Using the Work of Byron Katie for Anxious and Depressing thoughts

Here is a personal experience sent to me by a reader regarding the work of Byron Katie. For more details on Byron Katie please click the link. In this example we see how someone with anxiety can deal with matters concerning guilt and shame, as well as unecessary worry.

"I had had a bad day at work. Someone I work with had made a complaint about me and it lead to a host of confusing and contradicting emotions which were causing me low level anxiety and interrupting my sleep and the enjoyment of my weekend. Basically, I felt cheated, out-raged, ashamed, guilty, and worried.

In the past I have had CBT (Cognitive Behaviour Therapy). This therapy claims to help you deal with negative thoughts through a process of rationalisation. It can be useful but personally I don't find it very powerful. That is to say that when a thought is really biting, really invading every moment, I can't seem to shift it using CBT.

Byron Katie's method is actually not that different from some aspects of CBT (as far as I can see). But unlike CBT there is no behavioral component and the questioning of negative thoughts is done using a simple four question script.

All you have to do is take the first aspect of the problem, in this case my belief that I did something wrong, and subject it to the four questions. This leads you on a process of investigation that can be very relieving.

In my next post we will look at how you identify the beliefs that are holding you back and how to use the four questions on them.

I don't believe that this is a sure fire instant cure for anxiety. I do however believe that it is a very powerful tool which, if used properly, can really help a lot.

del.icio.us tags: byron katie, anxiety, worry, negative, thoughts, release

Inositol for Anxiety

Every once in a while a natural product or food supplement comes into the public domain which promises a lot:

• Anxiety Relief
• Cheap
• Drug Free
• Side effect free
• Permanent

Let's face it, 5-HTP, tryptophan, amino acid complex, kava kava etc didn't really do it for the most part. That isn't to say that they don't have their place and many people have got some kind of good results from them, and from a balanced diet that includes the main sources of them. But the holy grail of anxiety sufferers they ain't.

Recently there has been a lot of interest in Inositol for the treatment of OCD, anxiety and depression. Sometimes, when substances like this are sold as a cure all, it is hard to believe that they are any other than just hype as a result of poor research. I say this as I have just read that Inositol is sold as a solution to baldness and hair loss. That said, there is some evidence to suggest that Inositol is as good as SSRI anti-depressants in the treatment of mood disorders.

Rather than buy expensive food supplements, I would be inclined to moderate your diet to make sure you are getting sufficient ability for your body to produce Inositol. Good sources of Inositol include wheat germ, brewers yeast. bananas, liver, brown rice, oat flakes, nuts, unrefined molasses, raisins and vegetables.

del.icio.us tags: anxiety, ocd, inositol, 5-htp, kava kava, amino, acid, complex, tryptophan, cure, sources, natural, food supplements

More Mindfulness Meditation

This is just a little addition to my last post on Mindfulness Meditation which can be read by following this link.

Watching the breath, without trying to change or control it, is the backbone of mindfulness meditation. And, as I previously talked about, when the conscious mind interrupts with either fantasy, worry or recollection I gently take my attention back to my breath, after acknowledging the thought. The key being to keep in the present time, where everything is absolutely as it is meant to be.

The idea that everything is as it is meant to be is sometimes a hard one to grasp. In brief, we live in a world of cause and effect, where every action eventually has an outcome. Anxiety and depression for instance have causes (emotional, physical, genetic, spiritual), and because of those causes whatever is happening right now, is exactly as it should be. The laws of cause and effect do not make mistakes. Odd outcomes have odd causes preceding them. Therefore wherever we are, and how ever we feel, we are in the right place. We can't change the past, we can control the future, but only by accepting where we are right now.

We spend such a small amount of time in the present. Our minds tend to be on what has happened and what we think is going to happen. Being in the present gives us a release from our cyclical lives.

As well as watching the breath there are other ways to stay in the present. Notice other sensations in your body as they happen right now. The pressure and texture of whatever is supporting you, sounds, smells etc. Just notice them and see what they are doing right now.

