Category: Anxiety

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How to Reduce Rumination and Stress by Doing More and Thinking Less

Man in Blue Hoody walking through a field
Taking a brisk walk in nature can help you let go of your worries

Ruminating. Catastrophising. Panicking. All describe the breakdown of logical reasoning that happens when we are in such a state of anxiety that our thinking is paralysed. So how is it possible to stop going over and over a source of worry? The answer isn’t more thinking, it’s more doing.

Why Can’t I Stop Thinking and Switch Off My Brain?

The coronavirus has most of the world on edge. It’s limiting our possibilities for movement and making our lives even less predictable challenging us to manage our mental health. And in the social distancing of these new conditions, some find themselves alone and obsessively thinking about the same things over and over, causing them to feel physically sick with worry or having a panic attack. My English speaking clients in this situation plead with me, How can I change my thoughts?

But the key lies not in changing thoughts but changing activities. When a person’s physical stress response is so high, the logical reasoning part of the brain fails and the survival part of the brain kicks in. This is the legacy of our evolution, an animal instinct to withdraw, like crawling back into a shell for protection. Unfortunately when humans withdraw they stop participating in activities that benefit them such as engaging with others and physical movement.

Those of us who have been conditioned by work that uses our brains in preference to our whole bodies try to think-through and problem-solve unpleasant feelings instead of addressing them directly through physical means. But the best way to lower the acute stress response is to get physical and use more of the whole body, not just that little part of the brain behind the forehead that is responsible for cognition (thinking, judging and problem solving).

Book a real time coaching or counselling session for support

How to Escape the Isolation Chamber of Rumination

Ruminating on a problem without the benefit of more information or a different perspective is akin to trying to make a decision from inside an isolation chamber: we have to get out and experience the world through the senses. The solution to rumination and catastrophising isn’t more thinking, it’s more doing. And specifically doing activities that engage the senses. Not only will doing something physical help you to relax, it will loosen up your thinking and help you gain perspective.

Exercise is the obvious first go-to. I don’t recommend high-intensity exercise for stress reduction because it can spike the sympathetic nervous system that is responsible for elevating the body’s stress response. But moderate intensity exercise such as brisk walking, light jogging, kicking a ball around, moderate swimming or dancing can help a person to get out of their head and into the body. These activities will help relax the muscles, releasing physical tension. Even in the middle of winter, many Swedes will go out and walk in the lightest part of the day because they know that moving the body and experiencing the world through different senses is key to lowering the stress response.

The other activities that work well for reducing the stress response are anything that involves hand and eye co-ordination or acts of companionship. Research has indicated that activities involving hand and eye coordination actually repair neural pathways. Sharing time with friends who are experiencing a lower stress response can actually reduce your own anxiety. So what does this look like in practical terms?

Strategies to Treat Acute Stress Response

I’m aware that those who have recently moved to Sweden or other foreign countries do not always have much living space or many friends. So hobbies like car restoration, carpentry or bee-keeping might not be possible. Here are some suggestions for activities that don’t require a lot of space or capital outlay and that you can do alone…

Creative activities that engage the hands and eyes will help you relax and also assist with anxiety and depression. For example: painting, drawing, photography, jewelry making, building things with lego or completing jigsaws, podcasting, making Youtube videos or creative writing. Hobbies like video-gaming, geocaching, collecting antiques, coins, toys or memorabilia, playing chess (even against a computer), learning to program, code or make apps, sewing, knitting, making clothes, cooking, genealogy, learning and playing a musical instrument or learning a language could also take your mind off your worries. If you only have your work or relationship to think about, is it any surprise that your mind has nowhere else to go?

Then there are relaxation treatments such as getting a massage, enjoying a floatation tank, playing with pets (your own or someone else’s), walking in nature, colouring-in books or watching comedy videos on a streaming service. Chilling out is a great way to lower stress response.

And thirdly the companionship of spending time with friends and reaching out to someone you love like a son or daughter or cousin or long-term friend, even if they are in another country, can lead you to feel better. Physically or virtually not being alone is beneficial and it’s amazing how showing interest in someone else can assist you to get out of your head. Try it!

Superman figurine standing in a broken half eggshell

Finally, if you are so stressed up that you are unable to exercise or get into a hobby or reach out to a friend or family member, consider consultating a doctor at the Vårdcentral about medication to assist in the first instance. Some people self-medicate with alcohol or recreational drugs but it is better to get professional support to assist you until you are able to take more steps on your own. Any form of medication is only a short-term fix and does not address the cause of anxiety. The use of prescription medication needs to be monitored by a medically qualified person.

If, after lowering your stress response, you still have a problem that needs to be solved, you can talk to a professional therapist who can guide you through problem-solving strategies.

To make an appointment for coaching, advice, support or therapy, please contact me.

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Keep Your Head: Managing Mental Health During Coronavirus in Sweden

Uncertainty about COVID19 in Sweden has lead to a decline in mental health and increase in anxiety conditions

Mental Health has become a buzzword expression around the world since the COVID19 pandemic began. When the coronavirus keeps us socially distant, how can we manage to keep it together?

The coronavirus COVID-19 is a source of stress for many English speakers in Sweden. While health authorities in the UK, Australia and San Francisco enact policies such as of ‘lock-down’, containment, quarantine and ‘shelter-in-place’, the Swedish government proceeds with a business-as-usual approach, emphasising personal freedom and relying on the Swedish culture of collective responsibility. Expats and other English speakers immigrants in Stockholm, Gothenburg and Malmo are understandably worried. When your adopted country follows a policy dramatically different to most others and at odds with many scientists it makes sense that you might feel vulnerable.

Request a counselling appointment over video or phone

If you are alone, confused and unsure what to do, the first thing is to focus on what is within your control and let go of what isn’t. That’s part of what I call ‘keeping your head’. Everybody has the capacity to lower their own stress response, although knowing this isn’t enough. We start by becoming aware of what is going on in the body and then act to change how we feel. That takes practice but it is the first step in improving your mental health.

