Episode 28 – Childhood Abuse with the Secret Psychiatrist

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses childhood physical, emotional and sexual abuse as well as neglect. This episode may be distressing to some listners and may not be suitable for younger listners.

Get our next book here

The Secret Psychiatrist





If you cannot wait for our next episodes on Childhood Abuse and Conduct Disorder and Oppositional Defiant Disorder you can get advanced access by going to Patreon. You can support us with as little as $2 a month to get advance access to our episodes and a range of other awards. We hope to be able to donate money to a range of mental health charities once we reach certain targets.

If you feel suicidal call 999 immediately.

If you need to talk you can contact:

Smaritans on

Mental Health Resources:

Rethink Mental Illness

Mind The Mental Health Charity

  • Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
  • Text: 86463
  • http://bit.ly/2p6rntK

If you need support with child abuse:

NSPCC 0808 800 5000
0800 1111
In the US
Childhelp National Child Abuse Hotline
(1800) 4-A-child
(1800) 422-4453


Call for Participants: Social Media, Young Adults and Wellbeing

Is social media important to you? Do you use it frequently? Is it an everyday part of your life?

We are very interested to hear from you about this.

We are doing research to learn about the way young adults 18 – 34 years use social media, what they use, how much they use it, and why they do.

We are curious to learn from you and your beliefs about the impact that social media has had on your life and those around you, how you feel when using it, and any good and bad things about using social media?

We hope to use your thoughts to help to make social media safer for young adults like you.

This survey is completely anonymous.

We expect that the survey will take around 15 mins to complete

This research project has been approved by the Human Research Ethics Committee of The University of Melbourne. Human Ethics ID: 1750388

For more information about the project, or to complete the survey, please follow the RedCap Survey link below. You may open the survey in your web browser by clicking the link below: Social media use, young adults and well-being

If the link above does not work, try copying the link below into your web browser: https://redcap.healthinformatics.unimelb.edu.au/surveys/?s=3CM3P3R7HM

If you have any further questions or concerns, please contact the researchers: Professor Lynette Joubertljoubert@unimelb.edu.au Paul Dodemaidepdodemaide@student.unimelb.edu.au

Episode 27 – Post Traumatic Stress Disorder in Children with the Secret Psychiatrist

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses Post Traumatic Stress Disorder.

Get our next book here

If you feel suicidal call 999 immediately.

The Secret Psychiatrist





If you cannot wait for our next episodes on Childhood Abuse and Conduct Disorder and Oppositional Defiant Disorder you can get advanced access by going to Patreon. You can support us with as little as $2 a month to get advance access to our episodes and a range of other awards. We hope to be able to donate money to a range of mental health charities once we reach certain targets.

If you need to talk you can contact:

Smaritans on:

Mental Health Resources:

Rethink Mental Illness

Mind The Mental Health Charity

  • Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
  • Text: 86463
  • http://bit.ly/2p6rntK

Episode 26 – My Courage to Tell: Facing a Childhood Bully and Reclaiming my Inner Child by Laura E. Corbeth

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses physical abuse, emotional abuse, cruelty to animals, bullying and neglect leading to PTSD.

Get the book here

If you feel suicidal call 999 immediately.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463

Episode 25 – Talking to the Secret Psychiatrist

Find out more at www.mentalhealthbookclub.com

Trigger warning: we talk about suicide, alcohol, bullying and stigma of mental health.

This episode is a little different it is our first interview and hopefully not the last with The Secret psychiatrist, working in the NHS (National Health Service) in London. We talk about stigma and cyber bullying and get an expert view on the mind.

Find out more about the Secret psychiatrist on Twitter, Facebook, Instagram or their Website.

Tell us what you think – we would love to hear from you, contact us at Twitter, Facebook, our new Instagram page or via Email.

If you need additional support with your mental health:

Call 999 immediately if you feel suicidal.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463


Episode 24 – Dialectical Behaviour Therapy Pt2

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses self-harm, suicide, drug abuse and destructive behaviours.

If you feel suicidal call 999 immediately.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463

Dialectical Behaviour therapy – notes


Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment developed by Marsha Linehan, PhD, ABPP. It emphasizes individual psychotherapy and group skills training classes to help people learn and use new skills and strategies to develop a life that they experience as worth living. DBT skills include skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Developed in the 1980’s by Dr Marsha Linehan as a result of her own practice of treating women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm, and self-mutilation in the 1970’s. After some discussion with colleagues she identified that she was treating women who met the criteria for BPD. She originally started their treatment with CBT and wanted to investigate it’s effectiveness in helping people whose suicidal thoughts were as a result of extreme pain and distress. During this time some three significant issues were found to be particularly troublesome in the treatment of these individuals:

  1. The unrelenting focus on change which is a key component of CBT felt invalidating to the individual client and so clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop out rate. And, obviously, if clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. In other words, therapists were unwittingly under the control of consequences largely outside their awareness, just as all humans are. For example, the research team noticed through its review of audio taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, or emotional withdrawal, or shame, or threatened self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they didn’t want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients – suicide attempts, urges to self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, etc, — AND have session time devoted to helping the client learn and apply more adaptive skills.

So Linehan and her research team added dialectics and validation to the standard CBT model

They added in new types of strategies and reformulated the structure of the treatment.

So, the new strategies, are known as Acceptance-based interventions, or validation strategies.

Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way.

Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal”, helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves.

The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: Clients also must change if they want to build a life worth living. Thus, the focus on acceptance did not occur to the exclusion of change based strategies; rather, the two enhanced the use of one another.

In the course of weaving in acceptance with change, Linehan noticed that a third set of strategies – Dialectics – came into play. DBT therapists and patients aim to adopt a dialectical world view, with its emphasis on holism and synthesis of opposing perspectives.

This worldview enables the therapist to blend acceptance and change in a manner that results in therapeutic movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become mired in arguments, polarizing positions, and extreme positions. Beyond the dialectical worldview, specific dialectical strategies used in session, such as the devil’s advocate technique, irreverence, and the use of metaphor can help to prevent the therapist and client from becoming stuck in the rigid thoughts, judgments, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Thus, these three sets of strategies and the theories on which they are based form the foundations of DBT.

it is now recognized as the gold standard psychological treatment for people with BPD. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders. 

Goals of DBT

To have a life worth living

Its unique to each individual – it could be music, books, horses, crafts etc

It is not a suicide prevention program and is not a way for people to stop doing behaviours that bother others

DBT helps the individual who needs it

In other words, there is hope if you feel suicidal and DBT is one of those ways to overcome those feelings

Crisis plan

I had a crisis plan that all clients had to agree to. It listed their expectations of me and what I should expect from them.

It also had the agreed goals that I wanted to achieve from therapy:

Short term:

  • practise the use of skills in everyday life e.g. at home and with friends
  • reduce impulsive behaviour e.g. spending, etoh, meds, eating and destructive expression of anger

Long term:

  • the ability to have emotions but not react impulsively e.g. expressing needs to Husband in a way that isn’t destructive
  • to experience joy and positive emotions freely without shame

I agreed to a 14 month therapy plan 2 sessions per week one therapy session and a 2.5 hr skills session. The use of the DBT crisis phone, attend all sessions, work at reduce suicidal behaviours, work collaboratively with the therapist, reduce therapy interfering behaviours such as using alcohol, drugs or attending hung over, arriving late and forgetting my homework.

Defining DBT

Dialectical – philosophy known as a dialectic which is 2 things that seem opposite to each other but in fact can both be true at the same time e.g. everyone is doing the best they can, but everyone also needs to try harder

in DBT the main dialectic is balancing acceptance with change you have to try different things to get the life you want you have to be motivated and work harder

DBT therapist is in a kind of dance understanding where you are coming from and also pushing you when they can

B is Behaviour and that is anything that can be reinforced and rewarded

Reinforcer is anything that is likely to get the behaviour to occur again

e.g. study hard get an A on your exam the A is the reinforce and you are more likely to study hard again or giving your dog a treat if he sits the treat is the reinforcer

in DBT therapists work with you to establish target behaviours

things you are working to increase and often in the beginning decrease to make your life better e.g. suicidal thoughts, self-injury, restricting meals, bingeing and purging, using drugs or alcohol, engaging in risky sexual behaviour, reckless driving, physical aggression, and shoplifting

therapy which is different to other types of therapy traditions

main goals:

  • stay alive
  • stay in therapy until you can meet your goal which is the most important and gives the individual a life worth living

DBT therapists job to know how hard it is to change and simultaneously push you to keep you moving forward

DBT therapists also believe that therapy with someone is really a relationship between equals so asking a question about their lives would mean they would more than likely just respond honestly

Therefore the work in DBT therapy is done by both of you

DBT has been and still is being researched and has been shown to be most effective with people who have difficulty regulating their emotions meaning that your life may feel a bit like an emotional rollercoaster and will help you if:

You are more effected than your friends if plans are cancelled or things don’t go your way

You cry at movies a lot or even commercials

You feel like you were born into the wrong family like you are a lion cub born into a family of house cats


Components of DBT (full DBT)

Four modes of treatment

  1. Structured individual therapy – focus on behaviours and dialectics the balance between acceptance and change. You will also be asked to do some tracking of your emotions and behaviours between sessions
  2. Skills group – 2-2.5 hrs long where you learn a new skill to manage emotions tolerate distress and have effective interpersonal relationships
  3. Skills coaching – calling your therapist to help use your skills and not engage with your target behaviours
  4. Consultation team – less obvious support each other and do the best treatment possible
  1. Individual therapy

Individual therapy typically involves weekly one-to-one sessions with a DBT therapist. Each session lasts approximately 45–60 minutes.

The individual sessions have a hierarchy of goals, including:

  • To help keep you safe – by reducing suicidal and self-harming behaviours.
  • To reduce behaviours that interfere with therapy – by addressing any issues that might come in the way of you getting treatment.
  • To help you reach your goals and improve your quality of life – by addressing anything that interferes with this, such as other mental health problems like depression or hearing voices, or problems in your personal life such as employment or relationship problems.
  • To help you learn new skills to replace unhelpful behaviours and help you achieve your goals.

