Perspectives on what works in psychotherapy


I love what I do, I am passionate about what I do and I enjoy what I do and all that it brings. If you were to ask me what and why, I am not sure I could answer that specifically. When people get what they wanted, when I see a shift in someone’s thought process, when I see an acceptance or a coming to terms with something. Or when a new feeling is accepted or experienced and growth takes place. They’re all amazing and rewarding, yet to sum those feelings up, they’re about a connection based on our relationship in that moment. that’s the key to therapy and change, that relationship.
It’s not always easy to determine if you’re going to connect with someone yet that’s the key, the relationship.
This article talks about clients with anorexia, yet it could be written about any issue you may bring to therapy. To trust, to allow challenge, to experiment with what does and doesn’t work, to express emotions within a therapeutic safe relationship and to live in today,  not yesterday’s out of date decisions nor in the fears of tomorrow.

Psychotherapy: What Works?
Posted: 06/04/2012
“What is REAL?” asked the Rabbit one day, when they were lying side by side near the nursery fender, before Nana came to tidy the room. “Does it mean having things that buzz inside you and a stick-out handle?”
“Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you when a child loves you for a long, long time, not just to play with but REALLY loves you, then you become Real.”
— Margery Williams, The Velveteen Rabbit
There is no “one-fits-all” psychotherapy for anorexia nervosa. In an effort to learn more about what “works” and what doesn’t, my Massachusetts General Hospital colleagues Eugene Beresin, M.D. and Christopher Gordon, M.D. and I interviewed a group of women who had received individual therapy and recovered from the illness. Their perspectives on psychotherapy helped inform our work with individuals who are struggling with anorexia.
New patients don’t open the door of the therapist’s office bright-eyed, cheerful, and eager for treatment. For the most part, individuals with anorexia don’t feel ill or see their eating behaviors as unhealthy. They want no part of therapy. The idea of sitting down and talking about themselves feels foreign and scary. From their standpoint, the therapist is out to make them fat. Particularly frightening — almost unthinkable — is the possibility that the therapist will raise the topic of eating more and gaining weight. Tense and shaky, or sullen and defiant, patients sometimes experience the urge to bolt out of the room.
“First, I had to trust.” This is easier said than done. At the beginning of therapy, patients don’t know what to expect. Some individuals sense that they are better off remaining silent and that anything they say will be held against them, as if they are standing trial in a court of law. They may feel very alone or bombarded with powerful pangs of guilt about calories eaten or ounces gained. They may be thinking: “What is this thing called therapy?” “What am I expected to talk about here?” How is therapy supposed to help me?” “What does the word ‘help’ mean?” This last question is important, and a patient’s answer to it can fluctuate or change as therapy proceeds.
“I didn’t know how I felt.” Trapped in an unforgiving world of shoulds and should-nots, individuals have a hard time recognizing their feelings. They are often receptive to therapists who participate actively in sessions, helping them to better understand themselves and coaching them on how to relate to others. The very nature of the patient-therapist relationship can help individuals learn where emotions come from and how to manage them. For example, becoming angry at the therapist and being encouraged to talk about this in session can gradually instill confidence that it is natural and human — or, as the Skin Horse suggested, “real” — to experience and express emotions.
“I wasn’t sure I wanted to grow up.” Teenagers experience huge emotions and extreme moods. One moment they long for independence; and the next, for security. As they mature — emotionally, cognitively, physically — relationships, academics and athletics take on new importance, and pressures seem to mount. The stress of adolescence is significant, and teens often feel overwhelmed. For these individuals, anorexia can represent a way to slow down the biological clock, to get their bearings, and to maintain control before traveling on to adulthood.
“It was important to like myself better.” Well into treatment, individuals with anorexia continue to consider themselves defective, inferior, or “bad.” They may come to realize that anorexia gave them a sense of accomplishment or specialness. The challenge is to find ways to experience these positive feelings without focusing on weight loss.
“Experimenting helped.” Insight alone does not free individuals from the grasp of anorexia nervosa. There must be a willingness to experiment — to take risks. People with anorexia go about everyday life in a very structured, programmed way in an effort to cope with their fear of the unknown. Although it is very challenging for patients to modify their routines, they are often able to do so once they feel that the therapist values and respects them for who they really are. Risk-taking becomes possible when it is introduced in small, achievable steps that gradually build self-regard. In this way, patients — with the guidance of the therapist — chip away at the anorexia, a little bit at a time.

Is it time to tackle your obstacles to life?

Sometimes with or without therapy, life can feel like it isn’t our responsibility to change or that the obstacle is too over whelming so what’s the point. This could be anxiety, depression, the way we deal with change or anyissue. This is alovley story that shares what the point is. No matter who you are, what you have or where you come from, life may at times have a boulder in the ahead ahead.