Symptoms of Coronavirus Pandemic Stress

Both irritability and withdrawal from contact with others are common signs of acute stress and declining mental health. These parallel the ‘fight or flight’ response that has evolved to protect us. You might be experiencing one or the other or both. The usual symptoms of anxiety and depression – difficulties with concentration or memory, restlessness, panic, a sense of hopelessness or doom, sadness and feelings of worthlessness – might also be present. If you take the time, you will notice their corresponding sensations.

Take a few moments now to sit in silence and notice what is happening in your body. Where do you feel tension? How busy are your thoughts? What sensations do you feel when you pay attention to your breath or your heartbeat?

Forgetfulness, trouble focusing and an inability to solve problems or know what to do are signs that anxiety has affected your cognition. The Acute Stress Response (also known as ‘Fight or Flight’) has another manifestation: Freeze. This is the kind of paralysis of both thought and action we might experience when a stressor starts to shut down cognitive functioning. To the body, it’s the same phenomenon as an animal might experience when suddenly confronted, like a deer that freezes at the realisation it has been seen or the ‘rabbit-in-the-headlights’ response of a beast on a road at night. When a stressor becomes overwhelming, our capacity to reason and use logic drops away and our animal self reacts in self-protection.

The Importance of Self Care during COVID19

I work with expats and English speakers around the world and have noticed the impact to mental health is similar whether the person is in Birmingham, Bahrain or Beijing. People are on edge with the ongoing changes to public health ‘rules’ as well as the uncertainty about the virus itself. Many are WTF (working from home), whether by choice or obligation, and this is putting pressure on relationships and disrupting well-being routines that were taken for granted. Even those in the ‘open’ cities of Sweden – Stockholm, Gothenburg, Malmo, Uppsala – are struggling emotionally and physically. As much as the government campaigns might try to convince us otherwise, the coronavirus pandemic and ‘social distancing’ divides us, it doesn’t bring us together. We have to work at staying connected and that takes energy.

The 5 Fundamentals of Well-Being are:

  1. Adequate sleep;
  2. Regular, nutritious meals;
  3. Regular exercise;
  4. A balance between work, rest and play;
  5. The opportunity to talk about problems.

How many of those can you tick off? Checking in with yourself is just as, if not more, important as connecting with others. To know what you need from others, you first need to have good contact with yourself. If you have noticed things don’t feel right, take some time to listen to your sensations and see if you recognise your emotional state. Your body can guide you to what is important right now. Listening to your body is the first step to keeping your head. And if you are struggling with knowing what you need, a conversation with a supportive professional can help.

To make an appointment or find out more about my services, contact me.

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Emotional Self Help Books for Expats and English Speakers in Sweden

I need help with Anger Management / Distraction / ADD / Overwhelming Emotions…(strike out what does not apply) …can you recommend something to read? 

Clients are often asking me for book recommendations. While self-help books aren’t the same as therapy or coaching sessions, they have their place and can sometimes be useful if reading is your thing. If you aren’t quite ready to attend counselling or want to try some things for yourself first, take a look at the categories below and try some of these titles. That’s also an inexpensive alternative. But don’t leave it too late to ask for human help. Often it is easier to recover when frustration or other emotions are not so overwhelming.

Here I’ve collected a few of the titles I’ve found to be useful and effective for dealing with anger, distraction, anxiety and out-of-control emotions. Some of these books were recommended to me by English-speakers who have come to live in Sweden. Others I discovered myself in the course of professional development.

Anxiety, Concentration, ADD and Mindlessness

Researching your condition on the Internet can hazardous! On many occasions I’ve been contacted by expats or other English-speakers who, after surfing around the net, fear they have ‘Adult ADD‘ (aka Attention Deficit Disorder). They talk of being easily distracted, having difficulty staying on task or constant forgetfulness. But neither ADD nor ADHD suddenly begin in adulthood. Unless you had serious problems with your schooling as a child, it’s more likely you are suffering from something associated with anxious states of mind or you just need to tone up your mindfulness.

Books for Improving Concentration and Attention (especially if you are worried about ADD or ADHD)

your brain at work coverYour Brain at Work: Strategies for Overcoming Distraction, Regaining Focus, and Working Smarter All Day Long by David Rock.

This book provides, in simple terms, an in depth understanding of how the brain works and how to optimize use of your brain. Rock also discusses how and why the brain gets overwhelmed. If you are interested in getting a scientific understanding that can help you get back in control of your brain, this book could be helpful to you.
We live in a world with ever increasing distractions thanks to the Internet and technological revolution it has brought. This is no less true in Sweden than elsewhere. Modern communication seems to demand we are more accessible. Increasingly we find our attention divided between tasks. Rock exposes the effect of these demands on the brain. This is cognitive neuroscience, fairly detailed stuff, but explained in conjunction with practical tips.

Regaining Focus and Balance through the Strategy of Mindfulness

mindful path to self compassion coverThe Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions by Christopher Germer.

Many of us are in jobs that require us to use our intellect all day long. For some, the best way to tackle an overwhelmed mind is not by using our intellect to understand the science of the brain but to live more in the present. That starts with being kind to ourselves and also means listening to the body and allowing it to tell us what it is experiencing and what it needs. When we spend most of the day in our heads, we can lose touch with the rest of our body. Mindfulness involves strategies that can be learned. This book will assist you get back to the present and find a new balance.

Germer’s book is an easier read than Rock’s, and his approach is different. It’s less about understanding neuroscience and more about connecting with and awareness of sensations and emotions. If you see yourself more as a ‘feeling’ type of person than a ‘thinking’ type of person, this is probably the better book for you.

The Chimp ParadoxThe Chimp Paradox: The Mind Management Programme for Confidence, Success and Happiness by Dr Steve Peters.

The Chimp Paradox is really about managing emotions (a product of our inner ‘chimp’) and using reasoning (our ‘human’ quality). Peters is a psychiatrist who specialises in sports performance and he is concerned with helping people to understand and manage their emotions and thoughts. This is quite a quirky book that lies somewhere between the drier science of Your Brain at Work and the warm, feel-good The Mindful-Path. Peters teaching skills are clear: the book is full of diagrams and metaphors. His models are easy to understand and fun to read.

