How do you process emotions when there is a lot to offload? I thought it might be helpful if I shared one of the tools I use as a therapist. This technique that helps me to offload and process the week involves expressive writing in a structured way.

Offloading strategies

We all have strategies, tools, and techniques that work for us and help us to decompress. These include playing sports, talking with friends, offloading to those close to us, watching a match, and engaging in mindful activities or hobbies that give us space and a different perspective. These can all help us when it comes to processing emotions.

Using Expressive Writing and The Morning Pages as methods for processing emotions

As a therapist, I often have much to offload and process on top of my other responsibilities. For over twenty years, I’ve been using a combination of Julia Cameron’s ‘The Morning Pages’ and James Pennebaker’s Expressive Writing technique. As good as the Morning Pages are, I have often struggled to fit them into my week. So, over the past four years, I have been trialling different writing days, times, and lengths to see what works best for me.

How long should we write for?

In February this year (2024), Professor James Pennebaker, the founder of the Expressive Writing technique, held a training course for CBT Therapists. One of the things that stood out to me, as one of the participants in that course, was what he said about the duration of writing. He shared how his research had shown that this technique could still work even with very short periods of writing, even five to eight minutes! Hearing him say this validated what I had found when using the method. My duration at that point was eight minutes of writing. But after Professor Pennebaker’s session, I began trialling a double writing session method where I wrote for seven minutes, paused, and then wrote for another seven minutes. The first section was for offloading, and the second was for processing what had been written.

Why a second period of expressive writing?

Professor Pennebaker stated that his research had found that if people only used expressive writing to offload or to ‘brain dump’, this wasn’t always as helpful as if they then went on to process what they had offloaded. What this means in practice is that you could just brain dump onto the page, as Julia Cameron asks us to do in the morning pages, but it is only when you go deeper and reflect on what you have written that the benefit of this practice emerges. For example, you might notice patterns or habits of behaviour. You might notice that a similar issue has happened before. You might discover insights that were not obvious before. In this space, you can then think about what you would want to do next if there was something you wanted to change.

The importance of processing

This ‘processing’ is where the magic can happen. It can provide fresh insights, offer a new perspective on an issue, and perhaps give a deeper understanding of how or why we feel the way we do about something. It could also lead us towards integrating something which had been hard to grapple with previously, or it can lead us towards compassion and acceptance for ourselves. I believe that this processing is why Julia Cameron asks us to write three pages long-hand in the morning pages. She wants us to go beyond the surface of an issue. When I use the morning pages, I find there to be two parts to the process. There is an initial ‘dumping’ or offloading section, and then, around halfway through, just after the point at which I have to push myself to keep writing because it can feel like I have come to a dead end, I seem to write down to a deeper level. This is where I find the gold. The nuggets of insight, clues as to what I was really bothered about, patterns that I hadn’t noticed before.

This brings me to the method I find works best for me. It isn’t the only way. You might want to experiment, as Professor Pennebaker encourages us to do. He has stated that no one time period works for everyone when it comes to expressive writing. You have to find what works for you, but this is my preferred method of offloading and processing, using expressive writing.

Chart feelings

First, I get a baseline for what I am feeling. I draw a circle, then a line through the circle, from top to bottom, and then a line from left to right. See below:

At the top, write Hyper; at the bottom, write Flat. On the left, write Pleasant, and far right, unpleasant.  You could fill in the feelings in the circle. For example, flat and unpleasant would be depression, and hyper and unpleasant would be panic or anger. Pleasant and hyper could be excited. Flat and pleasant would be calmness. There are the extremes at each end of the line and in between are the more subtle feelings.

Before my writing session, I put a number 1 somewhere in the circle for how I feel now. In this example, I felt a bit flat and unhappy (I’d had three things happen that made me feel loss, disappointment and rejection).

Set the timer

Then, I set my timer for 7 minutes.

Write for 7 Minutes

I write for 7 minutes about what is present for me right now or whatever comes up when I think about the past week. I find this technique helpful on Sunday to help with that Monday feeling.

It is important to keep it recent. This is about offloading and processing what the mind is currently managing. It isn’t therapy. It is a short-term offloading and processing technique. *

I keep writing with whatever is on my mind, even if it seems irrelevant or I don’t know how I feel about it. I also notice any sensations in my body and include them in my writing. I note down thoughts that I am having. I try not to judge myself, but if I do have judging thoughts, I write these down, too. Sometimes, I need to remind myself to be a bit kinder if I am being too self-critical. 

Remember, this writing is not to be shared. It does not have to be grammatically correct or have a perfect structure.

Pause and Write for another 7 Minutes

When the time is up, I pause and breathe. Then, I set the timer for 7 minutes and write again.

This time, I reflect on what I have offloaded. I write what comes up for me about this. I write about whether I notice any patterns or habits or whether I have felt this way before. I notice if I have any thinking patterns like all-or-nothing thinking or mind reading – which is thinking that I know what other people think about me. I notice what feelings the issue is bringing up and reflect on why that might be. If I am being hard on myself, I might ask myself, “What would a compassionate and supportive friend say if they were in that situation?”

If I have nothing to write about in this second 7-minute session, I might move on to another issue from the previous week. Or I might start planning out what I want to do or change based on any insights that have come up.

