Three top tips for a better sleep

Stress and sleep

When we go through particularly distressful periods of time, our sleep is very often the first habit that can be affected. Given it’s strong role in nurturing our cognitive and physical skills in our daily life, it is important to take care of our sleep habits in exactly the same way we take care of other areas of our lives.

It can happen to anyone to go through particularly difficult periods of time and to experience occasional troubles sleeping.

Indeed, we could have problems falling asleep (the so-called initial insomnia), or we might wake up several times during the night and have problems falling asleep again (middle insomnia) or we might wake up too early in morning, not being able to fall asleep again (terminal insomnia).

Sometimes these problems could be triggered by specific stressful events, by bad habits regarding your sleeping routines or by distorted beliefs about sleep.

No matter what the cause is, if these troubles persist for at least one month and they have a significant impact in your daily life, it is recommended that you take care of the problem and consult a specialist, in order to avoid the chance of it becoming chronic.

 

Tips for a better sleep

Here are some of the little, but important, tips that are usually recommended in order to adopt a healthy sleep hygiene:

       Check the time spent in the bed

We should not stay in bed for too long if not asleep. Usually the 85% of the total time spent in bed should be ‘sleeping time’; this means that only 15% of this time should be spent awake.

As a consequence, the first tip to keep in mind is that we should spend as little time as possible awake in bed. If you find yourself for an extended period of time awake, with little chances of falling asleep, it is usually better to get out of bed, go to another room or the couch and do something else until you feel sleepy enough to go back to bed.

Why’s this? Our bed should be a stimulus associated only with sleeping. Usually when we have trouble sleeping, we tend to start thinking, worrying and ruminating, fostering our anxiety and waking up our sympathetic system (that definition is not an alli of relaxation and sleep). Spending too much time awake in bed implies indeed the risk of associating it with the experience of being awake and having stressful negative thoughts.

       Stop having naps

Having little naps during the day is not recommended if we tend to have trouble sleeping; think about naps as little thieves, every time we have a daily nap, a portion of our night sleep is stolen.

       Take care of your bedtime routines

If you have trouble sleeping, the preparation before going to bed is particularly important. Try to create some relaxing routines that your body will soon associate to ‘relax/sleep time’ and that can represent a sort of clear boundary between your day time and your night time. Examples could be:

  • having a bath or a particular washing routine
  • having a chamomile or another soothing drink
  • doing something relaxing before going to sleep (listening to music, relaxation techniques, reading a relaxing book etc.)

 

Looking after your sleep is important. If you feel that you have troubles doing it by yourself, seek help. A psychologist can help you understand the causes of your issues and work on your worries and on the bad habits that could continue to affect negatively your sleep.

Assertiveness: top tips

How many times have you found yourself in trouble while asking for help, expressing your disappointment to someone or your preferences when making a choice?

Have you ever surrendered to other people’s choices because of guilt or embarrassment? Have you ever acted too aggressively in order to get what you want?

If any of the above applies to you, you might have experienced trouble being assertive.

Assertiveness refers to the ability to be able to express your choices, preferences and critics in an honest and clear way, that respects yourself and other people.

In some instances being assertive can be particularly difficult, especially when close relationships are involved or our performance is at stake. One may be easily scared of not being liked, rejected or negatively judged when expressing a desire or an idea that it is different from the interlocutor’s. Conversely, one may expect other people to think the same way or have the same preferences, therefore not accepting other people’s point of view.

Generally, in social relationships there may be found three different recognisable – and often alternate, depending on the instance – patterns: passive, aggressive or assertive behaviour.

A passive behaviour may imply swallowing emotions, desires or personal preferences as well as adopting someone else’s preferences to please others. Passive people have trouble saying no to people’s requests; they always apologise for every little thing and usually tend to play a passive role in relationships.

Usually, people with a passive behaviour are driven by a fear of upsetting others or breaking their relationship if they express their personal preferences, and are most often afraid of being negatively judged. They might believe that their own preferences are not equally valuable and equally worthy of respect. Predictably, they suffer from low self-esteem issues.

