Damon Ashworth Psychology

Tag: treatment

  • Why Bother Overcoming Fears?

    Why Bother Overcoming Fears?

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

    PADI Temporary Card — Open Water Diver

    Name: Damon Ashworth
    Instructor Number: 305944

    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. But, I did it because a close friend asked me if I would be her dive buddy for the course, and I thought 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 many theory tests 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. We saw a shipwreck, some amazing coral and sea life, and even a few small reef sharks during the open water dives.

    The scariest part to me was when I was up to 18 metres underwater, knowing that I’d need to stop for 3 minutes at 5 metres on the way up and ascend slowly to avoid decompression sickness. It meant that if I felt a bit anxious or panicky for whatever reason, I couldn’t just get out to the surface straight away and start gasping for air. Instead, I had to remain calm, breathe slowly and steadily using my regulator, put some confidence in my divemaster 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.

    Fortunately, I successfully completed the dives and all the skills. Some moments were pretty cool, especially seeing the wreck and 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 I did it.

    So how do I know if it was worth it? Should I have bothered challenging myself to do something where I worried I could have died if something went badly wrong?

    When Is It Worth Facing Your Fears?

    The answer is it depends. It depends on:

    1. What scares you?
    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 is the thing that you fear? and
    4. Will it impact your quality of life if you do not face up to your fear or try to overcome it?

    Suppose what you fear has a low risk of actually occurring. The activity is relatively safe even though it feels scary, and not doing it has a significant negative impact on your life. In that case, it is worth trying to challenge yourself and overcome 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 high but not quite at the panic stage.
    3. The 2010 Diver’s Alert Network Workshop Report found that only one-in-211,864 dives end in a fatality. SCUBA diving is riskier 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 on stairs than we are from SCUBA diving.

    4. If I never went SCUBA diving, I doubt that it would have reduced my quality of life in any way. I did it mainly because I wanted to spend time with my friend, and I wanted to challenge myself to face my fears, as not being able to overcome any fears would have a substantial negative impact on my quality of life.

    I am glad to get my PADI Open Water Certificate based on the above information. 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 five or a six. 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

    Looking at the above common phobias, they 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 crowds, and lightning strikes have killed people. Germs and bacteria spread disease too. 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. Unfortunately, our brain is not very good at distinguishing dangerous things versus things that feel dangerous but are pretty safe.

    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. It should have at least five tasks that you want to do ranked from least scary to most scary (scale from 0–10). For Arachnophobia, it may be a 2/10 for looking at pictures of spiders to a 4/10 for watching videos of spiders. Then a 6/10 for looking at spiders in an enclosure to a 10/10 for letting a spider crawl up your arm.

    3. We start with the least scary task first and stay in the situation for at least 10 minutes if possible. It should be long enough for the anxiety to peak and then reduce substantially during the exposure exercise. A psychologist can teach specific behavioural and thinking skills to help lower stress levels during exposure.

    4. We reflect on the exposure experience afterwards and try to change our previously held beliefs about what we fear. It 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 three and four with the next task on the exposure hierarchy. Then, once we become comfortable with the next step, we take each step until we are successful with all tasks on the hierarchy. By the end, you have overcome or mastered the fear.

    What if What I Fear 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 globally. If you want to overcome this fear, you might want to learn instead 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. However, testing ‘The Edge’ experience at the Eureka tower in Melbourne or even riding ‘The Giant Drop’ on the Gold Coast might be a pretty safe way to challenge your fears.

    Facts can really help some people challenge their beliefs about their fears, but nothing beats putting ourselves in a feared situation first and then challenging 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. Likewise, 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’m not particularly eager 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 everywhere, so I couldn’t avoid germs entirely even if I tried.

    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 pretty safe as long as I don’t panic and follow 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. So 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.

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

    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 primary 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 manage emotions in ourselves and those closest to us that can make a significant difference.

    Parenting Styles

    In 1971, 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 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, 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 penalties, and being directive towards the child rather than discussing things with them.

    3. Permissive

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

    The graph above highlights a fourth style known as uninvolved (Maccoby & Martin, 1983), including very little control or strictness and very little parental warmth.

    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 leads 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). In addition, 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). For example, 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). However, try to see if any of the following strategies 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.
    • Emphasise why they must follow the rules.
    • Help them 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.”

    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 how we bid for connections with others and respond to others bids.

    A bid is simply any form of expression, whether 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. But, conversely, 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, influencing 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 the following:

    • Commander-in-chief (dominance and control)
    • Explorer (exploration and discovery)
    • Sensualist (sensual gratification, pleasure)
    • Energy Czar (regulates the 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’s figure out how we can help you.“) = more bidding, turning toward, with the 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 partners when they are older.

    4. Sharpen Your Emotional Communication Skills

    By learning effective communication skills, we are more likely to say what we mean and feel without the other person becoming defensive. As a result, it can increase our chances of positive changes occurring and improve relationship satisfaction.

    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!”)

    A — Ask 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, 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,
    • Christmas and Family Day with the extended family,
    • New Year at the beach every year, or
    • Anything else that you can repeat regularly

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

    So there we have it. 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 communicate and find shared meaning with your children. Then, you will be well on your way to raising emotionally healthy children. I wish you all the best with the inevitable challenges along the way.

    Dr Damon Ashworth

    Clinical Psychologist

  • Positive Psychology – The Secret to Optimal Well-being

    Positive Psychology – The Secret to Optimal Well-being

    For many years, Psychologists focused exclusively on alleviating suffering. A worthy objective, but the treatments tried to reduce depression or anxiety, not increase happiness or life satisfaction. If someone is no longer feeling sad, will they suddenly feel happy? Perhaps, but not necessarily.

    The field of Positive Psychology tries to address these concerns.

    Martin Seligman has written three major Positive Psychology self-help books titled ‘Learned Optimism’, ‘Authentic Happiness’ and ‘Flourish’.

    Seligman was interested in studying depression and ran some experiments at the University of Pennsylvania in the late 1960s to develop his theory of learned helplessness. Initially, the dogs were given electric shocks at random intervals and were not allowed to stop the shocks or escape the situation. After a while, even when Seligman provided the dogs with a chance to stop or exit the shocks, he found that they would not do anything about it. The relevance to people with depression is that an individual in an aversive environment who learns that they cannot change their outcome will continue to hold this belief even in situations where this isn’t the case. They won’t improve their position because they think it won’t make a difference anyway. But what if it does?

    ‘Learned Optimism’ was seen as the antidote to learned helplessness and focused on changing people’s outlooks and teaching them resiliency to better distinguish between things you can change and things that you can’t. By putting their energy into what they can do instead of blaming themselves for something out of their control, they became more motivated to develop knowledge and learn skills to make changes they desired in their lives. Regardless of what has happened in the past, having a slightly optimistic outlook on life leads to better emotional and physical health. It helps people persevere through the bad times, look after their health and put their best long-term interests first. Research has even shown that it can lead to a better survival rate following a heart attack.

    In ‘Authentic Happiness’, Martin Seligman extended these ideas and said that happiness was not just a matter of genes or good luck but could be sought out and created. You can do this by discovering your character strengths and virtues and putting these into action as much as possible.