Then, I go back to my feelings circle and chart where I am in the circle after the writing. I notice if I feel a bit more or less activated and where the feeling is on the line between pleasant and unpleasant. I put a ‘2’ here, but you could use dots like in the images below. I created these graphics in Canva. This circle of feelings model is a representation of the affective circumplex model by Posner et al (2005).

If I feel like I am still in the middle of processing at the end of the second 7-minute session, I might set a timer for another 7 minutes.

That’s it. That is my weekly process. Have a try to see if you find it helpful.

There is a large body of research into expressive writing as a technique, but as Professor Pennebaker points out, it doesn’t work for everyone. It can, however, be helpful for some of us. Professor Matthew Lieberman has also done a large body of work on ’emotion labelling’. He has found that it can be therapeutic to put our feelings into words and that labelling our emotions can activate the parts of our brain that help us to objectify but also integrate and process these feelings.

CBT-Enhanced Expressive Writing Course

If you would like to learn more about expressive writing, and be guided through how to use this as well as learn some powerful CBT strategies for managing emotions. Have a look at my online self-paced course.

CBT-Enhanced Expressive Writing Course

A Powerful blend of expressive writing, CBT tools and therapeutic sound to process emotions.

Master your emotions and unlock the healing power of writing.

This unique course combines the transformative practice of expressive writing with proven Cognitive Behavioural Therapy (CBT) techniques and the soothing benefits of therapeutic sound.

Designed to help you process difficult emotions, manage day-to-day feelings, and build emotional resilience, this course provides practical tools and guidance for your personal growth and well-being.

What You’ll Learn:

• The art of expressive writing: Discover how to write about challenging and traumatic experiences in a way that promotes emotional release and healing.  
• CBT tools for emotional management: Learn strategies to process and regulate the feelings that arise during writing.
• A four-part module on writing about traumatic events
• Everyday emotional resilience: Gain skills to manage your day-to-day emotions using expressive writing as a therapeutic outlet.  
• The power of sound for healing: Experience how music and sound can deepen your emotional processing and enhance your writing practice.   

OVERVIEW:

• 29 Videos
• 50-page Course Book & Extra Worksheets/Handouts
• Access to my Expressive Writing Community for advice, info, support, sharing and community.

CONTENT:

• Expressive writing history and practice
• Expressive writing, diary writing and free writing
• Expressive writing and The Morning Pages
• Writing practices
• Managing & Processing Emotions
• Interoceptive awareness: a new way of managing how we feel
• The Hot Cross Bun and how to unpack and process how you feel
• How to write about traumatic events
• Constructing a Personal Processing Plan
• Adding music to our expressive writing practice
• Binaural sound
• Bilateral Sound
• General therapeutic sounds & playlists

Why This Course Matters:

Transform how you process emotions and overcome patterns that are keeping you stuck.

Feel empowered to take control of managing the feelings you may have following traumatic or difficult experiences.

It offers you an alternative to talking about your feelings, for times when we find speaking difficult.

*A note about traumatic experiences

If something traumatic happened over the past week, it is important not to overwhelm your brain by trying to process it too soon. In this case, you would only write about how you feel in this moment. For example, the things you need to do today, things that might be niggling you, who you could speak to for support. What things might comfort you now? Where and who would be the best people to be with to feel safe, calm, and supported? This is what your system will need now, rather than rushing to process the trauma.

A quick breathing exercise. Try this now:

Try it now. Check in with your body. What posture are you hold- ing? What position is your spine in? Is it slumped, or twisting to the side? Imagine straightening it a little bit, and actually let your spine move to where it wants to. Then notice your stomach: are you holding it in? Let it go, let it flop out. Adjust yourself if you notice any twists or tenseness anywhere else. Take a big breath in and let it flop out like a big sigh. Now, do a scan to see what sensations you notice. Is there a tingly feeling, or any niggles or pains anywhere? Just notice them and see what happens as you observe them, with curiosity and without judgement.

Take a breath in and slowly breathe out, trying to make that out- breath last for a count of six. Do this again, then once more, and now take a big breath in and let it flop out like a big sigh.

FINE-TUNING OUR EMOTIONAL AWARENESS: EMOTION- FOCUSED INTEROCEPTIVE AWARENESS

We have just practised noticing what was happening in our bodies and aimed to observe without judgement. Now I’d like to ask you to notice your bodily sensations the next time you notice an emotion. I’m going to call this emotion-focused interoceptive awareness, because it involves noticing this felt sense as part of your emotional state. Whether you are feeling angry, frustrated, worried, tired, sad or disgusted, try to turn your attention to what your body is actually doing, inside and out. It can be hard. I know, because I’ve trained myself to do this and it took me a while. Either I didn’t notice anything or I was taken over by an emotion and forgot what to do. It takes practice to develop a new pattern, but we can do this.

Armed Forces

Combat Stress – www.combatstress.org.uk Forces Online – www.forcesonline.org.uk Help for Heroes – www.helpforheroes.org.uk SSAFA – www.ssafa.org.uk/get-help/forceslineContact Armed Forces –

www.contactarmedforces.co.uk/we-can-help/i-have-served

Ambulance workers

www.nhsemployers.org/retention-and-staff-experience/ ambulance-workforce/head-first

Counsellors and Psychotherapists

The  Therapist  Hub  has  details  of  groups  for  therapists: www.partnersforcounsellingandpsychotherapy.co.uk/the-therapist-hub.

