1. Pace yourself: Plan what you need to do and be realistic about what is achievable. You may want to do different rooms / tasks on different days so you are not doing everything at once and getting exhausted. Break down your housework into smaller tasks and pace yourself throughout the day. Avoid overexertion by taking frequent breaks and alternating between different types of activities – can you manage some tasks whilst sitting (maybe dusting some ornaments or tidying a drawer, or even ironing with the board at sitting height). Listen to your body and rest when you need to, to prevent exacerbating your pain. Muscles can often benefit from just 5 minutes of rest, so doing a mix of some standing, some sitting and some walking activities can help to preserve your energy.
2. Modify your movements: Consider adapting your movements and using ergonomic tools or assistive devices to minimize strain on your body. For example, use long-handled tools for cleaning or “reachers” to pick up objects from the floor without bending over. Cordless vacuum cleaners are often much lighter than corded, upright ones. Ask people to help with chores, particularly if they live with you or offer to come in and help! There are no medals for doing chores all on your own. Find techniques that reduce the impact on your joints or muscles and make tasks more manageable. Be mindful of the cleaning products you are using. Some strongly scented ones can give people headaches which adds to pain. Try to find products that you know will suit you.
3. Use proper body mechanics: Pay attention to your posture and your movements while performing housework. Lift objects properly by bending your knees and using your leg muscles rather than straining your back. Avoid repetitive movements that can aggravate your pain and try to maintain a neutral spine position whenever possible.
4. Prioritize and delegate tasks: Identify the most important tasks and focus on those while letting go of non-essential chores. Delegate tasks to family members or consider hiring help if possible. Remember that it’s okay to ask for assistance when needed, as managing chronic pain requires prioritizing self-care and reducing stress on your body.
5. Apply self-care techniques: Incorporate self-care techniques into your routine to manage pain and promote relaxation. This may include applying heat or cold compresses to painful areas, practicing deep breathing exercises, using relaxation techniques like meditation or guided imagery, or engaging in gentle stretching exercises to improve flexibility and reduce muscle tension. Also, make housework fun! Sometimes putting your favourite music on and dancing whilst cleaning the kitchen or washing up etc can get your endorphins, or pleasure hormones flowing, and these are the body’s natural pain killers. Have something nice to treat yourself to when the chores are over and enjoy your achievements. Don’t worry if something is not perfect, or if someone does not do it quite the way you would. Use the good-enough rule and ask yourself if it looks a bit cleaner / tidier / fresher than it did yesterday. If it does, it’s good enough!

Remember, it’s essential to consult with your healthcare provider or a pain specialist for personalized advice and guidance on managing chronic pain effectively while performing household tasks.

 

Dr Sue Webb
Clinical Psychologist
May 2023

It’s Not All In Your Head: I Had A Panic Attack But I Thought I Was Dying!

 

Have you ever had a panic attack? 5% of the UK population can suffer from regular panic attacks, and these are very physical and emotional experiences. Sometimes there can be a long build up to it, with stress and tension happening for days or weeks beforehand, but often it can feel like it comes out of nowhere, and is a big shock to the system.

Many of my patients have suffered from a series of panic attacks or had one which has been so big, they felt they were having a heart attack and may have ended up in A&E in hospital. Whatever the reason for the attack, most people come for help because they are very frightened about losing control and causing it to happen again. These feelings are completely understandable, and anyone who has experienced one will know how terrifying and overwhelming it can be. But as with a lot of psychological reactions, knowing what is happening to you is half the battle to conquering it, and not feeling frightened about it goes a hugely long way to controlling it.

The symptoms of a panic attack are very physical and include some or all of these:

• Difficulty breathing
• Palpitations
• Dizziness
• Nausea
• Chest pains
• Sweating
• Visual disturbance
• Feeling “unreal” or dissociated
• Shaking

What causes panic attacks?