    If you are interested in discovering what your natural character strengths are:

    1. Please go to www.authentichappiness.sas.upenn.edu and fill out the VIA Survey of Character Strengths.

    2. The survey results will rank your Strengths from first to last. First, determine if your top 5 strengths are your key character strengths or virtues — you will know if the responses “feel right” to you. Then, if a lower-ranked item seems to better fit you than any of your top 5, write down your new top 5.

    3. Ask yourself, how much do you currently put these strengths into practice? In what ways do you apply them or live by them? For example, if love of learning or creativity is your highest ranked strength, do any changes need to be made in your life so that you can experience these more (e.g. study a new course or take on another creative pursuit)?

    4. If changes need to be made, set yourself some SMART (S — specific, M — measurable, A — attainable, R — realistic, T — timely) goals for how you can put these virtues into action. If these are your key character strengths and virtues, it is likely to lead to a higher overall sense of emotional well-being.

    In ‘Flourish’, Seligman proposed only five elements crucial for optimal psychological well-being or for someone to flourish. He called this his PERMA model of well-being:

    P — positive emotions — We all need love, joy, hope, compassion, gratitude, awe and excitement in our lives. What activities frequently bring about these emotions for you? Can they be sought out, or can you engage in these activities more regularly?

    E — engagement — Sometimes referred to as ‘flow’, engagement is the state when we are no longer in our heads or consumed with worries but completely immersed in whatever we are doing. By reading the book, ‘Finding Flow: The Psychology of Engagement with Everyday Life’ by Mihaly Csikszentmihalyi, I realised that we could create the conditions for these engagement experiences. Typically, you can achieve this with activities requiring some skill and challenge but not too much. So it is when I am playing a sport, in session with a client, or engaging in a creative pursuit. However, it is different for everyone and doesn’t always happen each time you do an activity. It is what athletes refer to when they are “in the zone” or what M. Scott Peck referred to when he spoke about how his best-selling book ‘The Road Less Traveled’ seemed to write itself. Mindfulness training, apart from its other benefits on stress, pain and prevention of depression relapse, can also lead to a higher likelihood of full engagement with a situation.

    R — positive relationships — Whether we are extroverted or introverted, humans are still social creatures who seek to be understood and accepted for who we are and have a sense of belonging with others. We also like to share experiences, as you will notice with any child who waits for their parents to look and see what they are doing before engaging in an action. It was the moral of the story in “Into the Wild”, the 2007 movie starring Emile Hirsch, where the main character wrote, “Happiness only real when shared”. But negative relationships also cause a lot of pain, so the secret may be in how to seek out and foster the right connections (e.g. friends, partners), as well as how to improve the ones that we already have or may not be able to choose (e.g. family, bosses). If you are having problems with this area of your life, the book ‘The Relationship Cure’ by John Gottman is an excellent place to start, as is seeking out a trained relationship therapist.

    M — meaning — Friedrich Nietzsche first said: “he who has a why to live can bear almost any how.” Viktor Frankl also determined in ‘Man’s Search for Meaning’ that purpose was required to withstand the daily atrocities he faced as a Jewish prisoner of a German concentration camp during World War II. Frankl, a Psychiatrist, believed so much about the importance of meaning that he developed a treatment called Logotherapy, which focused on helping others find meaning. He dedicated the second half of his book towards this goal and his subsequent psychotherapy. Depending on your beliefs, there may or may not be a universal meaning of life, but each individual must determine its importance. Where possible, it is then essential to try to live your life in that way, as long as it doesn’t break the laws of your society or cause harm to others. Values clarification exercises can assist with this.

    A — achievement — People like to achieve things, succeed, and win for their own sake. It is why there are so many cheats for video games and corruption in the corporate world, and drug cheats in athletic competition. So many people will do what they can to win. Achievement can be winning something, gaining knowledge, building skills, or completing a task. Having three achievable goals each day would go a long way towards improved well-being.

    Psychology is about more than the alleviation of suffering. It is about helping people understand, grow, develop mastery and self-efficacy, and live the best life they can!

    Dr Damon Ashworth

    Clinical Psychologist

  • How Can We Effectively Manage Guilt and Shame?

    How Can We Effectively Manage Guilt and Shame?

    What are shame and guilt?

    Neuropsychologist Dr Harvey Jones and I discuss shame and guilt and how to manage these tough emotions in our latest podcast.

    The fascinating and comprehensive book ‘Shame and Guilt’ by June Tangney and Ronda Dearing describe shame and guilt as universal human emotions that are functionally important at both an individual and a relationship level.

    Features shared by shame and guilt (Tangney & Dearing, 2002):

    Shame and guilt are both very private and personal emotions. They are predominantly internal experiences that are more difficult to observe or measure than other universal emotions, such as anger, sadness or joy.

    Yet, they are also social emotions, in that these emotions develop during interpersonal interactions with our family and those closest to us.

    Both shame and guilt can be classed as “moral” emotions in that our experience of them can hopefully propel us to act more morally.

    They are both closely linked with how we see ourselves about others. They continue to profoundly influence our behaviour in interpersonal situations throughout our lives, especially in contexts involving perceived transgressions, mistakes or moral failures.

    Shame and guilt both involve becoming self-conscious following a personal transgression and evaluating our behaviour about our perceived self, familial and societal norms. Based on this evaluation and what we internally attribute the violation to, we judge our behaviour and potentially internal sanctions towards ourselves if we deem the behaviour morally or socially unacceptable.

    Although Philosophers and Psychoanalysts have been theorising about shame and guilt for over a century, it is only really since the late 1980s that Psychologists have begun to systematically research and examine the nature of shame and guilt and the implications that these emotions and experiences have. Unfortunately, as well as being difficult to observe directly, many people tend not to have a clear understanding of the differences between shame and guilt.

    Features where shame and guilt differ (Tangney & Dearing, 2002):

    Focus of evaluation

    • With shame, the focus of the evaluation is on the global self (e.g., “I am horrible!”)
    • With guilt, the focus of the evaluation is on the specific behaviour (e.g., “What I did was horrible!”)

    Degree of distress

    • With shame, the degree of distress is generally much higher than with guilt, with more significant pain.
    • With guilt, the degree of distress is generally much lower than with shame, with less pain.

    Phenomenological experience

    • With shame, people tend to shrink and feel worthless, powerless and small
    • With guilt, people tend to feel tense, remorseful, and regretful

    Operation of “self.”

    • With shame, the self becomes split into an “observing self” and an “observer self.”
    • With guilt, a unified self remains intact

    Impact on “self.”

    • With shame, the self becomes impaired by a global devaluation (because of the focus of evaluation on the self)
    • With guilt, the self is unimpaired by a global devaluation (because the focus of the evaluation is on the specific behaviour)

    Concern vis-a-vis the “other.”

    • With shame, one becomes concerned with an internalised others’ evaluation of the self.
    • With guilt, one becomes concerned with the effect that their specific behaviour has had on others.

    Counterfactual processes

    • With shame, one tries to mentally undo the undesirable aspects of the self that have become apparent through denial, defensiveness, blaming others or aggression.
    • With guilt, one tries to mentally undo the undesirable aspects of their behaviour through being moral, caring, socially responsible and constructive.

