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.

By unpacking a situation into these different elements, you can start to see the links between what happens and the stories or interpreta- tions that you might automatically jump to. This can then help you to target these areas in therapy in order to change what happens for you in future.

If you’d like to have a go at doing one of these for yourself, bring up the last time that something bothered or upset you. It doesn’t have to be something huge.

In the circle under No. 1 (Situation/Context), enter where you were or what was happening. Add anything that helps to set the context. As you think about this event or experience, notice if you are seeing an image of what happened. In No. 2 (Images, memories), put a word or phrase that sums up this image.

Notice what is happening in your body right now. Even if it is slight, can you detect anything? Maybe a gripping feeling in your gut, or a heat in your face, or the slightest of pains in your head. Bring the image back up into your awareness and notice any shifts or changes in your body. Put whatever you notice, even if it doesn’t make sense, into No. 4 (Somatic). What label would you use to describe how you feel about this event? Put this into No. 5 (Emotions). As you notice this feeling and the things that bothered you about this situation, what thoughts go through your mind? What is the main thing that upset you about this situation? Put these into No. 3 (Thoughts). What did you do? For example, ‘I went home’, ‘I said nothing but kept thinking about it’. Put what you did into No. 6 (Behaviours).

As you look at this, what do you think is the main story that you were telling yourself about this event? For example, ‘I always mess things up’, ‘I can’t trust anyone’ or ‘I can’t cope’. Don’t worry about not having the right words: just put whatever snippets come to mind. Have a look at your circle, notice all the different elements that make up your experience in that situation. There are others that we could add here – for example, consequences of what you did, features of the space you were in at the time, past experiences with key people in your life. But we have to start somewhere, and this is a good place to start. As you look at this circle, notice all the different elements that you have unpacked, and the way that one relates to the other. For example, a certain thought makes you feel a certain way. Or when you feel a certain feeling, you tend to ‘do’ (a behaviour) a certain thing. Notice the way that the situation led to you seeing it in a particular way.

What you can do is complete one of these circles each time you feel upset or bothered by something. You will then have a collection and can look for patterns. Are there some meanings or stories that seem to pop up frequently? Do you notice that certain emotions always give you a particular sensation in your body? What tend to be the go-to things that you do when you feel upset?

For example, you could discover that certain situations always have a tendency to make you worry you are not good enough, or when certain feelings come up for you and you feel criticized, you always tend to ruminate and find it hard to shake the feeling. A therapist could help you take this further to see what significant people or events in your life have influenced these core ways of viewing yourself, others and the world, and help you to shift and change your stories and interpretations.

www.sciencedirect.com/science/article/abs/pii/ S0165032719313023?via%3Dihub
Howell, A. J., & Passmore, H. (2019). Acceptance and commitment therapy (ACT) to reduce depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260(1), 728-737. DOI: 10.1016/j.jad.2019.09.040

Levin, M.E., Haeger, J.A. and Pierce, B.G. (2016). ‘Web-Based Acceptance and Commitment Therapy for Mental Health Problems in College Students: A Randomized Controlled Trial’, Behavior Modification, 41:1.

CBT THERAPY

Cristea & Hofmann (2018) outline the evidence base for CBT and argue that, whilst CBT is not perfect, it is the gold standard because it is the best standard that we have at the moment. www.ncbi.nlm.nih.gov/ pmc/articles/PMC5797481/?fbclid=IwAR3aaVJflkzabEn3-dd1_ ZCQBjKximg3qE0SFcVab2LQCQk8qAtjW-5pTEE

DANCE MOVEMENT THERAPY

The studies below are a fraction of the evidence available for dance move- ment therapy, but they indicate how it can help with executive function, memory and mood.

academic.oup.com/cercor/article/16/8/1157/455551

www.sciencedirect.com/science/article/abs/pii/ S014976341830664X?via%3Dihub

www.sciencedirect.com/science/article/abs/pii/ S1744388119300970?via%3Dihub

EMDR THERAPY

Boudewyns, P. A., Stwertka, S. A., Hyer, L. A., Albrecht, S. A., & Sperr, E. V. (1993, February). ‘Eye movement desensitization for PTSD of combat: a treatment outcome pilot study’. The Behavior Therapist, 16(2), 30-33.
Shapiro, E. (2009). EMDR treatment of recent trauma. Journal of EMDR Practice and Research, 3(3), 141-151.