What you do about that is up to you?



The Obstacle in our Path

In ancient times, a King had a boulder placed on a roadway. Then he hid himself and watched to see if anyone would remove the huge rock.

Some of the king’s wealthiest merchants and courtiers came by and simply walked around it. Many loudly blamed the King for not keeping the roads clear, but none did anything about getting the stone out of the way.

Then, a peasant came along carrying a load of vegetables. Upon approaching the boulder, the peasant laid down his burden and tried to move the stone to the side of the road.

After much pushing and straining, he finally succeeded. After the peasant picked up his load of vegetables, he noticed a purse lying in the road where the boulder had been.

The purse contained many gold coins and a note from the King indicating that the gold was for the person who removed the boulder from the roadway.

The peasant learned what many of us never understand! Every obstacle presents an opportunity to improve our condition.

What is the point of therapy and why won’t you tell me what to do?

I am often asked what therapy is and why don’t I cure, fix or tell clients what to do? I was reminded of this story yesterday and it explains beautifully just why I don’t do that…

Butterfly Story


A man found a cocoon of a butterfly.

One day a small opening appeared, he sat and watched
the butterfly for several hours as it struggled to force
its body through that little hole. Then it seemed to stop
making any progress. It appeared as if it had gotten as far
as it could and it could go no farther.
So the man decided to help the butterfly, he took a pair of
scissors and snipped off the remaining bit of the cocoon.
The butterfly then emerged easily.
But it had a swollen body and small, shriveled wings.
The man continued to watch the butterfly because he expected
that, any moment, the wings would enlarge and expand to be
able to support the body, which would contract in time.
Neither happened!
In fact, the butterfly spent the rest of its life crawling
around with a swollen body and shriveled wings.
It never was able to fly.
What the man in his kindness and haste did not understand
was that the restricting cocoon and the struggle required
for the butterfly to get through the tiny opening were
nature’s way of forcing fluid from the body of the butterfly
into its wings so that it would be ready for flight once
it achieved its freedom from the cocoon.
Sometimes struggles are exactly what we need in our life.
If we went through our life without any obstacles, it
would cripple us. We would not be as strong
as what we could have been. And we could never fly.
So have a nice day and struggle a little.
When you are under pressure and stress, remember
That you are a better person after you have gone through it.
Author Unknown

Addictions, new versus old?

I read sky news today and the following article about addiction. The chemical impact of dopamine on the brain has been subject to recent years of research and the consequence on addicts and how they are then affected. So although this is potentially a new addiction it is essentially an old problem. We have putchildren in front of television for years and computer games, for which there is more and more research on their impact.


This has a different flavour though. Society is developing screens for new born babies and tiny toddlers promoting the good feeling recognised chemically by our brains. So it is a question of what are we potentially creating in ourfuture generations. A question which I feel my parents generation questioned when tv was introduced too. So again is this an old problem is a new format?

The sky article:

video play icon
Last Updated 11:40 22/05/2012
James Matthews, Scotland correspondent

New research suggests that youngsters are at risk of “screen addiction” because of the time they spend watching TV and playing computer games.

A study has shown that in the UK, 10 and 11 year-olds have access to five screens in the average house.

The average screen time for British adolescents is 6.1 hours per day and rising.

A child born today will have spent one full year of 24-hour days watching screen media by the age of seven.

Researcher Dr Arik Sigman told Sky News that he believes a generation of children is now at risk from becoming “screen addicted”.

He said: “We’ve always thought that it’s only substances that affect the chemicals in our brains.

“We now know that experiences – whether it’s gambling or playing computer games, looking at screens – also produce similar brain chemical changes, particularly a chemical called dopamine. It’s a reward chemical, it makes you feel good when you do something you like.

“If children are producing this day after day, for many hours per week, during the important developmental years for their brain, this would have consequences later on, leaving some children unable not to look at screens for much of the day.”

Dr Sigman recommends a number of measures as an answer to the problem.

He suggests preventing children being exposed to a screen until they are at least three years old and recommends that youngsters are given access to screens for less time, less frequently.

He says that the British Government should issue guidelines to parents on an appropriate length of time for youngsters to be exposed to a screen.

Some countries recommend a limit of two hours per day of “recreational” screen exposure for children over seven years-old.

Where’s the middle? Do you fear you’re losing out?

Where’s the middle?


I am very aware recently in a pattern of missing out the middle for a lot of people with very different situations. Anxiety, if I see the end not being ok then I’m not ok, where’s the middle? If I eat this then I will feel ok, where’s the middle? If I panic about what may happen then I don’t have to deal with the middle?


