Ask the expert: Mark Smyth
Welcome to ReachOut.com’s Ask the Expert service
Through this service the ReachOut.com team will be working with a group of professionals and experts with detailed and specialist knowledge of youth mental health issues such as anxiety and depression to answer your questions and address your concerns. The issues covered will be the same as those covered throughout ReachOut.com but through this service we will be able to provide valuable insight into more specific and personal concerns that you may have.
Each month we will concentrate on one particular mental health area and work, mainly, with one specific collaborator. Mark Smyth is psychologist who specialises in anxiety.
Questions and answers
We won’t have all the answers to every question – but we do have access to the best available information, so let us know what’s on your mind by submitting a question here.
Your question and answer from Mark will be published here at the beginning of each week, so you may wait up to a week for an answer.
The advice provided through this service is not intended to replace face-to-face professional advice or any on-going support that a person may be receiving. If you or someone you know is in crisis now you should go to emergency support information.
I know i need help but I am so afraid of talking with people… i HATE sitting down face to face with someone.. having to talk! i want the help but I cant force myself into it… i suffer with depression, anxiety, and self harm… its getting so out of hand ! i dont know what to do. the thought of going out for help is un nerving… any suggestions…?
first of all thank you for taking the time to get in touch with us. What that tells me is that although you feel like its too difficult to talk and you feel like you can’t force yourself into it, you do have motivation to want things to change, and the first step was contacting us. Recognising for yourself and being able to admit that things have been getting out of hand for you was also a really important step in thinking about and seeking help.
Your description of the thought of going for help feeling un-nerving is actually a very accurate and common feeling that the vast majority of my clients would experience the first time that they visit. Most would report feeling unsure of where to start their story, that it won’t make sense, that they’ll get too upset etc. At the end of the session, when we discuss how they felt it went, a significant majority report “I didn’t think I would have said as much as I did”, “it wasn’t as bad as I thought it would be”.
They key point in this is that in a session with a therapist you are not alone, they are there to help and support you to talk as much or as little as you feel would be helpful. There isn’t always an expectation of talking non-stop. Your therapist is also there to help to guide the discussion and help you to manage any anxiety or distress you might experience in the session.
The other point to consider is that not all types of psychotherapy / support involved sitting directly opposite someone. For example, if you were to see someone trained in psychoanalysis you would commonly lie on a couch and not be able to see the person at all or in other types of therapy you could sit side by side with the therapist. Psychotherapy can and should be flexible to the needs of the client where possible and appropriate.
Even if the what I have said above doesn’t re-assure you as much as you need before you move towards having a conversation with someone face to face it might be worth looking at healthier options and different distractions if you feel the urge to self-harm.
There are tips here ie.reachout.com/inform-yourself/suicide-and-self-harm/deliberate-self-harm/ on ReachOut.com that might help. I would also strongly recommend having an initial consultation with your family doctor in relation to your difficulties with self-harm and depression and they would also be a good option in relation to referring you to other services in your area.
The ReachOut.ie staff noted that from your IP address it looks like you are in the United States, is that right? If you are in the United States, then there is a ReachOut.com website in the USA. It might be worth getting in touch with them as they will have a better idea about online and face-to-face supports available in the USA. Their website is www.us.reachout.com. They have lots of useful information about the different types of mental health supports available, how you access them and what alternatives to face-to-face supports are out there. For some the option of online counselling can be a really helpful step towards seeking help in a face-to-face setting.
As overwhelming and difficult as things might feel at the moment try not to give up hope, the supports are there for you to help you to learn more effective ways of coping with how you have been feeling, the important thing is being able to be open to giving them a chance to help you.
Im 16 years old and I’ve self-harmed on and off for nearly two years. Last summer my mam found out and i was able to stop for a while but very soon it came back. I was able to keep it a secret for a long time until it started happening much more often, going from once or twice a month to once or twice a week within a few weeks. About a week ago i worked up the courage to tell my Mam that it hadn’t stopped and i told her about how scared i was.
She decided that i should see a councillor and i will be starting with him on Thursday. Only problem is I’m terrified. I find it difficult to confide in people having only told one of my friends about what was happening and she only knows a small part of the story. I can barely speak to my mam about all this and although i think it may be easier to speak to someone i don’t really know about all this, I really don’t know what to expect.
thank you for taking the time to get in touch and to share with us about how difficult things have been for you. What impresses me is that you have already taken what is typically the most difficult step, disclosing to someone that you had been self-harming and that it scared you. Having overcome that important first hurdle is already a big achievement. In terms of what to expect when you meet your counsellor there will be no right or wrong things to say and you will talk as much as you are able or feel comfortable to. What going for counselling typically involves is going to talk to someone who will listen to your story in a non-judgemental way, that you can share your story with and together help to try and make some sense of it. It’s also about having a time and a place to begin to safely release what I’m going to assume are lots of strong and difficult emotions that you’ve been trying to keep buried inside for at least the last two years. An initial session should include a discussion about confidentiality, what the limitations are on confidentiality and what might happen if they were worried about your safety.
Having self-harmed for that long tells me that you want to cope with how you have been feeling but you’re either unsure of how else to cope or it feels too scary to think about trying to cope with them on your own. The good thing about going to counselling is that you will be going to see someone who begin to look and help you to see behind the cutting and what experiences and emotions have made you feel as bad as you obviously have done. Counselling can also help to look at other ways of coping without having to self-harm. Another thing I’ve picked up from your email, which hopefully might help allay some of your fears is that talking to someone has helped before. I know you said you only stopped self-harming for a while after your Mum found out but what that tells me is that people knowing about how difficult things have been for you, how hard it has been to cope, helped you not to self-harm. What I would hope for you is that if you knew you had a safe non-judgemental place you could go for regular counselling you would know that you would have a time each week that you could safely release difficult emotions.
In the mean time you can find really useful information about coping with self-harm on Pieta House’s website and ReachOut It’s also sometimes helpful for your family GP to know about how difficult things have been for you as they are really good at knowing about what additional supports are available locally for you and to be able to give you medical advice about to best look after any physical scars you may have.
Thank you for getting in touch and I want to again congratulate you for taking the first steps in learning new ways to cope and for trusting someone to share your important story with them.