    Motivational features

    • With shame, the desire is to hide, escape, or strike back
    • With guilt, the desire is to confess, apologise, or repair

    How to measure Shame and Guilt

    I challenge you to take the Test of Self-Conscious Affect (TOSCA Version 3) to determine if you are more prone to shame, guilt or blaming others across work and social situations.

    When I took it, my results were:

    “I seldom blame others.”

    “I use guilt self-talk an average amount.”

    and

    “I use shame self-talk an average amount.”

    It was nice to see that I do not blame others when I realise that I have made a mistake and am often accountable and responsible for my actions. However, it does seem that I tend to punish myself too much following a transgression. But what do these findings mean for real life?

    The TOSCA has been used widely in studies on shame and guilt since 1989. It defines guilt as a more adaptive response to a situation where the focus is on the desire to repair or right the specific wrong caused. Conversely, shame is a less adaptive response where the attention is on a global negative self-evaluation without any reparation generally being taken.

    Research Findings on Shame and Guilt

    Research findings using the TOSCA have found that “Shame and guilt have important and quite different implications for interpersonal relationships.” For example, based on 12 years of research, Tangney and Dearing (2002) have found that:

    Individuals who are prone to shame:

    • They are more likely to blame others for adverse events through humiliating others, bullying, and violence.
    • They are more likely to experience bitterness, resentment and a seething kind of anger and hostility towards others and the world. They are also inclined to express their anger in aggressive and non-constructive ways, particularly in close interpersonal relationships. The shame-anger dynamic may help explain what occurs in many domestic violence incidents.
    • They are less likely to be empathetic, as the global self-focus of shame impedes sensitivity and impairs connection.
    • They are more likely to be vulnerable to a range of psychological difficulties through internalising the shame, including depression, low self-worth, self-loathing, eating disorders, and addiction.
    • They are more likely to be suspended from high school, use illicit drugs, engage in unsafe sex practices, abuse their spouses and attempt suicide (when individuals were first assessed in fifth grade and then followed up on years later).

    Individuals who are prone to guilt:

    • They are more likely to understand, empathise and connect with others.
    • They are more likely to accept responsibility for their transgressions.
    • They are less likely to be angry, hostile and aggressive. Conversely, people who feel guilty and angry are more likely to express what they feel assertively and constructively.
    • They are less likely to experience psychopathology as long as the guilt is “shame-free.”
    • They are more likely to apply to college, engage in community service, begin drinking alcohol at a later age, and use birth control (when individuals were first assessed in fifth grade and then followed up on years later). They were also less likely to try heroin, drive while intoxicated, and be arrested or convicted of a crime.

    Is guilt always a helpful emotion?

    No. Two maladaptive forms of guilt (Kim, Thibodeau & Jorgensen, 2011) have been correlated with depressive symptoms to a similar degree to what shame is. These are contextual-maladaptive guilt, which involves an “exaggerated responsibility for uncontrollable events,” and generalised guilt, which involves “free-floating guilt that is unrelated to any specific context” (Kim, Thibodeau & Jorgensen, 2011). This excessive or inappropriate guilt would not be helpful to experience regularly.

    What Can We Do?

    A. Manage guilt effectively

    With guilt, the steps for dealing with the emotion are pretty straightforward:

    1. Has a transgression occurred where you have not lived up to your own (or an internalised other’s) moral standards?
    2. Can you make up for this transgression in any way?
    • By taking responsibility for your action?
    • By fixing the mistake and cleaning up the mess?
    • By genuinely apologising and showing remorse for your actions?
    • By understanding and empathising with the person if you hurt them?

    3. How can you learn from the mistake so that you are less likely to repeat the same transgression in the future?

    4. What plan can you put in place so that you are less likely to repeat the same transgression in the future?

    If you feel guilty for having a particular thought, please understand that we cannot control what ideas pop into our consciousness. What we can control is how we interpret or respond to the ideas that do arise. Considering that we have at least 10,000 thoughts a day, it is implausible that all of these thoughts will be positive, happy, kind, pro-social thoughts.

    No transgression has occurred if it is just a thought, and there is no need to feel guilty, no matter how antisocial, nasty, sinful or taboo these thoughts may seem. A court of law can never charge you for impure thoughts. You do not need to put yourselves on trial either. Even psychologically healthy people have weird or unsettling ideas, as evidenced by this list of common intrusive thoughts (Purdon & Clark, 1992). Our actions define our character and how others see us, not our internal monologue. The above steps only need to be worked through when your efforts do not live up to the person you would like to be.

    Once you have worked through these steps, there are no additional benefits that you can achieve by continuing to feel guilty, punishing yourself for your transgression, or not forgiving yourself for your actions. Everyone makes mistakes. We must utilise guilt as an indicator that we have not been living consistently with our most important values and then practice these steps to get back on track.

    If you continue to feel guilty after this, try to accept your feelings and make room for the emotional experience. Then try to change your focus to whatever is most important to you in the present moment. For example, it could be the sport or computer game you are playing or connecting with others if you are out socialising. By asking yourself, “What’s Most Important Right Now?” it becomes a lot easier to get out of a cycle of ruminating about what you have done and feeling guilty for it.

    B. Encourage parents, teachers, bosses, managers, coaches, and mentors to help others to learn from their behavioural mistakes so that they can improve and maintain a positive sense of self, rather than criticising who they are or shaming them for doing something wrong

    We must educate people in these roles about the differences between shame and guilt and let them know that even if using shame seems to be effective in changing behaviour in the short term, it can have devastating long-term consequences. It can damage your relationship with the person and their mental health and behaviour.

    Shaming children is especially dangerous and shows them that their love, worth and approval is conditional. As a result of being shamed, children will eventually give up, become rebellious, try to be perfect, or subjugate their own needs and please others to maintain their fragile sense of being loveable, good enough or worthy.

    Once people become knowledgeable about focusing on the specific behaviour rather than the person as a whole, it can enhance their sensitivity and effectiveness in all relationships.

    C. Develop a Growth Mindset

    I have previously spoken about mindsets, as researched by Carol Dweck. When examining the difference between shame and guilt, I noticed the similarities between shame and a fixed mindset and guilt and a growth mindset.

    Both guilt and a growth mindset are focused on improving following setbacks, rather than remaining stuck, giving up or blaming someone else for your shortcomings. In addition, research indicates that you can cultivate a growth mindset over time.

    The similarities between guilt and a growth mindset suggest that it is also possible to change from being more shame-prone to being more guilt-prone. As you become more guilt-prone, you will begin to learn from your experiences and continue to grow without being held back by the transgressions that you have made in the past.

    D. Embrace your imperfections, allow yourself to be vulnerable, and share your feelings of shame with those that have earned the right to hear your story

    In “The Gifts of Imperfection’, Brene Brown defines shame as the following:

    “shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.”

    Brene Brown

    Brene has found that shame needs the three ingredients of secrecy, silence, and judgment for it to grow and spiral out of control in our lives. She also believes that we all experience shame to some degree and that even though we are afraid to talk about what we are ashamed of, it is actually by talking about our shame that we are least likely to be controlled by it.

