Football Tackles Stigma

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The Football Association (F.A) is at the forefront of leading sports bodies tackling mental health issues both on and off the pitch. Professional footballers, so long seen as heroes and often afforded almost God like status, are, when it comes to it, mere mortals like the rest of us. They too suffer from stress, insecurities, anxiety and depression. Footballers such as Stan Collymore, Paul Gascoigne, Gary Speed and Clarke Carlisle have all battled mental health problems.

In the space of just a few years with high level players coming forward there is a shift happening. No longer is the stigma such, that sports personalities have to stay silent for the sake of their careers.  However, until such time that we can all be open in every walk of life to talk openly about our mental health difficulties, I am afraid many will choose to suffer in silence because they are afraid it will affect their careers.

It is a really positive thing that across sport itself, mental health issues and stigma are being addressed. This will really help to shape the views of young people, who are themselves the future of sport and ambassadors for change.

The F.A is developing educational forums with workshops aimed at coaches, referees, players and others involved in the game at all levels; while the Professional Footballers Association provides a 24 hour mental health helpline staffed by trained counsellors.

The pressures of playing at a high level, risk of injury and the emotional highs and lows all contribute to emotional stress. A study by the World Players Union (FIFPro), indicated that 38% of professional footballers suffer symptoms of depression and anxiety.

It’s not only football that has taken a lead in tackling stigma and mental health problems. The Sport and Recreation Alliance along with other sports bodies in partnership with MIND, the mental health charity, have developed a mental health charter for sport and recreation.

Rugby has launched its “state of mind” programme to raise awareness of mental health issues. Ambassadors for mental health include Great Britain and England international player Adrian Morley and super league clubs all have indroduced player welfare managers. Other sports such as cricket have mental health ambassador Andrew Flintoff and Monty Panesar championing the cause.

Source: “Sport Fights Stigma” by Pennie Taylor, Benenden members magazine: Be healthy, Spring 2017, Issue 38.

Image Reference: By Andre Kiwitz (originally posted to Flickr as olympics-soccer-11) [CC BY-SA 2.0 (, via Wikimedia Commons

12 Tips to Improve Mental Wellbeing

The New Joy
When we are talking about mental wellbeing what we are really referring to, is how we are feeling and coping on a day to day basis. For most of us this tends to vary from day to day. If we are feeling unhappy, overwhelmed and struggling with the demands of day to day life, it could be said that our mental wellbeing is not so good. On the other hand if we feel happy, confident, productive and engaged with the world we live in, this is a sign that our mental wellbeing is good. This also tends to suggest that our overall mental health is also good.

Many things can affect our mental wellbeing and such things as loss, relationship difficulties, money worries, work stress and even loneliness. There are also a number of things that may predispose and make us more vulnerable to poor mental health and wellbeing. These include childhood abuse or trauma, social isolation or discrimination, homelessness, poor housing or social isolation or discrimination. Caring for a sick relative or friend, unemployment, long term physical health difficulties and even being the victim of some kind of crime or accident. It could be said that if mental wellbeing is poor over a long period of time this is more likely to result in mental health problems, such as depression and anxiety.


There are however, a number of things that we can do to stay mentally well and build our mental wellbeing. These include:


1. Taking time to talk to others about our feelings. There really is some truth in the old saying “a problem shared is a problem halved,” Just talking something through can help us feel lighter. Sometimes another person may be able to offer advice or a different perspective and this can help. It need not necessary be a mental health professional, a caring friend or family member can provide the listening ear so often needed.


2. Building friendships and relationships with others is an important part of staying well. Choosing positive, supportive and happy people to be around, rather than negative people who are always moaning and critical is very important. Volunteering and helping others can really help to feel you are helping others and contributing to society.


3. Staying physically active is a cornerstone to wellbeing. Good diet, adequate sleep and regular exercise all promote good mental health. Reducing reliance on alcohol, recreational drugs  and cigarettes can also help us to feel better about ourselves as we take care of our bodies.