My best friend has recently told me a lot of things about her past. I know she is depressed but she said she hasn’t been diagnosed because her father won’t do anything. Her mother doesn’t live with her because she told me she hung herself last year. My friend lives with her Granny at home as her dad works in Dublin and only comes home at the weekends.
I know that she self-harms because she showed me scars on her stomach. She is subjected to bullying in my school as people are bullying her and calling her weird and an emo and its actually horrible. Only last week I had to miss three full classes staying with her in the bathroom because she was crying her eyes out. She told me that she witnessed her uncle committing suicide when she was only 7.
My school literally does absolutely NOTHING to help her. The school guidance counsellor is a 50 year old man who does NOTHING and told her she has a horrible attitude. Is it only me that thinks you shouldn’t be saying things like that to a depressed self-harming teenager ?
There is no one she can talk to in school regarding teachers. She only speaks to me and it’s a huge weight on my shoulders because I can’t concentrate in class and I’m in 4th year. I know that probably sounds selfish but I just feel like she’s leaning on me too much and needs to talk to someone else.
My Mam knows a guidance counsellor in a school she teaches in near us that would be willing to talk to her if she had the time but if my friends Dad finds out he’ll go ballistic. Her older sister has left the house and is smoking and has breast cancer and that’s another thing adding to the list.
I feel like no one can help her and it kills me to see her upset and depressed and self-harming. I really don’t know what to do. Can you please help? I know it seems like a lot but i’ll lose it if I don’t do anything.
there are lots of different and important parts to your email. I will do my best to help to suggest what might be ways to start to figure out what our options are.
The first thing that jumps out at me, and that I want to begin with is your sentence “I know that probably sounds selfish but I just feel like she’s leaning on me too much and needs to talk to someone else”. This doesn’t sound selfish at all, in fact it is an incredibly mature and wise statement. I meet lots of young people who try to be a friend and counsellor/psychologist to one or more of their friends. What I have seen in each case is that the young person is not equipped (and how could they be expected to be?) to take on their friends difficulties, especially when it involves difficult issues like depression, self-harm and suicide and they end up feeling overwhelmed and upset themselves. These are potentially difficult topics for trained professionals to discuss with clients, so much so that we need supervision and support around how we do this work, so how would a teenager be expected to cope with this responsibility? What your sentence above tells me is that you are worried about your friend and realise that she needs more support than you could be expected to give, that to me is being a good friend.
The other really important point I think we need to focus on is the importance of you looking after yourself, we tend to call it “self-care”. If we want to be ever in a position to help others we first have to make sure we are looking after ourselves. It would seem that you’ve discussed these concerns with your Mum who is connected to the other guidance counsellor. I’m happy about this because it means you don’t need to shoulder the burden about knowing about your friends difficulties all by yourself.
“Is it only me that thinks you shouldn’t be saying things like that to a depressed self-harming teenager?” One of the most important skills in helping someone who has the various difficulties your friend experiences is listening without judging. I’m sorry that it seems that your friend has not had such an experience in school so far. In my experience there would be very few if any schools who would be set up to support your friend to the level that it seems like she needs. Your description of your friend’s experiences so far in life would worry me a lot. We look out for “risk factors” in a young person’s story and the more risk factors that are present the more concern we would have for that young person’s safety. Your friend’s story above contains many factors that when added together would tell us that she and her family need help, and probably urgently.
I work day to day as part of a Child & Adolescent Mental Health Service (CAMHS) alongside colleagues from Social Work, Occupational Therapy, Speech & Language Therapy and Psychiatry. Your friend’s story, that you have described so well above, would be one that we would be familiar with. Usually a referral that would be similar to your friend’s story would be seen by at least two if not more of the team. This hopefully will help you to see how successfully supporting your friend would involve a team of experienced professionals and it would be huge if not impossible task for you to take on.
However you have already played a very important role so far in that your friend trusted in you enough to share her story with you, but what is important now is that her story is shared with experienced professionals who can work to keep her safe. I see from your email that you are worried about what her Dad’s reaction might be to her seeking help. That is also the advantage of having a team of people available. In most cases one of the team also has a specific role in working with and helping the young person’s parent around whatever issues come up.
Please be assured that help is there for your friend, and what I would like to see happening for both your and her benefit is getting her linked in with a CAMHS team in her area as soon as possible.
There are a number of ways that someone can get linked in with CAMHS. The most common way and best way is through a family GP. Your friend’s family GP may also be the best person to help her Dad / Granny understand why a referral to CAMHS would be needed. Another way of getting a referral to CAMHS would be through attending a local Accident & Emergency Department in the local hospital. Depending on the area you live in, some A&E departments will have on call psychiatry services who can make emergency assessments of someone’s mental health and risk to themselves. It is really important that you share your concerns as you described above to us with your Mum and perhaps she could encourage your friend’s Granny to bring her to their family GP. The more responsible adults that know about how difficult it has been for your friend the more protective it will be for her and you.
My sibling suffers from depression. It feels like she’s not putting in any effort to get well again. I know it sounds terrible but sometimes it feels like she uses her depression as an excuse to be vulgar and extremely angry towards her younger siblings and family members. We have tried talking to her but nothing seems to get through to her. We are desperate for her to come back to us, it has upset our family so much. She won’t talk to anyone. She has gone to the doctor and admitted that she is depressed but she just doesn’t make any half effort towards us and it is breaking us for the worst. The lies have gotten out of hand, along with her attitude and behaviour. She doesn’t realise it’s effecting the entire family and not just her. We are stuck and can’t seem to move forward. What should we do? I am currently in my Leaving Cert and I am falling behind with my work. I can’t concentrate with worry and I’m afraid to leave the house in case she does anything crazy
thank you for getting in touch with us. It sounds like you’re in a tough position. It’s not unusual for us to see the impact of something like depression affecting a whole family and not just the person who is depressed. Increased irritability and sometimes aggression is not unusual in someone who is depressed, it’s another way of expressing and communicating difficult emotions. We can be empathetic to how our family member might be feeling and how difficult it must be for them but I think we should also be able to calmly and respectfully feedback to the person when we feel their behaviour towards us becomes disrespectful.