I came across this article about fomo, fear of losing out and while it talks about technology, for me at least, there is an interesting link with other situations. If our coping mechanism has been to do x or y, then we may lose something familiar and safe, safe not meaning good here and that’s scary. We know if we carry on doing what were doing and it’s not working anymore then something has to change. Again though, could the fear of losing out affect our process. I also wonder if fomo has always been a part of other issues for people. So if you read this article and see what you do as part of your issue then maybe you can start to see a way out too? It’s not just about the technology for me. While this is an addiction, I do again as I’ve said wonder if this fear is part of many other indications for people and that not only is the fear of missing out an issue, so is the fear of missing what we know.  That’s where the therapist comes in.


FOMO Addiction: The Fear of Missing Out
Founder & Editor-in-Chief
As serendipity often strikes randomly, I was reading an article in The New York Times by Jenna Wortham the other day at the same time I was reading the chapter in Sherry Turkle’s new book, Alone Together about people who fear they are missing out.
Teens and adults text while driving, because the possibility of a social connection is more important than their own lives (and the lives of others). They interrupt one call to take another, even when they don’t know who’s on the other line (but to be honest, we’ve been doing this for years before caller ID). They check their Twitter stream while on a date, because something more interesting or entertaining just might be happening.
It’s not “interruption,” it’s connection. But wait a minute… it’s not really “connection” either. It’s the potential for simply a different connection. It may be better, it may be worse — we just don’t know until we check.
We are so connected with one another through our Twitter streams and Foursquare check-ins, through our Facebook and LinkedIn updates, that we can’t just be alone anymore. The fear of missing out (FOMO) — on something more fun, on a social date that might just happen on the spur of the moment — is so intense, even when we’ve decided to disconnect, we still connect just once more, just to make sure.
Like the old-school Crackberry addict, we’re now all in the grip of “FOMO addiction” * — the fear of missing out on something or someone more interesting, exciting or better than what we’re currently doing.
Connected to this fear of missing out on something better that’s going on without you are these fake personas we promote on websites like Facebook. I say “fake” because we often present only the best side of our lives on social networking sites. After all, who wants to be “friends” with someone who’s always posting depressing status updates and who seems to be doing nothing interesting in their lives?
So they are indeed fake, because instead of us being completely real, many (most?) of us censor what we post to our social media profile these days. The people on Facebook are often simply their idealized selves — with a bit of misery thrown in from time to time to “keep it real.”
A friend who works in advertising told me that she felt fine about her life — until she opened Facebook. “Then I’m thinking, ‘I am 28, with three roommates, and oh, it looks like you have a precious baby and a mortgage,’ ” she said. “And then I wanna die.”
On those occasions, she said, her knee-jerk reaction is often to post an account of a cool thing she has done, or to upload a particularly fun picture from her weekend. This may make her feel better — but it can generate FOMO in another unsuspecting person.
Or as Sherry Turkle notes,
“Sometimes you don’t have time for your friends except if they’re online,” is a common complaint. […]
When is downtime, when is stillness? The text-driven world of rapid response does not make self-reflection impossible, but does little to cultivate it.
Turkle’s descriptions of some of the teens who’ve told her their story is downright scary. Teens who believe they need to be available 24/7 (x-apple-data-detectors://0) to their friends, because, you know, someone might get dumped or into an argument with their parents. They need instant gratification and solace. Nobody can wait anymore — not because they can’t — but because they don’t need to.
After all, if you could eat all the ice cream sundaes in the world without any serious repercussions (like weight gain or being sick), why wouldn’t you? That’s how many of us our nowadays ingesting social media and technology — taking in as much as we can, simply because we think we can.
But it’s a lie we’re telling ourselves. Humans weren’t built this way.
Turkle nails it on the head with this comment in the article:
“In a way, there’s an immaturity to our relationship with technology,” she said. “It’s still evolving.”
I think that succinctly summarizes the problem — our relationship with technology is still in its infancy, and we’re still feeling our ways around it. We don’t quite know how to interact well — mindfully, meaningfully — with it. Count how many times you check your email or smartphone for messages, texts, status updates, etc. in a day. 10? 100? 1,000 or more? You may be surprised.
Technology that we’re at one with and that promotes social balance and harmony wouldn’t require such obsessive checking behavior, would it? It would understand and complement natural human social behavior. It would differentiate for us what’s important and what’s not (the idea of “smart agents” from a decade ago still resonates).
Teens think they “get it” — that technology is a natural extension of their social lives. But they’re mistaken — they’re still crafting their lives around the technology and the social connections they entice us with, rather than the other way around. They stay up all night waiting for the next status update. They interrupt a face-to-face conversation to make sure whatever’s going on elsewhere isn’t better. I wonder how this is a good way to promote future, strong social connections?
I have my doubts.
I believe, much to their detriment, that the makers of social networking technologies have some rough idea — but not in any nuanced or scientific way — how the tools and products they create are changing human behavior. (If these companies really wanted to take their efforts to the next stage, they should consider hiring some psychologists!) It’s an impulse control problem — we cannot easily control our impulse to “check” the technology to ensure something “more important” isn’t waiting our immediate attention.
The reality is that there are few things so truly important in life, they can’t wait. Sure, I understand it if you’re the President of the United States — you have a legitimate reason to check your texts during dinner. But everyone else, not so much. We’re succumbing to our FOMO when we do so.
Fear of missing out (FOMO) is a very real feeling that’s starting to permeate through our social relationships. The question is — will we ever settle for what we have, rather than cling to the fear that we may be missing out on something better? Social media like Facebook and Twitter are making this increasingly more difficult.

