Let's talk about…how getting active, being in nature and having CBT can help after you've had a baby

In this episode of Let's Talk About CBT, host Helen Macdonald speaks with Sarah, Sally, and Leanne about Sarah's experience of having Cognitive Behavioural Therapy (CBT) after giving birth. They explore how CBT helped Sarah regain control during a challenging postnatal period, addressing struggles such as insomnia, anxiety, and adjusting to new motherhood.

Sarah shares her journey of balancing therapy with the therapeutic benefits of movement and time spent in nature. CBT therapists Sally and Leanne discuss the powerful combination of therapy, physical activity, and connecting with nature for improving mental health.

Useful links:

NHS Choices- Insomnia-https://www.nhs.uk/conditions/insomnia/

NHS Guidance on feeling depressed after childbirth: https://www.nhs.uk/conditions/baby/support-and-services/feeling-depressed-after-childbirth/

MIND information on how nature can help mental health: https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health/how-nature-benefits-mental-health/

For more on CBT the BABCP website is www.babcp.com

Accredited therapists can be found at www.cbtregisteruk.com

Listen to more episodes from Let's Talk About CBT here.

Credits:

Music is Autmn Coffee by Bosnow from Uppbeat

Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee

License code: 3F32NRBYH67P5MIF

This episode was produced and edited by Steph Curnow

Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen MacDonald, your host. I'm the senior clinical advisor for the British Association for Behavioural and Cognitive Psychotherapies

Today I'm very pleased to have Sarah, Sally and Leanne here to talk with me about having CBT, in Sarah's case, when you've recently had a baby and also the value of getting more active and getting outside into nature and how that can help when you're also having CBT. Sarah, would you like to introduce yourself, please?

Sarah: Hi, I'm Sarah. I'm, 37 from Sheffield and like I said, just recently had a baby, and she's absolutely wonderful. She is a happy, loud little bundle of joy. I ended up having CBT though, because the experience of having the baby wasn't what I thought it was going to be, I think is the reason. And I, just went a little bit mad, so I got some help. Yeah, I'm normally a very happy, positive, active person. Lots of friends, very sociable, always like to be doing things, always like to be in control and have a plan. I like to know what I'm doing and what everyone else is doing. And all that changed a little bit and I didn't really know what to do about it. So yeah, got some therapy.

Helen: Thank you Sarah. So, we'll talk with you a bit more about what that was like. And first, Sally, would you like to just briefly say who you are?

Sally: Yeah, so I'm, my name's Sally. I am a Cognitive Behavioural Therapist, working both in the NHS and in, in private practice at the moment.

Helen: Thank you. And Leanne,

Leanne: Hi, I'm Leanne. and I'm a cognitive behavioural therapist as well. And I also work in the NHS and in private practice with Sally.

Helen: Thank you all very much. What we're going to do is ask Sarah to tell us a bit more about, when you use the term mad, perhaps I could ask you to say a little bit more about what was happening for you that made you look for some therapy.

Sarah: Wel the short answer to that is I developed insomnia about 12 weeks postnatally, didn't sleep for five days. Baby was sleeping better than most, you know, so it was equally frustrating because there was no real reason I didn't think that I should be awake. And sleep obviously is very important when you've had a baby. As I said, I like to be in control, like to prepare, like to know what's going on. So I did hypnobirthing, I prepared, I planned, I packed the biggest suitcase for this birth of this baby that I was really excited for and I thought I'd prepared mentally for every eventuality- what kind of birth, what would happen afterwards, but all very physical because they're the sorts of things that I could understand and imagine. And basically I ended up having an emergency C section, which in the moment I was fine with and I didn't think I was bothered by it, but the level of pain afterwards, that then again affected my level of control over looking after the baby. And the level of debilitation it created that I wasn't expecting- this is the key thing, I wasn't expecting it. That meant that I wasn't able to be me, really. I wasn't able to not least look after a baby, but get myself dressed, get myself showered, walk to the shop, drive a car, play netball, walk my dog. And I wasn't able to do any of that. I didn't appreciate that I was struggling with that, with accepting that. And because it went on for so long, and of course with this comes the baby blues that everyone talks about, but that's meant to only last apparently a couple of weeks. I, you know, you kind of just think, oh, well, I feel all this. I feel pain. I feel sad. I can't stop crying. But all that's meant to happen, all that's normal and it's sort of became the norm. So I was like, well, this is normal. This is how I'm going to feel forever.