    “If we want to live and love with our whole hearts, and if we want to engage with the world from a place of worthiness, we have to talk about the things that get in the way — especially shame, fear and vulnerability”

    Brene Brown

    How to become more shame Resilient (Brown, 2010):

    1. Understand shame.
    2. Recognise what triggers shame for you, both externally (e.g., other people’s critical messages) and internally (e.g., your unrealistic expectations).
    3. Check to see if these criticisms or expectations are realistic or accurate.
    4. Realise that being imperfect does not mean the same as being inadequate or unworthy of love.
    5. Reach out to people who have earned the right to hear your shame experiences.
    6. Talk about what makes you feel ashamed and whatever else you may be feeling about the experience.
    7. Ask for the type of support that you need from them. It could be some kind words or reassurance. It could be something they can do for you (even if it is turn up and listen). It could be some hand-holding, back rubbing, or a hug. Or it could be some quality time, something to cheer you up, or a fun outing to help you change focus and move on.

    Once our previously shameful experiences are out in the open, we begin to own our story and realise that we are loveable and worthy, just the way we are. Although it is easier to experience this if our closest relationships provide us with unconditional acceptance, love, and belonging, we only need one person we can open to for shame to reduce and improve. If there is no one in your life that you would feel comfortable talking to about your shame, then a psychologist you feel safe with can help.

    Dr Damon Ashworth

    Clinical Psychologist

  • What Makes Some Things Fade Fast, and Others Stand the Test of Time?

    What Makes Some Things Fade Fast, and Others Stand the Test of Time?

    After writing blog posts for the last eight years, I find it quite interesting to see which articles are immediately successful and which remain successful over a long period.

    The most popular blog post that I have written since 2015 is titled ‘How Have Intimate Relationships Changed Over the Years, and Where Does it Leave Us Now?’. It was first published in May 2016 and did okay initially. However, it continued to build over time, and its most successful month for post views was April 2018, nearly two years after it was first released.

    Most posts tend to track like the typical movies at the cinema, a book at the book store, or a song at the record store (back when they still existed). Their biggest week of views (or sales) tends to occur right near the start, and a lousy opening release indicates that the overall views (or sales) aren’t likely to be that great either. Very rarely, this isn’t the case.

    Movies

    At boxofficemojo.com, they even talk about and predict opening multipliers for films or how much a movie will gross compared to its opening weekend takings. One of the most significant drops was the remake of ‘Friday the 13th’ in 2009. It grossed over $40 million in the first week, less than $8 million in the second week, and only $65 million all up on the US Box office. It was a multiplier of only 1.625, indicating no staying power. Essentially, anyone who wanted to see it saw it as soon as it came out, and that was it.

    At the opposite end of the spectrum, you have ‘La La Land’, which started with just over $9 million in ticket sales in the US in the first week, but over $12.5 million the second week and more than $151 million at the US box office all up. Good reviews and Oscar buzz must have played a bit of a role, as its overall take was nearly 17 times that of its opening weekend. In 2005, ‘Sideways’ produced a multiplier of almost 30 times its opening weekend, and ‘Titanic’ and ‘ET’ remained at #1 at the US Box office for 15 and 16 weeks, respectively.

    Avatar is the highest-grossing movie of all time worldwide. It stayed in release for 238 days and grossed 2.924 billion dollars. Titanic, released in 1997, is still the fourth highest-grossing movie worldwide. Avatar: The Way of Water is third. James Cameron directed all three movies. He knows how to make films that impact people.

    Songs

    In the UK, Wet Wet Wet pulled their song ‘Love is All Around’ after 15 weeks at number 1 on the charts, and Gnarls Barkly did the same with their song ‘Crazy’ after nine weeks at #1. Maybe they worried about being one-hit wonders. Can anyone remember any of their other songs?

    Other songs may not have even been that big at the time but continue to be hits months and years after first being released. For example, ‘Mr Brightside’ by the Killers, ‘Chasing Cars’ by Snow Patrol and ‘My Way’ by Frank Sinatra never even reached number 1 on the UK charts but remained in the top 100 singles chart for 203, 166 and 133 weeks in total respectively.

    Books

    ‘The Alchemist’ by Paulo Coelho stands out like no other with books. Initially, sales were so slow when first published in Portuguese in 1988 that the publisher gave back the author’s rights after a year. Since then, it has gone on to win over 100 international awards, been translated into 80 languages, and sold over 65 million. Publishers also rejected Harry Potter 12 times before it was finally accepted and sold millions of copies worldwide.

    So how do some movies, books and songs defy the odds and have seemingly miraculous staying power? I’m not sure if the exact reason is fully known, but it does seem to be that they all make an emotional impact on the audience and come out at the right place and the right time to have the effect that they do. One year earlier or later, and the same magic just may not be recreated. It’s why remakes often fail.

    What if you could recreate that, though? Are there particular elements that all big successes have? That helps things go viral? That leads to the box office or New York Times bestselling gold?

    What Makes Ideas Hang Around?

    Most watched videos on YouTube of All-Time:

    1. Baby Shark = 9.58 billion views (released June 2016)
    2. Despacito = 7.61 billion views (released January 2017)
    3. Johny Johny Yes Papa = 5.85 billion views (released October 2016)
    4. Shape of You = 5.51 billion views (released January 2017)
    5. See You Again = 5.31 billion views (released April 2015)
    6. Bath Song = 4.60 billion views (released May 2018)
    7. Learning Colors — Colorful Eggs on a Farm = 4.53 billion views (released February 2018)
    8. Masha and the Bear — Recipe for Disaster = 4.47 billion views (released January 2012)
    9. Uptown Funk = 4.34 billion views (released November 2014)
    10. Phonics Song With Two Words = 4.27 billion views (released March 2014)
    11. Gangnam Style = 4.24 billion views (released July 2012)

    Looking at the above list of the most-watched videos on YouTube, are there any similarities that seem evident to you?

    Yes. All of the top 11 are either music videos or videos for children. So there is something about these videos that make adults and children want to watch them again and again. But what is it?

    In their book ‘Made to Stick’, Chip and Dan Heath show that any successful idea has two essential qualities:

    1. It is memorable, and
    2. People are eager to pass it onwards

    They also say that successful ideas have the following six elements: the acronym SUCCES. They are:

    S — Simple: They manage to uncover the core of the idea and don’t complicate it too much beyond that. Like a boy survives evil, but his parents don’t; gets rescued from an awful family; goes to wizard school, and is the one chosen to save the day.

    U — Unexpected: They surprise people and grab their attention by doing something unexpected. ‘Gangnam Style’ definitely did this.

    C — Concrete: They make sure an idea can be grasped and remembered later. Like this plot: Poor boy meets rich girl on a big boat; they fall in love; the ship hits an iceberg and sinks; the rich girl doesn’t share the door; the poor boy dies.

    C — Credible: They make an idea believable or give it credibility. Expert or celebrity testimonials in ads might be the best example of this.

    E — Emotional: They help people see the importance of an idea. Watch ‘Sugar’ by Maroon 5, and you’ll know that it has a clear emotional tone (surprise, joy), and the message is unmistakable (Having a famous band turn up to play at your wedding would make a pretty cool story to tell the grandkids one day).

    S — Story: They empower people to use an idea through the power of a story. Would you please think of how successful Marvel has been with their movies through the power of storytelling and how DC hasn’t quite managed the same? ‘Batman vs Superman’ sucked.

    Yes, I am aware that they didn’t include a final S in their acronym, but maybe that is Heath’s way of being unexpected. Nevertheless, I still find it annoying.