Sleep walking with depression, anxiety, addiction etc


I found this article in the Telegraph interesting today. It seems more people sleepwalk than previously thought. The fascinating point for me is that people with depression are 3.5 times more likely to sleep walk than those withou depression.  That’s a fair increase. Also those who are alcohol dependant or have OCD are also more likely.
Its not clear if this is a symptom, due to the condition or in fact down to medication. Yet it must also affect the level of sleep and it’s effectiveness. I’m curious as to why these psychological issues versus others too. People on ssri’s we’re also found to sleepwalk twice a month or more, well they were 3x more lonely than those who weren’t on the medication. Maybe an intake questionnaire could be do you sleepwa
 therapies have been found to be helpful for these conditions so go see someone?
One third of people experience sleepwalking, study shows
One in 25 people were found to sleepwalk as adults
Picture: Alamy

Twice as many people suffer from sleepwalking than previously suspected, with nearly a third experiencing it at some point in their lives, new research has revealed.

Scientists found one in every 25 adults are prone to night time wandering, with 29.2 per cent reporting some form of sleepwalking since childhood.

The study also showed an association between nocturnal disruption and certain psychiatric disorders, such as depression and anxiety.

The researchers said the study “underscores the fact that sleepwalking is much more prevalent in adults than previously appreciated.”

Lead author Maurice Ohayon, professor of psychiatry and behavioural sciences at Stanford University School of Medicinein the United States, said: “Apart from a study we did 10 years ago in the European general population, where we reported a prevalence of two per cent of sleepwalking, there are nearly no data regarding the prevalence of nocturnal wanderings in the adult general population.”


The researchers studied nearly 20,000 members of the public in 15 US states, using a telephone survey to build up a picture of their mental health, medical history and medication use.

From they, they asked them specific questions related to sleepwalking, including frequency of episodes during sleep, duration of the sleep disorder and any inappropriate or potentially dangerous behaviour during sleep.

Those who did not report any episodes in the last year were then asked if they had sleepwalked during their childhood.

The researchers determined that as many as 3.6 per cent of the sample reported at least one episode of sleepwalking in the previous year, with one per cent saying they had two or more episodes in a month.

More than 80 per cent of those who reported sleepwalking as adults said they have done it for more than five years, with a third having a family history of the condition.

It found sleepwalking was not associated with gender and seemed to decrease with age.

Those with depression were 3.5 times more likely to sleepwalk than those without, and people who abused or are dependant on alcohol or suffer obsessive-compulsive disorder were also significantly more likely to have sleepwalking episodes.

People taking SSRI antidepressants were three times more likely to sleepwalk twice a month or more than those who took none.

Prof Ohayon said: “There is no doubt an association between nocturnal wanderings and certain conditions, but we don’t know the direction of the causality.

“Are the medical conditions provoking sleepwalking, or is it vice versa? Or perhaps it’s the treatment that is responsible.”

Prof Ohayon said although although more research is needed, the work could help raise awareness of the association among primary care physicians.

He added: “We’re not expecting them to diagnose sleepwalking, but they might detect symptoms that could be indices of sleepwalking.”

The findings were published in the journal Neurology.