EXPRESSIVE WRITING THERAPY

Mogk, C., Otte, S., Reinhold-Hurley, B., & Kröner-Herwig, B. (2006). ‘Health effects of expressive writing on stressful or traumatic expe- riences – a meta-analysis’. Psycho-social Medicine, 3, Doc06. www.ncbi.nlm.nih.gov/pmc/articles/PMC2736499/

Park, D., Ramirez, G. and Beilock, S.L. (2014). ‘The role of expressive writing in math anxiety’. Journal of Experimental Psychology: Applied. 2014, 20:2, 103-111.

ONLINE THERAPY

Chakrabarti S. (2015). ‘Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches’. World Journal of Psychiatry, 5(3), 286–304. doi.org/10.5498/wjp.v5.i3.286

Epstein, R. (2019). ‘Distance therapy comes of age’. Scientific American.

www.onlinetherapyinstitute.com/wp-content/uploads/2010/02/scimind1.pdf

Guille,C., Zhao, Z. and Krystal, J. (2015). ‘Web-based cognitive behavio- ral therapy intervention for the prevention of suicidal ideation in medical interns’, JAMA Psychiatry, 72:12, 1192-1198.

Simpson, S, Richardson, L, Pietrabissa, G, Castelnuovo, G, Reid,

C. ‘Videotherapy and therapeutic alliance in the age of COVID–19’. Clinical Psychology & Psychotherapy. 2020; 1– 13. doi.org/10.1002/cpp.2521

Luo, C., Sanger, N., Singhal, N., Pattrick, K., Shams, I., Shahid, H. (2020). ‘A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis’. EClinicalMedicine, Vol. 24, 100442, July 1,

2020.

Zwerenz, R., Becker, J., Knickenberg, R.J., Siepmann, M., Hagen, K. and Beutel, M.E. (2017). ‘Online self-help as an add-on to inpatient

psychotherapy: efficacy of a new blended treatment approach’. Psychotherapy and Psychosomatics, 86, 341-350.

PSYCHOANALYTIC THERAPY

www.bpc.org.uk/information-support/the-evidence-base

www.bpc.org.uk/download/696/Evidence-in-Support-of-Psychodynamic-Psychotherapy.pdf

PHONE THERAPY

psyche.co/ideas/telephone-therapy-is-convenient-and-it-works-lets-use- it-more

CRITIQUES OF PSYCHOTHERAPY

digest.bps.org.uk/2017/03/20/have-we-overestimated-the-effectiveness- of-psychotherapy
www.theguardian.com/society/2017/feb/12/online-therapy-thousands-but- does-it-work

When I say ‘pay attention to how you feel’, what I mean by this is noticing not only what goes through your mind, but also what is going on physically in your body. If you get a gripping sensation in your gut, this is a feeling, if you feel your breath getting faster and quicker as you say something to someone, this is a feeling. The thoughts that go through your mind as you have these sensations are part of the feeling too. A feeling does not have to be an intangible concept. Feelings are thoughts going through your mind, and sensations, impulses and movements in your body. If you start to notice these, you will get to know where you tend to ‘feel’ certain emotions. For example, when I feel nervous, I feel this straight away in my lower gut. It’s a ‘wrenching’ feeling.

Have a go right now. Do a quick body scan and check if you are hold- ing any tension anywhere. Are you biting your inner lip, or clenching your toes, or holding tension anywhere else? Take a big breath and let it flop out as you release tension.

The next time you notice you feel on edge, stressed, tense, anxious or frustrated, scan your body to see what you notice. Whereabouts is this ‘on-edgeness’? Is it in your gut? Your head? Are you clenching your jaw? What words would you use to describe how you feel right now?

It can be difficult to put words to a feeling. One of the reasons for this is because we are trying to use a different part of our brain to ‘describe’ what we are experiencing. But this can be helpful in giving us a little bit of distance and a space within which to choose what to do next. If we practise this, we can get much better at not letting emotions blindside us. Have a look at the list of emotion words below. Instead of using the word ‘anxious’, could there be another word you could use? Maybe ‘appre- hensive’, ‘doubtful’, ‘unsure’? Add your own words to the list if you’ve found one that isn’t on there. This is part of our emotional literacy, and I know I wasn’t taught to do this when I was younger. It’s important that we can describe and manage how we feel, that we know what emotions are, how to recognize them within ourselves and how to talk to others about what we feel.

