[00:00:04] Speaker A: Hello and welcome to a Wonder Care podcast. [00:00:08] Speaker B: I'm Sheena Mitchell, pharmacist and mum of three. [00:00:10] Speaker A: I combine healthcare and practical advice to. [00:00:13] Speaker B: Support you on your parenting journey. [00:00:15] Speaker A: Today, I'm joined by Connell Harper. Connell is a cognitive behavioural therapist, otherwise known on Instagram as At Cognitiveconnell. His primary degree is psychiatric nursing and then he went on to complete two postgraduate courses in cognitive behavioural therapy and his masters through Trinity College in Dublin. Connell has treated a diverse population of individuals in multiple settings, including an acute psychiatric unit and secondary care psychology service. He now works in a specialist perinatal psychiatry service and runs his own private business with extensive experience treating multiple mental health problems at varying degrees of complexity. In addition to this, Connell has been a visiting lecturer on postgraduate CBT courses in Trinity. And in 2020, he established the CBT department in a maternity hospital, as well as his private practice in Castle Knock. Today, myself and Connell talk about the biggest problems facing this generation regarding mental health, I ask the question, is our lifestyle causing an increase in anxiety and depression, or have these problems always been there, but just not diagnosed? We also talk about what causes women to feel more anxious in pregnancy and in the postnatal period. Colonel explains to me what the perinatal period is and why there's an increase in mental health problems for women. During that period. I discuss my own experience after the birth of my third child in hope that other women will see that mental health is something that impacts on everyone. All in all, this episode is full of brilliant information and I really, really enjoyed speaking to Connell. [00:01:47] Speaker B: So let's dive in. Hi, Connell. Thank you so much for joining the show today. [00:01:54] Speaker C: Thank you. [00:01:54] Speaker B: Obviously, with your vast experience, I really wanted, I suppose, to dig down into why you think that this generation are struggling so much with mental health issues and why that might be. Do you think it's more prevalent or is it just do we talk about it more? [00:02:11] Speaker C: I think there's a couple of reasons. I think that there's a kind of institutional reason in that the more diagnostic tools we have, the more we're going to find diagnoses for things. So over the last kind of 20 years, there's been an explosion of diagnostic kind of criteria. So now there's a name for everything. And if there's a name for everything, there's a condition for everything. And I think that that's one reason. I think another reason is that people want to seek treatment. And one of the only ways that you can seek treatment is to have a kind of qualified disorder. It's the way to access services. So if your child before, they were kind of seen as maybe difficult, inadvertent, commas, whereas now we know that there's specific maybe behavioral disorders they might have, like ADHD or autism, and without that formal diagnosis, you can't access services. So people kind of want or need those things. And then I think finally you touched on it is that we actually have the language for it and there's a certain level of acceptance around anxiety or low mood or whatever that might be. And I think social stigma has reduced a little bit. I also think that COVID was the first time ever that the entire world had a collective reason for a problem. And I think suffering is often easier to tolerate when it's all collective. I think pre COVID. If I met you and you told me, oh, I've low mood, oh, that's your problem. You know what I mean? Whereas if I meet you after COVID, we tell that's COVID, or I'm depressed COVID. And we can all kind of roll our eyes up to heaven and say, well, it's COVID, it's COVID, it's COVID. Whereas where were all these problems before COVID People had these difficulties. But it's a shared understanding and a shared reason that we can all suffer together. And I think those are the main reasons that mental health problems are more prevalent today than they have been historically. [00:03:54] Speaker B: And as you say, like in the olden days, I remember hearing, oh, well, she's taken to the bed for three weeks. You're like, you don't just take to the bed. That's not okay. So maybe our standards of wellness have increased and our awareness of what quality of life should be has improved, and we realized that we shouldn't be struggling on our own, which is a very positive thing. But as you said, unfortunately, I'd imagine there's a lot of diagnosis still not happening because of stigma. And sadly, with things like autism, even if you have a diagnosis, it can be still hard to access health care in this country, which is very frustrating. But does our lifestyle, like, I've noticed as a mom of three who's self employed, that life is very busy. My life looks very different to, what, say, my mom's life looked like, or her mom's life looked like. And that is mostly to do with, I'm going to say finance, really, in a way. It's also to do with choice. Previously, women didn't have a choice to be included in the workforce, maybe as much as they do now. And now women have real passions and drive to chase their careers and to reach goals that interest them solely. We're more selfish in a good way. But in previous generations, there wasn't the same stress and struggle us over finances, over childcare, over our very materialistic dreams. And even the children are very much wanting expensive things. Like, I got the PlayStation question the other day. Maybe I could ask Santa for a PlayStation. And back in the day I sound like I'm 90. But anyway, even back in my era, you'd be delighted with kind of a teddy that lit up or something. Things were more basic. You'd be happy with the bike. Everything now has changed, the pressures are different. Do you think that has an impact on the levels of anxiety within our communities? [00:06:04] Speaker C: To a certain extent, yes. I'm a 90s child myself, and I think that when we grew up, the only toys that you knew about were the toys that were advertised on TV. And I suppose that there was a certain toy that came out every Christmas that everybody wanted, but you knew there was a good chance that you weren't going to get it. Do you know what I mean? Because your parents weren't too worried about disappointing you, because they weren't too worried about kind of the social shame of you not having a specific toy or whatever that might be. Whereas now you have