A panic attack is an exaggeration of the body’s normal startle reaction to a dangerous or fearful situation. If you are driving and a dog runs out in front of you, your adrenaline would help you to break quickly. You would also experience some of the above symptoms, with pounding heart, sweaty hands, very tense muscles and breathing very fast. However, once the danger is over, your body would calm down and you may thank your lucky stars that no one was hurt and you can carry on with your day. This was a natural, and helpful reaction.

But what if that reaction happened when you were just going around the supermarket, doing your weekly shop? Or sitting in the cinema waiting for a film to start, or even thinking about leaving the house and having a panic attack? It is likely that you will try to make sense of the situation, and jump to conclusions about why it has happened. You are also likely to avoid the situation that apparently caused the fear to try and stop it happening again.

This results in your fear reaction becoming hyper-sensitive and being easily triggered by events which remind you of the awful feelings. So, you stop going to the supermarket, or to the cinema, or even going out of the house.

When you worry about something it can be hard to distract yourself and it can become very persistent. One worry can lead to another and so on, and lots of negative thoughts will cause your mood to be low, to feel more tired, and that can affect your coping resources and make you more susceptible to anxiety. Anxiety and fear can also be made worse by substances like alcohol, nicotine, caffeine or hunger.

Is Panic Dangerous?

No, no one can die of a panic attack. The feelings may be horrible but they are actually a normal reaction (which would usually keep you safe from harm), but which have been unfortunately triggered by a normal situation. You are not having a heart attack, or going mad, or going to faint. You need low blood pressure to faint, and a panic attack with raise your blood pressure, not lower it, due to increased heart rate.

Five Tips For Coping With A Panic Attack:

1. Remind yourself that panicky feelings are normal reactions, just in the wrong place – they won’t hurt you.
2. Take some slow deep breaths, in through your nose and out through your mouth. Tell yourself that you are safe and nothing bad is happening.
3. Rate your anxiety between 0-10, where 10 is extremely high, and monitor your level over a few minutes. It should start to come down as you start to slow your body down.
4. Notice which muscles are tense and stretch them out to help them relax. Pull your shoulders down, unclench your hands, if your mouth is dry sip some water.
5. Stay with the situation. Try not to get away from it or avoid it. Once your brain understands there is nothing dangerous going on it will calm down and be much better next time.

 

Dr Sue Webb

Chartered Clinical Psychologist

August 2022

Have you ever suffered from a physical illness, which has had lots of physical symptoms, had treatment to clear it up, but still not felt “quite right”? Many illnesses can leave us feeling very tired afterwards, and very nervous about certain symptoms persisting or returning. This isn’t unusual but it can be incredibly frustrating and debilitating. For many years I have had bouts of cystitis which follow exactly that pattern. I experience the heartsink feeling of trying to tell myself I don’t need the toilet at 2am whilst knowing that I am going to need anti biotics to clear it up as soon as possible. Fortunately, the treatment usually works, and I gradually feel more comfortable. But the feeling of needing the toilet or the fear of being out and being “caught short” can persist for many days after the doctor has told me that the infection has gone. It hangs around and will make me feel very anxious, tense and worried that I am still ill.

With longer illnesses this pattern of experiencing symptoms once the main cause has been successfully treated can greatly interfere with someone’s ability to get on with life again.

Vertigo is a good example of this. Labyrinthitis is an infection in the inner ear which causes balance problems for the sufferer and can produce constant feelings of dizziness, nausea and vomiting for weeks. These symptoms can understandably make someone quite incapacitated. However, many people find that once the infection has been treated, they still experience dizziness, brain fog, nausea and other physical symptoms. It can cause anxiety about going back to work, driving, being in public places and other worries. In fact, these experiences become a form of health anxiety and are much more fuelled by psychological responses rather than infection-related biological responses.

