Fight or Flight

lucyDr. Lucy Oldfield is a practising Clinical Psychologist working in a primary care adult mental health setting in the NHS alongside  lecturing at Goldsmiths on the Foundations in Clinical Psychology and Health Services MSc programme. Her clinical work is focused around anxiety and mood disorders with a specialist interest in Post-Traumatic Stress Disorder.

Here, in honour of #TimeToTalk Day, she recounts recent work for iCope on specific phobia. 

This piece was originally published here.


Jessica* had a lifelong phobia of butterflies but being a new mum she was very conscious of transferring this phobia to her two-year-old son.


“I’d put myself in dangerous situations before. I had run onto a road of traffic without any control because a butterfly had come near me and I’d never want to be in that kind of a position while I was holding my little boy’s hand. I was also having panic attacks and dealing with stress at work too, so I self-referred to iCope. And, I have family who are based in the Philippines. So although the UK isn’t scattered with butterflies there are large breeds in my home country and it used to really put me off going there.”

iCope is a psychological therapies service, they provide talking therapies and work with a range of conditions including stress, worry, depression and insomnia. Clinical Psychologist, Dr Lucy Oldfield, who worked closely with her, explained: “I met Jessica for a face-to-face assessment to get some more detail about the problem. “Treatment for phobias, anxiety and panic is psychological, and ultimately it is about exposing the person to their fear in gradual steps but to tackle this you need an overarching understanding of their condition. “There was a particular traumatic event in her history which she hadn’t connected to why she had this phobia. It was an important factor in itself because she was feeling very ashamed of being afraid of butterflies and thought most people would think this was a silly fear and that it didn’t make sense. “Jessica was also having panic attacks when there were no butterflies around. On her way into work she would sometimes feel very nervous and think she needed to get off public transport. We realised this was all connected as fear of fear.”

There were a number of stages to her treatment. Jessica explained, “We created the behaviour that someone displays during a panic attack. For me, I would start breathing differently and we experimented with that. This was before we began to look at my phobia.“ The first stage was to outline the most feared outcomes in a gradual order. For example, it was anything from saying the word ‘butterfly’ which was making Jessica feel sick and disgusted, to actually physically seeing the insect. The treatment involved confronting each item in the list head on as quickly as possible. Jessica said: “In the early stages we began by drawing butterflies on paper, we’d cut them out, throw them in the air to simulate their flying which initially made me feel very anxious and panicky but became fun over just a few minutes. After that session I continued doing this at home. I played a game with my son, colouring in and drawing butterflies. I did feel like I was making progress. Then we began looking at photos, still images, colour, black and white. I had control over the computer and was choosing the right image. I was looking at the screen long enough that the physical symptoms actually subsided and I learned that the panic was easing.”

Exposure to these fears allows us to rationalise what is happening at the emotional, ‘felt’ level, so it is powerful to learn that anxiety always drops if we stay in the situation for long enough. Lucy explained: “The session was going well, but at the end a picture jumped out. It was a huge butterfly which looked as if it was on somebody’s face. This was the first time I witnessed the peak of Jessica’s anxiety. She sprang off her chair, onto the other side of the room, cowering, clearly very distressed. She was very embarrassed about it but it was useful for me to see, because if we were outside she may have run into a road – she didn’t have any control over it. These kinds of reactions are useful for me to use as a learning tool.” Jessica went away and decided to look at more pictures on the internet, then she started to watch documentaries.

Before the next step – seeing a real butterfly. “I went to an exhibition at the Natural History Museum and looked at the cases of dead butterflies. I felt like I had learnt to manage my emotions.” But that wasn’t the final step – the final step was to face her fear. “We went to an exhibition where there were real butterflies. Initially, I was very calm but as we got tickets and walked towards it my panic increased. Before we walked in, there were some strips of plastic and I didn’t want to go in but we spend a lot of time recapping what I had learnt. “I knew that the worst thing for me would be coming so far and not being able to actually walk in and face my fear. We began by putting one hand through the gap, one foot and then we were inside. I did jump a few times but after a while I was walking around myself. Although I was feeling panic-stricken it was nowhere near how I felt before the treatment.”