So let’s have a go. I’d love to ask if we could create more words for emotions together. I’m going to start a list here and would like to invite your words too. You will have had experiences that differ from mine, so I do not have the monopoly here.

Next time you notice yourself feeling something, be it sad, thoughtful, unsure, worried, angry, embarrassed, I’d like to ask you to notice where you feel this physically in your body, and then find a word on the list to describe the feeling or put your own word to it. The more that you do this the more you will be identifying the subtleties in your own feelings. This gives you more mastery over what you feel.

AFRAID

Explanation: feeling fearful and apprehensive
Alternatives: Alarmed, anxious, apprehensive, fearful, frightened, intimidated, nervous, panicky, petrified, scared, shaken, startled

ANGRY

Explanation: feeling and/or expressing fury or annoyance 
Alternatives: annoyed, cross, enraged, exasperated, furious, incensed, indignant, irate, hacked off, heated, mad, outraged, provoked, raging, ranting, raving, riled, vexed

CALM

Explanation: being at peace, still and relaxed
Alternatives: at peace, relaxed, serene, settled, soothed, tranquil, untroubled

CONNECTED

Explanation: feeling part of something, feeling like you belong (an important feeling for our nervous system)
Alternatives: affiliated, associated, engaged, kindred, linked, related, tied, connected, loved, belonging

DISGUSTED

Explanation: feeling sickened or turned off
Alternatives: appalled, nauseated, repelled, repulsed, sickened, turning away from

ENTHUSIASTIC

Explanation: feeling interested and willing
Alternatives: avid, committed, desirous, devoted, eager, ebullient, excited, fervid, keen, passionate

EXCITED

Explanation: thrilled and ready for action
Alternatives: animated, aroused, enthusiastic, expectant, high, moved, roused, stirred, stimulated, wild, yearning

FLAT

Explanation: without expression, feeling in limbo
Alternatives: empty, depressed, dispirited, downhearted, drained, numb, shocked, tired, weak, weary, without energy, worn out

FRUSTRATED

Explanation: being held back, prevented from doing something or your expectations remaining unfulfilled
Alternatives: disappointed, discouraged, disheartened, irked

INSPIRE

Explanation: to fill with energy, to make something seem possible 
Alternatives: encourage, energize, galvanize, influence, infuse, motivate, persuade, stimulate

IRRITATED

Explanation: not feeling able to rest, being on edge, snappy 
Alternatives: agitated, crabby, disagreeable, flustered, fractious, grumpy, hassled, impatient, miffed, nettled, tetchy, peeved

LONELY

Explanation: feeling like you can’t connect to others
Alternatives: abandoned, alone, companionless, estranged, forlorn, friendless, isolated, outcast, solitary

RELIEVED

Explanation: a feeling of being able to release yourself from tension 
Alternatives: cheered, comforted, glad, grateful, happy, pleased, reas- sured, thankful

SAD

Explanation: feeling the loss or absence of something or someone 
Alternatives: blue, depressed, down, empty, gloomy, glum, grieving, low, melancholy, mournful, pensive, sombre, tearful, unhappy, wistful

SAFE

Explanation: believing that you are protected from danger in that moment (very important for a healthy nervous system to notice when you feel safe) 
Alternatives: impregnable, out of danger, protected, safe and sound, secure, comforted, soothed

SURPRISED

Explanation: taken aback by something unexpected
Alternatives: astonished, astounded, baffled, bewildered, confused, confused, dismayed, embarrassed, fazed, flummoxed, mystified, perplexed, puzzled, stumped, stunned

SUPPORTED

Explanation: feeling like you have the help that you need (something to do for ourselves, as well as for others)
Alternatives: advocate, aid, assist, boost, champion, defend, encourage, help, hold, promote, stand up for, stick up for

UPSET

Explanation: an unpleasant mix of feelings
Alternatives: agitated, choked, confused, disconcerted, dismayed, dis- tressed, disturbed, distraught, distressed, gutted, hassled, hurt, overwrought, ruffled, shaken, tormented, troubled, unhappy, wrenched

WORRIED

Explanation: thinking about what might go wrong and feeling anxious as a result
Alternatives: anxious, apprehensive, avoidant, bothered, concerned, distracted, disturbed, fretful, hesitant, jittery, nervous, on-edge, perturbed, restless, shaken, suspicious, tense, troubled, twitchy, uneasy

animal-assisted-interventions/accreditation-and-qualifications

Horses, dogs, cats, goats and even chickens are being utilized as part of outdoor therapy approaches which have nature and connec- tion at their heart. The science of social connection and attachment supports this approach as our bonds with animals can provide us with many benefits psychologically.