If you like the idea of being coached, and you are ready to take up a new perspective on your performance, The Chimp Paradox might be the best book for you. It has been described as a ‘mind programme’, so be prepared to start reprogramming the way you respond to your emotions!

Books for Developing Calmness and Responding to Anger

WildmindWildmind: A Step by Step Guide to Meditation by Bodhipaksa

People often ask me if I do ‘Anger Management’. Well the first step in managing Anger is awareness of it and the emotions which precede it. Meditation provides one of the best ways to develop awareness of emotions. Despite what some people say, anyone can learn to meditate. It doesn’t involve ‘blocking out thoughts’ as such but the practice of focussing. If you are willing to try focussing according to a set procedure, you will find that you are meditating.

I’ve had the pleasure and good fortune to have met Bodhipaksa (a Scotsman and veterinary science graduate formerly named Graeme Stephen) and can vouch he is a very decent chap! He has been practising Buddhist meditation for over 20 years and teaching for over 10 years. This is one of the simplest and easiest to follow step-by-step guides to meditation by an excellent teacher. It will tell you how to do the fundamental practices that help develop calmness and positive mental states towards others. These are proven techniques to respond to and reduce the influence of Anger and other emotions.

Guided Meditations coverGuided Meditations for Stress Reduction also by Bodhipaksa

This isn’t actually a book but a set of guided meditations on CD. There is also an audio-book version if you prefer that. So if you aren’t much into reading and prefer listening to a voice guiding you, you can use these audio tracks to help reduce your stress response.

Our thoughts affect our bodies both in terms of the sensations we feel and the emotions we experience. And what we feel in turn affects our thoughts. This cycling can leave us in a state of hyper-arousal or acute stress response (aka ‘fight-flight-freeze’). Focussed awareness can reverse this and bring us back to the present-moment experience. If you are struggling with stress, guided meditation could be a way forward for you. Try the CD and consult myself or a meditation teacher if you continue to experience difficulties.

CBT Books For Expats

Cover of change your life with CBTChange Your Life with CBT by Corinne Sweet

CBT means Cognitive Behaviour Therapy and it is ‘flavour of the month’ in Sweden right now. It’s not particularly new, having it’s roots in the 1950s and rising to prominence in the 80s and 90s, and is regarded as a ‘2nd wave’ therapy (we’ve experienced 2 more ‘waves’ since!). But psychoanalysis used to be the only talk therapy with credibility in Sweden and CBT is quite easy to justify through research evidence so more people have heard of CBT than Narrative Therapy. That’s not to say Cognitive Behaviour Therapy isn’t effective, because for many people it is. To an extent, CBT is also very favourable to self-help so there are a lot of books on the market to choose from.

I picked up Corinne Sweet’s book a few years ago on my way back to Sweden at the bookstore at Gatwick Airport. It is basic but I think it is one of the most accessible and easy to read texts on CBT. If you are suffering from mild anxiety, ‘catastrophising’ or various negative thoughts, this is a great starter for you to find out how to reduce fear and develop more happiness.

cover of Think Good Feel GoodThink Good – Feel Good: A Cognitive Behaviour Therapy Workbook for Children and Young People by Paul Stallard.

I don’t work with children these days but a colleague showed me her copy of this book and I’m not surprised that it is a best-seller. There’s not much around in terms of CBT workbooks for children and this book also provides very helpful guidance to parents and clinicians. I’ve had parents contact me to ask if I will work in English with their kids. I usually send them to a child specialist because I am an adult specialist. If the CBT model interests you, I’d recommend getting a copy of this workbook, reading it yourself and then using it with your children. Sure it costs a bit more than the average book, but it is packed full of helpful activities and will provide you with an excellent grounding in CBT if you decide to see a therapist or counsellor in person. Obviously, if the difficulties are very serious or urgent, it is always best to seek help from a practitioner as soon as possible. In that case, get in touch with a ‘BUP’ (child and youth psychiatry) clinic directly or through a GP at Vårdcentalen.

One last suggestion… This summer, get yourself an Amazon Kindle. Okay, I admit it I am biased. I am a Kindle convert! But it is so much easier than travelling with a stack of books. You can read all of these books on Kindle plus novels or other non-fiction books as well and the latest version even works in bed with the lights out! If you don’t have one already you can buy a Kindle at this link.

Amazon Kindle pic

I hope to post again with some more book recommendations for inspiration, motivation and commencing a new life in Sweden. Just send me an email if you would like to be informed of new articles. I’m also available for consultations online over Skype webcam, by phone or email exchange. In the meantime, happy summer reading!

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Sleepless in Summer: 6 Steps to Better Sleep in Sweden

Sleepless in Stockholm

What can I do to improve my sleep?
Is it normal to have trouble sleeping in the summer in Sweden?

Insomnia or having trouble sleeping is not just a summer problem for expats in Sweden. It extends to native Swedes and across the year. Every season I read similar stories in the Swedish press. Some struggle with winter sleep, when the days are short and darkness long. Others find it hard during the spring or fall (‘autumn’ to those of us not from America). For whatever reason, the turning of each season can have a similar disruptive influence.

But if you’re in Sweden and reading this between May through to July, chances are, like me, you’ll know what it’s like to be in bright sunlight at four in the morning or nine at night. I realise it’s even more extreme for those who live north of Stockholm. So I’ve put together a checklist of tips and included some links to products that might be useful…

1. Create a Good Sleep Environment

phillips wake up lightMake your bedroom as dark as possible and try to keep it cool. It’s worth investing in black-out blinds for summer in Sweden. They are quite inexpensive at IKEA. If you succeed in making your bedroom so dark that you can’t tell when it’s sunrise and sunset, you can create your own regularity with a wake up light. These are devices that simulate sunrise to help your body get into a more even rhythm. This Philips Wake-Up Light with Colored Sunrise Simulation is top of the range and comes with a choice of nature inspired wake up sounds, plus light and sound settings to help you go to sleep. Those who use wake-up lights tell me they are great and they are just as useful in the Swedish winter!