    If you found any of this information memorable or valuable, please feel free to share it or pass it on to others. This post probably won’t be the next ‘Mr Brightside’, and that’s okay by me. I’m happy to compromise.

    Also, a big thanks to Feedspot for featuring Damon Ashworth Psychology at #1 on the top 35 Australian Psychology Blogs on the web.

  • How to Spend Your Money for Optimal Happiness

    How to Spend Your Money for Optimal Happiness

    Not all the best things in life are free.

    I was on holiday in Queenstown, New Zealand, back in 2016 and was amazed at how beautiful the scenery was. I was also amazed by how many experiences were on offer for people visiting or living there.

    On my first day in Queenstown, I walked into the town. I immediately saw brochures for the speedboats, canyon swings, skydiving, mountain biking, snowboarding and heli-skiing in several shop windows.

    I began hiking up a mountain, and suddenly someone whirred by me through the trees on a zip line travelling at 70km/h. It looked scary but also exhilarating.

    Further up the hill, I came across a luge track where families and friends were roaring down the mountain in their carts, smiling and laughing and generally having a great time while taking in the breathtaking views. I saw people bungee jumping from a platform off the side of the mountain, and just above that were people paragliding down to the valley floor.

    I don’t recall seeing many unhappy faces that day. On the contrary, most people were fully engaged by others or what they were doing. Engagement is crucial for optimal well-being.

    However, apart from hiking and taking in the scenery, these activities did come at a considerable cost. The several days of skiing that I did afterwards at the surrounding Alpine Resorts were no exception.

    If I had taken more money with me on that trip to New Zealand, I would have been able to experience a more extensive array of potentially fun activities. Furthermore, as long as I enjoyed these activities, I believe they would have contributed to a higher level of happiness.

    Can money ever buy us happiness?

    Anyone who says that money can’t buy us happiness is looking at it too simplistically. I’ve seen too many financially stressed clients know that a significant gift of money would be a massive assistance in their time of need. It would reduce their stress and hopefully increase their level of financial security, happiness and overall well-being. Right?

    Looking at past lottery winners, we can see that winning a large sum of money does increase short-term happiness. However, 12 months later, the lottery winner has typically returned to their pre-win levels of joy and sometimes feels even worse.

    Furthermore, even people who have up to 10 million dollars of net worth often don’t feel financially secure and still believe that if they had more money, they would feel more confident, happier, and more able to buy everything they wanted.

    It seems that it almost doesn’t matter how much money we have. As a result, most people will continue to feel financially insecure and typically strive to make more money than they have currently. But is this the best way?

    Another fascinating study found that beyond a certain amount of money (approximately $70,000 annually), an increase in salary does not typically lead to greater overall emotional or physical well-being. On the other hand, it seems that we do need to have enough money to look after our fundamental needs (food, shelter, water, safety etc.) and have a little bit of leisure or fun. However, making more money doesn’t seem to hold the answer to happiness, especially if we spend it in the ways that most people do.

    Why does more money not equal more happiness?

    I believe that the traps of Materialism and Capitalism are to blame, especially in Western culture. We think that working hard, making lots of money, and buying lots of stuff is the secret to happiness and success. This equation is just a myth, however, and it is required for consumerism to flourish. Consumerism prioritises short-term and societal growth above individual functioning or what is best over a long-term basis. It drives us to believe that we need the stuff to be happy, and this is often at the expense of things we need in our lives to flourish.

    So what can we do about it?

    In the excellent book “Stuffocation” by James Wallman, he makes the case that most people in Western society have too much stuff due to their consumer lifestyle. It is complicating our lives and stressing us out. This stress is now offsetting any of the benefits that come from the stuff that we buy. So should we throw everything out?

    Wallman does explore Minimalism as a possible solution to our Stuffocation. However, he doesn’t believe that Minimalism is the antidote because it is purely defined by what materialism isn’t. True freedom can only come from doing what is suitable for us, not doing the opposite of what is wrong. Minimalism is too confining.

    We could all just quit our jobs too, and stop making money, but the financial debt would catch up to us pretty quickly unless we somehow learned to become entirely self-sufficient and live off the land. Some people and communities can do this, but it’s not for everyone.

    Working less may help. Sweden has recently led the way with this by shortening their workdays down to 6 hours. Many people complain about being time-poor, and reducing how much time we spend at work would increase the amount of time available for people to use in whichever way they find most meaningful. It could be time with family, friends, engaging in exercise or hobbies, or taking some time to reflect and relax. We could cut down through improving productivity or efficiency (books like the ‘7 Habits of Highly Effective People’ by Stephen Covey or ‘Getting Things Done’ by David Allen could help) or cut down our commitments. Our productivity declines if we work more than 9 hours per day or more than 48 hours per week, so this should be a helpful guide for the maximum hours to work for optimal happiness.

    Once you have the extra time, it’s still about making sure that you spend your money in ways that will give you the biggest bang for your buck.

    How to spend money in ways that can increase happiness

    (1) buy more experiences rather than material objects — Wallman believes that Experientialism is the antidote to Materialism and Consumerism. We need to invest money in experiences and not in stuff. We need to be able to engage in these experiences. They also need to be accessible and affordable to have a significant impact on our overall well-being. If you have to invest in stuff, buy stuff that will make life easier for you to have more of the experiences you would like and less of the experiences that you don’t.

    (2) make sure that you are buying things for the right reason — A car or even a ride-on lawnmower can be a way to make things easier or to have an enjoyable experience, or it can just be more stuff. We need to determine why we want to buy something, and if it is about impressing others (showing our status) rather than for our enjoyment, it probably won’t lead to long-lasting happiness.

    (3) buy more frequent and smaller pleasures, rather than less frequent and larger ones — People are relatively insensitive to the price of an object. If we buy less expensive things, we get a similar pay-off or reward (in happiness terms) for a much smaller cost. The less expensive stuff we buy, the less we need to work and save, and the less credit card debt we’ll have. With the Australian Securities and Investment Commission stating that Australians owe nearly $32 billion in credit card debt, or over $4,300 each, this is advice that a lot of us could take on.

    (4) avoid credit card debt and overpriced insurance — Have you ever noticed that all of the tall buildings in cities tend to belong to either banks or insurance companies. There is a reason for this. They prey on our cognitive biases and utilise effective marketing strategies to get us to buy things now and pay them later. The average Australian pays over $725 of interest annually on the $4,300 they owe on their credit card at an interest rate between 15 and 20%. Suppose we pay only the minimum repayments, whether a credit card or a home loan. It will take a long time to pay it off and cost you a lot more money in interest. So spending more to reduce our interest or getting a debit card rather than a credit card will help us to not waste money for nothing in return except for immediate gratification. With extended warranties and no excess insurance, we will have to pay a premium for “peace of mind”, so it’s essential to work out if that peace is worth the extra cost for you. Insurance works like the lottery — we always think, “what if it happened to me?” and forget about the actual probability of these events occurring.

    (5) delay gratification by booking ahead — With more expensive experiences, the longer we can plan these, the better it is for us. Not only do we get the experience, but also the anticipation and excitement leading up to it. So the next time you want to be spontaneous and book a concert ticket or holiday, book it for six months in advance and thank me for the increased happiness later.

