Many people look forward to having free time. Yet when that free time finally arrives, many people feel restless, uneasy or even experience a sense of guilt.

For many thoughts begin to appear such as:

"I should be doing something productive."

"I've wasted enough time already."

"Other people are working harder than me."

"I don't deserve to relax until everything is finished."

If you can relate to this then you may be experiencing what psychologists sometimes refer to as productivity guilt.
​

What Is Productivity Guilt?

Productivity guilt occurs when we feel uncomfortable or ashamed when trying to rest. Instead of seeing relaxation as a normal human need, we begin to view it as something that must be earned upon which it is then never fully enjoyed (often due to a sense of guilt).

Many people believe that the solution is to become more productive or to excessively escape through over stimulation. Productivity guilt often persists regardless of how much a person achieves. Sometimes doing more can make things worse because after completing many tasks, there are more things one can feel guilty about.

In therapy, it is not uncommon to meet individuals who are objectively successful but still feel that they are never doing enough whilst finding it impossible or very difficult to relax.

The problem is the relationship we have developed with achievement.

Where Does Productivity Guilt Come From?

Many possible explanations exist:


Childhood Experiences

Many people grow up receiving praise when they perform well whilst getting criticised when not being busy or when trying to relax. One’s self worth can then become very conditional and motivated by achievement. Many individuals that experience productivity guilt can therefore have a tendency to be self critical.

Some families place a strong emphasis on hard work and achievement. While these values can have benefits, they can also create an internal belief that resting is lazy, selfish or irresponsible.

People often continue to follow these rules long after leaving home, without questioning whether they are still helpful. That’s why things like Cognitive Behavioural Therapy can be helpful in order to recognise the momentum of your past.


Anxiety and Control

For some individuals, staying busy serves another purpose. Work and constant activity can distract from difficult but informing emotions such as anxiety, sadness, loneliness or uncertainty. These emotions often come to the forefront when one is trying to relax and do less.

In these situations, productivity can become a coping strategy rather than simply a way of getting things done. This can be noticed with many that can’t sleep at night as when nothing else is going on one becomes aware of one’s problems.


​Perfectionism

Perfectionists often live according to very rigid and high standards. For them there is always another task to complete, another goal to achieve or another way to improve. As a result, relaxation begins to feel undeserved because the to-do list is never truly finished. The goalposts keep moving.

The Hidden Cost of Always Being Productive

For many productivity guilt may appear helpful. As it can motivate people to work hard and accomplish a great deal. However, there are often significant costs.

Many people who struggle to switch off may experience:

* Chronic stress
* Anxiety
* Burnout
* Sleep difficulties
* Increased anxiety
* Irritability
* Relationship problems
* Reduced enjoyment of life

Perhaps most importantly, they may lose the ability to rest without feeling guilty. This creates a cycle in which recovery time becomes increasingly limited, which makes even more stress and exhaustion likely.


Why Rest Is Not Laziness

Many people think of rest as the absence of productivity. Rest serves an important psychological and biological function. Athletes understand that recovery is essential for performance. Muscles grow during periods of rest, not during training itself. The same principle applies to mental wellbeing. Human beings are not designed to operate at maximum capacity all day, every day.

Concentration, emotional regulation, creativity, and decision-making all benefit from periods of downtime.


A CBT Perspective

Cognitive Behavioural Therapy (CBT) often examines the rules and beliefs people hold about themselves and the world.

Someone experiencing productivity guilt might have beliefs such as:

* "I should always be productive."
* "Successful people don't waste time."
* "If I stop, I'll fall behind."
* "My value depends on what I achieve."

The difficulty is that these beliefs are often accepted as facts rather than tested as assumptions.

One useful exercise is to simply re-frame when self criticism feels excessive or not in line with one's values. So one may notices certain thoughts and re-frame them in a more accepting way. This sometimes can feel corny but the point of the exercise is to activate the mechanism of self acceptance and compassion in order to reprogram the brain and not so much the content of what is being reframed.

In addition some people have a conditioned, less conscious response to relaxing in that their body tenses up without experiencing any thoughts. Embracing breaks and time off in a healthy way without escapist stimulation can be helpful in those moments.

​Learning to Rest Again

Overcoming productivity guilt does of course not mean abandoning ambition or responsibility. It instead means recognising that well-being requires balance, whilst calibrating your ambition in line with your values instead of it being motivated by your symptoms.

Many people benefit from gradually practising relaxation without trying to justify it.

This might involve:

* Taking a walk without tracking performance
* Reading purely for enjoyment
* Spending time with friends
* Sitting quietly with a cup of coffee
* Taking a day off without filling it with tasks

Initially, this can feel surprisingly uncomfortable.

However, discomfort does not necessarily mean something is wrong. It may mean that one is doing the right thing.


Final Thoughts

Many cultures celebrate busyness. When somebody asks how we are doing, "busy" is frequently worn as a badge of honour. Work and achievement can all be valuable. So can rest, connection and simple enjoyment.

Anxiety can feel relentless and understandably many people look for “natural” ways to reduce anxiety before or alongside seeking therapy. Supplements are often marketed as extremely effective quick fixes but the truth is more nuanced.

Some supplements have reasonable amount of evidence behind them. Others are more experimental, supported mostly by small studies, anecdotal reports or just internet hype. A few supplements can even make anxiety worse.

This article explores both the evidence-based options and more speculative supplements.
First: Supplements Are Not a Substitute for Addressing the Cause
Before discussing supplements, it is important to say this clearly:

If someone is chronically stressed, burnt out, isolated, sleeping badly, drinking too much caffeine, stuck in a toxic environment, or trapped in patterns of avoidance and overthinking, supplements alone alone are not going to solve the source of those anxieties.