For more on using Mindfulness Mediation with anxiety and panic read

(UK Amazon Calming Your Anxious Mind: How Mindfulness and Compassion Can Free You of Anxiety, Fear and Panic )

 

(US Amazon Calming Your Anxious Mind: How Mindfulness and Compassion Can Free You from Anxiety, Fear, and Panic )

del.icio.us tags: mindfulness, meditation, anxiety, panic, stress

Mindful Meditation - how I do it and what it does for me.

Meditation is a very personal thing. There is only one rule in meditation: there is no right way.

Generally, when one starts to meditate a critical inner voice tells you that you are doing it wrong, that it's not "working" or that nothing is happening. This is quite common and that's why many people start meditating and then give up almost immediately. Everyone, not just those prone to anxiety and panic, can get something from meditation, or learn something about themselves. For that reason I have decided to post a short description of how I meditate.

Before I do that I want to say that I have tried various forms of meditation normally with the goal of "curing" anxiety. Also, I learnt mainly from various books and CD's and not from great masters, although if you have one available this might better! I want to make this clear now because how I meditate may not be how they meditate, and no doubt you will develop your own practice.

Firstly let me say something about posture. Most of the books, CD's, Yogi Masters etc normally have you sitting or kneeling with an erect posture. This is great, it can also be very uncomfortable. Personally I like to start in the "correct" posture, but am also kind enough to myself to allow myself to use postures which I find more comfortable. Quite a lot of my mindfulness is done while I am lying in bed, on my side, on my back or on my front, positions that many meditators would pull their hair out at!

I start to meditate just by watching my breath. As outlined by Jon Kabat-Zinn in one of his many excellent books on the subject, I watch my breath at the point where air enters and leaves my mouth, and in my stomach. I watch and listen to the sensations and sounds.

I don't concentrate

I don't concentrate on these things, I watch them and listen to them because the idea is to get in touch with what's happening at that moment, in that moment. Not in the past or in the future. As soon as there is an element of "must", "I must concentrate", an obsession, I find myself outside the moment, in the past or in the future, listening to the endless conversation going on in my mind.

My watching and listening dispassionately, without judgement, completely accepting what my breathing is doing, I am in the moment.

The mind will talk

The mind's personal conversation with itself is never ending. The mind thinks, that is what it does, there is nothing wrong with that. And you will consciously listen, there is nothing wrong with that either. It is often tempting (maybe natural?) to react to our minds words, to entertain them, repeat them over and over again, to slow them down and play out fantasies, to get lost in our thoughts. This can at times be highly pleasurable and also frightening, depressing and a host of other feelings, depending on what our mind is thinking about.

Let the mind talk

Let the mind talk, which is a bit like saying let it rain. The mind will talk and the rain will fall. Why waste energy trying to stop them? Instead, let the mind be, just gently draw your attention back to your breath. It doesn't matter that some time, seconds, minutes or hours have passed by while you have moved from meditating to daydreaming. You haven't failed or done anything wrong. But if your mind tells you you have done something wrong, let it say that, and take your attention back to the breath.

Relevant Articles on Meditation

Mindfulness

Meditation

Meditation Search Results

del.icio.us tags: mindfulness, meditation, anxiety, breathing, panic, cure

Fear of Flying Courses - a personal experience part III

Hi

This is the 3rd and final part of Chris's experience on Virgin Atlantic's Flying Without Fear course. If you have missed parts One and Two please follow these links to go back and read them now.

---

After lunch we were introduced to the Psychotherapist David Landau. He is the regular psychotherapist for these courses and also runs a private practice in West London.

He gave a talk about fear, negative thoughts, and the like. He also said that we weren't phobic, just scared. He said:

"If you're willing to fly but simply scared then you do not have a phobia. You wouldn't be here if you did."

I beg to differ, the course info on their web site says:

"We have helped people with all levels of fears from mild anxiety to full-blown panic attacks and vomiting at the mere mention of aircraft."

If that doesn't describe phobic people I'm a Dutchman. This left a slightly unpleasant taste in my mouth. I felt like the website blurb had somewhat misled me.