Your DBT therapist is likely to ask you to fill out diary cards as homework which you can use to monitor your emotions and actions. You will be asked to bring these cards with you to your therapist each week to help you look for behaviour patterns and triggers that occur in your life. You then use this information to decide together what you will work on in each session.

Behaviour Chain analysis

It looks at your patterns of behaviour in a particular situation – something happened, then what happened next, and then this happened, then this happened, then I though this, then the problem behaviour happened, and then this happened – so you describe the chain of events

So it’s like a series of questions your Doctor might ask or you have a problem with your computer, it is refusing to print a document and you go through a problem solving process e.g. has it worked before, is it plugged in to the power, is it switched on, is the computer talking to the printer, is it out of paper

So, in DBT it’s about identifying the target behaviour (the self-harm or injury, the binge eating, the purging, the drinking alcohol, the reckless driving etc)

Then assess the controlling variables – what is it that’s causing this behaviour

Always asking what’s the function of this behaviour? (what’s keeping it going what’s reinforcing it?) but usually we don’t know even if it seems obvious because if it was obvious someone would have moved in and changed it by now

So you go through the process with an open mind to see the variables that make this behaviour happen again and again

You usually go through the situation chronologically – earlier to later and ideally the problem behaviour is three-quarters of the way through so there is stuff before the behaviour and stuff after it

Both the therapist and client work through the problem as it is the easier to repeat the chain for similar behaviours allowing the clinician and client to identify the variables that keep coming up that explains the behaviour as well as identify if there is something missing

When I was doing this with my therapist she would put it on her white board and we would draw out the events with arrows and thoughts that would pop in – it was more like we were just having a conversation about the event but we were then adding meaning to it and directionality as to what parts impacted other parts and she would validate me and my feelings

So, the chain analysis is split into five sections

  • Vulnerabilities
  • Prompting event (the thing that made the story turn)
  • The links in the chain of events
  • The problem behaviour
  • The consequences

Sometimes you will find that there are things missing – in the video that I have posted in the show notes Dr Charles Swenson talks about one of his clients that he was talking to and doing a chain analysis. They are talking about an event were the client punched the boss in the head and he asked why, and they say because they were angry. He follows this up with do I need to know this will this happen when you are angry should I get some protective gear and they were like no I am angry most of the time so that shows something in the chain analysis is missing – and the client says well he smirked at me and that’s the important prompting event and then you can look into why they have this pattern of behaviour that if someone smirks at them the deserve to be hit. Showing that sometimes the prompting event isn’t easily recognised the first time around

When with your therapist what will often happen is that the chain doesn’t get discussed directly in the form described above the vulnerability, the prompting event, the links, the problem behaviour but it will often begin with the problem behaviour

Step 1: describe the prompting behaviour

Whilst doing this you need to be:

  • Specific and detailed and not using vague terms
  • Identify what you did, said, thought, felt and identify what you didn’t do
  • Describe the behaviour as if you need someone to act out what you did
  • If the behaviour was something you didn’t do ask yourself if a) you did not know you needed to do it b) you forgot it and later it never cane to your mind to do it c) you put it off when you did think about it d) you refused to do it when you thought about it e) you were wilful and rejected doing it or some other behaviour, thoughts or emotions interfered with you doing it
  • If a or b was the cause, then move to step 6

Step 2: describe the prompting event

What was it that started the whole chain of behaviour?

  • Begin with the environment even if you don’t think it was a result of an environmental prompt possible questions to help the person get there are:
  • What exact event precipitated the start of the chain reaction?
  • When did the sequence of events that led to the problem behaviour begin? When did the problem start?
  • What was going on right before the thought of or impulse for the problem behaviour occurred?
  • What were you doing/thinking/feeling/imagining at that time?
  • Why did the problem behaviour happen on that day instead of the day before?

Step 3: describe specific vulnerability factors before the prompting event.

  • What factors or events made you more vulnerable to reacting to the prompting event with a problematic chain? Areas to examine are:
  • Physical illness; unbalanced eating or sleeping; injury
  • Use of drugs or alcohol; misuse of prescription drugs
  • Stressful events in the environment (positive or negative)
  • Intense emotions, such as sadness, anger, fear, loneliness
  • Previous behaviours of your own that you found stressful coming into your mind

Step 4: describe in excruciating detail the chain of events that led to the problem behaviour. Imagine that your problem behaviour is chained to the precipitating event in the environment. How long is the chain? Where does it go? What are the links? Write out all links in the chain of events, no matter how small. Be very specific, as if you are writing a script or play. Links in the chain can be:

  • Actions or things you do
  • Body sensations or feelings
  • Cognitions (i.e. beliefs, expectations or thoughts)
  • Events in the environment or things others do
  • Feelings and emotions that you experience

What exact thought, feeling, or action followed straight after the prompting event? Then what followed that and so on

  • Look at each link in the chain after you write it. Ask yourself if there was any other thoughts, feelings or actions that could have occurred. Could someone else have thought, felt acted differently in the situation? If so explain how they could see it differently
  • For each link in the chain ask whether there is a smaller link that you could add in and describe further.

Step 5: describe the consequences of the behaviour. Again be specific, how did the other person react immediately or later? How did you feel immediately following the behaviour? Later? What effect did the behaviour have on you and your environment?

Step 6: describe in detail at each point where you could have used a skilful behaviour to head off the problem behaviour. What key links were the most important in leading to the problem behaviour. If you eliminated these behaviours, the problem behaviour probably would not have happened.

  • Go back to the chain of behaviours following the prompting event. Circle each link where if you had something different, you would have avoided the problem behaviour.
  • What could you have done differently at each link in the chain of events to avoid the problem behaviour? What copy behaviours of skilful behaviours could you have used?

Step 7: describe in detail prevention strategy for how you could have kept the chain from starting by reducing your vulnerability to the chain.

Step 8: describe what you are going to do to repair important or significant of the problem behaviour.

  • Analyse: what did you really harm? What was the negative consequences you can repair?
  • Look at the harm or distress you actually caused others, and harm or distress you caused yourself. Repair what you damaged, e.g. you broke a window and you bring them flowers – fix the window. Repair a betrayal of trust by being very trustworthy long enough to fit the betrayal, rather than trying to fix it with love letters and constant apologies. Repair failure by succeeding, not by berating yourself.






Diary card

In between the sessions I would be asked to keep a diary card which I have added an example in the show notes which would help me, and my therapist see how my week had been. I would record my urges giving it a rating between 1 and 5 (1 being the least and 5 being the highest urge) to self-harm, suicide, and use alcohol/drugs. I would also rate my emotions and my vulnerabilities so if I was in pain, sad, shame, anger and fear. I also identified some problem behaviours for me it was spending, drinking and taking alcohol and rate those on urges again 1 – 5. I then would identify if I followed through on my urges e.g. did I self-harm or did I drink, or did I take alcohol. The last section identified if I felt joy and if I used skills on a 0 – 7 scale.

And what it means by skills is if I was applying the skills I learnt from skills training ro actual life.

0 – did not even think about using skills

1 – thought of using skills but did not (did not want to)

2 – thought of using skills but did not (although wanted to)

3 – tried skills (but could not use them)

4 – tried skills (but it did not help)

5 – tried skills (and it helped)

6 – used skills (but it did not help)

7 – used skills and it helped

It also asked if I wanted to quit therapy – which would be always addressed first in a one on one therapy session

Indicate my confidence of controlling my emotions, behaviours and thoughts

If I used the DBT phone (which they would have a report about)

Did I attend the skills session this week?

On the back of the card it had a list of the skills and then I could indicate I had tried and worked on the different skills

Skills training in groups

In these sessions DBT therapists will teach you skills in a group setting. This is not group therapy, but more like a series of teaching sessions. There are usually two therapists in a group and the sessions typically occur every week. The room is sometimes arranged like a classroom where your skills trainers will be sat at the front. The aim of these sessions is to teach you skills that you apply to your day-to-day life.

There are typically four skills modules:

  1. Mindfulness – a set of skills that help you focus your attention and live your life in the present, rather than being distracted by worries about the past or the future. The mindfulness module may be repeated between modules and sessions may often start with a short mindfulness exercise. (See our pages on mindfulness for more information.)
  2. Distress tolerance – teaching you how you can deal with crises in a more effective way, without having to resort to harmful behaviours such as self-harm.
  3. Interpersonal effectiveness – teaching you how to ask for things and say no to other people, while maintaining your self-respect and important relationships.
  4. Emotion regulation – a set of skills you can use to understand, be more aware and have more control over your emotions.

In these group session you may be asked to do group exercises and use role-play. You are also given homework each week to help you practise these skills in your day-to-day life. By completing the homework weekly, you might find that these skills gradually become second nature and you become better at dealing with difficult situations.

When I did each of these modules where 8 weeks and new people would join the group after each block and others would “graduate” from skills training.

Those 8 weeks were split into 2, the first two weeks focused on mindfulness which is a core module and then 6 weeks on one of the additional modules, interpersonal effectiveness, emotion regulation and distress tolerance.

Each of the modules had handouts – each person was given a skills handbook which I still have and have purchased the second edition (link in the show notes)





What is mindfulness?

Simply means awareness – awareness of what’s happening as it’s happening both in the inside world and the outside world. It comes from a very ancient word, but it’s probably easiest to understand if you think of its opposite mindlessness. Mindlessness – where you keep forgetting to do things, you don’t listen properly, you’re not attending properly, the world is going by without you really being there for it or here for it and mindfulness is the awareness that emerges when you make a decision to train your mind, to some extent, to check in more often to how things are.

It’s a way of living awake, with eyes wide open.

It’s a set of skills, mindfulness practice is the intentional process of observing, describing, and participating in reality non-judgmentally, in the moment and with effectiveness

Why does DBT use mindfulness

A characteristic of BPD is people’s inability to regulate their emotions (emotion dysregulation) and things that may seem trivial for some can be extremely triggering for someone with BPD because of judgements we make about situations and what others are thinking.