children who on social media watch YouTube videos of other children unwrapping presents and seeing the high turnover and seeing what's involved in that. And parents feeling a need to kind know in advertacomas keep up with the Joneses that there's an expectation on them to provide for their children because they don't want to let their children down. And oftentimes that comes around from parents not experiencing certain things in their own childhood and trying to meet their childhood needs through their own child. So for example, if I grow up in an environment where maybe I didn't get a lot and I remember birthdays and Christmases being very disappointed by that, when I have my own children, I'm trying to protect them from what I would deem kind of traumatic experiences. So I go out and I splurge on them because I really want them to have what I didn't have. And I think a lot of parents do that and they feel that need to keep up with societal pressures, but it's more important to maybe step back from that and say, well, what's so bad about your child being disappointed? It's up to you as a parent to teach your child how to learn and how to manage with the feeling of disappointment rather than trying to avoid them ever having it. Like, no one wants their child to be disappointed, obviously, but it's more important that you teach your child how to manage being sad, how to manage being disappointed, because they're going to happen at some point and they can't live in bubble wrap forever. [00:07:54] Speaker B: Yeah, and you're right. We've kind of become a bit conditioned to trying to make things better through any means. And you're absolutely right. I find that sometimes I have to go through phases of practicing saying no just because, like, okay, these kids are really becoming quite demanding rather than grateful for basic things. And it could be to do with time on a screen or whatever. The other thing I think that really impacts certainly my day to day stress rather than anxiety now, but is time poverty. And I know that's something that a lot of families suffer with and it affects the quality of their relationships and their ability maybe to do self care, whether that be in exercise or reading a book. Like reading a book sounds like an absolute novelty to most mums who are busy because there is no time in the day when you're trying to work or care for however many children with so many activities. So do you think time poverty is an issue or is it more that we're pushing additional pressures that maybe we don't need to on ourselves? [00:09:08] Speaker C: I think it can be a combination of both. I suppose where I work in the specialist psychiatry services dealing with new mums and pregnant women, you do see a certain amount of time that sacrifice, but not towards anything in particular. It's more this sense of being busy and keeping up with what they feel is important. So I think a lot of women, when they are kind of in that newborn stage, inevitably they're not going to have time to read a book because the sleep pattern is destroyed. Their body is going to be sore recovering from childbirth, and there's going to be numerous other issues. But kind of fast forward six months, a year on from that. The idea is that you try and establish a routine that allows for some level of kind of personal time that allows for, even if it's 1520 minutes, to get a bit of time to read a book and to do something nice for yourself. And if you're not able to make that time, the question is why? I mean, I'm sure it's a prioritization issue for a lot of women, where they might be prioritizing, oh, well, the dinner has to be made. Well, absolutely, but why can't your partner make the dinner? Or why can't someone else make the dinner? Or maybe you can get a takeaway this one night, maybe actually sit down, use that time that you would have spent cooking to do something else. And what a lot of people do is that they might say, well, do you know what? I won't cook tonight, I will get the takeaway. But they'll fill that empty time with another job that they feel needs to be done, rather than actually thinking, is this something that absolutely needs to be done in this moment? And say, well, what's more important, my time or the time that I kind of create for my family? So I think that it's a combination of time poverty, but also when you think of poverty, you think of kind of financial literacy and it's a time literacy issue in this and that. How able are you to manage and structure your time? How able are you to make a routine for yourself and how able are you to stick to the routine? Do you support it's in place that are going to enable you to stick to a routine? So a lot of what I do in my work is helping women, especially in that kind of postnatal period, because women in the postnatal period will 30% of them will suffer what's called adjustment disorder, which is just trying to adjust to life and they'll have specific symptoms that come about as a result of that. A lot of my work is helping those women establish a routine with a newborn, but to make sure that 5% of that routine minimum is devoted towards something for them as an individual and not to get lost. Because if you think about a triangle where you've person, partner and parent in the early stage of your life, you're in that kind of completely self absorbed child mode where you expect everything to just kind of come to you and fall to you, which is very normal. And then you start kind of teenager, you start meeting other people and you straddle that line between person and partner a bit more and you learn to share your life and do different things. But then you become parent and suddenly there's no more person and there's no more partner and you're all in on mummy mode or all in on daddy mode and you lose that sense of yourself kind of as an individual, but also kind of romantically sexually with your partner. And it's all about the baby and it's really important that people develop a little bit of time for their relationship and for the relationship with themselves, so they don't get lost in that. [00:12:03] Speaker B: And I think that's really important advice and something that is definitely missed because when you have babies, you're your last priority. So, as you say, you don't need to be booking a spa weekend or running a marathon or doing anything that's going to consume huge amounts of time, but to give yourself even ten minutes to have a shower and just hand over the baby? Or just to try and prioritize quite a cup of tea? Or some way of getting some little selfish headspace where no one is at you and you're responsible for nothing other than yourself. And I think the