He took us through a series of physical relaxation exercises which were accompanied by a free CD. And also a visualization exercise which had some similarities to NLP in it. This was all relevant stuff, and I think most people got pretty relaxed. I didn't, all I could do was fidget and worry, no matter how I tried.

All in all I guess I had been waiting for the psychologist to be my salvation, I had dreamt that after that session I would be able to get onto the plane.

The Flight

I didn't make it onto the flight. I went through customs and as soon as I had passed security and knew that there was no going back I felt completely panicked. We walked a long way to a distant gate and I decided enough was enough. The team tried to persuade me to go on, but I didn't. I refused, and eventually a security man led me back through to the arrivals lounge.

Anxiety self-help course Click Here!

Conclusion

I was the only person not to go on the plane (with the exception of those, even worse than me, who left the course earlier in the day). Other people really felt like turning back but managed to press on. I think a lot of fearful fliers got a great deal from the course. I think people who can already go on a plane, albeit with gritted teeth, will get a great deal from the course. But I think real phobics, people who fear an anxiety or panic reaction, would do best to consider all their options before departing with their money.

That DOES NOT mean I am suggesting you don't go on a fear of flying course. I just mean you need to be ready to go through that fear barrier, don't go pretending it will disappear and everything will be easy.

When you are ready to take the step, a course like this can be a very supportive atmosphere in which to get into the air.

I'd just like to say a big thank you to Chris for sharing that with us.

del.icio.us tags: fear, flying, aviaphobia, panic, phobias, plane, scared of flying, anxiety

Fear of Flying Courses - a personal experience part II

Hi!

This is the second part of Chris's experience of Virgin Atlantic's Flying Without Fear course, which he attended last year. The article follows on directly from part one, which was posted yesterday. Please follow this link to it and start reading from the beginning if you haven't done so already.

***

Two Kinds of Fear

There are, broadly speaking, two kinds of fearful fliers.

Type 1: They are scared of the plane crashing, that don't feel that it is rational or reasonable for human kind to fly, and they worry that turbulence can break a plane apart and send it plummeting to the ground. These people are scared of terrorism, hijacking, structural failure and severe weather. 

All of their fears are unfounded as long as they stick to commercial passenger jets which either start or terminate in Europe, North America, Japan or Australia. Because of safety standards the chances of anything terrible happening on these flights is too miniscule to worry about.

Type 2: These people tend to suffer more anxiety than fear. They are worried about claustrophobia, heights, being out of control, and losing control and going mad/dying due to panic. In essence this type suffer from exactly the same kind of condition as an agoraphobic person, although in more specific circumstances.

Often type 2 people are not so concerned about the safety of the plane. They are not in any great doubt that the plane will land safely. There doubt is that they themselves will still be safe/alive/happy when the plane lands.

Obviously, these two types are heavily stylized and many people will straddle parts of both. But most people will fit into one predominantly and this is important.

Anxiety self-help course Click Here!

The Course was Great for Type 1s

The two pilots and the group leaders did a great job of educating people as to the mechanics of flight. They explained how actually the plane climbs very gently and moves very little during turbulence, it only feels more because there is nothing to measure it against as there is when say a car goes up a hill. And at take off although it feels like you are climbing at a 45 degree angle it is actually never more than 11 or 12 degrees. Really very gentle.

What is more, a plane is never more than gliding distance away from an airport. Amazing to believe, but apparently even on a run say from London to New York across the Atlantic, in the extremely rare (literally much much less likely than winning the lottery) event of complete engine failure, a jet could glide to airports  in Ireland, Iceland, Greenland, Canada or elsewhere. Indeed in one such event over the Atlantic an Air Transat Airbus 330 lost all power and glided to a safe landing. It's total glide distance? 150 nautical miles!

The afternoon session with a psychologist was meant to be the focus for Type 2 people like me. I will come to that later. First, it was time for lunch.

