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Depression can often feel like signing a contract to live with painful emotions, negative thought processes, isolation and a future filled with misery. This contract can often feel like there is no way out, no termination policy and that happiness may at best happen in only a few brief moments before falling back down into the pit of despair. People may try one or two methods to get out of depression: eating healthy, exercising more, seeing a therapist, taking medication, finding more meaning in life, resolutions to engage socially and build relationships. Sometimes, one of these can be enough for some people. However, for many, they only bring about a short reprieve or maybe just take the edge of the depression so not to suffer as much. But is that really what you want?

Did you notice something about the methods above? The methods have all been shown to help with depression, however, they can be grouped into three categories: social, psychological and biological. It seems where people stuck is a result of focusing on one or two of the categories. In reality, there is an interplay between these categories, and focusing on improving one category could (and often does) improve the others. However, despite this interplay, it seems to me that having a plan to explicitly make progress in all three areas increases the possibility of creating a shift in mood state that has more of a lasting and profound effect.

There are ongoing debates regarding the cause of depression, in my opinion it is different for each person. However, it seems that the causes can also be grouped into these three domains. For example: Biological (disposition due to genes, an unhealthy life style); Social (breakup in intimate relationships, punitive friendship groups or bullying, unsupportive families) and Psychological: meanings placed on events, conflicts between thoughts. Indeed, the interplay remains.

The Social domain could focus on gradually moving out of isolation; improving relationships with friends, family, significant others, colleagues; and sharing hobbies (which could call into the biological and psychological domains depending on the activity), departing from friendship groups who are unsupportive or ‘unhealthy’ and creating bonds with caring and supportive people, for example. The Biological domain could focus on exercise, eating healthily and sleeping well for example. The Psychological domain could focus on the emotions, thought processes, meanings in life now and the meanings and difficulties of past events, or not feeling happy until a ‘successful life’ is achieved for example. It could also include spirituality however you interpret the meaning of the word spiritual.

What would be beneficial in each domain is dependent on each individual. Also, some individuals may not be able to work on one domain unless sufficient work in another has been achieved. There are also examples where some domains can never be perfect due to individual circumstance (e.g. ill health or physical disability, imprisonment etc.). What I think is important to remember is to do the best you can with each area. With this in mind, I think it is also important to work at a slow and steady pace. Indeed, that may be all a person can do (and may seem too much for others). However, there may still be people who create plans to tackle and change in as many areas as possible as quickly as they can. Although this may sound appealing, I do warn against it because creating a new whole new schedule, with many goals can mean setting yourself up for failure which can then act as fuel for depression. What I’m not saying here is that goals are not achievable, because they are. I’m simply warning of the common trap of trying to change too much too soon. Change is tough, building new patterns in life is a challenge and takes time, but it is well worth the effort. Depression is a cycle which is tough to break, a state which is hard to ‘pull yourself out of’. However, we do have a choice. The choice is to engage in our negative thinking processes and painful emotions, or, learn how to recognise they are there, and choose not to entertain them and start making positive steps for recovery 😊
Continuing looking at psychological distress and well-being from different perspectives, I would like to introduce a short description of just one of the contributions from Phenomenological Psychology. Phenomenology is essentially the study of our experience, how things appear to us, how we perceive our reality. Just as my last post on Character Analytic theory, Phenomenology adds a great perspective to understanding what is going on within ourselves and provides us with another way of looking at psychological distress and well-being.

Firstly, I would like to break down human experiencing into 2 main categories: 1) pre-reflective experiencing and 2) reflective experiencing. Pre-reflective experiencing is our constant flow of experience, it is always changing. It is our initial encounter with the world around us: the taste of a drink, the smell in the air, the feeling of my fingers on my keyboard, our immediate response to the immediate situation. Reflective experiencing, on the other hand, is our thoughts about our pre-reflective experience, these thoughts are heavily influenced by our view of ourselves and the world around us. For example, I am someone who does not like any kind of sea food (I know, call me strange), and I believe that I will not like to eat anything that has a hint of sea food in it. It is possible however, that I may taste a dish which has a few prawns mixed in it, and I may enjoy it on a pre-reflective level. However, my reflective experience (influenced by my strong belief that I hate any type of sea food) can distort my experience and I believe that the food is not nice to eat. This is a very simple, somewhat crude explanation of how our beliefs can influence our experiences.