Conversely, people with an aggressive type of behaviour tend to often ignore other people’s point of view and force others to think or act in the way they desire. This kind of behaviour usually brings about relational conflicts.

Contrarily, assertive people are able to express their ideas and feelings in an honest and direct way, while defending their rights and respecting other people’s ones, without experiencing guilt or shame.

How to be assertive?

Assertiveness is not an easy-to-apply skill, as life teaches us that each situation requires a balanced mix of several kinds of behaviour.

Here are some tips that may help you increase your assertiveness skills:

  • Recognise which traits you show more frequently. Do you have a tendency towards passive, aggressive or assertive behaviours?
  • Think about the reasons why you tend to behave in a passive or aggressive way (e.g. fear of negative judgment, low self-esteem issues, etc.).
  • Actively practice assertiveness in your daily life, starting from being honest with yourself about what you want in a relational situation, and ask for it in a clear and respectful way.
  • Please, bear in mind that in the same way as every new skill, assertiveness requires practice. So don’t be too hard on yourself if you’re not getting it quite right yet.
  • Speak to a therapist if you need help to develop or increase your assertiveness skills or the reasons behind your aggressive or passive behaviours are too complex and difficult to cope with.

Comfort zone: in or out?

“As you move outside of your comfort zone, what was once the unknown and frightening becomes your new normal” Robin Sharma

Very often we hear managers, psychologists or life-coaches talk about the importance of stepping out of our comfort zone.

But what exactly is a comfort zone?

Let’s try to imagine ourselves as surrounded by a big and transparent bubble, that defines a boundary between which experiences, behaviours and people we allow into our daily life and which ones, on the contrary, we decide to leave outside.

Inside the bubble, there is a so called comfort zone, in other words, all the elements that create a psychological state of calm, sense of control, low stress and anxiety and therefore a state of safety and familiarity. Conversely, outside of the bubble exist all the things that represent a potential danger and source of stress.

You can imagine that the bubble’s extension and walls’ thickness are very personal: For some of us, the bubble will be pretty big and with a subtle wall that will allow the person to easily step out of it, while for others, the bubble can be a tiny one, with very thick walls, difficult to cross.

The interesting thing is that the inside of the bubble is usually a reflection of our beliefs, in particular what we believe that we are able to handle or to deserve. And this acknowledgement gives us great power to expand our bubble.

Given that it is natural to create our own comfort zone, habits and routines that make us feel protected, sometimes we may create walls which are too thick for the allowing of receiving new experiences that are fundamental to our personal growth.

A very good, though extreme, example of the risks of staying too much in our comfort zone is what often happens to people suffering from panic and agoraphobia.

Suffering from panic attacks is a very intense experience that brings the person to be so scared of the possibility of having other episodes, that it is likely that they will start to avoid all the situations that have triggered the episodes in the first place.

The person will start to avoid potentially risky environments and will step back in his comfort zone. The bad news is that avoidance has the bad habit of self expanding, making a comfort zone progressively smaller and smaller. Not exposing ourselves will give us the illusionary feeling of safety and it will reinforce the idea that in the end, avoidance works, because we are not experiencing anxiety anymore. And in the blink of an eye, without even realising it, we may become slaves of our little comfort zone, enhancing the problem and not facing our fears without testing ourselves.

Sometimes, lying in our comfort zone can be a good way of charging our batteries and winding down, but it is important every once in a while to put ourselves out there, face what we fear, make mistakes and learn new things.

Only expanding our comfort zone will allow us to eventually see that this is no big deal, as we thought, and in the case it actually is, that we can make it and we can learn from our mistakes and grow.

If you feel that it is particularly difficult for you to step out of your comfort zone, you may want to seek help. Psychotherapy may help you deal with the beliefs that are holding you back and help you improve your condition.