2. Avoid Stimulants Late in the Day

Obviously tea and coffee later in the day can mess with sleep patterns. As much as Swedes enjoy their fika, it might be worth declining those particular beverages after about 4pm. And I know they are difficult to avoid but computers, ipads, smart phones and television tend to emit light that also stimulates the brain. Save them for when you are not in the bed. If you like to read and it helps you to sleep, this Kindle Paperwhite doesn’t cause the strain of looking at a regular screen (Amazon offers a 30 day money back guarantee in any case). I’ve finally made the switch from paperbacks to a Kindle and I’m a complete convert to digital books now. And if you share a bed, it’s also less likely to bother the person beside you than having a light on.

3. Set a Routine for Going to Bed

Picture of a kindleMost of us followed a bed-time routine set by our parents when we were children. And those with children will know it works better than chaos. In addition to preparing the sleeping room and avoiding stimulants, this is an aspect of ‘Sleep Hygiene’. No, it doesn’t mean washing yourself before bed! It means having a ‘clean routine’. For some, a shower before bed helps but others find it makes them too ‘pigg’ (that’s Swedish for ‘alert’ or ‘peppy’). Discover what’s best for you. Our bodies have memory. They associate doing certain activities with required energy levels for certain times of the day. In short: we can train ourselves to sleep, even if we have developed some bad habits over the years.  Set yourself a series of steps and stick to the order of them. Some things to include are:

– Making a note of things to do in the morning (winding down for the day)
– Changing clothes into sleepwear
– Brushing teeth and going to the toilet (of course)
– Perhaps reading in bed (get a Kindle!) or listening to music using a digital timer that turns off the music after you have fallen asleep.

Jawbone Up BandIf you like gadgets, you might also like to take a look at the Jawbone Up Band. This amazing little device slips around your wrist and tracks your sleep quality including how often you wake up in the night and when. Knowledge is power! Apparently Rupert Murdoch tracks his movements using a Jawbone. You can set it to vibrate gently on your wrist within a range of time, ensuring you wake at your most refreshed (i.e. when you are in lighter sleep- it is very clever!). The Jawbone Up might also be a better alternative to the light device if you share your room with someone who wants to sleep in.

4. Keep Your Bed for Sleep (and Sex)

Anxiety is the enemy of a restful mind. If you are lying awake in the night worrying about not being able to sleep, it is probably better to get up out of bed and do something like read or listen to relaxing music. Keep your bed for sleep and sex. If you are agitated you could even do a little housework that doesn’t take much mental energy, but don’t take on any big projects. If your brain is usually in sleep mode in the early hours of the morning, then it won’t be working very logically at that time. Don’t make any important decisions at a time when you would normally be sleeping. And once again, avoid opening your computer in the night and definitely keep it out of the bed!

5. Use Medications and Herbal Preparations with Caution

Valerian bottleTrauma, grief and loss, adjustment… Occasionally things can happen in life that make it difficult for us to sleep at a time when sleep is particularly important. Meds can help but some prescription sleeping medication can cause dependency, so it is important that you discuss your needs with a qualified and registered medical practitioner and don’t just buy something over the Internet. The use of strong sleeping medication needs to be monitored so talk with a GP if you think you might need it.

However preparations that are available over the counter in Sweden in a pharmacy or health food store are generally fine to use, but you should also investigate potential drug interactions first if you are taking other medications. A herbal preparation called Valerian is available to treat insomnia as an alternative to sedative drugs. Some people also report that Valerian helps to reduce anxiety.

Also available is Melatonin, a naturally occurring substance that has been demonstrated to advance the sleep phase, promoting the onset of earlier sleep and morning awakening. Some shift-workers use Melatonin when re-setting their body-clock.

6. Talk About Your Problems

Finally, if you are having trouble getting to sleep, waking through the night or unable to get back to sleep, it’s possible that it has more to do with what is on your mind than the very long daylight hours of a Swedish summer. It can be a difficult step to take, but talking about your concerns can be an effective way to get a better night’s sleep, particularly if it leads to working out a way to resolve particular issues. I’ve tried to make it easier for people to meet with me by offering online consultations over webcam or phone but it is also possible to write to me via email and receive a reply, if you need and prefer the time to get your thoughts together.

Contact me for appointment times or my fee schedule. And please share this post with others on Facebook or through Twitter if you found it helpful.

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Anxiety Therapy in Stockholm: Walk and Talk or Talk and Tea… You Choose!

Stress Meter

Treatment for Anxiety is now attracting the same attention given to Depression over recent years. And it’s no wonder. Many people are unaware that Anxiety is affecting their lives and as a result become confused as to how to better approach their symptoms. Talk therapy can offer new ways of responding to Anxiety, and you don’t even have to do it sitting down!

Expat counselling brings me into contact with a wide range of people and personalities. I meet bankers and barmen, teachers and tradies, researchers, roadies and radio journalists. Some come to Sweden for relationships, some for money and some for recognition. It isn’t easy being an immigrant in Scandinavian culture regardless of how advanced Swedish society seems to be. Relocation, cultural differences and relationships are stressors and how we respond to stress affects how well we adjust and how happy we are.

When people come to me, they have often already researched their symptoms on the Internet and tried to diagnose themselves. So what is actually a stress response has been interpreted as ADHD, or OCD, or Depression, or Aspergers Syndrome, or Bipolar. These are the most common diagnoses people are concerned about. It is quite common for Depression to be preceded by Anxiety. However misdiagnosing yourself with the help of the Internet can mean using an ineffective treatment for the condition or falling into a sense of hopelessness. Some even come to the conclusion they have a genetic fault or biological deficiency that cannot be fixed.

I reckon that most people have come to these understandings because we don’t hear enough about Anxiety and how we can respond more effectively to it. Hopefully that is about to change. However this brings another danger: the idea that there is a ‘quick fix’ to Anxiety. My experience is that those suffering from Anxiety are also susceptible to promises about ‘fast results’ or ‘cures’. Taking medication can sometimes help but some drugs are addictive and only worsen the problem. A promise of complete recovery can be much more appealing than the idea that we might have to work at reducing Anxiety or even learn ways to live with it.

