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As a clinical psychologist, I often see the excitement and motivation that come with the New Year. It’s a time when many of us set resolutions to improve our physical health—whether that’s starting a new exercise routine, dry January, losing weight, or eating healthier. While these goals are important and can significantly impact our overall wellbeing, there’s a common tendency to overlook an equally important aspect of health: our mental wellbeing. The Overlooked Element: Mental Health We often underestimate how much our mental health influences every part of our lives. Poor mental health can manifest in various ways—stress, anxiety, depression, or burnout—that can undermine our physical health efforts and diminish our quality of life. Conversely, a strong mental state can empower us to stick to healthy routines, make better decisions, and build resilience against setbacks. The Power of the Mind-Body Connection One of the most interesting aspects of our health is the link between our minds and bodies. This mind-body connection is a two-way street: our mental state influences our physical health, and our physical health, in turn, affects our mental wellbeing. How does this work? Stress and Physical Health:   Stress triggers the release of hormones like cortisol, which, over time, can lead to increased blood pressure, weakened immune function, and changes in brain structure affecting memory and emotional regulation. Physical Activity and Mental Health:  Exercise stimulates the release of endorphins and serotonin—neurochemicals that boost mood and reduce feelings of anxiety and depression. Regular exercise acts as a natural antidepressant. Sleep and Emotional Regulation : Sleep quality directly influences our ability to manage emotions. Poor sleep can heighten feelings of irritability, anxiety, and sadness, creating a vicious cycle. Mindfulness and Physiological Responses:  Practices like meditation activate the parasympathetic nervous system, promoting relaxation and recovery by reducing heart rate, blood pressure, and stress hormones. The feedback loop When your mental health is compromised, due to persistent anxiety—you might experience physical symptoms such as headaches or fatigue, which can increase stress, creating a vicious cycle. Conversely, engaging in physical activity or mindfulness can help break this cycle, illustrating how intertwined the mind and body  are. Why It’s Essential to Look at Both Approaching health holistically means recognising that mental and physical health are interconnected. Improving physical fitness without addressing mental wellbeing can lead to frustration or burnout, making maintaining this long-term difficult. Conversely, fostering mental health can enhance motivation, resilience, and recovery capacity. Tools to Enhance Your Mental Wellbeing Here are some evidence-based strategies to support mental health in 2026: ·      Practice Mindfulness and Meditation:  Regular mindfulness can reduce stress, increase self-awareness, and promote emotional regulation. Even a few minutes daily can be beneficial. ·      Establish a Support Network:  Strong relationships provide emotional support, reduce feelings of isolation, and increase resilience. Seek help when needed. ·      Set Realistic Goals:  Breaking larger goals into smaller, achievable steps helps maintain motivation and confidence. ·      Prioritise Sleep : Adequate sleep is essential for mental clarity and emotional regulation. Develop a consistent sleep routine. ·      Engage in Regular Physical Activity : Exercise not only improves physical health but also releases mood-enhancing chemicals. ·      Limit Negative Inputs : Reducing exposure to stressors like excessive news or social media can prevent emotional overload. ·      Seek Professional Support When Needed:  Therapy provides tools for managing stress, anxiety, or depression, especially during challenging times. Final Thoughts As you start this New Year, remember that true health is a balance of both physical and mental wellbeing. The mind and body are deeply interconnected—what impacts one influences the other. Supporting your mental health alongside your physical goals creates a sustainable, fulfilling path to overall wellness. A healthier mind supports a healthier body—and vice versa. Let’s make this year about nurturing both aspects of ourselves for a happier, more resilient life.