This happens because our minds start generalising the symptoms. If they have been unpleasant whilst we have been ill, we get tuned in to look for them – trying to check if they are still there. We become hypervigilant, and can even “test” ourselves a lot: “Do I still need the toilet? Am I sure about that?” “Can I walk in a straight line without falling over or is my balance still bad? If I swivel my head quickly will I feel sick?”

We inadvertently keep checking ourselves and generally, the more you look for a sensation, the more likely you are to feel it. Panic attacks can develop from these behaviours and people start avoiding everyday things which would  provide distraction, so a vicious circle of hypervigilance, sensation and avoidance happens.

To help calm these feelings down, try to focus on regulating your breathing and notice what happens to symptoms when you are relaxed and breathing properly. Look for times when the symptoms ARE NOT around rather than when they are. If you are watching a good programme, enjoying time with a good friend, engrossed in a project or concentrating on work, are the symptoms still there, or do they calm down and go away? If they go away when you focus on something else, or are distracted, it’s a sign that the physical symptoms you get are more psychological, because your brain has got sensitised to look for them. All of these tips should gradually help your mind to understand that you have control over your body again. The symptoms should calm down and go away, leaving you to get on with your day again.

If it is hard to get over it on your own, cognitive behaviour therapy can be very helpful to tackle this problem – please don’t feel you have to “just put up with it”. There is help out there for this type of problem so do talk to someone about it.

Dr Sue Webb
Chartered Clinical Psychologist
January 2023

How Well do You Tolerate Uncertainty? Well? Or Maybe Not Quite As Easily As You Had Perhaps Hoped!

 

Being able to tolerate uncertainty is a well -known concept in psychology circles. It has been widely written about by very eminent Clinical Psychologists such as Michel Dugas and Paul Salkovskis, in relation to anxiety disorders and Obsessive Compulsive Disorder (OCD) in particular, and it helps us to understand why OCD can be such a difficult disorder for sufferers to deal with.

Imagine a typical scenario which most of us experience at some time in our daily lives, where you are going out for the day and your home will be empty for that time. Before you leave, you may do a general check of windows and doors being shut, turning lights off and check that cooker switches are off. You lock the front door, get in the car, and half way down the road, you suddenly wonder if you locked the door properly. This might be the time that even though it was minutes ago, you can’t quite remember if you did it thoroughly or not. This sets up a mental dilemma. Do you turn around and go back home to check, in which case you will be late, or do you carry on and hope that you did lock it. Except that your brain will probably be telling you by now that if you hadn’t locked it and you get burgled because you were irresponsible, then it would be all your fault. The insurance wouldn’t pay up and your family would be devastated at losing all their precious possessions.

This uncertainty has to be weighed up and dealt with pretty quickly. For many people without OCD, they are able to have the thoughts and over- ride them, perhaps telling themselves “I probably did lock it, I’ve just forgotten. Even if I didn’t lock it, I live in a quiet road, it will be ok. I need to get to work or I’ll be late”. You are able to continue your journey and the chances are, with all the other distractions around, the feeling of panic fades, and if you do still think about it when you reach your destination, you can then picture the memory of you having locked the door. You have “tolerated” the feeling of uncertainty and dealt with it.

People who are vulnerable to OCD and other anxiety disorders are not so lucky, and they experience huge problems dismissing uncertainty. In more recent years, research has found that the messages of doubt which we can all experience seem to have a super- efficient highway to the “fight or flight” mechanism for people with OCD. This means that their bodies go on hyper- alert, adrenaline is pumping, and the uncertainty becomes overwhelming and impossible to ignore, particularly if it is linked to something that they feel is their responsibility. This unfortunately means that they are likely to HAVE to go back and check the front door as the only way to seek immediate reassurance.

Learning to tolerate uncertainty can be useful for all of us, regardless of whether we have OCD or other anxiety disorders. Learning relaxation techniques can be very helpful for calming down our negative thoughts and our stress alerts. There are also many other Cognitive Behaviour Therapy techniques which help to deal with these problems. There are 3 different relaxation videos to try on my website: . These are a good first step to developing good coping strategies for the time when you catch yourself thinking “Oh no, what if I have forgotten to …..”

