Treatment options for dealing with anxiety and depression

Studies have shown that roughly one in five of us will suffer from anxiety or depression at some point in our lives. There are, of course, many types of anxiety. For some anxiety might involve suffering the symptoms of Generalised Anxiety Disorder (GAD) to full blown panic attacks to obsessive compulsive disorder (OCD). In England, according to the Mental Health Foundation, women are almost twice as likely to be diagnosed with anxiety disorders as men.

Anxiety may be termed as a form of fear which may usually be associated with the thought of a threat or something going wrong in the future. However, it may also arise from something occurring in the present time and in the case of GAD there may not be any particular reason for feeling the fear.

Depression can affect individuals in very different ways and in varying degrees of severity. For some it can involve feeling blue and lacking in motivation whilst for others it can express itself in aggressive behaviour or even in suicidal thoughts. Depression is the predominant mental health problem worldwide, followed by anxiety, schizophrenia and bipolar disorder.

The massive increase in depression diagnosis since the 1950s can’t be put down entirely to a decrease in parenting skills. An increased neuro toxic environment in the modern world could be seen as gradually lowering the quality of brain health. See more on neurogenesis and improving brain health.

A mental health condition could be termed as suffering problems, especially over a period of time, with thinking, behaviour and or mood. See my article on Counselling Directory if you are considering treatment options and wondering about the following questions:

  • Can you eat yourself well?
  • Are antidepressants dangerous or effective?
  • Are mental health problems genetic?
  • What kind of talking therapy will help?

See also the practical tips for maintaining your mental health produced by the Mental Health Foundation.


Men are at greater risk of physical illness from chronic anxiety

ecnpA major research study from the European College of Neuropsychopharmacology (ECNP) and the University of Cambridge reported on its findings earlier this week. The study involved tracking over 16000 Britons over a period of 15 years and found that men who suffered from anxiety were more at risk of dying from cancer as those men who don’t suffer from anxiety. It also found that the correlation held true regardless of other risk factors to cancer such as the levels of alcohol consumption, smoking and the rate of physical activity. There were a few standout points from the study. One of which was that the association was not shared by women.

Why are men more likely to suffer greater physical risk from chronic anxiety?

The results of this new study lend another piece of evidence that links chronic fretfulness to  sickness and death in males. However, the evidence still leave doubts over why this should be. An obvious, and perhaps lazy, explanation might be that men tend to smoke and drink more alcohol and don’t look after themselves as well as women. However, after researchers compensated for those factors, the strong association remained.

There are other studies that could add weight to the recent study to show the greater risk of physical illness from chronic anxiety (thanks to a Times2 article on the subject by John Naish).

A Finnish study in 2014, that tracked middle aged men for over 23 years, found that men who scored highly for anxiety were more vulnerable to the risk of death from all causes, not just from cancer.

A recent University of Edinburgh study found that those with ‘subclinical’ depression or anxiety had a 29 per cent increased risk of dying from heart disease and stroke over a decade than those who did not. ‘Subclinical’ is a term used to define a scenario whereby sufferers thought it unworthy of medical attention. It must be said that Dr Tom Russ, who led the study, is not saying that anxiety actually causes illness. His point is that the results of the study may show an association but the proof for causation might not be present. For instance, it could be that individuals with undiagnosed cancers suffer from pains that cause anxiety, although that doesn’t appear to explain it fully.

men-and-anxietyIt could be that chronic anxiety in men causes physical reactions that ignite the body’s defences, thereby sparking long-term inflammation that in turn may cause a wide range of illnesses such as cancer. For example, psychiatrists at the VU University Medical Center in Amsterdam reported that  men who develop anxiety disorders in adult life show significantly raised levels of inflammatory chemicals in their bloodstream, such as C-reactive protein (CRP), a phenomenon not occurring with women. CRP is not in itself necessarily harmful, as it can play a very useful role in the immune system such as protecting against the threat of infections, but can be dangerous if they persist at chronic levels. In particular, they are linked to a raised risk of developing cancers, heart disease and even diabetes. The production of CRP can also occur from sleep disturbance associated with anxiety.