key there is that it can be a very small amount of time until you're capable of increasing that time. And that happens as kids age. And I suppose that again is important to remember because you can feel quite overwhelmed and hopeless when you have a newborn in the house and you feel like months are years, in a way. [00:13:02] Speaker C: Absolutely. [00:13:03] Speaker B: Yeah. So it can be a very difficult time. Obviously it's joyous, you're delighted with your baby, but as you said, that adjustment to your relationship and to your partner and yourself really changes. So from the start, I suppose set aside a little bit of time to kind of keep in touch with those relationships is definitely a good idea. [00:13:24] Speaker C: And I think that one thing as well, that kind of people tend to conflate. And I'm going to kind of maybe talk a little bit more about women here, because I'm more familiar with working with women in the perinatal services is that they conflate that making time with themselves equals some form of selfishness and that that time for themselves means that they're taking time away from the baby or taking time away from the children. And I suppose there's a difference between making time for yourself versus taking time away from your children. And there's often this conflation or confusion that occurs for a lot of women that, oh, I'm making time for myself, therefore my baby or my child is without me, and that's a bad thing, and my child won't be able to cope. And they completely underestimate their child's ability to cope. You're not always going to be able to be there for your child. And having structured time away from your child in which you can kind of prepare them and say, listen, Mammy's doing this today, and this is why. She's doing it and explaining it to the child so they don't feel you're kind of abandoning them for the day or whatever it is, or even if it's half an hour. They're appropriate boundaries to set in place with a child. And again, this feeds back into teaching your child how to manage negative affect or negative feelings. There's going to be times where your child is upset that you can't be there or they're disappointed or they're hurt or whatever it might be, and that's okay. It's important for children to experience them. And as a parent, either mommy or daddy to be able to come in and explain like, sometimes you're going to feel like that, and that's okay. Mommy won't always she'll always love you and she'll always be there for you emotionally, but she might not be able to be physically present for you every step of the way. And that's okay to teach that to children, obviously, you might not jump in with that. If they're kind of two years old, they might not understand that. But as they get a bit older, obviously kind of parental assessment is kind of key in that. But it's important that kind of parents recognize a child being upset is not a parental failure. It's a parental failure if you don't teach them how to manage the upset and teach them how to manage the distress. And that's something that we do in my private practice quite a lot is those kind of parental trainings and helping parents to kind of meet the child's emotional needs. [00:15:27] Speaker B: And that's a big thing because the moment that scenario, like I remember going out to work while on maternity leave and literally getting into the car crying myself because my child had been so upset that I was leaving as a baby. And you can't explain it, and you're like, well, but even now, look at youngest is eight, and I still get you're going to work again. And it's like, guys, I work at home most of the time now. You are very lucky that I am around. [00:15:59] Speaker C: But that's a super example of how no matter how much you give, they will always want more. [00:16:07] Speaker A: I am delighted to partner with one of my all time favorite products, Salon Plus. This is the world's 1st 100% natural dry salt therapy device. It's clinically proven to relieve a wide variety of allergens and respiratory conditions. This salt therapy method has been trusted for generations and has become hugely popular worldwide. As more and more people recognize the superb results achieved from a natural and noninvasive method. This device will help you breathe easier and sleep better. [00:16:39] Speaker C: And whatever you do as a parent, no matter what level you do it to, and doing it to 110%, the child will turn around and go, I kind of want 112% from you, actually. Do you know what I mean? You need to pull up your socks as a parent and get your act together because they are kind of bottomless pits of emotional needs and that's the beauty of children. And as a parent, it's a fantastic journey to go on and watch them kind of navigate through the voyage of life and develop that understanding about them emotionally and psychologically. But it's also important that the child understands boundaries and understands that actually mummy and daddy have things to do and it's important that they're able to do them. And you teach the child how to navigate that with the parents without putting adult responsibility on them or without kind of saying, well, if mummy doesn't go to work, we won't have food in the fridge. And the child is kind of looking at you terrified, kind of going, why won't we have food in the fridge? Do you know what mean? So it's about explaining boundaries, but without worrying them about adult responsibility. [00:17:35] Speaker B: I can tell you now, a lot of women listening to this will be just starting going, mommy would like to close the door of the bathroom. Privacy. When you say children will want 112% like they'll want 200%, they want to live in your blood, that's what we decided. They're like absolute little things, but the wonder is that they give that much love back. So it's just to try and remember that because when you're there getting the cuddles and the benefits, it's great too, but it is hard to manage at times. So I know you work an awful lot with women in the perinatal stage of their parenthood. Can you explain to listeners what the perinatal period is? [00:18:18] Speaker C: Yeah, I'll try. So the perinatal period is from conception until one year postnatal, so from the period of pregnancy and for one year after birth. And the term only kind of came around in around 2016 2017. It was only kind of formalized the term to have perinatal kind of problems as such. Like the term perinatal OCD Obsessive compulsive disorder was only kind of really formalized around 2017 2018. So it's a relatively new system in Ireland, and in Ireland, the perinatal model of care was developed in 2017 in which we developed a hub