As a clinical psychologist, I've spent over a decade witnessing the power of talk therapy. For many of my clients navigating life transitions, relationship challenges, or general stress, having a safe space to verbalise their thoughts and feelings is incredibly helpful. We work together to build insight, challenge negative patterns, and develop coping skills. And often, they leave therapy achieving their goals and able to enjoy life without the symptoms that were holding them back.   But sometimes, despite all the talking, coping strategies and insight, a persistent core of anxiety remains stubbornly resistant to change.   Have you ever felt this way? You understand  why  you feel anxious. You can logically explain the origins of your fears. You can even identify that your thoughts are irrational, yet, when a specific trigger hits, your heart still races, your chest tightens, and logic flies out the window.   Clients who are experiencing this, usually attend sessions frustrated with themselves and thinking they are doing something wrong.  However, this is not the case. They have mastered the rational part of why they are anxious, but are missing the piece of the jigsaw that allows their nervous system to release the physiological aspect of the anxiety…. And this is something that talking alone can be difficult to achieve.   This is where EMDR can be helpful. So how does it work differently?   The Left Brain vs. The Embodied Right Brain   The reason lies partly in how our brain processes information—and especially emotion and trauma.   Talk therapy primarily engages the  left hemisphere  of our brain. This is the seat of language, logic, analysis, and thought. It’s great at making sense of the world. When you tell me about the anxiety you have experienced during the week, we are using that left brain to organise your experiences into a coherent narrative.   However, deeply stored emotions, instinctual survival responses, and traumatic memories live predominantly in the  right hemisphere  and deeper, older brain structures (like the limbic system). The right brain is more holistic, visual, and non-verbal.   When a traumatic or overwhelming event occurs—whether it’s a major incident or a series of smaller, stressful experiences, that are usually associated with anxiety symptoms—the brain's usual processing system can get overloaded. The memory isn't stored as a neat narrative on a shelf; instead, it becomes  fragmented . It gets "stuck" in the right brain, still carrying the raw, unprocessed emotional charge of that moment in time.   These fragmented emotional pieces don't speak the language of words. They speak the language of sensation:   A racing heartbeat. A sudden jolt of fear when entering a crowded room. A pervasive sense of unease or panic that seems to come out of nowhere. This is why clients can sometimes feel stuck. They are trying to use the left-brain language centre to fix a right-brain emotional storage problem.   The EMDR Difference: Unsticking Fragmented Emotions   This is where  Eye Movement Desensitisation and Reprocessing (EMDR)  offers a powerful addition to therapy.   EMDR is an evidence-based approach that helps the brain reprocess these "stuck" memories and fragmented emotions. It doesn't rely solely on talking. Instead, it uses a process called bilateral stimulation—typically guided eye movements but sometimes tapping or tones—to activate both sides of the brain alternately. Think of it like jump-starting your brain’s natural healing system.   When we focus on a distressing memory or feeling while engaging in bilateral stimulation, it seems to mimic the brain activity we experience during REM sleep (when we naturally process the day's events). This process facilitates communication between the logical left brain and the emotional right brain. The "stuck" memory is no longer frozen in time with its intense emotional charge. It begins to integrate. The fragmented pieces finally connect to the larger narrative network. The insight you gained in talk therapy can finally "land" in your nervous system.   SO how does this look in practice?   I worked with a client recently—let’s call her Fiona—who struggled with public speaking anxiety. Fiona is a highly intelligent professional who understood exactly  why  she was anxious: she had a history of being harshly criticised by a boss during presentations early in her career. In our cognitive behavioural therapy (CBT) sessions, we successfully challenged her beliefs about her competence. She knew, logically, that she was capable.   Yet, the moment she stood in front of a group, her body took over. Her voice would shake, her palms would sweat, and her heart would race. Her left brain knew she was safe; her right brain was convinced she was back in that original, threatening situation.   We introduced EMDR. We didn't need extensive new conversations about the past. Instead, we targeted those specific, "stuck" memories of her boss's criticism using bilateral stimulation.   We observed a significant shift. The intensity of the physical reaction began to drop rapidly during sessions. By the end of her treatment, the memory of the critical boss was still there, but it no longer held any emotional charge. Fiona's body stopped reacting with panic. She recently led a major presentation feeling grounded and focused, not anxious. The insight had finally integrated into her nervous system.     Reprocessing the Past for Present Calm   The goal of using EMDR isn't to erase memories. It's to neutralise the emotional pain associated with them.   In my practice, clients are often surprised by the shift at the end of a session. They might say, "I can still remember what happened, but it doesn't bother me anymore as it feels more distant." The anxiety symptoms—the physical panic, the avoidance behaviours, the intrusive fears—start to fade because the underlying emotional fuel has been removed.   If any of this resonates to how you are feeling; that you understand the why of your symptoms, but still feel trapped by persistent anxiety, it might be time to consider EMDR that can work directly with the nervous system. Healing is possible, and sometimes, it requires our emotional brain to catch up with what we are thinking!

Ever wondered why seemingly small things can trigger us? Ever looked back on a situation and thought “I over reacted to that,” but not sure why? Ever experienced big emotions to a seemingly small event such as the kids leaving the towel on the floor or not being listened to by your partner? You are so not alone, this can be really common….. but why does this happen? Our early life experiences, both big and small, can shape who we are and how we see ourselves. By the age of seven we have already developed an internal narrative about ourselves, how others may think about us and the world we live in.  This narrative is then used as a lens that we see our experiences through, to try to protect us from any potential threat. Small-t trauma is not something that a lot of us are aware of as it is not as well-known as PTSD or what we call big-T trauma that we hear of in the media.  However, small-t trauma can still have a big impact on how we develop a sense of self and can impact on our emotional and psychological well-being. Examples of small-t traumas that may have been experienced in our early life include: Being teased or bullied Witnessing conflict between parents or caregivers Feeling left out or excluded Being blamed for something that wasn't our fault Being shamed or ridiculed Having our accomplishments downplayed Being constantly criticised, rejected or compared to others Experiencing insensitive remarks Feeling unsafe or unsupported Over time, repeated exposure to small-t traumas can lead to the development of negative beliefs about ourselves, with a common narrative being a sense of "not good enough". This can be triggered by a variety of factors including, negative feedback, comparing ourselves to others or setting unrealistic standards on ourselves, which we cannot sustain. Once a "not good enough" narrative develops, it can be difficult to break free from. We may start seeing ourselves as unworthy of love, success, and happiness. This can lead to a number of negative consequences, such as: Fear of success:  We may be afraid to take risks or pursue our goals because we believe that we will ultimately fail. Relationship problems : Our "not good enough" narrative can damage our relationships. We may be overly critical of our partners or withdraw from them emotionally because we don't believe that we deserve to be loved. Parenting problems:  If our childhood was difficult, it can affect how we parent our own children.  