if we are hiding something, even if we wouldn’t like to admit it.

Existential philosophers believe that our biggest challenge in life is to come face-to-face with the true nature of who we are. I think that over time, it is our actions and not our intentions that become our character, or who we indeed are. I aim to be the best partner, and person that I can be, and to learn from any mistakes that I make along the way so that I hopefully never repeat them again. What about you?


Dr Damon Ashworth

Clinical Psychologist


Parenting is Tough, but Science Suggests Clear Strategies that Help You to Raise Emotionally Healthy Children

In 2018, the American Psychiatric Association identified what they considered to be the three major goals of parenting:

“1. Ensuring children’s health and safety

2. Preparing children for life as productive adults, and

3. Transmitting cultural values”

Many environmental and biological factors influence a parent’s and a child’s capacity to reach these ambitious goals. However, there are still a few simple changes in how we try to parent our children and how we work to manage emotions in ourselves and those closest to us that can make a significant difference…

tilt shift lens photography of woman wearing red sweater and white skirt while holding a boy wearing white and black crew neck shirt and blue denim short

Parenting Styles

In 1971, a researcher named Baumrind identified and developed three main parenting styles. These parenting styles include parents’ attitudes and values about parenting, their beliefs about the nature of children, and the specific strategies they use to try to help socialise their child.

The parenting styles are known as:

1. Authoritative

Includes being warm and involved in the child’s day-to-day life, helping the child with reasoning and inductive thought processes and reflective practices, democratic participation, or letting the child have a say in what goes on, and being good natured and generally easy-going with the child.

2. Authoritarian

Includes being verbally hostile towards the child, using corporal punishment, not reasoning things through with the child, using punitive control strategies or excessively harsh punishments, and being directive towards the child rather than discussing things through with them.

3. Permissive

Includes high levels of warmth, but a relaxed and non-consistent discipline style, with minimal rules, expectations and guidance. This includes lack of follow through on consequences, ignoring misbehaviour and boosting self-confidence rather than disciplining the child.Image result for parenting styles

The graph above highlights that there is a fourth style known as uninvolved (Maccoby & Martin, 1983), which includes very little control or strictness, and very little parental warmth too.

Subsequent reviews by Baumrind in 1989 and 1991 found a clear winner for parents who employed an authoritative parenting style over an authoritarian or a permissive parenting style, especially once children reach higher.

An authoritative parenting style has been shown to lead to the more significant development of child competence, including better maturity, assertiveness, responsible independence, self-control, better co-operation with peers and adults, and academic success (Baumrind, 1989; 1991). Children of authoritative parenting also exhibit higher levels of moral conscience and prosocial behaviours (Krevans & Gibbs, 1996).

Other research has found that non-authoritative parenting styles can lead to a higher risk of depression, anxiety, ADHD and conduct or behavioural problems (Akhter et al., 2011). Authoritarian parenting can lead to antisocial aggression, hostility and rebelliousness (Baumrind, 1991), and anxiety (Chorpita & Barlow, 1998).

Indulging children too much and not setting appropriate boundaries can reduce the child’s academic performance and social competence (Chen et al., 2000). Permissive parenting can also lead to low self-control and impulsive, bossy or dependent behaviour in children (Baumrind, 1967).

Uninvolved parenting leads to a greater risk of behavioural problems and depression (Downey & Coyne, 1990).

The chart below clearly highlights the consequences of each style of parenting:


If you want to develop a more authoritative parenting style, be warned that it is the most time-consuming and energy demanding of all the methods (Greenberger & Goldberg, 1989). If you would still like to give it a go, try any of the following strategies from a questionnaire developed to identify an authoritative parenting style, and see if they work for you:

  • “Learn the names of your children’s friends.
  • Ask about your child’s problems or concerns at school and communicate with their teachers about any issues that they may be having
  • Encourage the child to talk about their troubles
  • Give praise and acknowledgment when the child does something positive
  • Tell your child that you appreciate what they try or accomplish
  • Give emotional comfort and understanding when the child is upset
  • Respond to the child’s feelings and emotional needs
  • Show sympathy or empathy when the child is hurt or frustrated
  • Express affection by hugging, kissing or holding your child when it is appropriate to do so
  • Explain the consequences of your child’s behaviour
  • Give your child the reasons for the rules you have
  • Emphasize why the rules need to be followed
  • Help them to understand the impact of their behaviour by encouraging them to talk about the consequences of their actions.
  • Explain how you feel about your child’s good and bad behaviour
  • Take into account your child’s preferences when making family plans
  • Allow your child to give input into family rules
  • Take your child’s desires into account before asking them to do something
  • Joke and play with your child
  • Show patience with your child
  • Try to be easy-going and relaxed around your child.”

girl sitting on smiling man s shoulder

The Relationship Cure

There isn’t an author out there who has conducted more in-depth and scientific research on interpersonal relationships than John Gottman. ‘The Relationship Cure: A Five-Step Guide to Strengthening Your Marriage, Family, and Friendships’ is his 2002 book that offers a 5-step guide to improving the quality of your relationship with your partner or children.

The five steps to improve your relationships are:

1. Look at Your Bids for Connection

We need to analyse both how we bid for connections with others, and how we respond to other people’s bids for connection.

A bid is simply any form of expression, whether it be a verbal question, a visual look, or a physical gesture or touch that says, “I want to connect with you!

A response to a bid can be either an encouraging sign that shows that you also want to connect by turning towards them, or a discouraging sign that indicates that you do not wish to connect, through turning away from them or turning against them.

Over time, turning towards responses lead to even more bidding and responding and a stronger, closer relationship. Both turning away and turning against reactions leads to less bidding, hurt or suppressed feelings, and the breakdown of the connection you share in the long-term.

2. Discover Your Brain’s Emotional Command Systems

There are seven main areas in which people differ that can influence relationship needs. Once you have discovered if you and your family members are low, moderate or high on each system, it becomes easier to see how it affects the bidding process in the relationship.

The systems are referred to as the:

  • Commander-in-chief (dominance and control)
  • Explorer (exploration and discovery)
  • Sensualist (sensual gratification, pleasure)
  • Energy Czar (regulates need for energy, rest, relaxation)
  • Jester (play, fun)
  • Sentry (safety, vigilance)
  • Nest-builder (affiliation, bonding, attachment)

3. Examine Your Emotional Heritage

People typically develop one of four emotional philosophy styles. These styles are learnt during childhood and can affect your method of bidding and your ability to connect with others.

The four emotional styles are:

  • Emotion-dismissing (“You’ll get over it!“) = less bidding and turning away
  • Emotion-disapproving (“Don’t feel that way!“) = less bidding and turning against
  • Laissez-faire (“I understand how you feel.“) = bidding may or may not increase
  • Emotion-coaching (“I understand. Let me help you!“) = more bidding, turning toward, with the added bonus of guidance being offered for how to cope.

Families that create emotion-coaching environments give their children a higher chance of having more successful and loving relationships with their parents, siblings and friends. They also tend to get along better with their co-workers and romantic partner when they are older.

4. Sharpen Your Emotional Communication Skills

By learning effective communication skills, we are more likely to be able to say what we actually mean and feel without the other person becoming defensive, which can increase our chances of positive changes occurring and relationship satisfaction increasing.

The four steps of effective communication are as follows:

D – Describe the situation, and stick to facts, not judgments

(e.g., ”When you don’t clean up your room”, not “When you are disrespectful and don’t care about your things!”).

E – Explain how you feel

(Emotions – e.g., “I feel hurt and upset!”. Not opinions – e.g., “I feel like you don’t care about me or the house rules!”)

AAsk for what you need or would prefer

(Behaviours – e.g., “I would prefer that you follow the rules we have established and clean up your room before going outside to play with friends”. Not feelings – e.g., “I would prefer if you actually cared about this family and your things like you say you do”).