Supplements may slightly reduce the intensity of symptoms or improve resilience. Therefore they are usually most effective when combined with:

    • Good sleep
    • Reduced caffeine and alcohol intake
    • Regular exercise
    • Therapy
    • Stress management
    • Better boundaries and lifestyle changes
​
With my clients I often see anxiety maintained by cycles of avoidance, reassurance-seeking, perfectionism and chronic nervous system activation. No supplement fully can fully address those issues.

Supplements With the Strongest Evidence

Lavender Oil (Silexan)

Lavender may sound “alternative,” but oral lavender oil actually has surprisingly decent evidence behind it.
Several systematic reviews and randomised trials suggest that lavender oil preparations — particularly a standardised form called Silexan — may reduce general anxiety symptoms. Some studies even found effects comparable to low-dose anti-anxiety medication in mild-to-moderate anxiety.

People often describe lavender as:

    • Calming without heavy sedation
    • Helpful for physical tension
    • Useful for sleep-related anxiety

Possible downsides:

    • Digestive upset
    • “Lavender burps”
    • Not everyone notices a meaningful effect

Lavender aromatherapy may help some people relax acutely, though oral forms appear to have stronger evidence than simply smelling lavender oil.

Magnesium

Magnesium is probably one of the most commonly recommended supplements for anxiety.
There is some evidence that magnesium supplementation may reduce subjective anxiety, particularly in people who are magnesium deficient or under chronic stress. However, the research quality is mixed and not especially strong.

People who may benefit more include:

    • Those with poor diets
    • High stress levels
    • Sleep difficulties
    • Muscle tension
    • Heavy caffeine use

Magnesium glycinate is the one to go for because it tends to be gentler on the stomach.

Common experiences reported:

    • Better sleep
    • Slightly calmer nervous system
    • Reduced muscle tension

However, many people in online communities report little or no effect.

L-Theanine

L-theanine is an amino acid naturally found in tea.
It is often described as promoting “calm focus” rather than sedation. Some people find it particularly useful for caffeine-induced anxiety or mental overstimulation.

A common pattern reported online is:

    • Subtle relaxation
    • Reduced mental “edge”
    • Improved focus under stress

But results are inconsistent. Some people swear by it, while others feel absolutely nothing.
This is fairly typical with anxiety supplements generally: individual responses can vary significantly.

Ashwagandha

Ashwagandha has become extremely popular in recent years.
It is considered an “adaptogen,” meaning it may help the body cope with stress. Some studies suggest it can reduce stress and anxiety symptoms, especially where chronic stress and elevated cortisol are involved.

People sometimes report:

    • Feeling more emotionally stable
    • Reduced stress reactivity
    • Better sleep

However, others describe:

    • Emotional numbness
    • Feeling “flat”
    • Digestive issues
    • Increased lethargy

Ashwagandha also interacts with thyroid function and is not appropriate for everyone but many online communities swear by it.

Kava

Kava is one of the more controversial supplements for anxiety.
Some evidence suggests it can reduce anxiety quite effectively, sometimes more noticeably than gentler supplements.

However:

    • It can be sedating
    • It may impair coordination
    • There are concerns about liver toxicity
    • Quality control varies significantly
​
Because of this, kava is something people should approach cautiously and ideally discuss with a healthcare professional.

More Experimental or Speculative Supplements

This is where things become less evidence-based and more anecdotal.
Some people report substantial benefits from supplements that currently have weak or limited research support.

Saffron

Saffron is increasingly discussed online for anxiety and mood. Some early studies are promising.

People sometimes describe:

    • Improved mood
    • Reduced obsessive thinking
    • Less emotional heaviness

However, the evidence base is still relatively small compared to mainstream treatments.

NAC (N-Acetylcysteine)

NAC has become popular in online mental health and “biohacking” communities.
Some researchers are interested in its effects on glutamate regulation and compulsive thinking. It has been explored in conditions involving rumination and repetitive behaviours.

Anecdotally, some people say it helps:

    • Intrusive thoughts
    • OCD-type symptoms
    • Mental overactivity

Whilst others report feeling no effect whatsoever.

Taurine

Taurine is often mentioned in supplement communities for calming the nervous system.
The evidence is limited, but some people report reduced physical anxiety and improved sleep quality. It is sometimes combined with magnesium.

Lemon Balm

Lemon balm has a long history in herbal medicine and may have mild calming properties.
For some people, it feels gently relaxing. For others, it simply causes sleepiness.

CBD

CBD exploded in popularity for anxiety, though research findings remain mixed.
Some people report significant relief. Others notice no effect unless taking very high doses, which can become expensive. Quality control is also highly variable due to the complex legal situation in many countries.

The Problem With Supplements for Anxiety

One major issue is that anxiety itself has a lot of variance. What causes it and how it shows itself varies a lot from person to person.

One person’s anxiety may be:

    • High physiological arousal
    • Trauma-related hypervigilance
    • Obsessive thinking
    • Burnout
    • Existential anxiety
    • Social fear
    • Chronic stress overload

A supplement that helps one type may do very little for another. There is also the placebo effect — which is not “fake,” but reflects how expectation and nervous system regulation interact.

Additionally, many people online try:

    • Five supplements at once
    • Constantly changing doses
    • Extremely high doses
    • Combining supplements with caffeine, alcohol, or poor sleep

This makes it difficult to know what is genuinely helping and sometimes mixing supplements can make things worse instead of better.

Some Things That Commonly Worsen Anxiety

Ironically, people often focus heavily on supplements while ignoring the things most strongly associated with worsening anxiety.