and spoke model. Hubs being centralized, larger hospital sites and spokes being kind of ancillary or smaller sites. So for example, the Coomb is a hub and then the spoke is port leash. The Rotunda is a hub, obviously being a larger hospital. And so all women now in pregnancy and postnatal period up to a year are entitled to access those services if they have mental health problems for free. [00:19:15] Speaker B: I was not aware of that. That's brilliant. How easy or difficult is it to access? [00:19:21] Speaker C: It depends. I suppose that like any mental health service, the service that we run is a tertiary psychiatry service. So it's kind of for moderate to severe mental health problems. And oftentimes what happens is that women will present, they get an assessment and then it'll be kind of deemed what's the most appropriate route of treatment? So it might be actually you're not maybe unwell enough inadvertent commas for a service in which case you might be referred to primary care or you might be referred back to your GP and you might do a kind of course of SSRIs or antidepressant medications. Or if you are kind of deemed kind of to have a kind of mental health problem that's impacting the quality of your life day to day, then you'd be linked in with the services for a range of kind of psychological supports, medication supports or other interventions. [00:20:10] Speaker B: Okay. Can you describe, I suppose, some of the issues that might crop up during pregnancy and postpartum? [00:20:18] Speaker C: Yeah, so in terms of the literature, there's a huge spike in mental health problems in the perinatal period. And for women you're never more at risk of domestic violence and mental health problems than during the perinatal period. And the mental health problems can be due to a ranger of factors. So you've got biological vulnerability. So there's kind of genetic or biological predisposition to developing mood disorders. There might be kind of stress and life changes. As I mentioned, adjustment disorder is one hormonal changes. So oftentimes spikes and troughs of oestrogen and progesterone. There's kind of dramatic fluctuations in them which can disrupt, I suppose or affect the neurotransmitters in the brain. Obviously lack of social support is a huge issue. Then there's financial constraints. It's not cheap to have a baby. Then there's other factors such as kind of relationships breaking down. Oftentimes that's one of the major contributing factors. People are in a relationship, the girl gets pregnant, presents to the Coomb or to the Rotunda or to another hospital and at the start the guy is all on board. Six months into the pregnancy the relationship isn't working out, he abandons ship and now she's kind of raising the child by herself. Another one, I suppose postnatally can be traumatic birth experiences. That's a really common one tocophobia which is a fear of childbirth is another issue that can present for people in the pregnancy period. Then lack of sleep and then there can be medical complications. Gestational diabetes, preeclampsia and different things like that can exacerbate symptoms. [00:21:47] Speaker B: What would be the most common presentation of symptoms as a result of some of those traumas or experience? How do they manifest, really? [00:21:56] Speaker C: So for a lot of women who've experienced, say, birth trauma, some of the most common symptoms that they might find is being extremely angry. They might have flashbacks, they might have nightmares, they might have night sweats, they might be extremely anxious, or they'll feel a kind of sense of trauma. One way to do this is if you have had birth trauma, to think about the hospital that you went to and if you kind of get that kind of shivery sensation, you kind of can't even think about it. That's often an indication that maybe you've suffered some kind of trauma. Unwillingness to discuss it or inability to discuss it without kind of welling up and becoming overly distressed can be an indication of birth trauma. I suppose in terms of the most common mental health presentations that we tend to see in the perinatal service would be generalized anxiety disorder is the most common anxiety disorder that you would see in the general population and it's also the most common that you would see in the perinatal population. And then I suppose there's also a huge rate of obsessive compulsive disorders and increase in the general population. You will see cross males and females variants of maybe 1.2 to 1.8%, whereas in the perinatal population that can be as high as 9%, which is almost a 500% increase. So huge increases in perinatal OCD in. [00:23:13] Speaker B: Terms of low mood or I suppose the stereotypical depression, you hear a lot about postnatal depression, but I assume it's not just postnatal. Obviously depression is quite common within the general population, unfortunately, at the moment. But is it more common while pregnancy is going on, or is it more common postnatally after maybe the changes in hormones and all of the change in, I suppose, lifestyle and everything. The shakeup that happens after you have a baby. [00:23:52] Speaker C: The shakeup is a good way of describing it. Postnatal depression would probably be if I was to tier them in terms of presentations. Anxiety will be the number one presenting difficulty most people have then would be postnatal depression. One of the difficulties with postnatal depression is that there's often a certain amount of guilt and shame associated with it. The reason being is that society tells you, oh, you're having a baby, it's the best time of your life. You should be delighted and you should be full of joy. And what could you complain about? What people aren't saying is that actually having a baby is really, really hard. It's a really big challenge. There's a lot of adjustments. It can be an awful pain sometimes you're not sleeping, your body is sore. There's huge adjustments. And so when women are kind of feeling down or feeling flat. They can often feel disconnected from their baby. And so they're kind of a little bit ashamed of that. And they feel like that they are failing as a mother, so they tend not to reach out and try and get help because it'll draw attention to the fact that they are struggling. And one of the most common causes of death for women in the post in the one year after birth is suicide. So it's a really serious problem. And I suppose that the main red flags for women to look for in that sense is to look for feeling disconnected or detached from the baby. Kind of thoughts about suicide or self harm, feeling that life isn't worth living. They'd be the kind of main things to be looking