Equilibria Psychology offers advice, assessment and therapy to children, teenagers and adults. Shona Lowes is an experienced Clinical Psychologist from the UK with previous experience working in Russia, The Netherlands and Singapore.
If you wish to contact me directly please do not hesitate to email me at: firstname.lastname@example.org.
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I haven't posted on my blog for a while, but this is one that I have thought of writing several times, as I know many people who experience difficulties with sleep.
Switching off and settling down, ready for sleep
This visualisation can be used to help you fall asleep at the beginning of the night or to return to sleep after waking during the night.
It is worth reading this a few times and then trying it out, this will enable you to practice before using this strategy to induce sleep. Each person’s visualisation is different, you may consciously think about a restful place but when you allow your eyes to close, you might find that your mind discovers a place that you hadn't consciously considered, the place may also change each time you practice. Just go with it, there is no correct way to do this, the important thing is to free your mind from the day to day stresses to find a calm and restful state, perfect for falling asleep.
Stage 1: Comfort
Get yourself in a comfortable position, begin to focus on your breath, taking an occasional and deliberate deeper breath. Allow your eyes to close as you focus on your breath and mentally scan your body from the top of your head to the tips of your toes, make sure each part of your body feels comfortable and in a good position. Do this a few times if you don't quite feel comfortable the first time you do it.
Stage 2: Colours down to a restful place
Visualise the colours of the chakras which go from the top of your head to the base of your spine. Don't worry if you don't know anything about the chakras, the process of visualising a series of colours and imagining the colours from the top of your head down your body gives you a focus and a structure to this stage of the visualisation. You may not be able to visualise the actual colour, so it is fine to imagine the word of the colour or visualise the word written in your minds eye.
Start with the colour violet or a light purple. Visualise this colour at the top of your head, visualise a swirl of colour, or the word or if this is difficult, just say the word ‘violet’ to your self whilst focusing on the top of your head.
Continue to do this through all of the colours, spending a few moments on each colour and moving your attention within your body down to the next colour of chakra.
The colours are:
Violet - top of the head
Indigo - the space between your eyebrows
Turquoise - the throat
Green - the heart
Yellow - area around the navel
Orange - below the navel and above the pubic bone
Red - the base of the spine
As you leave the colour red behind in your imagination, you move on to the next stage.
Stage 3: A restful place
Imagine yourself stepping down into a restful place, this may be a place at home or somewhere else indoors, or it may be a place outside in nature. It might be a place you actually know or it may be a place you create and imagine. Settle down in this place for a few moments - imagine how your body feels rested, notice within your imagination the temperature or the movement of a gentle breeze or just the stillness. Notice any sounds in your restful place, notice how you are dressed, what you can see, you may even notice the smell of this place.
Stay here for as long as you like and then when you are ready, move on to the next stage.
Stage 4: Peace and calm
As you move away from this restful place you can see in front of you some steps. Imagine yourself standing at the top of the steps, again use all of your senses to truly visualise yourself. Then begin to step down, counting the steps from 10, slowly and deliberately taking these steps down …..9……8……7……. until you reach the bottom. At the bottom you find yourself in your own peaceful place, a quiet place, no one else is around, you walk slowly, taking in the different aspects of this place, you find yourself watching, listening, feeling the air, the ground under your feet. If you stay here a while you might just find yourself enjoying the peace and the calm.
You may fall asleep at any stage throughout this process. If in stage 4 you are still awake you can continue to focus on the peace and the calm or you might decide to leave this place and you can do this by walking back up the steps counting from 1-10, maybe stopping off briefly in the restful place and then going in reverse order through the chakras. As you end at violet, take a deep breath and feel yourself in a better state for sleep than you were before.
You can adjust this visualisation to suit yourself and with your own creative imagination but aim to keep the 4 stages of the process. The first few times you practice you might want to just practice with one of the stages and then add the other stages as the process becomes more familiar to you.
Mindfulness is simply being present in the here and now. Being present means with your body and your mind (thoughts).
We can be present in our body by being aware of our senses, as you read through this pay attention to each sense in turn. The sense of touch
Notice how your feet feel as you walk, how it feels to have physical contact with the chair you are sitting on, your elbow on the desk, the feel of the pen in your hand etc
The sense of sight
You can be present in the room you are in by really noticing what you can see, you may have been in the same room many times before but each time, if you look carefully you notice something different, even down to the tiniest detail. Notice colours or shapes or how one object rests against another, notice if something is straight or at an angle.