Now obviously, this is no big deal; who cares whether I like sea food or not? But what could happen when this type of denial or distortion happens in our lives with more important matters? And why can our beliefs influence our reflective experience enough to deny our primary, and constant flow of experience? Additionally, I think this is one of the reasons why mindfulness can be beneficial, because you are trying to experience raw experience without pre-judging or describing the experience, the aim is to feel it more with curiosity rather than to describe it with what you already know.

Using this way of thinking, psychological well-being can be described as a closeness between our pre-reflective and reflective experiencing (an exact match between the two is impossible according to phenomenology). Phenomenology holds that there is an objective reality out there but we can never know it fully, we perceive it with our unique, individual interpretations of the world, and therefore, the only true reality is our own unique reality. Psychological distress, can now be seen as a distance between pre-reflective and reflective experiencing, i.e. our unique, individual reality, is far away from the objective reality of the experience. Let me briefly put this into context with a more concrete, relevant and fictional (although not uncommon) example:

Steve (aged 4) grew up with his parents who were very strict, very unaccepting of people with differing views, and believed that everything in life has a specific order; everything else was wrong or unworthy of thought or praise. Steve, had difficulties meeting his parent’s expectations and was heavily criticised from a young age. It was not uncommon for Steve to hear the words “you should be better than that”, “why can’t you do things properly”, “you are not a good example to your younger sister”. Very quickly, Steve introjected these words into his self-concept and became part of his belief system. That is, Steve grew up believing he should be a better person, who could never do anything right and that he is a failure to his parents and younger sister.

Later in life, Steve acted according to his beliefs. That is, he didn’t try hard at school- why would he? He would only get it wrong. Everything he tried to do in life, he only put in half the effort- after all, he was someone who never done things properly. He also felt awkward socially, he did not feel worthy of his friends and it felt more comfortable for him to spend most of his time alone- after all, if he wasn’t good enough for his parents, and was a let-down for his younger sister, why would he be good enough to be around anyone else? Over time, the words of his parents shaped his beliefs about himself. Through repeatedly acting in accordance to those beliefs, Steve’s negative beliefs and negative self-concept became confirmed with each repeated act and became sedimented. As with all human beings, Steve sees and interprets the world, himself, what he does, and what others do, through the lenses of his belief system. There where times, however, when Steve had received praise from school teachers, he wanted the praise and on a pre-reflective level, this was welcoming. However, his secondary process was to deny this experience, rejecting the praise and believed that the teachers were trying to make him feel better- because after all, his introjected beliefs (secondary experience) had distorted the primary experience.

This is a process which happens to everyone, although, not every person has negative belief systems of this kind. However, one way to overcome this type of difficulty is to put aside the belief system, and focus on primary experience and then aim to create new meanings based on a more accurate view of realty. Not an easy task, especially when beliefs run deep. However it is possible and a skilled therapist can help you through this process.

I hope those of you that have tried the grounding breathing useful. I have had confirmation that it has been helping people so that is great news. I recommend checking out and practising “Grounding Techniques #1” first. The breathing really is the basis of practising grounding and, for maximum benefit, I recommend practising it briefly each time you use the techniques described here. As simple as these techniques are, they really do help in bringing you into and ‘grounding yourself in’ the present moment. This is really important in being ‘present’ in your life, as I have often been told: “to live in the past is to live in Sadness, regret and Depression, and to live in the future is to live in fear and Anxiety. Of course, we must think of the future for planning etc., and we have to think of the past to remember important things, learn from our experiences and so on. However, if we are constantly out of the present moment, we stop engaging in life and disconnect from ourselves and ultimately those around us too. Also, it all too easy to be go through the motions of our daily tasks, so much so that we can lose touch with our experiences and can even continue to go through the motions of life without engaging with it. Also, we may spend out time constantly thinking “I must get x done otherwise Y won’t ever happen. However, when Y comes we can forget how to enjoy it as we are no longer used to being present moment. Now, what is grounding via using your sense? Well, it is simply focusing on one aspect of your experience at a time, engaging with it and bring your focus into the ‘here and now’. Later, you can engage your senses more simultaneously, embracing the totality of experience. So, let’s get to it.