for. In terms of postnatal depression, that was. [00:25:16] Speaker B: Something I was aware of before I had my own three children. Those main symptoms that you described there, and I haven't shared this before. Bosch I had no, I suppose, mental health struggles after my first two pregnancies, and I relished in being a new mom, but on my third baby, and there was no delivery issues. It was textbook, really straightforward pregnancy. And he came on time. He was great. He was a great baby. But for me, I didn't feel disconnected from him, maybe. And luckily, I didn't have suicidal thoughts. For me, it was much more subtle than that. For me, I just got very, very angry and frustrated at everything and everyone. Not the baby weirdly, because I was consumed by the baby, but anybody else around us, and that included the other children, and it included my husband. And the penny only dropped for me one day. I was sitting in funky monkeys in Dundrum. And I would just like to say that funky Monkeys is not a trigger for upset. Usually. I don't mean any disregard to that establishment. It entertained my children for years. But I remember sitting there one day and just bursting into tears over nothing. And it was mostly because I was so angry. And that was my kind of watershed moment. That was when the penny dropped and I went, okay, Sheena, that's not okay. This isn't your normal behavior. You've had other babies. You know what you are like as a mother, and this doesn't feel great. And I remember going straight to the GP after that, and they decided I had postnatal depression. And I did take medication for it at the time, and within two weeks, it was like night and day. And I'm not saying obviously, medication isn't step one. It never should be. And cognitive behavioral therapy is the guideline based number one step. But for whatever reason at the time, I refused to engage, which is something I would definitely change if it ever happened again. But I think I didn't have stigma because I was so used to working in the pharmacy. So once I got. The diagnosis. I was very happy to engage with the treatment and it really did change my life at that time. So reaching out for support for me was so important and it doesn't always have to be because I know women and women will think, well, this is just me and no, I'm not suicidal, so I'm not that bad. But actually if you're very angry or very unhappy, you do deserve to feel okay. And yes, that time is hard and difficult and I had three under three, so it was hard, but it didn't have to feel so toxic and sad and I didn't have to feel so angry. And it was such a welcome respite to feel well again. And I took the medication for a period of five or six months and then I was able to slowly, under my doctor's guidance, reduce off it. And luckily I didn't get a return incidence. But I don't think it's something that people realize how significant it is until you're out the other side and you can look back and go, oh my, I was so miserable. [00:28:48] Speaker C: I suppose there's a couple of things on that and the first is thanks very much for sharing that because I know that there's probably an awful lot of women that are listening to you. And I speak right now who go, god, I'm the only person that experiences this. And I think that hearing someone like yourself, a competent professional also mammy, is very nice because I think it's inspiring to hear people speak up about it because it requires a lot of confidence. So thank you for doing that and let me be a part of that because it's not easy. The second thing I would say is that when I suppose identified risk factors earlier in terms of those kind of not feeling disconnected from the baby, I suppose to break this up into kind of tier one and tier two. Tier one being kind of the kind of crisis point where you're kind of having those thoughts and that's more the kind of thoughts of suicide, self harm, not being attached to the baby. But then there's tier one which as you very correctly pointed out, more kind of subtle or nuanced factors. And these are often things like feeling tearful for as you said, no reason. It can also be things like poor concentration, poor sleep, poor appetite, low sex drive, different things like that. And just feeling kind of unmotivated. And one way to describe that is just a general sense of deflatedness just feeling and not having the energy to kind of go about or that everything that you're doing seems to be way more of a struggle than it should be. So tasks that you used to enjoy doing, you don't enjoy them so much anymore or tasks that you were able to do kind of at the drop of a hat now feel like they require an awful lot of energy to do. If you're experiencing those symptoms consistently for a period of two or more weeks, there's a very good chance that you're developing low mood symptoms and I want to be very clear in differentiating low mood from depression. Low mood is where people kind of have that general deflated kind of meh sense to life, where things are a little bit more difficult or a bit more challenging or they lack the motivation. Whereas depression is where it is a serious psychological problem where people are very much in the depths of it and can't see a way out. And I'd strongly recommend that if you're in tier one or tier two that you get immediate help and just try and address that as quickly as humanly possible. And as you said, cognitive behavioral therapy is obviously the kind of first protocol or medications and there's international treatment algorithms that show that the two working together are an excellent combined force as well. So it doesn't have to be one or the other, but it's important that women and men go and get the support they need at an early stage. It's better to be preventative than reparative. And it sounds like you got there at a preventative stage before things got worse. Whereas had you held onto that, bottled it up for a couple of more months, mood deteriorates further, you might have found yourself at a nine out of ten on the depression scale rather than the kind of five or a six. And then it's not as quick a fix as it might have been at an earlier stage. [00:31:39] Speaker B: Yeah, and it's hard because it's one of those things that I'm not sure my husband, because I was so angry, even if he saw it, he certainly wasn't going to say it, but him as a pharmacist as well, there was definitely just a kind of what is going on? Scenario where it was just a personality change. And I could feel the pressure on my head, like there's a dark cloud weighing down on you and you can't see out of it. And so there's lots of ways to move it, as you said. CBT and even I love