Dealing with health loss

Health loss

Grief and mourning are intense experiences that we will encounter on our paths at some stage in our lives. The loss of a beloved one or something important to us can bring forth intense feelings of sadness, emptiness, anger, incredulity, guilt or a mix of these emotions. We all have our own very personal rhythm when going through the stages of loss and the most wanted outcome is to deal with what happened, by accepting and adapting to the big change.

A particularly tough kind of grief is the one linked with the loss of physical or mental health.

Developing specific diseases may be more understandable and slightly easier to accept depending on our personal resources, age, familiarity and the period of life that we are going through. Unfortunately it can happen, that some diagnoses suddenly come up with no preliminary warnings, maybe at an early stage of our life, by bringing severe limitations to our lifestyle.

Accepting to be ill, can be a particularly tough one. Indeed, the discovery of a severe diagnosis brings us back with unexpected violence to the reality of our limits, transience and to the fact that we are indeed human beings. In our daily life, our brain usually works pretty well in keeping these awarenesses far away from our conscience, but getting sick is quite a reality check.

The loss of our idea of health is an intense life-changing element, that we may undergo facing exactly the same struggles as we do when losing a beloved person. It compels us to face our limits and deal with the restrictions imposed by illness. We may realise that our desired future will be different from the expectations we had and that some of our long-term goals may not be easily reachable any more. We may find ourselves forced to change habits, routines and lifestyle, to even take strong medications and potentially experience undesired side effects. We may feel overwhelmed and powerless, as nothing of all this has been directly chosen by us.

Losing our expected future and our expected self, can be a source of intense depressive feelings and it calls forth all our strength and resources to deal with, reset our expectations and mindset in order to accept our new reality and move on to the best of our ability. Dealing with health loss by ourselves can be particularly daunting and overwhelming.

Remember that you are not alone, seek out for help, ask for support from the people who surround you and when this is still not enough, reach out for specialistic help. Psychotherapy can help you deal with this burden and move towards acceptance.

Trapped among worries and rumination, what about Mindfulness?

Past, present and future are the three elements of our timeline that strongly influence our self, mind and our psychological functioning. Our sense of self is shaped by our past history, and our expectations and goals are a sort of compass that orientates our present. Our mind constantly navigates among past, present and future and most of the time we are not completely aware of this.

How many times have we found ourselves trapped by worry regarding the future? And how many times was that scary vision of the future not even close in time as it may potentially happen although we are not even sure when?

Or on the contrary how many times have we found ourselves ruminating over and over again on past episodes, on things that happened and that we would like to change, on our mistakes and people’s behaviours?

While worrying about the future typically leads to anxiety, rumination often causes low mood.

Beyond the negative consequences that this mindset has on our mood, it also involves a specific risk: missing out on the present moment – our today.

Being constantly focused on tomorrow or yesterday doesn’t allow us to be present in what is happening in the now hence to appreciate and enjoy the beauty of what we actually have or are experiencing.

Oriental philosophers have been the first to embrace this thought and to transform it into a real mantra for living, using meditation as a daily activity. In recent years, some principles of Eastern philosophy have been adopted and tailored to the Western lifestyle, and it comes with the name of Mindfulness.

Being mindful means being aware of the present moment, being in the here-and-now and it can be practiced through meditation or simply by asking yourself gentle questions in order to bring awareness to your senses.

Beyond the efficacy of stimulating a state of calm and awareness, mindfulness can be a powerful tool to fight and contrast our mind’s tendency to wander into the past or future when such activity is not needed or useful.

If you recognise yourself in this tendency to focus too much on the past or future instead of the present moment, working on being mindful through psychotherapy can be quite helpful in tackling such inclination.

How intolerance of uncertainty makes you anxious

Intolerance of uncertainty

One of the main constructs linked with anxiety is intolerance of uncertainty.

Uncertainty is a peculiar companion of our life, not particularly loved by most of us but surely always present. Daily life situations, economical and political unstable scenarios doubtlessly intertwine to trigger issues related to our threshold of tolerance of uncertainty.