Grief and social media


Reading an article in the Telegraph recently I was reminded of a conversation I had recently at St Barnabas in Worthing, an amazing hospice.
We had discussed the future of social media in the current grieving process. People are even informed of deaths through twitter or Facebook first. That seems appropriate when it’s a celebrity but what if you hear about a loved one, a family member or a friend? That adds a whole different suffering for some.
Also the fact that twitter and Facebook accounts aren’t that easy to close when someone dies in that they’re an immediate reminder as feeds stream up. Some people want a shrine, a reminder and to see that person. Others really don’t and can’t handle that reminder.
So we have to look at social media and grief in our futures. The article looks at the side that is nasty currently. That safe hiding place within which someone feels protected enough to be abusive over another’s death. It also looks at an individual’s right to say goodbye and grieve over their celebrity, their “star”. People have done this for a long time. The difference here is the public nature of that grief that doesnt require waiting for a report. I do wonder what the future holds with social media, announcements of death, coping with death and loss for all of us in the future with the likes of twitter and facebook.
Some people need help with grief and the death of someone they love or admire. Be that someone close or distant. It is still a loss. Some people cope brilliantly, too brilliantly and look for help later. Counselling and psychotherapy are a great place to get started with grief and death. No one can make promises yet talking therapies have good outcomes generally for those coping with the death of someone.
It is a safe place to say goodbye and work out what that means to you.  I offer psychotherapy for bereavement and counselling for bereavement too in Lancing, London or with skype.
The Article

Why Twitter grief deserves respect
Adam Yauch
Beastie Boy Adam Yauch (centre) died last week.
Picture: REX

When a celebrity dies, social media websites are awash with grieving fans. Not a fan? Then leave them be, writes Shane Richmond.

Have you ever seen a funeral procession go past and felt the urge to shout abuse? Perhaps something mild such as “I’ve never heard of him!” or “He was rubbish!”. No, me neither.

And yet on social networks there are some who can’t resist heckling people for paying their respects to someone who has died. The last week has seen two notable deaths: author and illustrator Maurice Sendak (http://www NULL.telegraph NULL.html) and Adam Yauch of the Beastie Boys (http://www NULL.telegraph NULL.html). One wrote several much-loved children’s books and the other was responsible for a series of influential and critically acclaimed albums.

In both cases, after the usual period of wondering whether this was another of Twitter’s recurrent celebrity death hoaxes, the RIP tweets came en masse. Amid those was the occasional tweet from someone saying they’d never heard of the deceased or didn’t like him or just wanted everyone to stop expressing sadness about the death of a stranger.

The level of grief involved when a celebrity dies is clearly of a different magnitude to the death of a loved one. It is grief, nevertheless, and intruding on it is disrespectful, even if it isn’t anywhere near as disrespectful as shouting at a passing hearse.

When somebody touches your life in a positive way, whether by writing a book or recording an album, it is natural to be a little sad to hear that they have died. If they’ve touched your life in a more significant way – perhaps you saw them play live dozens of times over the years, or associate their book with a long-dead relative – then you might be sadder still.

In this age of social media, you’ll probably share that sadness on Twitter or Facebook. What right does anyone else have to judge whether your sadness is excessive or misplaced?

When Fabrice Muamba, the 24-year-old Bolton footballer, collapsed on the pitch during a match against Tottenham in March (http://www NULL.telegraph NULL.html), Twitter was quickly aflame with worry. “Pray for Muamba” was a phrase shared across the social network as fans feared for the midfielder who was perilously close to death in the most public of circumstances.

Even so, the Manchester United fanzine Red Issue chose to dub these people “grief junkies” (http://menmedia on a Private Eye-style front page that mocked concerned Twitter users. A spokesman for the fanzine said: “You see it more and more. Whenever celebrities become unstuck it’s a big issue while there are people being killed in Syria and Afghanistan who are not worth a mention.”

The spokesman accused people of tweeting “fake sentiments”, as if he would somehow be able to know whose feelings were genuine and whose weren’t.

Should Manchester United fail to win the Premier League title this weekend and thus end the season without a single trophy, I’m sure that Red Issue will remind fans that their suffering is nothing compared with that of the people of Syria. But perhaps not.

It is a common theme among those who would seek to police other people’s emotions to claim that they are feeling too sad about something trivial and not sad enough about something important. But being sad about one thing, such as your team failing to win a single trophy despite being one of the richest football clubs on the planet, does not mean that you cannot also be sad about any number of other things.

I suspect that the problem is one that frequently arises with social media: people mistake a series of small, independent actions for some kind of collective, organised campaign. Thus a group of people each tweeting that an article has upset them become “a heavily orchestrated internet campaign” to those who don’t understand the technology.

Likewise, when a lot of people tweet “RIP” in memory of a recently deceased celebrity, the stream of tweets can quickly start to look like a campaign. It’s as if a funeral parade had suddenly formed outside your window. If you don’t know the person who has died then the urge to ask what all the fuss is about must be hard to resist.