to hear other preventative methods because I know for me personally, on an ongoing basis, even now, for me, it's the outdoors. If I can get myself grounded in the outdoors and exercise, it doesn't have to be extreme, it can just be a walk for me that really helps my mood for the entire day. And also obviously with sleep, now we know with sleep you produce melatonin kind of roughly 12 hours after direct exposure to sunlight in the morning. So I always say to people, try and get out outside. Not very easy in the Irish weather, no for 15 minutes early in the day and obviously eating healthy and keeping alcohol consumption moderate or low if you're suffering from depression, it adds to depressive feelings. So is there anything else like that that you think would be good for people to kind of be aware of? If their mood is starting to drop and they're like, okay, well, I will go and get help, but let's just see if it's a bit of low mood and see if I can do any self help at home first. [00:33:14] Speaker C: Yeah. So the first thing I'd say is that I actually have a blog on this, on my website, Cbtsolutions ie. If people want to go and have a look at that because there's some kind of good tips that are on that and the blog will always be up. So if they want to reference that offhand. I think one of the most important things that people can do if they're kind of feeling a little bit low is to start by setting goals for themselves. Okay? If you don't have a goal to work towards in life, it's going to be very hard to develop a purpose. One of the big things with setting goals is that if I'm undergoing a little bit of suffering in my life, I can tolerate an awful lot of suffering if I know I'm working towards something bigger. And so if you don't have something bigger or some kind of purpose you're working towards, be it that you want to run a five k, or you want to do whatever it might be to read that book, or whatever your purpose is that you're trying to develop, if you don't have a goal, you're not going to be able tolerate the suffering. And so you're going to kind to give up on things very quickly. The more you give up on things, the more you feel like a failure which makes your mood feel like it's going to go even lower. So set goals that are very realistic and make sure that you have the actual time set aside to achieve them. The other thing I would say to people is to set a routine. If there's no routine, especially postnatally, nothing's going to work out for you. And this isn't about kind of I need to get up at 09:00 and if I'm not up by nine I've failed. This is about setting windows of time for yourself. So you want to be up between nine and half ten in the morning so you've got a little bit of allowance or a bit of flexibility in it. It's a guide to live your life by not strict rules that you have to stick to or you face punishment. [00:34:49] Speaker B: And I loved, I read in some baby book and I can't reference it because it's been too long, but what I did with all of my kids was followed this acronym which was easy and so it was Eat so the baby eats, so Feed the baby, eat activity baby. The activity when they're very little is just changing the nappy but as they get older it might be just a bit of like a little interaction or a little playtime and then sleep and then you time. So E-A-S-Y. So we had no time schedule, but the schedule had to follow that pattern. So eat, activity, sleep, you time and that kind of incorporates, I have to say, the you time ended up being laundry or like maybe getting food. And the sleep sometimes happened in harnesses on me. So you work with what you can. In general it's a nice way of doing it rather than maybe stressing about times because newborns are so unpredictable. But even the babies tend to fall into that routine. They kind of know that when they wake up they'll be fed and after they fed, they know they'll probably get their nappy changed and then there might be a bit of playtime and then you're watching out for sleep use. Even that maybe might be helpful. [00:36:05] Speaker C: That's excellent. I think that the easier the advice, the more it'll be taken on board. And I think that what I would say to anybody. Whether you're considering therapy or you're considering medications or you're just struggling, if you're not eating properly and you're not sleeping properly, no amount of therapy or medication is going to be that helpful. You need to get the basics down and that can be just trying to get a sleep pattern or sleep routine developed some form of meals where you're eating at least two to three good sized meals a day and some form of moderate exercise. And I know that they're kind of harped on about and they become almost cliche, but they're cliche for a reason because they work. And so what I would suggest people, is that set time frames which if you feel you're struggling, try and do those three things for at least a week to ten days. And if you're doing them for a week to ten days and there's still no change in your mood or your anxiety, then consider getting professional help and trying to link in with people. Set a date or a deadline. Often what happens for a lot of people is that they experience these symptoms and they say, asher, if I feel a bit better in a while I won't need therapy or if I don't feel better by a certain time, but what is that time? What is that date? And be honest with yourself and say, well listen, if that was your child and they were experiencing what you were experiencing, how long would you let it go on for before you got them some professional help? And if that's what you do for your child, why would it be any different for yourself and to kind of respect yourself enough? Because if you're not right, that's going to have an impact on your child, you know what I mean? And children who grow up whose parents who are depressed or who have anxiety sort of are far more likely to develop them themselves. So there's a difference between doing what's right for the child, but actually modeling that as well and kind of showing them. Actually, it is important to get help if you're not going, if things aren't working out. [00:37:55] Speaker B: Yeah, I think that's a very good message. And sometimes showing vulnerability is teaching them empathy, because there are times in life where the kids will be like, oh, no, are you okay? If you could even just trip and find yourself in your life, you let them comfort you. And even simple things like that, you have to teach them, and they'd randomly come over and rob my back. Or it's nice, I think, to allow them to have a relationship with you rather than a one sided, kind of constant educational role for