4. Taking up a hobby, interest or pastime is really helpful. Doing things we enjoy can help to express how we feel through activity in way that is similar to childhood play. Whether it’s cooking, gardening or DIY, or maybe something more creative such as joining a local drama group. What we do in between the more mundane activities of life can give us a boost.


5. Setting some kind of life goal, “bucket list,” or challenge gives us something to aim for. When we begin to reach our goals we can feel positive about our achievements.


6. Learn to recognise the sort of things that drag you down. Keeping a mood diary can help us identify triggers. These may be many and can include people, places and events. Sometimes things like lack of sleep, overwork or even eating certain foods can underpin mood changes. Try to be a detective and identify the villains that scupper your wellbeing.


7. Take care of yourself. Try substituting the term “selfish” with the term “self-caring.” In other words, looking after you. Take the pressure of yourself, take small steps towards your goals and learn to be accepting and compassionate towards yourself. In other words, speaking to yourself with kindness and understanding as you would a friend you cared about.


8. Learn to accept yourself, stop being critical and learn to take yourself and life a little less seriously. Little things like smiling and saying hello to people, as well as valuing the things you do, however small. Learn to be assertive and trust in yourself a bit more.


9. Make building your self esteem and confidence a long term aspiration. Appreciating that you are important and that you are, who you are, a unique human being. Stop comparing yourself with others, forget about striving for perfection, identify your positive traits, such as caring for others or loving your pets.


10. Take time to read self help books, websites and blogs (such as this one!) to help you build your mental wellbeing change negative beliefs and old unhelpful ways of thinking and behaving. Find yourself a therapist who can help you work on these areas, think of them as a mental wellbeing coach.


11. If you have mental health problems take an active part in your treatment. Talk to your healthcare provider about your medication and learn to manage it in a way that helps you. Make sure you know about your medication, side effects and the best times of day to take it. Also if you wish to reduce or come off your medication, try to do it as a team with support from your therapist or healthcare provider. Take time to make a crisis plan and tell health professionals, family and others what helps and doesn’t help.


12. Finally join a support group or a group associated with a hobby or interest, such as a knitting, reading or art group. Join others for Pilates or other activities. Reach out to others, accept compliments and find time for you.


Until next time





Ref: How to improve and maintain your mental wellbeing – Mind                                                                                                                                            
Image:By Bart Everson – Flickr: The New Joy, CC BY 2.0,

Find your Self-belief

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How many times have you opted to stay in your comfort zone rather than try something new? How many things have you not done because you didn’t believe in yourself? Missing opportunities leaves us feeling regret and erodes our sense of self.

I really believe that all of us were born with infinite energy to achieve things. It takes courage to move out of our comfort zone, but growth happens right on the edge not in the middle. Yes, it may feel scary, but by gritting your teeth and facing your fears of not being good enough you can achieve great things.

There are a number of things you can do to begin to make changes and no better time than the present to do so.  Go out and do something with others, perhaps joining a local choir or club. Many organisations welcome volunteers no matter how little time or experience you have. Helping other people is not only good for them and a great thing to do; it also makes us happier and healthier too.

Going for a walk or doing some other outdoor activity can help with self-esteem. Research shows that getting active makes us happier as well as being good for our physical health. It instantly improves our mood and can even lift us out of a depression.

Trying out new things or learning a new  skill can gives us a sense of accomplishment and helps boost our self-confidence and resilience.

Set yourself some goals for 2016. Something exciting, new, ambitious but realistic.  Setting goals  and having dreams gives our lives direction and brings a sense of accomplishment and satisfaction when we achieve them.

Stop comp airing yourself to others.  No-one’s perfect. Dwelling on our flaws, makes it much harder to be happy. Learning to accept ourselves, warts and all is the key to improving our self-belief.

If you’ve ever felt there must be more to life? The answer is, there is!  Next time that negative inner voice tries to talk you out of something… say NO.

Make 2016 your year.