Common contributors include:
    • Excess caffeine
    • Poor sleep
    • Alcohol rebound anxiety
    • Chronic stress
    • Doomscrolling
    • Isolation
    • Poor diet
    • Lack of exercise
    • Overworking
    • Suppressed emotions
    • Constant reassurance-seeking
​
Reducing these often has a larger impact than taking a supplement.

Final Thoughts

Some supplements may genuinely help certain people with anxiety. Lavender, magnesium, L-theanine, and ashwagandha are some of the better known ones that also have a strong evidence base..
However, supplements are rarely miracle cures.
In clinical practice, the biggest long-term improvements usually come from understanding the anxiety cycle itself:

    • What triggers anxiety
    • What maintains it
    • What behaviours reinforce it
    • How avoidance keeps fear alive

Supplements may occasionally lower the volume slightly, but they do not usually resolve the underlying psychological processes driving anxiety.
If anxiety is significantly affecting daily life, therapy — particularly evidence-based approaches such as CBT — remains one of the most effective long-term interventions available. Feel free to enquire about CBT Therapy with me by clicking here.

If you are thinking about engaging in therapy, you’ve probably asked yourself:
“Is online CBT actually effective for anxiety, or does it make more sense to do in-person therapy?”
When you’re anxious, you want to know that something works and isn’t just convenient.

Online Cognitive Behavioural Therapy (CBT) is highly effective for treating anxiety in most cases works just as well as face-to-face therapy. However, effectiveness depends on more than just the format. Successful therapy depends on how the therapy is used by yourself and your therapist and whether it fits your situation. This guide will give you a realistic answer so you can decide with confidence.

Cognitive Behavioural Therapy (CBT) is a structured, evidence-based approach that focuses on the relationship between thoughts, emotions, behaviours, a client’s environment, biological factors. The goal is to identify, put a structure to difficulties and generally understand what’s going on in order to then devise a plan that treats a given issue.

When delivered online (via video or phone), how CBT is done remains exactly the same. A typical online CBT session involves discussing what do in the session (agenda setting), reviewing what has been practised (homework) whilst then engaging with what’s relevant.

The key point:
CBT does not rely on physical presence—it relies on clarity, structure and consistent application.

This is one of the most commonly searched questions:
“Does online CBT actually work?”

A large number of studies comparing online CBT vs in-person CBT show that outcomes are broadly equivalent for generalised anxiety, social anxiety, panic disorder and many more mental health problems someone could be suffering from.
People engaging in remote based CBT typically experience a significant reduction in anxiety symptoms, an improved ability to manage worry and overthinking whilst benefiting from lasting changes in behaviour and thinking patterns. To be realistic CBT usually doesn’t completely alleviate all of the issue one has, but helps with stuff.

One of the main reasons for this is that CBT is highly structured. Progress depends less on the setting and more on: how consistently sessions are attended, how actively the client engages, how regularly techniques are applied in daily life, how much the therapist and the client are a good and how much effort the therapist puts in.

👉 What you do between sessions matters more than whether therapy is done online or in person.

Online CBT is not just a niche alternative but the preferred option for many people. Its is very suitable if you have a busy or internationally mobile lifestyle. Removing travel time makes it easier to attend regularly and consistency is one of the strongest predictors of successful outcomes.

Online CBT may be especially effective if you have a demanding work schedule, travel frequently, are an expat or prefer working in English while based abroad, feel more comfortable speaking from the comfort of your own environment and prefer a structured, goal-oriented approach.

For many professionals and expats, online therapy offers an increased likelihood of continuity irrespective of one’s own circumstance. Instead of interrupting therapy due to relocation, you can maintain steady progress over time.

Online CBT is not the best fit for every situation. It may be less suitable if you are in acute psychological crisis. However, attending face to face sessions with a therapist as your sole source of mental health treatment wouldn’t be enough either way. You do not have access to a private space for sessions, you struggle significantly with focus or engagement when talking with people remotely or if you strongly prefer face-to-face interaction. In these cases, in-person or hybrid therapy may be more appropriate.
​The honest answer is that neither format is inherently superior. What matters more are the underlying factors that drive progress.

If you’re thinking about starting therapy, a short initial conversation can help clarify whether this approach is right for you. I therefore offer a free 15-minute consultation where we can discuss what you’re dealing with, explore whether online CBT is suitable and generally see whether we are a good fit.

Depression is complex and it isn't realistic to identify a correct causal pattern with every person. Conversely focusing on a single solution does not always help. Although CBT remains one of the most evidence-based treatments, there’s growing interest in whether supplements can help with treating depression.
​
Supplements are not a replacement for therapy or medical treatment. But some supplements can be helpful when used correctly.
This article cuts through the noise and focuses on supplements with actual evidence behind them. Don't however forget that supplements don't replace Cognitive Behavioural Therapy. You can book therapy in Richmond and remote based with me.

Omega-3s—particularly EPA (eicosapentaenoic acid)—have one of the strongest evidence bases among supplements aimed at treating depression.
Considerations to keep in mind:

• EPA-heavy formulations appear more effective than DHA alone
• May reduce inflammation linked to depressive symptoms
• Particularly helpful in mild-to-moderate depression

Takeaway: Look for a supplement with at least 1,000 mg of EPA daily, ideally with a higher EPA-to-DHA ratio.

Low vitamin D levels have been repeatedly associated with depression, especially in countries that enable less sunlight exposure.
Why it matters:

• Vitamin D plays a role in brain function and mood regulation
• Deficiency is widespread in the UK and Northern Europe
• Supplementation may improve mood in certain individuals

Practical takeaway: If you aren't exposed to much sunlight, supplementation can often be beneficial. Blood testing is ideal, but many people benefit from 1,000–2,000 IU daily.