I can hear your frustrations coming through loud and clear in your email and it sounds like there’s a difficult and tense atmosphere in the home, which must be very difficult for you to try and prepare for your Leaving Cert in. As difficult as it might be to hear, the best thing that you can do at the moment is to focus on what is possible and what you can control, which is your Leaving Cert. Your sister’s mental health is something that is out of your control. When we try and focus our efforts on something we can’t control, such as a loved one’s mental health, as much as we’d like to be able to, we end up feeling frustrated, angry, scared and powerless. Looking after yourself at this difficult time and focussing on your studies is not being selfish or doesn’t mean you don’t care for your sister, it’s the logical and recommended thing to do.
From your email it sounds like communication has been tough in your family. I’ve met and worked with many families who have tried and tried to motivate and get their loved one to talk to them about how they are feeling. It probably sounds like a cliché but it’s also true that people will talk when they are ready to. My experience has been that sometimes the more a family member tries to get a loved one to talk the less likely they are to. My advice would be to be empathetic to your sister, to notice and reflect back to her that as a family you are all there to listen and to help when / if she wants to talk. For someone who is depressed knowing that help is there, that someone is ready to listen when they feel up to talking is reassuring.
It’s great that your sister has taking the important first step of visiting her GP and admitting that she has been feeling depressed. What that has also achieved is connecting your sister with a medical professional who can connect her to relevant mental health supports and also be responsible for assessing and ensuring her safety. When you say you fear leaving her in case she does something “crazy” I’m going to assume you mean you fear she may harm herself. This is not a responsibility you can realistically take on, especially with your Leaving Cert coming up soon.
Another option that your family could pursue is family therapy. That could afford everyone a safe and supportive space to be able to explore how difficult things have been for everyone and to work out better and more respectful ways of communicating with each other. Your family GP might be know what family therapy services are available in your area.
The best of luck with your Leaving Cert and try to make sure to look after yourself at this difficult time,
Please can you help. my wonderfully clever 14 year old son who is presently studying for his junior cert has told us he is being bullied in school for a while now. I am heartbroken as he had the problem in 1st year and I thought we had dealt with that but it turns out that while we managed to sort out one bully some more appeared afterward and he did not want to go through the whole ordeal again. We are seriously considering changing schools next sept as he is very upset right now and doesn’t want us to do anything about it in fear it will make matters worse., I would really appreciate any advice you could give in dealing with him and how to reassure him he is not the one at fault. We are awaiting a meeting with the school but in the meantime I really want to help my son.
Hi June, thanks for your email.
It sounds like you and your son have been through a very difficult time. The first thing that I noticed from your email is that you have one of the most important things that any Mum can have with their teenager, to protect them and psychologically support them, communication and trust. Sometimes it can be a very difficult thing for a teenager to admit that they have been bullied by their peers, and doubly difficult to admit that it has happened again. I have met teenagers who have kept repeat bullying to themselves for years because they didn’t want to burden their parents and because they feared that admitting it kept happening would make them look like social failures. The fact that your son disclosed it to you initially and then trusted in you and your relationship to disclose it again shows the strength of your relationship with him.
The unfortunate and sad reality of life is that no one is immune from the corrosive effects of those who decide to bully others and make them feel bad. Avoiding bullies in life, whether that’s in school, workplaces or clubs is not something that we can ever guarantee. Moving to a different school might have some positive effects in the short term but there are also other factors to consider such as there’s no such thing as a bully free school and also the challenge for teenagers in fitting in and being socially accepted half way through secondary school when social groups have already formed. Does your son have friends in his current school, what would it be like for him to not have the support of these relationships?
Learning to cope with bullies and use the support of those in positions of authority (teachers, managers etc) to report this behaviour so it is challenged is a more realistic proposition. Yes it has happened again to your son, but he survived the first incident which also shows that he has the strength to keep going, to cope, with your support.
You don’t need to wait to find out from me how to help your son, you already are. You’re listening to him, empathising with how difficult things must be for him and have organised a meeting with his school to advocate on his behalf. The primary responsibility for the identification, prevention and management of bullying is with your son’s school. Each school should have a written and detailed anti-bullying procedure in place which you are entitled to ask to see and to enquire as to how this procedure has been put into place in his school to protect him and others. It is understandable that your son is anxious about you intervening on his behalf, most likely he is terrified of being labelled a “rat” which is the unfortunate term that some teenagers use to describe those who disclose information to people in authority like Teachers or Gardai. I wonder whether his school could provide an in-house person like a counsellor or year head that would regularly check in with him to support him around managing the behaviour of his peers. The links below to the Dept of Ed policies on bullying and the DCU Anti-Bullying Center provide useful information that could help you to prepare for the meeting with the school and also to educate your son about bullies, why they do what they do and about why its not his fault.
I wish you both the best.
I am suffering with severe anxiety issues causing me sharp chest pain. nerves pains and upper back pain. nothing works for me except Klonopin but i am scared of taking it due to what i read about it in internet. but i dont find any choice since i feel like dieing slowly. i tried self help, visited physchiatrist, Homoe medicine but not use so far. so Do you suggest me to take klonopin medicine? answer soon. Do people die if they have this pains often. please answer my severe question. and also tell me why head is so heavy all day and i dont have any worries, no thinking but i have lot of anxiety and one doctor said i have chemical im balance with harmonal change. what is this alll about. i dont want to die like this. i want t live like a normal human. please anwer soon. i have severe paiins in my chest and upper back and i dont have any fear as such. but i am suffering from severe anxiety.
thanks for your questions. I’m sorry to hear that you have been going through such a tough time. I’m not surprised at all that so much of your anxiety is experienced through physical symptoms, that’s a typical feature of anxiety. In relation to your questions about medication, the people best placed to answer your questions in that area are either your GP or a Psychiatrist. Anxiety can feel unbearable at times, like it is going to completely overwhelm you and I have often had clients tell me that they fear they may die from it. As strange as it may sound considering how hard you find it to cope with anxiety at the moment, you are living like a normal human in that it is normal for every human to experience anxiety. You note in your email that you don’t have any fears as such, I wonder if what you actually fear the most is the feeling of anxiety itself. What’s important to remember here and to remind yourself of when you feel this way is that as uncomfortable and upsetting as a feeling may be, it can’t physically harm you, and it can’t last forever. I noticed that in the range of supports that you mentioned you didn’t note trying a psychologist that specialises in cognitive behaviour therapy ( CBT). Self-help resources can be useful tools but sometimes when anxiety such as the level that you experience takes hold of us we need the assistance of someone who can help us to make sense of what we are feeling and help us to practice the various strategies which have been shown to be effective in helping us to cope better. It would seem from your email that your experience of anxiety is such that it is consuming significant amounts of your emotional and physical resources on a daily basis. My advice would be that it would be helpful to seek a referral through your GP / Psychiatrist to a psychologist with experience of CBT who could help you to understand your anxiety better and guide you through the techniques to help you cope with it better. Alternatively you can find a psychologist in your local area through the Psychological Society of Ireland
Caitriona says: I experience anxiety on a daily basis but find myself generally worse while sitting in a classroom in school. I was just wondering if you had an tips for making the school day more bearable.