Construction Workers

www.constructionindustryhelpline.com/app.html

Doctors

Doctors Support Network – www.dsn.org.uk/support-for-doctors Doctors – www.practitionerhealth.nhs.uk

Education workers

www.mentalhealthatwork.org.uk/toolkit/staff-mental-health-in-education

Emergency Service Workers

www.mind.org.uk/news-campaigns/campaigns/blue-light-support

Finance and Accounts Workers

www.caba.org.uk

Football

www.thefa.com/about-football-association/heads-up

Football writers

www.mentalhealthatwork.org.uk/toolkit/

mental-health-some-pointers-for-football-writers

Frontline Workers

www.mentalhealthatwork.org.uk/toolkit/ourfrontline-socialcare

Healthcare Professionals

www.aomrc.org.uk/covid-19-mentalwellbeing/#1465858640552- 4ee2b70e-5fbe

Health for Health Professionals Wales – www.hhpwales.co.uk NHS Practitioner Support – resolution.nhs.uk/services/ practitioner-performance-advice/advice/support-for-practitioners

Legal Professionals

Law Care – www.lawcare.org.uk/information-and-support Wellbeing at the Bar – www.wellbeingatthebar.org.uk/staying-well

Police

Oscar Kilo – oscarkilo.org.uk/category/resources/looking-after-yourself/ Police Care –

www.policecare.org.uk/get-help/people/emotional/counselling Welfare Support Line –

www.pfoa.co.uk/support/welfare-support-programme

Veterinary workers

Vet Life – www.vetlife.org.uk/how-we-help/vetlife-health-support Vet Mind Matters – www.vetmindmatters.org

www.rcvs.org.uk/news-and-views/publications/helping-you-help-others

(There are a huge number of these, so if you don’t see one specific to you, do a search online, as I was not able to include them all here.)

Abuse

Adult survivors of abuse/neglect in Scottish care settings – future-pathways.co.uk/

Narcissistic Abuse, the Echo Society – www.theechosociety.org.uk/counselling-serviceWoman’s Trust (Domestic Abuse) – womanstrust.org.uk/?fbclid=IwAR02n- 8rtBmtWEfMn0U wd5_JISiIf0tePtzPEjyu0b1p16TzfGQt3da9o

Addiction

Get Connected – www.getconnected.org.uk/about-us/

Drugs – www.talktofrank.com/get-help/find-support-near-you

Anxiety

No Panic – nopanic.org.uk/telephone-support-services/

Autism

Action for Aspergers – www.actionforaspergers.org/asperger-counselling/

BAME

Aashna – www.aashna.uk/

Aashna is a service that offers long-term therapy to ‘individuals diverse in culture, social background religion sexuality, age, gender, disability and other diversity, who struggle to access culturally sensitive therapy’.

Black African and Asian Therapy Network – www.baatn.org.uk/Find-a-Therapist

Black Health Initiative – www.blackhealthinitiative.org/counselling Chinese Mental Health Association –

www.cmha.org.uk/our-services-/counselling

Bereavement

Child Bereavement UK – www.childbereavementuk.org/booked-telephone-supportSurvivors of Bereavement by Suicide (SOBS) UK – uksobs.org/we-can-help/e-mail/

Children and Young People

Childline – www.childline.org.uk/get-support/1-2-1-counsellor-chat/ Place2Be, mental health support for children in schools – http://www.place2be. org.uk/our-services/services-for-schools/mental-health-support-in-schools/ Youth Access –

www.youthaccess.org.uk/services/find-your-local-service

Depression in New Fathers

depressioninnewdads.com/book-a-consultation/

Eating Disorders

National Centre for Eating disorders booking.eating-disorders.org.uk/ counsellors/search

Beat – helpfinder.beateatingdisorders.org.uk/

Farmers and Rural Communities

Counselling for farmers – www.counsellingforfarmers.com Countryside Counselling – countrysidecounselling.org.uk

DPJ Foundation (Wales) – www.thedpjfoundation.co.uk/contact-us/ Strong Heart – www.strong-heart.co.uk

Farsi Speakers

Farsi Speakers Counselling Service (NHS Barnet) – www.farsophone.org.uk/index.php/en/?jjj=1600632420649

Islamic Community

Institute of Islamic Counselling and Wellbeing – islamiccounselling.info/our-counsellors/

Jewish Community

Jami – jamiuk.org/get-support/what-we-do/online-support/

Location-Specific

Turn2Me (Ireland) – turn2me.ie/page/our-storyThe Maytree Centre (London) – www.maytree.org.uk Anxious Minds (Newcastle and Tyneside) – www.anxiousminds.co.uk/talking-therapies-newcastle/

Refugees

Refugee Therapy Centre – refugeetherapy.org.uk

Post-Natal Depression

PANDAS Foundation – pandasfoundation.org.uk

Pregnancy

Pregnancy Crisis Care – www.pregnancycrisiscare.org.uk/about-us.php

Self Injury

Self Injury Support – www.selfinjurysupport.org.uk/our-support-services

Sexual Abuse and Rape

Male rape and sexual abuse – www.survivorsuk.org/young-people/counselling/

Safeline – www.safeline.org.uk/what-we-do/counselling-therapy/ Rape Crisis – rapecrisis.org.uk/get-help/want-to-talk/

Rape Crisis Scotland – www.rapecrisisscotland.org.uk/ about-local-rape-crisis-centres/

Sexual Offenders and Potential Sexual Offenders

StopSO – stopso.org.uk

Anna Freud Centre

www.annafreud.org/on-my-mind/self-care/

A really useful and interactive page of resources geared towards young people.