Furthermore, psychiatrists at the Emory University School of Medicine reported that chronically raised levels of inflammatory chemicals can cause the brain’s centres, that initiate our fight-or-flight response, to become overactive (an area of our brain called the hypothalamus).

gut-fear“Gut fear”, that wrenching physical symptom of anxiety when your body is telling you to watch out because there is danger ahead, seems to have a physical affect on the brain. Evidence points to how inflamed stomachs damage our mental states, through neurological links such as the vagus nerve, which links our gut and brain, and by changing the balance of the billions of bacteria that thrive in our guts. For a full explanation on the physical symptoms of anxiety see the Anxiety UK website.

Scientists at the University of Exeter found that when people with depression, a common result of chronic anxiety, were given drugs to block the effect of their bodies’ inflammatory chemicals, their symptoms were mildly alleviated.

Such evidence clearly demonstrates the need for men to take seriously the deadly impact of anxiety.  Therapy can be a lifesaver for men but they invariably only attend when things are at a crisis point in their lives. We all need to address why men find it so difficult to reach out for support and there are no easy answers.

For more information on what works for the treatment of anxiety see my most recent article on Manxiety: The Importance of Men addressing their anxiety.

See also:

The acute mental health needs of men
Engage with the power of imagination to ease anxiety
Help your brain to reduce anxiety
Self discipline exercises that will ease your anxiety
Anxiety UK – for information on symptoms


Digital detox from smartphone addiction

ofcom-logoThe latest Ofcom research into internet usage informs us that fifteen million UK internet users have taken steps to ‘digitally detox’ in an attempt to establish a more healthy balance between technology and ‘real life’. The Communications Market 2016 (August) is Ofcom’s thirteenth annual Communications Market report.  The key findings from the latest report found that roughly one in three of adult internet users has specifically sought a period of time offline. For those unfamiliar with Ofcom, they are the communications regulator in the UK (similar to the Federal Communications Commision in the USA).

Noel Bell ITV Good Morning BritainITV’s Good Morning Britain featured the story in their edition yesterday and invited me onto the show to talk about addiction to smartphones and digital detox. They also invited a family who had undertaken an experiment of having dinner but only communicating by messaging around the dinner table as an attempt to understand how we miss out on social cues by engaging exclusively by electronic means.

I am often asked what constitutes addiction.  For me, addiction is a serious bad habit, can be highly condensed, reinforced and consolidated across many neural networks. Fear is a huge factor in all addictions and every addiction has a stress factor. Addiction can be present when you are doing something repeatedly and negative effects start to occur in other areas of your life. You find it very difficult to cut down the activity when you seek to regulate the behaviour. But according to the medical view, Gambling disorder is the only behavioural (non-substance related) addiction, as it’s the only one included in the Diagnostic Statistical Manual (DSM), currently in its 5th iteration.  DSM is how psychiatrists diagnose ‘mental disorders’. As an aside, pathological gambling had long been considered by the American Psychiatric Association to be an ‘impulse control disorder’, rather than an addiction. Internet gaming disorder (psychiatrists just love to pathologize with words like disorder, don’t they?) is, however, listed in section 3 of DSM-5 as “conditions for further study”. So, presumably there may be room for smartphone addiction in future iterations of the Manual.

How do you know if you have a problem with mobile devices?