Art Therapy and Art Psychotherapy – www.baat.org/ About-BAAT/What-we-do

Art therapy/art psychotherapy (the terms are used interchangeably) is a state-regulated profession in the UK. Art therapists are regulated by the HCPC, so only a therapist with the appropriate training and registration can call themselves an ‘Art therapist’. Art therapists are practising artists who also have training in psychotherapy – usually with a psychodynamic focus. It can be a very powerful non-verbal approach. Have a look at some of the comments from people who have experienced the approach here: www.baat.org/About-Art-Therapy/ Art-Therapy-service-users-share-their-experiences.

See also Sensorimotor Arts Therapy – http://www.sensorimotorart-therapy.com/sensorimotor-art-therapy

Autogenic Training – www.autogenic-therapy.org.uk and www.autogenictraining.org

Autogenic training involves sets of repetitive exercises in combina- tion with the assessment and feedback of what is happening in the body. It’s aim is to promote mindful relaxation and stress reduction.

Bibliotherapy, ‘the Ancient Art of Book-Healing” – www.relit.org.uk

We don’t just read for pleasure. We read to understand, to learn, to be surprised, to find hope and to feel a bit less alone in the world. Reading and listening to stories can enrich our lives in so many ways. Being part of a book club helps us share stories and feel connected with others, and reading for wellbeing is also part of this movement towards harnessing the power of reading.

Here are some of the organizations and projects that are involved in bibliotherapy:

Books on prescription – reading-well.org.uk/books/ books-on-prescription/mental-health

The ‘Overcoming’ series – overcoming.co.uk/14/Help-for-Mental-Health

The Emergency Poet – emergencypoet.com/about/ and The Poetry Pharmacy – www.poetrypharmacy.co.uk/

The Poetry Pharmacy – A book by William Sieghart, founder of National Poetry Day and the Forward Prize. – www.penguin.co.uk/ authors/132348/william-sieghart.html?tab=penguin-books

Quiz – ‘What is your poetry prescription?’ www.penguin.co.uk/ articles/2017/poetry-pharmacy-quiz

Shared reading – www.thereader.org.uk/what-we-do

Biofeedback, Heart-rate Variability (HRV) and Neurofeedback

Psychophysiological methods are starting to be utilized by some psychotherapists. Advances in neuroscience are indicating potentially exciting avenues of integration between the brain and body, and between our relationships, environment and psychological functioning.

Blended Therapy

Blended therapy is where you have the support of a therapist or wellbeing practitioner whilst completing certain therapy modules online. You will have an assessment of what you are struggling with and the therapist will help you to set some goals for what you hope to get out of the sessions. The therapist will then help select relevant modules for you to work through and you will have review sessions to talk through how you are getting on. SilverCloud is a programme that is often used in blended CBT practice.

CBWT – Cognitive Behavioural Writing Therapy

CBWT was developed by Arnold van Emmerik as ‘Interapy’ and was later expanded to Internet-Based Cognitive Behavioural Writing Therapy (IB-CBWT). As a technique it is a combination of expres- sive writing therapy, trauma-focused therapy and cognitive behav- ioural therapy for trauma. In a multi-centre randomized controlled trial in 2017, it was found to be as effective as EMDR for children between the ages of 8 and 18. (Roos et al., 2017).

Cyber Therapy

This is a name that is synonymous with ‘online therapy’. There are several training courses for therapists to gain skills in online working. Some use the term ‘online therapist’ whereas others use the term ‘cyber therapist’.

Dance and Movement Therapy – admp.org.uk

Dance therapy involves helping to regulate feelings using the move- ments of the body. It is an integrative practice that uses the medium of the body rather than talking.

