Traditionally ‘addiction’ was defined as a state of dependency on a chemical substance (e.g. alcohol, cocaine, cannabis, nicotine) which involved a strong physiological and psychological need and a compulsive inability to resist taking the substance; despite the individual anticipating probable negative consequences. More recently, it has been recognised that behaviours other than taking chemical substances can be highly addictive – such as gambling, over-eating, sex and pornography. See [glossary to="alcohol-misuse"]Alcohol Misuse[/glossary], [glossary to="drug-misuse"]Drug Misuse[/glossary], [glossary to="sex-addiction"]Sex Addiction[/glossary] and [glossary to="pornography-addiction"]Pornography Addiction[/glossary]. For food addiction, see [glossary to="comfort-eating"]Comfort Eating[/glossary].
Agoraphobia is a type of anxiety in which you become frightened of particular situations where you feel it would be difficult to leave or escape. Common examples include a fear of being in tubes, cinemas, supermarkets, as well as large open spaces such as parks. It is often associated with having [glossary to="panic-attacks"]panic attacks[/glossary] in the feared situation, or in anticipation of facing the feared situation. People who experience agoraphobia tend to avoid their feared situations, and gradually feel less and less confident about going out. Without treatment the range of situations in which you feel comfortable often narrows over time. Agoraphobia can leave you feeling ashamed and depressed as you are unable to participate in roles and activities that you used to value and enjoy. Treatment for agoraphobia involves understanding the nature of your fears and then learning skills and techniques to cope with them, so that you can gradually get back to doing the things you value.
Alcohol – misuse, dependency and addiction
Many people drink more than they feel is strictly good for them, but it can be difficult working out whether drinking is really a problem or not. On the positive side, alcohol can provide an easy way of relaxing, connecting with other people and feeling less socially inhibited. On the negative side, drinking heavily can leave you feeling out of control, tired, depressed and in poor physical health. Often people find themselves drinking more heavily when they are trying to cope with a difficult emotional state – such as feeling low, anxious, frustrated or bored. When considering whether to cut down or stop you may weigh up the pros and cons on your life; as well working out how able you feel to make changes on your own. Often therapy can be very helpful in deciding whether you really want to make a change, and if you do, helping you cope with the feelings (both physical and emotional) that underlie your drinking.
Anorexia shares many features with [glossary to="restrictive-eating"]restrictive eating[/glossary] but is more severe. It is technically defined by a very low Body Mass Index (BMI) and, in women, the absence of regular periods (not due to any other medical condition). The drive to remain thin and feel in control is overwhelming, and many people with anorexia feel they have no real choice but to maintain a low weight. Therapy can offer an opportunity to be understood, without being judged or controlled. The therapist explores how you would like to relate to eating, food, and your body and then develop a ‘healthy side’ of yourself to move in a positive direction for you.
Refers to a state of uneasiness accompanied by dysphoria (unpleasant mood) and physical signs of tension. Attention is focussed on anticipating possible failure, misfortune or danger. In anxiety disorders, people become preoccupied with a feared event, and typically over-estimate the likelihood or severity of this event and underestimate their ability to cope if the event occurred. Because severe anxiety is an aversive experience people often develop ‘fear of fear’ in which you start to anticipate and fear becoming anxious (irrespective of any other event happening or not). This often results in an attempt to avoid situations that might make you anxious, and therefore a reduction in the range of things you feel able to do. Anxiety can become focused on a wide range of events or situations including particular places, tasks or social situations. See [glossary to="agoraphobia"]Agoraphobia[/glossary], [glossary to="panic-attacks"]Panic Attacks[/glossary], [glossary to="social-anxiety"]Social Anxiety[/glossary] and [glossary to="generalised-anxiety-disorder"]Generalised Anxiety Disorder[/glossary].