The sense of hearing
Become aware of sounds in your environment, start with obvious sounds like the voice of the person who is talking, but then notice less obvious things like the sound of movement of another person or even the sound of your own movements. Start with sounds within the room and then extend your attention wider to see what you can hear outside the room.
The sense of smell
The sense of smell is sometimes a little more difficult but it is still useful to notice and practice noticing the smells in different environments, maybe food smells, perfume, wash powder, animals etc. The sense of smell often triggers memories before the other senses even seem to be connecting in the environment.
The sense of taste
Taste is the final sense to use to help you be more present, this can obviously be practiced at mealtimes. Have you ever experience having eaten something and not noticed? Maybe you see that the food has gone quickly and there is none left. This is when you have eaten mindlessly, perhaps because you are watching tv, texting a friend or checking something on-line or you may be deep in conversation with another person and just eating automatically. Eating mindfully is to notice and experience every mouthful, notice the first taste and how this changes as the food is moved around your mouth, notice the texture of the food, notice the feel of the food in your mouth, on your tongue and teeth.
There are certain situations that we are commonly not fully present, these are usually frequently occurring and automatic actions or situations. For example: walking, eating, showering, brushing teeth, getting dressed, travelling in the car.
Mindfulness and memory
How does mindfulness relate to memory? Quite simply the more you notice something the clearer it will be imprinted in your memory whatever sense is prominent. If you take the sense of seeing, if you glance at a set of objects on the table and then I remove one, you may not notice what has gone, only that something is different or a sense that something is missing. However if you have paid attention to more of the detail you would immediately know what has gone. You can practice this with random objects on a tray, look at them, then hide them and get someone to take one away, its then easy to identify what is missing. A bit more difficult is to give a full description of everything on the tray, but this is possible if you pay full attention and notice every detail, imprinting it in your memory.
The more you practice mindfulness the more mindful you will be. Start practising either by trying to focus on one of your senses or by choosing particular activities to really carry out in a mindful way.
If you do experience difficulties remembering things, start by noting what, where and when you forget or times when your memory often fails you and decide how to be more mindful in that situation. You can also chose something to trigger being more mindful, maybe use a little sticker on a book or object that you need to remember, or notice something small or interesting about the door of a room, so that it jumps into your attention as you walk through it and reminds you that you need to remember something.
By pairing things together in your awareness and paying attention to two things together, seeing one can then trigger remembering the other. For example looking at the detail of the blue pen on your desk at home, next to your notebook, see them clearly together, then when you need to remember, picking up one will remind you to pick up the other.
Developing visual memory
You can also really work on developing your visual memory which can hold more information than your auditory memory. This is good also for remembering information for exams or tests. Our visual memory can be still like a picture or move like a video. Still pictures are good for remembering facts or unrelated pieces of information, moving pictures in our mind help us to remember actions, series of events or something we need to do.
Practice using visual memory, create a picture in your mind using the following words, take one word at a time and add it to your picture in whatever unusual way you like:
Then test your memory straight away, after an hour and again the next day without looking at the original list, this can be helpful to do with a friend or family member. You will be surprised that you remember all, or almost all, of the items and that this memory remains even after a time delay.
Practice using your moving visual memory for the following story; visualise each bit in any way you like, there is no right or wrong way to create the ‘movie’ so long as you can use it to recall the story.
Jamie was a tall boy, he was striding along the quiet and narrow street, he had bright blue laces in his brown shiny shoes, a baseball cap and jacket. As he reached the end of the road a small black dog ran quickly past him, surprising him. He noticed the grey and gold sign of the book store as he turned the corner. He was aware that the doorway was busy, with people going in and out. He walked into the shop behind a small balding man in a beige jumper, as he walked easily past him he saw immediately the sign for the science fiction section.
Use your visual memory to recall everything you can about this story, again try this with a friend or family member and see if you can still remember it after a time delay.
For more information on using mindfulness, awareness and visualisation to help with memory, please contact me.
Panic is a physiological reaction which can be triggered by something external to you but more often it is triggered by negative and fearful thoughts. Often you may not be able to identify the exact trigger as the anxiety and panic quickly overwhelm you.
The initial physiological reactions such as heart beating faster, shortness of breath, shaking, tight chest, nausea or unsettled stomach, become more intense as your thoughts immediately focus on these feelings with ‘oh no I am going to have a panic attack’, you can very quickly feel out of control of your own body’s reactions, your emotions and your thoughts.