​Magnesium is involved in many biochemical processes, including those that regulate stress and mood.
What it may help with:
    • Anxiety and irritability
    • Sleep quality
    • Nervous system regulation
Evidence:
Some trials find that magnesium supplementation can reduce mild depressive symptoms, particularly where a deficiency exists.
Practical takeaway: Forms like magnesium glycinate or citrate tend to be better absorbed and gentler on the stomach.

 Saffron is one of the more surprising entries—but also one of the most promising.
Research highlights:

• Several studies suggest saffron can be as effective as SSRIs in mild-to-moderate depression
• May influence serotonin levels
• Fewer side effects compared to antidepressants

Practical takeaway: Typical doses range from 28–30 mg daily (standardised extract).

B vitamins are essential for brain function and neurotransmitter production.
Key points:

• Low B12 and folate levels are linked to depression
• Supplementation may improve response to antidepressants
• Vegans and vegetarians are at higher risk of deficiency

Practical takeaway: Consider a high-quality B-complex or targeted supplementation if deficiency is suspected.

An adaptogenic herb often used for stress and anxiety.
Potential benefits:

• Reduces cortisol (stress hormone)
• May improve resilience to stress
• Indirectly supports mood

Evidence: More robust for anxiety than depression, but useful where stress is a major driver of symptoms.

Not all “natural” supplements are safe or effective.
Use caution with:

• St John’s Wort – can interact dangerously with antidepressants and other medications
• 5-HTP – may increase risk of serotonin syndrome when combined with SSRIs.
• High-dose or poorly regulated products bought online

Always check with a GP if you’re taking medication.

Even when supplements help, they don’t address the psychological mechanisms that maintain depression.
From a CBT standpoint, depression is often driven by:

• Negative thinking patterns about the future, oneself and one's environment. For severely depressed clients this can be the default state.
• Behavioural withdrawal and other unhelpful behavioural patterns which keep clients stuck.
• Avoidance cycles
• Low reinforcement from the environment

Supplements may improve your baseline—but they may not change everything that needs to be addressed.
That’s where structured therapy can become helpful.
If you’re struggling with persistent low mood, booking a session will help you find  a way forward.

Think of supplements as part of a broader system, not a solution in isolation:

• Therapy → addresses thought patterns and behaviour
• Lifestyle → sleep, exercise, routine
• Supplements → support underlying biology

Used together, they can be powerful.

There is no “magic supplement” for depression. But there are evidence-based options that can support recovery—especially when used alongside therapy and lifestyle changes.
If you’re considering supplements:

• Focus on those with real evidence (Omega-3, Vitamin D, Magnesium, Saffron)
• Avoid stacking too many at once
• Track your response over time

And most importantly: if your depression is ongoing, don’t try to solve it alone.
You can find structured, evidence-based support through by booking a therapy session with me, or explore therapist matching options via seekapsych.com.

This article is for informational purposes and does not replace medical advice.

Remote work as been increasingly common in recent years. While working from home can have many advantages, many are noticing psychological costs to working from home. From blurred boundaries to the problems that go with increased isolation, home-based work can negatively influence your mental health. Many clients that I treat find that their mood decreases and that they worry more when they have spent extended periods of time alone.
​
From a cognitive behavioural perspective, one's environment has the potential to influence mood, behaviour and stress levels. Renting office space — whether a private consulting room, a serviced office, or shared workspace can provide numerous mental health benefits. We will now explore the reasons for this.

Humans are wired for connection. Even brief social interactions like greeting someone in the morning or chatting over coffee, can have a positive influence on mood.
When working from home, opportunities for spontaneous interaction are reduced. Over time, this can contribute to loneliness, low mood and heightened anxiety. If someone is already a bit socially anxious, withdrawal from others can often make their anxieties worse.
A rented workspace introduces light but beneficial social contact, which research consistently links to improved resilience and also reduced stress.

One of the most powerful mental health benefits of office space is separation from settings that are meant to provide a different function.
When your kitchen table doubles as your desk, it becomes difficult to “switch off.” This blurred boundary can lead to:

• Persistent stress
• Difficulty relaxing
• Sleep disruption
• Gradual burnout

Physically leaving a workspace reinforces a behavioural cue: work has ended and makes it easier to relax in your home environment. In CBT terms, this supports stimulus control and reduces rumination outside of working hours.

Home environments often contain competing stimuli — chores, family members, deliveries, screens and other kinds of distractions.
Your own office space signals to the brain that it is time for focused work. This environmental cue can cause:

• Enhances concentration
• Reduces procrastination
• Lowers deadline-related stress
• Improves task completion satisfaction

In CBT, we explore how environmental structure supports behavioural activation and therefore an increase in mood. A clear workspace supports intentional and goal-directed behaviour.

A healthy routine helps stabilise mood. It reduces uncertainty and decision fatigue.
Commuting (even a short walk), arriving at a workspace and finishing at a set time provides predictable structure. This predictability can:

• Reduce anxiety
• Improve motivation
• Enhance sleep patterns
• Support emotional regulation

Without structure, work can gradually expand to fill all available time. This causes exhaustion and leads to reduced recovery.

Your own environment shapes how you see yourself.
Working in a professional setting reinforces a healthy identity and a sense of competence that is partially driven by the direct interaction with others. For therapists, consultants, and independent professionals in particular, having a dedicated office can:

• Increase confidence
• Strengthen boundaries with clients
• Support professionalism
• Reduce imposter feelings

Physical space therefore has a big influence on our lives.