Lunch

Major grumble time. A lot of people who suffer from anxiety are affected by what they eat. The course catered for vegetarians and diabetics etc, but it did not cater for wheat intolerance. What's more tea and coffee were flowing like there was no tomorrow and all that caffeine, as well as biscuits, are bad for anxiety even if they can feel calming in the short term. Things may have changed now, but at the time this struck me as an area on which they could improve.

In the third and final part we will talk about the afternoon session with the psychologist and the all important flight!

Part three of the fear of flying course - click here.

Related Sites

Overcome Anxiety Click Here!

del.icio.us tags: fear, flying, aviaphobia, panic, phobias, plane, scared of flying, anxiety

Fear of Flying courses - a Personal Experience

Many of you will have seen various fear of flying courses advertised by airlines and on the Internet. In the UK the most popular ones are:

• Virgin Atlantic's "Flying Without Fear"
• British Airways linked "Aviatours"
• Flybe's "FlyingFear"

According to their web site, all of these courses follow roughly the same format:

• An explanation of how flying works from a pilot
• An explanation of turbulence
• A discussion calming fears of safety and crashing
• A buffet lunch
• A relaxation seminar from an expert or a psychologist
• A question and answer session
• A flight

Each of these courses cost between £180-250 approximately. I think most people with a severe fear of flying would agree that £250 is a small price to pay to overcome your fears. After all, most of these courses advertise 95% success rate, so it is a good investment.

Chris from Somerset (in the southwestern UK for those of you who aren't from round here) has written to me with an appraisal of the Virgin Atlantic "Flying Without Fear" course which he partook in last year.

Take it away Chris!

"I decided to go on the course because I've suffered from a complete horror of flying for about ten years. I used to be OK flying but gradually I became more nervous. I have suffered from other phobias as well, mainly involving travel. For a long time I was too claustrophobic to travel by train, underground, boat and also drive on the motorway.

The Virgin course FAQ section stated on the web site:

"I am the most scared person ever that you could imagine - how could you help me?
We have helped people with all levels of fears from mild anxiety to full-blown panic attacks and vomiting at the mere mention of aircraft. "

Obviously they knew something about overcoming fear of flying then. If they took people like this and still had a high success rate. I took the decision and signed up.

The Big Day

Overcome Fear of Flying Click Here!

Of course I was pretty nervous by the time the big day arrived. I lived some distance from the airport, so I had to pay extra for a bed and breakfast. I had trouble sleeping the night before but managed to get a few hours. Before I slept I watched plans landing at the nearby airport. A huge Air Canada 747 floated in as the sun set and it looked so beautiful and serene I really believed I could do it.

By the time I arrived the next morning I felt awful and had already made my mind up that I would sit through the spoken, land based part but escape before the flight.

Inside the venue though everyone was friendly and supportive and I got chatting to a few people who were also pretty nervous. I felt encouraged.

Group Work

The group organisation of the course is excellent. Although there were 100 plus people there, we were organised into groups of 8 or 9 with a very friendly and understanding team leader who was an ex-cabin crew with a lot of experience. It was good to have that personal encouragement and to get talking to those around us. Interestingly there were far more women than men. Fear of flying effects more women? Men are too stubborn or arrogant to do anything about it? I don't know which but certainly there were many women who had young children, and it is said that this can bring on anxiety where before it didn't exist.

The Pilots

The main hosts of the day were two Virgin Atlantic Pilots. They were witty, honest and very good public speakers. They explained the principles of flight and took us through the reasons flying is incredibly safe. I found this aspect quite interesting and a little reassuring. But when all is said and done it didn't particularly help me. I had the wrong kind of fear. I knew the technology was amazingly safe now.

To be Continued...tomorrow or maybe monday....Click here for part two of the fear of flying course.

Related Sites

Fear of flying self-help course Click Here!

del.icio.us tags: fear, flying, aviaphobia, panic, phobias, plane, scared of flying

Depression linked to low birth weight

In the ongoing search to understand the causes of depression a US study has reported some interesting findings.

After studying data over a number of years from a 1400 children they found a significant link between birth weight and depression.