Until next time, Steve

Twitter @cbt4you

Steve Clifford                                                                                                                                                 Integrative Psychotherapist.                                                                                                                 Cognitive Behavioural Psychotherapist.

Image: By Camdiluv ♥ from Concepción, CHILE (Colours) [CC BY-SA 2.0 (, via Wikimedia Commons

Cooking to Cure; A Nutritional Approach to Anxiety and Depression


Book Review

Cooking to Cure; A nutritional approach to anxiety and depression, is an inspiring, practical guide to nutrition and how a nutritional approach may help you eat your way towards better mental health. It represents an exciting cutting edge approach to health and is something researchers all over the world are looking into.

Could changes to our diet be as effective as pills? Could you take control of your dietary intake to improve your mental health? With depression and anxiety as one of the most common mental ailments in the western world, it is high time we sat up and looked at dietary factors.

This wonderful book explains in a very clear and understandable way how nutrients affect the brain and our moods. It details the nutritional contents of foods that are known to play a part in depression and anxiety, how much you need every day and even has a recipe section full of mouth watering meals.

As someone who has for many years appreciated the “truth” and power of nutrition as prevention and cure, Angela reflects on changes to eating habits over the years. She draws on scientific research to support the hypothesis that as our diets have become more and more depleted of essential nutrients, so too the incidence of depression and anxiety has rocketed. She tells us how replacing commercially processed food with “real” food (not faddy diets!) we can reclaim our health and well-being.

It is empowering and a must-read for all sufferers of depression and anxiety.

Available from:

Until next time, Steve.

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Steve Clifford                                                                                                                             Senior Accredited Integrative Psychotherapist.                                                                 Accredited Cognitive Behavioural Psychotherapist.

If you see a therapist, how many sessions are you likely to need?

Is this one question or many?  If you see a therapist, how many treatment sessions are you likely to need?  Sometimes that’s a little like asking “If I go on a journey, how long should I travel for?”  Happily though, we do now have enough research evidence to be able to respond fairly helpfully to this “how many treatment sessions?” question.  To give useful answers though, it’s probably sensible to break the very general “how many sessions?” query into a number of more targeted sub-questions.

These sub-questions could include “On average, how quickly am I likely to feel appreciable benefit?”, “How many sessions will it take to achieve full recovery?”, “Are there some kinds of problem that are likely to need more treatment sessions than others?”, “Is there any point in getting ‘top-up’ sessions after the main therapy has finished?”, “How would I know if the therapy isn’t working?” and “If the therapy isn’t working, what’s the best thing to do next?”  Let’s look at these sub-questions in a bit more detail.

How quickly am I likely to feel appreciable benefit?  A good place to look for answers to this question is in the 2013 sixth edition of the excellent Handbook of psychotherapy and behavior change.  In his chapter “The efficacy and effectiveness of psychotherapy”, Michael Lambert reviews relevant publications and concludes (p.204) “Therapy is highly efficient for a large minority of clients, perhaps 30% of whom attain a lasting benefit after only three sessions.” and when monitoring for “reliable improvement … it appears 50% of patients respond by the 8th session and 75% are predicted to need at least 14 sessions to experience this degree of relief.”

“Reliable improvement” is a formal way of measuring “appreciable benefit”; it is not however “recovery”.  In the“Handbook of psychotherapy and behavior change” chapter Measuring change in psychotherapy (Ogles 2013) it’s highlighted that two of the “most prominent definitions of clinically significant change include: (1) treated clients make statistically reliable improvements as a result of treatment (improvement), (2) treated clients are empirically indistinguishable from ‘normal’ peers following treatment (recovery).”  The most widely used assessment measure for “improvement” is called the “reliable change index (RCI)”.  The RCI was developed over twenty years ago (Jacobson and Truax 1991) and it compares pre-treatment and post-treatment assessment scores while taking into account the precision of the assessment measure being used. “The change is considered reliable, or unlikely to be the product of measurement error, if the change index (RCI) is greater than 1.96.” (p.155).  If you’ve continued to read this far without developing a headache, it’s probably helpful to underline that “reliable improvement” is the most widely used measure of “appreciable benefit” and Michael Lambert’s comments about “reliable improvement” in the previous paragraph largely refer to the “reliable change index (RCI)”.  Now what about “recovery”?