At this point I didn't have insomnia. I just could not stop crying. And I mean, like I couldn't, I didn't talk to anyone for two days at one point, because I knew if I opened my mouth to say anything, I would start crying. Like literally anything, I would just start crying. What the clincher for me was when I spoke to a doctor, I thought they were going to say get out and about, do some therapy, which at the time, I'm going to be honest, I thought, I can't sleep. I need a fix now. What I now know is I was doing a lot of behaviours that over time culminated in my body going, you're not listening to me, you're not well. Right I need to do something physical so that you wake up and do something about it. And that was the insomnia. So, I went to the doctor fully expecting them to say, do some mindfulness, do this, do that. And at that point I was just, you need to fix this now. I need to sleep. I need drugs. And yes, that's what they gave me, but they did say you need to do CBT- but what they did say what the first thing the doctor said was, you need antidepressants. Now, as a nurse working in GP surgery for them to jump all the self-help stuff and go take these tablets was like, Oh, right. I'm not okay. and it gave me that like allowance to say, I need to take tablets. But I already had said to myself, but I want to do not just mindfulness and helpfulness for myself. I want to do structured CBT because that way it is something I'm doing to give me back my control and I've got a plan.

And because I already knew CBT was wonderful. Yeah, I didn't really understand what it was, how it worked, the structure of it. And I get that there's different types for different problems. but I knew that's what I wanted to do, once I had tablets to help me sleep and knew the antidepressants were going to work eventually, which did take a while. I was at least doing something myself that would help me forever. And I just thought, what have I got to lose? I need to do something. And until I started CBT, basically, I just felt like I was running around in circles in the dark. And the CBT gave me control and focus and, right, this is what we're doing going that way. Because until I started CBT, you know, I was Googling everything. Right, I'll try this. Right, I'll try that. And because it didn't work within 24 hours, I'd then try something else and try something else. Now it was making it worse, obviously. So, to have the CBT and have my therapist say, do this one thing for a whole week. I was like, all right, okay. That's quite a long time, but there's obviously a reason.

Helen: Sarah, thank you for telling us all about that. What I'm hearing is that you had a combination of massive changes in your life, which will happen when you've had a baby, all sorts of things about the kind of person that you are, kind of added to all your really careful and sensible preparations for having this baby and then really being taken by surprise almost by all the other impact that it had on you and taking a while really to look for help and to look for a very specific kind of help then. And I'm just wondering in the context of all that, what it was like when you first went to see Sally for therapy?

Sarah: Well, like I say, it was brilliant. It was like having someone turn the lights on and point me in the right direction and say, right, head that way and don't turn off and don't go any other direction. Just keep going that way. And it will eventually result in this. It's like if you go to the gym and you're running on the treadmill and you're thinking, well, is this going to achieve what I want it to achieve? And until it does start to, you've not got that positive reinforcement, to keep going. So quite often you stop, and that's what I was doing. I was trying one thing, trying the next, because I was so desperate for it to just go away, this insomnia. Which obviously at the time was one thing, but I understand now there was a whole other problem going on but the insomnia was what I needed fixing. I found CBT for insomnia, but Sally said, do you want to do a more generic anxiety control type approach and I said, yeah, because that's what if before this, you know, five, six years ago, little things would happen.

And I think, Oh, I should do CBT for that. So it's clearly the same thing. So yeah. Why don't we just tackle it as a whole? And that was definitely the best thing to do.

Helen: It sounds as if one of the things that was really helpful was looking at the bigger picture, as well as focusing on taking enough time to make changes. Okay. Can you tell us about the specific things that you did in therapy that you saw as particularly helpful.

Sarah: Yeah. Like you say, what was helpful was being given a timeline really, and a direction. Like I say, when you go to the gym, you're not sure if it's going to work, I had to just trust Sally that what was she was explaining to me was going to work. And of course, at the time I couldn't see how it was going to work, but at least someone I trusted was telling me it will this, just do this?

What was most helpful I could say was being told you've got to do the homework yourself. There's no point in being just told stuff. It was explained to me. And then what was helpful was then being told, go away and do this one thing for a whole week and then we'll review.

So it really just broke down my thoughts, behaviours, my thought processes that I was going at such a hundred miles an hour that I wasn't giving, even giving myself time to think or realise I was having, and essentially that's what CBT is, you know, making you stop, think and unpick your thoughts and your behaviours and then trying to change them accordingly. So yeah, that the homework was helpful. And then obviously reviewing that homework, which with, before I even got to the review, a week later, I was able to physically feel and see why I was being asked to do what I was being asked to do.

Helen: And I'm just thinking the analogy that you used there about being in the gym that you wouldn't necessarily expect to be super fit or running five miles the first time you got on the treadmill, but there was something that was tending to make you, you use the word desperate really to make a difference immediately. Because things needed to change. And during the therapy, was there anything that you found particularly challenging or something that either you and Sally talked about it, but you really didn't want to try it?