We may worry that we're not a good enough parent and be self-critical or compare ourselves to parents who seem to always get it right. Self-sabotaging behaviours:  We may engage in self-sabotaging behaviours, such as procrastination, perfectionism, and people-pleasing, in an attempt to avoid failure and rejection. So, what can we do to change this? The good news is that it is possible to heal from small-t traumas and change our "not good enough" narrative. Here are a few tips: Acknowledge and validate our experiences.  It is important to acknowledge and validate our experiences, even if they seem minor. This means allowing ourselves to feel the emotions that come up, and accepting that what happened to us was real and hurtful. For example, if we think about the towel being left on the floor, it is unlikely to be about the towel, but could be that we are feeling unheard, disrespected or not important, as we have asked 100 times already! Identify our negative self-talk . Pay attention to the thoughts that go through our head when we make a mistake or experience failure.  When we notice the “not good enough “ narrative piping up, challenge these thoughts by reminding ourselves that everyone makes mistakes, and that we are good enough, even when we fall short. Be kind and understanding towards ourselves.  When we make a mistake, instead of beating ourselves up, try to be understanding and forgiving. Remind ourselves that everyone makes mistakes, and that we are doing the best we can. Focus on our strengths . Make a list of our strengths and accomplishments and read it over whenever we are feeling down. This will help us to remember that we are good enough, even if we do mess up sometimes. The key things to remember is that many of us have experienced small-t trauma and that recognising this is a great first step in changing things for the better.  Being able to drop the “not good enough” narrative can be a game changer and is totally possible…. And you might just not shout quite so loud next time the towels are left on the floor too!!

As parents, we all want our children to be happy, confident, and resilient. But young people today face more pressures than ever—social media, exams, peer comparisons, and worries about their future. It’s normal to feel concerned when your child seems different or struggles with their feelings. In November 2023, the Mental Health of Children and Young People report published by NHS England, found that 20.3% of 8-16 year olds had a probable mental health difficulty. This shows that it is not uncommon for young people to have times where they struggle and as a parent, you are not alone.   The good news is summer holidays are nearly here, and they can be an ideal time to step in and help your child improve their mental wellbeing. Here’s why now is a great time to consider professional support—and some practical ways to support them along the way.   Recognising the Pressures on Young People   Children today are dealing with a lot. The constant presence of social media, academic expectations, and peer pressure can lead to stress, anxiety, or feelings of inadequacy. Sometimes, they hide these feelings, but signs like withdrawal, mood swings, sleep issues, or irritability can signal they’re struggling.   If your child's mood or behaviour has changed significantly and persists for more than a few weeks, it’s worth paying attention. These could be signs that they need a little extra help to manage their mental health.   Is It Just a Phase Or Something More?   Many parents will contact me unsure whether their child needs support.  It’s understandable that parents get concerned, as it is hard to see your child struggling and we have an urge to “fix it” or make it “go away.”  It is important to recognise that a lot of us, at some point in our lives, will have times where our mental health is a bit of a struggle and young people are no different. Many young people will go through a tough patch—feeling sad or anxious temporarily, but for some these feelings may be ongoing or interfere with everyday life.  This is when professional support can make a real difference.   Questions to Ask yourself:   •    Are these feelings lasting longer than usual? •    Are they affecting your child's schoolwork or social life? •    Do they seem overwhelmed or hopeless?   If the answer is yes, reaching out to a mental health professional can help clarify what’s going on and give your child the tools they need to cope.   Why Summer Holidays Are Ideal for Support The break from school offers a less stressful environment for therapy. Without the pressures of exams and homework, your child might be more receptive to exploring their feelings and engaging in therapy.  It also means they don’t have to leave lessons and answer questions about “where they are going?”  Scheduling appointments can be easier, and they have more time to process and practice new strategies in a relaxed setting.   How Therapy Can Help Your Child   Therapy provides a safe space where your child can openly share their feelings and learn practical skills to manage them. It can also be easier for some young people to open up about things they find difficult to someone that isn't connected to their family or friends. A therapist can help your child:   •    Understand and label their emotions, reducing confusion and shame. •    Develop coping strategies for anxiety, sadness, or anger. •    Build self-esteem and resilience against peer pressure. •    Improve communication skills and express themselves confidently. •    Address specific issues like bullying, social anxiety, or self-harm.   Research shows that therapy can lead to improvements in mental health, which often last well beyond childhood. Children who learn healthy ways to handle their feelings tend to do better academically, socially, and emotionally as they grow up. They’re more likely to develop positive relationships, handle stress effectively, and approach challenges with confidence.   The Long-Term Benefits   Investing in your child’s mental health can have lasting effects. Children who receive early support often:   •    Experience better mental health throughout adolescence and adulthood. •    Develop strong coping skills that help them navigate future challenges. •    Have higher self-esteem and better relationships. •    Are more resilient when facing stress, setbacks, or new situations.     Supporting Your Child Alongside Therapy   While therapy is a powerful tool, here are some simple ways you can support your child every day:   •    Create a safe space for honest conversations. •    Maintain consistent routines for stability as much as you can. •    Encourage calming activities like walks, mindfulness, or creative outlets. •    Model healthy coping behaviours yourself. •    Use books or online resources to help them understand their feelings. •    Reach out to other parents or support networks—you’re not alone in this.   Trust Your Instincts   Supporting young people when they are struggling can be challenging but trust your gut. If you notice persistent changes or feel your child isn’t coping well, please do reach out. Taking these steps can lift the weight of worry from your mind. Knowing you’re doing what’s best for your child can bring peace of mind and confidence in how to support them. It can help you feel more prepared and less unsure about how to guide them through their challenges.    If you would like to understand more about therapy and if it could be helpful for your child, you can book a free telephone consultation and have a chat with me.  On this call you can explain what your concerns are, what you feel would be helpful and together we can come up with a plan to support your child in feeling more like themselves again and more able to enjoy the summer. Please email me at dr.sarah@berger.me.uk  or call 07498 519586.