Dr Sue Webb

Chartered Clinical psychologist

August 2022

 

 

It’s Not All In Your Head!

Why my exercise can be a pain, but it is so good for my anxiety

 

This Summer has been a bit different for me. I know, a bit of a strange thing to say since the last 2 years have been incredibly different for all of us. But usually, I would think about booking a Summer holiday for the family and we would all have a week or two away in July or August, depending on who is on holiday from university / what Summer job they have / and what my friends and my mum are doing.

This year, everyone seemed to be doing something different. My son is in a new job, my daughter was travelling, my other son and his fiancée are madly saving for their wedding next year, my mum is beginning to find her feet after we lost my dad nearly 2 years ago and is starting to have some short breaks with friends. Even my partner has been busy dealing with various life events, helping his kids with stuff and fitting in work trips in between.

So, I felt this would be a good time for me to focus on my business. Since Covid, my business like many others, has been much more online. It’s been an exciting time over the last 18 months, recording my online video courses for managing chronic pain and my mini course for overcoming insomnia. Also writing books and developing workbook diaries to go with the courses and making relaxation videos and other resources to help people. This has all been a massive learning curve for me, and in between of course, I now run my CBT psychology clinics face to face, through Zoom, Skype and WhatsApp, and all of the other mediums we never dreamed we would be using to help people deal their problems before 2 years ago.

What I had not factored in, was how difficult it can be to deal with all the stress without having a proper break every now and again. If I am at home, I end up doing other chores, instead of taking time out to do even simple things like sit on my swing seat for half and hour and read my book. And of course, the less time I allow myself to switch off, the more I notice feeling worried about people and work and unable to keep things in perspective.

However, what I do have is a routine which I feel helps to keep me on track with my mental health and I am very grateful for it. At the beginning of the week, I do a dance class, first thing in the morning. Often, I wake up and think – “yes, but I have so much to do, maybe it’s better to do that instead”. Fortunately, I go on automatic, and once I am in the class and concentrating on the steps, I can feel myself unwind, my head starts to clear, and my decisions about plans for the week seem much easier to make once I am physically relaxed. Mix this together with some lovely friends in the class, whom I love having a coffee with afterwards, and I have a great start to my week.

Similarly, at the end of the week I try to get to a yoga class. This is good for me as I use it as my “yay, the weekend starts here” time. In order to do the class, I am often rushing to get finished from work, and battling through the traffic, thinking “why am I even trying to do this? This is not relaxing!”. But, once I’m there, in a calm atmosphere, where I have to listen and concentrate, I can feel my body unwinding and I am so glad I made the effort.

I find it so helpful for my mental health to try and do this type of “time out” each week. It definitely slows my worrying down and gives me some time to think “ok, what do I really want to do about “A”, “B” or “C” problem” in a much more constructive way. I am also better able to look around me and notice the lovely things that are out there, and just noticing nature or some lovely scenery, which can be so important when I am spending a lot of time helping people to deal with a lot of pain and challenges. I feel very grateful to be able to do my classes regularly, but when you are looking after yourself it doesn’t need to be anything difficult when it comes to exercise. A gentle walk around the park, or visiting a favourite place you love with a friend can be just as therapeutic and beneficial. And actually, although routine may sound boring, doing it at a regular time, on automatic so you don’t argue with yourself, can be the best way to boost your mood and clear your head from worry for a while. Enjoy.

 

Dr Sue Webb

Clinical Psychologist

August 2022

 

 

Obsessive Compulsive Disorder (OCD) is an anxiety disorder which can be incredibly disabling for the sufferer, and cause lots of anxiety and heartache for the loved ones around them. It is a very misunderstood problem, and in every day tasks, people will often tell their friends “Oh, I’m being a bit OCD today, I keep checking my door”, or “I’m being very OCD as I can’t get that song out of my head”.