Hi Caitriona, , I’m not surprised that you experience anxiety on a daily basis as it would in my opinion be unusual for anybody to be able to go through an entire day without experiencing anxiety at some point during the day. We all experience anxiety about everyday things but rarely stop to think about it or label it as anxiety. Everything from when we wake up in the morning and worry about if traffic will be heavy on the way to work / school, what to wear on a date, if we will get a project in on time, what mark I’ll get in an exam or if someone will talk to me in school or will I be ignored.
All examples of situations that can cause us anxiety but also ones that we find ways to cope with. What I wonder about is how you cope with your anxieties outside the classroom and if you could use / adapt those strategies in the classroom where it is more prominent?
I have no doubt that it is a difficult position for you to be in, to be sitting in a classroom, with feelings of anxiety that make you feel uncomfortable and that you feel you can’t get away from. One of the important things in helping us to cope with anxiety is to understand the connection between the situation we are in that is triggering the feeling of anxiety, what we are thinking at the time and how we act to manage that anxiety. It would be good for you to maybe take some time to think about what your fears are while you’re in the classroom. I also wonder what are the “what if….” thoughts that accompany your anxieties. Common examples might include: what if the teacher asks me a question and I have to talk out loud, what if I get a question wrong, what if everyone laughs at me or thinks I’m stupid, what if no-one talks to me in class today, what if someone asks me what I did at the weekend and I didn’t do something as cool as them, what will they think of me.
Anxiety is a normal human response to perceived threat. So in your situation you more than likely feel there is some threat to you, usually social (what others will think of us) within a classroom situation. The first step is being able to identify to yourself what that perceived threat is, then you will be in a better position to evaluate the evidence for / against that perception. Anxiety has a way of messing with our ability to think straight, to see the evidence that contradicts our feelings and our fears. To make your day more bearable it is important to logically evaluate the thinking underlying your feelings and fears and to try and come up with a more balanced way of viewing the situation. As you probably know already, feelings of anxiety don’t usually lead us to easily consider both the potential negatives and positives in any given situation. At the end of any given day when you’ve sat through a whole day in the classroom, feeling anxious, the natural way of thinking would be “that was horrible feeling like that all that, it was unbearable”. It’s not as easy to reflect back and to think, “that was tough feeling like that today but you know what, I coped, I got through the day, I survived, despite how uncomfortable it was”. And that’s essentially what we have to do with anxiety, to learn how to cope with it, to see that in many situations every day we survive it, we live through it and we get on with our day / our lives and most importantly, that it will pass. I would hope that by exploring a little more some of the thoughts associated with your anxiety will help you to understand what you have been feeling a little better and will begin a process of making things a bit more bearable for you.
Hi , I’ve been suffering from anxiety/panic disorder for over a month now I’m must about at breaking point , i was brought into hospital 3 times as i felt i couldn’t breathe , pounding heart tightness in the chest , they did all the bloodwork, ekg , chest xray and told me everything was normal and diagnosed with me anxiety , I’m 27 and had a baby almost a year ago and well this is just after jumping out of nowhere. I’m constantly feeling uptight , moody , and getting dizzy spells and feeling weak . I’ve changed my diet and eating right but I’m just thinking of having more attacks all day long the more i try to pick myself up and not think of it the more its making me worse and thing there is something really wrong with me , I’ve talked to my gp and he told me to just keep breathing properly which i am , i can’t afford a shrink so that’s. not an option , i was taking diazepam for 3 days that made me worse and spaced out . It just seems the more I’m trying to move on with my life and enjoy time with my daughter and partner the worse I’m getting . I went away for the weekend with my partner and not being crude but we tried to get intimate with each other and i went into full blown panic attack which happened when my heart rate went up . I’m stuck in a cycle i can’t get out of and really don’t know what to do
Hi Pauline, first of all thank you for taking the time to write to me and share with me your experience of anxiety and how difficult that it has been for you. Again similar to the other letters sent in this week, your story is very familiar to me and that’s a huge thing to remember, that a lot of people have been, are and will be feeling exactly as you have been for the past month. The first thing that I would take reassurance from is that you have completed all the relevant medical checks and the professionals have re-assured you that there is no underlying medical reason for what you have been feeling. I want you to try and think for a moment about what it would be like if I asked you to get up from where you are right now and go for a 10 mile run. What physically would be happening in your body at the end of that run? Well if you’re anything like me, and hopefully you’re not (unfit) you would feel like your lungs were on fire, couldn’t breathe, heart pounding, shaking legs. At the end of this would your first thought be that you were having a panic attack or would you think, oh god I’m unfit I need to try and fit in a bit more exercise in my life. You described at the end of your email how when your heart rate went up as you were getting intimate with your partner and it triggered a panic attack. I want you to think back to before anxiety got a hold of you, to remember perhaps being on a first date with your partner, to when perhaps at the end of the night you are wondering is he going to lean in for a kiss, odds on that if you were in that situation , or could imagine it that your heart would have been pounding out of your chest. However, before anxiety started to confuse how you interpret things you would have recognised that increased heartbeat in that situation is perfectly normal, as it is when we are involved in any physical exercise, including physical intimacy. However anxiety gets into our heads and in some ways puts blinkers on us and makes us think that there can only be one reason for our hearts beating faster and it has to be bad, no worse, it has to be catastrophic and we have to make it stop. Perhaps think back to when you were in labour, your heart would have been beating very very fast, you would have had rapid breathing to help you to manage the labour, I’m guessing that in that situation you didn’t wonder / think about if you were having a panic attack but instead rightly attributed your physical symptoms as being an expected symptom of the labour itself.