Still, resist you should. Do you really need to be the person standing outside the virtual memorial service shouting abuse? (http://www NULL.telegraph NULL.html)

Healthy models


I read this morning, courtesy of the BBC that Vogue has pledged to use healthy models. They are checking id so the models are over 16.
From what I can read, healthy seems to be those with a BMI that is considered “healthy” and those that don’t “appear” to have an eating disorder. Whilst both statements concern me, this last statement is my issue.
So many people with eating disorders don’t “appear” to have one. How many times have you stood at a buffet and judged the other person taking food, be that too little or too much? Many people walk through the door with all kinds of eating disorders and when I look at them I can’t guess which one it is. I may hazard a guess and yet I am not qualified to diagnose them either. How is someone interviewing a model for a catwalk or a photo shoot going to diagnose an eating disorder? I have realised that a lot of people, males and females with eating disorders do enough with labels and diagnosis themselves by looking on the Internet and doing their own research.
So you can’t tell by looking. Can you tell by asking? Anything that is powerful to affect your life on a daily basis, you may lie about to protect. Not knowingly. What I do see however is many people that come to see me use these models, celebrities and actors, actresses and sports people as a bench mark for what they want to look like which in many cases is unattainable or unhealthy in that they aren’t  naturally that way let alone other factors.  Putting food outback stage or at photo shoots may be healthy, yet will it necessarily affect an eating disorder?
If the way you eat, the way you think and feel about food, your body image or self esteem is affecting your life, go see someone. Talk, if you’re ready and able then take that step as eating disorders can be beaten.
Article BBC  4th May
Vogue magazine editors pledge to use ‘healthy’ models
Vogue’s decision has been praised as an “evolution” of the industry. The 19 editors of the global editions of fashion magazine Vogue have pledged to work with only “healthy” models.
“Vogue believes that good health is beautiful,” Jonathan Newhouse, chairman of Conde Nast International, Vogue’s publishers, said in a statement.
The editors have agreed to “not knowingly work with models under the age of 16 or who appear to have an eating disorder,” the statement said.
Casting directors will also be asked to check models’ IDs at photo shoots.
The editors have also promised to encourage “healthy backstage working conditions”, including food options.
“Vogue editors around the world want the magazines to reflect their commitment to the health of the models who appear on the pages and the wellbeing of their readers,” Mr Newhouse said.
In its statement the group recognised that there were “pressing issues relating to ill-health in the industry” and that models serve as role models for “many women”.
‘Evolution’ in industry
It said it would seek to ensure that those in its pages were “well cared-for and educated in ways that will encourage and help them to take care of themselves”.
Former model Sara Ziff welcomed the move.
“Most editions of Vogue regularly hire models who are minors, so for Vogue to commit to no longer using models under the age of 16 marks an evolution in the industry,” she told the Associated Press news agency.
The US, French, Chinese and British editions of the magazine are among those that will start following the new guidelines with their June issues.
In 2009, Vogue’s UK editor Alexandra Shulman criticised fashion houses for sending sample clothes too small for many models to wear.
In the magazine house’s statement, Vogue editors said they would encourage designers “to consider the consequences of unrealistically small sample sizes of their clothing, which limits the range of women who can be photographed in their clothes, and encourages the use of extremely thin models”.
Until now, the focus around the weight of fashion models has been towards those who model on the catwalk, rather than in magazines, following the death of two models from what appeared to be complications relating to eating disorders in 2006 and 2007.
London Fashion Week designers have signed a contract with the British Fashion Council to use models who are at least 16 years of age and, in Italy and Spain, the main fashion bodies have banned catwalk models who fall below a certain Body Mass Index level.

Anxiety, prescriptions and what?


With 7 million tranquilliser prescriptions on the NHS, the nation is at the end of its tether. What’s to blame?

Life was flying along for Zoe Brook. At 23, she had a fast-paced job she loved, in public relations, and had just moved into her first home with her then-partner. It was, she says, all that she had dreamt of.

That was until the night she sank to the floor, paralysed by fear, her own voice sounding muffled and as though on a time delay, while her view of the room darkened into the narrowest tunnel vision.

She thought she was dying. In fact, it was the start of an anxiety disorder that was to become her new reality, and to dominate her twenties. After finally sleeping, she awoke disorientated and petrified – a state that continued for more than three years, in which waves of panic attacks were “punctuated with glimpses of the real world”.

Looking back, she believes the anxiety was her body’s response to a pace of life she could not sustain. “When everything is busy and going well, you just keep on going. Then suddenly you look down and see that there is nothing anchoring you; and so you fall.”

She is not alone. Last year, close to 7  million prescriptions were issued by the NHS for anti-anxiety drugs. As economic woes have worsened, and job and mortgage worries become rife, the numbers being treated in hospital for such disorders have soared – with more than 17,000 outpatients’ appointments last year, four times as many as in 2007.