I found this fantastic example on the cognitive behavioural Los Angeles website: http://cogbtherapy.com/cbt-blog/mindfulness-in-dbt

e.g. you are a shop assistant at a clothing shop and you like the part of the job where you like interacting with customers, you like clothes and you like the working environment. But there is one part of the job that you don’t like is folding jeans (for me I loved folding jeans!) it’s boring but you need to do it for a part of your day but as you are folding the jeans your mind starts to wonder and you start making negative judgments about everything like your job sucks, this is stupid, this is a waste of time etc.

Rather than spending the time focusing on folding the clothes, your mind is busy telling all kinds of disturbing stories about this task, and will likely trigger emotions such as anger, resentment, even despair and as a result it impacts your emotions for the rest of the day. Another aspect of BPD is this issue were certain emotions can linger for a long

What’s worse, these emotions have a way of impacting the rest of your day. Now instead of tolerating 30 minutes of an unpleasant chore, you spend the whole day in a foul mood, judging all aspects of your job negatively, feeling worse every minute. Because being in a bad mood for most of the day, more days than not, is very unpleasant, you start having judgments about your mood, thinking, “I can’t take this anymore.” So, what started out as a relatively insignificant thing has caused a lot of suffering.

A mindful approach to this dilemma would be to approach the unpleasant task in the spirit of acceptance, willing to engage in it without engaging in a lot of judgments about it. The moment you notice a judgment, your turn your mind to folding the clothes, aware of the sensation of the fabric against your fingertips. Noticing the movement of your arms. Describing the smell of the new fabric as it reaches your nose in waves. By fully engaging in the task, repeatedly turning the mind to it, there is little room for negative attributions. You may now even find it to be a calming, soothing activity. This is one-way mindfulness can help avert an emotional downward spiral.

Mindfulness can help us to make the best decisions because we can get into the wise mind which I will talk about shortly. But because people with BPD have often grown up in an invalidating environment with people around you constantly telling you that what you are feeling is wrong you start to question everything. You don’t believe how you are feeling about situations e.g. someone has said that you did a good job and instead of taking that as a positive you think they are lying, they are just saying it because that’s what people do, they don’t really mean it and so you get angry instead of feel pride for a job well done. Or you are upset about someone who told you that it was time to stop dressing like a student even though you had been wearing trousers and blouses to work. You feel offended because you had tried really hard and you tell someone that it upset you and they say it’s something to not get upset and sad about and you believe them. Over time you start to lose who you really are and no longer believe your own emotions and what they are telling you. People who have become really good at being a self-invalidator you start to live lives that are inconsistent with your own values and dreams if at this point you still have them! They don’t find it important when their needs are being sacrificed for those of someone else. All of this results in people who do not do what is best for themselves, which is a hard way to live life. As a result, they are unhappier, and thus more prone to becoming emotionally dysregulated.

Mindfulness can help with that emotional dysregulation by way of helping to relinquish the struggle with painful emotions. One of the reasons people develop emotion dysregulation is because they try to quash or control their emotional responses to things. This just doesn’t work – I know this intimately because I spent years and years just trying to control my anger and then when I failed to control it then I would end up feeling shame and guilt and then more anger, so I was kind of stuck in this cycle.

Mindfully experiencing emotions is the opposite of the control strategy. With mindfulness, you simply observe what comes up with the emotion.

In skills training mindfulness covered seven skills in three sets:

  • Wise mind
  • What skills of observing, describing and participating
  • How skills of non-judgmentally, one-mindfully and effectively

Wise mind

So, wise mind is one of the three states of mind: wise mind, emotion mind and logical mind. Wise mind us the inner wisdom that each of us have, when we access this we can say that we are in wise mind. Wise mind consists of emotion mind and logical mind and the integration of them together. So imagine this all in a venn diagram which are two overlapping circles, emotion mind is in one circle, logical mind in the other circle and that interlocking section in the middle is the wise mind.

For people with BPD we tend to get stuck in emotion mind, and particularly for me the logical mind is no-where to be seen so I had to do a lot of work to try to develop a wise mind approach to different situations.

What skills in mindfulness

These are the skills that you employ whilst doing mindfulness you observe, you describe and participate. You do each of them one at a time.

Observe: pay attention on purpose to the present moment that you are in

Describe: you put the observations into words – example describe what it’s like to record the podcast.

Participate: to fully engage in the activity, become immersed in whatever you are doing

How skills in mindfulness

These skills are related to the what skills, how do you do the what skills of observe, describe and participate, you do that non-judgmentally, one-mindfully and effectively. Unlike the what skills that you practice one at a time (although you could argue that observe and describe have a lot of overlap) you practice the how skills all at the same time.

Non-judgmentally: stick to the facts, don’t evaluate if what you are observing describing or participating in are good or bad, accept each moment, acknowledge the difference between what is helpful and harmful, safe and dangerous but don’t judge those thoughts, acknowledge your values, wishes, emotional reactions but don’t judge and when you find yourself judging yourself, don’t judge your judging

One-mindfully: rivet yourself to now, be completely in the present moment, one thing at a time like right now I am doing this podcast, notice if your mind wants to be only half-present, and the want to be somewhere else physically or mentally, the desire to do something else acknowledge that thought and then come back to one thing at a time. The mind will wonder. Let go of distractions if things are distracting you keep going back to what you are doing again and again. Concentrate your mind if you find yourself doing two things at once go back to one thing at a time.

Effectively: be mindful of your goals in the situation and do what you need to achieve them, focus on what works e.g. don’t let emotion mind get in the way) play by the rules, act as skilfully as you can, do what is needed for each situation and not what you wish it to be, the one that’s fair or the one that’s more comfortable. Let go of wilfulness (the barriers that you put in place to stop you being effective, deciding not to use skills because it is just too difficult to use them) and not choosing to do something that may achieve your goal.

There are several apps that you can download to your phone to practice mindfulness.

Interpersonal effectiveness 

The idea of interpersonal effectiveness skills will help you to maintain current relationships and help you develop new relationships and deal with conflicts that occur in relationships. Interpersonal effectiveness gives you the skills to be able to effectively communicate with others your own needs.

So, the main aims of this module are to:

Be skilful in getting what you want and need from other people

Build relationships and end destructive relationships

Walk the middle path (maintain relationships)

You learn about the things that get in the way of you being interpersonally effective such as not having the skills, not knowing what you want, emotions are getting in the way etc.

As part of this module you learn the skills of DEAR MAN, DEAR GIVE, DEAR FAST and it will help you to identify which situation the skills would be most important and effective





(Stay) Mindful

Appear Confident


Describe: the situation that you are in stick to facts and tell the other person exactly what you are reacting to

Express: your feelings or opinions about that situation – the other person doesn’t know what you are feeling

Assert: what it is that you need so ask for what you want or say no clearly. Again, don’t assume others know what it is that you want

Reinforce: or reward the person ahead of time by explaining the positive effects of getting your needs met, at this point you could also identify the negatives if you don’t get what you need.

(Stay) Mindful: stay focused on your goal and employ the broken record if needed e.g. you keep asking or you repeatedly say no

Ignore attacks so if the person tries to attack you change the subject, ignore the threats, comments and attempts they are making to get you to say yes or ignore you needs. Don’t respond to those attacks (which is easier said than done) ignore any distractions and keep making your point.

Appear confident: use a confident voice, confident body language eye contact

Negotiate: be willing to give a little to get what it is that you are asking for, offer other solutions, if the other person thinks they will not met your need then reduce what you are asking (but don’t give everything e.g. there is a certain time I expect to see my husband come through the door and he didn’t and didn’t tell me I asked if he could call and he said no just assume that I am never going to be home by a particular time). You can always ask the other person what they could do to help met your needs.

Example: I went to the fridge to find that you had used all the milk. This really embarrassed me as I had offered our guest a hot drink and couldn’t deliver it. I would really like it if you could tell me when you finish the milk, or the milk is getting low and we need more. That would really be appreciated and would make me less frustrated with you if you did that. Thank you.

DEAR MAN, GIVE skills if you want to maintain the relationship

 (be) Gentle

(act) Interested


(use an) Easy manner

(be) Gentle: no attacks (no expressing anger), no threats (don’t describe painful consequences), no judging (if you loved me you would x) and no sneering (eye rolling, smirking, etc.)

(act) Interested: listen to the other persons point of view, don’t interrupt, use body language that shows you are listening e.g. leaning forward, eye contact etc.

Validate: using both words and actions show that you understand and empathise with the other person about the situation

(use an) Easy manner: smile! Use humour, soft voice

DEAR MAN, FAST skills to maintain your self-respect

(be) Fair

(no) apologies

Stick to values

(be) truthful

(be) Fair: fair to yourself and the other person, validate your own feelings and wishes as well as the other person

(no) apologies: don’t over apologise about your opinion, about your request, about disagreeing

Stick to values: don’t sell out what you believe

(be) truthful: don’t lie don’t act helpless, don’t exaggerate or make up excuses

Emotion regulation

The goal of this module is to reduce the emotional suffering an individual is suffering from. The key message is that even though emotions can be difficult particularly for people suffering from BPD they are actually important and have a function to play in our daily lives. One thing I wanted was to get rid of my emotions which is not the one of the goals of this module.

What happens is that it gives people the skills to be able to regulate emotions that you want, not regulate emotions that other people tell you that you should and reduce the intensity that those emotions are felt.

In terms of the chain analysis emotion regulation can help you in reducing the vulnerabilities that you may be experiencing, which in turn helps your emotions to not become painful and increase your resilience to emotions. By this DBT skills help you to reduce the peaks of emotions that you feel and then help you to recover from extremes of emotion.

This module requires you to use core mindfulness skills particularly non-judgmental stance and observations and helps you then to be able to describe those emotions.

For me the only emotion I could feel and recognise was anger but not everything is anger sometimes it was sadness coming out as anger. Or shame coming out as anger. This module takes you back really to the beginning of your understanding of emotions because unless you know what the emotion is you cannot effectively regulate it.