Dramatherapy – badth.org.uk

Dramatherapists are artists and clinicians and dramatherapy is the therapeutic use of theatre and dramatic arts as a psychological therapy. It makes use of a range of artistic mediums such as pup- petry, mask work, story and improvisation.

Expressive Writing Therapy – See Writing and Wellbeing

Hellerwork Structural Integration – hellerwork.com/ what-is-hellerwork

Hellerwork is a body-based method of structural integration that aims to integrate body, mind and movement.

Holistic Therapies

This book is about psychological therapy, which is focused on the use of psychological theories to help people who are struggling with their mental health. I have not been able to include the vast array of holistic therapies that are available, although it is fair to say that many of these have psychological effects. If you are looking for a holistic practitioner, the Complementary and Natural Healthcare Council (CNHC) provides an independent register of complementary healthcare practitioners (www.cnhc.org.uk).

Journal Therapy – See Writing and Wellbeing

Music Therapy – www.bamt.org/music-therapy/what-is-music- therapy/mental-health-care.html

Through improvised music rather than talking, music therapy can be an aid to feelings and help people to communicate in alternative ways to traditional talking therapies.

Online CBT

Text-based, Synchronous Instant Messaging

The traditional face-to-face, one-on-one therapy model has been shifting since 2010 but has accelerated in the last five years. COVID- 19 restrictions forced many therapists into online and phone ses- sions with clients; however, a substantial number of therapists were already working online. The company IESO (formerly Psychology Online) has been offering text-based, instant-messaging therapy since 2014. The client and therapist communicate by typing into an instant message chat screen.

Online Programmes – Asynchronous (work through it in your own time)

Other companies such as SilverCloud also offer online CBT modules to clients. SilverCloud offers a series of self-contained programmes that you can work through. For example, CBT for depression would take you through a series of modules all based around different CBT strategies, such as thinking patterns, core beliefs and how they affect us, and behavioural aspects of depression.

In the NHS these online CBT modules are routinely used in practice along with telephone therapy, video therapy and the newer virtual reality therapy.

The  MIND  website  lists  other  programs  available as alternatives to SilverCloud: www.mindcharity.co.uk/ online-self-help-programmes-websites-resources.

Email and Message App Therapy (Asynchronous, not an instant reply)

There are also some therapists who offer text-based therapy via email or messaging apps such as Signal.

Outdoor Therapy

Ecotherapy – www.goodtherapy.org/learn-about-therapy/types/ econature-therapy

Ecotherapy is a generic term for doing therapeutic activities outside in nature and bringing nature into the activity in some way.

Gardening, nature-based and community conservation for wellbeing projects

farmgarden.org.uk tcv.org.uk/greengym groundwork.org.uk thrive.org.uk carryongardening.org.uk

Forest Bathing – foresttherapyinstitute.com and natureandforesttherapy.org

Also known as shinrin yoku in Japan, where it originated, ‘forest bathing’ is the term we now recognize as referring to walks in nature, in woods and forests. A large body of research has been and is currently still being carried out on the exact reasons why this is beneficial to our health, but it is being shown to have significant benefits. Even a 20-minute walk in green space is enough to make a difference.

Natural Mindfulness – natureconnection.world/category/natural-mindfulness

Mindfulness guides use nature to support mindfulness practice. The website above also lists ecotherapists and forest bathing practitioners.

Outdoor sports and Wilderness therapy – www.blackdogoutdoors.co.uk and waveproject.co.uk

Wilderness therapy projects such as ‘Black Dog Outdoors’ aim to use outdoor activities and sports such as climbing, paddleboarding and biking as not only forms of exercise but ways for people to connect and be supported by others.

Phone Therapy

As we saw above with email and instant messaging, therapists have been adapting the way that they work, and phone therapy is another alternative to face-to-face therapy. It is often used by Employee Assistance Programme providers of counselling services and for CBT therapy as well. It can work effectively for some people and I have experience of this proving to be beneficial to clients. The key here is finding the method that works for the person and not assuming it will work for everyone.

Running and Walking

Dynamic Running Therapy (DRT)

A blend of mindfulness, walking/running and talk therapy along with psychoeducation on anxiety and depression. Developed by William Pullen.

ParkRun – www.parkrun.org.uk

Free, weekly meetups for people to walk, run or jog and join with others. There will be an agreed distance but participants are free to either walk, jog or run.