But why is uncertainty such a scary monster for some of us? 

If we look at our daily life through a magnifying glass, we will notice that it is permeated by little daily elements of uncertainty. All things considered, no one has a crystal ball to make well-thought-out decisions and to know for sure what the future will bring. Therefore a dose of uncertainty is normal to experience in life.

We are all different in how we react to uncertainty, but for some of us it can be a cause of intense unease and distress.

If you have trouble dealing with uncertainty, you may find yourself trapped by worry and negative thoughts.

The main feature of worry is that it hinges on a chain of negative possibilities, one followed by another, that brings forth a catastrophic and doomed scenario, in our mind much more likely to happen and scarier than it actually is.

Most of the time habitual worriers believe that thinking and anticipating all the possible negative outcomes helps them feel safer and more prepared if the depicted scenarios become real.

Conversely, relying on worry is usually far from being a constructive strategy, as one may easily get lost among negative scenarios and feel confused and scared.

Among worriers’ preferred coping mechanisms, they also avoid uncertain situations and keep things under control as much as possible. The reason this happens is that we often associate uncertainty with a potential danger and a negative outcome, despite the fact that such outcome might not even occur in the first place.

How to deal with uncertainty? 

Accepting that uncertainty is unavoidable and constitutes an inevitable part of our life is helpful and a good starting point. Focus on what you can actually change and improve (and therefore on what you have control of), such as your reactions to uncertainty: decrease your anxiety level through relaxation techniques, do not avoid situations with potentially unknown outcomes by default and challenge your negative thinking. Talking about it with a therapist may definitely help.

Six anxiety traps

Anxiety traps

Psychiatrist Robert Leahy begins one of his books on anxiety and worry asking the readers quite a particular question: if you had to explain to a martian what anxiety is and how an anxious person resonates, how would you do it? 

Usually we are so trapped by our worries and anxieties that we tend to get hooked on a sense of danger and urgency, not thinking about the thoughts that are causing and/or maintaining this psychological state.

Let’s see which are the common “rules” of thought that anxious people usually obey and that can be themselves, as a matter of fact, anxiety traps. These traps are considered by cognitive behavioural therapists the main constructs of anxiety, thus targeted by treatment.

  1.  Personal responsibility: “if something bad could happen, it is your responsibility to prevent it”. Very often anxious people perceive an excessive sense of responsibility, stronger than the actual one.
  2.  “Uncertainty is intolerable and there is no space for doubt”. Anxious people tend to avoid situations characterised by uncertainty, as usually they forecast negative outcomes out of it. Getting control over situations is very often the preferred mean to overcome uncertainty.
  3.  “Negative thoughts are true and real facts”. This is the so-called thought-action fusion; a cognitive bias where thoughts can be confused as actions and facts, and not as just mere interpretations and subjective constructions of reality. People using this bias often believe that having a negative thought may have a strong (and unrealistic) impact on the actual realisation of that thought in the real world.
  4. “If a negative thing happens, it reflects me as a whole person”. Anxious people usually tend to negatively judge themselves generalising a single bad result or behaviour to their person as a whole.
  5. “Failure is unacceptable”. Failing, instead of being perceived as a possible source of learning, is seen in a very rigid way, often with no alternative explanations. Making it scarier than what it could be.
  6.  “You must get rid of negative emotions straight away, because they are dangerous and you are not able to deal with them”. Painful emotions are often considered as useless and source of further negative emotions. As a consequence, one of the aims of anxious people is often not to feel negative emotions, locking down such important information about their inner world.

If you suffer from anxiety and you recognise yourself in obeying these “rules of thought”, you may start questioning how useful they are and start to change your approach.

Cognitive behavioural therapy may help you change the way you resonate and cope with anxiety in a different way.

References:

R. Leahy, “The worry cure: seven steps to stop worry from stopping you”, 2006.

Taking care of our relationships

Relationships: their impact on our life

The powerful effect of having positive and healthy close relationships is very often undervalued.