*Jessica is not her real name

Dr. Lucy Oldfiewld is on Twitter @oldfieldLucy




Why a lack of sleep makes us depressed … and what we can do about it

Alice_Gregory_Oct_2015Alice M. Gregory is Professor of Psychology at Goldsmiths, University of London. She is a member of the Advisory Board for a digital parent education endeavor on infant and toddler sleep that is being supported by Johnson’s Baby. She is a Corresponding Editor (Sleep) for the Journal of Child Psychology and Psychiatry. She has previously received funding to support her work from multiple sources including the MRC, ESRC, Leverhulme Trust and the British Academy. She is a member of the Labour Party. She is currently writing a book (Nodding Off: Sleep from Cradle to Grave) to be published by Bloomsbury Sigma in Spring 2018.

Alice M. Gregory, Goldsmiths, University of London

Historically, insomnia has been thought of as secondary to other disorders such as depression. The idea was that you became depressed – and that your sleep got messed up as a consequence. This might involve difficulty falling asleep, excessive time awake at night or waking up earlier than hoped.

This may make sense to those who have experienced depression and found that thoughts of distressing events such as of a deceased loved one, or previous failures, keep them awake at night. The possibility that depression leads to insomnia is also consistent with research in which I have been involved – where we found that adults with insomnia were more likely than others to have experienced anxiety and depression earlier in life.

But could things really be the other way around? Could poor sleep be making you depressed? Over the past decade or so it has become increasingly clear that disturbed sleep often comes before an episode of depression, not afterwards, helping to do away with the notion that sleep problems are secondary to other disorders.

This is not too hard to relate to either – just think about how you feel after you have slept poorly. Perhaps you feel tearful or snap at those around you. The literature seems to back up the idea that our ability to regulate our emotions is reduced after a bad night’s sleep. Insomnia has also been shown to predict depression defined according to diagnostic criteria.

So why does poor sleep lead to depression? Lots of different mechanisms have been proposed. To give just a few examples, let’s start by thinking about our behaviour. I, for one, am more likely to cancel an evening out with friends or an exercise class after a poor night’s sleep. This could be part of the problem, as such events are exactly those that may help to keep depressive symptoms at bay.

If we think about what happens to the brain when we miss sleep, there are clues as to why sleep and depression are linked. One study on this topic focused on an area of the brain called the amygdala. This is an almond-shaped structure located deep in the brain that is believed to play an important role in our emotions and anxiety levels.

It was found that participants who had been sleep deprived for approximately 35 hours showed a greater amygdala response when presented with emotionally negative pictures when compared to those who had not been sleep deprived. Interestingly, links with parts of the brain that regulate the amygdala seemed weaker, too – meaning that the participants were perhaps less able to control their emotions. Such findings could help to explain how poor sleep may actually cause difficulties such as depression.

Inherited insomnia

Over the years, my own work has taken a behavioural genetic perspective in an attempt to understand the links between poor sleep and depression. From my twin research and work led by others it seems that poor sleep and insomnia symptoms could be, to some extent, part of the same genetic cluster – meaning that if we inherit genes which make us susceptible to insomnia, we may also be vulnerable to depression.

Lonely hours.

When trying to explain the link between sleep and depression, I’m also intrigued by recent work on the immune system and depression. Studies have found that those suffering from, or at risk of, depression may show high levels of inflammation in their bodies. Their immune systems appear to be in hyper-drive as if they’re fighting infection or healing from injury. When we disturb or restrict sleep we may also experience inflammation, so perhaps inflammation could also help to explain the link between sleep and depression.

So what can we do about it? It has been proposed for some time now that by improving sleep we can perhaps prevent or treat depression. Recently, data have started to emerge from studies suggesting that this may indeed be the case. For example, researchers at the University of Oxford in collaboration with the psychological therapy provider Self Help Manchester evaluated whether an online treatment for insomnia reduces symptoms of anxiety and depression. They advised people with these difficulties to take steps such as keeping a consistent wake time, getting out of bed when they can’t sleep, and challenging beliefs that a bad night’s sleep is incapacitating.

They found that both anxiety and depression symptoms were reduced after insomnia treatment. Other groups are currently looking at whether by improving our sleep we can reduce other types of psychiatric difficulties, too. But even before this work is complete, the take-home message from research to date is clear: we need to begin to prioritise our sleep.

The Conversation

Alice tweets about sleep at @ProfAMGregory

Alice M. Gregory, Professor of Psychology, Goldsmiths, University of London

This article was originally published on The Conversation. Read the original article.

How are you? Mental Health Awareness in Higher Education

JonesSianEToday is World Mental Health Day. Two years ago, Dr. Sian Jones, a Teaching Fellow in the Department, blogged on mental health awareness in undergraduates.