 Burnout often develops gradually. Warning signs include:

• Emotional exhaustion
• Cynicism or detachment
• Reduced productivity
• Irritability
• Persistent fatigue

When work and home merge, recovery time can shrink. Renting office space restores psychological distance, which is essential for sustainable performance. It is therefore also important for you to design your home life that also resembles the psychological components that drive and enable helpful rest and downtime. This means avoiding escapist behaviours whilst also pursuing meaningful activities.

Not everyone needs in person office space for them to attend. Some people can make the most of and benefit from a hybrid approach — working from home part-time while using a rented office or their employers office.
If you notice:

• Difficulty switching off
• Increased irritability
• Reduced motivation
• Feeling isolated
• Blurred boundaries

Your environment could well be contributing to your stress levels.

At Klein CBT, I understand that mental well-being is shaped not only by thoughts but by behaviours and / or  the environments we shape and live in.
Small structural changes — such as separating work and home — can significantly improve mood, clarity and resilience. It can even enable experiencing a sense of purpose.
If you are experiencing stress, anxiety, burnout, or low mood professional support can help you identify  changes that may improve your mental health.

If work stress, burnout, or anxiety are affecting you, I offer a free 15-minute introductory call to see whether my style of CBT would be a good fit for you.
You can learn more about my therapy services here:
👉 Online and Phone Based Therapy
👉 Therapy in Richmond
👉 Mental Health Assessments

Exposure and Response Prevention (ERP) is the psychological treatment for Obsessive‑Compulsive Disorder (OCD) with the strongest research backing. ERP is a core part of how I help clients recover from OCD which includes Pure O and other forms where compulsions are largely mental (internally based) rather than visible.
This client guide explains how ERP can be applied for Pure O and other types of OCD presentations and why a strong emphasis is on acceptance based approaches compared to traditional thought challenging.

​“Pure O” is an informal term used to describe OCD where obsessions are prominent and compulsions mostly play out inside of someone’s head. OCD always involves compulsions but they are not always obvious.
OCD often revolves around types and themes such as scrupulosity or cleanliness (there are infinite variations when it comes to OCD. Not all are “officially” listed.) Common Pure O themes include:
    • Harm OCD
    • Sexual OCD
    • Relationship OCD (ROCD)
    • Religious or moral OCD (scrupulosity)
    • Existential OCD
Mental compulsions often include:
    • Reassurance seeking (from yourself or others)
    • Mental checking
    • Analysing or problem-solving thoughts
    • Neutralising thoughts with “good” thoughts
    • Reviewing past events
    • Googling or researching for certainty
When working with me, ERP for Pure O focuses on identifying and reducing these internal responses, rather than trying to control or eliminate uncomfortable thoughts.

​ERP has two essential components:
    1. Exposure – intentionally allowing feared thoughts, images, feelings or uncertainty to be present (sometimes a mixture of all of these things.)
    2. Response Prevention – choosing not to engage in compulsions (including mental ones). An important point her is to keep response prevention simple. Over-planning on how to work on your OCD can become a compulsion in itself.
The goal of ERP is not short term relief. Instead, it helps retrain the brain to learn that:
    • Intrusive thoughts are not dangerous
    • Anxiety is uncomfortable but tolerable
    • Feelings rise and fall without needing to be fixed
    • Certainty is not required to live a meaningful life
Over time, this weakens the OCD cycle as the sense of threat associated with triggers and / or obsessions lessens.

​Many people come to therapy having tried to argue with or logically challenge their intrusive thoughts:
    • “That would never happen.”
    • “I know I would never do that.”
    • “This thought makes no sense.”
While cognitive restructuring can be useful in other difficulties, in OCD it can often run the risk of keeping the problem going.
From a clinical perspective, thought challenging:
    • Keeps attention locked on the obsession
    • Treats the thought as meaningful or dangerous
    • Becomes another form of reassurance
    • Fuels the need for certainty
OCD is not persuaded by logic. When seeking therapy with me, ERP is designed to help clients step out of the mental debate altogether.

Rather than trying to change or disprove thoughts, acceptance based ERP focuses on changing your response to them. Ideally you will end up doing less and not more.
This approach draws on both ERP and Acceptance and Commitment Therapy (ACT) and is effective for Pure O and other forms of OCD.
Key principles include:

• Allowing intrusive thoughts to be present without fixing them
• Making room for anxiety instead of resisting it
• Letting uncertainty exist without resolving it.
• Letting go of control.
• Choosing behaviour based on values, not fear

This does not mean liking thoughts or agreeing with them. It means learning that you can live well even while they are there.

​1. Identifying Mental Compulsions
The first step in effective ERP is helping clients clearly identify what they do in response to intrusive thoughts.
In therapy, we explore questions such as:
    • What do you do to try to feel safe or certain?
    • What mental actions follow the thought?
    • What are you hoping will happen if you think this through?
ERP targets the stuff people do to get some sense of control and short term relief. This could be something visible or something they do in their own head.

2. Designing Meaningful Exposure Exercises
For Pure O, exposures often involve intentionally allowing thoughts, images or uncertainty without doing anything about them. Keep it simple!
Examples may include:
    • Deliberately bringing on feared thoughts
    • Reading or writing triggering statements
    • Imaginal exposure to feared scenarios
    • Allowing doubt to remain unresolved
The exposure is allowing these experiences without correcting, neutralising, or analysing them.

3. Response Prevention Through Non Engagement
Response prevention means learning to notice urges to analyse, reassure, or check — and choosing not to follow them.
Instead of thought challenging, clients are supported to practise noticing their triggers and / or obsessions whilst not taking the bait of engaging with them.