Understanding the panic reaction is an important first step in regaining control. Firstly it is important to realise that anxiety and panic are a temporary state and the range of physical reactions can be reversed, quickly, by the use of some very simple techniques. These techniques should be practiced initially at times when you are not anxious to ensure that you are so familiar with the technique, you can use it easily when you become anxious or begin to panic.
Slow and deep breaths
What normally happens when we begin to experience anxiety is that our breathing becomes fast and the breaths short, it may seem almost as if you are panting or gasping for breath. This pattern of breathing has an effect on other parts of our body, including an increase in heart rate. In the clinic setting I use a bio-feedback device which clearly demonstrates the rapid impact of deliberately changing the breathing pattern, the heart rate becomes more regular after only two or three deep breaths. Practice slow and deep breaths throughout the day, take two or three and then allow your breathing to return to a normal and natural rhythm. Whenever you notice even minor symptoms of anxiety or you notice those negative and fearful thoughts creeping in, just repeat this deep breathing practice. It also helps to take your attention away from your thoughts by focusing on each breath, notice how it feels for the air to enter your nostrils and flow down through your body and similarly for the exhale.
Focus on the here and now
The negative and fearful thoughts that usually accompany anxiety and panic, tend to be related to either the past or the future or both. You may dwell on unpleasant and painful experiences from the past and you may be fearful of bad things ahead. More specifically. if you have previously experienced panic, you will fear being overwhelmed by anxiety especially if you are in a public place. It is this fear that most often exacerbates and accelerates the severe anxiety symptoms. You can counteract this negative past/future thinking by focusing on what is actually present in the here and now, what is in your physical environment rather than in your head. By making use of your senses, notice where you are, notice your feet on the floor or how your body feels in contact with the chair, look closely at something around you, notice the detail and the colours, listen to the range of sounds in the room and go wider to what you can hear outside the room. Practice being mindful in this way throughout your day, you will be amazed at how it interrupts and changes your thoughts.
Rational and positive thinking
You can also manage the thoughts by challenging them, taking a different view or perspective. Again this can be easier said than done when you are in the midst of a panic attack but by practicing this regularly, when you are not anxious, it will become more natural when you most need it. Telling yourself that the anxiety will pass, that you have techniques to control the panic, focus on positive events ahead or positive experiences from the past, telling yourself things wont be that bad and that things usually work out.
You might find that just one of these strategies suits you and works for you or you may use all three in combination. The important thing is that you understand the rationale for the approach you are using so that you can truly believe that you are able to gain control of panic.
Keeping a written record for yourself can help you to see how you are progressing in your practice and by seeing the impact the techniques have on your emotional state, you will begin to feel more confident that you have control over your own reactions.
Young children often experience difficulties falling asleep at bedtime. This may be an ongoing problem for your child or it may just happen occasionally, perhaps caused by stress, anxiety or general worries. A good routine at bedtime is essential for providing the cues for sleep and it might include, a bath, a drink and a snack and story time. It doesn't matter exactly what the routine is for your child as each child and family is different but the important thing is that elements of the routine are always the same and that it is in some way quiet and calming. Ending the routine with a story is an excellent way for your child to switch off from their day and to be able to relax and settle ready for sleep. If your child is having particular difficulties settling and switching off their thoughts it may help to have a regular 'sleep story' to end the routine. Here is a short sleep story for you to try:
The Sleepy Butterfly
Snuggle down now,
Wriggle around until you feel comfortable,
Close your eyes,
Breath in through your nose slowly,
Breath out through your nose slowly.
Did you know that when your eyes are closed, it is easy to use your imagination?
You can see anything you want in your mind,
You can listen and hear,
You can even imagine how something smells.
Imagine you are sitting on a rock near the sea,
Listen carefully for the sound of the waves, can you hear the sea?
Breath in through your nose slowly,
Breath out through your nose slowly,
Can you smell the sea?
Imagine now you can see a butterfly,
Fluttering around in front of you,
Look carefully at the butterfly,
Notice the colours,
Notice the shapes and patterns on the butterfly's wings.
Notice the gentle fluttering in front of you,
The beautiful sleepy butterfly,
You can see the butterfly clearly,
Your own butterfly, in your own mind,
all the colours you like,
It is the most beautiful butterfly you have ever seen,
Fluttering, now slowly, feeling sleepy,
Ready to rest,
As you breath slowly in through your nose
And slowly out through your nose,
Your butterfly lands very carefully on the rock next to you,
The sleepy butterfly,
It's time to rest
It's time to sleep.