This can be true especially for young adults working hard in big and international cities, that are often only temporary homes where people come and go, making it very difficult to cultivate close relationships over time. Let’s add work, stress, distances, little free time… and social networks and online dating that sometimes may give people the utopian feeling of being hyper connected with a large amount of people.

But in reality how many of these connections are effectively supportive and close relationships?

In the last century, an increasing number of psychologists and scientists have highlighted the importance of healthy relationships in our well-being: from the development of our personality and identity to its positive effect in mediating the impact of stress and trauma.

Relationships, perceived happiness and life length

Recently, psychiatrist Robert Waldinger found interesting results about relationships from the Harvard Study of Adult Development, a longitudinal study that surveyed the life of around 700 participants during a period of 75 years. Researchers kept track of important variables like the participant’s physical health, quality of their marriages, work satisfaction and social activities.

In this research they found out that the element that impacted the most on the participant’s health and happiness was the perception of having good quality relationships.

Indeed people having positive relationships with friends, family or the community tended to be happier, healthier and to live longer. Secondly, it is the quality of the relationships that matters for people over 30, not the quantity: unhappy married couples described themselves as less happy than people who were not married at all.

Relationships and pain tolerance

Another research study carried out by Katerina Johnson’s group found out that pain tolerance seems to be linked to social network size. Having a good and supportive social network may be linked to the production of endorphins in our brain, helping us to better tolerate pain.

These results highlight the importance of taking care of our relationships, of nurturing and cultivating them, as when they are positive and supportive they can be so beneficial for our wellbeing.
As their positive impact can be so powerful, unfortunately their negative impact can be as intense.

If you feel that you are having troubles in your relationships and you would like to understand better what is preventing you to fully benefit from your social network, you may consider talking it through with a counsellor or a psychotherapist.

References

Johnson K., Dunbar R; “Pain tolerance predicts human social network size”. Scientific Report 6: 25267, 2016.

Lewis T; “A Harvard psychiatrist says 3 things are the secret to real happiness”, 2015. 
http://uk.businessinsider.com/robert-waldinger-says-3-things-are-the-secret-to-happiness-2015-12?r=US&IR=T

http://robertwaldinger.com/

Depression: a few false myths

Depression false myths

Despite the fact that depression will be the second most disabling illness by 2020 (WHO, 2012), it still causes wrong beliefs and false myths, interfering with the act of seeking and receiving appropriate treatment.

Let’s look at a few of them.

1. Depression doesn’t exist, we are all a bit depressed 

Many people think that depression is nothing but sadness and that everybody can experience it every once in a while.

Well, this is definitely false. Depression and sadness are very different in terms of intensity, duration and the impact they have on our daily lives. While sadness is a temporary feeling, as it doesn’t prevent us from experiencing positive emotions nor has it a significant impact on our daily life, depression can significantly account for changes in functioning and mood.

To be diagnosed with depression, the symptoms must be present for at least two weeks, most days and for most of the time.

Sadness and low mood are only some of the symptoms experienced by depressed people (beside lack of interest in the usual activities, diminished energy, feelings of worthlessness or guilt, change in sleep patterns and appetite, thoughts of death and difficulty concentrating).

2. Depression is all in our head and it does not have any biological root

Once again, false: nature and nurture interact to trigger and cause depression.

Genetic liability and life events play a role in this. As far as biology is concerned, a specific variation of a serotonin transporter gene seems to increase susceptibility to depression.

Besides, depression doesn’t only affect our thinking, but our body as well. Depressed people can experience different changes in their physical habits: some may experience a significantly increased or decreased appetite; some may have trouble sleeping while others may oversleep; some may go through motor retardation as opposed to agitation. This means that depression comes with a varied constellation of several different symptoms.