So this module takes you through 8 key emotions, anger, disgust, envy, fear, happiness, jealousy, love, sadness, shame and guilt.

DBT skills teaches you a model of how to describe emotions and how to then put a name to that emotion, it talks you through the prompting events, your vulnerabilities because there are things that can impact how you deal with emotions, the biological changes in the body that emotions can cause, e.g. how changes in the brain impact your nervous system with the unconscious increase in heart rate and temperature and the body sensations that accompany the emotion and how that links in with how you then express that emotion in body language, words and actions. At that point you have a better understanding as to what the emotion is and then can name it but there is a possibility that you are expressing a secondary emotion rather than the primary emotion. E.g. when I express anger and in reality, its sadness or fear.


You had wanted to go out with friends but they have all cancelled, your start to feel your heart rate increasing, your temperature rising, your muscles tightening, your fist clenching, your teeth clamping together and tension in your jaw. Resulting in your shouting at the people who have let you down = anger but underlying that you are sad, you blame yourself for the friends cancelling, your irritable and grouchy and you are seeing the world in a negative light.

So when you feel the emotions you are taught to be able to change those emotions by checking the facts, does your emotion match the situation are you making assumptions about why everyone has cancelled? Is that really the case?

If you have identified that your emotion is not aligning with the facts – you are to blame but everyone has the flu which has been going around – your anger is not fitting in or isn’t effective, I mean being angry at people who are sick isn’t going to help. So, you decide to use opposite action skills, you do the opposite to what you feel like doing and that will change your emotion.

If the facts are the problem, as in say someone has said that they would be somewhere at a certain time and they turn up three hours later than the issue is that the person turned up three hours late and hasn’t acknowledge the issue. When using problem solving you realise that you would benefit by using your DEAR MAN skills to tell them that you are both sad and angry that the person was late and hasn’t apologised and that you would appreciate that apology. As a result of approaching the problem with this solution then it will help you to reduce negative emotions.

The other part of this module is strategies that will help to reduce your vulnerability in everyday life, particularly when you are in emotion mind by using the acronym ABC PLEASE.

A – accumulate positive emotions which is split into 2 – short term and long-term. Short term do pleasant things that you can do right now and long-term make changes in your lifestyle maximizing the positive events occurring

B – build mastery, do things that make you feel successful and competent as that helps with making you not feel helpless and hopeless and for me completely useless

C – Cope ahead of time with emotional situations rehearse and plan ahead for emotional situations and the best way for you to deal with it. I spent a lot of time practicing certain skills such as DEAR MAN and ways to change my emotions when they were not supported by the facts.


These skills are teaching you to look after your mind by taking care of your body. Most people identify that emotions are more difficult when you are sick, or if you haven’t had enough sleep and this is what the PLEASE skills address, so PL is treat (p)hysica(l) illness, balance (eating), (altering) avoid mood-(a)ltering substances, get (e)xercise

Distress tolerance

In distress tolerance the idea is to help the client gain the skills needed and the ability to survive times of crisis without making things worse e.g. when I would have an overload of emotions I would self-harm, drink, take OTC medication etc.

This module is important because of two things.

  1. Pain and distress is part of everyday life unfortunately. There are times that everyone will feel overwhelmed and so dealing with those in a non-destructive way will improve the person’s life. If you don’t accept that fact that this will increase the clients suffering.
  2. Developing distress tolerance is important when you are trying to change your behaviour because pain and suffering can hinder your ability to change behaviours

This module comprises of two main strategies, crisis survival skills and reality acceptance or radical acceptance skills.

So, in crisis survival you are taught STOP skills, pros and cons of behaviours, TIP your body chemistry, distract with wise mind ACCEPTS skills, self-soothe with the five senses and improve the moment that you are in.

STOP skills

S: STOP don’t just react stay in control regardless of what your emotions are trying to get you to do on impulse.

T: Take a step back, take a break if you need to, take a deep breath and think about your next step hold back the impulsivity

O: Observe, and notice what is happening inside and outside of your body, observe what is happening in the situation you are in.

P: proceed mindfully, take charge and decide what you plan to do next and act with awareness not just on auto-pilot where you can get carried away with your emotions. What is going to make the situation better or worse?

Pros and cons are used when you have a decision to make about two different options, what are the pros and cons of the situation if you act on your urges that are being governed by your emotions and what will happen if you don’t act on that urge.

TIP skills – changing your body chemistry (new skill I didn’t do this one)

T: Tip the Temperature of your face with cold water helps you calm down fast

I: Intense exercise helps to calm the body when it is revved up by emotion.

P: paced breathing – breath deep in the belly, slowing down the breath, breathing out longer than in

P: paired muscle relaxation – whilst breathing into your belly, tense your body muscles, notice the tension in your body, while breathing out say the word relax in your mind and let go of the tension and feel the difference in your body

Distracting skills


Activities: watching tv, doing a jigsaw, listen to music, exercise, play sports, go out, play cards, crosswords or word searches

Contributing: volunteer, help friends or family, surprise someone, give things away, call someone

Comparisons: compare your feelings now to another time when you felt different, think of those coping the same as you or less than you, compare to others less fortunate

Watch reality shows about other’s problems (I found this the most difficult as I would use it as a way to tell myself of and invalidate my own feelings.)

Different Emotions: read emotional books or tv shows, or listen to emotional music

Pushing away: push the situation away for a period of time, mentally leave the situation, notice ruminating and yell no, refuse to think of the painful situation

Other thoughts: count to ten, count colours in a painting or a poster or outside, watch tv or read

Other sensations: squeeze a ball, listen to really loud music, have a hot cold shower

Self sooth using the senses

Taste: eat your favourite food, chocolate, drink coffee, tea hot chocolate, eat your favourite childhood food, add some spice to your food

Touch: have a hot bath, or shower, pet your dogs/cats, have a massage, stroke a fluffy pillow, hug someone, feel your worry stone

Hearing: listen to music, listen to an open fire, nature sounds, hum, sing to your favourite songs

Smell: nice smelling candles, bath bombs, spritz aftershave or perfume, coffee, the smell of a book, fresh air in the countryside

Vision: buy a beautiful flower, go to a scenic spot and observe, watch a sunrise or sunset, watch your dog’s playing

Reality acceptance

Split into radical acceptance, turning the mind, willingness, half-smile and willing hands and allowing the mind: mindfulness of current thoughts.

So, there are certain things in life that we just have to accept because we cannot change it such as things that you have done in the past, and that can cause pain if we keep thinking about it and going back and telling ourselves off.

Radical acceptance: is accepting something all the way, accepting it in your heart, mind and body. When you accept the reality and stop fighting against it because reality is not what you want it to be then it will just continue to cause you pain.

There are several things that need to be radically accepted: reality is as it is the facts of the past and present are what they are regardless of whether you like it or not. There are always limitations on the future not only for yourself but for everyone. There is always a cause to every situation that can cause pain and suffering. Life can be worth living even with painful events in it.

I was diagnosed with MS during the time I was going through DBT and radical acceptance was a key to helping me deal with my discomfort. So, I have RRMS, what does that mean, the uncertainties, the realisation that as a result of the illness I probably wouldn’t be accepted for permanent residency, would I be able to continue work? All these questions in my mind at the same time as hoping that they got it wrong, but usually MS is diagnosed only when everything else has been ruled out. I have spoken in other podcasts about when I arrived back in the UK how each time when I changed NHS trust areas that they would say no its wrong. So, I had to radically accept the situation, this was just the situation I was in, it wasn’t going to change, and my life would be unpredictable.

There are many reasons why accepting reality can prove beneficial to the individual going through DBT.

  • Rejecting what is happening wouldn’t change the fact that I had RRMS
  • The way for me to deal with the situation I was in would only happen if I accepted it e.g. accept that there are times when I am exhausted and may need extra rest
  • Pain can’t be avoided it tells us something important, the reason why I got diagnosed was because I was experience a change in the way my body felt and ignoring wouldn’t have changed the reality that I was sick
  • Rejecting the fact that I had MS would have just caused me more suffering – don’t get me wrong that is not easy to do
  • Refusing to acknowledge the situation would just keep you stuck, angry, bitter shame, guilt
  • Acceptance may lead to sadness, but calmness often follows

As I said this is not always the case there are times when I wish things were different, that I have hope that they got it wrong but then I need to turn the mind, in DBT we are told to imagine a fork in the road or if you are British a t-junction, you have two choices, acceptance or rejection. You have to purposefully turn your mind to acceptance to keep you on the path to radical acceptance.


As part of acceptance you have to be willing to participate in your world. So you must have the right attitude when approaching life. So going back to the MS example I had two options I could fight against the diagnosis, and ignore anything was wrong get really distressed when I couldn’t continue and then retire to my bed hide under the duvet and refuse to live my life, or I could choose to acknowledge what was happening, change some of the things I was doing to allow myself to be able to better deal with my condition, take my medication and face the world. If I was being wilful which at times I certainly was I would have just given up and felt out of control.

Half-smile and wiling hands

These are both techniques to accept reality with your body.

Half-smile is where you relax your face, neck and shoulders and slightly raise the corners of your mouth and adapt a relaxed facial expression as a way to accept reality. Our emotions can be partially controlled by our facial expressions and can give people some control over the emotion they are feeling.

Willing hands are similar to half smile but were clenched fists and hands can influence your feelings of anger if you are able to relax your hands, arms and shoulders then you send the message to your brain and is a way of you doing the opposite to what you might be feeling.

Dealing with addiction (new part of skills)


D: Dialectical abstinence

C: Clear mind and Community reinforcement

B: Burning bridges and building new ones

A: alternate rebellion and adaptive denial

Dialectical abstinence is the blending together complete abstinence and harm reduction, whilst not doing the harmful behaviour there are going to be times when you slip up and so then the aim would be to minimise the damage you have been doing.

e.g. drinking whisky because I wanted to be numb, but I chose alcohol I didn’t like to try to make me not repeat the behaviour.

