Category Archives: Mental health

Control, influence or concern—understanding these circles could transform your life!

In some ways I feel incredibly fortunate to have gone through some dark times, when I’ve been mentally ill, I’ve had access to therapy that’s taught me, not only how to manage my mental illness, but how to cope with all sorts of nasty things that are thrown at us over time! Don’t get me wrong, I don’t have it all sussed, but I noticed something being passed around on social media, I’d completely forgotten I’d learnt in therapy that people might find helpful in times like these.

woman sitting in front of computer head in hands worrying

Do you find yourself worrying about other people not wearing face masks properly? Or feeling that you’re not doing a good enough job home schooling your children because everyone else appears to have it more together than you? Does it feel like you’re winding yourself up into a frenzy but there isn’t really anything you can really do about it?! This could be because you’re spending energy in the wrong place.

Everything in our lives can be separated into circles depending on how much control, or influence we have over them. Click here to see a visual representation, below is a description of why it helps to do this:

Circle of control

These are the things you have full control over; spending time and energy on these things will have the biggest benefit on your life.

Circle of influence

These are things within your influence, there’s something you can do to have some impact on the outcome but that doesn’t mean the outcome will always be in your favour. You may gain some benefit but don’t spend too much energy on these things.

Circle of concern

Most people find themselves spending time worrying most about these things but is there any point expecting energy when there’s nothing you can do to really have much influence? There’s no harm in feeling concerned that there’s a global pandemic, this is called “being human” but put the concern in the right place—you can wash your hands after you’ve been the supermarket, you can remember to wash your face masks so you have a clean one ready to go out, you can ensure you’re leaving enough space when you’re in the post office queue but you can’t do anything about the R number!

If you find yourself feeling hopeless about everything, as seems to be quite common at the moment, please be reassured that this won’t last forever. Turn your eyes to the small things you are in control of and you’ll feel more empowered. Don’t worry about the bigger picture, that can feel quite daunting.

For each worry you have, think to yourself “how much control do I have?”, if it’s something you have full control over, put it in the centre circle, if you realise you have no control over it, put it in the outside circle and let go of worrying about it. If, however, you realise that you have some influence over it, it’s ok to put it in the middle circle but keep your concern in proportion. Don’t spend too much time worrying about it if there’s not really much you can do about it.

This technique is well known to help people in the general population as well as people struggling with mental illness. However, if you feel your anxiety might be out of proportion to size of the concern, it’s impacting your sleep or it’s preventing you from going about your everyday life, it’s important to seek professional support.

Tablets and capsules

The little known nocebo effect—what harm can it do?!

As someone who’s known long term mental illness, I’m well aware that the brain is an incredibly powerful tool. My mind has taken me to some very dark places but I’ve had to use the one thing that made me ill to recover my health and I’ve learnt that my mind can control my body in extraordinary ways!

Many people will know that to see how effective a medication (or even a vaccine!) is, we need to test it is against a placebo drug, often sugar pills or saline solution in order to see if the “real” drug is more effective than nothing. If the people receiving the dummy pills or solution have a similar positive effect as the drug being tested, there’s some other effect happening. The placebo effect is the patients belief in the treatment.

The nocebo effect, from the Latin “to harm” occurs when the patient’s negative expectations lead to a negative side effect.

male holding arm muscle in pain

Statins are a drug used to control cholesterol levels in people at risk of cardiac disease or stroke. So people may be on them for years. A common side effect can be severe muscle aches or even cramps. This side effects can be so debilitating that it leads to patients needing to take a break from their medication. A trial published in the New England Journal of Medicine showed it didn’t matter whether patients were taking statins or placebo, their experience of side effects was very similar. They experienced the nocebo effect of muscle pain and cramps.

So are the muscle pains and cramps imagined?! Are the patients making the symptoms up?! No, this is not what the trial shows. The trial shows that if side effect is expected, the mind and the body can work together to produce side effects, even if the medication itself doesn’t cause the effect.

Educating statin patients about the nocebo effect can support the patients to remain on the medication. If they discover that the medication itself isn’t causing the pain, they can remain on the life saving statin and manage the pain in a different way.

Known side effects of psychiatric medications include an increase in psychiatric symptoms. A patient who’s already feeling depressed, anxious, struggling with low self esteem or thoughts of self harm could be prescribed a medication designed to help them feel better and a side effect may be suicidality. Educating mental health patients about the nocebo effect could be key to decreasing side effects. Simply being told that suicidality is a side effect may lead to the patient experiencing the side effect. However, if you’re also educated about the idea that expecting the side effect may lead to you experiencing it, could mean that you therefore don’t experience it.