R – Reinforce the potential benefits to them, you and the relationship if they could do what you have asked

(e.g., “Then your things won’t get wrecked, you can play, I can relax, and we can all have fun together later instead of me having to nag you all the time!”).

You might be sceptical, but it really can work, and it does become more comfortable with practice.

5. Find Shared Meaning with Others

This can be done by sharing your dreams or visions with each other, or it can be about developing consistent rituals together that over time can lead to more shared experiences and a stronger emotional bond.

With the kids, this may be prioritising having dinner around the table with the whole family and chatting each night without technology, or it could be:

  • a regular movie night every Friday,
  • church every Sunday morning,
  • games night once a week, or even
  • Christmas and Family Day with the extended family
  • New Years at the beach every year, or
  • Anything else that you can repeat on a regular basis

Rituals provide great memories for the children and predictability too and help them to feel loved and secure. What you do does not matter too much; it is about what is meaningful to you and your family.

baby approaching men s black sunglasses

So there we have it. If you try to develop an authoritative parenting style, turn towards your child’s emotional bids, foster an emotion-coaching philosophy in the home, and try to effectively communicate and find shared meaning with your children, you will be you will be well on your way to raising emotionally healthy children. I wish you all the best of luck with the challenges along the way!


Dr Damon Ashworth

Clinical Psychologist


Mental Illness and Mental Health


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Mental Health Newsletter January 2019

Welcome to the first Mental Health Newsletter in 2019. The topic for the month of January is Mental Health and Mental Illness.

three women sitting on grass
Photo by Luis Quintero on Pexels.com

What is Mental Health?

The World Health Organisation defined mental health in 2014 as “a state of well-being in which every individual:

  • realises his or her own potential
  • can cope with the normal stressors of life
  • can work productively and fruitfully, and
  • is able to make a contribution to his or her own community.”

What is Mental Illness?

  • Mental Illnesses are health conditions involving changes in emotion, thinking or behaviour (or a combination of these).
  • For something to be considered a mental illness, It must cause significant distress or functional impairment at work, with studies, at home, or socially with family and friends
  • Males are more likely to externalise their distress or act out – they experience more substance abuse, anger, violence and suicide than females
  • Females are more likely to internalise their distress or struggle on the inside – more depression, anxiety, eating disorders and sleep problems than in males

5 Facts About Mental Illness (WHO’s Fact File):

  1. Around 20% of the world’s children and adolescents have mental health difficulties
  2. Mental health and substance use difficulties are the leading cause of disability worldwide
  3. About 800,000 people commit suicide every year, making it the second leading cause of death for individuals aged 15-29
  4. Rates of mental health difficulties tend to double after emergencies (including natural disasters)
  5. Stigma and discrimination against individuals with mental health difficulties and their families often prevents them from seeking help
two women with man hugging by the sea

Common forms of Mental Illness

Anxiety and Depression are the two most common forms of mental health issues, but there are many others, including sleep difficulties.

Below is a chart from https://ourworldindata.org/mental-health that highlights the worldwide prevalence rates of mental illnesses:

Disorder Share of global population with disorder (2016) Number of people with the disorder (2016) Share of males:females with disorder (2016)
Any mental or substance use disorder 15.5%[13-22%] 1.1 billion 16% males 15% females
Depression 4%[2-6%] 268 million 3% males 4.5% females
Anxiety disorders 4%[2.5-6.5%] 275 million 3% males 4.7% females
Bipolar disorder 0.6%[0.4-1.5%] 40 million 0.55% males 0.65% females
Eating disorders (clinical anorexia & bulimia) 0.14%[0.05-0.55%] 10.5 million 0.07% males 0.2% females
Schizophrenia 0.3%[0.2-0.45%] 21 million 0.29% males 0.28% females
Alcohol use disorder 1.4%[0.5-5%] 100 million 1.9% males 0.8% females
Drug use disorder (excluding alcohol) 0.9%[0.4-3.3%] 62 million 1.1% males 0.5% females