Clear mind is similar to wise mind but comprises of addict mind and clean mind combining the memory of addict mind and the fact that you are clean again having the knowledge that relapse is not impossible but that it is not inevitable.

Community reinforcement, being in certain situations will make it more difficult for you to make the best decision, e.g. continuing to be friends with your drug dealer, or going to a bar to socialise if you have an issue with alcohol but to have a compromise and find other ways to ensure that your lifestyle is more rewarding than your past addictive behaviours.

Burning bridges is you accepting that you will not engage with the addictive behaviour ever again. As previously stated you get rid of the things that will enable you to full back into addictive behaviours. E.g. tell your friends that you are quitting.

Building bridges helps you to deal with cravings that you may get by changing the image and smell opposite to the thing you are addicted to.

Alternative rebellion if one of the reasons for your addictive behaviour is to push back against what is expected, or as a way to combat boredom then try other things to use as a rebellion that is not so destructive such as: shaving your head, unmatched shoes, dye hair a wild colour – I went purple, dress up or down, get a tattoo (I got two), so many other things you can do.

Adaptive denial is when you cannot get rid of the urge and craving for the addictive behaviour you can try to change that behaviour for another one e.g. urge to have alcohol, have something sweet or savoury. Or try to put of the behaviour, so at the moment I am struggling once again with binge eating so I am taking it 5 minutes at a time, and I have increased it to 30 minutes at a time if I can keep putting it off it means at that time I can cope at this time and each subsequent time and slowly I will get to the point when I know I don’t want it.   

DBT skills session format

First half review everyone’s homework


Mindfulness practice

Skills session

Telephone crisis coaching

DBT often uses telephone crisis coaching to support you in using new skills in your day-to-day life. This means that you can call your therapist between your therapy sessions when you need help the most, such as in the following situations:

  • When you need help to deal with an immediate crisis (such as feeling suicidal or the urge to self-harm).
  • When you are trying to use DBT skills but want some advice on how to do it.
  • If you need to repair your relationship with your therapist.

However, you can expect your therapist to set some clear boundaries. For example, calls are usually brief and the hours that you can call them will be agreed between you and your therapist. They may also agree some other rules with you where, in particular circumstances, you may be asked to wait 24 hours before contacting your therapist.


How effective is DBT

There has been a large amount of research on the use of DBT in the treatment of BPD which was at one point identified as a mental health condition that was untreatable. DBT is now the gold standard for the treatment of BPD, with evidence showing a decrease in deliberate self-harm, and an increase in reported quality of life which I can personal vouch for is that without DBT I don’t think I would be here. I was part of a study performed in the Hunter and whilst speaking with my therapist at the time she identified that she thought that I would have responded well to the control therapy because I was so motivated.

A systematic review and meta analysis of a reseach study about the efficacy of DBT showed that there might be some bias in terms of publication bias (results with less favourable outcomes not published) and inflation of results by bias (which is tried to be controlled for on RCT) in the result reported and that when people where followed up that the results were unstable.






Episode 23 – Dialectical Behaviour Therapy Pt1

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses self-harm, suicide and destructive behaviours.


If you feel suicidal call 999 immediately.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463

Book 13 – In my Heart: A book of feelings by Jo Witek and illustrations by Christine Roussey

Sometimes my heart feels like a big yellow star, shiny and bright.
I smile from ear to ear and twirl around so fast,
I feel as if I could take off into the sky.
This is when my heart is happy.
Happiness, sadness, bravery, anger, shyness . . . our hearts can feel so many feelings! Some make us feel as light as a balloon, others as heavy as an elephant. In My Heart explores a full range of emotions, describing how they feel physically, inside. With language that is lyrical but also direct, toddlers will be empowered by this new vocabulary and able to practice articulating and identifying their own emotions. With whimsical illustrations and an irresistible die-cut heart that extends through each spread, this unique feelings book is gorgeously packaged.

Book 12 – Finding Audrey by Sophie Kinsella

From the bestselling author of the Shopaholic series comes a story of humour, heart and heartache. Finding Audrey is Sophie Kinsella’s first novel for teens, sure to appeal to her legions of adult and young adult fans all over the world.

Audrey can’t leave the house. she can’t even take off her dark glasses inside the house.

Then her brother’s friend Linus stumbles into her life. With his friendly, orange-slice smile and his funny notes, he starts to entice Audrey out again – well, Starbucks is a start. And with Linus at her side, Audrey feels like she can do the things she’d thought were too scary. Suddenly, finding her way back to the real world seems achievable.

Be prepared to laugh, dream and hope with Audrey as she learns that even when you feel like you have lost yourself, love can still find you . . .

I think it is a good portrayal of mental health issues but there are certain things that are a bit strange – her almost immediate love for Linus and her mother’s behaviour general but I think that is meant to be humorous

Book 11 – My Courage to Tell: Facing a Childhood Bully and Reclaiming my Inner Child

It was more than sibling rivalry.
“This is a story about hope, resilience and strength for anyone experiencing psychological abuse.

Laura really does something incredible with this book. She finds the strength and courage to tell a story about abuse – a story that will be all too familiar for millions of men and women – a story that often never gets told. She shines a spotlight on an area that demands our attention. Her brave account of suffering psychological abuse at the hands of an older brother, under the watchful eyes of her mother, is heartbreaking, riveting and empowering. It is a story that needs to be told.”

Dr. Anita Federici, Clinical Psychologist (Foreword)

My Courage to Tell
My Courage to Tell is the story of one woman’s struggle to overcome a childhood of abuse at the hands of her cruel, bullying brother. Memories of this abuse remain deeply buried until an Aunt dies in Manhattan, leaving an estate Laura Corbeth must settle with her estranged brother. As she tries to administer the estate, Laura is plagued by symptoms of post-traumatic stress. Suppressed memories start to rise to the surface.

Laura begins to remember, and to face, a childhood of psychological and physical abuse. No cuts. No bruises. No scratches. Her brother was sly, constraining her to spit in her face, lick her or perform tickle torture. He took pleasure in dominating her and playing on her fears – relishing his control over his younger sibling. His lies and manipulations terrified her. Witnessing his torture of animals, left no doubt in Laura’s mind that her tormentor would follow through on his threat that he would kill her if she told.

And, where were her parents? Rather than investigating Laura’s deteriorating situation, they believed their son’s continuous lies as he denied his abuse of Laura. When they did catch glimpses of their son’s cruelty, they put it down to sibling rivalry. But it was not sibling rivalry. It was ruthless, relentless, psychological and physical abuse. And, by not dealing with it, her parents were complicit. Unheard, unprotected, Laura was completely on her own. My Courage to Tell is one of the first memoirs to shine a light on abuse from a sibling’s perspective. It also reveals how families that buy into the lies and manipulations, ignore the problems and stonewall, enable the abuser and foster mental illness.

Travel with Laura as she uncovers her past, finds the help and courage to face that past and ultimately confronts her abuser and her family.

“Psychological and emotional abuse (terms I use interchangeably) are often misunderstood, minimized, or ignored. Over the past decade alone, there have been substantial advances with respect to identifying, preventing and treating those who have suffered sexual and physical abuse; however, there has much less attention to identifying and addressing psychological abuse.

My Courage to Tell makes the invisible visible. Reading Laura’s account of healing and recovery is inspirational and is an outstanding contribution to the literature on psychological abuse in families. Her willingness to confront and share the scary and painful reality of her childhood and detail how various treatment interventions allowed her to work through distressing memories, emotions, and beliefs will pave the way for others who recognize themselves in Laura’s story.

Episode 22 – Etched on me by Jenn Crowell Part 2

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses self-harm, suicide and  sexual assault.

Get the book here

If you feel suicidal call 999 immediately.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463

Patreon Episode 1 – Becky’s Struggles with Mental Health

This is the first patreon only episode of the Mental Health Book Club Podcast, were the full interview is avaliable. You will only be able to do that by being an extremley awesome person and heading over to patreon.com/MHBC and donating as little as $2 a month to the Mental Health Book Club Podcast.

By becoming a patron of the podcast you will be able to have some additional perks which we will add to over time. There are three levels of support that you can provide, bronze, silver and gold.


  • Access to the Patron-only feed with early release episodes
  • We will announce your name on an upcoming episode as a contributor
  • Eligable for giveaways


  • A handmade crochet book mark (by Sydney and Becky)
  • Plus all previous rewards


  • Priority book recommendations
  • Your emails are given priority
  • Plus all previous rewards

Once we hit some monthly goals – $200 we will donate $50 a month to Mind the mental health charity.

If you are not able to support us through patreon thats okay, just listening to the podcast makes us very happy. But there are some things you can do to offer us additional help, you can following us on Twitter, Facebook, by Email, Subscribe to the podcast, Leave us a review or just tell people about us. All of those will help to spread the MHBC podcast word.

Episode 21 – Etched on me by Jenn Crowell Part 1

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses self-harm, suicide and  sexual assault.

Get the book here

If you feel suicidal call 999 immediately.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463

BBC documentary: No more boys and girls: Can our kids go gender free?

Unfortunately this program is no longer available but here is an interesting article discussing the key themes of the documentary.


Episode 20 – Our thoughts on The Quiet Room and Made You up

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses self-harm, violent behaviour, sexual assault,  drug abuse and suicide.

Get the book here

If you feel suicidal call 999 immediatly.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463

Episode 19 – The Quiet Room: A Journey Out of the Torment of Madness by Lori Schiller and Amanda Bennett

Find out more at www.mentalhealthbookclub.com

Trigger warning: this podcast discusses self-harm, violent behaviour, sexual assault,  drug abuse and suicide.

Get the book here

If you feel suicidal call 999 immediatly.

Smaritans on:
116 123 (UK)
116 123 (ROI)
Find out more at their website http://bit.ly/2wMpKZ5

Mental Health Resources:

Rethink Mental Illness
0121 522 7007

Mind The Mental Health Charity
Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
Text: 86463

Mental Health Book Review: Am I Normal Yet by Holly Bourne

Our Review

Overall rating:

Am I Normal Yet is a breath of fresh air talking openly about the issues surrounding mental health. Evie suffers from OCD and at sixteen not only does she have to fight with her own mental health but she has to deal with the inevitable teenage issues of college, friends and boys and let’s be honest being a teenager is hard enough without the additional issues Evie has to face.