CCI, Centre for Clinical Interventions

www.cci.health.wa.gov.au/Resources/Looking-After-Yourself

Another website used often by therapists to give self-help and psychoe- ducation information to clients.

Esther Perel

estherperel.com/blog/how-to-find-the-right-therapist-for-you

Every Mind Matters

www.nhs.uk/oneyou/every-mind-matters

Get Self-Help

www.getselfhelp.co.uk/about.htm

A favourite of many CBT therapists, this website was set up and is man- aged by CBT therapist Carol Vivyan.

Local Libraries

www.gov.uk/local-library-services

Local libraries have self-help books available as well as information about local groups that you can join.

MIND

www.mindcharity.co.uk/advice-information/

how-to-look-after-your-mental-health/online-resources/

Distraction Apps

www.mind.org.uk/need-urgent-help/how-can-i-distract-myself/ videos-websites-and-apps/

Mindfulness

The Free Mindfulness Project – www.freemindfulness.org

Lots of free mindfulness exercises to download for free, plus mindfulness apps and a discussion forum.

NHS

www.nhs.uk/conditions/stress-anxiety-depression/self-help-therapieswww.nhs.uk/conditions

NHS  leaflets  about  different  mental  health  conditions  – web.ntw.nhs.uk/selfhelp

Overcoming

overcoming.co.uk/709/Overcoming-Apps

Self-assessment, self-help and apps from the respected ‘Overcoming’ series.

Psychology Tools

www.psychologytools.com

A very handy resource for therapists and clients for information about different issues we can have with our mental health and info sheets on how to manage.

SAMH, Scottish Association for Mental Health

www.samh.org.uk/about-mental-health/self-help-and-wellbeing

This page of self-help resources has a questionnaire you can answer to get your ‘wellbeing score’.

Self-Help Services

www.selfhelpservices.org.uk/about-us

A user-led charity providing lots of self-help resources.

Students Against Depression

www.studentsagainstdepression.org/self-help

Trauma

istss.org/public-resources/trauma-basics

The International Society for Traumatic Stress Studies (ISTSS) has some helpful info on trauma and PTSD.

The Wellness Society

thewellnesssociety.org/about

Aims to bridge the gap between private therapy and waiting for NHS services by providing self-help tools and information.

MENTAL HEALTH APPS

ACT Coach – mobile.va.gov/app/act-coach

Developed by the US Department of Veterans Affairs, this app is a good introduction to the principles of the ACT approach.

Action for Happiness – www.actionforhappiness.org/app

Babylon – www.babylonhealth.com/download-app

Speak to a doctor about any health issue.

Beat Panic – www.nhs.uk/apps-library/beat-panic Be Mindful – www.bemindfulonline.com

BiaMother – biamother.com

App for new mothers.

Buddhify – buddhify.com

A mindfulness meditation app with lots of different options for different age groups.

CALM App – www.calm.com

A longstanding mindfulness app.

CBT Thought Diary App – www.cbtthoughtdiary.com Catch It – www.nhs.uk/apps-library/catch-it

Chill Panda – www.nhs.uk/apps-library/chill-panda COVE – www.cove-app.com

Daylio – daylio.net

A daily journal and mood tracker app.

Fear Tools – www.feartools.com

An app based around CBT principles for reducing fear and anxiety.

Free Mindfulness Apps – www.freemindfulness.org/apps

Happify – www.happify.com

An app that gives you a ‘happiness score’ and lets you plot your moods and thoughts and work towards changing habits and patterns that are not working for you any more.

Headspace – www.headspace.com/

The original mindfulness and mediation app that has been around since 2010.

Insight Timer App – insighttimer.com

An app that has a large amount of different types of meditations for you to try to help with stress, sleep problems and anxiety.

MIND

List of apps for wellbeing: www.mindcharity.co.uk/ advice-information/how-to-look-after-your-mental-health/

apps-for-wellbeing-and-mental-health/

MoodFit – www.getmoodfit.com

A well-set-out all-round app.

Moodflow – www.moodflow.co

An app that tracks your mood and gives you a clear visual on what certain periods of the year have been like for you and which days were worse or better.

MoodMission – moodmission.com

An app whose founders have carried out peer-reviewed research and a randomized controlled trial into the app’s effectiveness.

NHS Recommended Apps – www.nhs.uk/oneyou/apps/

Overcoming – overcoming.co.uk/709/App

The ‘Overcoming’ range has apps for anxiety, depression and self-esteem.

Samaritans Self-Help App – selfhelp.samaritans.org

Sleepio – onboarding.sleepio.com/sleepio/nhs/77#1/1

A respected sleep app.

Shine – www.theshineapp.com/get-started

An app for Black, Indigenous and People of Colour.

