TC Psychology

Receiving a diagnosis of a health condition, particularly chronic health conditions, can be extremely difficult for anyone. The adjustment process can take a long time, as the person learns more about their condition, finds ways to manage it or even put their symptoms in remission, and learns how to navigate life with the condition. However, for many of the clients I have spoken to, and for myself at one point, there is also the risk that the person begins to lose their identity to the condition. 

Typically, our ‘identity’ is all the things that make us us – our likes, dislikes, personality traits, characteristics, strengths, passions. Our identity tends to be fairly stable, and it is what makes us different from everyone else, and is a big part of where we ‘fit’ in a social setting. For example, part of your identity might be your humour, or the fact that you care so much about others, or your ability to just say it how it is, or that you are great at drawing. 

For some people, when receiving a diagnosis of a health condition, they can find that over time, sometimes unnoticed, they begin to see themselves as the health condition. Much of their thoughts and actions relate to the condition (not eating this, not being able to do that), and this of course can impact on the other parts of their identity – for example, if being sociable and funny is a part of your identity but now you are consumed by concerns about your health and feeling different from everyone, it would be very hard to carry on being sociable and funny. This can lead to a sense of the person ‘not feeling themselves’ and people talk about ‘losing themselves’ to the condition. It’s almost as if their health condition becomes bigger and bigger, and their identity and other parts of their life get smaller and smaller. 

In my experience, there are a few common things that can increase the chances of our health condition becoming our identity. Firstly, if we find that all we think about is our health condition, then it makes sense that we feel like we’ve lost ourselves, as there is just no mental capacity to think about anything else. It can be helpful to spend some time thinking about who you were before the health condition, what did you like doing, how did you tend to think about things? How can we start to incorporate some of those things back into our lives?  You can also think about what type of identity you would like to have, even with a health condition. 

Secondly, being aware of how we talk about ourselves and our health is so important. If you find yourself telling everyone you meet about your condition, take a moment to reflect on whether this is actually helping you, or perhaps whether it is actually ensuring that the health condition seeps into every aspect of your life and keeps you feeling different from everyone around you? If you do find it helpful to tell people, then that’s ok, but for many, the regular talk about the condition can be unhelpful for them. 

Thirdly, be careful of who you spend your time with. It is very common for those with health conditions to join condition-specific forums such as Facebook groups. This is of course well-intended – you join these as you are looking for advice on ways to manage, or you want to be around people who get it. However, all too often what actually happens is that you now spend hours scrolling through reems and reems of posts that mainly involve fear, anxiety, talk about symptoms and conflicting advice. The other issue this can cause is that people can spend a long time on these groups, therefore missing out on other parts of their life. It can be helpful to really assess how you feel before and after being on these groups – are they actually helping you, or are they making you feel more scared and more hopeless? We know that for almost every health condition, stress can absolutely exacerbate symptoms, and yet in our quest for help, we can unintentionally put ourselves under more stress and anxiety. 

I am not at all saying that wanting to be around people who get it is a problem – not at all, I think in the right format, this can be helpful. But I do find commonly that for many people, this isn’t the kinds of groups they are on, and this can lead to a further sense of being hopeless and scared. So it can be helpful to spend a bit of time reflecting on what you might be getting from such groups, and whether they are helping or perhaps keeping you feeling stuck. 

The issues I’ve outlined in this article are just a few of the very common things I see in my practice. I have also been in the exact same place – receiving a diagnosis and then completely losing myself to it and feeling different, alone and consumed by it all of the time – and this was largely because my attempts to cope were actually increasing my anxiety and fear, making the health condition an even bigger part of my life, and in doing so chipping away at my identity. 

And this is not to say that people should just ignore the symptoms of their health condition and pretend its not happening, or get annoyed with themselves for worrying about it. Often, symptoms of chronic conditions can be very difficult and can mean that you need to adapt some parts of your life. What I am saying though, is that in my experience, the psychological impact of the condition can be underestimated and can for some people cause more distress than the actual condition, or at least make it far more difficult for them. 

If you resonate with this article, and feel you have perhaps lost your identity to a health condition, know that you are not alone. In my experience, spending some time getting psychological support focused on the adjustment process, helping you to identify the impact it has had on you, and ways to cope with a condition whilst still living a meaningful life with identity can be invaluable. 

Dr Theresa Comer, Clinical Psychologist.