How many sessions will it take to achieve full recovery?  By “full recovery”, we mean here “indistinguishable from ‘normal’ peers”.  Trying to attain “full recovery” rather than just “reliable improvement” is important for the obvious reasons that we feel better and function better after full recovery than we do after reliable improvement. It’s also important because the chance of relapsing is considerably less after full recovery than it is after reliable improvement – see, for example, Recovery and subsequent recurrence in patients with recurrent major depressive disorder.  Again Michael Lambert’s chapter is an excellent source of evidence-based information and he writes “For patients who begin therapy in the dysfunctional range, 50% can be expected to achieve … recovery after about 20 sessions of psychotherapy.  More than 50 sessions are needed for 75% of patients to meet this criterion.”  Now these are average findings.  Some therapists achieve better results than this and others worse.  Commenting on one of the relevant major studies, Lambert (p.197) writes “Outcome by therapist showed considerable variability, with the most effective therapist’s patients showing rapid and substantial treatment response, while the least effective therapist’s patients showed an average worsening in functioning.”  This variation in therapist helpfulness is such an important issue and I have written extensively about it – for example, in the recent blog postFascinatingly, therapists themselves vary considerably in their effectiveness”.

Unsurprisingly clients also make a big difference to the number of therapy sessions they need to make progress. As in most areas of our lives, commitment and hard work help hugely.  With cognitive & behavioural therapies, encouraging clients to actively work on relevant challenges between therapy sessions adds considerably to effectiveness – see, for example the paper Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. As the paper Homework compliance counts in cognitive-behavioral therapy” shows, committed clients who really tackle these between-session challenges make better progress. You see the same pattern in mindfulness training, with the recent paper The effects of amount of home meditation practice in mindfulness based cognitive therapy on hazard of relapse to depression showing that clients, who work to do the formal daily meditation practice, achieve better results than those who don’t.

Are there some kinds of problem that are likely to need more treatment sessions than others?  Yes!  In general clients who want help with more severe problems will probably need more treatment sessions to achieve recovery.  By more severe, I’m referring to variables like the extent & intensity of symptoms at presentation,  how long the problem has been going on for, and how resistant it has proved to previous attempts at therapy. Relevant too is the overall quality of the client’s life … so it’s not just the severity of the presenting problems that govern speed of response, but also the strengths & resources the client has more generally in other areas of their life.  “Is there any point in getting ‘top-up’ sessions after the main therapy has finished?”  Often this is the case, especially for problems that have gone on longer before therapy was started.  “How would I know if the therapy isn’t working?” and “If the therapy isn’t working, what’s the best thing to do next?”  These are very important questions.  Again I have written extensively about these issues – see the two recent blog posts Routine outcome monitoring can really help therapists clarify where they need to try harder and Practice-based evidence can complement evidence-based practice so very well.

So what are the overall messages?  “If you see a therapist, how many sessions are you likely to need?” is a really relevant question, not least because it’s likely to help having some idea of the size of the journey before embarking on it.  Reiterating Lambert’s review findings, quite a few clients (possibly about 30%), may only need three or so sessions to achieve very worthwhile benefits.  About 50% are likely to have achieved worthwhile benefit after eight sessions and approximately 75% after fourteen.  There is a problem here though.  Aiming for formal “full recovery” makes better sense if possible.  Here we may well need twenty sessions of therapy to help about 50% of clients to full recovery.  To help 75% reach this very desirable goal may well take at least fifty sessions, so for example Arntz & colleagues’ recent successful treatment of clients suffering with diverse personality disorders – Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders – involved forty sessions in the first year of treatment and ten in the second. As Richard Layard & David Clark have so cogently argued in their tremendous 2014 book Thrive: the power of evidence-based psychological therapies, there is a compelling case – in terms of both relief of suffering and economic saving – for more major investment in the treatment and prevention of psychological disorders.  Research strongly suggests that, in general, clients are more often under-treated than over-treated. This comment however crucially assumes that worthwhile progress is being made.  It is important to consider careful monitoring of treatment response using well-validated questionnaires to clarify that this is the case.  Lack of response over the first three to six sessions should be a red flag.  Is this therapy practised in this way by this therapist really right for this client?  I have looked here at the “how many sessions?” question and I hope this post will help those involved in therapy be more informed about what is likely to be an adequate dose.