In today’s busy world, managing stress, anxiety, and emotional challenges can feel overwhelming. Among the many therapeutic approaches available, Cognitive Behavioural Therapy (CBT) has gained recognition as an effective, evidence-based method for improving mental health. But what exactly is CBT, how does it work, and what benefits can it offer? Let’s explore his together. What is CBT? Cognitive Behavioural Therapy, commonly known as CBT, is a type of psychotherapy that focuses on identifying and changing negative thought patterns and behaviours. Developed in the 1960s by psychologist Aaron Beck, CBT is grounded in the idea that our thoughts, feelings, and actions are interconnected. By altering unhelpful thoughts and behaviours, individuals can improve their emotional wellbeing and develop healthier coping strategies. The Process of CBT CBT is a structured, goal-oriented therapy that involves implementing strategies we learn together, in between sessions, to enable positive change. Here’s what the process usually looks like: Assessment and Goal Setting: The therapist works with you to understand your concerns, gather background information, and set clear, achievable goals that are important to you. 2.   Identifying Negative Thought Patterns: Through discussions and exercises, you learn to recognise unhelpful thoughts that contribute to your emotional distress. 3.   Challenging and Reframing Thoughts: You are taught to question the validity of your negative beliefs and replace them with more balanced, realistic thoughts. 4.   Behavioural Techniques: The therapy includes practical exercises such as exposure, activity scheduling, or relaxation techniques to modify maladaptive behaviours. 5.   Skill Development: You develop coping skills and strategies to handle future challenges independently. 6.   Review and Maintenance: Sessions often involve reviewing progress and planning how to maintain improvements over time. The duration of CBT varies, but it is typically one of the shorter-term, therapies, usually lasting between 6 to 20 sessions. What Does CBT Help With? CBT is versatile and has been shown to be effective for a wide range of mental health issues, including: Anxiety Disorders: Generalised anxiety, panic attacks, phobias, social anxiety. Depression: Reducing feelings of hopelessness and improving mood. Stress Management: Developing resilience and coping skills. Obsessive-Compulsive Disorder (OCD): Managing compulsive behaviours and intrusive thoughts. Post-Traumatic Stress Disorder (PTSD): Processing traumatic experiences. Sleep Problems: Addressing insomnia and improving sleep hygiene. Substance Abuse: Changing thought patterns related to addiction. Positive Outcomes of CBT Engaging in CBT can lead to numerous positive effects, including: Reduced Symptoms: Significant decrease in anxiety, depression, and other mental health symptoms. Enhanced Self-Awareness: Greater understanding of thought patterns and their impact. Improved Problem-Solving Skills: Better ability to handle future challenges. Increased Resilience: Developing coping strategies that foster mental strength. Greater Emotional Regulation: Managing emotions more effectively and reducing mood swings. Long-Term Benefits: Skills learned in CBT often have lasting effects, empowering individuals to maintain their mental health improvements. Final Thoughts Cognitive Behavioural Therapy offers a practical, collaborative approach to overcoming emotional difficulties and fostering mental resilience. Its focus on changing thought patterns and behaviours to equip you with tools that can be used beyond therapy sessions, leading to sustained improvements in wellbeing. If you’re facing mental health challenges, consider reaching out to me at I have a team of great mental health professionals that are trained in this approach, who can support both young people and adults.  Let’s turn down that inner critic that is making life feel a struggle and start feeling happier again.  Please read my testimonials at https://www.berger.me.uk/testimonials .  Life can feel easier and happier…..so let’s do this!!!!