Losing someone you love can be one of the most sad and painful experiences in life. Grieving and being able to move on can be a difficult journey, sometimes triggering unresolved losses from the past, as well as uncertainty about your future. Grief can evoke a whole range of emotions including hopelessness, anger and despair. Therapy can be helpful in coming terms with your loss, particularly if you feel stuck or unable to move on with your life after a period of grieving.
Borderline Personality Disorder / Traits
(also known as Emotionally Unstable Personality Disorder) Borderline Personality Disorder (BPD) is defined by a number of characteristics including an unstable sense of identity, an strong fear of being abandoned or rejected, low self esteem, labile mood, suicidal feelings, and in some cases, self harm. Traditionally, BPD has been associated with some very negative stereotypes; however, in the last 10 years the view of BPD has fundamentally changed. There is a new understanding of the problem as resulting from very difficult early experiences, in some cases combined with a naturally sensitive temperament. In fact, most people have some fear of being rejected or abandoned, at times feel unsure of how they are, and find their mood can swing surprisingly quickly - in BPD these issues are just more severe and you find it more difficult to cope with your emotions. People with BPD have usually had very difficult experiences when they were children - typically they never learnt to feel that they were loveable, acceptable or wanted, or that other people could be trusted to meet their needs in a safe way. It is important to note, the borderline ‘traits’ are often present without meeting criteria for a full disorder. This means, for example, that you may have a strong fear of being abandoned or rejected but may not self-harm or feel suicidal. Schema Therapy has been specially developed to help with the problems underlying BPD, and have been shown to improve people’s sense of well being, their personal relationships and to reduce self harm.
Bulimia Nervosa
In Bulimia Nervosa you alternate between episodes of bingeing on food, followed by an attempt to compensate – including vomiting, use of laxatives, excessive exercise and extreme dietary restriction. People with bulimia often have a sense of self-loathing and experience a feeling of release, comfort or self-expression through bingeing. Sometimes bingeing is triggered in response to breaking a dietary ‘rule’ (for example eating a biscuit when you are trying to keep to a 1,500 Kcal diet), whereby the feeling of guilt, self criticism and/or frustration of having broken the rule is so great you give up all control, promising yourself you’ll make up for it later. At other times, bingeing may be triggered by emotional factors, such as feeling rejected, let down or criticised. Many people with bulimia keep their problem hidden, as they feel ashamed and out of control. Therapy can provide the opportunity to understand the thoughts and feelings driving the problem, and form a healthier relationship with food and your body.
Clinical Psychologist
Clinical psychologists will have completed a three-year psychology degree and a professional three-year, postgraduate clinical psychology training course. They use their knowledge and skills of psychology and psychotherapies to help people address difficulties connected with various aspects of their lives and improve the quality of their lives. Clinical psychologists do not prescribe drugs, but are able to help people think about when such treatments may be appropriate.
Cognitive Behavioural Therapy
The idea behind Cognitive Behavioural Therapy is that your thinking influences the way you feel and act. We all have our own ways of understanding events around us, and the meaning we give to them can in some situations lead to problems such as anxiety, depression or low self-esteem. CBT is collaborative. Therapist and client work together to understand and identify unhelpful thinking styles that lead to mood problems, and promote more balanced ways of seeing things. CBT is a therapy that needs the client’s active participation and it can give people skills and strategies to overcome their problems and cope more effectively with any future problems that arise. An important part of CBT is working on tasks between sessions. CBT has been shown to be effective for a wide variety of problems. The length of therapy will depends on circumstances but CBT usually lasts for between 8-16 sessions.
Comfort Eating
Eating lowers our level of physiological arousal, effectively having a calming effect on the body. It's unsurprising then, that many people turn to food for comfort when they are faced with a difficult emotional state (for example feeling sad, anxious or frustrated). In moderation, comfort eating is largely harmless, however it can become a problem if it becomes more habitual. This can ultimately feel similar to an addiction, as for some people food provides immediate (if short lived) relief from feeling bad. Unfortunately, over-eating can then leave you feeling out of control, guilty and worried. To compensate, you may try to restrict your diet but this can swing too far the other way, resulting later in very strong urges to eat, followed by another cycle of overeating or bingeing. Some people do not compensate for comfort eating, but usually still feel very concerned about their weight. Breaking the pattern of dieting and/or overeating involves understanding the feelings that drew you to food as a comfort in the first place. The therapist can then help you learn new skills to negotiate these feelings without turning to over-eating.