    (6) use your money to give to or help others — There was a study where they gave individuals $20. Half of them spent it on themselves, and the other half gave it away to someone else. They then tracked the happiness of these groups over some time. Whilst the happiness levels were similar between the two groups immediately after the event, the group who gave the money away were significantly higher only two weeks later. So giving to others does make a difference, both to them as well as to you. It is a lovely message to keep in mind with Christmas around the corner.

    If you are interested in other ways to increase happiness through spending, please check out the fascinating article titled ‘If Money Doesn’t Make You Happy Then You Probably Aren’t Spending It Right’ by Elizabeth Dunn, Daniel Gilbert and Timothy Wilson.

    Dr Damon Ashworth

    Clinical Psychologist

  • The Importance of Sleep for Good Mental Health

    The Importance of Sleep for Good Mental Health

    Sleep difficulties are a feature of nearly every mental health difficulty, including depression, anxiety, trauma, substance use issues, bipolar disorder and psychosis or schizophrenia. Take Depression for example. Up to 90% of individuals with Depression have sleep difficulties, and two out of every three have significant enough sleep problems to also have a diagnosis of Insomnia.

    alarm clock analogue bed bedroom

    Worse still, Insomnia does not tend to go away on its own without appropriate treatment. This is because once people start to sleep poorly, they tend to develop ways of thinking and behaving around sleep that make their problems worse over the long run.

    Fortunately, there is a treatment out there that can improve your sleep. It’s called Cognitive Behavioural Therapy for Insomnia (CBT-I), which directly targets these unhelpful thoughts and behaviours around sleep.

    CBT-I is an effective treatment for insomnia, with many studies showing it to be similar to sleeping pills at improving sleep in the short-term, and much more effective than sleeping pills at improving sleep in the long-term.

    Research shows that CBT-I consistently reduces the time taken to get to sleep, decreases the amount of time spent awake during the night, and improves sleep quality and efficiency, with improvements persisting after treatment finishes. This is unlike sleeping pills, which typically lead to sleep difficulties coming back once people with insomnia stop taking them.

    Sleeping pills are also not recommended for use beyond 2-4 weeks at a time, because they stop working after a while and people need to take bigger doses over time to get the same effects. Sometimes doctors prescribe them more because they think they will work faster for patients, but even one session of CBT-I has been shown to make a significant difference to one’s sleep at night!

    beach during sunset

    CBT for Insomnia consists of four main components:

    1. Psychoeducation: This provides people with helpful information around sleep, including homeostatic pressure, circadian rhythms, hyper-arousal and sleep hygiene recommendations. Sleep hygiene means having a comfortable bedroom environment, minimising light exposure before bed, exercising during the day, minimising caffeine and alcohol and doing things to wind down or manage worries before bed.
    1. Sleep scheduling: This provides people with helpful information on when they should be going to bed at night, the time they should be arising from bed in the morning, and the ideal amount of time that they should be in bed for each night. Stimulus control and sleep restriction are the two main interventions included in sleep scheduling, and both are scientifically supported for improving sleep quality and sleep efficiency if done properly.
    1. Relaxation techniques: Because hyper-arousal plays a huge role in Insomnia, it is important to help people develop strategies to quieten the mind and calm the body, during the day, before bed and in bed. Relaxation techniques can include imagery training, meditation, biofeedback training, deep and slow breathing and progressive muscle relaxation.
    1. Cognitive Therapy: This provides people with the skills to challenge their unhelpful or unrealistic beliefs about sleep. A lot of individuals with Insomnia attribute all of their tiredness, mood difficulties or poor performance at work to their sleep difficulties, and this puts too much pressure on them to get a good night’s sleep. It is therefore important to get them to see the other factors that may contribute to how they feel during the day, present them with data that challenges their fears, and help them to develop realistic expectations about their sleep.

    In Vanuatu, there is currently only one psychologist located at the Mind Care Unit in Port Vila who is trained in CBT-I. Please come down to receive this effective treatment if you or a family member is struggling with poor sleep. Until then, there are other sleep strategies that you can try:

    orange cat sleeping on white bed

    BEST SLEEP INTERVENTIONS OVERALL

    In 2017, Dr Damon Ashworth, Clinical Psychologist and Sleep Researcher, ran 26 two-week experiments on his sleep to determine which interventions were most helpful for him.

    He gave each intervention a score out of 100, based on how effective he found the strategy (25 points), how easy it was to apply and use the strategy (25 points), and how much scientific evidence there was that showed that this strategy could improve sleep (50 points).

    Here are all of the sleep interventions he tested, ranked from best to worst based on their overall score out of 100:

    palm trees at night

    High Distinction

    1. Stimulus control = 85/100
    2. Winding down before sleep = 85/100
    3. Sleep restriction = 81/100
    4. Relaxation strategies pre-sleep = 81/100

    photo of a man sitting under the tree

    Distinction

    1. Meditation = 77/100
    2. No alcohol = 75/100
    3. Wearing blue-light blocking glasses before sleep = 75/100
    4. Listening to music in the evening = 73/100
    5. Yoga/Pilates = 72/100
    6. Constructive worry or writing down plans = 71/100

    white teddy bear with opened book photo

    Credit

    1. Avoiding TV before bed = 69/100
    2. Melatonin = 68/100
    3. Aromatherapy = 68/100
    4. Sauna or hot bath in the evening = 68/100
    5. Morning sunlight = 65/100
    6. Reading or listening to audiobooks pre-sleep = 63/100
    7. Exercise during the day = 61/100

    black ceramic tea cup on brown surface

    Pass

    1. No caffeine = 58/100
    2. Food that helps sleep = 57/100
    3. Controlling temperature = 57/100
    4. Massage in the afternoon = 57/100
    5. Comfort of sleep surface = 56/100
    6. Sleeping alone = 53/100
    7. Creativity in the evening = 52/100