Feeling Stuck in the Past? Let's Talk About EMDR.   As a clinical psychologist, I see every day how past experiences can have on our present lives. Sometimes, even after decades have passed, certain memories or events continue to feel painful, and intrusive. They can leave us feeling anxious, overwhelmed, and like we're constantly battling an invisible force of threat. A lot of the time making us feel powerless or out of control.   If you're reading this, perhaps you resonate with that feeling. Maybe you've experienced trauma, or perhaps other challenging life events have left you feeling emotionally overwhelmed. You might be struggling with anxiety, depression, difficulty sleeping, or feeling on edge. You might be wondering if there's a way you can move forward and enjoy life again.   One of the main approaches I use within my therapy with clients to support them reach their goals is EMDR (Eye Movement Desensitisation and Reprocessing) . EMDR is a therapeutic approach I've seen bring relief from symptoms and reduce overwhelm with my clients and also as a client myself, who has had her own EMDR therapy.  I would like to share a little bit about what it is and how it could potentially help you.   So, What Exactly is EMDR?   Think of your brain as having a natural system for processing and integrating new information and experiences (the technical term for this is adoptive information processing). Most of the time, this system works beautifully, allowing us to learn, grow, and move through life. However, when we experience something particularly overwhelming or traumatic, this processing system can get "stuck."   The memory of that difficult event doesn't get filed away properly with a beginning, middle and end, as it becomes a fragmented memory. Instead, it remains in a kind of "frozen" state, complete with the original intense emotions, negative thoughts, and physical sensations you experienced at the time. This is why you might have flashbacks, feel the same fear or sadness all over again, or experience physical tension when something reminds you of the past. Your brain is doing what it thinks is helpful and looking out for anything in your environment that feels similar that might be a related threat but has just got the volume turned up too much.  Like a car alarm that gets set off by a fly!   EMDR is designed to help your brain unstick  those unprocessed memories. It's not about forgetting what happened, but about helping your brain process it in a way that makes it less distressing and allows you to feel more present and in control in your daily life.   How Does EMDR Work in Therapy Sessions?   If you decide to attend EMDR therapy you will go through a carefully structured process. It's not just about talking about the trauma; it's about engaging your brain's natural healing abilities.   The core of EMDR involves bilateral stimulation . This is typically done by guiding your eyes back and forth while you focus on the distressing memory. I might also use other forms of bilateral stimulation, such as using buzzers in both hands, or using alternating sounds through headphones.   While you focus on the memory and the associated thoughts, feelings, and sensations, the bilateral stimulation helps activate both sides of your brain. It's thought to mimic the natural processing that happens during REM sleep, allowing your brain to reprocess the memory in a way that reduces its emotional intensity.   During the process, you might notice different thoughts, feelings, or images coming up. This is part of the reprocessing. It's like watching a movie of the event, but with the volume turned down and the emotional intensity significantly reduced. At all times we keep one foot in the present ,whilst observing memories from the past, so you remain grounded and safe throughout the entire process.   What Can You Expect from EMDR with Me?   While every person is unique, many of my clients experience significant positive changes through EMDR therapy. Here are some of the benefits you might notice:   •    Reduced Intensity of Distress:  The overwhelm feelings associated with the traumatic memory begins to fade. The memory becomes less emotionally charged and less likely to trigger intense reactions. I hear frequently at the end of a session that the memory “feels more distant.” •    Shifting Negative Beliefs:  Traumatic experiences often lead to negative self-beliefs ("I'm not good enough," "I'm in danger," "It was my fault"). EMDR helps to dismantle these beliefs and replace them with more accurate and empowering ones. •    Increased Emotional Regulation:  You'll likely find it easier to manage and regulate your emotions, feel less overwhelmed by triggers and more in control of your responses. •    Improved Relationships:  As you heal from past wounds, you may find it easier to connect with others and build healthier relationships. •    Greater Sense of Peace and Freedom:  The constant burden of unresolved trauma can feel incredibly heavy. EMDR can help you release that weight, allowing you to feel more able to live in the present. •    Reduced Physical Symptoms:  Many people hold tension and stress related to trauma in their bodies. As the trauma is processed, these physical symptoms often decrease. •    Increased Self-Confidence:  As you process difficult experiences and develop a more positive view of yourself, your self-confidence can flourish.   Is EMDR Right for You?   If you're struggling with the lingering effects of past difficult experiences, and you're looking for a way to find lasting relief and move forward, EMDR is definitely something we can explore together. It's an effective approach that has helped so many of my clients reclaim their lives from the grip of trauma, anxiety or low mood.   If you would like to read some of my reviews from clients that have found this approach helpful, please click on this link https://www.berger.me.uk/testimonials If you would like to have a free chat to discuss how this may be an approach that could help you, please contact me at dr.sarah@berger.me.uk     Life can feel easier and get better!