She says “Today, there is more awareness among students and beyond – and more research (check out Alex Haslam’s research in evidence of this).

Yet, undergraduates I see still worry that they are the only ones not coping. This is definitely not the case – and anyone experiencing mental health difficulties is not alone”. Read on...

Goldsmiths Students: If you or a friend is experiencing difficulties with their mental health, check out the range of support available at the Student Centre.

Through the Academic Looking Glass

Earlier this month, TimetoTalk held their first ever time to talk day, to encourage us to talk about mental health, by doing simple things, like asking people how they are when you meet them.  Since university mental health awareness week (with a focal day on 19th February) ends today, and bearing in mind my experience with students, I feel the time is ripe to do as the organizations have been urging, and help raise awareness of student mental health. Here goes…

I’ll frame it around the lecture I’m giving this evening. Part of the lecture is about the power of descriptive group norms to guide behaviour. This has been shown powerfully in studies by Dr. Andrew Livingstone, now at the University of Exeter. His research focused on students, and showed that participants with a positive attitude to heavy drinking and who identified strongly with the ingroup reported stronger intentions to…

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Memory and sense of self may play more of a role in autism than we thought

lornaimageLorna Goddard, Goldsmiths, University of London

It’s well-known that those with autism spectrum disorders including Asperger’s syndrome develop difficulties with social communication and show stereotyped patterns of behaviour. Less well-studied but equally characteristic features are a weaker sense of self and mood disorders such as depression and anxiety. These are connected with a weaker ability to recall personal memories, known as autobiographical memory.

Research now suggests that autobiographical memory’s role in creating a sense of self may be a key element behind the development of autistic characteristics.

Autism is much more common in men than in women, to the extent that one theory of autism explains it as the result of an “extreme male” brain, where autistic females are assumed to be more masculinised. Historically, however, research participants have been predominantly male, which has left gaps in our knowledge about autism in women and girls. Psychologists have suggested that the criteria used for diagnosing autism may suffer from a male bias, meaning that many women and girls go undiagnosed until much later in life, if at all

What we remember of ourselves

This is supported by research that suggests women with autism develop different characteristics than autistic males – particularly in respect to autobiographical memory.

Personal memories play a key role in many of the psychological functions that are affected in those on the autistic spectrum. Personal memories help us form a picture of who we are and our sense of self. They help us predict how others might think, feel and behave and, when faced with personal problems, our past experiences provide insight into what strategies we might use to cope or achieve our goals. Sharing personal memories in conversation helps us to connect with others. Recalling positive memories when we feel down can help lift us up, while dwelling on negative personal memories can induce depression.

What’s become clear from studies of autobiographical memory in autism is that while those with autism may have an excellent memory for factual information, the process of storing and recalling specific personal experiences, such as those that happened on a particular day in a particular place, is much more difficult. Instead, their memories tend to record their experience in general terms, rather than the specifics of the occasion. This might be due in part to their more repetitive lifestyle, in which there are less occasions that stick out as memorable, but also because they are less self-aware and less likely to self-reflect. However, our research suggests that this memory impairment may be exclusive to autistic males.

Missing or indistinct memories can add to the sense of otherness, confusion and anxiety experienced by autistic people.

Divided by memory

We examined the personal memories of 12 girls and 12 boys with autism, and compared them with an equal number of girls and boys of similar IQ and verbal ability without autism. We asked them to remember specific events in response to emotional and neutral cue words such as “happy” and “fast”. We also asked them to recall in as much detail as they could their earliest memories, and recollections from other periods of their life.

We know that girls tend to demonstrate better verbal skills and are better at recognising emotions. Might this affect the content and degree of detail they could recall from their own memories? We also wondered whether any gender differences we might find would be replicated between boys and girls with autism, or whether autistic girls would be more like boys – as predicted by the extreme male brain theory.

What we found was that autism did lead to less specific and less detailed memories, but only for the boys. The girls with autism performed more like non-autistic girls – not only were their memories more specific and more detailed than the autistic boys, but like the girls without autism, their memories contained more references to their emotional states than both the autistic and non-autistic boys. So rather than an extreme male brain, the girls with autism were more like girls without autism.

This better autobiographical memory might be one reason why autistic females are often better at masking the difficulties they have with communication and socialising with others, and so are more likely to go undiagnosed. Of course, this poses the question that if they have the building blocks of good communication – access to detailed personal memories – why are they still autistic?