Symptoms of Depression:

  • Feel sad most of the time
  • Don’t feel like doing anything
  • Don’t enjoy things you used to enjoy
  • Difficulties sleeping
  • Loss of appetite
  • Loss of energy and fatigue
  • Feelings of guilt and worthlessness
  • Suicidal thoughts or plans

Symptoms of Mania (Part of Bipolar Disorder):

  • Elevated or irritable mood
  • Decreased need for sleep
  • Increased activity and energy
  • Increased talkativeness or rapid speech
  • Risky behaviour without thinking of consequences (spending, sex, gambling, drugs, driving, big life changes)
  • Easily distracted
  • Grandiosity or inflated self-esteem

Symptoms of Psychosis or Schizophrenia:

  • Delusions: fixed false belief not shared by others in the person’s culture
  • Hallucinations: hearing voices or seeing things that aren’t there
  • Disorganized speech or behaviour:
    • Mumbling
    • Laughing to self
    • Strange appearance
    • Signs of self-neglect or unkempt appearance

Symptoms of Substance Use Disorders (Alcohol or other drugs):

  • Acute intoxication: a transient condition following intake of a substance resulting in disturbances of consciousness, cognition, perception, affect or behaviour.
  • Overdose: When a person has had too much of a substance and they have acute adverse physical reactions or mental effects.
  • Withdrawal: Unpleasant symptoms following the cessation of a substance – usually the opposite symptoms of the substance used.
  • Harmful use: Using a substance to the point where it damages health, relationships or work and/or study.
  • Dependence: A loss of control over how much someone uses a substance and a reliance on the substance on a regular basis. Includes strong cravings and withdrawal symptoms when not using.
people taking group hug
Photo by rawpixel.com on Pexels.com

Managing Mental Illness

  • Mental illnesses are preventable. There are effective strategies for preventing mental disorders such as depression.
  • Mental illnesses are treatable. There are effective treatments for mental disorders and ways to alleviate the suffering caused by them.
  • Some mental illness may need to be managed by medication, especially Bipolar Disorder, Schizophrenia and Severe Depression.
  • Other mental illness can be managed effectively through talking strategies such as Mental Health Psychosocial Support or Psychological Therapy. Especially anxiety, panic disorder, insomnia, post-traumatic stress, and mild to moderate depression.
  • Access to health care and social services capable of providing treatment and social support is key. This is where you can all help by referring anyone that you think may be struggling with a mental illness to the MindCare clinic at the hospital in your province.

If you are in Vanuatu and would like further information and assistance regarding mental health please contact:-

Mind Care Clinic
Psychiatry Department
VOIP: 1972

Namalinuan Clinic

Mental Health Clinic

Mental Health Clinic

Mental Health Clinic

or reach out to us via the Mental Health Vanuatu Facebook page.


Dr Damon Ashworth

Clinical Psychologist

Which Archetype Are You?

Ever notice how any successful story throughout history tends to have a similar cast of characters?

If you haven’t bothered counting, I’ll let you know that most characters will fall into one of 12 principal roles, and this explains why and how we can find favourite stories so relatable. Carl Gustav Jung, a famous psychoanalyst, defined these characters and the journey they go on as Archetypes.

activity adventure backlit backpack

What is an Archetype?

An archetype is something that symbolises primary human motivations, drives, desires and goals. It influences how one finds meaning in life, what one values, and the personality characteristics that one has. Most people tend to identify primarily with one archetype, although it is possible to be a mix of a few different ones.

Below are the 12 archetypes, with a brief description below them:


If you’re a visionary, you value innovation above all else. You look for patterns in the ordinary and try to create order out of chaos. You are intuitive and tend to find it much more comfortable than others to accurately predict trends and look into the future. You love to exchange ideas, share your opinions, and try out new gadgets. But you also have a tendency to overthink things or catastrophise if stressed and overwhelmed. When this happens, it is essential for you to retreat to somewhere secluded and/or scenic so that you can once again focus in on your next innovative idea that you would like to put into action.