Click Here to Ask a Question or Make an Appointment

How Can I Reduce Anxiety?

Firstly, most people with Anxiety know that it can affect how their physiology works including changing the way they breathe, their heart rate and the feeling of control over their body. But not so many have learned that the reverse is true as well: you can lower physical and psychological Anxiety through consciously changing your breathing, using relaxation techniques and getting back in touch with your physical being. It is much easier to read about these methods than put them into practice. So getting the help of a therapist to try them out can make a huge difference. Let’s talk about the acute stress response of flight / fight / freeze and how important it is to drop out of that if your really want to get a handle on Anxiety.

Mindfulness Book
Secondly, the practice of Mindfulness. Mindfulness is about being right here, right now. Not in the fear of the future or the regret of the past, but physically present in the moment. It is about focussing attention, without judgement, in calmness and clarity. It is not new but at least 2500 years old and it has stood the test of time. Mindfulness offers you a way of observing your feelings and emotions (including Anxiety) without being pushed around by them. It is highly effective but requires work and practice. This is where the therapist or counsellor can support you by explaining the practices of Mindfulness and helping you monitor your progress. If you are interested in reading about Mindfulness and Stress reduction, I recommend A Mindfulness-Based Stress Reduction Workbook available here on Amazon.

Thirdly you can work with your thoughts. This is why Cognitive Behaviour Therapy (CBT or KBT in Swedish) has become so popular. It can be effective but so much depends on how the therapy is undertaken, the relationship between you and the therapist and, most importantly, whether you are outside of the stress response enough for your cognitive capacities to function properly. There are other approaches to working with Thoughts as well. Deconstructing ideas and concepts and working out how the thoughts arose in the first place can be a significant aspect to talk therapy. Again it requires a degree of trust is established between you and your counsellor.

Walking Talk Therapy

I offer a unique approach to working with Anxiety which I call ‘Walking Talk Therapy‘. Of course, you are always welcome to take a comfortable armchair in my consultation room and chat over a cup of tea (including herbal tea), coffee or glass of water. But if you prefer to walk and talk, we can do that and get some exercise at the same time. It is generally well known that exercise helps alleviate many forms of Depression but it can also be effective for Anxiety. This is at least partly because we are using our whole body when we walk and we can work with the breath in different ways as we walk. These are the most effective means to reduce an acute stress response. It can help us to access a more relaxed sense of ourselves, feel more free and clear our thoughts so we have capacity to think differently.

We aren’t all the same and some of us respond better to some Anxiety treatments than others. So apart from face to face appointments in my consultation room and Walking Talk Therapy, I also offer therapy for Anxiety over the Internet through Skype webcam, Instant Message and Email Exchange. So it doesn’t matter where you are in Sweden or anywhere else in the world, through web technology we can communicate and work cooperatively to reduce Anxiety and change your response to stress.

If you are ready to make an appointment or if you want to know more about my availability and fees, contact me now and let’s make a start. There is more information about me and how I work in these pages but if you have any questions I would be happy to answer them directly.

Did you appreciate this blog post? Please consider making a link to it from your site, tweeting it on Twitter or liking on Facebook.

I look forward to hearing from you!

Ash Rehn.

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Swedish Culture Shock: 5 Practical Ways to Deal with Stress

man with stress

Providing counselling services for expats in Stockholm, I’m often helping my clients to manage and find ways to relieve stress. This stress might be related to cultural factors including the difficulty many report in making friends with Swedes or it could be to do with a close relationship or marriage. It can be associated with a combination of factors, for example work pressure, unfulfilled hopes or plans, perceived expectations or the adjustment to a new life in Sweden. The impact of stress isn’t always obvious.

People come to me wanting new ways to think or ‘mental tools’ for dealing with their circumstances. But regularly I meet people who so stressed-up, they can’t think so easily, in new ways or old. This article is about some very basic things you can do to manage stress. If that interests you, read on.

Stressing out? Ask for a consultation now!

5 Ways to Manage Stress

Here are 5 fundamental steps you can take to start getting back in control of the stress in your life. These tips are recommended by doctors, psychologists and major organisations like the British NHS (National Health Service).

1. Eat well.

When we don’t refuel our bodies regularly, our physiology can go into a stressed state and our more subtle cognitive (thinking) capabilities can be adversely affected. It’s much harder to problem solve when hungry, for example. On the flipside, using food to numb emotions can lead to overeating and unintentional weight gain. Aim for a balanced diet and regular nourishment.

2. Ensure you get enough sleep.

Sleep is regenerative and gives us a chance to let go of tension. It’s the body’s passive way of regularly relieving the effects of stress and becoming refreshed by allowing the brain to go into ‘quiet mode’ so we regain physiological balance. Of course sometimes stress can also interfere with sleep, in which case we don’t get the regular physical and mental refreshment we need. If your sleep is affected, develop a routine to support sleeping (google ‘Sleep Hygiene’). Sleeping tablets are not an ongoing answer, but if you are severely sleep deprived, you might need to discuss this with a GP. There are also gentle herbal treatments that some people find helpful.

3. Take regular exercise.

Exercise is a great way to shake out the effects of stress. When we exercise, we are directly working on our physiology and we can reverse the automatic stress response that happens to us when we are under pressure. For those of us from warmer countries, in the winter it can be difficult to find the motivation to exercise in Sweden and not everyone lives in central Stockholm or has access to indoor gyms and fitness centres. But even a short walk can make a difference and is better than nothing.

4. Put some structure in your day.

We all need to offset work with rest and play. Again, this can be difficult for expats without strong social connections. When we are trying to do the same thing for too long each day, the consequences are usually boredom, frustration and irritability or depressed mood. Everyone has chores they have to do (things like shopping, cooking, cleaning, washing etc), but without the balance of imaginative activities, our stress reactions can take over. Planning some exercise, social activities and time for creative interests around your work and non-negotiable commitments will help to make sure you stay on top of stress.