4. Allowing Anxiety to Rise and Fall
A key part of ERP is learning that anxiety is self limiting.
When compulsions stop or are done less:
    • Anxiety often increases at first
    • Urges to gain certainty may feel strong
    • The mind may insist something must be done
In therapy, we focus on staying present and allowing anxiety to run its course, rather than trying to calm it.
With repetition, the nervous system learns that anxiety does not need to be controlled and often the anxiety itself lessens.
​
5. Living Life Alongside OCD
Some of the most powerful ERP work happens in everyday life.
This includes:
    • Making decisions without full certainty
    • Continuing relationships, work or activities despite being anxious
    • Allowing intrusive thoughts during valued actions
Recovery is not about feeling confident — it is about acting without waiting for confidence first.

• Using acceptance language as subtle reassurance
  
• Mentally analysing while appearing calm
  
• Waiting to feel better before moving on
  
• Measuring success by how little anxiety is felt
  
• Constantly over-planing or reminding oneself of suitable ERP methods.
  
• Often stopping all compulsions at once can be too challenging and risky. Graded exposure can often help (exceptions exist)
  

If a strategy is designed to make anxiety disappear, OCD is usually still in control.

ERP is a structured but flexible treatment.
Clients often notice:

• Early changes in how they respond to thoughts
  
• Gradual reductions in distress and rumination
  
• Increased confidence in handling uncertainty
  

Progress is rarely linear, and setbacks are a normal part of recovery.

ERP for Pure O and other forms of OCD is most effective when it moves away from thought challenging and toward acceptance, willingness and behaviour change.
If you are struggling with Pure O or another form of OCD, I offer specialist, evidence based treatment using ERP and acceptance based approaches.
Therapy is available in Richmond, London, online and over the phone. A free initial consultation is available to discuss whether this approach is the right fit for you.

Christmas. A magical time of lots of family. The thought of navigating the holiday season with your children and parents can spark both joy and mild panic in equal measure (approach/avoidance). So here’s a little guide to help you keep your sanity while still enjoying the festivities.

Let’s start with your expectations. Not every gift exchange will be heartwarming, every meal exceptional and emotive, and every family game a laugh-filled success. For many there will be burnt turkey, awkward silences and someone inevitably arguing.
Tip: Try to let go of perfection. In CBT terms, notice your expectations, label them as and ask yourself: Does this expectation help me enjoy the day, or just set me up for stress? The more you let go, the more stuff you can do without feeling like all has failed.

Have some structure and realistic scheduling. This is however not a work environment so the festive season should not only be consisting of tasks.

• For kids: Plan a few activities, but keep them short and sweet — little wins help build up momentum.
  
• For parents: Build in quiet moments. Even a short coffee break or a stroll can keep tempers cool.
  

Misunderstandings multiply around the table. Here’s a simple framework:

• Express, don’t explode. When you’re rushed or forcing yourself to be in a good mood, delaying responses to your anger and frustrations may help.
• Set gentle boundaries. It’s okay to say: “I’ll help with the kids for an hour, then I need a break.”

Family members often have different values or opinions. Instead of rolling your eyes, try curious observation. Ask questions, listen actively and notice when you get triggered without having to then engage in a battle (I disagree but I don’t have to force my opinion onto others).
CBT twist: notice your internal reactions, label them, and choose a response that works for you. It’s a tiny exercise in emotional regulation — and it works wonders over Christmas dinner.

Christmas with children and parents doesn’t have to be a minefield. With flexible expectations, structured time, gentle boundaries, curiosity and humour, you can survive — and maybe even enjoy — the holidays.

Obsessive-compulsive disorder (OCD) is typically treated with SSRIs and Cognitive Behavioural Therapy. Many patients are interested how they can make use of supplements as an adjunct to conventional treatment approaches. Research on supplements is still somewhat limited but growing.
See below summary for supplements that have some clinical evidence. For each supplement we note what the treatment mechanism is and what trials show. Always discuss supplements with your doctor as they can interact with medication and have side effects. This is not medical advice.

NAC is an antioxidant that is derived from cysteine. It modulates glutamate neurotransmission. In OCD trials (typically over 12 weeks using 2.4–3.0 g/day), NAC has reduced symptom severity. A systematic review found NAC “reduces the severity of symptoms, with a good tolerability profile”. It may help with compulsions and is often studied as an add-on to SSRIs. Typical dosage is 2–3 g/day (split AM/PM).

• Mechanism: Increases brain glutathione (antioxidant) whilst regulating glutamate, which may calm overactive brain circuits that are linked to OCD.
  
• Evidence: Several small trials/case reports indicate a beneficial effect. For example, one trial showed significantly lower Yale–Brown OCD scores on NAC vs placebo. (However, studies are small and more research is needed.)
  
• Safety: Well-tolerated; common side effects include mild nausea, rash, constipation or gas. It has a sulfurous odor (odorless formulations exist). No major drug interactions noted, but always check with your doctor.
  
• Caveat: NAC is NOT to be seen as a replacement for standard OCD treatments. It’s an adjunct (often used with medication/therapy).
  

Myo-inositol (MI) is a nutrient that is in involved in cell signaling (including serotonin and glutamate pathways). In one placebo-controlled trial, 18 g/day of MI (monotherapy) improved OCD symptoms. However, adding MI to an SSRI offered no additional benefit over SSRI alone. This suggests MI might help some patients if used instead of (not with) medication. Research is limited.

• Mechanism: Influences inositol-related signaling in neurons. This could be affecting neurotransmitters involved in OCD.
• Evidence: One study with a small sample size found that MI alone reduced OCD severity. But the evidence is quite sparce.
• Safety: High doses (15–18 g) are required and side effects are mostly GI (bloating, gas, diarrhea). These usually lessen over time.
• Note: MI is generally safe but high-dose powders are bulky.