Let’s look at your situation from another related angle, you mentioned that “I’m 27 and had a baby almost a year ago and well this is just after jumping out of nowhere. I’m constantly feeling uptight , moody , and getting dizzy spells and feeling weak”. Obviously being male I have no direct experience of what having a baby must do to someone’s body but what I do know is that pregnancy and the physical, emotional and hormonal changes which must occur for the body to prepare itself to bring a baby into the world are enormous. How the body and mind recovers from the exertions need to bring this life into the world differs from person to person and for some the hormonal changes (which can often affect mood and anxiety levels) can persist for quite a while afterwards.
On a practical level the advice from your GP in relation to focusing on your breathing is sound advice. You mentioned thinking about having panic attacks all day long and also trying your best not to think about them but they still occur. One of the unfortunate things about anxiety is that the strategies that we employ to try and manage / cope with it can sometimes make it worse / maintain it. The two thinking styles you mentioned above are two of the most common ways unfortunately of maintaining anxiety. First of all, thinking about / predicting that an anxiety / panic attack is going to happen makes it more likely that it will occur, it’s called a self-fulfilling prophecy. If you are constantly waiting for a panic attack to happen you will be on edge, anxious, vigilant for the first signs, then when any physical symptoms which might be similar to anxiety occur (e.g. increased heartbeat walking up a flight of stairs) you spot it immediately and end up telling yourself “see I knew it would happen”, rather than understanding that your increased heartbeat was as a result of physical exercise. The other thing we do is to try and block it out, to try and not think about it. Thought stopping / blocking unfortunately is also not an effective way of managing our anxieties because during the act of telling ourselves not to think about our anxiety, we are still actively thinking about it.
I hope some of the above information makes sense and perhaps might help you to think about your anxiety a little differently. I wonder about maybe talking to some friends, family members or at your local mother and toddlers group to other Mums about how they felt in the weeks and months after they had their children. What you may find is that some if not all experienced many of the physical symptoms that you’ve been finding difficult but perhaps for them they put it down to the after effects of pregnancy / labour, and of the physical and emotional impacts of caring for a baby. The key point to remember is we can all learn to cope better with anxiety once we understand our own particular anxieties better and avail of support from those close to us and in everyday situations. You are normal and things can get better.
hi , I’ve been suffering from anxiety for nearly 5 years now every day is a struggle , now i feel I’ve just gone from bad to worse thinking the worse about every little tingling felling i get , is it going to kill me .I fell like I’m inventing pain but then i think is it something serious, I’m trying to change and move on but it seems like it has such a hold on me at this stage i don’t want to give in as i have a wonderful partner and two beautiful kids, can you help me by sending me some info on where to get help.
the first thing that I notice is your strength, both physical and mental strength to cope with such significant anxiety for almost 5 years, not to give up hope of being in a position to being able to cope better with your feelings, which is a very realistic goal. One of the interesting things about anxiety is that it makes predictions all the time, predictions which fill us full of anxiety, worry and sometimes even terror. I wonder how many times have you worried over the past 5 years that one of the tingling pains was going to result in some sort of medical disaster or as you mentioned, one might kill you.
The other thing that I almost always talk to clients about is how overly anxious people are the worst predictors of the future I have ever met. The only things they can predict are imminent disasters, which rarely if ever come true and if something negative does happen it’s rarely as bad as the anxious thought predicted. One of the things that anxiety hates is people recognising how bad it is at predicting things and not taking it as seriously as it would like you to. Take your example, how come none of the predictions about the tingling sensations have (thankfully / hopefully) had any serious medical repercussions for you? I can already guess how you might respond to that question, but what if the next time it might be something serious? Once anxiety gets a hold of us it will do anything to try and maintain its hold over us, to make us think that the world is full of danger and that we are more vulnerable to those dangers than anyone else around us. However, if you look back over the past 5 years, what percentage of your anxiety fuelled worries have actually come true exactly as predicted, I would guess very little if any, but your anxiety doesn’t want you to think about that in case the next time you have an anxious thought you don’t give it as much emotional energy as you have been for the past number of years.
What I have found in discussions with people is that when we spend all our time worrying about anxiety, about when it will hit us next, watching out for physical signs in us, being almost hyper vigilant for any sign of anxiety feeds it and keeps its hold upon us. If it’s possible, and I have found that it is possible, for a great number of people, to move from a position of worrying about it constantly to one of acceptance that anxiety is as normal a human emotion as happiness, anger, sadness, frustration etc. is an important first step in being able to cope with our anxieties more successfully.
Another useful analogy to bear in mind is one that I recently learned from a colleague who runs the Mater Hospital Social Anxiety Programme. If we can imagine our anxiety as being like the sea, the sea is in constant motion, with waves coming into shore day and night. If we were standing in the sea those waves would keep on coming, as anxiety (and many other feelings) do. The smaller waves (every day anxieties) hit us, momentarily feel uncomfortable and pass us by without us needing to do anything about them. We live with and cope with these every day anxieties all our lives. However, anxiety, like life itself, can be unpredictable, and at some point in our lives bigger waves are going to come towards us and perhaps momentarily knock us off our feet, but a wave, like anxiety will with time, pass us by, and we can get back up and continue with our day / life. However, the more you resist it, the more you try to fight it and block it out, the more energy you give it. I know it will go contrary to your instincts and responses to your anxiety for the past number of years, but the less attention you pay to it, the more you devote your energy to accepting its existence and to believe that it will pass, as it inevitably will do, the less of a stranglehold it will have over you.
To address your specific question about where to seek help, you have a number of options. Your GP should be able to refer you to a local primary care psychologist if such a resource is available in your locality. As mentioned in a previous post you could also independently find a psychologist yourself using http://www.psihq.ie/find_psychologist.asp. For those people who like to find self-directed ways of managing their own anxieties, I have found the book “Overcoming Anxiety for Dummies” to be a really practical, user friendly resource for people to find new techniques to try out. Don’t be put off by the title as I was when I first seen it in the bookshop. I was slightly dismissive of what it might offer without evening opening the book but soon found my presumptions about its content to be unfounded and have used ideas from it with clients for a number of years. Lastly, don’t give up the fight now after coping for so long, having the energy, motivation and drive to learn new ways to cope with your emotions is more than half the battle and I wish you luck with whichever option you choose to pursue.