The visionary archetype tends to include the designer, the detective, the director, the entrepreneur, the hermit, the futurist or the strategist.


If you’re a caregiver, you value being compassionate, caring and kind to others, but especially your family and friends. You struggle to say no to people because you love to help out and give as much as you can. Burnout is a risk if you spread yourself too thin, however. You are easy to get along with, flexible to various situations, and always willing to do what is required to adapt to and fit in with others without losing your sense of self. Your favourite activities involve spending time with those you love, and you are the person that people call or talk to if they have been going through something tough or are in crisis.

The caregiver archetype tends to include the loving parent, the teacher, the nurse, the doctor, the best friend forever, the rescuer, the mentor, the healer, the veteran and the civil servant.

royal report

The royal wants power and to be in control. They love being a leader and the boss and love living the high life and the sense of entitlement that comes with this. The royal is not afraid to throw money at a problem so that it will go away, and is willing to use their status, title or name to get what they want and feel that they deserve. Activities, holidays and clothes all need to be the best that money can buy.

Royal archetypes include the king, the queen, the prince or princess, the boss, the executive, the politician, the diva and the networker or social climber.

performer report

The performer is all about entertaining others and being the centre of attention. Even at social and family gatherings. Like Lady Gaga, they live for the applause and moving others emotionally or making them laugh. The performer wants to be seen and believes that being dramatic and in the right places with the right people is the best way to achieve this.

The performer archetype includes the actor, the entertainer, the comedian, the clown or fool, the eccentric, the trickster, the storyteller, the spellcaster, the magician and the provocateur.

spiritual report

The spiritual person has their faith as the cornerstone of who they are. They are belief driven, and pray and seek for what they know to be true to come to fruition. They love to engage in yoga, meditation, and connecting with others on a deeper level and can feel very connected with others and the world around them. The biggest trap for the spiritual person is magical thinking and not doing enough to take action and change the questionable things in their lives. They instead have hope and faith that things will work out the way they want, even when all the evidence suggests otherwise.

The spiritual archetype can include the shaman, the saint, the mystic, the guru, the angel, the missionary, the martyr, the disciple and the Samaritan.

tastemaker report

The tastemaker values the beautiful nature of things above all else. They pay attention to trends, fashion and decor, and ensure that whatever they have is as aesthetically pleasing as possible. Different from the royal, they don’t assume that this is just about what is most decadent or expensive. A tastemaker loves to explore new restaurants, shops, technology and holiday spots. Their weakness is judging others who do not prioritise aesthetics as much as them.

The tastemaker archetype includes the fashionista, the goddess, the gentleman and the metrosexual.

explorer report

The explorer loves adventure, exploring the world, and seeking excitement wherever they are. They are curious about everything new and things they are yet to encounter, and as a result, fear commitment and being stuck in one spot or tied down by someone else in any way. The explorer feels drawn to things unseen and undiscovered and is willing to be practical about what it takes to live their life in this way. They love meeting new people and immersing themselves in new cultures and experiences.

The explorer archetype includes the adventurer, the traveller, the seeker, the discoverer, the wanderer, the individualist, and the pioneer.

advocate report

The advocate is always being a champion for a good cause and hoping that things will get better if they put up a fight for what they believe in. They may have a tendency of getting too caught up personally in the cause but are willing to back up what they believe in by getting signatures for a petition, fundraising money for a campaign, or organising a protest. They also try to live their lives in a way that is consistent with their values and standing up for those less fortunate or those without a voice, such as flora and fauna.

The advocate archetype includes the hero, the environmentalist, the crusader, the vegan, the lawyer, the feminist, and the human rights advocate.

intellectual report

The Intellectual takes pride in their extensive knowledge about things that are important to them. They are always seeking new information and trying to apply this information in a useful way to increase their wisdom. The intellectual can come across as a know it all, but they never feel like they have enough new things to learn. They love to spend time reading books and going to museums and are happy to impart their knowledge to anyone who is willing to listen.