Here are a few general questions you could explore about your relationship with your smartphone:

  • Do you use your smartphone more than you are comfortable with?
  • Do you panic when there is no cell coverage or wifi connection?
  • Do you neglect social interaction with friends and family by spending excessive amounts of time on your device?
  • Do you use your smartphone to gamble and spend more time (and money) than you had planned?
  • Do you sext with strangers and regret it afterwards?
  • Have you been the victim of revenge porn?
  • Do you compulsively use adult chat rooms, even when you don’t want to?
  • Do you start to feel lonely or depressed as a result of excessive engagement with social media?
  • Do you bring your phone to bed?
  • Do you feel increasingly stressed from feeling the need to answer work emails beyond the contracted work hours?
  • Is your sleep disturbed from excessive smartphone usage?
  • Do you spend excessive time on dating apps?
  • Do you lose interest in having sex with your partner?

You may have a problem if you are finding it more difficult to concentrate on daily tasks at home or at work, if you are concealing the amount of time spent on mobile devices, if you have a fear of missing out (FoMo) and have a sense of dread or panic if you leave your phone at home. Common withdrawal symptoms from smartphone addiction are anger/irritability, restlessness, sleep problems, difficulty concentrating and craving access to your device.

Treatment options

We all need to use online services from statutory services so a complete abstinence based approach is problematical. Indeed we need to be online to progress in careers and to connect with people. However, we can take steps to reduce our reliance on our devices. We can try to set goals for device-free times. We can set our phones to airplane mode during the day and especially at night. We can try to avoid reading work emails beyond certain times,as well as turning devices off two hours before sleep so we comply with sleep hygiene requirements.

If you think you have a problem, you could also consider not bringing mobile devices to bed and removing social media apps from phones. Maybe you could try to refrain from the constant checking of social media updates. See how you cope. If you begin to feel empty, moody and depressed as a result of putting in boundaries you could be experiencing a form of withdrawal.

Considering doing these steps might tell you all you need to know. How does it feel to potentially implement some of these suggestions? Does it seem reasonable or do these suggestions fill you with dread?

Seeing a therapist can be useful to motivate you to set boundaries with your mobile device usage and to address problem behaviour. You could explore what is behind your intense need to feel connected and learn to cope better with everyday anxiety. Therapy could be a means of building your coping skills to better help you to deal with boredom, rejections, loneliness and worry. There can, of course, be underlying issues with depression which might be worth exploring so it may be appropriate to go and see your GP too.


Engaging with the power of imagination

creative imaginationOur  ability to engage with imagination is what distinguishes us from all other species. But it is something we have rarely been taught how to work with. Our ability to compute and to analyse (the typical left side of the brain functions) have been well developed in our education systems, but not our capacity for imagination.

If we think of this in terms of the elements, then air, and perhaps fire, have traditionally been the dominant elements in our socialisation. Air encompasses intellect, computing and analysis whilst fire brings confidence and risk-taking. These are all great qualities and have served us well in creating everything that surrounds us. The trouble may come when we are not balanced as individuals. The ability to have grounding experiences (earth) and to process our feelings and emotions (water) have largely been left to extra curricular activities. Meditation and yoga practice are now everywhere, admittedly, even in primary schools, but there is still a long way to go before we can begin to see a more holistic approach to teaching and learning in the education sector.

Here is an exercise on trying to engage with the active imagination. A preamble for working this way would involve taking some mindful steps in becoming receptive by undertaking some deep breathing exercises. The following questions could act as a guide:

1. What are your current main stressors?

2. How does this affect your body?

3. It is like ……?

4. Is there a memory where you felt like this before?

5. If this symptom was a friend what might it say about your life?

(This exercise might not, however, be suitable for people who might be experiencing psychotic symptoms).

Seeking to engage with an exercise like this can help to produce images and symbols which can help bypass mental defences, when the thinking function is dominant. So often we can feel stuck in our minds, whether it is worrying about things that haven’t happened, or tiring ourselves out by searching online for more and more explanations to questions that are hard to answer.

For more on this topic see my latest article on Engaging with the power of imagination to help ease anxiety.


Staying healthy with a demanding workload

workload management

Are you worried about your ability to cope with a demanding workload?  Do you believe that you are suffering symptoms of anxiety as a result of your ability to cope with deadlines and organisational objectives? Do you feel in need of support to devise a self care plan to maintain a healthy emotional state?  If these questions are resonating with you then take a look at my latest article on work-related stress and staying healthy with a demanding workload.