Their findings showed that girls who were underweight at birth (in this case weighing less than 2.5kg) were at a much higher risk of developing depression in later life. The statistics were quite startling: Underweight baby girls were more than four times as likely to suffer from depression. It should be stressed that the study failed to find a link between the birth weight of boys and depression in later life.

In previous studies it has been mooted that depression, or its causes, may lie dormant from birth and become awakened later in life under stressful or emotionally painful circumstances.

For more on beating Depression Click Here.

Interestingly, no evidence was found to suggest that low birth weight is linked to mental health issues such as anxiety disorder, eating disorders or panic disorder.

When statistical studies such as this find a strong correlation it is common to assume there is a straightforward cause and effect relationship. This is wrong. It may be that a low birth weight leads to depression but there are other possibilities. It is possible, for example, that extreme poverty main be a cause of both low birth weight and indicative of an environment in which depression is more likely to develop. Or perhaps a sign that the mother is unable or incapable of nourishing herself properly, likewise a potential cause, if eating habits are passed from mother to child, of depression in later life.

Whatever the cause is (and there are so many possibilities that we may well never know exactly what causes a specific instance of depression) it is important that anyone in an "at risk" group of developing depression has a good support network available and knows how to recognise symptoms and seek help.

del.icio.us tags: depression, low self-esteem, birth, weight, link, study, anxiety

Guided Imagery Meditation

I have had a great deal of success using basic kinds of healing meditations. I have used them in both a mental and physical context.

For physical relief it seems they can be useful in a whole range of areas from aching joints to a blocked-up nose.

But, perhaps more usefully, they have helped me with anxiety, low self-esteem and depression. It seems that by focusing in on the actual part of the body (often head or stomach) where the emotion is actually being felt, you can actually relieve, move or deal with that emotion.

Click her for the Panic Away Programme.

I wouldn't say this is a miracle cure, but it is a great help! And it is very easy to learn and can easily be practised in a short space of time.

I also think it is great to include these with for example the Sedona Method, which helps one to release negative emotions.

del.icio.us tags: mediation, guided, anxiety, depression, low self-esteem, sedona

Childhood Stress may cause permanent physical damage to brain

New research by Stanford University has found that the hippocampus seems smaller and "withered" in children who suffered severe physical or emotional stress in their youth.

The suggestion is that this less active hippocampus leaves children less able to deal with stress and at a higher risk of suffering from anxiety.

A physical cause of anxiety has far reaching consequences for the cure vs manage debate. Those who believe that anxiety disorders, panic attacks and phobias have largely emotional causes are able to hold out much more hope for a complete recovery than those that believe anxiety is a physical/chemical/genetic phenomena we have to live with just like hair colour. Assuming that the hippocampus can not be revitalized, this research suggests that people who suffer from disorders caused by childhood stress may only ever be able to manage their symptoms, as opposed to finding true release. 

It should be stressed that the subjects in the Stanford research had acquired PTSD "as a result of physical, emotional or sexual abuse, witnessing violence or experiencing lasting separation and loss."

It should also be stressed that no physical or genetic causes of anxiety disorders have been proven. More to the point, every anxiety sufferer has a different story with different causes. A gene might make you more susceptible to anxiety, but it does not make the anxiety a forgone conclusion. People do recover from anxiety disorders fully. So one should not be disheartened by the idea of there, in some cases, being concrete causes.

Much more research is needed before we can know the truth about how stress effects the hippocampus. It has already been suggested by other leading researchers that the withered hippocampus might be a cause of stress, rather than a result of it.

del.icio.us tags: hippocampus, anxiety, standford, research, medical, schools, stress, PTSD, withered

Cognitive Therapy vs Psychoanalysis

If you speak to a doctor about anxiety or panic attacks two things will come to that doctor's mind: drug therapy and cognitive behaviour therapy. These techniques work like magic - for some people.

There has always been a significant group of people for whom these techniques were ineffective. Some could not tolerate the side effects of the drugs or the drugs didn't work. For some CBT let them take a step forward, but then they would immediately take two steps back. Perhaps CBT and Drug therapy, both symptomatic treatments, failed to touch any of their underlying causes.