As you fall asleep you can still look at all the colours of your beautiful butterfly as it rests and sleeps ......
Anxiety is a normal and usually adaptive human state.
When we are anxious our internal physiology changes due to increases in adrenalin, this gives us real physical symptoms such as feeling shaky, heart beating fast, change in body temperature, breathlessness, dizziness, butterflies in the stomach, nausea, vomiting etc
Sometimes these feelings become so overwhelming that you don’t know how to deal with them and this can then affect your behaviour. You might avoid certain situations or find yourself struggling so much that you need to get out of a situation as quickly as possible, this might make you feel a bit better. However, although escape or avoidance can be effective in the short term, they can also lead to more problems developing which really start to affect your life.
Anxiety can be triggered by an event – something happening outside of ourselves that we can’t control. Very often anxiety is triggered and maintained by our thoughts, if we tell ourselves that something is difficult, terrible etc then our body will react to these thoughts with anxiety.
When anxiety has built up over a period of time it is very difficult to see a way out, it operates like a cycle and when anxiety is high it is difficult to find alternative ways of thinking or behaving to break the cycle so we tend to stick with the same short term solutions.
Anxiety - Making changes
The three main areas to focus on are:
Physical feelings of anxiety
Think about the last time you felt really anxious or even had a panic attack, write down the actual physical symptoms. Are your symptoms always the same?
How did you react the last time you had these symptoms of anxiety? Did you try to avoid a situation or escape from a situation? Did you try to do something to manage the anxiety? What did you do and did it reduce the physical symptoms?
What thoughts were going through your head either before you noticed the anxiety or when you were experiencing the anxiety?
By noticing what is happening for you and keeping a record of your physical feelings, actions and thoughts you can begin to understand what is going on, making sense of what happens when your anxiety increases can help you begin to develop better strategies for coping and eventually for reducing anxiety.
The next step is to start to try out some different strategies which will be aimed at reducing the physical anxiety by using relaxation, trying out different behaviours and seeing what happens, and picking up any negative thinking and trying some positive alternatives.
Here are some simple strategies you can try to start with:
When we are anxious our breathing tends to become shallow and fast, this is something that we can change relatively easily with practice. At times when you are not feeling particularly anxious, pause and take three very slow deep breaths, feel the air going through your nose and feel it going deep into your body, imagining it is reaching as far as your stomach. When I see teenagers in the clinic I use a bio feedback device which measures heart rate and after only three deep breaths this always shows that the heart rate becomes more even and regular, proving that deep breathing has a very quick effect on what is happening in the body. When you have practiced the deep breathing at times when you are not anxious, you can then feel more confident to use it when you begin to feel the first signs of anxiety, making you feel more in control of what is occurring in your body.
For each of the ‘anxiety thoughts’ you have identified create a coping thought to replace it and then practice saying this to yourself. A very simple example would be to replace‘I can’t do this, it is always so difficult’ with ‘I have done it before and it has been ok, I just need to take the first step and once I am in the situation I will feel better’.
If you require any further advice please contact me
General information and guidelines for the management of toileting problems in schools and at home.
The nature of difficulties
There are a range of difficulties that may be present in preschool and early school aged children, it is important to gain a level of understanding of the specific difficulties experienced by each individual child.
The two main categories of toileting problems are:
Enuresis (wetting) - nocturnal (wet beds) and diurnal (day time wetting)
These terms are used for children who are above the age that you would expect toilet training to be complete - for daytime usually over 3 years old but really it is not considered a problem until the child is over the age of 5 years. Of course there is a wide range of individual differences and even before the age of 5, we can help and support children to develop the necessary behaviour for successful toileting. Children usually achieve daytime control earlier than night time control and it is not unusual for bedwetting to still be occurring up to the age of 7 years
The child may never have achieved successful use of the toilet during the toilet training phase or they may have had some success and then regressed.
It is important for the child to have been assessed by a doctor to rule out any specific problems that can be treated medically. Often encopresis is associated with constipation (as either the cause or result of with-holding, avoiding or delaying opening the bowels) and in this case medical intervention is necessary prior to working on the behavioural and emotional aspects of the issue.
There is often a level of anxiety present for the child, which can be related to a range of different aspects of the toileting experience and is individual to each child.
Toileting issues are frustrating and difficult to manage for parents and carers and so it can be really helpful to have a focused plan of action to help and support the child through the process of learning appropriate toileting behaviour. A calmer approach can have a positive impact on the child.