Omega-3s (fish oil) have many anti-inflammatory and neuroprotective effects. However, one small trial (11 OCD patients that were on a stable course of SSRIs) added 2 g/day EPA and found no significant improvement that was beyond placebo. The current state of evidence does not support omega-3s for OCD specifically. However, omega-3 supplements are generally safe and may infer benefits for mood and heart health.

• Mechanism: Omega-3 is thought to modulate neuronal membranes, inflammation and neurotransmission. The exact effect on OCD is unclear.
  
• Evidence: Only one published OCD trial (EPA vs placebo) which showed no benefit. Meta-analyses have found a beneficial impact of omega-3s with depression/anxiety. Trials focused in treating OCD are however lacking.
  
• Safety: Side effects are mild (heartburn and nausea). Beware that high doses can thin blood.
  
• Caveat: Omega-3s can be used for general health, but are not a replacement for OCD therapy.
  

St. John’s Wort is an herbal antidepressant with mixed results for treating OCD. An early open-label study showed symptom improvement, but a subequent trial found no benefit over placebo. In general, SJW appears to be ineffective for treating OCD.

• Mechanism: May increase serotonin (among other neurotransmitters), but its effect on OCD circuits is unproven.
• Evidence: Only two small studies exist. The controlled trial failed to show an improvement. SJW may help with treating comorbid depression, but not OCD.
• Safety: Side effects can include insomnia, headache and GI upset but are usually mild. Important: SJW strongly interacts with many medications (SSRIs, birth control, anticoagulants) and it can make sense to avid taking it when taking other drugs.
• Caveat: Due to a lack of benefit and potential drug interactions, SJW is generally not recommended for treating OCD.

These herbal remedies have one small trial each for managing OCD (from the same research group out of Iran).

• Borage: An Omega-6 source thought to affect serotonin transport. A 4–6 week trial reported reduced OCD and anxiety symptoms with borage extract. However, this is preliminary. Use only PA-free (pyrrolizidine alkaloid-free) borage products to avoid toxicity.
• Milk Thistle (Silybum marianum): Traditionally a liver tonic. One trial (6 weeks) found results that are comparable to fluoxetine in OCD. But this is a single study and unreplicated.
• Caveat: Because the available data is weak, borage and milk thistle remain unproven. Discuss liver enzymes and pay attention to quality if considering them.

These are natural serotonin precursors. No controlled studies show any benefit for treating OCD. High doses can cause fatigue, headache and nausea. Combining them with SSRIs can trigger serotonin syndrome (overload of serotonin). Due to lack of proof and safety concerns, tryptophan/5-HTP are not recommended supplements.

Some nutrients have been studied: OCD patients often have low vitamin D and occasionally low B12 or folate.

• Vitamin D: Studies find most OCD patients are vitamin-D deficient and low vitamin D correlates with worse OCD symptoms. No large trials have tested high-dose vitamin D in OCD, but correcting a deficiency is wise for overall brain health which may help boost mood. It is recommended to use standard doses and avoid exceeding safe upper limits.
  
• B Vitamins: Low B12 (and sometimes low folate) have been observed in OCD cohorts. While supplementing a deficiency is important, there’s no strong data that extra B12/folate meaningfully reduces OCD symptoms.
  
• Other Minerals: Magnesium and zinc can support general nervous system function. No specific OCD trials exist.
  

Supplements can be a useful aid alongside standard OCD treatments, but they are not replacements for medication or cognitive-behavioural therapy. Always talk to a doctor before starting any supplement. Reliable brands are recommended in order to ensure quality. Feel free to contact me for a free consultation to see if Cognitive Behavioural Therapy next to taking supplements could be useful for you.

Cognitive Behavioral Therapy (CBT) in Richmond is common and represents an effective set of approaches that are effective for the treatment for a variety of mental health conditions. These include anxiety, depression and obsessive-compulsive disorder. Third-wave CBT approaches such as mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT) and dialectical behaviour therapy (DBT) differ from Beckian Cognitive Therapy by incorporating concepts like mindfulness, acceptance and emotional regulation. Third wave approaches often don’t focus on challenging thoughts. An emphasis is on changing behaviours. These more modern approaches have measurable effects on the brain. Understanding which areas of the brain are impacted by third-wave CBT can provide insight into how these therapies facilitate psychological change.

Third-Wave CBT: An OverviewThird-wave CBT approaches lay an emphasis on acceptance and the relationship individuals have with their thoughts and emotions. Unlike traditional Beckian Cognitive Therapy, which focuses on identifying and restructuring distorted thoughts, third-wave therapies help individuals change the relationship with relevant internal experiences by observing thoughts, accepting discomfort whilst engaging in a direction that is in line with one’s values. Mindfulness meditation, defusion (observing internal experiences) and emotional regulation represent important elements.

Key Brain Areas Impacted by Third-Wave CBT1. Prefrontal Cortex (PFC): Enhancing Executive ControlThe prefrontal cortex is responsible for executive functions such as decision-making, impulse control and emotional regulation. Mindfulness-based approaches like MBCT strengthen the PFC by improving self-awareness and cognitive flexibility.

• Impact of Mindfulness and ACT: Regular mindfulness practice is an element of third-wave therapies which increases activity in the PFC. This enhanced activation allows individuals to pause and respond to situations rather than reacting impulsively.
• Emotional Regulation: By strengthening the PFC, third-wave CBT helps clients manage emotions and reduce rumination.

The PFC may be underactive in problems such as anxiety and depression. Third wave therapies restore balance and improve mental clarity.