CBT - A Great Therapy

CBT has become a fashionable therapy for anxiety, phobias and panic because it is relatively cheap, quick, and easy. It is a good therapy, it has helped many millions of people, and it has an important role to play in the fight against all manner of mental health issues. But remember, it is not a cure-all, and it is not the only weapon in the psychologist's armory.

Medical / psychological arrogance

As CBT is cheap and statistically proven to be effective (for some people), much of the mental health establishment have put it on a pedestal to the detriment of all other therapies. Other therapies tend to take longer, in some cases much longer, and it is hard to statistically analyze results as many factors can cause changes over long periods of time. For example, a woman goes into psychotherapy and two years later her panic disorder is much improved, dare she say cured. Now, was that improvement in her life due to the psychotherapy, or due to the fact that in those two years she got a new job, her father died, and she got divorced?

Analytical Therapy got a bad name 

Analytical therapies tend to be much longer, and therefore more costly affairs. And then there are the stories about people who spent $6,000 on therapy over three years, or $20,000 over ten years, and felt no different. And the misconception about therapists who sit in darkened rooms while you lie on a couch and talk about inappropriate parental fantasies.

Fashions changed

Suddenly, CBT was in and nothing else was worthy of discussion. This was irresponsible and foolhardy on the part of the medical/psychological establishment. There is no magic bullet for anxiety disorders and therefore there must be a range of treatment options available. Obviously some of these will be symptomatic, some will be temporary crutches, some will be aimed at changing self-esteem, and some will be looking at root causes.  

New evidence

As I have said, it has always been hard to statistically prove the efficacy of long term approaches such as analytical therapy. However, in February 2007, The American Journal of Psychiatry published a paper which showed that short term analytical therapy had been found to be highly effective in treating a study group with Panic Disorder.

The results

The therapy used in the study was Psychodynamic therapy, which has been around for some time (psychodynamics was born in 1874). What was particularly interesting about its use in this study was that it had been pared-down to target panic-disorder in a short space of time. Almost three quarters of the study group improved significantly, this was better than the 39% who improved significantly with more fashionable symptomatic relaxation techniques.

The future

What this study shows is that there is more than one effective tool for beating anxiety disorders. It also shows that there are options beyond CBT and drug therapy. Looking for the underlying causes of anxiety and other mental health issues may not be the answer for everyone, but if other things aren't working for you then they may well be worth a try.

del.icio.us tags: anxiety, panic, disorder, drugs, medication, cbt, cognitive, behaviour, therapy, analysis, underlying, cause, treatment

Sick - The UK mental health service needs help

Yet more shortcomings of the way people with mental health are treated in the UK have come to light. This is a sick system which is failing. The whole attitude and ethos behind the treatment of anxiety, depression, self-harming, eating disorders and other non-physical based issues is damaging, out-dated, and sometimes cruel.

At the moment the system only really works when people are assertive and proactive in seeking the correct treatment. The problem with this is that people who say self-harm necessarily have low self-esteem, and do not believe their case is worth fighting for. What is needed is the diametric opposite, for the system to help those people who are unable or unwilling to see that they are worth it.

In a recent report by the BBC, a women told of her history of self-harm and low self-esteem which was ignored by teachers and medical professionals alike.

What really came through in the report was a complete lack of understanding, recognition, and caring by those people whose function in society is to help people.

Two specific areas shocked me.

Firstly, that a teacher would tell a child who had self-harmed to "stop being stupid" is outrageous. In this day and age of broken families and cold communities it is imperative that teachers know who to call when a child presents with signs of abuse whether self-inflicted or otherwise. This is a big problem in the UK, and in the rest of the developed world. But it doesn't have to be. These issues are treatable.

The second thing I found shocking was that no therapy was available for patients on a psychiatric ward. It is arrogant, short-sighted, and dangerous to see the kinds of common mental health issues such as low self-esteem and self-harming as being due to chemical imbalances that can be treated with drugs. People who have grown to help themselves need therapy. Drugs are only a crutch, a stop-gap. There is no way that drugs can permanently change the way you think about yourself. That comes from therapy.