    Sleep Recommendations

    (Stepanski & Wyatt, 2003)
    1. Decrease time in bed – Sleep efficiency is a better predictor of satisfaction with sleep and daytime mood than total sleep time. So if you only get 7 hours of sleep per night, spend 7.5 hours of time in bed. This will allow for better sleep over time.
    2. Regular bedtime and arising time – Reducing variability in your sleep can make a huge difference in how long it takes you to get to sleep, how restful a sleep you have, and how refreshed you feel in the morning. Have a set bedtime, and whenever you feel sleepy around this time, go to bed. Then set an alarm so that you can wake up at the same time each day. If you want to sleep in on weekends, allow yourself no more than one hour later than you usually wake up. Following this regardless of how much sleep you get helps to strengthen your circadian rhythms and build up your homeostatic pressure to ensure better sleep over time.
    3. Exercise – Vigorous exercise prior to bedtime is actually unhelpful for sleep, but expending more energy during the day is likely to lead to better quality sleep at night. The earlier in the day it is done, the greater the effect it will have.
    4. Less caffeine and alcohol – Minimise these substances where possible, especially within 4 hours of bedtime as they both have significant effects on sleep quality. Alcohol can reduce worries and result in getting to sleep quicker, but results in poorer sleep quality in the second half of the night. Alcohol can also can lead to more snoring due to the loosening of the throat muscles. Caffeine boosts cortisol levels, a.k.a. stress, and results in less deep sleep and more awakenings.
    5. Do not try to sleep – It is something that has to come on naturally. The harder you try to get to sleep, the less likely you will be able to, as trying activates the autonomic nervous system, which also increase how stressed you feel. The more you allow yourself to relax, the more likely sleep is.
    6. Do not keep looking at your phone or alarm clock during the night – If your alarm is set, then there is no need to know the time in bed. This will only increase performance anxiety if you look and see that you have not slept for very long. Put it in a draw, cover it with a shirt, or face it the other way.
    7. Keep naps short – Napping during the day reduces your pressure for sleep by the time you get into bed at night. If you have to nap, keep it less than 30 minutes so that you don’t go into a deep sleep, and do it before 4pm so that sleep pressure can build up again by the time you go to bed that night.
    8. Engage in relaxing activities before bed – Just like waking up, going to sleep is a transitional process. Don’t expect that your mind will shut off immediately as soon as you get into bed. Whatever it is, do something relaxing as a pre-bed routine. Watch some T.V., read a book, listen to some music, have a hot bath, practice yoga, mindfulness or relaxation techniques. Then maintain that relaxed state in bed and allow sleep to come.
    9. Use the bedroom only for sleep and sex – This means no reading, eating, internet surfing, game playing, phones, T.V., planning, worrying etc. in bed. Want bed = sleep.
    10. Make worry list before bed – To prevent your mind from racing in bed, reflect on the day about 2 hours before you want to sleep, write down any worries, concerns or problems you may have, create a to-do-list, or plan for the day ahead. Then if thoughts come up in bed, remind yourself that you have already sorted them out or that they can wait until tomorrow.
    11. Leave the bed if awake – Sometimes no matter what we try, you may find yourself awake in bed. If you do not fall to sleep within what feels like 20 minutes, get up, go to another room, and do something relaxing until you are sleepy before returning to bed. Over time, this will recondition the bed with sleepiness rather than frustration and allow you to fall asleep quickly. If you are worried that you may never sleep if this was the case, give it a try for a week. It may be the most difficult recommendation to follow initially, but it produces long-lasting results quickly.

    Dr Damon Ashworth

    Clinical Psychologist

  • The Four Ultimate Concerns in Life

    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. So before you think that makes me someone you would never want to speak to, I’ll ask if you have ever read anything by Irvin Yalom, American Psychiatrist and Author?

    His book ‘Existential Psychotherapy’ is a true masterpiece he worked on for 10 years and is written as eloquently as any of his other titles, including ‘When Nietzsche Wept’, the best fiction novel award winner 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 life and humanity are about.

    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, 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 to negatively impact our lives less, 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 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 we are no longer there. No fear. Just nothingness.

    Being aware that we will die shapes and influences our lives much more than we would like to admit. This is because so many of our anxieties and phobias at their core are fear of some 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 they have so that they can make the most of the precious time they have left on this planet. Time 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.

    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.

    Or

    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 fusing with others. Still, the breakdown of either can lead to pathological anxiety and/or depression.

    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 manage death anxiety is to only focus on whatever 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 impact someone’s life positively. That way, I’ll hopefully not have too many regrets and be glad for the time I have had on this planet, no matter how long it ends up being.

    2. Freedom

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

    Every country in the world talks about fighting for the freedom of its citizens and about taking away some people’s freedom to ensure the safety and security of all. Therefore, the existential dilemma is 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 an authentic and genuine life.

    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 available options. They also know that if no one else is telling them what to do, it is ultimately their responsibility if things do not work out the way they want them to. People wish to choose for themselves but fear not having someone to blame when things don’t work out.

    There are various defences 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, hoarding, or any 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. But, we can also 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.

    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 blame ourselves or change things 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 not to choose. This means that no matter what they do, it is impossible not to make a decision that impacts the direction of their lives. Even if we choose to follow what someone else wants us to do, we still choose to do this. Therefore, why not take responsibility for our own lives and forge our own paths?

    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 fuse with another fully. This is also a strategy for dealing with death anxiety, with people trying to be the “ultimate rescuer” of someone else. It can lead to an individual feeling temporarily less alone. Unfortunately, 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 have always relied on others to survive. This drive creates a desire to feel closer to, more understood, and more connected to people than we can ever achieve and sustain.

    Growing up, many people feel loved and comforted in an unbalanced relationship 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”, a selfish love where we only think about how useful the other person may be to us. Creating 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 how 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 and our desire not to have it is challenging, but it can help 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.

    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, most 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. People who truly believe these systems 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 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. If possible, address these other issues first, 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 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.

    Yalom strongly believes that a desire to engage in life and satisfying relationships, work, spiritual and creative pursuits always exists within a person. Therefore, the key to managing meaninglessness is 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

  • It’s Okay to Still Fall into Life Traps… We All Do!

    Life traps are self-defeating ways of perceiving, feeling about, interacting with oneself, others, and the world.

    If you want to get a sense of what your life-traps may be, the book ‘Reinventing your life’ by Jeffrey Young is an excellent place to start, as it goes into 11 different ones. If you want a more in-depth analysis, however, then go and see a Psychologist who specialises in Schema Therapy.

    A Psychologist has much more thorough and scientific questionnaires that can give you results on 18 schemas (life-traps), help you identify your most common traps, and show you what you can do both in therapy and outside of it whenever you realise that you have fallen into a trap.

    My Life-traps

    I have taken the Young Schema Questionnaire (YSQ-L3) three times to help identify my main life traps. The first time was at the beginning of 2014 when I was stuck in the middle of a complicated relationship while also trying to complete the last part of my Doctoral thesis and play basketball at a semi-professional level.

    The second time was in April 2017, when I was in a Clinical Psychology job that I loved. I had also stopped playing basketball at such an intense level and played with some friends (and without a coach) twice a week, which was way more fun.

    The most recent time was August 2018, where I had just finished up my work in private practice in Melbourne, Australia and was about to leave my friends and family to volunteer for two years in Port Vila, Vanuatu, as part of the Australian Volunteers Program (funded by the Australian Government).

    I want to share these results with you to show you that:

    1. context influences personality and how people view themselves, the world and others,
    2. personality and ways of perceiving yourself, relationships, and the world can change, and
    3. Even though it is possible to grow and improve over time, we all still fall into traps at times, which is okay. It’s about identifying when you have fallen into a trap and then knowing what you need to do to get out of it.

    When looking at the results, a 100% score would mean that I have answered every item for that life-trap a 6, which means that they describe me perfectly. The higher the % score, the more likely I will frequently fall into this life trap.