As a clinical psychologist who has experienced anxiety and attended therapy myself, I found understanding the Window of Tolerance helpful in my recovery, and so thought I would share this with you today. So, What Is the Window of Tolerance? This idea, introduced by Dr. Dan Siegel, focuses on the optimal emotional state where we can function effectively, feel connected, and engage with life. Imagine your emotional range as a window. Different factors may reduce the width of this window, such as experiencing trauma, biological factors or if we are neurodiverse .  This can mean that it is more challenging for us to remain in the yellow and so we have to work harder to be able to emotionally regulate.  When you’re inside this window of tolerance you can manage stress and emotions well. However, when stress or anxiety pushes you out of it, you may find yourself in one of the following states: •            Hyper-arousal (Fight or Flight):  Here, you might feel overwhelmed, anxious, or irritable, ready to "fight" a threat or "flee" from it. This is when you are in the red on the diagram.  I speak with clients about the evolutionary perspective of this state being you are trying to run away from a lion to stay alive. •             Hypo-arousal (Freeze or Flop):  In this state, you might feel numb, withdrawn, or depressed—essentially "freezing" or "flopping" instead of engaging with your emotions or surroundings. This is when you are in the blue part of the diagram.  From our example above, this occurs when you have tried to outrun the lion, but recognise this strategy is not working.  Your system them turns to trying to act dead with the hope the lion will run past you.  Both of these states are trying to help you stay alive, but we are no longer needing to outrun the lion.  However, our system can perceive aspects such as needing to perform a presentation, social situations, failing at an exam or others judging us as the same level of threat, so our nervous system responds in the same was as if we are still cave people! How Can Therapy Help? In therapy, one of our goals is to create a warm and safe space so we explore emotions, triggers, and coping strategies. Here’s some examples of how we can broaden your window of tolerance: 1.          Mindfulness and Grounding Techniques: Mindfulness exercises, help you stay present and recognise your emotional state without judgment. Grounding techniques, like deep breathing, can anchor you in the moment, reducing anxiety and enhancing emotional regulation. 2.          Cognitive Behavioural Therapy (CBT): Identifying negative thought patterns and work to reframe them. This can make a significant difference in how you respond to stress and anxiety. 3.          Emotion Regulation Skills: When you recognise you are out of your window of tolerance, tools, such as the "STOP" method (Stop, Take a breath, Observe, Proceed), can empower you to regain control over overwhelming moments. 4.          Exposure Therapy: If anxiety holds you back, we can gradually expose you to those stressors in a safe way, helping you learn that you can handle difficult situations. 5.          Building a Support Network: Identifying relationships in your life that can offer support, helping you connect with others during challenging times. The Positive Outcomes of an Expanded Window of Tolerance As you spend time in therapy, the aim is to broaden your window of tolerance so you are better equipped to handle life’s challenges and can remain in your most effective state. This will allow you to experience: •            Increased resilience during stressful times •            Reduced symptoms of anxiety and depression •            Improved relationships and communication •            Greater comfort in experiencing a range of emotions •            Enhanced overall well-being Conclusion Understanding your window of tolerance is a key step in managing anxiety and low mood. Therapy can support you on this journey, helping you find balance and resilience. If you're feeling overwhelmed, don’t hesitate to contact me at dr.sarah@berger.me.uk  Together, we can create a path toward a more fulfilling life and less overwhelm J

Dr Sarah Berger & Dr Joanna Astill We are all aware of the positive impact running can have on our wellbeing. We also know that at times, we can have a love-hate relationship with this activity; sometimes feeling motivated and uplifted and other times a sense that putting our trainers on is an effort. The menopause can play a factor in how we feel, but we don’t always recognise the relationship between how this can impact on our running. It is important to be clear on what is happening in our body’s during the menopause, to be able to work with this, rather than feel like we are fighting against it. Throughout this natural transition, we experience a decline in oestrogen, progesterone and testosterone, whilst cortisol levels – the stress hormone – increases. This can influence our motivation, recovery and our pace and can result in loss of muscle mass and muscle recovery. The good news is that there are things we can do to get the most out of each run, which can feel more aligned with these life changes. Tracking/Journaling: We will all have days in the month where running doesn’t feel as easy as on other days. By keeping a journal of menopausal symptoms, we may experience at different times in our cycle, and the impact that this has on our run, we can develop a better understanding of the patterns we experience. This can help us to plan our training so we are working with our body and can get the most out of each run. Intuitive Training: Once we have recognised that there is a pattern to how we feel and the impact this has on our running, there are ways we can adapt our training to include the following: Pacing: Our training can be split between easy runs and interval runs. Easy runs are slower and about improving our endurance and reducing stress on our muscles. They help us to feel less fatigued and support recovery. Incorporating these runs into our training can provide a great opportunity to be more mindful, which supports our wellbeing and reduces our levels of stress. Interval runs can help us maintain our muscle mass and also help with that annoying extra weight that can accumulate around our stomach during this phase. Strength Training: By incorporating things in our training such as lifting weights, using resistant bands and pushing our body against any load (e.g. squats and push-ups), we can reduce the risk of injury. Strength training also helps with muscle mass and bone density, both of which reduce as a result of the decline in hormones. Flexibility: The decline in oestrogen can result in us experiencing pain in our joints and muscles more frequently. We can include exercises that focus on enhancing our flexibility in a gentle way