One of the things that has come up a lot recently in my discussions with people, is body image. Research shows us that body image difficulties are extremely common for both women and men, and are likely exacerbated by social media and expectations about how we think we ‘should’ look. Whilst this article focuses on female body image, we know that men also often struggle with body image difficulties, and that this has been increasing over the years. 

When you look back at societal ideals over the years, it is no wonder that people struggle to feel comfortable in their own bodies! Societal ideals have varied wildly. In the 1950s, adverts for sugar products to help women gain body fat were commonplace, with tag lines such as “when I was skinny, men wouldn’t look at me”. The message given to women at that time was that being slim with little body fat was not attractive. This in some ways mirrors earlier eras, including the 1930s, whereby voluptuous women were viewed as more attractive, wealthy and fertile. 

Fast forward to the 1970s, and the message being pushed was for women to be skinny and slim-hipped.  This ideal continued for some time, though was also accompanied later by a shift from an emphasis on pale skin to a desire for tanned skin. 

Around 2010, societal ideals changed from ‘skinny’ to ‘strong’ and muscular, and hashtags such as #strongnotskinny flooded the internet. This era encouraged women to have visible muscles, and in particular a big bum. 

More recently, there has been a huge shift into body positivity, with messages about loving yourself at every size, and all sizes are beautiful. In many ways, this move has been viewed as positive by those in larger bodies, and those who don’t meet the standards of the ideal. 

However, as a client said to me this week (posting with consent), “I’ve never been skinny, I’m not very strong, and I don’t love myself at every size, so where do I fit”? My client talked about almost feeling ashamed that she didn’t like her larger body, and secretly wanted to change it, but felt she couldn’t be open about this as then she would be going against the body positivity movement. I’ve also had a couple of clients who were naturally very slender and slim, and who struggled with their body image as they felt they needed to gain muscle or body fat to fit in, and even had comments made towards them such as “you are not a real woman, real women have curves”. 

Whilst sometimes well-intentioned, there are so many problems with any ‘movements’ about body shape/size – mainly that these put such an emphasis on the importance of your body shape for ‘fitting in’ or being ‘desirable’, that people will inevitably think there is something wrong with them if their body doesn’t fit the ideal, which frankly most women’s bodies don’t. What this often leads to is a pursuit of meeting such expectations, combined with feelings of inadequacy, shame and constant comparisons. 

How on earth would anybody actually keep up with the changing ideals? If you were born in the 1980’s like me, by now you will have needed to be very skinny for a time, then gained a lot of muscle, developed a tan, and now have a large bum as well! And if I don’t fit into those expectations, then I’m told to love myself regardless!

Body image issues as well as eating disorders such as anorexia, and orthorexia are common and can be all-consuming for those struggling with them, and it’s easy to see how social media and societal messages influence this. If you feel that you may benefit from psychological therapy around any of these issues, don’t hesitate to get in touch. 

Dr Theresa Comer, Clinical Psychologist.

In part 1 of this series on stress, we identified some of the different types of stress. These included ‘external’ stresses such as having too much on or not sleeping enough, and ‘internal’ stresses which included beliefs and narratives about ourselves and the world (such as ‘I’m not good enough’, ‘things will eventually go wrong’). This article aims to offer some tips to help you manage stress. 

  1. Delegating or asking for help

This is one that many people find very difficult – asking for help. When we have too much on, we sometimes feel that we need to just keep going, or we can even become self-critical about the fact we are struggling. None of these approaches tend to be very helpful in the long-run, unsurprisingly! Are there some things, even little things, that you could ask someone else to do instead? Is there someone who might be able to offer a hand to help you out? It may be that you don’t know the answer to this unless you ask.

2. Saying No 

In our society, many of us are not very good at putting in boundaries and saying no to things. It can be helpful to tune into our gut feeling when we are asked to do something – if deep down we know we will struggle to do it, or we don’t have the time, this feeling is usually pretty accurate. This can include a family member asking you to do something, or someone at work asking you to take on an extra task. This can also include things like your child asking to do another after-school activity on top of the many they already do – its ok to say no! It’s ok to stop meeting everyone else’s wishes in order to look after your own sometimes. If you find yourself thinking ‘there’s no way I could say no to anything’ – please ask yourself why this is, as this may be pointing to an underlying belief about needing to please others or needing to be perfect, which could be really getting in the way. 