    YSQ-L3
    2014 Results 2017 Results 2018 Results
    Schema or life-trap Schema or life-trap Schema or life-trap
    1. Subjugation – 75% 1. Self-sacrifice – 60.78% 1.Self-sacrifice – 60.78%
    2. Dependence – 64.44% 2. Punitiveness (self) – 57.14% 2. Emotional Deprivation – 59.26%
    3. Self-sacrifice – 61.76% 3. Emotional Deprivation – 51.85% 3. Punitiveness (self) – 50%
    4. Approval seeking – 54.76% 4. Unrelenting Standards/ Hyper-criticalness – 48.96% 4. Subjugation – 50%
    5. Punitiveness (self) – 51.19% 5. Approval Seeking – 48.81% 5. Unrelenting standards – 43.75%
    6. Unrelenting standards – 48.96% 6. Subjugation – 48.33% 6. Approval seeking – 41.67%
    7. Insufficient self-control – 46.67% 7. Negativity/ Pessimism – 43.94% 7. Vulnerability to harm/illness – 40.28%
    8. Emotional inhibition – 46.30% 8. Mistrust/ Abuse – 41.18% 8. Negativity/Pessimism – 39.39%
    9. Emotional deprivation – 42.59% 9. Dependence/ Incompetence – 41.11% 9. Dependence/ Incompetence – 38.89%
    10. Abandonment – 41.18% 10. Emotional Inhibition – 40.74% 10. Mistrust/Abuse – 37.25%

    What’s Changed?

    people riding canoe boat view from inside pipe

    By looking at the table above, the green items indicate an improvement in comparison to the prior assessment, meaning that these life-traps are a little bit less powerful for me. The yellow indicates no change since the last assessment, and the red indicates a worse score, meaning that these life-traps may have a more powerful sway over me.

    From 2014 to 2017, 7 out of the initial top-10 life-traps had improved, one stayed the same, and two had worsened. Two additional traps not included in the initial top 10 had worsened and made the list (Negativity/Pessimism & Mistrust/Abuse).

    From 2017 to 2018, seven out of the 2017 top ten life traps had improved yet again, with one staying the same and two becoming worse. One additional trap (Vulnerability to harm/illness) had increased. Still, I believe this was due to the medical and safety briefings that I had been going through in the preparation of moving to Vanuatu for 2 years.

    Overall, I am less likely to fall into any life trap in 2018 than in 2014 and 2017. For example, the average of my top ten in 2014 was 53.29%, whereas in 2017, it was 48.28%, and in 2018, it was 46.13%.

    I also rated 21 items a 6 (= describes me perfectly) in 2014, only five in 2017, and none in 2018. This means that I am much less likely to get completely pushed around by my life traps. However, they still have some sway on me, especially the self-sacrifice and the emotional deprivation schemas, and to a lesser degree, punitiveness and subjugation.

    Here is Young’s description of these schemas:

    SELF-SACRIFICE: Excessive focus on voluntarily meeting the needs of others in daily situations, at the expense of one’s own gratification. The most common reasons are: to prevent causing pain to others; to avoid guilt from feeling selfish; or to maintain the connection with others perceived as needy. Often results from an acute sensitivity to the pain of others. Sometimes leads to a sense that one’s own needs are not being adequately met and to resentment of those who are taken care of.

    EMOTIONAL DEPRIVATION: Expectation that one’s desire for a normal degree of emotional support will not be adequately met by others. The three major forms of deprivation are:

    1. Deprivation of Nurturance: Absence of attention, affection, warmth, or companionship.
    2. Deprivation of Empathy: Absence of understanding, listening, self-disclosure, or mutual sharing of feelings from others.
    3. Deprivation of Protection: Absence of strength, direction, or guidance from others.

    SUBJUGATION: Excessive surrendering of control to others because one feels coerced — usually to avoid anger, retaliation, or abandonment. The two major forms of subjugation are:

    1. Subjugation of Needs: Suppression of one’s preferences, decisions, and desires.

    2. Subjugation of Emotions: Suppression of emotional expression, especially anger.

    Subjugation usually involves the perception that one’s own desires, opinions, and feelings are not valid or important to others. Frequently presents as excessive compliance, combined with hypersensitivity to feeling trapped. Generally leads to a build up of anger, manifested in maladaptive symptoms (e.g., passive-aggressive behaviour, uncontrolled outbursts of temper, psychosomatic symptoms, withdrawal of affection, “acting out”, substance abuse).

    PUNITIVENESS: The belief that people should be harshly punished for making mistakes. Involves the tendency to be angry, intolerant, punitive, and impatient with oneself for not meeting one’s expectations or standards. Usually includes difficulty forgiving mistakes in oneself, because of a reluctance to consider extenuating circumstances, allow for human imperfection, or empathize with one’s feelings.

    Three out of my top four life traps have improved since 2014, but emotional deprivation, unfortunately, continues to climb with each assessment. I think that self-sacrifice, subjugation, and emotional deprivation schemas may be common life traps for people who decide to become psychologists. The therapeutic relationship is meant to be one-sided and focused on the patient or client’s needs, not the psychologist’s needs. For this reason, psychologists must get their relational needs met outside of their job and get their own therapy if needed to ensure that they can have a space about them. I wonder how these life traps will continue to evolve over the next two years in Vanuatu…

    How Can Life-traps Be Overcome?

    The first step to changing anything is awareness. If you are not aware that you are falling into any traps, it means that you either don’t have any, or you are so enmeshed in your experience that you cannot see them.

    Once you are aware of your traps, the next step is to understand them and why they occur for you. Most life traps originate in childhood typically, which is why most psychologists and psychiatrists will ask about your upbringing and your relationship with your parents in particular.

    Life traps are actually considered to be adaptive ways of coping with maladaptive environments. This means that your life traps were probably quite useful in the particular family dynamic that you had, or you wouldn’t have developed them in the first place. For example, my family often called me a martyr when I was younger because it didn’t matter what I wanted. In reality, it was just much more comfortable to let everyone else decide and take charge. Then if things didn’t work out, others couldn’t blame me. I saw it as a win-win but often didn’t get what I wanted because I didn’t speak up and then complained that my parents loved my siblings more, who were more than happy to speak up and ask for what they wanted.

    However, once you move out of the family home, these coping methods are generally ineffective. They tend to become maladaptive ways of interacting with yourself, others or the world. If I keep playing the martyr and refuse to speak up as an adult, my needs still don’t get met. As a result, I may become excessively demanding of others as a counterattack measure (not likely for me), or I may try to escape from all relationships where I need to speak up about my needs. Either way, it keeps the life trap going, and it isn’t helpful.

    I need to realise that there are relationships out there where it is beneficial for me to speak up, as people then know what I want and respond effectively to the situation at hand. It still doesn’t “feel right” when I think about telling others my wants or needs (and I’m not sure if it ever will), but I logically know that it is the best approach for me to take going forward. If I want to break free from my main life traps, I must learn to speak up reasonably when important to me (and others). By doing this, eventually, the life traps will become much less prevalent and less powerful too.

    If you have been trying with therapy for a long time but don’t think you are getting anywhere, please seek a Psychologist with experience in Schema Therapy. Also, if you are stuck in a relationship where your needs aren’t being met, it could help too.

    Learning about Schema Therapy and undergoing training in it has taught me more about my own personal life traps than anything else that I have done before and really does give me a sense of what my most significant challenges are going forward. I’ve made a lot of progress so far, but there is still a long way to go, and that is okay. I know that I will continue to improve with acceptance, self-compassion, patience, reflection, and perseverance, and I am confident you can too!

    Dr Damon Ashworth

    Clinical Psychologist

    P.S. For a full description of the other 14 maladaptive schemas, please click here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    (Therapeutic Alliance = 30% of overall outcome variance)

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

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

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

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

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

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

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

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

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

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

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

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

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

    Dr Damon Ashworth

    Clinical Psychologist