My Dad suffers from agoraphobia quite badly. I would really like to get him some help as it is really affecting the quality of his life and ours. Is CBT a good approach to take? He has been suffering with this for probably close to 40 years and has avoided getting any real help about it. How long do you think the treatment would take considering he has been avoiding dealing with it for so long? I’m pretty sure it all stems from an incident that occurred when he was around 20. I am getting married next year and would love to say that my dad could walk me down the aisle or even be comfortable getting to the various locations for it.
Hi there Eve,
thank you for taking the time to email in your query in relation to your Dad’s anxiety. I’m sorry to hear that he has struggled with managing his anxiety for such a long period of time. It is not uncommon where agoraphobia occurs in a parent that the impact is not only felt on the person themselves but on the family unit also. Yes CBT is an effective approach for the management of anxiety, including agoraphobia, however the difficult part it is really only effective if the person themselves recognises that there is a problem and is sufficiently motivated to want to make some changes to learn how to cope better with their anxiety. Maybe a good point to start is to have a look at one of the models of stages of change below and making a judgment about where you think your Dad might be on it:
The five stages of change are precontemplation, contemplation, preparation, action, and maintenance. Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware or under aware of their problems. Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action. Preparation is a stage that combines intention and behavioural criteria. Individuals in this stage are intending to take action in the next month and have unsuccessfully taken action in the past year. Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Action involves the most overt behavioural changes and requires considerable commitment of time and energy. Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action
Based on the length of time that you mention that your Dad has struggled with his anxiety and your comment that he has avoided getting help for his difficulties, it is likely that he is either at the Precontemplation or sometimes Contemplation stage of change. Any decision on making changes has to have at its core a decision by each individual person to want to change. They can of course be helped and guided by feedback by loved one and friends. Have you spoken to your Dad about how much you would love for him to be able to walk you down the aisle and be comfortable and happy at your wedding? Perhaps this may spark in him the desire to consider sourcing and committing to support for his difficulties. One of the processes which can help this process of change is to consider the potential benefits (pros) and costs (cons) associated with making the changes. One of the goals that your Dad might identify is to be able to walk you down the aisle. Writing a list of the pros and cons of aiming for this goal could help to focus him on what he needs to achieve. If this is a goal that he identifies he wants to achieve the next step is to take the goal and to work backwards to identify the steps which would need to be achieved for your Dad to achieve his aim. One of the best ways to help a person who has struggled with anxiety as long as your Dad has is to break the steps down into the smallest possible steps so that they are realistic and achievable for him. In psychological terms this is called “graded exposure with response prevention”. In light of the length of time your Dad has struggled with his anxiety he is likely to require professional support to devise a graded exposure plan and to provide him with the cognitive and practical strategies to cope with the invariable increase in anxiety that results from graded exposure. If your Dad is willing, your family GP will be the best person to make a referral to your local Primary Care Psychology Services or if these are not available locally perhaps Adult Mental Health. If your Dad wished to source support privately a list of registered psychologists can be found at www.psihq.ie From a family perspective you can also play a significant role. Depending on your Dad’s specific fears, there may be ways that the family have inadvertently been reinforcing or maintaining his fears, with the support and guidance of a CBT therapist and in conjunction with your Dad, there may be ways the family can disconnect from his anxieties in a supportive way. There is unfortunately no way of predicting with any degree of certainty how quickly your Dad might respond to therapy. In my experience the main factor in how quickly someone takes the skills learned on board and puts them into practice is their motivation to change. Your Dad it would seem has tried to cope with these difficulties for most of his adult life so making a decision to make changes at this point of his life is a potentially huge decision and the energy and commitment required should not be underestimated. However with the potential support of his family, GP and a therapist, positive change is always possible. Best wishes in supporting your Dad with his difficulties and with your marriage next year.
I get very upset at school when teachers get annoyed with others in the class even though I know they are not angry at me. Do you have any advice about how to handle it. Thank you. Hannah
thank you for the question. Sometimes before we know what strategy we might use to manage the situation, we first need to try to understand why it is the situation is upsetting us in the first place. To do this we need to know a little bit more about what kinds of thoughts you are having when you hear the teachers get annoyed at others. Does it make you think about a time that perhaps a teacher or another adult got annoyed at you and it was upsetting and hearing the teachers getting annoyed at others perhaps reminds you of that time? I wonder also do you worry that if the teacher get annoyed at others you could be next and are fearful of this? How long have you been feeling like this in these situations? If it hasn’t been for a long time I want you to try to remember back to a time when you were not upset by these kind of things, how did you cope with then or why didn’t it upset you then? I wonder also what else is going on for you at the moment? Sometimes when we are faced with multiple stresses; exams, relationship or family difficulties or any combination of difficult life events, then things that previously would have seemed small and wouldn’t have upset us suddenly feel huge and are difficult to cope with.
Taking a wider perspective on things, the fact that you get upset by the teachers being annoyed at your peers shows that you have strong empathy for others and can connect with the emotional experiences of others, this is a positive thing. One of things that may people I meet with aspire towards is not getting upset or distressed. Unfortunately this isn’t a realistic goal. What is more realistic, and what will benefit you throughout life is to work on developing distress tolerance skills. Distress, like most emotions is a state and states come and go, they don’t last forever. Realising this is important because when we feel upset it can feel like that feeling is going to last forever but that’s rarely the case. If you were to ask yourself what is the chance that you or any of your classmates will remember the teacher giving out to them in 1, 5, 10 years’ time? Pretty unlikely in my experience. As we grow older we are exposed to new experiences and new memories and events such as a teacher being annoyed at us fade into the background and we no longer have strong feelings associated with it. On a practical level, I wonder about maybe arranging to meet with your guidance counsellor in school to provide more day to day support in school to help you to cope with the difficult emotions that you’re experiencing. If you would prefer someone to confide in outside of school your guidance counsellor may be able to guide you towards a local counselling service where you could also safely explore further the emotions which are surfacing in school. Finally, what I would say is to not lose hope, you don’t need to cope with this on your own, help and support is there and learning to manage and cope with emotions in your teenage years is a skill that will stay with you for the rest of your life.
What if you are depressed and self-harm and you are super shy and feel that you can’t tell anybody because of fear of them judging you or laughing at you. What do you do ??