Walking for Health – www.walkingforhealth.org.uk

Another project which aims to connect people and improve wellbe- ing by taking part in walks together.

Hip Hop Therapy (HHT) – www.hiphoptherapy.com

HHT utilizes hip hop as a therapeutic medium to heal.

Safe and Sound Protocol – integratedlistening.com/ ssp-safe-sound-protocol/

The Safe and Sound Protocol is a headphone-based programme that is designed to reduce stress and auditory sensitivity while enhanc- ing social engagement and resilience. It was developed by Stephen Porges, the creator of polyvagal theory.

Sound Therapy and Sound Baths – www.britishacademyofsoundtherapy.com/what-is-sound-therapy/

Sound therapy involves the use of sound from specific instruments to influence brain waves and the person’s autonomic nervous system.

Tension and Trauma Release Exercises (TRE) – traumapreven- tion.com/what-is-tre

TRE is a set of exercises that are designed to assist the body in releasing pockets of stress, tension and trauma.

Somatic Stress Release – www.drscottlyons.com/about

These are body-based stress release techniques devised by Scott Lyons.

Virtual Reality and Augmented Reality Therapies

VR headsets and other wearables that connect via Apple Watch, for example, can provide information on internal bodily signals such as blood pressure, heart rate, heart rate variability, muscle tension and breathing rate. Virtual reality headsets are currently being used in some NHS services to help clients with phobias and psychosis. This therapy works on the principles of exposure therapy as part of CBT and helps clients to gradually feel less threatened in situations that they would usually avoid or feel overwhelmed in. Here’s a link to several studies carried out by the department of psychiatry at the University of Oxford:

www.psych.ox.ac.uk/research/oxford-cognitive- approaches-to-psychosis-o-cap/projects-1/ oxford-virtual-reality-vr-for-mental-health

Voice

The Naked Voice Foundation – www.thenakedvoice.com

Founded by Chloë Goodchild, this is a programme of exercises and techniques to help you discover your authentic voice.

Voice Dialogue – www.voicedialogueinternational.com

A psychospiritual therapy using voice to contact the many selves within us.

Voice Analysis – www.healthoptimising.co.uk/assessments/ well-mind-assessment

The Voice Analysis system aims to pinpoint patterns in your speech and identify emotional issues that can be targeted and resolved.

Writing and Wellbeing

Writing has become an important addition to wellbeing activities. Talking is about putting experiences into language and making meaning. Writing is also about translating experiences into language, but in a slightly different way, and it can be just as beneficial as talking. We can see this in the research into expressive writing. This area is also called ‘therapeutic writing’ and ‘journal therapy’. It also encompasses ‘poetry therapy’. In the UK, Lapidus is the main membership organization for practitioners of writing and wellbeing (www.lapidus.org.uk). There are also degree courses in therapeutic writing offered by the Metanoia Institute and the University of Sussex.

Expressive writing is the use of writing about emotions and emotional experiences, as a way to offload, release or disclose rather than suppress one’s feelings. It is also a method that helps to make sense of what we feel and process difficult experiences. The ‘expressive writing’ paradigm is said to have begun with the work of James Pennebaker in 1986. One of the standout findings was how participants’ immune responses changed after writing. Pennebaker attributed it to what he termed ‘disclosure’. He found that when people disclose certain experiences, they process the associated emotions and engage in meaning making about the event, which helps to reduce distress.

This is very similar to what happens in psychotherapy, in particu- lar trauma therapy. But writing can be a helpful addition for those who find talking difficult. Handled in the correct way, the therapy should be about safe, grounded containment, learning self-regulation skills, then processing stuck emotions and negative meanings to come to a new understanding. Emotions are multisensory events too; for example, they are the actions or unfinished actions of muscles in the body, a rise in blood pressure as the body readies itself for action. The processing of emotion in psychotherapy is a physical process, not just a cognitive one. This is described in exquisite detail in Bessel Van der Kolk’s book The Body Keeps the Score (Van der Kolk, 2014).

Yoga Therapy

Yoga is being used frequently by some trauma-therapy centres, particularly in the US, and an evidence base is beginning to grow for its effectiveness in soothing and balancing the nervous system. An example of yoga in a therapy setting is trauma-sensitive yoga: www.traumasensitiveyoganederland.com.