The Intellectual archetype includes the philosopher, the student, the geek, the sage, the scientist, the theologian, the crone, the inventor, and the judge.


The rebel’s core values are justice and autonomy. They are fiercely independent and cannot be contained by the social niceties, order and dutifulness. They do what they want at all times, and like adventure and excitement, challenging convention and being deliberately provocative too. They are at risk of not thinking through the consequences of their decisions, and as a result can overconsume drugs or alcohol or get into trouble with the law, at work, or with those closest to them.

Rebel archetypes include the warrior, the hedonist, Don Juan, the femme fatale and the wild man or wild woman.


The athlete lives for staying active, fit, and in shape. They love to compete in anything involving physical activity and are happiest when they have achieved a big, athletic goal.  The athlete has a tendency to turn everything into a competition, which can annoy others, but they are just as happy pushing themselves to improve their health and body. Clothing is worn for comfort and performance only, not aesthetics. The athlete loves to attend sporting events and is also happy to watch sport on the TV.

The Athlete archetype includes the competitor, the outdoorsman, the dancer, and the tomboy.


The creative loves being original and genuinely expressing themselves. The creative hates to just repeat or copy what others have done before them. They are happiest creating something from nothing, and this may include a piece of art, but it could also be a meal, an outfit, room in a house or even an idea. The creative does have a tendency to be a perfectionist, and this can make it difficult to begin a new project. Once you get started, you then tend to get into the zone until a project is complete or you need a break.

The creative archetype includes the artist, the chef, the child, the poet, the novelist, the shapeshifter and the romantic.

bench chair friends friendship

What Are Your Main Archetypes?

At archetypes.com it’s possible to find out which archetypes you are most similar to. This may help you to identify what journey it is you need to take in life, or what areas may be best for you to focus on going forward. Included below are my results:

I’m pretty happy with these results, and not surprised by my top 2, but I was surprised to see visionary my third highest archetype. I’ve never thought of myself as that imaginative or innovative, but I do want the world to change for the better and am willing to do what I can to improve the mental health of others.

Based on these results, it’s apparent that I love to help others, but I need to be cautious about taking on excessive responsibility for others or feeling too guilty or inadequate when I can’t help as much as I would like to. I love to learn and be curious about new things, but I still need to be humble and understand that there’s still so much that I’ll never know. I also need to realise that not everyone wants to learn like I do, and that is okay too.  Lastly, when I have an innovative idea, it is vital that I put this plan into action so that I can make a real difference. I would also benefit from making sure that I connect with others and collaborate with the right people to help make these dreams become a reality.


I know that archetypes and the test are not highly scientific, but I still found them useful to think about what story I am trying to live out, and what values or principles I am being guided by. Caring for others, learning new things, and creating positive change is what I care about. What about you?
Dr Damon Ashworth
Clinical Psychologist

33 Thoughts About Turning 33

This will be an unfiltered post. No thinking things through. No edits. Just reflections on life, age, and anything else that pops into my head. Here goes nothing:

  1. Turning 33 feels weird
  2. I feel old at times, especially in my body
  3. I still feel like a child at other times too, and I wonder whether I will ever feel like a proper adult
  4. I can’t believe I have so much grey hair now
  5. It’s strange to wonder where the time has gone
  6. Yet when I think about it, I really have done a lot and had many amazing experiences in my time on this planet
  7. I’m happier now than I have ever been before
  8. We never really know how our life will turn out
  9. I couldn’t have planned for what has occurred in my life, and yet it’s pretty amazing that things have turned out the way they have
  10. I’m excited about the future
  11. I used to get scared about the idea of getting older, but I don’t anymore
  12. I’ve stopped searching for the right answers these days, and instead focus on asking and living the right questions
  13. I don’t regret much from my past, even though some of it really sucked at the time
  14. I still don’t fully understand people, even after I have studied psychology for 8 years, seen patients since 2010 and read over 200 psychology books
  15. I probably never will fully understand myself or someone else, and that is okay by me, as long as I keep trying to learn and grow
  16. 33 is a palindrome
  17. When I was younger, I would have seen 33 years old as “really old” and “over the hill.”
  18. I thought that I would have been a parent by now
  19. I am glad that I haven’t just tried to follow the crowd and live a traditional life
  20. I used to think it was better to receive gifts from others, now I can see how much better it is to give
  21. I worried and stressed way more than I needed to as a child
  22. I focused on my body image and appearance way too much as a teenager
  23. I’ve never really looked after myself that well when it comes to what I put into my body. This will eventually catch up to me if it hasn’t already
  24. I’ve let go of being perfect, which feels great
  25. Not everything happens for a reason, but we can learn something from everything that we go through
  26. Everyone suffers in life to some degree
  27. Everyone has baggage
  28. Life isn’t about getting the best job, house, partner, but the best one for you and your lifestyle and values
  29. No one truly knows what the future holds, and that is both exciting and scary
  30. It’s much better to only focus on trying to change what is in my control
  31. Having unconditional positive regard and compassion for others is tough to do but really rewarding if you can
  32. Living an honest and ethical life is so much less tiring in the long run than being dishonest, self-centred and egotistical
  33. There are a lot of kind people out there, and being kind to others is the best way to see it.

Thanks for reading these last three years, and happy holidays to you all!


Dr Damon Ashworth

Clinical Psychologist

Do the Little Things We Do Matter?


I love the above quote by Lao Tzu. It really highlights to me that all of the little choices we make in life are important, especially in the long run.

Not any one choice, or any particular action, unless it is unusually severe or unforgivable. I’m talking about the little things that we do on a regular basis which cumulatively build up over time and define the type of person that we are, and who others see us as.

This may be something like choosing to make your bed every morning or getting up to go the gym before work or having a veggie smoothie rather than a jam-filled doughnut and caramel macchiato for your 3pm work snack. Taking the easy or not so healthy option may not seem like such a big deal if it’s just the once, but what if this then becomes habitual over time?

Without even realising it, you may wake up one day and recognise that you have a severe sugar, junk food, caffeine, nicotine, alcohol, TV or smartphone dependency, and it’s no longer as easy to stop this behaviour as you may have hoped for or believed.

Most obese, unfit and unhealthy individuals probably didn’t expect that they would be where they are, but it didn’t just happen overnight either. They started with an initial thought, felt something, experienced an urge or craving, and made a choice to act in a certain way. The more they repeated this action in similar situations, the more the brain learnt that this is just what they needed and that this behaviour should be repeated whenever they thought or felt this way.  Eventually, the action no longer felt like a choice, but a compulsion, where they may not have even realised what it was they were doing until it was too late, let alone be able to change it going forward.

William James said something similar, but offers a solution out of this trap:

Thoughts become perception, perception becomes reality. Alter your thoughts, alter your reality. - William James

I’m not sure if I agree with William James completely, because in my experience it is often easier to act ourselves into new ways of thinking, rather than think ourselves into new ways of acting. While how we think and feel about things is important, if we don’t also challenge and change our behaviour, it is going to be very difficult to make any type of positive long-term change. Change our behaviours first regardless of our thinking, however, and we will have more and more evidence that is contrary to the unhelpful thoughts or beliefs that we hold. In time, it then becomes more comfortable to shift these negative thoughts and perceptions, shaping your reality.

Why Bother Trying to Change?

Someone asked me the other day “will you ever just be satisfied with how you are, and eventually stop using questionnaires and other measures to keep trying to track and change your life?

It seemed like a weird question to me, but it is consistent with how my father tends to view life too. He knows what makes him happy in life, and does it. He’s not too worried about changing or growing and just focuses on enjoying each day, even if it’s the same as yesterday.

That’s great for him, and on some level, it would be nice, but I just don’t think I’m built that way. Maybe it was because I was a pretty stressed out, anxious and sometimes unhappy child. Or perhaps I have seen how much I’ve been able to improve my life and my relationships with others through learning about psychology, reading a lot, going to therapy, making specific behavioural changes, and continuing to monitor and challenge myself over time.