3. Depression is related to creativity and sensitivity

Since many gifted artists, scientists and musicians of the past suffered from mental disorders, one may tend to believe that suffering from a mental condition relates to being creative and sensitive. Well, this doesn’t apply to depression as a condition. There are so many creatives who have never suffered from depression and conversely, lots of depressed people whose nature is not particularly creative.

 4. Depression is always triggered by specific events

Specific events may sometimes trigger depression, such as the loss of a beloved one or a trauma.
As previously mentioned though, nature and nurture intimately intertwine and it’s not possible to pinpoint a single cause of depression.

5. If I start using antidepressants, I’ll be hooked forever

Taking medication for mental health treatment may be scary, because of the possible side effects as well as the fact itself of being on medication.

In the case of depression, depending on the severity of the specific case, a psychiatrist may deem clinically appropriate to prescribe medication. A combination of medication and psychotherapy is often recommended, especially in severe cases.

The length of antidepressant treatment usually depends on the case severity and the number of depressive episodes experienced.

 

Despite the abundance of false myths, depression is a severe and disabling condition that should never be underestimated.

If you think you are suffering from a depressive episode, consider talking to a specialist to receive appropriate treatment as soon as possible.

References:
World Health Organisation, http://www.who.int/mental_health/management/depression/wfmh_paper_depression_wmhd_2012.pdf

“False beliefs: the current treatment of patients with depression”, Lecrubier Y; Current Psychiatry Reports 2003, vol 5(6): 419-422.

Fear of flying

Fear of flying

Despite being one of the safest means of transport, fear of flying is a common anxiety problem for many of us.

Boeing Corporation found out that 17% of Americans declare to be scared of flying and that this fear is the third most popular reason for avoiding planes (Laker M, 2012). Furthermore, it seems that around 6% of the population suffers from a diagnosed plane phobia, the so-called aviophobia.

This means that if you are afraid of flying, you are most definitely not alone.

Different shades of anxiety

Fear of flying can manifest itself in different ways and its consequences can affect us by impacting several aspects of our life. In less severe cases, it may just generate mild and unpleasant uneasiness when travelling, while for others, it may cause intense anxiety well ahead of time, making our airborne journey a very distressful and negative experience.

Anxiety can be managed using any sort of safety behaviours like choosing a specific seat or side of the plane, or having specific rituals before the flight such as checking the weather forecast, as well as self-medication (homeopathic or non-homeopathic) or a glass of wine aboard to calm the nerves. Again, for others, the idea of flying may be terrifying to the extent that setting foot on a plane is utterly inconceivable.

Triggers of fear of flying

Different factors may trigger this fear, such as being exposed to a traumatic event related to flying (directly or indirectly), or behaviours taught by a “model” of behaviour (the so-called social learning), or suffering from other phobias (i.e. claustrophobia or fear of heights) or other psychological disorders.
Specifically if you suffer from a panic attack disorder and you experience one of them during a flight, it is most probable that you will be very anxious in future flights; instead if you suffer from a generalised anxiety disorder, it is very likely that you will be very distressed when travelling in general.

Cognitive factors

Several psychological factors affect this problem.

Very often, flying phobia stems from the lack of control experienced while on a plane.

Avoiding to fly is a maintaining factor and will worsen fear in the long-term, as fear has to be faced to be overcome. Some cognitive biases can contribute to the fear of flying, like the tendency to catastrophise noises, turbulences and our own bodily reactions and emotional responses (as possible cues of an upcoming disaster), cognitive distortions (by perceiving a low-probability event as a highly possible one) and intolerance of uncertainty.

Fear of flying: treatment

If you feel that your fear of flying is negatively affecting your life, lifestyle, work and relations by limiting your degree of freedom, you should think about asking for help.

A Cognitive behavioural psychotherapist can help you manage anxiety by changing the negative beliefs and biases in which your fear is rooted; psychotherapy indeed can help you to start enjoying the pleasure of flying and travelling again.

References
Laker M, “Specific Phobia: flight”; Activitas Nervosa Superior 2012, 54, no 3-4.