This book has a strong theme of feminism running throughout and didn’t end in the very clichéd love conquers all view of the world that some books I have been reading recently have contained. If only recovering from mental health was so easy, dating and having another person in your life will often complicate matters and make you feel even more insecure than you may have been before.

You get to see the ups and downs associated with mental illness and the issues associated with medication and therapy, along with concerns about others reaction to a mental health diagnosis.

It is also interesting to read about the fact that the condition that Evie is suffering from can be considered “typical OCD” with Evie performing the stereotypical repetitive behaviours being commonly seen with OCD, doesn’t mean that it is any less severe and debilitating to a person’s life.

I must admit there was one part of the book I disagreed with as yes not all discussion about mental health has been useful that what it is doing is highlighting that more public discussion is needed. I would like to remain hopeful that if people were fully away of mental health conditions and their impact that they wouldn’t be using the terms incorrectly if their knowledge of the condition was complete.


Mental illnesses have gone too far the other way. Because now mental health disorders have gone “mainstream”. And for all the good it’s brought people like me who have been given therapy and stuff, there’s a lot of bad it’s brought too. Because now people use the phrase OCD to describe minor personality quirks.

“Oooh, I like my pens in a line, I’m so OCD.”


I think that people have been mislabelling themselves as being OCD for years, long before mental health illnesses started to become more widely accepted in society’s broader conversation.

We at the Mental Health Book Club would highly recommend this book.

Listen to our full review in Episode 17

Episode 18 – Obsessive Compulsive Disorder

Trigger warning: this episode contains discussion about suicide and self-harm.

Get the next book here

If you feel suicidal call 999 immediatly

If you need to talk you can contact:

Smaritans on

Mental Health Resources:

Rethink Mental Illness

Mind The Mental Health Charity:

  • Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
  • Text: 86463
  • http://bit.ly/2p6rntK

Obsessive Compulsive Disorder


Imagine that your mind gets stuck on a particular thought or image (which is the obsessive thought)

Then this thought or image gets constantly replayed in your mind, over and over and over again no matter what you do . . .

It’s not like you want these thoughts – it feels like an avalanche, its overwhelming . . .

Along with these thoughts you start to have intense feelings of anxiety . . .

Anxiety is a normal emotion that people feel because this emotion tells you to respond, react, protect yourself and do something to reduce that anxiety. It’s our brain’s warning system indicating that you’re in danger.

But this can cause confusion because on one hand, you recognize the fear you are feeling doesn’t make any sense, it’s not reasonable yet it feels real

But your brain is lying to you causing you to question why this would be happening?

Why would you be experiencing feelings if they weren’t true? Feelings don’t lie . . .



  • Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
  • Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
  • Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.
  • Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colours, or arrangements.
  • Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.


Unfortunately, if you have OCD, they do lie. If you have OCD, the warning system in your brain is not working correctly. Your brain is telling you that you are in danger when you are not.

When scientists compare pictures of the brains of groups of people with OCD, they can see that on average some areas of the brain are different compared to individuals who don’t have OCD. Those tortured with this disorder are desperately trying to get away from paralyzing, unending anxiety.


It becomes a vicious cycle:



How many people are affected?


  • There are literally millions of people affected by OCD
  • It’s the fourth most common mental illness in many western countries
  • It affects men, women and children regardless of their race, religion, nationality or socio-economic group.

United States

  • Best estimates for the USA are about 1 in 100 adults – or between 2 to 3 million adults currently have OCD.1,2
  • This is roughly the same number of people living in the city of Houston, Texas.
  • There are also at least 1 in 200 – or 500,000 – kids and teens that have OCD.
  • This is about the same number of kids who have diabetes.
  • In terms of at school:
    • Four or five kids in any average size elementary school will have been diagnosed with OCD.
    • In a medium to large high school, there could be 20 students struggling with the challenges caused by OCD.3


United Kingdom

  • Current estimates suggest that 1.2% of the population have OCD, which equates to 12 out of every 1000 people
  • Therefore, it can be considered that, approximately 741,504 people are living with OCD at any one time.
  • 50% of all these cases will fall into the severe category, with less than a quarter being classed as having mild cases.
  • These estimates are still considered to be underestimated
    • Many people affected by OCD suffer in silence because of embarrassment and fear of being labelled.
    • Others are unaware that their suffering is a recognised medical condition



Most of us have worries, doubts and superstitious beliefs. It is only when your thoughts and behaviour make no sense to other people, cause distress or become excessive that you may want to ask for help.  OCD can occur at any stage of your life. If you experience OCD you may also feel anxious and depressed and you may believe you are the only one with obsessive thoughts.


  • Obsession.
    • An obsession is an unwelcome thought or image that you keep thinking about and is largely out of your control. These can be difficult to ignore.
  • These obsessions can be disturbing and are accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.”
  • These OCD obsessions are time consuming and get in the way of important activities the person values, which is important as it determines whether someone has OCD — the psychological disorder — rather than having an obsessive personality trait.
  • You might believe that something bad will happen if you do not do these things. You may realise that your thinking and behaviour is not logical but still find it very difficult to stop.
  • https://www.rethink.org/diagnosis-treatment/conditions/anxiety-disorders

What Obsession in OCD is not

  • Occasional thoughts about getting sick or about the safety of loved ones is normal
  • Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD. While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on. In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxietythat gets in the way of day-to-day functioning.
  • https://iocdf.org/wp-content/uploads/2014/10/What-You-Need-To-Know-About-OCD.pdf
  • https://iocdf.org/about-ocd/

Misuse of language

  • We use “obsessing” or “being obsessed” commonly in every-day language.
  • Casual uses of the word means that someone is preoccupied with a topic or an idea or even a person.
  • “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it.
  • You can be “obsessed” with
    • A new song,
    • A new TV series
    • A podcast
    • A food
    • But you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession.
  • In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms.



  • Compulsion.
    • A compulsion is something you think about or do repeatedly (repetitive behaviour) to relieve anxiety. This can be hidden or obvious. Such as saying a phrase in your head to calm yourself. Or checking that the front door is locked.
    • https://www.rethink.org/diagnosis-treatment/conditions/anxiety-disorders
    • People with OCD are aware that they will only experience temporary relief and that the compulsion is not a solution but the problem is for them is that they feel that they don’t have a better way to cope.
    • Compulsions can also include avoiding situations that trigger obsessions.
    • These compulsions are time consuming and get in the way of day to day life.
  • In most cases, individuals with OCD feel driven to engage in compulsive behaviour and would rather not have to do these time consuming and many times torturous acts.

What compulsions are not:

  • Not all repetitive behaviours or “rituals” are compulsions. Bedtime routines, religious practices, and learning a new skill involve repeating an activity over and over again, but are a welcome part of daily life.
  • Behaviours depend on the function and context:
    • Arranging and ordering DVDs for eight hours a day isn’t a compulsion if the person works in a video store.
    • Behaviours depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library.
    • Certain activities such as Bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life.
    • Similarly, you may have “compulsive” behaviours that wouldn’t fall under OCD, if you are just a stickler for details or like to have things neatly arranged. In this case, “compulsive” refers to a personality trait or something about yourself that you actually prefer or like.

Common OCD obsessions and compulsions



Like all other mental health conditions, OCD can only be diagnosed by a trained professional and there are no blood tests or brain imaging tests to diagnose OCD. The diagnosis is made based on the observation and assessment of the person’s symptoms.

OCD can start at any time from preschool to adulthood. Although OCD does occur at earlier ages, there are generally two age ranges when OCD first appears, between ages 10 and 12 and then between the late teens and early adulthood.

Related problems for people with OCD

Some people with OCD may also have or develop other serious mental health problems, including:

  • depression – a condition that typically causes lasting feelings of sadness and hopelessness, or a loss of interest in the things you used to enjoy
  • eating disorders – conditions characterised by an abnormal attitude towards food that cause you to change your eating habits and behaviour (we see that xxx has was misdiagnosed to begin with anorexia)
  • generalised anxiety disorder – a condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event
  • hoarding disorder – a condition that involves excessively acquiring items and not being able to throw them away, resulting in unmanageable amounts of clutter

People with OCD and severe depression may also have suicidal feelings.


DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3)

A.    Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

  1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

  1. Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviours or mental acts.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behaviour, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behaviour, as in autism spectrum disorder).

Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.



  • F42 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
  • The 2018 edition of ICD-10-CM F42 became effective on October 1, 2017.
  • This is the American ICD-10-CM version of F42 – other international versions of ICD-10 F42 may differ.

Type 2 Excludes – which means that these are considered separate disorders

  • obsessive-compulsive personality (disorder) (F60.5)
  • obsessive-compulsive symptoms occurring in depression (F32F33)
  • obsessive-compulsive symptoms occurring in schizophrenia (F20.-)

The following code(s) above F42 contain annotation back-references that may be applicable to F42:

Mental, Behavioural and Neurodevelopmental disorders

Approximate Synonyms

  • Hoarding
  • Hoarding disorder
  • Hoarding disorder co-occurrent with lack of insight and/or delusions
  • Hoarding disorder w absent insight or delusional beliefs
  • Obsessive compulsive disorder

Clinical Information

  • A disorder characterized by the presence of persistent and recurrent irrational thoughts (obsessions), resulting in marked anxiety and repetitive excessive behaviours (compulsions) as a way to try to decrease that anxiety.
  • An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behaviour which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension.
  • An anxiety disorder in which a person has intrusive ideas, thoughts, or images that occur repeatedly, and in which he or she feels driven to perform certain behaviours over and over again. For example, a person may worry all the time about germs and so will wash his or her hands over and over again. Having an obsessive-compulsive disorder may cause a person to have trouble carrying out daily activities.
  • Disorder characterized by recurrent obsessions or compulsions that may interfere with the individual’s daily functioning or serve as a source of distress.
  • Obsessive-compulsive disorder (ocd) is a type of anxiety disorder. If you have ocd, you have repeated, upsetting thoughts called obsessions. You do the same thing over and over again to try to make the thoughts go away. Those repeated actions are called compulsions. Examples of obsessions are a fear of germs or a fear of being hurt. Compulsions include washing your hands, counting, checking on things or cleaning. Untreated, ocd can take over your life researchers think brain circuits may not work properly in people who have ocd. It tends to run in families. The symptoms often begin in children or teens. Treatments that combine medicines and therapy are often effective.