5. Talk about your problems.

It might sound like a cliche, but sharing problems and feelings really is a release valve for stress. It works differently for different people. Writing in a journal or diary can be one way of expressing thoughts and feelings but it doesn’t necessarily give the sense of a listener being present. Talking with friends can provide an outlet for emotions. However many English speakers tell me they find it difficult to make friends in Sweden and you might not have been here long enough to establish trusting friendships. Or perhaps you want to discuss something you feel you can’t share with a friend and need someone who you can be sure will remain impartial and maintain your confidentiality. That is where a counsellor comes in.

Some people tell me they just want to ‘dump’ what is happening for them, to ‘get it off their chest’ or make a confession about something they have been thinking about or doing. Others want a sounding-board (boll-plank in Swedish). Others want to have a good cry and to express how they feel. Some expats ask for help with decision-making or problem-solving. All of these are fine with me. The most important thing is: Don’t keep the problems to yourself!

Vulnerability to Stress and Building Resilience

Our vulnerability to stress and our coping skills for dealing with it can change with our circumstances. For example, people who have experienced trauma or child abuse when young sometimes have a heightened stress response to day to day events. But moving to a country like Sweden and adjustment to a new culture can involve a lot of stress as well. Building resilience to stress takes time. Don’t leave it too late to get help. If you are struggling with stress, make an appointment to discuss ways forward. If you are not sure, but think that managing stress might be a problem for you, contact me to find out how we might work together.

Email for an appointment time

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Life Coaching in English to Turn Your (Swedish) Life Around

motivation and life coaching in Sweden 2013

Not adjusting to life in Sweden? Worried about your mental health? Can’t concentrate and think you have ADD or ADHD? Struggling with the winter? Don’t let the darkness, Snökaos (snow chaos) or winter blues drive you to depression. Whether you choose to do it in-person or by webcam, you might just need a few sessions of life coaching to get back on track.

Here’s how therapy and life coaching with an English speaking coach and counsellor might make a difference to life in Sweden.

Bollplank, Sounding Board or Reflective Surface

Talking with your partner sometimes is not enough. Sometimes we are just too close to someone to offer a different perspective and it can seem like a lot of pressure if a sambo, husband or wife is the only one to talk with. The Swedes have an expression ‘bollplank’ which in English is akin to ‘sounding board’, someone or something we can throw our thoughts against to test them out. (Literally it is a plank of wood for kicking footballs against). In my work I call it the Reflective Surface.

There are many ways to employ a reflective surface: some people keep a journal or diary, video blog, artwork, cooking, craft… In fact any activity that combines structure and imagination with a product can provide a means to reflect your identity and ideas back to you in a positive, affirming way that supports change. A conversation can also be a reflective surface. In my office I use a whiteboard which is a literal reflective surface and sometimes I use it to hold onto the expressions or words that come up in a session. But even without the whiteboard, meeting with a coach serves the same ends because you hear yourself saying things and the coach can hold onto your words and ask you about them. A life coach can help with:

  • Sharing what has been happening
  • Working out what is important
  • Making goals
  • Following through with intentions
  • Acknowledging and celebrating progress.

If everything seems to be going well for your partner but not for you, don’t take it out on your sambo. Make it you New Years Resolution to get your own ‘bollplank’ and let the relationship be what it should be.

Seasonal affective disorder (SAD)

A lot of people approach me thinking they have ADHD because they can’t concentrate at home or work, or both. And there is a lot of discussion at the moment about ADHD, particularly in Sweden where there is a huge expectation that people are on time, focussed and ‘get with the program’. The norms of behaviour in Sweden are very influential. If you have seen preschoolers being marched around the city in pairs, you will get what I mean. This is a society where, to a large extent, cooperation and compliance are unspoken rules. I mention this because it is important to understand that cultural influence and social expectations can play a part in how we feel and how quickly we adjust.

But difficulty concentrating can also be a symptom of depression. When we feel low, unmotivated, frustrated or insignificant, it can be harder to stay on task. In a way this is our instinct or animal side at work, trying to get our bodies moving again. Movement and exercise to treat Depression has been recommended.

Here are some other signs and symptoms that you might not be alright:

  • You are spending all day inside and not going out at all
  • Mood swings or constant irritability
  • Feeling like a zombie or not feeling anything at all
  • Eating constantly and more than you need to (or a loss of appetite)
  • Drinking alcohol everyday or most days on your own
  • Not engaging with friends
  • Ruminating thoughts, ‘overthinking’ and dwelling on failure
  • Less attention to self care or neglecting basic hygiene (not showering, brushing teeth or changing clothes)

The good news is that you don’t necessarily need a psychologist or to go on medication simply because some of these are present. The benefit of working with me is you can tell your friends / family / sambo that you are seeing a coach for adjusting to life in Sweden. You can even meet me online, over webcam or for instant message counselling if you don’t want to take on the snökaos or you are living in Uppsala, Västerås, Nyköping or otherwise on the outskirts of Stockholm. Likewise if you are in Malmö, Gothenburg or Umeå or somewhere more remote, online coaching means you save the travelling time and can get help from the warmth and comfort of your own home.

Of course, if you are at any serious risk or your health is deteriorating quickly, you should not hesitate to consult a GP.

From Therapy for Depression or Adjustment to Coaching for Life Goals

When life seems to be stuck or falling apart, it can help to talk it over, make a plan and have someone to engage with and help you to monitor progress. A lot of people start to meet with me for therapy around a particular issue and end up feeling better to the point that our sessions become more about coaching and moving forward. Recently I have been speaking with people about:

If you have found me through ForwardTherapy.se price and cost of coaching might not be your main concern. You are probably more interested in finding a professional who understands what you are going through and offers the advantage of sessions in English. But just send me an email (preferred) or call and leave a message for a callback if you would like more information about my fees and payment options.

Engelsktalande Samtalsterapeut (English Speaking Counsellor): A Word For Spouses and Sambos

If you think your partner, wife or husband might benefit from coaching, kognitiv beteende terapi / cognitive behaviour therapy with an english speaking coach (kbt på engelska) or just a bollplank with someone other than yourself, feel free to send me an enquiry. I am used to working with people in relationships where one partner is struggling with culture or climate or relocation adjustment and there is some conflict in the relationship as a result. There is more information here på svenska.