Assessing the problem
Rule out or treat any medical issues which may be contributing to the problem.
Collect information on what has happened for the child through the toilet training process e.g.: when did toilet training begin, how did the child respond, what level of success (if any) was achieved at different stages, any specific negative experiences that may have led to specific anxieties around toileting, any practical difficulties related to getting to the toilet (e.g.: distance to the toilet, only toilet at home/school is upstairs, bathroom cold, toilet too high ...... )?
What is happening now? Who normally deals with the child in relation to toileting? Does the child communicate his toileting needs in any way? Any successful toileting experiences lately? What were the conditions that may have helped the child be successful? What conditions may be contributing to difficulties using the toilet currently? Any differences between home and school? Any differences between day and night? What level of awareness does the child appear to have (e.g.; does he seem to know that he needs to go - fidgeting, crossing legs before wetting, does he leave it too late to attempt to go to the toilet, does the child ever wet a little and then is able to stop himself? Does the child go for a long time and then urinate a lot? or does he wet little and often?
If both enuresis and encopresis are present you need to ask the questions in relation to these separately.
What does the child say about the problem? What makes it difficult for him to use the toilet? How does the child distinguish himself from other children of the same age in relation to using the toilet? Does the child express feelings of embarrassment or anxiety? Does the child have any ideas about what might help him or make it easier to move forward (the child’s idea can often be the starting point for any plan and because it has meaning to the child then it is more likely that progress will be made).
Educating the child
Involve the child in the assessment and intervention planning. Work as a team together parent, teacher and child, to understand the problem and then work out what to do.
Talk to the child about how the bladder works, using simple drawings and explaining where the bladder is in the body and how it fills up gradually, reaching a point where it sends a message to the brain, what the badder might say to the brain (children are quite good at coming up with unusual communication with characters, little people, voices - go with their creative ideas while still keeping the general, simplified, physiological functions of the body). Explain how the body is able to hold on to the urine even when the message has been sent to the brain and that there is usually enough time to get to the toilet. You can talk about how we might help the brain to listen and hear the message from the bladder or how we can teach the body to hold on to the urine long enough after the message has been sent.
A step by step plan
Establish where the child is now and what are the important factors to keep in mind from the assessment of the problem.
The long term goal is of course to be able to use the toilet appropriately and independently, however this may seem too unachievable for the child so set a few mid term goals and then break the first of these into much smaller achievable steps.
The first step might be for the child to communicate that they are wet, this might change what has been happening so far, in that, instead of being disappointed that he has wet himself, both the child and adult are pleased that he was able to say that he needed changing.
The second step might be to go to the bathroom as soon as he feels the need to urinate and then even if not in the toilet, it is a step nearer and the child can feel proud that they have made this change.
You might need to consider practical adaptations such as providing a step next to the toilet, having something interesting to see in the bathroom, keeping the bathroom door open.
If the child is sometimes able to use the toilet you might help them to learn that they can stop the urine mid flow and start again, they can practice this, which will help to develop the skill of holding on.
If the child feels anxious, make any possible adaptations in the environment to help reduce the anxiety and help them to learn some calming strategies using breathing techniques or relaxation stories.
Regularly taking the child to the toilet might be the first step and even if the child doesn’t manage to urinate, he should be praised for trying and cooperating.
The goals and the steps to achieve these goals, will be completely individual, be as creative as you like and keep the steps as small and achievable as possible, don't be tempted to rush the child forward before they are ready.
Keeping a record of progress
It is important to keep a record of the number of wetting incidents and the number of successful uses of the toilet, noting down any relevant factors that either seem to help or hinder the child.
It is easy to lose track when you are having to deal with frequent changes of wet clothes and mopping wet floors, so by keeping a record you can reassure yourself and your child that progress is being made and you might also gain a better understanding of the problem.
Rewards and reinforcement
Verbal praise for achievement of each of the small steps helps the child to feel more confident and encourages them to continue to try to overcome the problem.
Use of stickers on a special toileting success chart can also help the child to see they are doing well.
Re- evaluating and updating the plan
At regular intervals re-asses what is happening and if the child is making progress you can set a new goal. If the child is not making progress, you might need to look at setting a different goal or breaking a goal down into even smaller steps.
If you are struggling to find the appropriate goal or if the child has made some progress but seems to be stuck again please do not hesitate to contact me for further information or advice.
I have focused more specifically on enuresis here, for encopresis you can take the same general approach of assessment and planning, however there are some additional things to consider and understand if the child has experienced constipation, contact me for more information.