And again, the attitude of a nurse that said "If you really wanted to kill yourself you'd do it properly" beggars belief. In truth the only remedy to that situation is to sack, retrain, or reassign the nurse in question. They have no place and nothing to offer in a mental health setting.

Medical arrogance and under-funding are to blame for this situation. A less narrow minded attitude towards therapy and proper budgeting may help remedy it.

Related Articles

Depression in Pregnancy

Depression and Suicide in Girls

del.icio.us tags: self-harm, depression, low, self-esteem, anxiety, eating, disorder, mental, health, uk, failure

Pregnancy depression 'is missed'

While post natal / post partum depression is widely recognized (if poorly dealt with) condition, depression during pregnancy is proving to be a much larger problem than society or healthcare professionals had previously thought. It does seem that like almost always minor mental health problems are being overlooked. Depression, anxiety, stress and eating disorders are obviously highly undesirable during pregnancy, and not without their dangers from both mother and child. So why has this problem been seemingly ignored for so long?

Often, pregnant women don't want to take too much medicine, particularly some types of anti-depressants. At time of writing there seems to be a gray area over the use of some anti-depressants during pregnancy.

If people are coming off depression medication, particularly if they are coming off quickly, they need to be under proper supervision from healthcare professionals, and receiving counseling if necessary.

It might be that the patients themselves have to demand this, rather than be offered it.

 

This story from the BBC.

GPs and midwives need to do more to spot signs of depression in pregnant women and new mothers, a health watchdog has said.

The National Institute for health and Clinical Excellence (NICE) said women with anxiety or eating disorders also need to be identified.

Up to one in seven women experience a mental health disorder at some point in pregnancy or after the birth.

Mental health experts welcomed the new guidance.

They say it might help to increase the number of women who are diagnosed with depression, anxiety, eating disorders and severe mental health conditions such as schizophrenia and bipolar disorder.

Current estimates suggest the figure could be as low as 30%.

'Bad mother' fears

Dr Steve Pilling, a consultant clinical psychologist who worked on the guidance, said there was "very significant under-recognition" of mental health issues in pregnancy.

NICE advises healthcare staff dealing with pregnant women of new mothers to ask three questions during ante or postnatal checks:-

• Have you felt down, depressed or hopeless during the last month?
• Have you been bothered by having little interest or pleasure in doing things?
• Is this something you feel you need or want help with?

The guidance states that women needing psychological treatment should normally be seen within one month and no longer than three months after an initial assessment.

Treatments may include counselling or anti-depressants, with the health worker explaining how medication may affect breastfeeding.

Experts who worked on the guidance said it was important to identify women not seeking help because they feared being seen as a "bad mother".

They warned that leaving mental illness untreated could have consequences for both mother and child, including poor educational performance for the child and anxiety.

Judgement concerns

Dr Gillian Leng, who led the team which compiled the guidance, said: "This is not just about helping women get through the 'baby blues' - we are looking at all types of mental health disorders and distinguishing the ups and downs of everyday life for more serious conditions."

Fiona Shaw, a patient who also helped draft the guidelines, told how she was admitted to a mental health unit after the birth of her second daughter.

She was not eating and was self-harming but had been told by her doctor to either take anti-depressants and stop breastfeeding or just "grin and bear it".

She added: "Many women are concerned they will not be listened to if they come forward, or that they will be judged, or that their condition is not serious enough to warrant help from a healthcare professional."

Paul Farmer, chief executive of mental health charity Mind, said: "We welcome these guidelines, which look to be a very promising start.

"The challenge, as always, will be ensuring that they are implemented."

"Parents deserve the very best support at the start of their child's life. The resources to make these excellent guidelines a reality must be available, otherwise they risk becoming little more than a wish-list."

Margaret Edwards, of the mental health charity Sane, added: "We welcome the recommendation that psychological treatment to be provided at an early stage and urge action to increase access to such therapies, to minimise the need for medication during pregnancy."

del.icio.us tags: depression, pregnancy, missed, diagnosis, anxiety