As Britain enters the Age of Anxiety, great swaths of the population appear to be nearing the end of their tether.

However, Dr Linda Blair, a clinical psychologist, believes that economic pressures are aggravating a far deeper problem; that modern technology, with its ability to bombard us with messages 24/7, has rendered many of us unable to “switch off”.

“We have actually created a more anxious state,” she says. “When our brain is expecting some kind of news, we prime ourselves to be on alert. With texts, emails and social media, on top of images from TV news, we are constantly on alert, and that can make people chronically anxious, and chronically exhausted.” She advises her patients to take some time away from their gadgets at least once a day – even if it is just for 10 minutes.

Dr Joanna Moncrieff, a consultant psychiatrist and senior lecturer at University College London, agrees and is concerned that Britain is following the path trodden by America in medicalising a social problem instead of examining the values behind it.

“We live in a culture that makes people anxious,” she says. “It encourages the idea that everything can be achieved or bought, that 100 per cent is not enough, that you have to be the perfect wife and mother, and succeed in your career.”

Meanwhile, too much faith has been invested in scientific progress, therapy and a pill for every human ill. “And we have become less able to tolerate and endure life’s ordinary difficulties.”

There has certainly been a distinct shift in the public image of anxiety disorders and the drugs used to treat them. While Valium earned a reputation as “mother’s little helper” among 1960s housewives, by the 1980s the group of benzodiazepines had become better known as “jellies” and “benzos” by recreational users seeking a high.

Today, the same group of drugs are being discussed in far glossier circles.

Earlier this month, Alexandra Shulman, the editor of Vogue, admitted she has regularly suffered panic attacks – and always carries some Xanax in her handbag as her “lucky charm”.

British supermodel Jodie Kidd and her sister Jemma, the Countess of Mornington, have both undergone successful treatment for anxiety and panic attacks which they described as “crippling”.

“The attacks felt like that split-second before a car crash, when the adrenalin whooshes through your body and you think you are going to die,” says Jemma. “From the outside, I might have looked sorted, but on the inside, I was thinking ‘if only you knew… ’ ”

Both checked into the Linden retreat, in Worcestershire, also the choice of British novelist Plum Sykes.

Ms Sykes’s anxiety followed the onset of a rare migraine disorder that left her so dizzy she couldn’t care for her children. Though treatment for the condition was successful, the fear of such attacks left her virtually housebound, unable to take even the few steps from her home into a taxi unassisted.

“Life became a series of ‘what-ifs’.” she says. “I would imagine every possible worst-case scenario which could occur. In the end I became too frightened to do anything at all.”

In an article for US Vogue this month, she wrote about her stay at the retreat, and the dinner conversations with 11 other anxiety sufferers, including a 23-year-old policewoman who experienced panic attacks when her baby refused food.

“You must be terrified at work then,” Ms Sykes sympathised, “dealing with criminals and everything?”

“ ’Work’s fine,’ the policewoman cheerfully replied. “I just lock offenders in a cell. I’m not afraid of them. It’s when I’m at home that I’m anxious.”

When a person is fearful, the body is flooded with adrenaline in order to prepare it for extreme muscular activity, commonly known as the fight-or-flight response. In panic attacks, these reflexes are triggered despite an apparent lack of external threat, causing a response in the sympathetic nervous system with intense physical symptoms, including tunnel vision, hyperventilation and racing palpitations.

While the NHS prescribes drugs and, increasingly, cognitive behavioural therapy, to identify unhelpful thoughts and actions and replace them with constructive ones, the retreat’s founder, Charles Linden, an anxiety-sufferer for more than a decade, is adamant that when it comes to anxiety, neither approach works.

Instead, clients are given individualised programmes to follow, in Ms Sykes’s case insisting that she timetabled activities for every half-hour of every day so there was no time to look ahead and worry.

If some of his ideas sound kooky – tips to avoid panic attacks include “the cold apple” method, taking an apple from the fridge, and eating it slowly – the Kidds and Ms Sykes are among many celebrity clients who say they have been cured.

But Frank Furedi, professor of sociology at Kent University, fears that Britain has developed a culture that not only feeds and encourages anxiety, but also wears it as a badge of pride.

“At London dinner parties, everybody has a condition, an anxiety to talk about; if you don’t, there is something wrong with you. It has become normal and fashionable to be anxious; it is a little bit edgy,” he says.

He believes two twin forces are at work; that children are taught to “medicalise the everyday”, and learn a language of stress and anxiety, while our political classes have identified happiness as a public goal, with David Cameron last summer announcing plans to rate the country not just by its gross domestic product, but by the well-being of the public.