Using your senses: Touch, Sound, Taste, smell & sight.

Before using your senses to ground yourself, try some breathing. Also, if you are standing feel the ground beneath your feet, feel it supporting you and try literally to connect with the ground. Is the ground hard or soft? If you are sitting you can do also do the same by sitting up right (relaxed but not slouched) and feel your feet on the ground, and feel the chair supporting your back, and top of your legs and buttocks, maybe even your arms on arm rests. Again, is the ground and chair hard or soft? There is no need to do anything, just practice breathing and feel the connections and your body being supported for 30 seconds to a few mins or whatever suits you best. You may not be in a position to do this and that is fine, this is just an aid however you can still ground yourself using sense without doing the above.

Note: These are only common suggestions. Once you have the idea, feel free to create your own based on your situations and what works for you. Take your time doing these, it is not overly useful to just do one of these for a couple of seconds and carry on. Try to take a couple of minutes at least. Try to focus and really experience them as they are.

Touch- if you do the above, you are already doing this. Other things you can do are to focus on:
  • How your clothes feel on your body.
  • If you are holding a bottle of water you can focus on how it feels to hold it. Can you feel the ridges? What do they feel like? Does it feel colder where there is water?
  • Squeeze a small/ squidgy ball.
  • Place your hands under running water and turning them over and rubbing them together.

Smell- there are thousands of receptors in the nose that lead to the amygdala (the brain’s fear response and emotion centre), calming smells can do wonders in self-regulation and relaxation.
  • Carry essential oils with you, maybe choose a smell which relaxes you. You could even wrap a lavender tea bag in handkerchief as a substitute.
  • Take time to notice smells from nearby flowers, coffee shops, food places, a loved one’s hair during a hug.
  • Go outside, take in all smells from shops, train stations, fields of grass, can you smell the scent of freshly washed clothes?
  • When you buy something new, does it have that ‘new smell’?

Sight- Anyone can see Watson, but do you observe? - Sherlock Holmes
Ok, that quote might be wrong, but in one of the books he says something similar….. You get the idea 😊
  • Take a look around you, focus one by one on all the things you can see that are blue. Then, focus on the things you see that are red.
  • Choose an object, and focus on it. What is its shape? What are the colours? Can you experience its textures, ridges and patches of shade? Is the shade graded?
  • Do you have any favourite photos on your phone or hard copies you can carry with you?
  • Take the time to admire any scenery you come across; don’t just see it, observe it.

Sound- is there any sound in silence?
  • Focus on any sound you can hear. Is it loud? Is it far away? Does it have a rhythm or pattern?
  • Focus on nature, can you hear birds? Rustling in trees? Can you hear one animal or several? Are they in harmony?
  • Listen to music. Music can have a huge impact in your mood. Try to hear what instruments are playing and how they complement each other. When using music to ground yourself, try not to listen to a song that makes you feel sad or triggers memories that may bring you down and into the past. Find something that makes you feel calm and relaxed, make a playlist.

Taste- Ever tried the Raisin exercise from Kabat-Zinn?
  • When you eat, eat slowly. Can you taste all the flavours? The textures? Does it feel warm or cold? Dry or moist? Hard or soft?
  • Feel the food in your mouth before you chew.
  • Chew gum or suck on a mint or hard boiled sweet.
  • Carry a drink around with you (preferable one without a lot of sugar or caffeine). Drink it little and often, focus on the flavour and how it feels to pour it in your mouth and swallow.

