Vajra Blue

Mindfulness and Compassion. Understanding trauma in young people.

Mental health: taking a BET on treatment.


Mental health has become a major concern of the modern world.

There are rising levels of depression.

Ever increasing numbers of work hours are lost to stress and related disorders.

There seems to be an epidemic of suicide and self harm among the young.

Current treatment regimens seem to rely too much on medication, often as the only intervention, and fail to address the holistic picture.

The way treatment is funded makes a significant contribution to this. A diagnostic code is required by insurance companies and HMOs before they will pay for treatment. The interventions they then offer are tightly controlled to keep costs down, and so rarely seem to allow for adequate periods of psychotherapy, or other non-medical treatment.

Other factors that contribute to this world wide phenomenon of increasing numbers of people with mental health difficulties, are individual lifestyle, changes in community living, increased stressors in daily life, and where mental health problems are related to substance use, to personal choice.

The presentation of most mental health problems involves the interaction between our Behaviour, Emotions, and Thoughts. All three of these are in a close relationship. Behaviour can alter our emotions, and at the same time emotion can change our behaviour. The same is true for our thoughts and emotions, and for our thoughts and behaviours. If we change one of them we can bring about a change in the others.

What we choose to pay attention to becomes our reality.

In medical, and other professional practice, there is a difference between treatment and therapy.

Treatment is the overarching plan to provide help, and will address different aspects of the problem from several different directions. Social, medical, psychological, physical etc.

A therapy is the intervention that we use to bring about change in each of these domains. Therapies target one or more of them. Systems theory suggests that if we cause a change in one part of a system, then other parts will change too.

Carefully choosing which symptoms to treat, and how to do so, can lead to the use of the smallest intervention needed to bring about long lasting change. This idea underlies the use of Solution Focussed Brief Therapy and Single Session Therapy, as a way to provide cost effective and lasting change.

The close relationships between these three not only allows therapists to find various different options for helping every individual they see, but also gives us several pathways to bring about change in ourselves. We can find a way in to help through our choice of which bit of BET to use.

One major advantage of this open approach to helping, is that it makes it easier to work with a wide range of cultures and individuals, by adopting the approach that suits them best.


This is the easiest part of the triad to spot. Our behaviour reflects the content of our internal world, when we are struggling our behaviours tend to be unhelpful, and changing our habitual patterns can have marked benefits for our well being. When we change our behaviour it causes alterations in our emotional and cognitive responses.

If we can spend more time doing things that we enjoy, and that we are good at, especially if we do so in company, then we will have more positive experiences. This means that we will improve our self esteem, develop greater confidence, and produce changes in our sense of self.

It is not events that cause us difficulty, but rather how we think about them.


Where emotions are concerned the aim is to free ourselves from unwanted mental states. We can learn to tolerate our emotions as they are, and develop a more accepting state towards them. This involves the development of more self compassion, allowing us to have a greater, empathic understanding of our present state.

Developing this ability can help to counter act the effects of complex trauma generated by various forms of abuse. Distress, generated by everyday setbacks, is seen as intolerable, and this often leads to self harm, which can reduce, or even abolish the emotion. Self harm generates strong emotions in others, and the feeling that no-one can cope with these feelings only makes them more intolerable. The cycle then continues.

Mindfulness, and the development of self compassion, form a significant part of the succesful therapies for this kind of difficulty. They permit us to handle our emotions more successfully by giving our feelings both an accurate label, and the realisation that they are only short-lived.

Taking up a reflective practice, such as yoga, mindfulness, journaling, or Tai chi, can contribute to detecting these unhelpful thoughts, resulting in fewer periods where negative emotions can be present. If we notice such thoughts we can challenge our emotional attachments to them, and, at the same time, we will become aware when we display positive mental states that might otherwise go unnoticed.

Comparatively simple lifestyle changes such as exercise, improving our sleep, and choosing a sensible diet all bring additional benefits for our mental health and well being. Greater physical fitness and greater resistance to everyday illnesses are additional benefits.


How we think about events alters our emotional state – usually for the worse. This means that we tend to withdraw from situations and isolate ourselves. The resultant reduced social contact leads us to think in more negative ways, resulting in rumination. This triggers the body to go into protective mode, and at times can trigger a full on fight or flight response.

Rumination is where we go over our negative thoughts over and over again, and results in worsening mood.

If we are gong to challenge our thoughts there are several actions that we can take.

1. Reflect.
This involves making the effort to become aware of our thoughts, and then thinking about how we think.
What is the nature of our thinking?
What triggers particular chains of thought?
What is the result of this way of thinking?
This questioning helps us to become aware of our cognitive errors, and the unhelpful modes of thought that we use in habitual ways. Reflection also allows clarification of any associated change in our emotions.

2. Dispute.
Thoughts are just thoughts. They reflect how we feel and are not necessarily true. It is important to challenge any irrational thoughts, by looking for evidence both for and against them and checking them against reality. Just because somebody is looking in your direction does not mean that they are looking at you. If someone laughs, it is probably not at you.

3. Emotions.
These often trigger our thoughts. If there is no clear trigger for an emotion, the mind will often invent one by adding thoughts to go with the feeling. If we reflect upon our emotional states we will gradually be able to see this process in action. We will come to see these thoughts for what they are; wrong, exaggerated, and irrelevant. This association of thinking with mental states helps to explain why many hungry people find the rest of us to be annoying!

4. Mindfulness.
If we can be mindful and start to live in the present moment, then we can stay open-minded about our thoughts. By being curious, and observing our mental state, we can avoid ruminating on the past or obsessing about the future. This leads to less depression and anxiety. What we choose to pay attention to becomes our reality.

Taking up habits such as a “what went well” diary, or practicing gratitude, can help us to find alternative viewpoints, generate more solutions, and see the positive in any given situation as well as the negative. This can only help us to tolerate the emotions that we do have.

To take steps to improve our own mental well being is sensible. If we can develop greater awareness of our inner and outer worlds, we can then act in a timely manner to adjust the things that we do, or think, in order to maintain stability in our world. Such self-care may well mean that we will not need anyone else to develop a treatment plan for us, instead we can provide our own therapy.

Practicing mindfulness is just one of many steps we can take to look after our own mind.


Author: SandySB

Child and adolescent psychiatrist. Parent. Blogger.

2 thoughts on “Mental health: taking a BET on treatment.

  1. As a Buddhist and someone who suffers from depression I find your post relevant. My main tools to work with my depression are mindfulness, making sure I interact with people. and having interests which engage me! I find formal meditation often makes the depression worse so I am flexible about how much I do.


    • I agree that mindfulness is not a cure all. It means that we have to spend time with our self. Not always a pleasant experience.

      We end up face to face with our thoughts. When depressed they will be dark making us worse.

      Balancing mindfulness with that in mind is difficult.

      Sitting with thoughts is hard enough without the added bleakness of depression.

      I find a little and often works best when my mood is low.
      A bit more and regularly when I am more resilient.
      May you be well.