Such a relatively short question has so many other questions which come out of it but also has many answers. It sounds like you are going through a very tough time and have struggled to cope with lots of strong emotions and thoughts. The first answer and most important one is that you look for help as a priority. Professionals who work in mental health or counselling services are trained to be non-judgemental and supportive and you can be assured that if you meet with one of these people and disclose your feelings of depression and that you have self-harmed you will not be laughed at. The very fact that you took the time to email in your questions says to me that you want help to try to find other ways to manage your feelings and emotions and this is a good starting point. Young people I work with often speak to me about how tired they get from having so many different emotional filled thoughts running constantly through their head and they feel like there is no way to figure them out or no way to make them stop. When we spend so much of our days consumed in our minds with our thoughts we can convince ourselves that no-one will understand what it is like to think or feel like we do and therefore we need to keep everything in our heads and to ourselves or someone might judge us and think we are mad. If you feel like this sometimes then you are not the only one and supports are there that can help you feel understood, but don’t just take my word for it, the following links can explain perhaps better than I can:
Based on the small amount of information you have given me, what I am sure of is you have a very interesting story to tell, no doubt a difficult one, one in which you have been upset or hurt, but none the less an interesting one and one worth sharing with someone trained to listen to and understand your story. Taking the risk to trust in a counsellor or psychologist can feel like a daunting one, to tell your story to a stranger, but it’s a risk worth taking in my opinion. When we are the central character in our own story we can struggle to step back and fully understand what we are thinking and feeling and often we need the help of someone else to make sense of things and to see ourselves, others and the world in perhaps a more helpful way. Allowing someone else the privilege of hearing your story, of sharing the emotional pain you have been living with and struggling to cope with is one very practical, useful and safe way of relieving some of the emotional pain and giving your brain a break from all of the thoughts. The fact that you have felt the need to harm yourself to cope with your emotional pain should be a sign that perhaps the emotions you are feeling are so strong at present that you need someone for a little while to help you to experience, process and cope with them in a safer, more manageable way.
Now that you have been brave enough to take the first step and to seek advice on where to seek help, the next step is to actually access that help. My advice would be, if you feel comfortable with it, is to speak to your GP about how you have been feeling and that you have been self-harming. Your GP can act as the link person for you with other services to make sure that you get all the support that you need and that you deserve to help you through this difficult period of your life. Lots of services such as Pieta House have detailed information on their websites to help you to prepare for what the experience of going for counselling might be like to help to relieve some of your anxieties about disclosing your difficulties (http://www.pieta.ie/index.php/faq). Hope still exists, and it’s at your fingertips, but it needs you to reach out and grab hold of it and place your trust in a professional who can guide you through this period of your life. I wish you luck on your journey.
Hi my name is Emer. Im writing because for the last 10 odd years or more my brother has been possibliy the worse son/brother/uncle anyone could have possibly asked for.
Hes been smoking hash since i say the age of 15/16 or younger and takes numerous other drugs as well as alochol. He says hes been off all drugs since end of Jnauary but hes also a compulsive lier so i would not believe him the slightest.The problem now is he says hes suicidal?? This has been going on for numerous weeks now but its only after the weekend when hes coming off his drink/drug phase. My mother and father are probaly the best parents we could have asked for they barely drink dont smoke and have worked hard for us all there lives. But they have been too leniant on my brothers since the very beginning. Basically they have spoilt him silly and let him get a way with blue murder. But their getting older and not coping anymore.I have no respect for my brother i really dont care for him at all and I know that sounds heartless but he has just caused them so much pain that I have no love for him and hes never ever done anything thats made me proud or made me love him.
A couple of weeks ago his friend got him a job but now due to his drinking and what not he has lost that too so he has no income at all now and is slumping up in his house that my parents renovated for him. He contributed no money what so ever to it. Anywho the list is never ending. I dont think that there is any hope for him. But my parets say that once you have a child of your own youll learn that you can never give up on them and stop loving them.He says he needs help and wants to be put into somewhere that can do that. However since my paents done up “his house” we are keeping money alot closer as my dad was made retired at the time they were paying back the loan so they can afford to pay for him now to go in somewhere. They need help there at their ends witt. I love them and want them around for a long time more hes slowly not only killing himself but my parents also. So any advice you can give would be life changing and maybe life saving. Sincerley EK.
thank you for your email. You speak about the pain you feel your brother has caused your parents, but reading your email it would seem that you have had your fair share of emotional pain from this situation too. I hear anxiety, fear, frustration, lack of hope, empathy for your parents, anger going back years and years, this takes its toll on everyone, you included.
I don’t think you sound heartless, not in the least, if you were you wouldn’t have taken the time and effort to email looking for help and advice. One of the things that I speak to people the most about is trying to objective about what situations are within our control and trying to accept those that are not. This is doubly hard when we are trying to be objective about family members and loved ones. We never want to give up on family, to extinguish that last ember of hope that this time things will be different, that the family member will finally recognise how much they have contributed to the emotional pain that others are feeling because of their behaviour.
However, to be able to be in a position to help others we also have to look after ourselves first so I would see distancing yourself from your feelings for your brother as a protective stance, both for you and for your ability to support your parents. I work with lots of families whose primary instinct is to protect their child / children from any and all negative feelings (upset, anger, frustration, sadness, disappointment). It’s a parents instinct to do everything that they can to try and minimise distress to their child. However, part of developing and growing up is learning how to manage distress and / or failure and accepting consequences for the choices we make. If our parents continuously shield us, with the best of intentions, from the consequences of our actions then we don’t get the opportunity to make different choices.
Young people with addiction difficulties, as it would seem that your brother experiences, are often shielded from the negative interpersonal and societal consequences of their addictions by families who sometimes care too much for them. In this instance the only person who can truly save your brother is himself, it has to be something that he chooses for himself. This is something he doesn’t have to do completely alone, support from family is crucial in sustaining any positive changes he might make, but the initiative to make those changes has to come from your brother.
This brings me back to what I mentioned earlier about control. As much as we would sometimes wish that we could control the actions and choices of loved ones so that they would choose a more positive direction in their lives, we cannot, and this is difficult to accept. You mention that your brother is now asking for help and that one of the options will incur a significant cost to your parents. I wonder about what immediate actions your brother could take to indicate his willingness or readiness to accept help that could be evidenced before your parents consider making that financial commitment. How could he prove to them that he is ready for help, what small changes could he make that could begin to repair the loss of trust which has occurred over so many years?