Next year I will be relocating my office from Kungsholmen to Södermalm in Stockholm. But you can make a start now and put yourself on a better track for 2013. Start making your New Years Resolutions.

Write to me and I will send you full details of availability, fees and answer any questions you have. Please let me know if you prefer in-person (face to face in Stockholm) or online consultations.

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Anxiety and Regular Therapy in Stockholm: Temporary and Ongoing Solutions

Image of a man with stress associated with cultural adjustment

International relocation to Sweden is a major life change for most people, particularly if it is the first time they have moved somewhere English is not the first language. But for a person with persistent anxiety, the stress of finding accommodation, dealing with visa issues, trying to make friends and maintain relationships can make pre-existing worries feel much worse.

How can regular counselling appointments help Anxiety?

The advantage of building a relationship with a professional therapist or counsellor is that when things go ‘pear-shaped’, you have someone who knows you and can work in ways that suit your background and personality. Uncertainty coupled with the frustration of being in an unfamiliar place can lead to mood swings, irritation and sometimes a sense of despair or hopelessness. It can be reassuring to know there is someone in Stockholm or online who is willing to listen and help you through the transition of settling into life in Sweden or assist to deal with anxiety over the long-term, if that is what you want.

Sometimes I am asked the question: Which is better, brief counselling or ongoing therapy? The straight answer to this is that they can both be helpful in their own ways. It really depends on what you are looking for. ‘Counselling’ is often the term to describe a series of appointments with a particular goal in mind like getting strategies to make it easier to talk to people at parties or ways to manage mood swings after a relationship break up. Sometimes particular methods like CBT (cognitive behaviour therapy) or breathing techniques can be employed to meet specific objectives. Counselling appointments can also be a means to access health education or relaxation techniques. A series of counselling appointments might last 6-12 sessions over 2-3 months.

The word ‘therapy’ is usually used when people describe a process that takes place over a longer period, for example, from several months to a year. Therapy for anxiety can involve talking about previous life experiences and retelling these in ways that reflect new understanding or reveal skills and abilities that may not have been previously acknowledged. Or it can mean developing new approaches to fears or worries, putting these into practice, refining and modifying them over time while checking in with a therapist who helps monitor progress or maintain a sense of achievement. Of course some people choose to continue with their therapist even beyond a year. In this way, a therapeutic relationship can be akin to meeting regularly with a personal trainer, nutritionist or accountant. Ongoing therapy appointments aren’t just about solving problems. They can also be a way of maintaining your overall well being.

These are generalisations of course. You can attend therapeutic appointments with me in Stockholm or have coaching and counselling over Skype webcam for as few or as many sessions as works for you. Both approaches are more than just listening, and ideally are more than just being given skills or techniques by the therapist. Counselling and therapy work best when they are a collaborative process where both you and I work together.

What happens in Anxiety Therapy?

The answer to this question really depends on you, your preferences, experiences, hopes and expectations for the appointments.

I don’t work from a manual because people are not machines. While some of us have common experiences, we also have unique histories that require unique outcomes from therapy consultations. You might be someone who responds well to cognitive strategies and being offered new ways to think about distress and uncertainty. Or you might be looking for tools to modify your behaviour in  situations when nervousness takes over. Perhaps you just need a sounding board, to have someone hear what you are going through and ask questions so you can explain and understand your worries. Or maybe you just want to talk and get something off your chest?

I work with anxiety and depression every day. I’m used to meeting with people who feel nervous and don’t know what to expect from the appointment. When you come to see me I will do my best help you to feel comfortable and talk freely. You can talk to me in English and take a break whenever you need. What you say to me is confidential and I am bound by ethics and membership of my professional association to maintain your confidentiality. The only exceptions to this are where there is a high risk to a person’s life, when a child is in danger or if the law orders me to report something in particular. But even in these circumstances I will always try to discuss my concerns with you first.

There isn’t a set time frame for anxiety treatment. Adjustment to living in Sweden and culture-shock tend to require shorter term approaches than fears, hang-ups and suspicions that have been carried around for years. My intention is to provide you with a space where you can put down some of your psychological ‘baggage’, go through it with me, and decide what is useful and what isn’t. Together we can try to make sense of whatever is confusing you or holding you back so you can go forward. Hence ‘Forward Therapy’.

Trust develops as we get to know each other. If you have had difficult or unhappy memories of therapy appointments in the past, I welcome you to share these with me to help me provide you with effective consultations.

A Word about Drinking Alcohol and Stress

It is very common for expats to seek help for problems with drinking too much. Alcohol can enable people to relax and unwind, particularly when they are finding their job (or unemployment) stressful, if they feel they are not meeting the expectations of their partner or having other relationship issues. Unfortunately, drinking can also lead to the other extreme, a total absence of control, anger and more regrets. But even when people are struggling with drinking they don’t always want to stop completely. I will work with what you want to achieve in terms of your alcohol use and what you are aiming for, whether it is just a reduction in how much you drink, changing when or under what circumstances you drink or ceasing drinking completely.

We can meet in-person at my office in Stockholm, for Walking Talk-Therapy on Kungsholmen or over Skype webcam. If you would like to make an appointment, please contact me by email or leave a message on 08-559 22 636 for me to call you back.

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Walking Talk Therapy for Mental Health in English in Stockholm

A Park to Walk in Stockholm

The advantages of counselling and therapy shouldn’t just be psychological. Walking while talking is a new approach to talk therapy that benefits the body as well as the mind.

As a therapist who personally enjoys exercise and the positive effects of movement, I was not surprised when I read in the Sydney Morning Herald about research that demonstrated sitting was bad for our health.

I’ve written before about how exercise is important to both our physical and psychological health. Sitting for prolonged periods can reduce lifespan so decreasing our sitting time is just as critical to health as taking exercise. But modern lifestyles have many of us spending long work hours in front of our computers. It can be difficult to remember to take regular breaks let alone to keep moving our bodies.

So I am now also offering counselling, coaching and therapy in English in Stockholm while walking outdoors. This is a unique service for Stockholm that fits with making it easier and more beneficial for people to meet with a counsellor.