This blog has been reposted from

Until next time, Steve.

We would be delighted if you visit our facebook sites:

Steve Clifford                                                                                                                             Senior Accredited Integrative Psychotherapist.                                                                 Accredited Cognitive Behavioural Psychotherapist.



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All day long our minds are filled with constant chitter chatter. Most of it benign, some of it worry-some, and some of it down right troublesome.

Research suggests we have somewhere in the region of 65,000 thoughts every day and that on average our mental dialogue is in the region of 50 to 300 words per minute.

Much of this is self-talk, inwardly directed and a good deal of it is unhelpful. Because of the way it makes us feel, it is capable of raising our stress levels and bringing down our mood. In CBT circles we talk of NATs (Negative Automatic Thoughts) or ANTs (Automatic Negative Thoughts).

Such thoughts are:

AUTOMATIC              They just seem to come into your mind without any concious effort.

DISTORTED               They are not always supported by the things you know to be true.

UNHELPFUL             They are nearly always negative and make it difficult to change.

PLAUSIBLE               You accept them as facts without questioning them.

INVOLUNTARY         You do not choose to have them and they appear difficult to stop.

One of the problems is that we tend to be so identified with our thoughts that we often cannot see them for what they are…just thoughts. Instead, somehow we see them as us, and we feel we have no power over them. Often we give them power, believing them and that we are somehow at the mercy of them. Racing thoughts, obsessive ruminations and irrational fears take over.

How then can we learn to step back and take control? Well, let me introduce you to “thought flipping.”

I would like you to imagine that you are now going to install a “negative thought alarm.” As soon as a negative thought crosses your mind a silent alarm sounds. You then step in with absolute authority, grab hold of the thought and flip it on its head, by thinking the exact opposite.

Yes, expect a little battle at first, when your rational programmed mind tells you that such a practice is ridiculous and could not possibly be true. But like the Master you are, you use your authority and power to respond back in a direct and commanding way. The mind is reminded that it’s former thought was, at the very least, as lousy and ridiculous as the new flipped one. As you are the Master you will choose what is true.

Here is an example of thought flipping where we rewrite the negative mental script.
You find your mood dipping and you notice you are feeling angry with yourself. Your thoughts are as follows: “I am useless and have no sticking power, I missed an entire week at the gym.” By flipping the thought we create a different perspective and this can halt the negative mood slide. “I have been kind and listened
to my body and taken a break from the gym, so I am going to have a really good workout today, because I am truly committed to my goal of feeling good and honouring my mind and body.”

What you need to do is change the wording, in other words rewrite them. Which one do you want to be true? You choose?

It can be really helpful at first to get into the habit of writing down any serial negative thoughts that continue to pop into your mind. Do this when you notice the drain on your emotions and you start to feel down, depressed or anxious:

Write down your thoughts on paper and take a good look at it.

Do you know this thought is a fact, is it true?

Is this a helpful thought, does it serve you?

Write down a counter thought that opposes the negative thought

Change the wording of the thought to something more positive

Now each time the negative thought wants to dominate your thinking, assertively replace it with the new positive alternative.

So here we have it, thought flipping, tackling negative thoughts by re-creating positive alternatives with deliberate intent. Planting positive thoughts this way ensures that we take back control and create the reality we want.

Until next time, very best wishes, Steve.