Most of us experience periods of feeling low at some stage, where life starts to feel like a struggle and it's difficult to envisage getting back onto a more even keel. In more prolonged and severe depression, people typically feel some or all of the following: a loss of enjoyment in previously valued activities, difficulty concentrating, making decisions and initiating tasks, feelings of worthlessness or excessive guilt, altered sleep and eating patterns and suicidal thoughts or urges. There are many different theories about what causes depression, but most agree that it comes about when someone has experienced significant losses or deprivation in their lives, either as an adult, or in their early life. In some cases a person’s experience as a child has left ill equipped to deal with disappointments in adult life, and an adverse experience such as a redundancy or rejection triggers a strong sense of hopelessness and self criticism, which often results in the person withdrawing and becoming less active and involved in life than before. For others, there may be no obvious issues stemming from childhood, but they have suffered many losses and difficulties as an adult, leaving them feeling overwhelmed and unable to cope. Depression is one of the most common problems leading people to seek therapy.
Drug Misuse, Dependency and Addiction
Many people experiment with recreational drugs without any ill effects. However, some people find themselves relying on drugs in order to cope in their day to day lives, and feel otherwise unable to relax or enjoy themselves. Certain prescription drugs (for example Benzodiazepines and certain sleeping tablets) can also become a problem, and having initially intended to take a medication for a short period you may end up having trouble weaning yourself off. You may also feel quite torn about whether you want to change your drug use, as there are usually pros and cons to cutting down and you may feel unsure about whether you could stop, even if you wanted to. Therapy can provide a space to think about these issues without being judged. If you decide you want to cut down or give up using drugs your therapist can work with you to understand what is driving the drug use and help you make a change.
Eating Problems / Eating Disorder
See [glossary to="anorexia"]anorexia[/glossary], [glossary to="bulimia-nervosa"]bulimia[/glossary], [glossary to="comfort-eating"]comfort eating[/glossary], [glossary to="restrictive-eating"]restrictive eating / chronic dieting[/glossary].
Emotionally Unstable Personality Disorder
Another term for [glossary to="borderline-personality-disorder"]Borderline Personality Disorder[/glossary].
Food Addiction
See [glossary to="comfort-eating"]Comfort Eating[/glossary].
Generalised Anxiety Disorder
In this condition you are preoccupied with worry about a range of different things (for example relationships, work, your children). You may find it difficult to control your worrying, and also feel on edge, tired, irritable and have difficulty concentrating.
Low Self-esteem
Self-esteem refers to your attitude, evaluation or opinion of yourself. Low self-esteem is common in a range of psychological problems, as the fear that you are ‘not good enough’ can undermine your ability to form and maintain intimate relationships, perform at work and enjoy social situations.
To be ‘mindful’ means paying attention to the present in a particular way - with purposeful intent, in the present moment and non-judgmentally (Jon Kabat Zinn). Much of the time we spend our lives in ‘automatic pilot’ mode, reacting to situations based on particular thought patterns we have or emotions we feel, without being really in the present moment with total awareness of the situation and options for dealing effectively with it. This is particularly important at times of difficultly or when we feel distressed, depressed or anxious as thinking ourselves out of these moods or situations often doesn’t work and can create further frustration. Mindfulness-based therapies, including mindfulness-based stress-reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) focus on building up meditative practices and daily skills in mindfulness as a means to getting to know your own mind, mood and body and learning to how to develop a new relationship to them. Mindfulness-based therapies have been shown to help people struggling with chronic illness (chronic pain, hypertension, heart disease, cancer, gastrointestinal disorders) as well as for psychological problems including [glossary to="anxiety"]anxiety[/glossary], [glossary to="panic-attacks"]panic[/glossary] and recurring [glossary to="depression"]depression[/glossary].
