Anxiety 2 Calm: How to be happy

The UK daily newspaper The Independent (and the Independent on Sunday) have a campaign to improve mental health on the UK National Health Service.

I decided to re-publish this article by Dr Cecilia d'Felice as it is a rare cheerleader for psychotherapy. I have long maintained that the current obsession by the medical establishment with Cognitive Behaviour Therapy and SSRIs is damaging, and that the assumption that anything which is cheap and statistically valid is a cure-all is erroneous.

CBT does help many people. But for people with complex issues who do not respond well to CBT the UK healthcare establishment often has few answers.

Psychotherapy, I believe, can help unravel our negativity and promote happiness.

Here's the article:

As an introduction to her new column starting next week, Dr Cecilia d'Felice explains how therapy offers a proven, scientific route to feeling good about yourself.

Published: 21 January 2007

As each new patient walks into my office, I am always struck by their bravery. Often tearful and full of fear and uncertainty as to what therapy might do to them, they begin to tell me their story. Frequently, this is the first opportunity they will have had to describe their experiences to someone who is not a friend, partner or family member - someone, in other words, who can remain relatively objective and impartial. We do not know each other and yet we talk about their darkest fears and deepest despair - sometimes things that have never been spoken aloud before. For some, the relief of being able to speak freely means that, once they start, they feel they cannot stop. For others, it is harder to let go of their feelings - as if there aren't the words to describe how they suffer: they wonder what the point is, how anyone could possibly understand them and how therapy can possibly help them.

In these early sessions I am a historian; ravelling together pieces of their story to form a picture which varies in intensity and drama but rarely is without loss, suffering and confusion. Many have been emotionally or physically neglected, have seen their families split by divorce with little support or explanation, have been cruelly punished and criticised, bullied at school and work, have experienced sexual and emotional abuse or have lost a beloved parent or sibling. Some patients say they had perfect childhoods - as if to protect themselves and those they love from a less desirable truth (for this is rarely the case, as we eventually discover). Often, they describe alcoholic, violent parents withdrawn into deep depression, or unable to leave the house without panic or phobias. As adults they then find themselves depressed or anxious, almost as though they have learnt to be that way, as if they have been shown no other option. Therapy can help us understand the past, but is not about blaming the past - it is about trying to make sense of the present.

Often, at the end of the first session, patients want to know my opinion - whether they are ill or having a "nervous breakdown", or simply going mad. What strikes me is how often they feel totally alone with their feelings, believing that no one else has ever had these experiences. This is perhaps what makes them question their sanity, because they perceive everyone else as being somehow "normal" and able to cope with life with equanimity, meeting all challenges head-on.

When a patient with depression tells me how they feel, they often describe intense negativity towards themselves, their world and their future. They cannot see any good in themselves or other people, that the world is hostile and cruel and they feel worthless and hopeless. It often feels to them that no one else suffers in quite the way they do or can see the world as "realistically". They are surprised when the reading I give them on depression matches their own experiences, and often tell me it could have been written about them. When someone with panic attacks tells me about the physical terror they experience - with their heart pounding, trembling, unable to breathe, believing that they are about to lose control, go crazy or, worse, die - they find it an enormous relief to know that they are not alone. Other people feel these things too and the panic attack can be resolved relatively simply by learning a breathing technique. A man once described to me his inability to leave his house until he had checked and rechecked every aspect of each room, taking hours every morning, in the belief that it would prevent his loved ones getting hurt. He was amazed and relieved to learn there are others who do precisely the same thing, that it has a name - obsessive compulsive disorder - and that it, too, can be treated.

Therapy can help unravel the thoughts that lead to painful feelings and self-destructive behaviours - whether it's drinking, drugging or spending excessively, eating badly or self-harming. Therapy is not, however, a soft option; it requires courage and commitment. It seems as if there comes a time when people realise that something has to change, that they need to do something differently if they are to survive emotionally. For me, this occurred in my mid-20s, when I nearly bled to death during a surgical blunder after losing my unborn baby to a cancerous tumour. While slipping in and out of consciousness, I made a pact with myself that, if I survived, I would stop emotionally hiding from myself and try to work out how and why I had become the person I was. I had struggled in my early years to please everyone, yet often found myself feeling confused, frustrated and disappointed, as if I had no life of my own. I wanted to find ways to change what I could, while accepting what I could not. I figured out the best way for me to do this was to train to be a psychologist and to experience psychotherapy. I know at first-hand, both personally and clinically, how therapy can transform lives.

I do not claim to be an expert on happiness. Although I have clinical expertise, I personally do not find it helpful to adopt an "expert" role: to be an expert suggests that somehow you have all the answers and, when thinking about our emotional lives, how can this really be true? I prefer to see myself as a willing student, practicing what is known in Zen as "Beginner's Mind" - always wanting to find out more, to be curious and to experiment creatively with the big questions, including how to be happy.

I have had experiences where my mood felt frighteningly rigid and interminable in reaction to traumatic life events. I view these experiences now as reflections of my humanity, encompassing complex emotions that I share with everyone. It is rare that someone over the course of a lifetime will never have experienced emotional instability and it is not weak or a failure to have done so. My negative emotions no longer propel me in to a fixed state of unhappiness because I accept them compassionately as being part of my all-too-human vulnerability. Knowing that they will eventually pass, they also teach me to look for fresh perspectives, to try doing things differently, to take some risks.

Regular readers of this newspaper will know that it has been campaigning to improve the nation's mental health. As part of this endeavour, from next week I shall be contributing a column to The Sunday Review that will aim to explore, from a psychological perspective, what happiness is and how to achieve the many different forms that it takes. Each week I will examine some aspect of human behaviour that causes distress using the most current clinical advice. From the anxiety- provoking deluge of emails in your back- to-work inbox, to skilfully managing an over-demanding boss, to how to deal with insomnia, overcoming fear, or what to do if you have a panic attack. I will sometimes break down a difficult problem, such as anxiety or low mood, into week-by-week sections forming step-by-step, easy-to-use mini-workbooks. This will provide an opportunity to practice the exercises, techniques and suggestions I make before being introduced to the next level - just as I would do in therapy. I also hope that readers will send in specific examples of where happiness and wellbeing remain elusive. We can then explore these problems using therapeutic methods like cognitive behavioural therapy - which is scientifically proven to be helpful. And, because this is such a wide-ranging subject, I will also draw on "positive psychology", explaining how you can use it to improve the quality of your own life.

Emotional experience and clinical practice have taught me that happiness is a state of mind that is maintained through acceptance, compassion, resolution, altruism and humour. Basic needs such as sleep, diet, relaxation and exercise are also essential ingredients in promoting wellbeing and these too will be discussed. I hope to explore with you what it means to be happy, encouraging you to adopt some of the methods, techniques and philosophies that may help alter your state of mind and create both happiness and wellbeing in your life and the lives of those close to you. Next week, we will begin to look at stress: what it is, why it appears to be endemic and what we can all do about it.

Email Dr d'Felice at c.dfelice@ independent.co.uk

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