Stressheads – www.themix.org.uk/apps-and-tools/stressheads

An app for young people by The Mix.

Thrive (NHS) – www.nhs.uk/apps-library/thrive TOMO – hellotomo.co.uk

Worry Tree – www.nhs.uk/apps-library/worrytree

WYSA – www.wysa.io

For teenagers.

COMMUNITIES: ONLINE AND OFFLINE

ONLINE

Abuse

Adults survivors of child abuse: www.havoca.org/resources/forumwww.isurvive.org/forum pandys.org

nexusni.org

Anxiety

Anxious Minds – www.anxiousminds.co.uk – has an online community and Facebook group that you can join wherever you are in the UK. DARE – dareresponse.com/community/ – set up by Barry McDonagh, author of the book DARE. The website has links to his book, App, and a Facebook community.

Triumph Over Phobia – www.topuk.org/top-uk-groups

Autism, Aspergers and Neurodiversity:

wrongplanet.net/forums/ www.autism.org.uk/what-we-do/community

Bipolar

Bipolar UK – www.bipolaruk.org/ecommunity

Body Dysmorphic Disorder

www.bddandme.co.uk

Brain InjuryHeadway – www.headway.org.uk/supporting-you/online-communities

Children and Young People

Childline – www.childline.org.uk/get-support/message-boards/ Kooth – kooth.com

The Mix – www.themix.org.uk/get-support/group-chat

Depression

depressionuk.org

Divorce

Support Group – divorcesupportgroup.co.uk/divorce-support-groups

Drugs

Families Anonymous – famanon.org.uk/meetings/online-meetings/

The Withdrawal Project – withdrawal.theinnercompass.org/page/ twp-connect

Eating Disorders

support.beateatingdisorders.org.uk/app/social/home/

Family and Relationships

Families Need Fathers –

fnf.org.uk/help-and-support-2/fnf-online-forum

Family Lives – www.familylives.org.uk/how-we-can-help/ forum-community/?_ga=2.51933609.1457503942.1600701834- 163298806.1600701834

Gambling

Gamblers Anonymous – www.gamblersanonymous.org.uk/forum GamCare – www.gamcare.org.uk/get-support/group-chatroom

General Help7 Cups – www.7cups.com Befrienders – www.befrienders.org

Mental Health Forum – www.mentalhealthforum.net/about-us Mindfulness – www.freemindfulness.org/discussion-forums

Therapy Friends – sidebyside.mind.org.uk/about (formerly ‘Elefriends’) and Therapyfriends.co.uk

Hearing Voices Network –

www.hearing-voices.org/hearing-voices-groups/

Hoarding

Help for Hoarders – www.helpforhoarders.co.uk/forum

Men

Mentell – www.mentell.org.uk

An online community for men 18+ to talk.

OCD

OCD Action – www.ocdaction.org.uk/support-groups OCD UK – www.ocduk.org/support-groups/

Peer Support Online

www.safelyheldspaces.org/about

Post-Natal Depression

pandasfoundation.org.uk/how-we-can-support-you/ social-media-and-facebook-groups/

Self Harm

Self Harm UK – www.selfharm.co.uk/alumina/signup

Spiritual

Spiritual Crisis Network –

www.meetup.com/Spiritual-Crisis-Network-Community-Forum/

Transgender

Beaumont Society–

www.beaumontsociety.org.uk/online-support-groups.html

Trauma

ACES Too High Online Community – www.acesconnection.com/

OFFLINE

Mens Sheds Association – menssheds.org.uk/about/#who-we-are MIND – Social Spaces – www.mindcharity.co.uk/social-spaces Park Run – www.parkrun.org.uk

Walking for health – www.walkingforhealth.org.uk/get-walking/why-walk/ healthy-minds

Wave – www.waveproject.co.uk/about-us

RELIABILITY AND VALIDITY

Questionnaires that you complete yourself (rather than ones that a therapist/ clinician would complete) are also called self-report measures. It takes time to develop a measure to ensure that it shows two main things: reliability and validity. Reliability is when the measure is shown to be assessing the same aspect or behaviour at different points in time – in other words, how consistent it is. Validity is ensured when it has been found to measure that particular aspect or behaviour, and not something else. Validity is further refined by assessing whether it appears to measure what it is meant to (face validity), is measuring that particular feature and nothing else (construct validity) and shows that it can predict the feature being measured (predic- tive). These areas are all important in giving you a final score that you can feel is actually measuring what it is meant to measure. There are lots of fun questionnaires available on the internet, but they may not be able to claim they have this validity and reliability, so you cannot always be sure the score is a true reflection of what the questionnaire is meant to be assessing. For example, a question on a measure about depression could ask, ‘Are you irritable and anxious a lot?’ This question might seem to be measur- ing a feeling when can have when we feel low or grumpy (face validity). However, feeling irritable and anxious are aspects of generalized anxiety and also some hyper-arousal states following traumatic experiences, so it wouldn’t be a question that would show construct validity for a question- naire that only wanted to assess depression. There would need to be more work to include something like that; perhaps a part of the measure would have space for more agitated aspects of depression. But I hope you can see that when you take a test or measure, the score that you receive at the end has to be meaningful. You have to have confidence that the test is measuring what it should be.