Dictionary definitions of narcissism usually refer to ‘self-love obtained by contemplating oneself’. However, modern psychological theories of narcissism have a different view. Narcissism is characterised by a preoccupation with your own worth or status, maintaining control and ensuring your needs are met at all costs. Unfortunately, when these characteristics are very strong, it is easy to alienate and hurt other people as their needs can get overlooked. Many people who are described as ‘narcissistic’ are in fact compensating for an underlying sense that they will be ignored, mistreated, or undervalued unless they are ‘the best’ and in control at all times. When this is unachievable (for example following a rejection or failure) people with narcissism feel very vulnerable and alone, and try and avoid these feelings by either distracting themselves or working even harder to regain their status/control. Therapy involves understanding your particular pattern of behaviour and the underlying need for status, approval and control. Over time therapy can be extremely effective in developing healthier relationships and a more balanced sense of identity.
Obsessive Compulsive Disorder (OCD)
The main feature of OCD is the occurrence of obsessions or compulsions that are time consuming or cause marked distress or impairment. Obsessions are persistent thoughts, impulses or images that are experienced as intrusive and inappropriate. For example, a religious person may have persistent blasphemous thoughts, or a mother may have thoughts of harming her newborn child. The most common obsessions concern thoughts about contamination, doubting (e.g. whether you have turned the cooker off), and violent or sexual images. A compulsion is a repetitive behaviour, which may be overt and visible to other people or covert (usually a mental act). Overt compulsions include checking, hand washing and ordering objects. Covert compulsions include counting, praying, repeating words or concentrating on opposite content from the obsession. Compulsions are initially aimed to neutralise or prevent a feared event or consequence of the obsession. However, they often develop into a ritual, so the person may not be aware of why they are completing the compulsion. You may find the obsession (for example a thought about being dirty) makes you anxious and performing the compulsion provides immediate (if short lived) relief. This is often followed by distress and guilt as you may then feel out of control, often with the obsession resurfacing quickly and a new need to perform the compulsion.
Panic Attacks
A period during which there is a sudden onset of intense terror, fear or apprehension accompanied by physical symptoms such as shortness of breath, smothering or chocking sensations, increased heart rate, palpitations, chest pain, dizziness and nausea. Panic attacks are caused by a massive rush of stress hormones that are triggered by the brain when it detects some kind of threat, which can be either physical or psychological. People can become very frightened of having a panic attack and often avoid situations in which they have experienced them before. This can result in them feeling unable to participate in things they used to value, reducing their self-confidence and enjoyment in life.
Personality Disorders
Personality Disorders are defined as an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the culture of the person who exhibits it. To be given a diagnosis, this deviation has to be severe, pervasive, chronic and have a significant negative impact on the individual and/or those around them. Most people who are given a diagnosis of a personality disorder experience problems in their relationships, find it hard to cope with their emotions and feel unsure of who they are or their worth. In the past personality disorders were seen as an innate set of characteristics that were resistant to any attempt at change. The term itself unfortunately has connotations that there is something fundamentally and pervasively wrong with the person. Recent research and theory has radically revised this view. It has been shown that most people with a PD diagnosis have had very negative experiences as children, making it harder for them to learn how to cope with their own emotions and get on with other people. In addition, recent outcome studies show that people diagnosed with PD can do very well in a number of different types of treatment. The therapies that appear to be most helpful are well structured, have a clear inter-personal focus, and allow for a strong attachment between the client and the therapist. Schema Therapy both has good evidence for its effectiveness in treating personality issues / disorders. (See [glossary to="borderline-personality-disorder"]Borderline Personality Disorder[/glossary] and [glossary to="narcissism"]Narcissism[/glossary].)