As mentioned, these are very simple and if you wish you can create your own. The importance here is to really engage and experience with the object of your grounding. Whether it be sight, sound, smell, touch or taste, experience it fully, focusing on one object at a time. Take time out to do these at appropriate points throughout your day. Especially make use of ‘dead time’ in between tasks where you may have a minute or two spare which you cannot do much else with. Snatch an opportunity whenever you can 😊

This is the first step in using grounding techniques in order to ‘ground’ yourself in the present moment. Grounding can help people manage anxiety as it can enable you to bring your thoughts into the present moment as opposed to entertaining your thoughts and fears of the future; it can also help you to bring your thoughts back from the past. Grounding can also help you feel more calm when you are tense, feeling stressed and/or find yourself overthinking. The first exercise in grounding is breathing. Breathing may seem so small and simple, however, the rewards for doing it properly can be great. One thing to remember when you are trying to be calm, is to not trying to force it, but to just let it happen. Recently, I heard someone compare it to ripples in water. You cannot do anything to water to make it calm, you cannot force the ripples to stop, you just have to leave them to settle on their own and it is the same with thoughts. The aim is to recognise them, let them be, and let them drift away by focusing on your breath in the present moment. It takes a while so don’t give up 😊


Why is breathing so important in grounding? The answer is that our focusing on our breath is probably the best way to ‘anchor’ ourselves back to the present moment. Also, breathing is directly related to our nervous system. When the amygdala (the brain’s emotional response centre) senses threat, our breathing can change: fast breathing= hyper-arousal, slow breathing = hypo-arousal. The amygdala sends messages to the rest of our nervous system which warns the whole body, that something is not as it should be. You may become tense, become more alert, hands may shake, legs may start to tingle whilst preparing to run. What breathing correctly can do is send signals back to the nervous system, telling us that all is o.k., you do not need to prepare for fight, flight or freeze; you can calm back down to a state of equilibrium.
Also, focusing on a long exhale, allows for more oxygen to work its way around your body. This is not just because there is more space in the lungs to breath in, but more importantly, it is because the release of carbon-monoxide in the exhale allows for a release of oxygen in the red-blood cells already present within you. The red-blood cells contain plenty of oxygen to oxygenate the whole body and it is the release of carbon-monoxide which allows this.
So, here’s what to do:
  • Keep posture relaxed but not slouched. Upright, but not stiff or rigid. Try not to be laying down as you want your posture to support your intention to be awake but make sure it also supports your intention to be relaxed.
  • Inhale for a steady for a count of 5 seconds. Make sure you can feel your diaphragm expanding by breathing right into your belly. Breath in through your nose if possible.
  • Hold your breath. For a count of 3-4 seconds. This prevents any fast or slow breathing associated with hyper and hypo-arousal. This should help calm down the nervous-system.
  • Exhale for a steady count of 7 seconds (remember the reason for longer exhale). Make sure you empty your lungs, feel your diaphragm collapse inwards as you breath out.
  • If you find this makes you a little light-headed, don’t worry, it’s normal if you are not used to it. You can try an inhale of 3 seconds and an exhale of 5 then increase when you get used to it. Just remember the longer exhale.
  • Repeat x 10.

I recommend doing this twice a day- once in the morning and once in the evening – and then whenever you feel necessary throughout the day. It is important to do this regularly as it is the repetition that will allow you to get to a calmer place more easily when you need it most. There is more to grounding than this breathing exercise. In later posts, we will explore other methods of grounding by using all 5 sense.
There are many different frameworks for understanding psychological distress and well-being. It is accepted by many that there is no “right way” of understanding or working with mental health issues. Rather, many find it more appropriate and more helpful to clients to recognise that each approach has their strong points and weak points. Furthermore, each individual is unique and suffers in their own way and responds to different approaches in their own manner. Therefore, it is best to look at each approach, and ask, “what can I take from this?”, “how beneficial is this theory to the situation at hand?”. In this blog post, I would like to introduce you to the very basics of a 5-stage process put forward by Stephen Johnson, a character-analytic theory which I think is a great framework for understanding the creation of an individual’s psychological distress.

Stage 1- Self Affirmation

Self-Affirmation is very simply the expression of an individual’s needs. There are many different instinctual and relational needs which each of us have. A simple example, one need is for a child to feel loved by their parents or care givers. If a child’s needs are met, they then have the opportunity to internalise the affirmation of the environment and build a healthy self-structure and relate the world in a more positive way.