3. Making a small amount of time each day for yourself 

This can sometimes feel impossible, but can be as simple as sitting in the garden with a cup of tea for 20 minutes, or going for a quick walk in nature, or even just sitting down and shutting your eyes. Research shows us that having moments like this reduces the stress response and helps our body regulate back to a more relaxed state. You may think that this is unproductive, though research tells us that actually people who take breaks are more productive overall. 

4. Identifying stressors

We all feel stress for different reasons. It can be helpful to take note of the things that seem to make us feel more stressed, so we can focus more on helping ourselves. For example, if you notice that after going on social media you feel more stressed due to comparing yourself to others, then make a plan to reduce your time on it, or perhaps even come off it altogether for a time. If you find watching the news makes you feel more anxious or stressed, plan to stop watching it or turn off notifications at least. Perhaps it’s a certain person who makes you feel stressed or you find them difficult – it's also ok to limit the amount of time you spend with this person, especially when you are more stressed. 

5. If you cannot change the situation, reframe the situation

Remember how our brain believes what we tell it…..if we tell it that ‘life is really stressful and I’m doing a bad job of keeping up’, then we will likely feel more stressed. What if instead we could say ‘there’s a lot going on, and I’m doing a good enough job, I’m doing my best’. This also applies if you are able to say no to something – ‘Even though I’m not used to saying it, I’m allowed to say no, my needs are important too’. Our brains and our hormones react to the stories we tell it, and we know that changing the story can make a big difference to how we feel. 

6. Being realistic 

Many of us place high expectations on ourselves, and then criticise ourselves when we don’t live up to it. It can sometimes be helpful to think about what the main focuses or priorities are in your life right now. For example, if you have young children and not enough sleep,– that may mean that your house isn’t tidy, and you don’t have as much time to do things like going to the gym or focusing on your career, and that’s ok! We all have different seasons in our life, and its natural that at different points, we will have different priorities. The problem comes when we still try to do everything perfectly, and beat ourselves up for not achieving it. This is not the same as saying ‘don’t bother to exercise and just get used to an untidy house’ – of course, there are ways of incorporating things in, but again these have to be realistic to the life you have. 

7. Getting professional help. 

In part 1, I talked about how some of our stress can be internal – from the narratives and beliefs we have, such as ‘I’m not good enough’, ‘I need to please others’, ‘People don’t like me’, ‘I must be perfect’ – it’s easy to see how having these underlying beliefs could make everything feel more stressful. These can be harder to spot, because they are often entrenched and have been around a long time. Sometimes, people are able to notice if they have some beliefs like this, and gently start to challenge them. For others, getting professional support to help identify these and start to shift them can be extremely helpful for people.   

Dr Theresa Comer, Clinical Psychologist. 

All of us have some knowledge and experience of stress. Stress is often talked about, and we hear all the time about how stress is bad for us. This article (which is article 1 of 2) aims to shed a bit more light on stress, different types of stress and how it can impact us, so that you can think more about it in relation to yourself. 

First things first…

  1. Stress is inevitable to some extent. Everyone experiences stress at some point in their lives. 
  2. Stress isn’t inherently bad – for example, we know that cortisol (a stress hormone) rises sharply when upon waking, giving us the energy and drive to get out of bed and get our day started. We also need a certain amount of stress to get things done in our day. 
  3. Stress isn’t always a negative thing – some situations can be stressful, but they are also positive. For example, planning a wedding, or moving house can be both stressful but also exciting and bring happiness. 

Another important point to know about stress, is that it is supposed to be an acute and rapid response to a situation, to help you to cope with the situation. We are designed to spend most of our time in a more relaxed state, only needing the stress response for those occasions when there is a threat. For example, we cross the road and a car suddenly comes round the corner, our stress response kicks in instantly and it allows us to either jump back onto the pavement, or speed up to make it to the other side before the car comes. 

Remember that our brains are wired for survival, so they are routinely looking out for any threat, and if threat is perceived, the stress response will be activated. This is also known as ‘fight or flight’. During the stress response, a cascade of stress hormones are released into the body and this results in lots of physiological changes which are getting us ready to respond (heart rate increases, digestion turns off, pupils dilate). 

The problem we often see with stress is when it is chronic, and long-lasting, rather than acute and rapid. Chronic, ongoing stress is extremely common in today’s world. There are lots of potential reasons for this, and they are likely different for different people. Sometimes people know they are stressed because they can notice it very easily. However, for others, particularly when the stress has been chronic and long-lasting it can start to feel like the norm, making it perhaps harder to identify. 