The Benefits of Walking Therapy

Taking a walk each day can lift mood, free thinking and help us manage emotions. For some people, it can be a reasonable alternative to medication. But there are other advantages to therapy while walking outside as well. We know sunlight is important for production of vitamin D and general health. Talking with a counsellor while taking a walk treats your whole person, body, mind and spirit. The practice of walking itself can quieten thoughts and relieve anxiety. It’s refreshing, relaxing and the rhythm of a walk can also help to sort out problems.

Like other forms of counselling, Walking Talk Therapy is an opportunity to discuss strategies, get things in perspective, or simply get a sounding board for the changes you know you want to make. Being out in nature is conducive to healing and improved mental health. Expats can speak English during the appointment and benefit both from the change of scene and a compassionate listening ear. People who have experienced disappointment, loss or even trauma may find that time spent in nature is therapeutic in itself. Those seeking to improve their physical health and motivation can find active consultations even better than sessions that are office based. So counselling appointments while you walk offer a combined form of treatment.

With my Walking Talk Therapy in Stockholm, you are welcome to request help with the same kinds of goals or concerns you bring to office based appointments. Many people who come to see me talk about depression or anxiety, family and relationship issues. But the areas I specialise in include:

How Does Walking Talk Therapy Work?

Usually we start the first appointment in my counselling rooms on Kungsholmen in central Stockholm. If you decide to proceed with a walking appointment, we can go to Rålambshovsparken or along Norr Mälarstrand by Riddarfjärden. These parts of the island are quite beautiful throughout the year and provide plenty of open space for private conversations while walking. We can hold onto important points by jotting them down or taking an audio note as we go. Walking Talk Therapy is suitable for therapeutic approaches such as CBT (cognitive behaviour therapy) and narrative therapy.

If the weather is bad we can still meet in the office. The Swedish have a saying “there is no bad weather, only bad clothing” but it is always your choice whether we go out for a walk or sit inside and chat over a cup of tea or coffee.

So why not combine therapy and some exercise? It’s healthy, refreshing and better for both of us! For daytime appointments until 5pm you are welcome to choose a 50 or 75 minute consultation depending on how much time you have available.

My goal is to make it easier for people to see me so, of course, if you prefer to sit comfortably and talk we can still do that. I still offer a range of options including online counselling over webcam from Stockholm or anywhere in Sweden.

Call now on 08-559 22 636 and leave a message if I don’t answer.

Or contact me through the form on my website for more details.

I look forward to us walking together!

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Can Depression that Started in Sweden be Treated with Exercise?

man running

Improvement to mood is one of the most obvious effects of exercise. But can exercise actually be used as a treatment for depression?

An article recently featured in the Stockholm daily newspaper Dagens Nyheter says it can.  Jill Taube, a Swedish psychiatrist, has written a book about how exercise can help to cure mental illness. She points to studies that show the effects of exercise not only last longer than those of antidepressant medication, but physical activity appears to prevent the recurrence of depression better than antidepressants.

Exercise: A Prescription for Depression

Taube’s exercise ‘prescription’ echoes what the health and fitness experts have been saying for at least 20 years: a combination of cardio and strength activities for 30-45 minutes, at least 3 times a week. Obviously those who have not been exercising need to take it easy to begin with and build up to this. But the idea that there is something people can do themselves about depressed mood is great news for those who want to recover from depression and need more hope in their lives (although it might depress the drug companies!).

Antidepressent Use in Sweden, an Increasing Trend

What makes this research so remarkable is that Sweden has one of the highest rates of antidepressant prescription. According to OECD statistics, Sweden has the 3rd highest consumption rate of antidepressants in Europe (after Iceland and Denmark). And antidepressant prescription is on the rise in Sweden. The National Board of Health and Welfare (Socialstyrelsen) has issued guidelines to try to cut the rise of prescribed depression medication and encourage the use of talk therapy. But these changes will take time because the culture around prescribing antidepressants needs to change. A survey of GP attitudes from 2004 indicated that most doctors considered drug treatment with antidepressants alone was effective and sufficient in most cases of depression. Less than half the doctors thought that psychotherapy was required as a complement. This is despite reliable evidence of the effectiveness of talk therapy against moderate depression and the combination of counselling with medication being considered best practice. There is also evidence that effectiveness of antidepressant use really depends on the therapeutic relationship between doctor and patient.

Relief for Anxiety and Depression through Exercising

As a doctor, Taube is concerned with biochemical explanations of how exercise actually works and the article in Dagens Nyheter explains some of this. For the layperson it’s enough to know that it does work. Therapists are familiar with the way depression often goes hand in hand with anxiety (I often describe them as hanging around together, like schoolyard bullies) so it’s no surprise that exercise appears to help relieve anxiety as well.

Taube, who has herself experienced depression, is a dancing enthusiast but explains that other exercise like taking a walk or spin class can give the mind a break from Anxious Thoughts. We know that mental health difficulties can generally lead to poor physical health not only because problems like anxiety and depression stop us from getting out and enjoying life, but because the drugs that are prescribed for them have a slowing down effect on those who take such drugs. So people who are taking medication because they are affected by anxiety, depression and other mental health problems often gain weight and suffer cardiovascular difficulties or musculoskeletal problems because they don’t move themselves as much. Of course it is important to still seek the help of health professionals, particularly if you are experiencing a severe depression or having thoughts of wanting to end your life. Talking together regularly with a doctor, counsellor, therapist or psychologist is a better alternative to just taking drugs on your own.

In 2012 I will be continuing Walking-Talk Therapy  for those who want to have therapeutic and coaching conversations ‘on the go’. Going for a walk together through Rålambshovsparken, along Norr Mälarstrand or around Riddarfjärden is a great physical alternative to sitting down. Of course, if you prefer to talk inside, we can still meet over a tea or coffee in my private consulting room at Fridhemsplan. And for those who are outside of Stockholm or prefer more privacy, online counselling is always available over the internet.

Send me an email or call me on 08-559 22 636 and leave a message if you would like to make an appointment.

Jill Taube’s book “Själ och Kropp” is widely available from book retailers and online, but unfortunately only in Swedish at this stage.