You may also benefit from reading an article on blanking which I contributed to and which appeared in the April edition of GQ magazine.  Follow this link to the GQ Article on Blanking here.


Social media and the age of loneliness

By Brian Solis and JESS3 -, CC BY 2.5,We are living through an era of massive social change as technology continues to advance and we struggle to adjust ourselves with the pace of change. The so-called information age, or digital age, was supposed to make us all feel more connected. However, more and more of us are feeling lonelier and lonelier. The writer George Monbiot has written about the age of loneliness and observes that it is loneliness as a social change that clearly marks out our time from other mayor changes that preceded it. The difficulty in assessing where we are with the technological change is that we lack perspective, such is the rate of change.  This has been the case in other periods of huge change, such as the agricultural and industrial revolutions. It was only in hindsight that social commentators could properly assess the impact of what was really happening in the way individuals lived their lives and the actual implications of change.

Change invariably raises our anxiety levels.  As humans we generally like to stick to routine and what is familiar. Learning to adapt to change can be beneficial for the maintenance of our emotional well-being.

One huge change occurring in our present time is how we find mates and sexual gratification. The immediacy for hookups offered by social media and mobile dating apps is a game changer in terms of how we interact with each other. The casualty of all this stimulation, freely available on mobile apps,  may be emotional intimacy. We may be more connected electronically than we have ever been but we are more disconnected emotionally.

See my latest articles:

Overcome your anxiety browsing social media  

Lust, attraction and attachment with dating apps


Knowing your cognitive distortions to help with anxiety

It can be useful to bring awareness to your cognitive distortions especially in helping to cope with feelings of anxiety and depression. Cognitive Behavioural Therapy (CBT) can be very useful as a targeted approach to achieve balanced thinking.

CBT is flavour of the month in the NHS, and consequently can be downplayed by some within the psychotherapy profession, but I believe that it contains extremely useful tools and techniques for changing unhelpful thinking and behaviour. We owe a lot to Albert Ellis and Aaron Beck for helping us provide solutions to cognitive, emotional, and behavioral disturbances. See my article on identifying your cognitive distortions to help transform your relationships and better cope with anxiety and depression.



Defining your dealbreakers in relationships

Relationship counselling LondonThe Personality and Social Psychology Bulletin has published some interesting findings from six separate research studies about what makes us chose one person rather than another. The findings indicate that in practice individuals give greater importance to someone’s negative features (dealbreakers) than on their positive qualities (dealmakers). See my recent articles on defining your relationship dealbreaker and maintaining an equal balance in your relationship.

See also

Embracing your heart space to overcome fear and anxiety


Self-discipline exercises for the management of anxiety

anxiety managementDo you suffer from anxiety, feeling overwhelmed or ill at ease?

Read my article on useful exercises for the management of anxiety which will help you to feel better and increase your energy flows.  There are many benefits to improving your self-discipline such as greater energy levels and personal productivity. You will also have more personal power as well as higher levels of self-esteem as a result of practicing these exercises. The important thing to remember is to persist and to work hard in doing these exercises.  Self discipline is a habit so always try to avoid the easy option.

The benefits of working with a therapist are that you can be helped to unlock your automatic negative belief system, which can say things like “I can’t do this” or “it won’t work for me”.  Overcoming your negative belief system can help to transform your way of being. Working with a therapist can also provide motivation when you feel like wanting to quit the healthy choices and can be someone you share your worries with.

* Noel Bell is a fully qualified counsellor/psychotherapist registered with Counselling Directory who see clients in Paddington, London Bridge or Sydenham.



Anxiety and how to deal with it

Anxiety symptomsDo not suffer in silence if you are feeling anxious.  Anxiety can be a really normal response to something challenging  – we’ve all been there. Often, it’s just a sign that you’re standing on the edge of your comfort zone and about to do something really brave. Sometimes though, it can be more than that.