Types of stress

When we hear the word ‘stress’, we often think of things like having a stressful job, or rushing around all day with too much to do. Whilst these are clear stressors, there are other types of stress that are perhaps less obvious but can be problematic for us. 

Some less obvious sources of stress might be things like watching the news a lot, and therefore being exposed to scary events or accounts of suffering. Or not eating enough, or not getting enough nutrients for your body to work optimally. Or not sleeping enough. 

An even less obvious, but very common source of stress, can be the beliefs and narratives that we have developed. These can include a variety of messages, such as ‘I’m not good enough’, ‘I need to please others’, ‘People don’t like me’. These kinds of beliefs and narratives can be active much of the time, and very easily triggered, and therefore the stress response is chronically activated. Remember, the brain believes our thoughts and interpretations, so the brain treats these beliefs in the same way as it does an external threat. Unhelpful or self-critical beliefs sometimes stem from previous traumatic experiences, but can also develop due to messages we have seen from those around us, or from society. 

Many people find that even when they try to reduce their stress (for example by taking less on), they still find themselves feeling stressed much of the time, and in my experience this is often because of the internal stressors mentioned above which continue to play out. 

Stress and Health 

Research indicates that chronic and long-lasting stress has a variety of detrimental effects on the body. Here are some of the ways stress can impact the body:

When our body is in the threat/stress response, energy diverts away from things like digestion because the body is focused on making sure our energy is focused on fighting or fleeing. Therefore, it makes sense that chronic stress has been linked to digestive conditions such as irritable bowel syndrome, as well as symptoms such as bloating, gas and constipation.

Our thyroid controls our metabolic rate, and is highly impacted by chronic stress. Research indicates that chronic stress can slow the thyroid down, which can lead to several symptoms such as feeling very fatigued, feeling cold a lot, feeling low in mood, hair loss and dry skin. 

Research also indicates a link between chronic stress and its impact on our hormones. For example, there is evidence to suggest that chronic stress can impact on the production of progesterone in females, which can increase difficulties including premenstrual syndrome. There is also evidence that chronic stress can lead to the loss of the menstrual cycle for some (why would your body feel safe to reproduce if it feels so under threat?).

When stressed, our immune function is also lowered. Therefore, if we are chronically stressed, we are much more likely to pick up viruses and infections, and be less able to fight them off as well as we should. You may have noticed that when you are run down, you often get ill soon after. 

So, with all that said, look out for part 2 where I will talk more about what you can do to help yourself! 

Dr Theresa Comer, Clinical Psychologist. 

You may have noticed that when you look back, situations involving uncertainty have been really hard to deal with. Research tells us that dealing with uncertainty is extremely difficult for humans, so if you can relate to this, you are human! 

When we think about how our brains work, this makes total sense. Our brain’s main priority is survival, and therefore it looks out for threats to make sure we are safe. When a situation is certain, even if it’s something we don’t like, we can at least predict what might happen, and plan how we might cope. 

But when there is an element of uncertainty, our brains struggle to anticipate what might happen, how we will cope or what the end result will be. And because we are prone to focusing on threat, it is very common that our brains will try to think of different scenarios, which may involve ‘worst case scenario’ thinking. Even if we can think of several different potential outcomes, it is very common for our brain to believe that the worst case will happen. 

Let’s use an example of health – if you experience an unusual symptom, you might look online for answers, only to discover lots of different potential causes, including some very serious ones. It is quite common for people to then begin to believe that the worst-case scenario (i.e. the serious medical condition) must be true. 

Because of our brain’s focus on threat and therefore often on worst case thinking, it is really important that we can find ways of noticing when this happens so that we can find ways to reduce it. 

Here are some top tips:

  1. Notice when you are worrying and ask yourself if there is an element of uncertainty about the situation you are worrying out.
  2. If there is uncertainty, then remind yourself that this is your brain doing what is automatically does. In other words, it is trying to keep you safe 
  3. Remind yourself (out loud if needed) that there are actually several different potential outcomes, and keep in mind that the worst case very very rarely happens. 
  4. It can help to think back to other situations in which you worried about the worst case, and it just didn’t happen. 
  5. Remind yourself thar you can cope with difficult things – think about the evidence that you are actually resilient, that you’ve handled difficult situations before. 
  6. Find ways that work for you to make you feel safer – this could be talking to someone you trust, doing something you enjoy, or doing something that you know you find relaxing. 

Dr Theresa Comer, Clinical Psychologist

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