The reality of OCD for someone who has it is a very different picture. The disorder involves focussing on a particular worry or set of worries, the “Obsession” to the exclusion of everything else in their life. The “Compulsion” bit of OCD is a particular behaviour which a person carries out in order to try and calm down the worry and doubt, that is happening for them.

For example, Jane worried that a fire may break out in her house, and that if she was not careful, she may leave a switch on, or a device which may ignite when she was out. This caused her to have a very detailed routine of checking all of the sockets, the tv remotes, the PC, the light switches, the cooker and oven, the hairdryer and curling tongs and many more things, each day, before leaving for work. But because she needed to be sure it was all safe, and she could not always remember accurately because she was anxious, she had to check it all 3 times in a special order. This meant that she had to allocate an hour to checking before going to work every day, in order to get out of the door. This made her late for work every day, which made her anxiety worse.

There are different types of OCD. Jane has a classic type of OCD, but there are also ones called “Pure O”, where the obsession and compulsion appears to be completely in the mind. These are usually around beliefs about being a “bad” person – believing that you may want to hurt your family, due to intrusive thoughts about stabbing someone. So, every time you see a knife in the kitchen it triggers a terrifying thought. Or people who worry that they are sexually deviant, or they have a belief that if they think about the devil then they will go to Hell. When they cannot control these “awful” thoughts, they condemn themselves for thinking about them and feel even more focussed and terrified of them. After all, if someone tells you: “Do not think about a pink elephant in a blue field”, What do you think about?

OCD can be a very severe anxiety disorder, which is maintained by a person’s over-inflated sense of responsibility (eg “I have to keep my family safe by making sure I don’t poison them with my cooking, therefore I have to check everything I use, cook and clean 10 times to keep them safe, including washing my hands multiple times).

Research has shown that people with OCD find it much harder to override concerns about threat than others, so it gets exacerbated more than usual. If your brain is sending you a warning signal and going on “alert” mode constantly, this gets very hard to ignore. We also know that people with OCD find uncertainty really hard to cope with – if your hands are not scrupulously clean when you are cooking, how do you know that you won’t infect your child with something which can cause illness later on in their life?

The good news is that there is good treatment out there to help overcome OCD. For many sufferers, they find it hard to ask for help because they believe that their thoughts are so terrible, they never talk to anyone about their concerns. This unfortunately means that people can go for years without the proper help to control and overcome their fears.

Cognitive behavioural therapy for OCD is an evidence- based treatment which works. I have worked with many people who have suffered from both types of OCD and it is wonderful to see them reclaiming their lives again. Therapy is available from NHS IAPT services and private therapists, so don’t suffer in silence. There is good help out there, you just need to be brave enough to reach out and ask.

I have put a link below to a Youtube video in which Katie D’Ath gives a useful introduction for people who want to know more about overcoming OCD. Katie D’Ath is an experienced Clinical Psychologist who is also an expert in OCD.

19.OCD Treatment: How to stop your thoughts: Part 2 – YouTube

Dr Sue Webb

Clinical Psychologist

July 2022

suewebbpsychology@gmail.com

Insomnia can be one of the most difficult problems for human beings to deal with. We all need sleep on a regular basis in order to switch off from the day, process the information we have grappled with during the day, and for the body to have a chance to repair itself. But sleep is often a balancing act, and there are lots of other factors that can interfere with it. Emotional state can have a huge impact, whether we are feeling very down or anxious, and unable to stop worrying, or feeling lonely and agitated. Then there are physical problems, such as being in pain or feeling unwell, in which case there is the physical discomfort as well as the worry about why we are not well.

Environmental factors play a huge part, as any new parent will know, when a crying baby or fretful toddler can keep you up for hours, or noise (particularly someone snoring loudly next to you – just to add insult to injury!), or light. There are many different distractions in the modern world that interfere with the running of the circadian clock.