From a family perspective, I would suggest that the family engage with one of the family support agencies available to help families cope with having a family member with addiction difficulties. One such agency is the Family Support Network which can be found at fsn.ie. They also have very useful information about the process of addiction and the wheel of change with regard to motivation to change. As you know from your experience, having a family member with addiction difficulties is like throwing a pebble into a pond, the ripples move outwards and affect lots of people and not just the individual with the addiction. In light of this it is important that the focus of support is not just on your brother but on you and your parents too. If the family has a cohesive, unified and evidenced based approach for how you all interact with, support and manage your brothers difficulties then there is a greater chance of a positive outcome. I wish you and your family luck with the journey ahead.
ive a 12 year old son who was diagnosed with post traumatic stress disorder.he has been attending a psychologist since last december but hasnt improved.he only sees the psychologist once a fortnight but in between appointments we both feel so helpless and isolated as there is no other support.do you know of any support groups in ireland where we could speak to other people in the same position,thanks
thank you for taking the time to email your question into us. I unfortunately don’t know of any support groups specifically related to your difficulties, however I may have some other suggestions. Helping a young person with any type of anxiety related difficulty is something, which is in my opinion and experience, is best done on not just an individual but also a familial level as PTSD in a child can affect everyone in the family to different degrees. If it is the case that the primary source of intervention is with your son then I would suggest that the focus of the support needs to be expanded to include you and his Dad. As helpful as individual sessions with psychologists might be, it is realistically just one hour every two weeks so in the life space of the young person it is but a drop in the ocean. The primary source of support for your son on a day to day basis is his parents and the support should be just as much directed towards yourselves as much as it is your son. I can only imagine how many questions you must have about what is going on for your son and worries and concerns for his welfare. It is completely understandable that you would also need answers, guidance and support to be best able to help your son.
I wonder whether you could request alternative or additional sessions from the psychologist for yourselves to help to guide you in how on a practical level you can support your son and to give you a space to express your own feelings at this difficult time. If you are accessing a psychologist privately it is unlikely that multi-disciplinary support would be available. If that is the case you could also consider engaging with your local Child & Adolescent Mental Health Service (CAMHS). With a multi-disciplinary service the individual support to your son can be co-ordinated with the education and support for yourselves as his parents in how best to respond to PTSD. Accessing your local CAMHS service is usually best done through a referral made by your family GP. I wish you luck in accessing support you need and deserve locally.
can you treat dog phobias. both myself and 8 year old daughter suffer from this and it is ruining our lives
Many thanks for your email in relation to phobias about dogs. The quick answer to your query is absolutely, intervention for phobia’s about any particular trigger / issue is possible.
The main type of intervention which research and clinical experience tells us is the most effective for phobias is cognitive behaviour therapy (CBT). The type of approach which would be indicated in this case would be called cognitive re-structuring and in tandem, graded exposure and response prevention. What this all means is that you and your daughter would look at the anxious and phobic type thoughts that you both have in relation to dogs.
I’m going to go out on a limb here and guess that one or both of you have had some kind of traumatic experience with a dog at some point in your lives (being bitten or chased or frightened) and this contributes to both of your fears. Sometimes an event such as this can be so upsetting that something called generalisation can happen. What this means is, say for example we were bitten by a terrier, we would then associate all dogs with that terrier and develop a fear that because one dog bit us that we are at risk of being bitten by all dogs. In order to manage these feelings whenever we would see a dog we would do our best to avoid them. What happens then is that we feel relieved (which instinctively feels better than feeling anxious) and we tell ourselves that “thank god I got away from that dog because if I hadn’t he definitely would have bit me”. The next time we see a dog and we feel anxious we think back to what made us feel better really quickly last time and what did we do to make sure we were safe from attack, we avoided the dog. This instinct is something which is hard wired into humans for thousands of years, you may have heard of something called the “fight or flight response”. What that means is that when we sense danger we get ready to fight or to run away. For some people they can be so fearful of danger that they think is present that they are primed and ready to run away immediately.
What we need to do is to learn to challenge our thoughts, fears and presumptions that build up about the things we fear. For example, with yourself, have you always feared dogs, was there ever a point in your life, even in childhood where you did not fear them and if so why not? Are you both phobic of all breeds and all types of dogs? Do you have a belief system that tells you that all dogs are dangerous and you have to avoid them all? If we think about how could we begin to challenge that thought or assumption using evidence which is all around us, we could look at the example of assistance dogs. If all dogs were inherently dangerous and we have to avoid them, then how come guide and assistance dogs are given to people with visual difficulties or children with autism to help them? Would you think that you need to have the same level of fear about a Jack Russell as you would a Doberman? Once we have begun to recognise and challenge some of the thinking errors that we are making in relation to our phobia’s we can begin to conduct behavioural experiments in order to help us to think differently.
To do this we would have to write down all our fears about dogs and what level of exposure to them we would be able to cope with and then what the worst possible fear would be in relation to contact with a dog. We would start with the least anxiety provoking challenge, perhaps watching a dog from inside our house and learning to cope with the anxiety that this provokes in us and then in very small, gradual steps building up to the most feared event.
While this is something that both you and your daughter can be involved with and can support each other with, for me the most important person in this will be you. If you can demonstrate to your daughter that this is something worth tackling, that although it will be anxiety provoking and difficult at times, it is something worth sticking with.
Children understandably look to their parents to keep them safe and to guide them about what and what isn’t safe in the world. If we are fearful of something then they are likely to follow suit. If we can role model for them how to manage difficult emotions, such as anxiety, and how to positively manage our fears then they are more likely to copy these more positive behaviours also.
What I have outlined above is only a broad outline of what would be involved but I think it is good to be aware in advance of what is involved. Phobia’s of dogs are not unusual, I have met and worked with many people with similar fears and almost all have managed to learn to cope better with their fears. The single biggest common denominator with all of these people is that they were really motivated to try and conquer their fear. If you and your daughter have a similar level of determination it will make your task a lot easier.
There are a number of psychologists who can guide you in more detail about all of the above. The best place to look for a registered psychologist near you would be on:http://www.psychologicalsociety.ie/find-a-psychologist/
I would encourage you to have hope, this phobia can be successfully managed with a combination of professional guidance and motivation on your part. Best of luck to you both with it.