The next time you take one of those fun tests on social media, ask yourself: is this question measuring what it thinks it is measuring, or could there be another reason for this aspect or behaviour?

With all of this in mind I have tried to include links to measures that have been researched and show reliability and validity. The way that you can tell this for yourself is by checking the questionnaire or site for information about where the measure came from and/or who developed the measure. The page on the patient.info site that offers the PHQ9 is an excellent example here. Have a look here at the credits at the end of the questionnaire: patient.info/doctor/patient-health-questionnaire-phq-9.

CAN A QUESTIONNAIRE GIVE ME A DIAGNOSIS?

It is important to note that questionnaires such as the Anxiety and Depression test on the NHS website cannot give you a diagnosis or tell you why you are feeling the way that you do. However, if you do find that you are scoring in the moderate to severe range and this either continues for more than two weeks or is a repeating pattern for you, it would be important to contact your doctor and/or arrange an appointment with a therapist to talk through what is happening for you. Two people can both score in the severe range on the PHQ9 and the GAD7 for example, but one person may be struggling with the effects of trauma whilst another may be struggling with OCD. Both can be reasons for high scores on anxiety and significant difficulties with low mood.

LIST OF SELF-REPORT MEASURES

ACES (ADVERSE CHILDHOOD EXPERIENCES) AND RESILIENCE SCORE

acestoohigh.com/got-your-ace-score

www.threerivers.gov.uk/egcl-page/adverse-childhood-experiences-aces

ANXIETY –NHS IAPT SELF-REPORT MEASURES

Generalised-anxiety-disorder-assessment

AUTISM AND ADHD/ADD

The ADDitude website has several self-tests for ASD, ADD and ADHD as well as other tests that may be relevant. It is a great site for information and support from a friendly and informal perspective.

Note: The self-tests on this site are for screening and information rather than to confirm a diagnosis.

www.additudemag.com/download/autism-in-adults/?src=test

Note: The self-tests on this site are for screening and information rather than to confirm a diagnosis.

COMPASSION AND CRITICISM

goodmedicine.org.uk/goodknowledge/compassion-criticism 

or Kristin Neff’s site here

Kristin Neff’s site

– 

DEPRESSION

NHS IAPT self-report measures

patient.info/doctor/patient-health-questionnaire-phq-9

EMOTIONS

Emotional intelligence test

Several different emotional intelligence tests

Emotion beliefs questionnaire

Questionnaire_EBQ_Copy_of_questionnaire_and_scoring_instructions

FINDING THE RIGHT THERAPIST FOR YOU

Esther Perel

GENERAL SELF-ASSESSMENT TESTS FOR ANXIETY, MOOD, SLEEP

Good Thinking, a digital mental health initiative for London, supported by the NHS

– www.good-thinking.uk/self-assessments

HEALTH ANXIETY

Dr James Hawkins’ site has a comprehensive list of this and many other tests. Take a look here.

goodmedicine.org.uk/stressedtozest/2008/12/ handouts-questionnaires-health-anxiety-disorder

HIGHLY SENSITIVE PERSON SCALE (HSP)

Also called Sensory Processing Sensitivity, the HSP scale has been devel- oped by Elaine Aron, who has worked hard to ensure this construct is researched and shows validity and reliability. On Aron’s website there is a test for HSP in adults, as well as one for children, and a high-sensation- seeking test.

Highly sensitive person test

MIND PLAN QUIZ – YOUR MIND MATTERS

NEURODIVERSITY APP AND PROFILER

The app on this website gives you a ‘spiky profile’ result for neurodivergent aspects such as dyslexia, dyspraxia, ADHD, ADD and ASD.

OCD – OBSESSIVE COMPULSIVE DISORDER

I am linking to Dr James Hawkins’s page again here, as he has added the OCI (Obsessive Compulsive Inventory) in MS Word form with the sub-scales tagged to help you. He also includes the shortened form of this measure. The OCD scales are underneath the Panic info on this page. goodmedicine.org.uk/goodknowledge/

panic-ocd-depersonalization-information-assessment

PANIC

goodmedicine.org.uk/goodknowledge/panic-ocd-depersonalization- information-assessment

PERSONALITY

The Big Five – bigfive-test.com openpsychometrics.org/tests/IPIP-BFFM/

POSTNATAL DEPRESSION

patient.info/news-and-features/quiz-do-i-have-postnatal-depression

SOCIAL ANXIETY

psychology-tools.com/test/spin goodmedicine.org.uk/goodknowledge/social-anxiety-information- assessment

TRAUMA AND PTSD

There’s some detailed info on Dr James Hawkins’s page that will signpost you to some really helpful information about trauma goodmedicine.org.uk/goodknowledge/

ptsd-assessment-images-memories-information

The two most used self-report measures in UK therapy services are the IES-R and the PCL-5.