Causes of OCD

John Greist Clinical Professor of Psychiatry, University of Wisconsin; International OCD Foundation Scientific Advisory Board

Maggie Baudhuin, MLS Coordinator, Madison Institute of Medicine, Inc.

The cause of OCD is complicated and no one really knows what factors might be involved, but here are some of the things that are thought to impact the development of OCD:

  • family history – research has shown that you’re more likely to develop OCD if a family member has it, possibly because of your genes but these have been shown to only be partly responsible
  • differences in the brain – some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin
  • Research suggests that OCD involves problems in communication between the front part of the brain and deeper structures. These brain structures use a chemical messenger called serotonin. Pictures of the brain at work also show that in some people, the brain circuits involved in OCD become more normal with either serotonin medicines or cognitive behaviour therapy (CBT).
  • life events – OCD may be more common in people who’ve experienced bullying, abuse or neglect and it sometimes starts after an important life event, such as childbirth or a bereavement
  • personality – neat, meticulous, methodical people with high personal standards may be more likely to develop OCD, as may those who are generally quite anxious or have a very strong sense of responsibility for themselves and others
  • time of onset – some experts think that OCD that begins in childhood may be different from the OCD that begins in adults. For example, a recent review of twin studies3 has shown that genes play a larger role when OCD starts in childhood (45-65%) compared to when it starts in adulthood (27-47%).




Studies find that it takes an average of 14 to 17 years from the time OCD begins for people to obtain appropriate treatment.

Stigma and things that reduce people seeking treatment

Some people choose to hide their symptoms, often in fear of embarrassment or stigma. Therefore, many people with OCD do not seek the help of a mental health professional until many years after the onset of symptoms.

  • lack of public awareness of OCD, so many people were unaware that their symptoms represented an illness that could be treated.
  • Lack of proper training by some health professionals often leads to the wrong diagnosis. Some patients with OCD symptoms will see several doctors and spend several years in treatment before receiving a correct diagnosis.
  • Difficulty finding local therapists who can effectively treat OCD.
  • Not being able to afford proper treatment if you are in countries that you need to pay or that the NHS has not been able to provide the services you need and you decide to go private.


  • The medical profession has often considered OCD bizarre and as such assumed it to be rare. Families are often reluctant to talk about OCD due to the stigma attached to mental illness. Clearly OCD will have an effect on the sufferer, but it can be difficult to understand the effect it can have on their families. OCD is all-encompassing and all family members are inextricably involved with the sufferer’s illness.


In the UK There are two main ways to get help:

  • visit your GP – your GP will ask about your symptoms and can refer you to a local psychological therapy service if necessary
  • refer yourself directly to a psychological therapy service – search for psychological therapy services near you to see if your local services accept self-referrals

If you think a friend or family member may have OCD, try talking to them about your concerns and suggest they seek help.

Note: OCD is unlikely to get better without proper treatment and support.

The main treatments in the UK are:

  • psychological therapy – usually a special type of cognitive behavioural therapy (CBT)
    • that helps you face your fears and obsessive thoughts without “putting them right” with compulsions working with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions encouraging you to face your fear and let the obsessive thoughts occur without neutralising them with compulsive behaviours – you start with situations that cause you the least anxiety first, before moving onto more difficult thoughts called – exposure and response prevention https://www.psychguides.com/guides/obsessive-compulsive-disorder-treatment-program-options/
    • The treatment is difficult and may sound frightening, but many people find that when they confront their obsessions, the anxiety does eventually improve or go away.
    • People with fairly mild OCD usually need about 10 hours of therapist treatment, combined with exercises done at home between sessions. A longer course may be necessary in more severe cases.


  • medication if psychological therapy doesn’t help treat your OCD, or if your OCD is fairly severe – usually a type of antidepressant medication called selective serotonin reuptake inhibitors (SSRIs) that can help by increasing the levels of serotonin in your brain
    • Sertraline (Zoloft)
    • Paroxetine (Paxil)
    • Fluvoxamine (Luvox)
    • Fluoxetine (Prozac)
    • Citalopram (Celexa)
    • https://www.psychguides.com/guides/obsessive-compulsive-disorder-treatment-program-options/
    • You may need to take the medication for 12 weeks before you notice any effect.
    • Most people require treatment for at least a year. You may be able to stop if you have few or no troublesome symptoms after this time, although some people need to take medication for many years. Your symptoms may continue to improve for up to two years of treatment.
    • Don’t stop taking SSRIs without speaking to your doctor first, as this can cause unpleasant side effects. When treatment is stopped, it will be done gradually to reduce the chance of this happening. Your dose may need to be increased again if your symptoms return.

Side effects

Possible side effects of SSRIs include:

There’s also a very small chance that SSRIs could cause you to have suicidal thoughts or want to self-harm. Contact your GP or go to your nearest accident and emergency (A&E) department if this happens.

Most side effects improve after a few weeks as your body gets used to the medication, although some can persist.


Further treatment in the UK

Further treatment by a specialist team may sometimes be necessary if you’ve tried the treatments above and your OCD is still not under control.

Some people with severe, long-term and difficult-to-treat OCD may be referred to a national OCD service.

This service offers assessment and treatment to people with OCD who haven’t responded to treatments available from their local and regional OCD services.

To be eligible for this service, you must have been diagnosed as having severe OCD and have received:

  • treatment with at least two different SSRIs at recommended doses for at least three months
  • at least two attempts at psychological therapy, both in a clinic and at home
  • additional treatment with another medication, such as a different type of antidepressant called clomipramine, or an SSRI at a dose higher than normally recommended

Most people’s condition improves after receiving treatment from a national OCD service.


Living with OCD can be difficult. In addition to getting medical help, you might find it helps to contact a support group or other people with OCD for information and advice.

The following sites may be useful sources of support:

OCD Action, OCD-UK and TOP UK can also let you know about any local support groups in your area.


Psychosurgery (only found information about this from America)


Psychosurgery is used to alleviate symptoms of obsessive-compulsive disorder in patients who do not respond to medications or behavioural therapy.

As per the International OCD Foundation, four types of brain surgery have proven effective in treating OCD. They are listed on the OCD UK website but it was unclear if these are offered

anterior cingulotomy. Which involves drilling into the skull and burning an area of the brain called the anterior cingulate cortex with a heated probe. This surgery has provided benefits for 50 percent of those with treatment-resistant OCD.

  • https://emedicine.medscape.com/article/1343677-overview
  • anterior capsulotomy
  • . This surgery is similar to the anterior cingulotomy surgery, but doctors operate on a different area of the brain called the anterior limb of the internal capsule. The surgery has succeeded in giving relief to 50 to 60 percent of patients with treatment-resistant OCD.
  • the gamma knife. This treatment does not involve opening the patient’s skull. Rather, the skull is penetrated by multiple doses of gamma rays. While a single dose of gamma rays will not harm brain tissue, when multiple sources of gamma rays intersect, they create an energy level adequate to destroy targeted brain tissue. The gamma knife procedure has been helpful to about 60 percent of treatment-resistant OCD patients.
  • deep brain stimulation (DBS). Although this procedure requires opening the patient’s skull, it does not involve destroying brain tissue. Instead, electrodes are placed at strategic points inside the brain and wired to a pulse generator. The battery-powered generator, also called an implantable neurostimulator, sends pulses to the brain. It works in a similar fashion to a pacemaker. So far, only small studies have been conducted with deep brain stimulation, but the response rate is similar to the other surgeries.


Supporting someone with OCD

Families and OCD Barbara Livingston Van Noppen, PhD Associate Professor, University of Southern California International OCD Foundation Scientific Advisory Board

1. Do not regard OCD as the person’s fault and try not to believe that you or anyone else may have caused it. If the person decides to seek professional help, be supportive of that decision and encourage their determination to recover. Help your family member find the right treatment. The best treatment usually includes medicine, cognitive behaviour therapy, and family education and support.

2. Encourage the person with OCD to persist with their treatment, even when this seems difficult, and show appreciation of any improvement, however small.

3. Learn how to respond if your family member refuses treatment

  • Bring books, video tapes, and/or audio tapes on OCD into the house. Offer the information to your family member with OCD or leave it around (strategically) so they can read/listen to it on their own.
  • Offer encouragement. Tell the person that through proper treatment most people have a significant decrease in symptoms. Tell them there is help and there are others with the same problems. Suggest that the person with OCD attend support groups with or without you, talk to an OCD buddy through online support groups, or speak to a professional in a local OCD clinic.
  • Get support and help yourself. Seek professional advice/support from someone that knows OCD and talk to other family members so you can share your feelings of anger, sadness, guilt, shame, and isolation.
  • Attend a support group. Discuss how other families handle the symptoms and get feedback about how you can deal with your family member’s OCD. To find a list of support groups in your area, visit www.ocfoundation.org

4. Remember that symptoms may wax and wane. Some days, the person may be able to deal with symptoms better than others. Each person needs to overcome their problems at their own pace, even though this may be a lengthy process.

5. Learn about OCD Education is the first step, the more you learn, the more you will be able to help. You can:

  • Read books on OCD
  • Join the International OCD Foundation
  • Attend OCD support groups
  • Research online

6. Allow the person to explain their problems to you. This will help them to feel less isolated and ashamed of their condition. The symptoms may seem unrealistic and irrational to you, but the fear for the person with OCD, is very real.