such as stretches, pilates, tai chi and yoga. Recovery: As our hormones reduce, we need more time for recovery. Although we may be desperate to hit the pavement, we need to remind ourselves that recovery days are important for reducing our risk of injury, allowing our body to become fitter and our muscles to build back stronger. These are the days when we can focus on intuitive training and mix things up a bit. Hydration: It is helpful for us to remember that hot flushes and night sweats will impact on hydration, which can impact on our running performance, tiredness, and mood. It is also important to make sure we hydrate properly following a run! A way to recognise that we are dehydrated is to do the urine check; darker urine equals more hydration required! Balance & Self Compassion: It is important to understand that having high levels of cortisol and stress will worsen our menopausal symptoms, impact our body and ultimately our training. With life being really busy, along with the hormonal changes we are experiencing, it is understandable that there may be times when our inner critic pipes up more, leading to frustration or disappointment in our running performance. By being more compassionate and understanding towards ourselves, and remembering our values related to our runs (e.g. spending time in nature, health, being part of a community, sense of freedom, self-care) we can reconnect with the real benefits that we get from our running regardless of PB’s or distance covered. This will increase motivation for future runs. Although the menopause is a time of change and can feel challenging to navigate, it can also be a time of growth and self-discovery. As we move through this natural transition, we can see this as an opportunity to become more attuned to our body, our values and what we really desire. If you would like to know more about psychological strategies that can empower you during midlife and the menopause you can find more information at: https://www.femalesfeelingfabulous.com/home

The menopause is going to impact us all in some way, so it is important that we can navigate this transition in life with as much ease as possible. One of the first steps to be able to do is to understand what causes the different symptoms we are experiencing. Only then can we make decisions of how to address these and gain a sense of control, rather than feeling it is something that is happening to us. The physical symptoms associated with the fluctuation of Oestrogen, Progesterone and Testosterone such as hot flushes, weight gain and joint pain are well known to us all. However, presenting alongside these, are sy mptoms that can also have a psychological element, such as sleep difficulties, anxiety, low mood, brain fog and irritability. These can be significant and impact, on our daily functioning and confidence. For a lot of us, Hormone Replacement Therapy, the recommended treatment by the National Institute for Health and Care Excellence (NICE, 2019) can reduce a lot of these symptoms through addressing the imbalance of hormones. However, for some of us, we may find we still don’t feel quite ourselves and need a little more support to get our mojo back. Psychological strategies are also recognised as a recommended treatment (NICE, 2019) to support us to navigate this transition in life, whilst also enabling us to enhance our wellbeing in the longer term. These strategies acknowledge that the way we think, feel and behave about ourselves and the symptoms we are experiencing during the menopause, can have an influence on our mental health. Psychological strategies recognise that our past experiences as well as cultural expectations, and societies own biases around what is 'acceptable' and 'normal', will impact our menopause journey. One of the symptoms that 30%-60% of us will struggle with during the menopause is sleep. We all know that limited sleep can have an impact on all areas of life, so understanding the biological and psychological factors that impact this, can help us to get that better night’s sleep so we feel more able to engage in the things we enjoy. The biological factors of insomnia relate to the fluctuation in the sex hormones which triggers a level of distress in the body. Other hormones try to rebalance the system, but these also become out of sync, resulting in the stress response and an increase of cortisol and adrenaline. When our bodies are in a state of stress, this has an impact on the production of the sleep hormone, called melatonin, making it difficult for us to get to sleep. Add into th e mix hot flushes and night sweats that disturb the sleep cycle and it is not surprising that we struggle with sleep! With all these hormonal changes going on in our body, it makes sense that psychological factors are going to come into play, when we collapse into our bed and our mind starts running wild! At this time, thoughts may start to pop up about all the things that we “should” have done during our day or what we “must” do the following day, making our body go into threat mode and making it difficult to drop off. This can lead to another layer of anxiety, as we start to worry about not getting enough sleep and how this will impact on us functioning the following day. SO HOW CAN PSYCHOLOGY HELP US TO GET A BETTER NIGHT’S SLEEP??? MENTAL DOWNLOAD We all have those times when we get into bed and our mind feels like it is running 100 miles an hour. It can be helpful to spend 15 minutes each day, to complete a mental download. This can include worries, things we need to do or other aspects that play on our mind when trying to sleep. The best time to do this is 2-3 hours before we go to bed, to allow our mind to start to calm down ready for sleep. The following day, we can revisit the list and action the things that need to be attended to or disregard the things that have been resolved. RESETTING OUR CIRCADIAN CYCLE Our internal body clock is regulated by light and darkness so getting outside first thing in the morning for a minimum of 15 minutes, without wearing sunglasses, is a good way to start our day. This is great news for us early morning runners who like to hit the pavement first thing! As soon as we go outside in daylight, the sleep hormone melatonin is inhib ited and our sleep appetite, controlled by a release of adenosine starts to increase. This allows the ultimate amount of time for our body to build up our sleep drive throughout the day, ready for when we go to bed in the evening. ACCEPTANCE None of us want to be awake during the night, but this is going to happen to all of us at different times in our lives. After-all, a lot of us will have survived going out clubbing until the early hours (if we can remember that far back!) and the early days of parenting, with limited amount of sleep and we still managed to function! If we start beating ourselves up abou t how we need to get to sleep, then this is only going to prolong the time we remain awake. If we find ourselves being awake for longer than 15 minutes, it can be helpful to remind ourselves of the positive aspects that resting and relaxing in our cosy bed, regardless of whether we are asleep can have on our well-being. Dropping the struggle and self-criticism and taking a step back to notice our experience and accepting it as it is, can help us to disrupt the cycle of sleepless nights. Sleep is an important foundation for our well-being and can impact on all aspects of our day. Using these strategies can support us in a better night’s sleep, leading to feeling more motivated, brighter in mood and starting that run with a spring in our step. This article was written by Dr Sarah Berger, Senior Clinical Psychologist, co-owner of Stressed Out to Feeling Fabulous & long standing member of the Running Woman community