Stage 2- The Negative Environmental Response

There will be many times when the child’s environment does not meet their needs appropriately. In some cases, unfortunately, they may not be met at all. This is stage 2. Continuing with the above example, the child needs to feel accepted, wanted and thought of as a worthy person. The parent doesn’t just need to show their positive thoughts of the child just by using words. But also body language, attitude, and behaviours toward the child. It is not just verbal but a displaying of love using the whole body, mind and personality of the parent. A parent may love their child, and say it often, but if it isn’t shown using the whole of the parent’s being, then the child may not be able to feel it- this can often be unnoticed by the parents and they may believe they are doing the right things. The child may hear the positive words, but may hear the contradictory attitude, body language and actions a lot louder. Thus, the need will not be met.

Stage 3- The Organismic Reaction

This is the child’s initial reaction to their needs not being met, the affect. This could be anxiety, anger, feeling bereft. It is the child’s natural, and individual response. There is no “set way” that people respond, each of us react differently. However, it is felt very intensely which is difficult to handle, especially for children who have not yet learnt how to manage their experiences. Additionally, the child may not even have sufficient knowledge or skills in language to be able symbolise their experiences in order to make sense of it. Due to this lack the understanding, an individual may grow up not knowing the cause of their troubles and be confused or, even worse, self-blaming telling themselves “I have no reason to be like this”. Which is a scary and difficult position to be in.

Before proceeding to stage 4, it was worth noting that the first 3 stages are common experiences to all of us. Parents naturally ‘fail’ at times- it is impossible to meet all of a child’s needs all of the time, it just cannot happen and the child will find it tough at times. That’s life. Many believe, myself included, that parents must fail us at times, because if not, we will not be prepared to cope with what life throws at us in later life. Stages 4 and 5 however, occur when a child’s needs are unmet repeatedly or even less frequently but more severely- a ‘one off’ act of abuse for example. The repetition, or severity of unmet needs is essentially what pushes someone into stages 4 and 5 and create psychological distress.

Stage 4- Self Negation

This is the child imitating the environments blocking of the need. S/he responds by denying the initial need, believing that there is no need to be met. Not only does the individual block the need, but also blocks out their original, organismic response. Now, it is not only the environment denying the child of their basic needs, but blocking is now internalised and the child can continue to identify with the environment in a complex act of turning against themselves. Despite the individual blocking their own needs, they are irrepressible, in some way the individual will be crying out for their needs to be met on an unconscious level. This inner-conflict can last throughout the person’s life.

Stage 5- The Adjustment Process

This stage involves the individual doing the best they can, making the best of the situation and creating their own way of compromising. In other words, the individual may act in in accordance to stage 4. A very simple example, the child may unconsciously believe that: “no-one loves me, I do not need to be loved, in-fact I am unlovable” and the child can then act in ways that support this belief: rejecting affection, behaving badly to push people away and to confirm that they are a bad person. Not fully engaging socially, being unable to connect with people, act in self-destructive ways to ruin opportunities as they do not deserve them, the list could go on. Again, different people will react in different ways, partly influenced by which need was unmet, the manner in which it was unmet, and individual differences in personality structures, beliefs and way of responding. The examples given are not the only types of compromising, some people may over-compromise: “I do not need prizing of another because I keep on achieving and meeting my own standards”- which may be high, unrealistic and the goal posts can keep shifting because “I need to keep proving this to myself”. Reaching the goal posts may create satisfaction, but it can only be temporary, and the anxiety returns when the goal posts are moved further.

Concluding Comments

I find that this framework is great way to understand how distress can occur and hope I have stressed enough that each individuals experiences and way of coping will be unique. However, whatever the need that was blocked, whichever way the individual may respond, the individual’s aim in stage 4 is to avoid the pain of stages 2-3 via a complex denial of stage 1. Stage 5 however, is how the individual over-exaggerates as a result of this process, in order to get through the internal conflict and can lead to a plethora of unhealthy behaviours and the creation of a false-self. This false-self can be difficult to change due to the extreme internalisation of the whole process. However, if the individual is successful in their life tasks, healing the original wound and making changes can become a lot harder.