2. Amygdala: Reducing Emotional ReactivityThe amygdala is a small almond-shaped structure deep in the brain and plays a role in processing emotions, particularly fear and stress responses. With anxiety, PTSD, or depression, the amygdala is often hyperactive which can lead to heightened emotional reactivity and a subsequent exaggerated stress response.

• Impact of Mindfulness-Based Techniques: Mindfulness meditation, a central component of third-wave CBT, reduces amygdala activation. Regular mindfulness practice helps individuals observe emotions without these controlling their life.
• Cognitive Defusion in ACT: Cognitive defusion as used in ACT, allows clients to learn to see thoughts as mental events rather than absolute truths. This also helps to reduce emotional reactivity. By learning to observe distressing thoughts, the amygdala's stress response gets less.

This change allows individuals to manage situations with greater calm.

​3. Anterior Cingulate Cortex (ACC): Improving Attention and AwarenessThe anterior cingulate cortex (ACC) is involved in attention regulation and emotional awareness. Third-wave therapies, particularly mindfulness-based interventions, strengthen the ACC’s role in maintaining focus whilst minimising mental interference.

• Mindfulness and Focus: MBCT and DBT help people focus on the present, improving the ACC’s ability to sustain attention.
• Reducing Rumination: By enhancing the ACC’s function, third-wave CBT helps individuals break free from patterns of overthinking and rumination which is common in depression and anxiety disorders.

Strengthening the ACC supports a more balanced response towards daily stressors.

4. Insula: Increasing Interoceptive AwarenessThe insula is a region of the brain related to the awareness of bodily sensations such as the heartbeat, breathing and emotional states. Third-wave CBT approaches, particularly mindfulness and ACT, emphasise body awareness.

• Mindfulness Meditation: Practices like body scans activate the insula, thereby increasing awareness of bodily sensations and their connection towards emotional states.
• Emotional Acceptance: By improving interoceptive awareness, third-wave CBT helps clients accept discomfort and respond to emotions in a better way.

This heightened connection between body and mind fosters helps in many ways.

Neuroplasticity: The Brain’s AdaptabilityThird-wave CBT impacts the brain in ways that lead towards neuroplasticity, the brain’s ability to reorganize itself by creating novel neural connections. The regular practice of mindfulness, acceptance and emotional regulation related techniques strengthens connections between the prefrontal cortex, amygdala and other relevant regions.

Perfectionism can sometimes lead to excessive self-criticism and an unhealthy pursuit of unattainable standards. While striving for high standards can be positive, some types of perfectionism can bring significant emotional and mental distress. Types of distress that are common include anxiety, procrastination and burnout. Cognitive Behavioural Therapy (CBT) is an approach that helps address the harmful effects of perfectionism. This is how CBT can help you take practical steps toward finding balance:

1. Understand Yourself:
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First you need to understand what perfectionism looks like for yourself. Some for example engage in a critical self focus which keeps them stuck by preventing them from expanding their behavioural repertoire.


2. Unrealistic Standards:

Perfectionism can make people set unattainable goals whilst feeling defeated when they’re not met. Not feeling good enough deep down can make people always want to change their current state, whilst pursuing the futile quest of chasing unrealistic goals.

Perfectionism can make people view outcomes as either total successes or absolute failures.

Fear of Failure: Some people procrastinate because of the fear of not meeting their unrealistic standards.

The first step in overcoming perfectionism is understanding these patterns and recognizing how they contribute to stress, procrastination and maintain low self-esteem.

3. Be aware of Perfectionist Thinking:

CBT helps individuals identify and manage unhelpful thoughts. This includes:
Write down perfectionistic thoughts like, “If I don’t do this perfectly, I’m a failure,” and try to understand how this fits within the overall presentation of yourself. Being aware when these thoughts play out AS THEY OCCUR will help you not recognise that you are not your thoughts and you have far more control of what and how you do what you do in your life.


4. Defining Goals:

Set goals that are beneficial for yourself. It is crucial to avoid the trappings of over extending yourself after you have met predefined goals. Have a baseline that you want to cover and do not indulge in self criticism if you do not regularly exceed that baseline. Over extending yourself can become an addiction.

Focus on Progress: Shift the emphasis from achieving perfection to making consistent progress that is not black and white (do not do a lot one day and very little the other).

By adopting a more realistic approach, you’ll find tasks less daunting and more attainable.


5. Embrace Imperfection

Intentional Imperfection: Try completing a task to a “good enough” standard rather than a perfect one. For example, send an email without endlessly reviewing it.

Reflect often: Look back at your behavioural patterns and reflect how these interacted with aspects of your environment. If you know what drives your perfectionism and other problems then you will learn how so many helpful things such as understanding what prevents the snowball from getting bigger.

Overcoming Procrastination: Break tasks into smaller, actionable steps.

Balance Rest and Work: Schedule regular breaks and set boundaries to avoid burnout. Remind yourself that rest is essential for productivity.

By addressing these patterns, you can establish healthier routines and reduce stress.

6. Build Resilience to Criticism

A common fear among perfectionists is external judgment or criticism. CBT equips individuals with tools to cope:

Reframe Criticism: View feedback as an opportunity to grow rather than a personal attack.
Role-Playing: Practice responding to imagined criticisms in a therapy session to build confidence for handling real-life situations.
Learning to accept constructive feedback without equating it to failure will help you overcome perfectionism.

There are many ways to work on perfectionism and what is best for some may not be a good solution for others. In order to understand how you can best work on your own perfectionist tendencies, you need to understand yourself and then make use of that understanding in the best way you can. It does not make a difference whether you try and use CBT for perfectionism through in person sessions, online therapy or over the phone. Research has shown that all of these mediums are effective in treating perfectionism.