Menopause is something that we are all going to go through at some point, but we don’t always think about how this can impact on our running. For us to get the most out of our runs, whilst also improving our bone health, we need to understand what is changing in our bodies so that we can ensure our training can align us to navigate through this natural transition in life…. So, let’s take a look at how this can be achieved by first getting clear on what the menopause is. Menopause occurs when our ovaries no longer release monthly eggs, resulting in our menstrual cycle to end. During this time, we experience a decline in oestrogen, progesterone, and testosterone, whilst cortisol (stress hormone) levels increase. When a woman has not had a period for at least 12 months, she is seen to have reached menopause. In the UK, the average age for this to occur is 51 years. However, approximately 5-10 years before this, symptoms can start to become noticeable, and this is when a woman has entered the perimenopause. As we experience a decline in oestrogen, progesterone, and testosterone, we can start to notice things such as pace reducing, feeling less motivated, and it is taking longer for our body to recover. One of the reasons that these changes in our running can occur, is due to a loss of muscle mass which naturally starts to decline in our 40’s and is further reduced through oestrogen and testosterone deficiencies. Additionally, our muscle recovery can become slower. This means that the training we did in our 20’s and 30’s may need to be adapted slightly for us to get the most out of our runs. We know that running can be a fantastic way of reducing the severity of some of the symptoms of menopause, so what can we do to improve and get the most out of our running, whilst enabling our runs to be aligned with these life changes? RECOVERY As our hormones reduce, we need more time for recovery as our tendons, muscles and joints require a little extra time to rest. This is also at a time when our inner critic can pipe up and start telling us we are “not doing good enough and need to train harder or more often.” However, this can have a detrimental impact on our long-term training, as it increases the possibility of being injured. During a run, we break down our muscle fibres and deplete our glycogen, resulting in our body feeling tired. This is why our recovery time between runs is important, as this is when our body becomes fitter as our muscles build back stronger and fitness improves. A way to check in and monitor whether we need more rest in between runs is to do the stairs test. If you walk up the stairs and your legs feel tired, it can be a sign that you need to allow additional recovery time for your body to repair. STRENGTH TRAINING We can reverse the process of losing strength, make our bones stronger and increase mean muscle mass by including strength training into our routine. This is when we push our bodies against any load and has the benefit of reducing the risk of injury. This can include lifting weights, using resistance bands or using your own body weight as resistance such a push-ups, crunches or squats. PACING Including easy runs into our training program can improve our endurance and reduce stress on our muscles. This results in our body being less fatigued after a run and better prepared for when we next hit the pavement. A way to determine that you are running at your easy pace is to check if you can hold a conversation or sing a song whilst running. At the end of your run, you should be able to feel you could go on for longer when running at an easy pace. As a guide, 80% of your runs have been recommended to be at an easy pace. High Intensity training such as interval running is where you run for short periods of time at approximately 90% capacity and then have a slower resting period. This can be beneficial to be included into our training program as is can preserve muscle mass, increase running speed and allow the weight that can accumulate around the stomach area during menopause to reduce. One of these training sessions a week can enable improvements to your running time and efficiency and takes up less time too! FLEXIBILITY As oestrogen declines, we can experience stiffer joints and muscles so incorporating some yoga into our week can be a way to strengthen our muscles whilst enhancing our flexibility. This can be a great addition to our training plan and can be included on one of our recovery days. JOURNALING Whilst a lot of the physical aspects of the menopause are discussed and HRT can be a good way of supporting the rebalance of hormones to reduce the symptoms, it can also have an impact on our mental health. During this time, it is important for us to recognise what we have achieved and celebrate our wins. Tracking changes in our mind and body on days where we are smashing it and other days where we feel we are running through treacle, can give us a sense of predictability and control. By recognising the patterns that we experience, we can adapt our training to work with this cycle and reduce our levels of fatigue. With the changes in our hormones having an impact on our physical and mental health, running is more important than ever for us to continue to feel strong and empowering women. Whilst we move from the reproductive part of life, we can learn to look forward to productive years ahead, with more time for us to connect with what matter to us. Additionally, being able to talk to other women and not feeling you need to go through this alone is important and with a community around us like Running Woman, we can navigate, support and learn from each other. If you would like more information about menopause, please do let us know in the comments below. You can also find out more and gain additional support by joining the Females Feeling Fabulous facebook group. https://www.femalesfeelingfabulous.com/landingpage