“In the Second World War, we maintained the stiff upper lip. Today it is almost the opposite. The message is to call a helpline, get support, find somebody to help you. If you aren’t opening up and talking about your problems, then you are seen as morally inferior,” Dr Furedi argues.

Certainly the past 60 years have seen a vast expansion in psychiatry, and in the redefinition of social problems as medical complaints.

In 1952, the first edition of the US Diagnostic and Statistical Manual of Mental Disorders, the psychiatrists’ bible, that classifies mental illnesses, was 130 pages long and listed 106 psychiatric disorders. Today’s checklist, used across the world, runs to 900 pages and 297 disorders. A new version is due next year.

One of the most significant expansions, under psychiatrist Dr Robert Spitzer in 1980, led to the introduction of “generalised anxiety disorder”.

In recent years, Dr Spitzer has criticised his own work, suggesting that the criteria were so broad that up to 30 per cent of the population without serious mental health problems could fall under its classifications.

At Anxiety UK, the main charity for people suffering from anxiety disorders, phobias and panic attacks, chief executive Nicky Lidbetter believes people in this country have simply become more aware of conditions that have always existed, even if they went unnamed.

“I had a grandmother who was agoraphobic; we just didn’t have a word for it,” she says.

She sees first-hand how severe such disorders can be. “At worst, these can render a person housebound, or even roombound,” she says.

Ms Lidbetter also takes the view that modern technology and fragile economic conditions are putting increased numbers of people at risk. “People can usually cope with short bursts of pressure but what is much more difficult is situations of prolonged uncertainty, when there is no end in sight; conditions like our economic situation,” she says.

Stress can spur success, but it needs to be at a constructive level. As pressure ratchets up, coping mechanisms can falter. “When there is job insecurity, people take on more work than they can handle, they start surviving on coffee, not eating properly, and dropping the things that kept them well, the leisure activities, the trips to the gym,” she says.

She describes panic attacks as the “body’s internal alarm system”, sending a warning to slow down and take stock.

In Cheshire, Zoe Brook no longer suffers from anxiety. The mother-of-two has trained as a therapist, helping others with such disorders.

After three years of drug treatment, she learnt, by trial and error, to manage the warning signs.

Mrs Brooks describes anxiety as “a battle in the mind” and one that occurs not during the times of most pressure, but in the hours, days and weeks after – “the quiet times, when thoughts can rise to the surface”.

“The attacks paralysed me,” she says. “When I felt them coming, I used to grip the arm of the chair and steel myself for the wave. Then I realised you had to break it; to get up, to do something mundane, to take a deep breath, to potter about, to do anything.

“I began to realise that the best response was indifference – to laugh in the face of an attack.”

These days, when the going gets tough, she tries a different tack. “Now, I take a moment to lie on the grass, to look at the sky, and to see the shapes in the clouds. Sometimes you just have to stop and catch your breath.”

Debt and stress lethal combination


People have got into more debt recently. Some cope and some don’t. Some seek help practically, some don’t. Some seek psychological help too, some don’t. However, what is commonly accepted is the affect worry and stress has on our physical health.  This can be day to day and also much more serious.


This is an article from yesterday, from the Times of India using a poll from the Asdociated Press and AOL.


Stress is a killer, if you feel stressed please act for your own benefit.


Worrying about money can increase risks of several significant health problems – such as heart attack, ulcers, migraines, back pain etc. – a new study has suggested.

While it is not surprising that the main source of stress for most people is money, this new research has found just what people can expect from their worries.

In a comparison of people who had a high level of stress over debt and those who did not, it was found that people with high stress levels were twice as likely to have a heart attack compared with those who did not worry about their financial situation.

The poll, conducted by the Associated Press and AOL, also found that 27 per cent of people with high stress over finances reported ulcers or digestive problems versus 8 per cent of people who did not worry about finances.

Further 44 percent of people financially stressed reported having migraines versus 4 percent of people with low financial stress.

And 23 percent of people with financial stress were depressed, compared with 4 percent of people who were not stressed.

Highly stressed people were also 65 per cent more likely to suffer from back pain and muscle tensions than those with low stress.

The good news is there is an easy way to avoid health problems associated with worrying about finances.

Additional research has shown that people who take an active role in planning and learning about their finances were less stressed and more confident in their financial situations.

According to a TIAA-CREF Institute study, people who are educated about their finances are more likely to save for retirement.

Additionally, attending a financial-training program increased people’s feeling that they were in control of their finances by 25 per cent, according to a recent Metlife survpoll, conducted by the Associated Press and AOL



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