PCL-5: This pdf is from Lancashire’s Traumatic Stress service. It

includes a scoring key to help you assess whether your score is mild/ moderate/severe in accordance with the criteria in the DSM5. www.lscft.nhs.uk/media/Publications/Traumatic-Stress-Service/newPCL5.pdf

IES-R: This questionnaire is in both Word and PDF format on the

GoodMedicine website (it is towards the bottom of the page), along with a scoring key. The IES-R has sub-scales for ‘avoidance’, ‘intrusions’, and ‘hyperarousal’ – all key parts of PTSD. goodmedicine.org.uk/goodknowledge/ptsd-assessment-images- memories-information

England:

www.nhs.uk/service-search/find-a-psychological-therapies-service/

Wales: nhswales.silvercloudhealth.com/signup/

www.wales.nhs.uk/healthtopics/conditions/mentalhealth phw.nhs.wales/topics/latest-information-on-novel-coronavirus-covid-19/ how-are-you-doing/how-are-you-feeling/how-to-access-support/

Northern Ireland: www.nidirect.gov.uk/articles/mental-health-services Scotland:

clearyourhead.scot/support

www.samh.org.uk/find-help

Isle of Man:

www.gov.im/categories/caring-and-support/mental-health-service/ community-wellbeing-service/self-referral-form-for-counsellingtherapies/

Jersey: www.gov.je/Health/Mental/Pages/JerseyTalkingTherapies.aspxpatient.info/treatment-medication/self-referral/refer-yourself- for-nhs-talking-therapy-counselling

• 
  Self-defectiveness
  
• 
  Responsibility
  
• 
  Control and Choice
  
• 
  Safety and Vulnerability
  

Self-defectiveness
(there’s something wrong with me)

One of the things I’d like to point out about these core beliefs, and perhaps you have noticed this, is that the ones on the left are like absolute labels. Statements of fact and very all or nothing. This is because the brain likes to categorize, and usually these are developed in times of high emotion or when we are quite young – both of these are times when we will not be thinking in shades of grey or in abstract terms. As a result, we develop these quick ways to label ourselves, and they can be there for many years undetected and unchallenged.

Notice how the alternatives are less global labels, and more accepting of the shades of grey in a situation, and within us.

Do any of these core beliefs resonate with you at all? Did you notice a slight flinching or movement in your body, or did you look twice at one or two of them? Do you use any of these labels at all? It maybe that you have been using them without realizing the effect they can have on you. If you did identify with any of them, I want to let you know that you can re-evaluate them. This is where therapy can be helpful, in showing you how to change patterns like these, but the first step is to know what your patterns are and that it is possible to change.

The next time you find yourself rushing to negative labels that make you feel bad, such as ‘I’m just not good enough to do this’ or ‘I can’t cope’, pause and try your hardest to look for some shades of grey, don’t just believe the absolute label straight away.

Action for Aspergers – www.actionforaspergers.org/asperger-counselling

Anxiety UK – www.anxietyuk.org.uk/get-help/access-therapy/ Arbours Association – www.arboursassociation.org/psychotherapy/

Association of Jungian Analysts – www.jungiananalysts.org.uk/reduced-fee-scheme/

Beyond Barriers – www.beyondbarriers.uk/pricing Breathe UK – breathe-uk.com/counselling-services/ British Psychotherapy Foundation –

www.britishpsychotherapyfoundation.org.uk/therapy/ low-fee-intensive-therapy

Centre for Freudian Analysis & Research – cfar.org.uk/clinical-service/

CPPD UK Ltd – cppdlondon.com/low-cost-counselling/ CRUSE Bereavement care – www.cruse.org.uk/

Free Psychotherapy Network – freepsychotherapynetwork.com/ Gestalt Centre – gestaltcentre.org.uk/find-a-counsellor-or-therapist/

Guild of Psychotherapists – guildofpsychotherapists.org.uk/psychotherapy/ reduced-fee-clinic/#.X2eB2WjYpPZ

The Help Hub – www.thehelphub.co.uk/therapists/

IOPA – Institute of Psychoanalysis – psychoanalysis.org.uk/iopa-clinics/low-fee-scheme

LGBT Foundation – lgbt.foundation/talkingtherapies London Friend – londonfriend.org.uk/counselling/

Metanoia – www.metanoia.ac.uk/therapy/ metanoia-counselling-and-psychotherapy-service/

The  MIX  –  www.themix.org.uk/get-support/speak-to-our-team/ the-mix-counselling-service

The Philadelphia Association – www.philadelphia-association.com/therapy

The Psychosynthesis Trust – psychosynthesistrust.org.uk/counselling/ Re-Vision –

www.re-vision.org.uk/find-a-therapist/low-cost-counselling/

RELATE – www.relate.org.uk/find-your-nearest-relate

SAP – The Society of Analytical Psychology – www.thesap.org.uk/ about-sap/

Tavistock Institute – www.tavistockrelationships.org/relationship-help WPF Therapy – wpf.org.uk/need-to-talk/therapy-options/

CRISIS SUPPORT

If you are in the UK and are feeling suicidal right now, call 116123, or if you are under 19 call 0800 11 11.