It is worth noting that there are also many individual differences, and some people need more sleep than others, but generally 6-8 hours a night is considered the norm for adults. The main aim of sleep is to be able to drop off to sleep fairly easily, to complete the sleep cycle and to wake up feeling refreshed and able to have some energy to face the day, at least once you are up anyway! Someone may have a block of 5 or 6 hours of sleep, but actually feel able to function well, whilst someone else may have 7 hours of broken sleep and feel like a zombie the next day.

So how can you improve your quality and quantity of sleep if you are going through a bad time with it? Fortunately, there are lots of things you can do, before resorting to sleeping tablets. Just for information, sleeping tablets need to be carefully monitored and controlled by your doctor, as they can be addictive and unfortunately become less effective over time, as the body gets used to them, so these should only be taken under medical supervision.
Below are seven tips to help improve your sleep. These are NOT quick fixes, as it takes time for your body to adjust to a new routine, but long term they work very well for overcoming insomnia.

• • Adults are like children when it comes to sleep – we respond best to the same routine night after night, as our brains pick up on cues that it is time to slow down and prepare for sleep. If you cannot go to bed at the same time each night, try to go through the same steps in your routine anyway, and this should help.
  • Have a warm shower or bath about an hour before you want to go to sleep. Body temperature rises with the warm water, and drops when you get out, and the drop in temperature helps your body to slow down.
  • Eat regularly through the day. Eating and sleeping are very closely linked so if you are hungry you will not sleep very well! Equally, don’t have a heavy meal within about 3 hours of going to bed, as your body will still be busy digesting food. Milk and bananas have an enzyme in them that makes you sleepy, so a hot chocolate or milky bedtime drink can be comforting and helpful.
  • Keep your bed for sleep and sex! If you work in your bed, watch TV, scroll through social media and other activities, your brain won’t compute that it is time to unwind and get dozy. It will gear itself up for entertainment or concentrating on work tasks, and the light from mobile phones and tablets contribute to your brain staying awake.
  • Make your bedroom a place that is calm and relaxing, dark, not too hot or cold, and somewhere you like to be.
  • If you cannot drop off after 30 minutes try getting up, going to another room, and doing something quiet but distracting. Jigsaw puzzles are good, or word searches, reading or listening to a relaxation exercise. If you are worrying, write the worries down on paper and put it in a drawer, this helps to get the thoughts out of your head and let them go. Then try going back to bed after 15-20 minutes.
  • Get up at the same time each morning, regardless of how well you have slept during the night and try not to nap during the day. This can be really hard for a few days but it helps your body clock to re-set and get a block of sleep at night.

Recently a friend and I went to see the first show we have seen at the theatre for months – “Menopause the Musical 2”. It was a fast-paced, very entertaining show with 4 comedians, all ladies of a “certain age”, talking about their experiences of the menopause. Of course, the audience was largely comprised of women who were also 40 somethings plus who were, or who had experienced, the same stage of life and challenges as the characters in the show. It was a wonderful evening – the comedy was sharp, witty and poignant, and as a member of the audience, it was great to feel that everyone recognised and empathised with the topics which were being sung and talked about.

One of the things that struck me afterwards was how much content the writers had managed to cram into 2 hours, and it brought home to me what a massive impact this stage in a woman’s life has, not just on herself, but on everyone around her, from partners to children, parents, friends and colleagues, and still, how little it is really talked about in society generally. Fortunately, in these modern times, more is spoken about concerning girls starting their periods, hormone ups and downs during puberty, period pains and menstrual complications. It is getting a bit easier to talk about gynaecological conditions such as Polycystic Ovaries (PCOS), Endometriosis, Fibroids and fertility problems (though talking about them more openly and actually getting constructive help for them are still two very different things). But there remain big chasms in discussing menopause, and many women I work with still do not necessarily recognise what it is, know where to go to get help with it, or indeed, that there IS help out there.