There is some evidence to suggest that the automatic connection between our memories and knowing who we are, and how to use this information to inform how we act in problematic situations, is weaker in those with autism. This means that while women with autism can recall the past, they may not be using their experience to help them understand themselves and solve personal problems.

Even though they may be better able to socialise than boys with autism, this may come at a cost, as greater social interaction brings with it more personal problems, and when problems seem overwhelming this can lead to depression. Indeed, recent research suggests that among those with autism, depression in more common in women than men. This gender difference with respect to personal memories is an aspect of autistic characteristics that has been little studied, and should be explored further.

Lorna Goddard, Lecturer in Psychology, Goldsmiths, University of London

This article was originally published on The Conversation. Read the original article.

Brexit, it’s stressing me out


hosangDr. Georgina Hosang is a Lecturer in the Department of Psychology at Goldsmiths, University of London. Her research concerns the role of life adversity  and medical burdens for those with mental illness and the gene-environment interplay in mood disorders (Major Depression & Bipolar Disorder). Here, in the second of our Brexit-focussed posts, she considers the psychological stress that may come with Brexit. 

Strong reactions (‘tears and cheers’) to Brexit and the EU referendum have been observed among the British public. Some people may be surprised at these strong reactions and here we will explore the referendum using a psychosocial stress framework to understand why people are so affected by this political event. Other theories and frameworks could and have also been applied to Brexit.

Stress, more specifically psychosocial stress, is a common human experience (I’m sure you can recall a time when you felt stressed….) and can be defined as a process in which environmental demands exceed the individual’s adaptable capacity resulting in psychological and biological changes (Cohen, Kessler & Underwood-Gordon, 1995). Psychosocial stress covers frequent minor stressful incidents (eg. getting a parking ticket) and serious life changing and stressful events (eg. bereavement) (Kanner, Coyne, Schaefer & Lazarus, 1980). The origins of psychosocial stress may stem from events in our personal lives but may also come from those occurring nationally or globally (eg. political events or natural disasters) (Dohrenwend, 2006).


There are a number of reasons why people may have experienced the process and result of the EU referendum as stressful, regardless of which way they voted. The process often involved debate on the topic amongst colleagues, friends and family. On a larger scale a series of public debates also took place with several being televised and viewed by many. For some people such debates resulted in tension and even conflict (Guardian, 2016), which are known to be a source of stress (Dohrenwend, 2006). Moreover, the tone of the referendum campaigns was criticized for being negative, intolerant and toxic (Sky News, 2016) likely to further fuel conflict.


People’s reasons for voting to Leave or to Remain in the EU varied (Lord Ashcroft Polls, 2016), with immigration, the economy and values (eg. sovereignty or global role and peace) frequently cited (BBC, 2016; Pro Europa, 2016). Ultimately the Leave result is likely to evoke a sense of loss not just of the membership of the EU, but also the idea of European unity and peace, especially among Remain voters (BBC, 2016). Such a sense of loss is known to generate stress and is considered in the main stressful life events classification systems (Hosang et al., 2012).


The outcome of the referendum will have ramifications for us all (good and bad), although these are not entirely clear and haven’t happened yet.  Within the context of stress these future ramifications could involve the threat of future loss. For instance anticipated loss of opportunities has been reported as a concern amongst some Britains (Guardian, 2016). Moreover, the resignation of several political figures including the Prime Minister, has left the country in a state of flux and uncertainty which may further compound the stress the referendum has generated across the country. Both the threat of future loss and intolerance for uncertainty have been empirically linked to anxiety (Kendler et al., 2003; Carleton et al., 2012).


Against this background it is clear that the EU referendum may have been experienced as a stressful event for a variety of reasons. Several of these reasons involve politicians (eg. resignation of politicians) and political campaigns, but also involve conflict with friends and family. People respond to stressful events differently (Belsky & Pluess, 2009; Hosang et al., 2014), including depression (Hosang et al., 2012) and anger (Aseltine, Gore & Gordon, 2000), while others seem to cope well. Reports through the media and social media reflect how apparent these responses are amongst Britains.  In an extreme case we saw the murder of MP Jo Cox, which is thought to be politically motivated (Guardian, 2016). This was a very sad and sobering event, but fortunately, such extreme acts of violence are not common reactions. But it does remind us, especially politicians, that we have a duty to act in a balanced and responsible fashion to best manage the stress that such political events can generate for a nation.

Dr. Hosang mitigates against some stressors through Twitter, @DrHosang