A quote by Charles Bukowski probably sums it up better than I ever could:

Image result for charles bukowski people are strange quote

Some Worrying Statistics

We’re meant to do at least 4 hours of moderately vigorous physical activity each week according to the Centers for Disease Control and Prevention, and yet researchers have found that the average American adult only does 17 minutes each day.

According to the 2017 OECD findings, more than 50% of adults and nearly one-in-six children are overweight or obese and this figure is projected to increase further by the year 2030.

The World Health Organisation says that 3 million people died worldwide in 2016 as a result of harmful alcohol use in 2016. Fortunately, the drinking of alcohol has continued to decrease in Australia since its peak in 1974-1975. However, regular teen consumption of alcohol is still the most significant risk factor for problematic drinking of alcohol in adulthood.

In 2014 in the US, 6.2 million people were reported to suffer from an illicit substance use disorder, and more than 115 people die every day from opioid abuse or misuse.

Social isolation and loneliness are becoming much bigger problems these days, with one-quarter of all Americans reporting in a survey that they have no one that they can discuss important matters with or call in case of an emergency. Both social isolation and loneliness are correlated with an increased risk of dying younger too.

The average American household was watching 8 hours and 55 minutes of TV a day in 2009-2010 (the peak), but this has only dropped down to 7 hours and 50 minutes per household in 2018, which is still an extremely high amount. Viewing time per household increased every decade since the 1950s, and now seems to be the thing that Americans do for leisure, as was brilliantly documented in Robert Putnam’s sociological book “Bowling Alone”.

59% of all Americans and (48% of Europeans) now play video games, including 97% of teenagers in the US. A 2016 study found that 6% of gamers worldwide could be considered to be addicted, and another study found that 7% were problematic gamers, who played at least 30 hours each week.

Lastly, smart-phone usage continues to increase around the world, with excessive social media and smartphone usage also being linked to adverse mental health outcomes. As I’ve previously mentioned in another blog post, Australia is now fourth in the world regarding smartphone usage. The average for all Australian mobile phone users is 2.5 hours a day, which adds up to 38 days per year. We check something on our phone 30 separate times each day, and 45% of Australians now say that they couldn’t live without their phones.

Putting all of these statistics together, it’s pretty easy to see the long-term consequences of our brains wanting to conserve energy, take the easy option, or avoid pain. These little, seemingly insignificant moments probably happen at least 20 times a day, and in each moment, as long as we are paying attention, we have a choice. We can stay on autopilot and do what is easy, or we can tune into our core values, ask ourselves what type of person we would like to become in the long-run, and then take the action that is consistent with this vision, even if it feels strange or different or outright uncomfortable.

Going to the gym will always hurt the first time you go, but the 20 minute walk that you choose to do today is better than the 10km run that you put off until next week. It may be tempting to say that you’ll start a new diet next Monday, but why put off making a healthy decision in the here-and-now if you don’t have to? It is these moments that will eventually define who you become, and you can begin to make a positive long-term change today…

scenic view of snow capped mountain
Photo by eberhard grossgasteiger on Pexels.com

But What Do We Do if We Want to Change?

So let me ask you the following three questions:

  1. Is there anything in your life that you wish you could do more of?
  2. Is there anything in your life that you wish you could do less of?
  3. What is stopping you from making these changes?

If you answered YES to either question 1 or 2, and you don’t know the answer to number 3, it is worth exploring deeper…

It is worth finding out what makes you tick. It is worth finding out what your values are, what your personality is like, what your strengths are, and maybe even your attachment style. Change is possible…and inevitable. You just have to know what steps to take. Here are 25 ideas that could change your life, and 20 of my favourite quotes to motivate and inspire you to take action. I wish you the best of luck on your journey of self-discovery and growth. Like me, I doubt that you will regret it.

Dr Damon Ashworth

Clinical Psychologist