yourself. It's a two way relationship. So to keep that open, just want to ask a little bit more about anxiety and how people know what's going on and how to identify anxiety in themselves, particularly in the perinatal period. [00:38:47] Speaker C: Yeah. So anxiety is characterized by a group of symptoms. Some of the most common symptoms people will have are racing thoughts. They'll have kind of sweaty hands that have tight chest, racing heart. They might kind of have jelly leg sensation. They might also have a lump in their throat, tension in their jaw, tension in their forehead. You'll notice kind of tension in their shoulders, and different things like that. And they tend to be the kind of mainstay or the staple symptoms that indicate people are having anxiety. Then there's other things like poor concentration, poor appetite, poor sleep, restlessness, and inability to tolerate distress. And so if you're experiencing I know I'm after reading out an awful lot there, but if you're experiencing a few of them for a prolonged period of time, then it's worth considering how much is my anxiety impacting the quality of my life? Is it impacting with my sleep, with my appetite, with my relationship, or with my esteem or my sense of self? And if it's impacting with them for a period of longer than ten days to two weeks, then you're developing anxiety disorder. Technically speaking, anxiety from kind of the ground up is an inability to tolerate uncertainty. A lot of people develop anxiety from a young age. Women are more likely to develop it than men, kind of at around a kind of two to one ratio. Oftentimes what happens for children is if you grow up with a parent who's quite anxious, you use that parent as a reference point to navigate your world. So if you're my mom, you're bigger than me, you're faster than me, you're stronger than me, and so I kind of look to you for everything. Like, if I want food, cuddles, love, anything it comes from. So, you know, you're kind of that giant that polices the security of my earth. If you get anxious, I think, Jesus, if she's worried, what do I need to be worried about? You know what I mean? Almost like when you see a herd of horses and one gets spooked and they all leg it. If you're in a room where everybody is kind of ten foot tall and they're all way bigger than you, and they get scared, if they're scared of something, you should be really scared of something. And that's the impact it has on children. And what happens is that children have this kind of peaks and troughs as they experience mom's really anxious. I get really anxious. Mom relaxes. I relax. And so if a mom or a dad has a kind of anxious disposition, that means the child is going to kind of mimic that, and eventually the child will kind of go, you know what? It's actually not worth relaxing too much because that's going to be interrupted by mom getting really anxious or dad getting really anxious. And so they kind of maintain this kind of five out of ten on the anxiety scale. Vigilance state. Yeah, exactly. Because it's like, well, I'm kind of just watching out now when's mom going to freak out next? Or when's dad going to get really anxious next? And if it doesn't happen, there's a sense of phew didn't happen, but that's grand, but I should still be aware of it. But if it does happen, I kind of go, well, I knew it was going to happen, so it's not as bad as I thought it was going to be. So they maintain a kind of anxious baseline level, which is why you see that with children. [00:41:41] Speaker B: Can I just ask, is adrenaline levels, say, affected? And do you get like, fight, flight response, that kind of thing? [00:41:49] Speaker C: Yeah. The biological mechanism of anxiety is that there's a part of our brain called the amygdala, which is a Latin word for almond. And the amygdala is like a distress center, like an alarm that goes off in our brain. And so you're probably familiar with the expression, shut up, I can't hear myself think, or when you're looking for an address driving you lower down the stereo kind of thing, do you know what I mean? So you can see better. And so what happens is that when something distresses us, the amygdala is activated, okay? And the amygdala sends a signal to the hypothalamus, which is a kind of control center in the brain, which sends signals down to our adrenal glands, which are located on our kidneys, I believe. And that releases what's called norepinephrine and epinephrine. So adrenaline and noradrenaline. And that is what causes the heart rate to kind of increase, the blood to course to our veins for our body to tense up, and we enter fight or flight mode, we are quite literally getting ready to defend ourselves or to leg it away. And that was really helpful as an evolutionary tool kind of millions of years ago. So if you and I were walking through the jungle and a lion jumped out and you just sprinted. Just pure anxiety and ran. And I stood there and I started thinking about it. I turn into dinner, you go home and you evolve. Whereas in this day and age, there are no, well, I don't know where you live, but there shouldn't be any kind of wild animals jumping out to attack you. But it's the same biological response we have to things. So, oh, I'm late for work. Oh, my God, my boss is going to give out to me. And that thought triggers an emotional response. And cognitive behavioral therapy works on the premise that our thoughts influence our emotions, influence our physical sensations, which influences our behaviors. So a very common example would be for women, say, experiencing kind of low mood postnatally, the thoughts might be, I'm a bad mom. I can't get anything right. My child will end up just like me. I won't be able to cope. I can't manage. What's the point? The emotions might be low, flat, sad, deflated, anxious, upset, worried. The body will respond by feeling heavy, kind of low energy. And then the behavior might be to go to bed, or it might be to get really angry. And if I go to bed or I get really angry, both of them allow for like, a very temporary relief. And I kind of go, you thank God I kind of let that go, or thank God I went to bed for a little while. But long term, I feel more guilty that I went to bed because I'm away from my children or I feel guilty that I got really angry because it's not fair on my kids. And the long term consequences kind of go back and reinforce those negative thoughts that I'm not doing good enough. I'm letting them down. So we end up stuck in these cycles. And so it's really one of the things that we try and do in CBT solutions is targeting those negative automatic thoughts and helping women unpack them and men as well in trying to kind