The show was great at raising all sorts of normal menopausal symptoms, from sleep problems, hot flushes, joint pains, vaginal dryness and skin changes, to mood swings, (feeling calm and serene one minute, then weeping uncontrollably at a film the next, then enraged because someone left the top off the toothpaste again, even though they have always done that for years!). Anxiety and panic attacks, memory lapses and concentration difficulties, lack of libido and being unable to drink alcohol like you used to because bad headaches now outweigh the benefits. Then there are the issues of not being able to eat anything without piling on weight anymore, your body changing shape no matter how much you try to exercise (if you can find time to do it regularly of course, along with everything else you are still supposed to juggle!), and hair that changes colour even without dyeing it, and suddenly seems thin and lacklustre, despite using all the products you can “because you are worth it”!

So, what can we do about it? Research has shown that stress plays a big part in making the symptoms of menopause worse, so having good stress management techniques is a good place to start.

• See your GP if you have been feeling out of sorts with many different symptoms. They can do a blood test to see if you are in menopause or perimenopause and to check other influences in your health such as iron and vitamin levels. Your GP may then suggest treatments such as HRT and explain how it can help.
• Chat to someone you trust about how you feel and see if you can identify what is getting you down the most. If you are very tired, maybe you are doing too much and need to find ways to reduce tasks, delegate to others and get more help.
  Make time to get together with friends or have regular time to yourself to switch off and have some time out. Often people who are stressed, and juggling a lot of things focus only on the chores they have to do. It is really important to look after yourself by having some fun too and not being so hard on yourself.
• If you have aches and pains from menopause, mood fluctuations will often make this worse. Try to have a good sleep routine and get some regular rest. Pacing your activities is important for managing any long-term pain, and depending on the cause of the pain, HRT can be very helpful too – so talk to your doctor about this.
• The most important rule about dealing with menopause is do not feel you have to cope with it on your own. There is help and recognition out there. Therapy for dealing with the emotional stresses can help greatly, as can a sympathetic GP.

These past 2 years of Covid have been such a challenge for young people. They have had to get used to a very different way of learning, whether they are at school, college or university. Their lesson routines have got completely disrupted, initially having to stop attending school, but learning online; then going back into school but with masks and “bubbles” and social distancing, back to online learning now and again, as many teachers and pupils went down with Covid and had to isolate. The exam systems experienced major overhauls in record time so that pupils and students could be safely tested, and all this whilst being told they could not meet up with friends, or do their usual sports or clubs.

University students were also hit hard, particularly if they were just starting degrees in new places, away from home but not able to socialize, or the opposite – staying at home to study when they should have been having amazing experiences learning to be independent. No wonder young people are suffering from so much anxiety and confusion about the future at the moment!

One of the big difficulties I find young people I see in my clinic are struggling with is procrastination. They feel a lot of pressure to knuckle down, study and do well, as they are also aware of the competition for jobs once they leave, but many say they cannot make themselves work, and this leads to intense anxiety, low mood and insomnia. It can be very hard to motivate yourself if you are worried about getting things right, or wondering what will be possible in the future.

Procrastination often happens because people worry too much about getting things wrong. Feeling frightened about doing it incorrectly is what stops people starting! Here are 7 tips to try if you find you are going round in circles with revision or studying:

• Set yourself a realistic routine the night before, about what you want to study. Try to be very specific about a topic you want to revise and break it into 3-5 areas which can be covered in about thirty minutes each. Research shows that optimum concentration span is about 20 minutes.
• Agree a time with yourself that you are going to start studying. Think about when you are most awake and calm, so this will vary from one person to the next. If you are a night owl it may be in the evening, if you are a lark, maybe in the morning or early afternoon.
• Have your desk set up beforehand if you can, so you don’t waste time looking for things when you are supposed to be starting!
• Give yourself enough time to make sure you have eaten, are comfortable, and that people know you are going to be studying and won’t interrupt you.
• Start at your agreed time and try to write notes as you read – research shows that the mechanical act of writing helps to cement the information in our brains, so this is useful. If you worry about what to write or type, just start with headings and bullet points – put something down, it does not matter if it is right or wrong – you can alter it later. This is about getting started!
• After 30 minutes get up and have a wander, make a drink, go to the loo, get a bit of air. Doing something different, even if it just for a few minutes as this helps with circulation and mental processing. After 5 minutes try to do the next area of your topic.
• After 2 hours have a longer break and reward yourself with something nice. Ploughing on all day without a break when studying is hard to sustain and not constructive. It can really help to tell someone what you have been learning about, to consolidate it in your mind, so going for a walk and a chat with a friend or family member is great.

At the end of your study day tick it off your list and chill out. It’s important to have time for yourself outside work, and also to do some nice stuff at the weekend (even if it has to be short), so that studying does not become thankless – make sure you reward yourself! Good luck.

Chronic pain is a massive topic, and causes a lot of problems (and misery), for a large percentage of the population (In 2020 it was estimated that one third to one half of adults in the UK suffer from chronic pain at any one time), yet it is still a mystery for many health professionals and common treatments still rely on pain killers and nerve blockers. Both of these may help initially, but as the body gets used to them, their effectiveness reduces over time, resulting in greater doses being needed to control the pain effectively.

The definition of chronic pain is any pain which has lasted longer than 3 months, so it actually does not take very long before pain is deemed to be chronic. All sorts of conditions can cause long term pain, from sports injuries due to accidents or wear and tear on a joint, other unfortunate sudden accidents, such as falls in the home, back problems due to gardening, or car accidents. Then there are long term conditions which cause general pain all over the body, such as fibromyalgia, ME (Myalgic encephalomyelitis or Chronic- Fatigue Syndrome), rheumatoid arthritis, and others which doctors may describe as having “Medically Unexplained Symptoms”, such as long standing headaches, facial pain, IBS, colitis and conditions such a long Covid.

People with chronic pain can often spend many months or years trying to get help, and can feel very dismissed by physical health services who cannot find a definitive cause for the pain or no effective cure, or others feel that they are treated as hypochondriacs and told that “it is all in your head”.

There is a huge impact on quality of life for sufferers of long -term pain. They are less able to get out of the house, hold down a job, or have to take frequent sick leave if their pain becomes too bad. Relationships suffer when someone is in constant pain, very tired all the time and has little energy.

However, there is help out there, and our understanding is growing about how to help people manage these very frightening and difficult conditions. There is recognition that although chronic pain is definitely not all in your head, it is influenced by emotions, the way we think, how we interpret physical symptoms, and behaviour.

If you or a loved one are dealing with chronic pain the following tips may be helpful:

• Ask your GP to refer you to a multi- disciplinary pain clinic. They will do a full assessment, including physiotherapy for mobility and strength, a psychologist for assessing mental health needs, such as help for stress, tension, social and family needs, and identifying unhelpful behaviours, and a medical doctor, to review medication and help you to optimize pain relief and other medical interventions.
• Relaxation techniques are very helpful for learning how to relax tense muscles, which put extra pressure on nerves, and how to mentally switch off from daily pressures which add to stress levels.
• Cognitive Behaviour Therapy (CBT) is very helpful for tackling depression and anxiety, which can often build up with the constant demands involved in dealing with chronic pain (find qualified therapists in the BABCP register)
• Learn to pace your activities to stop the Boom – Bust cycle of pain flare ups happening. This is an unhelpful cycle of doing too much when you feel better (boom), followed by being laid up and unable to function for a few days when you seize up, and muscles complain (bust). This cycle is understandable, but it is not good for managing pain long term. It is better to have help to learn this properly as it can be hard to get it right on your own.

My online course “Tame Your Chronic Pain step by step” teaches all the CBT techniques needed to manage pain successfully and to pace properly, providing all the tools you need to achieve this.