I’m frequently dismayed at how may chemicals I have to put into my body to manage my chronic illnesses but if I didn’t taken so many medications, my body simply wouldn’t function; not only would my mind struggle to interpret the world but my metabolism wouldn’t work, I couldn’t digest food and my joints would seize up! I’m fortunate that I don’t tend to get too many side effects, except when I was trying out some pain medications (check out this blog). But no doctor has ever spoken to me about the nocebo effect when prescribing me any of the many, many medications I’ve been advised to take over the years.

How would you feel if, when you were prescribed some medication, the doctor said “I’m going to prescribe you x, you might feel nauseas on them, however, there’s something called the nocebo effect that means, if you expect to feel nauseas, you’re more likely to feel nauseas”?

Chronic illness is hard enough without all the medications we need to take, along with the side effects, but a little bit of education about the nocebo effect can help us be a little more in control!

How to survive Blue Monday and thrive this year

The 3rd Monday of the year has been found to be “Blue Monday”, the day when people most depressed, uncertain if the future and even hopeless. It may be pseudoscience but I think people are feeling pretty down this year. Some people find themselves in debt after Christmas, struggling towards the next payday, weather in the northern hemisphere is pretty bleak and this year in particularly, the Covid-19 pandemic has been dragging on just a bit!

I just had to respond with a blog about how we can manage this period of the year and learn some coping strategies that will benefit us for the rest of the year!

Person tiring their shoe laces

5 top tips:

  • Move everyday—some form of exercise whether it’s yoga or walk or a HIIT workout, moving your body is awesome for all sorts of reasons. It can be a good distraction, a time to think, or a time for mindfulness. It releases endorphins, the feel good hormone. You can get the whole family involved too!
  • Creativity—whether it’s poetry, pottery or a building a shed, being able to say “I made this” with a sense of accomplishment boosts even the lowest mood. Turning your hand to something new or picking up an old skill taps into a part of the brain that we don’t use everyday. Something we can all do is listen to music, while it’s not building or making anything it taps into an expressive part of the brain and can be incredibly powerful.
  • Writing—it’s been found that even just writing about what you’ve been doing each day can help build memories. For some people, writing can be a way of expressing themselves if they find it difficult to talk about how they’re feeling. If you pick up and pen and don’t know what to write, perhaps start with things you’ve done or things you can see, hear or smell, then try writing some about how you feel, it doesn’t have to make sense initially but you’ll soon get the hang of it!handwriting
  • Talking—this is an incredibly beneficial coping strategy. From talk to your a pet to choosing to take up personal therapy or anything in between. It’s important if you live alone to keep in contact—we’re incredibly fortunate with the range of technology (text, email, various video call options or good old fashioned phone call) these days we just need to use it!
  • Help others—looking after a pet or even a plant can really improve your mood and help your self esteem. Feeling depressed can make all your thoughts turn inward but making yourself look outward can bring a different perspective to your problems. It doesn’t have to be huge but once you start you might feel you want to do more and more!

A few simply dos and don’ts

  • Do express your emotions in a health way—have a good cry if you need to, punch a cushion, scream if it helps, these are all fine. Make sure you can differentiate between healthy and unhealth expressions of emotion.
  • Don’t turn to addictive behaviours—alcohol may be “socially acceptable” and may “feel nice” but it’s just a way of numbing your feelings and it’s ultimately helpful. Equally, turning to food or anything else you know is your usual coping habit is a way of pushing away your feelings. A more healthy way of coping is to find ways of being able to manage your feelings in the moment such as breathing techniques, talking or writing about them or try mindfulness. (It’s fine to have a drink but just ask yourself if you’re drinking to escape stress/feelings etc?)woman holding a glass of wine
  • Do limit time spent reading/watching news about Covid-19—make sure you know the pertinent information but beyond that don’t get sucked into the unhealthy political mud slinging that the media seem to enjoy.
  • Don’t compare your life to other people’s! You don’t see what goes on behind closed doors. Don’t endlessly scroll through social media, limit your time on social media if you can. Remember that what other people post is a highly edited version of their life and doesn’t reflect their reality. Try to only follow people or pages that bring you happiness (hide, mute or unfollow everything else—it really is that simple!).
  • Do remember you’re mental, physical and spiritual health are all linked, if you don’t look after one, the others will suffer. Doing something physical, like going for a walk or having a bath will do just as good for your mental health as it will for your physical health. If you didn’t think you had a faith but this pandemic has got you asking questions like “why would God do such a cruel thing?” perhaps it’s time to find an Alpha or Puzzling Questions course (or similar) and ask these questions. It’s ok to get angry at God, he can take it. Ask someone you know goes to church or contact your local church (or other faith community) online, they’re all doing far more online than they used to!

If you think your low mood is more than feeling a bit blue and these tips are not going to be enough, please seek professional support. It’s important to get support early.