of live a more fulfilling life to challenge the negative thoughts. And that's something that's very present. Anxiety and low mood. Yeah. [00:44:46] Speaker B: And I think the long term health impacts of addressing that are huge because we know that stress and anxiety contribute to so many disease states. And so by addressing what you might not see as serious mental health issues, your day to day anxieties and your tendency to allow yourself to, I suppose, live in that fight or flight mode is having an overall negative effect on your health. And so by addressing it, I suppose you're doing long term good on more than just your anxiety. So that is very good. Where can people find you and how can they reject? What kind of services do you provide in your private clinic? Obviously, you've explained how the public system works for the perinatal health, which is great. What kind of other mental health areas do you cover if people wanted to reach out? [00:45:39] Speaker C: Yeah. So in the practice at the moment, it's myself, two clinical psychologists and another psychotherapist. And I suppose the services that we offer tend to be quite goal focused, so when clients come to us, they're coming with a specific problem and we want to try and help them overcome that problem. So we treat disorders like low self esteem, low mood, depression, anxiety and anxiety will be generalized anxiety disorders, specific phobias, health, anxiety, very common presentation. We deliver a lot of online services as well, and there's a lot of literature, especially over COVID, that shows that online therapy is just as effective as in person, especially for people kind of maybe who are living in more rural areas that can't access that expertise. Everybody in the private practice and ZBT solutions either has a doctorate or is doing their doctorate. So it's a very high standard psychological service that we offer. We're based in Castle Knock for face to face appointments and know anywhere of clients in New York and Canada and Australia. So it depends. But Cbtsolutions Ie is the website we would treat all major kind of mental health disorders and again there'd be other programs available like assertiveness training for kind of corporate clients and different things like that. We also do a lot around kind of child and parent education classes and we offer kind of one to one sessions with parents who are struggling maybe around that discipline and not knowing how to manage that. Do a little bit of work around relationships, so people who've reached crossroads and going, oh, I don't know if is my wife right for me or is my husband right for me, and how to kind of figure that out. And we do that on an individual basis, not couples. [00:47:18] Speaker B: And what about kids? Do you treat kids? Sorry, other than that relationship with the parent, say anxious kids? [00:47:27] Speaker C: Yeah. So we do offer online therapy only at the moment for kids for that, and the spaces are very limited. We are doing our best to kind of reduce the waiting list. It's actually quite short at the moment for the online, which is great because there's a new person joining. So we're continuously kind of expanding and doing our best to meet the requirements to lower the waiting list down. Unfortunately, as I say to most people, it's very hard now to find good, competent, quality therapy where there's not a waiting list because there's a shortage of them the same way. If I want to go see a consultant dermatologist, there's a waiting list of like six months to see them because they're in demand. [00:48:10] Speaker B: I got a phone call the other day asking me if my child needed a dermatology appointment. And this is for the ten year old. And she was a newborn when she was referred. I had to think for ages I was going, Seriously? No, she's never had a skin problem. [00:48:26] Speaker C: I'd like to clarify, our waiting lists are not that long, just to be very clear. And one of the things that we offer all clients as well is that when they contact so if they go to Cbtsolutions, Ie, there's a contact form at the bottom of the website and they can have a little bit of a read about me qualifications and the guys working there. And we kind of offer everyone a kind of ten to 15 minutes phone call, first of all, to make sure the therapy is the right fit for them, because it might not be. It might be a case. They might need medications, they might need a different form of intervention, and we can kind of sign, post them in the right direction, and it saves people a ton of money and a ton of time, and we've no problem doing that. It's a service that we offer. [00:49:07] Speaker B: And I just want to say for and depending on whether I managed to get this video edited, put into the public forum or not, but for me, online COVID changed everything for people like I'm sitting here in Enfield, obviously you're over in Castle Knock and I may as well be in the room with you. Technology has come on so well, so I think it's really good for people to have that option because we do know that there's severe shortages of rural healthcare providers. A lot of it is urban based and quite limit the quality of therapy just based on geography. So it is a nice way for people to be able to gain access into the system. All for the online. [00:49:56] Speaker C: And one thing that we do when we do online is obviously we expect the client to use a laptop or a screen that's big enough because we do screen share, there's a lot of kind of feedback on notes and different things like that. So it's a lot more of an integrated experience between the two and it's more collaborative. And it's really about the question we ask everybody is, listen, if you were going to do eight to twelve sessions with us, what would you like to be different at the end of it and how would you know? And that way it kind of creates a very well crafted goal that we can work with the client towards achieving what they want, rather than kind of getting stuck in circular conversations that kind of go on for 1520 sessions. And you kind of think, I don't know why I'm still here, actually. It should be kind of pushing the client to achieve what they want to achieve so they get the value out of it. [00:50:42] Speaker B: No, that sounds absolutely brilliant. Thank you so much for taking the time to talk to me today. If you don't mind, I'll add that link that you mentioned earlier on your website into the show notes so that people can access it. And obviously I'll be sharing this episode on Instagram and Facebook and everything. So thank you so much for taking the time today. [00:51:00] Speaker C: Thanks for having me on. It was great. Thank you.