The most important thing to do if you suffer from anxiety is to reach out and seek help.  Whether you have experienced mild anxiety for 10 minutes or 10 years the crucial thing to know is that it is treatable and that your mood can improve.  Anxiety is a universal experience that has probably affected all of us at some point in time in our lives and in different conditions, albeit to a varying degree.

Anxiety only becomes a problem if the feeling of anxiety is more intense than you are used to or can tolerate.

The common physical symptoms of anxiety are: sweating, heart pounding, muscle pain, headache and tension.  The emotional symptoms can include: a feeling of impending doom,  feeling as though  you are losing control and feeling like you are about to do something out of the ordinary.

Do not suffer in silence if you need help and feel like you cannot cope – anxiety is very manageable. There are so many people who struggle with anxiety, so you certainly aren’t alone.

Anxiety feels awful. It can feel like you’re dying or losing your mind – you’re not, but it can definitely feel like this, which can make the symptoms worse. For this reason, one of the keys to managing anxiety lies in understanding where it comes from.

When the brain senses threat, it surges your body with oxygen, hormones and adrenaline to give your body the physical resources to keep you safe, either by fighting for your life or running for it. Here’s how that works:

  • breathing changes from slow and deep to fast and shallow to get oxygen into your body (this is why you might feel short of breath);
  • heart rate increases to get the oxygen around your body (if the oxygen isn’t spent by fight or flight, carbon dioxide drops which can cause dizziness or the feeling that you’re having a heart attack);
  • blood pressure increases to get blood to the large muscle groups – arms to fight or legs to flee (which is why your muscles might feel tight or trembly);
  • your body sweats to stop from overheating (you might feel clammy);
  • digestion shuts down to conserve energy (this is why you might get butterflies, a dry mouth or feel sick.)

As you can see, the symptoms of anxiety are a completely normal physiological response. The response is instinctive and automatic and will be triggered before you’re even aware that there’s anything to be worried about.  When the threat is real, this response is perfect, giving us strength, speed and power to get ourselves out of trouble. The brain can’t always tell the difference between a threat to physical safety and one that might be more psychologically harmful (such as shame, humiliation, embarrassment or rejection) so it surges the body with oxygen, hormones and adrenaline anyway.

Anxiety about anxiety

Here’s the problem though. Sometimes the brain’s threat radar is super-sensitive and a little over-reactive and will be triggered even when there’s no real threat. This is when anxiety can cause trouble. When there’s no need for a physical response (no reason to fight or flee), the oxygen, hormones and adrenaline build up and carbon dioxide drops. This increases the physical symptoms, which is why anxiety feels the way it does. Eventually, this can lead to ‘anxiety about anxiety’, when the trigger for an anxiety attack becomes the anticipation of the anxious feeling itself.

How to manage your anxiety

There are many ways to manage anxiety that don’t involve medication. In more severe cases, it might be warranted. Your first port of call should be your GP or a counsellor who can advise you of your options.  Your GP can advise about psychotherapy, although psychological treatment on the NHS will be time limited.  Combination treatment (drug and psychological treatment) is often recommended by clinicians for those feeling most at distress, and at most risk of relapse. Once the psychological work has been done, medication can often be tapered down, although this needs to be done under close supervision as stopping the tablets could trigger relapse.

Your self-care regime should include exercise as part of good general health as well as adhering to sound nutritional advice.  You could explore joining support groups for anxiety as well as learning to practice meditation and ensuring that you get a sound night’s sleep. The most crucial thing is that it is recognised in the first place for what it is and help is sought. Do not suffer in silence as isolation and secretiveness may only intensify your feelings of anxiety.

Read about Generalised Anxiety Disorder (GAD)

To see Noel Bell for counselling and psychotherapy in London call 07852 407140 or email