You may wish to know that Steve is now offering therapy sessions via Skype                   Please contact us through our website @

Visit our facebook sites:

Steve Clifford                                                                                                                       Senior Accredited Integrative  Psychotherapist.                                                                 Accredited Cognitive Behavioural Psychotherapist.


Adapted from: “Thought-Flipping: A guide for Taking Charge of Your Mind-Stuff,” by Leigh Donovan, 30/06/12, Spirit-full, a personal transformational blog.

Ref: “Negative Automatic Thoughts,”  Central Manchester and Manchester Children’s University Hospitals NHS TRust, Clinical Psychology, 2002

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Food and Mood


Most people reading this will recognise that our state of mind and food are inextricably linked. Just as devouring a whole packet of biscuits or demolishing a chocolate bar is something many people crave when feeling tired or fed up, so too, using food to express their mental anguish is a common phenomenon.

These days, thanks to global media coverage, the awareness of conditions like obesity and eating disorders such as anorexia and binge eating are much better understood. Having said that, neither condition is more accepted in our society; however, with the diet and food industry seemingly bombarding us with subliminal messages telling us to eat this, or cut out that, it is no wonder many opt simply for denial.

The food and diet industry have a lot to answer for. Many will remember the advice to avoid butter, eggs and animal protein in meat and dairy, with spreads and low fat alternatives on every supermarket shelf. Yet today, “going to work on an egg” is once again acceptable and many shun spreads and the harmful trans fats they contain in favour of butter once again. Saturated fats are no longer seen as enemy number one. The years of confusing messages have literally turned us all off. Perhaps, Granny was right all along…”a little of what you fancy does you good.”

Diets too have come to be seen as fads that do not work. Remember these: the grapefruit diet, the cabbage diet, the Beverley Hills diet, the Atkins diet, the F-plan? I could go on.  There are the substitutes, too, where liquid meal replacements, biscuits, bars and all manner of alternatives take the place of food.

No wonder we are all confused. Look at the way the supplements industry pedal vitamins, minerals, capsules and powders of every description. All being heralded for their great health benefits. Elixir of life or youth capsules, take your pick, hand over your money and the choice is yours. Who said that snake oil remedies do not exist!

Whichever way we look at it, one thing is certain and that is, eating problems are psychological. With the very rare exception of a metabolic disorder, perhaps;  obesity, anorexia and many other food related conditions have nothing to do with hunger and everything to do with meeting an emotional need. Food is used as a “medicine” to dull down emotional pain, to soothe or to mask an emotional discomfort. Food is a comfort and we all seek to push away discomfort. Food is used to fill up, cover up, and build up a protective barrier.

Quite literally, food (and alcohol) is to the adult, the surrogate breast or bottle. Smoking too, while technically more of an obvious drug than food per se,often serves the same purpose. Yes, food can become addictive as can the hormones released when starving, or the soothing pain felt by an anorexic when they seek to feel “in control.”

To get to the bottom of our emotional discomfort and the role food plays in this really is the domain of the psychological health professional. We need someone to hold up the mirror and tell us what is really going on. We need to understand why it is that our search for the “magic potion” and a “quick fix” will bring us nothing but more suffering. Furthermore, changing eating habits is not easy, after all, making changes means altering our comfort level and most people naturally balk at that.

If you have a food issue seek out a health professional with expertise on eating disorders who has no emotional ties to you. Someone who will hold the mirror up and help you see the real picture and help you to make changes to the way you eat and your relationship to food.

Until next time, best wishes Steve.

You may wish to know that Steve is now offering therapy sessions via Skype                   Please contact us through our website @

Visit our facebook site @

Steve Clifford                                                                                                                       Senior Accredited Integrative  Psychotherapist.                                                                 Accredited Cognitive Behavioural Psychotherapist.

Primary Ref: Sullivan, R (2009) “Reclaim your youth, growing younger after 40.” Montgomery Ewing Publishers.

Image: “Supreme pizza” by Scott Bauer – Licensed under Public domain via Wikimedia Commons –