Pornography Addiction
A situation where the use of internet pornography escalates to the point that it causes significant problems to the individual’s ability to function in daily life and produces adverse negative consequences in the areas of relationships, work or emotional well-being. An individual suffering from pornography addiction might typically spend hours using internet pornography each day, with the result that they may not for example, be able to meet their job demands or engage in relationships with others. There is debate about whether the term addiction is appropriate in this context as with [glossary to="sex-addiction"]sex addiction[/glossary] overall, but it is recognised that for some people their use of internet pornography can become highly problematic and in some cases lead to contact with law enforcement agencies.
Post-Natal Depression
Women experiencing post-natal depression experience similar symptoms as people with depression with an onset within around 4 weeks of giving birth. It should be distinguished from a short period of low mood and tearfulness in the first week after giving birth, commonly known as ‘baby blues’. Women with post-natal depression usually feel very anxious and emotionally distant from their baby (despite a strong conscious desire to connect with the infant). Many women feel especially guilty and ashamed about feeling depressed at a time they believe they should be happy. This can make it harder to talk openly, even though you may feel in desperate need of support and reassurance.
Relationship problems
Most of us aim to get on well with other people and feel close in our intimate relationships. However, this is often easier said than done with a range of problems cropping up at work and at home. These can span from having difficulty being assertive, to losing your temper, to finding it hard to open up to your partner or friends. Both individual therapy and Couple Therapy can help change the patterns that are causing a problem. It is usually best to discuss which would be most helpful for you at your assessment.
Restrictive Eating and Chronic Dieting
This refers to a pattern of continually trying to restrict how much you eat, often in order to lose weight, but also sometimes to feel in control. Typically, if you have this pattern, you constantly strive to follow an eating plan; and feel frustrated and self-critical when you deviate from it. Success in following the plan leaves you feeling great, but the sense of achievement is often short lived, either because you find yourself lapsing into eating more again – or because the rule becomes tighter (see [glossary to="anorexia"]Anorexia[/glossary]). Most chronic dieters feel preoccupied by food and their weight, and continually dissatisfied with themselves. The hope the new regime ‘will work this time’ is incredibly tempting, but the cycle of dieting and lapsing tends to resurface – leaving you feeling very stuck. Effective therapy for this pattern involves learning a new healthier relationship with food and your body.
A ‘schema’ refers to the lens through which we see the world, colouring how we feel about our lives, ourselves and other people.
Sex Addiction
There is a range of opinion about what constitutes sex addiction. Some experts believe sex addiction is very similar to substance addiction, where a state of dependency develops and physiological withdrawal is observed. Other experts believe that sex addiction is a form of obsessive-compulsive behaviour. It is generally accepted however that some people can lose control over their sexual behaviour and it can cause significant harm to their relationships, work, and emotional well-being. Physiological phenomena observed in substance addictions are often seen in sex addiction such as a need for markedly increased amount or intensity of the behavior to achieve the desired effect and the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms. Psychological understandings of sex addiction do acknowledge these kinds of physiological components, but attempt to understand the reasons behind the behaviour and the functions that it serves. In many cases people come to use sex as a way of trying to cope with overwhelming or difficult feelings like emptiness or anger. Sex can alleviate these feelings in the short term so it becomes reinforcing, but the behaviour causes harm to self-esteem, interpersonal relationships and overall well-being in the long-term.
Social Anxiety
Social anxiety refers to a fear of being exposed to unfamiliar people or to possible scrutiny by others. You fear that you will act in a way (including showing your [glossary to="anxiety"]anxiety[/glossary]) that will be humiliating or embarrassing and that other people will form a negative view of you. Social anxiety can cause you to withdraw from other people, often resulting in low self-esteem and loneliness.
Stress can be defined as psychological and physical strain or tension generated by physical, emotional, social, economic or occupational circumstances, events or experiences that are difficult to manage or endure. Stress can be maintained by worry, in which you perpetually ruminate on perceived problem or fear (see [glossary to="generalised-anxiety-disorder"]Generalised Anxiety Disorder[/glossary]).