7. While supporting the person with OCD, try not to support the obsessions and compulsions. The International OCD Foundations calls this recognising and reducing “Family Accommodation Behaviours” Family Accommodation Behaviours are things families do that enable OCD symptoms. Families are constantly affected by the demands of OCD. Research shows that how a family responds to the OCD may help fuel OCD symptoms. The more that family members can learn about their responses to OCD and the impact they have on the person with OCD, the more the family becomes empowered to make a difference! Here are some examples of these problematic behaviours:

  • Participating in the behaviour: You participate in your family member’s OCD behaviour along with them. Example: washing your hands whenever they wash their hands.
  • Assisting in avoiding: You help your family member avoid things that upset them. Example: doing their laundry for them so that it is cleaned the “right” way.
  • Helping with the behaviour: You do things for your family member that lets them do OCD behaviours. Example: buying large amounts of cleaning products for them.
  • Making changes in Family Routine: Example: you change the time of day that you shower, or when you change your clothes.
  • Taking on extra responsibilities: Example: going out of your way to drive them places when they could otherwise drive themselves.
  • Making changes in leisure activities: Example: your family member gets you to not leave the house without them. This affects your interests in movies, dinners out, time with friends, etc.
  • Making changes at your job: Example: you cut back on hours at your job in order to take care of your family member.

Note: The worst thing to do is to give reassurance to the person that their fears are unfounded. If you do this, the person will not learn this for themselves and the disorder will persist. Encourage the person to challenge the obsessions and compulsions.

8. People with OCD are often aware of the humorous aspects of their obsessions and compulsions. This awareness can be used to help them distance themselves from the condition. However, resist mocking the person’s symptoms as this may cause additional stress, shame and embarrassment.

9. At home, people with OCD should be encouraged to maintain as normal a lifestyle as possible. Families should not try to adapt their ways of doing things to accommodate the person’s obsessions and compulsions.

10. Remember that OCD is tough for families to deal with. Continue to communicate with each other. Remember also that the family, friends and carers of people with OCD need help and support themselves. Make sure you continue to do things you enjoy and have people to talk to about your own feelings and concerns.






Mental Health Book Review: A Bitter Pill to Swallow by Tiffany Gholar

Our Review

Overall rating:

Sydney’s rating:

Becky’s rating:

The Harrison School helps children and teenagers struggling with their mental health to continue with their education whilst being treated for the issues that they are experiencing. At the school, we meet Janina who has been diagnosed with depression and has been at the school for four years and is afraid to leave the schools safety.

Devante has been a witness to a life changing traumatic shooting in which the girl he cared about lost her life and he is finding life difficult. He attempts suicide but is stopped and decides to enrol at the Harrison School. Devante is diagnosed with acute stress disorder and he meets Janina. Their friendship helps them both on their journey to recovery.

As a result of a new addition to the Harrison School team is given a select group of students to look after and as a result starts to question Janina’s diagnosis. After investigation and new research it is decided that Janina is not mentally unwell but has been mis-diagnosed because the people around her failed to acknowledge her intellect. Showing that the labels we take on are fluid and can change over time.

Whilst at the Harrison School Devante begins to see that there are others in a similar situation to him, he is not alone and there are other people who are in a worst position than him.

This book shows the differences between different mental health conditions and their durations. It also shows the fluidity of mental health diagnosis and that labels are not necessarily everything and that treating teenagers as people has a huge beneficial effect.

Listen to our full review at:
Mental Health Book Club Episode 15

Mental Health Book Review: Autism Anxiety and Me by Emma Louise Bridge

Our Review

Overall rating:

Sydney’s rating:

Becky’s rating:

This is our first non-fiction book that we have read for the Mental Health Book Club Podcast. The book is written by Emma Louise Bridge, a 24-year-old female diagnosed with Autism and this is a collection of her diary entries exploring Emma’s world. After each diary entry Penelope Bridge, Emma’s mother, adds her own thoughts about the entries and summarises the main points that have a profound impact on Emma’s life.

We read about different scenarios that Emma faces which provide a real insight into the differences in the way a person with autism processes the world. Emma describes different ways of thinking, such as, literal thinking, theory of mind the impact changes in routine may have. There is also a lot of discussion on the issues that people may face as a result of hypersensitivities in terms of sound and touch and how Emma would find certain textures and noises difficult to handle.

This book really has two separate audiences – young people who might relate to the feelings and situations Emma describes, and those who are wanting to find out more about the impact of autism. The diary is interesting due to the insights into the workings of Emma’s mind and although Penelope’s summaries pull you out of Emma’s mind and sometimes detracts from the diary itself, it does provide valuable information that the second audience may be seeking.

Listen to our full review at:

Mental Health Book Club Episode 9

Mental Health Book Review: My Heart and Other Black Holes by Jasmine Warga

Our Review

Overall rating:

Sydney and Becky’s rating:

This book covers the topic of suicide and a suicide pact – if you feel that these topics may trigger you this is not the book for you. If you need urgent help and are in the UK you should call 999. Alternatively you can contact the Smaritans on 116 123 https://www.samaritans.org/how-we-can-help-you/contact-us or call Childline for free on 0800 1111 or contact them via their website at https://www.childline.org.uk/get-support/

Aysel, a sixteen-year-old who has decided that she wants to die. She finds Roman (Frozen Robot) in an online chatroom for people seeking a suicide partner as she is unsure if she can do this on her own and he has a very over protective mother. Both Asyel and Roman have suffered unimaginable tragedy, a father who has killed and a sister under her brother’s care dies from a seizure in the bath means both don’t want to continue.

As a result of their friendship and the fact that Asyel has someone to talk to about how she feels, she begins to notice her mood changing, and her depression lifting allowing her to see that she doesn’t want to die. However, Roman has a differing opinion and she spends her time trying to convince him to live.

Even though Roman had made up his mind and regardless of him being able to open up to Aysel the main positive message from this book is to talk about how you feel, don’t hide it, because when you are deep in depression you find it hard to see the reality. A very realistic message that can be understood by people who have been touched by depression, and that people who haven’t been there should know.

I think this is a very important topic to explore for all ages. Suicide is not something routinely talked about in general society, but hiding your feelings and any thoughts about suicide is dangerous. There is still so much stigma surrounding suicide that getting help should not be viewed poorly.

I was a little taken aback by some of the language and the concept of suicide pacts and partners in themselves. The advert that is posted by Roman states he doesn’t want a “flake” someone who will back out of the pact and this is referenced several times during the book. My issue here is that there could be some legal ramifications as there have now been cases where people have been prosecuted for encouraging another person to commit suicide (www.huffingtonpost.com/entry/tell-someone-to-kill-themselves-and-you-could-end_us_5945800ce4b0940f84fe2f19 and www.bbc.co.uk/news/uk-england-cambridgeshire-42142969) . I couldn’t help but wonder for a more impressionable person that by telling them I don’t want a flake could add additional pressure if that person changes their mind. (For me as a person with borderline personality disorder and find self-identity tricky I generally go along with the thoughts and opinions of others around me).

Whilst I think this story could happen in reality and that the book covers an important topic, but be aware that some of the language may make you feel conflicted.

Listen to our full review at:
Mental Health Book Club Podcast Episode 11

Mental Health Book Review: Anxiety Girl Falls Again by Lacey London

Our Review

Overall Rating:

Sydney’s Rating:

Becky’s Rating:

Sadie has moved on from her bout with anxiety and depression and has changed her entire life. She has sold her swanky apartment and moved into a quaint cottage, she has a new job as a counsellor leading several anxiety anonymous support groups and Ruby has become a prominent part of her life. She seems like she has turned her life around and has beaten her issues with mental illness.

Her life becomes more interesting when Aidan Wilder walks into one of Sadie’s support groups. He intrigues her so much that she can’t stop thinking about him and wants to learn more. She makes it her mission to help this new mysterious man fight against his own demons. As the book progresses we start to find out more about what brought Aidan into Sadie’s life after a heart-breaking tragedy leaves him lost and struggling to continue with life.

Those around Sadie that care about her begin to worry about how involved she has become with a man she barely knows and as a reader I began to question how ethical some of her behaviour is whilst helping Aidan, and if she is perhaps at times overstepping and becoming unprofessional with him.

The other cause for concern as a reader is the way that Sadie believes that she is done with anxiety and that it will never be a problem for her again, whilst for most reality is rarely like that. I can understand her annoyance at those around her constantly checking up on her wellbeing and that people can feel this way but she fails to see their point of view. After all, in the last book she had made a suicide attempt – at that point it is justified for people to be concerned about you.

Again this is a quick read, the descriptions and discussions about grief are realistic and I look forward to reading the next instalment in the Sadie Valentine series.

Listen to the full review:
Mental Health Book Club Podcast Episode 9

Mental Health Book Review: Dandelion Angel by C.B. Calico

Our Review:

Overall rating:

Sydney’s rating:

Becky’s rating:

Our behaviour is influenced by our parents, we often take on their mannerisms and behaviours. Let’s face it how many times have you found yourself doing something that you can associate with one of your parents?

But, what happens if a parent has an undiagnosed mental health issue that impacts their emotional response to the world around them? Well, it can have a long lasting and devastating impact late into their children’s adult life.

Dandelion Angel by C.B. Calico follows the stories of four adult daughters and their mothers who have undiagnosed Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder (EUPD). A parent with this mental health condition often results in an emotionally chaotic and unstable home environment for the children in their care. These mothers are often demanding, emotionally neglectful, rage filled and even physically abusive towards their own offspring.

In our opinion C.B. Calico explores the impacts of BPD on the entire family, in a sympathetic way, whilst not excusing the mother’s actions or behaviours. We learn about the childhood stories of the mother’s and whilst they are heart breaking in themselves, they are not there as an excuse to justify their later behaviour towards their children. Their stories are provided to give an insight into the situations that shaped them into the people we read about in this book. Each grown up daughter still bears the emotional scars left by their mothers, but yet all four have been able to move forward with their own lives in differing ways. This story provides hope to those who may have experienced similar upbringings.

Listen to Pt 1 of the full review here.

Listen to Pt 2 of the full review here.