If you are outside the UK click on these links for global and international helplines:

Suicide.org – International Suicide Hotlines

USA: The National Suicide Prevention Lifeline 1-800-273-TALK (8255) and https://988lifeline.org

WhatsApp – Global Suicide Hotline Resources

Your Life Counts

HELPLINES

Alcoholics Anonymous or Phone: 0800 9177 650

Alcohol Change UK (Drinkline)

Anxiety UK or Phone: 03444 775 774 or email: support@anxietyuk.org.uk

At a Loss (support for the bereaved)

Breathing Space, Scotland or Phone: 0800 83 85 87

Bullying UK

C.A.L.L. Mental health helpline for Wales

www.callhelpline.org.uk

Campaign Against Living Miserably (CALM)

www.thecalmzone.net/help/get-help/ Call: 0800 585858

Childline

www.childline.org.uk Call: 0800 1111

CRUSE Bereavement care

www.cruse.org.uk Call: 0808 808 1677

Domestic Abuse

Mankind – www.mankind.org.uk Respect – mensadviceline.org.ukRefuge – www.nationaldahelpline.org.uk Call: 0808 2000 247

Drinkaware support services list

www.drinkaware.co.uk/advice/support-services/alcohol-support-services

Emergency Service workers – PTSD999

www.ptsd999.org.uk/about/how-to-get-help

Call: 01223 755 130, email: support@ptsd999.org.uk or text: 07778 485 528

Family Lives (Previously Parentline)

www.familylives.org.uk/how-we-can-help/confidential-helpline

Family Rights Group

www.frg.org.uk

Farming Community Network

fcn.org.uk/help-health-issues/ or call: 03000 111 999

Galop (Helpline for LGBT+ people who have experienced hate crime or abuse) – www.galop.org.uk/how-we-can-help/

Call: 0800 999 5428 or email: help@galop.org.uk

GamCare (helpline for problem gambling)

www.gamcare.org.uk/get-support/talk-to-us-now Call: 0808 8020 133

LGBT Foundation

lgbt.foundation/coronavirus/wellbeing Call: 0345 3 30 30 30

LGBT Health Scotlandwww.lgbthealth.org.uk Call: 0300 123 2523

Marijuana Anonymous

www.marijuana-anonymous.org.uk Call: 0300 124 0373

MEIC (helpline service for children and young people up to the age of 25 in Wales)

www.meiccymru.org

Call: 0808 80 23456 or text: 84001

Mental Health Matters helplines

www.mhm.org.uk/helpline-webchat

Mermaids UK (support for trans and gender-diverse children and their families)

mermaidsuk.org.uk/about-us Call: 0808 801 0400

MIND

Crisis planning – www.mind.org.uk/information-support/ guides-to-support-and-services/crisis-services/

List of helplines – www.mind.org.uk/information-support/ guides-to-support-and-services/crisis-services/

helplines-listening-services/

Mindline Trans+

mindlinetrans.org.uk Call: 0300 330 5468

MindOut (online support for lesbian, gay, bisexual, trans and queer people)

www.mindout.org.uk/get-support/mindout-online/

Muslim Youth Helpline

www.myh.org.uk/helpline

Call: 0808 808 2008 or live chat on website

Narcotics Anonymous

ukna.org

Call: 0300 999 1212

OCD Action

ocdaction.org.uk/i-need-support/helpline/ Call: 0845 390 6232

Papyrus (charity dedicated to preventing suicide of young people)

www.papyrus-uk.org/hopelineuk Call: 0800 068 4141

Panic

nopanic.org.uk/the-no-panic-helpline Call: 0300 772 9844

Rural Support (Northern Ireland)

www.ruralsupport.org.uk/how-we-can-help/helpline/ Call: 0800 138 1678

SAMARITANS

www.samaritans.org

Call: 116123 (in UK) or email: jo@samaritans.org

SANDS (helpline for anyone affected by the death of a baby)

www.sands.org.uk

Call: 0808 164 3332 or email: helpline@sands.org.uk

Saneline

www.sane.org.uk/what_we_do/support/

Self-Injury Support for women and girls

www.selfinjurysupport.org.uk

Call: 0808 800 8088 text: 07537 432444 or email: tessmail@selfinjury- support.org.uk

SHOUT – www.giveusashout.org Text SHOUT to 85258

The Silverline (for people over 55 years old)

www.thesilverline.org.uk/helpline Call: 0800 4 70 80 90

Support Line (a helpline and support service aimed at those who are isolated, at risk, vulnerable and victims of any form of abuse)

www.supportline.org.uk

Call: 01708 765200 or email: info@supportline.org.uk

Survivors of bereavement by suicide (SOBS)

uksobs.org

The Survivors Trust (for people who have suffered sexual abuse)

www.thesurvivorstrust.org Call: 0808 8 010818

Switchboard LGBT

switchboard.lgbt/about-us Call: 0300 330 0630

Winston’s Wish (support for grieving children)

www.winstonswish.org Call: 0808 8 020 021

Young Minds

youngminds.org.uk/find-help/get-urgent-help/ Text: YM to 85258 for crisis support

Your Life Counts (global support line)

yourlifecounts.org

SAFETY PLAN

After you have spoken with someone on the helpline, make your own safety/crisis plan to support you. There are some great templates on the following websites:

getselfhelp.co.uk/suicidal.htm

www.stayingsafe.net/home

Note to those supporting friends and family members who are feeling suicidal: you do not have to fix the problem. It is OK to let the person feel what they are feeling, even though it can be heart-breaking to see them struggling and you will want to take this feeling away from them. Let them talk. It is OK to just ‘be’ with them. Too often we feel so anxious about not being able to solve the problem that this makes it hard for us to be with someone when they are upset.