Sarah: Well, as the weeks moved on, obviously the challenges that the homework got harder because it asked you to delve further in and make the changes of what you've, you know, you've realized just to give an idea, essentially the first week, I was asked to literally rate my happiness per hour as to what I was doing. Sounds simple. It is simple, but very quickly I realised, well, this doesn't make me as happy. So why am I doing it? And then of course you stop doing it because you know, it doesn't make you happy. And then over time, there's less time that you're unhappy. The second week, it was a bit more detail, rate how anxious certain things make you., So that was all fine. But once it got to the weeks where it was highlight the things that you've found out make you anxious, now do them or don't do them. Or, you know, if there's something you're doing to make yourself feel better, but actually you've realised it doesn't really work, it actually has a negative effect later on, don't do it. And if there's something that you're avoiding, but you know probably will make you feel better- do it. So that's obviously that's the scary bit because you've literally facing the spider, if that's what your problem is. but again, like every other stage during the CBT, I found it really easy. The main thing was I trusted Sally and also had nothing to lose.

One of the things, the behaviours that we realized I was doing was seeking reassurance from people on hypothetical worries. So you Google, you ask your experienced mums, why is my baby this colour or not sleeping or eating or the poo looks like this? They can't answer that. And you're wanting them to reply, Oh, it's this. And of course they can't. So, or I'd say to my husband, am I going to sleep tonight? He doesn't know that. And by doing that, I would reinforce the anxiety. But yeah, that was an example of something I stopped myself doing. And within days I realized, Oh, there was that thing that normally I would have asked about or Googled. I didn't. And actually nothing bad happened and I forgot all about it.

Cause that was the worry was that it all comes back to sleep. If I didn't ask, would I then lie awake at night worrying I don't know what the answer is, but I didn't. So yeah, the hardest bit was actually stopping certain behaviours or starting certain behaviours. But actually I found it very easy once I had done because the positive reinforcement was there, you know, it worked.

Helen: Thank you, Sarah. And, in a couple of minutes, I'm going to bring Sally into the conversation to talk about her reflections on what you've just been saying. Overall though, what are the things that you're still using now from what happened in therapy? What are the things that you learned and how are things now compared with when you first went to see Sally.

Sarah: Well, things are great. I'm on antidepressants still. I'm going to see the doctor soon. Cause they want you to be on those for six months before you even think about coming off them. I feel myself now, so I feel confident to do that. Um, and because I'm healed, I'm back to being myself physically. I play netball, I walk the dog. I mean, I walked for four hours yesterday because of dog walking and pushing the pram around and played netball as well. So that helps, you know, being out and about physically, being in nature where I would normally be definitely helps my mood. The CBT a hundred percent has helped because there's been change again with the baby. So we've gone from breastfeeding to weaning, sleep changes, cause it's all about sleep, putting her in her own room, thinking when she's going to wake up, is she okay? Am I going to get back to sleep? Is there any point in me going to sleep? Cause she can be awake in this many hours. You know, that's a whole new challenge that I've had to deal with and there's been times that I've stopped and thought, Ooh. There's a thing I'm doing here and it's a behaviour that we recognised was what I was doing originally, which when I did it too much caused the problem. So, I've been able to really be more self-aware, basically, checking with myself and go, stop that. You don't need to do that. Everything will be fine. And guess what it is.

Helen: Well, that's really good to hear. And what I'm also hearing is that it's not just that therapy helped, is that you're still using the techniques that you learn in the therapy.

Sarah: I am. And also, I meant to say. This might not be the same for everybody, but it's quite important for myself because I'm not at work at the moment, you know, I'm a nurse. I've lost a sense of not purpose, but people come to me every day at work asking for help and support and advice. And I love to be able to do that and hear them say that's really helped, thank you. And since having the CBT, because it is something people are more happy to talk about nowadays, the amount of people I've spoken to that have said, Oh, I've done CBT or Oh, I'm thinking about, I've been told I should do CBT. Or none of that just I'm doing this behaviour and I'm not happy. I feel like I've been able to be a mini therapist to a few other people. I've been able to pass the torch a little bit because even though the problem they might be having is different to insomnia or anxiety, a lot of what Sally taught me was, I found, they were telling me things and I was thinking, well, I'll just say this thing that I do because it would work. And I've been able to relay what Sally said to so many people. And that's given me a lot of, joy because I've been able to help people. And they've said, Oh, right. Brilliant. You know, either they've gone to therapy because I've told them why they should because they didn't have anyone telling them that before, they've gone and then come back and gone, that was great.

Or they've said to me, Oh, I didn't think anybody else was on Sertraline. 80 percent of the country are on Sertraline. It's fine. And that gives them support. Or like I say, the little technique Sally taught me, I've said, do this. And then they've come back and gone, do you know that really helped. So that's been nice for me too.

Helen: Well, if there's somebody out there listening to this, who hasn't had that kind of conversation with you, or someone else who's recommended CBT or things that you can do to help in a situation like that. Is there anything that you would want to say about, CBT or looking after your mental health that anybody out there who hasn't encountered it before might need to know or want to hear.

Sarah: It's free, most of the time. It's something that will help you for the rest of your life. Unlike, you know, a course of antibiotics. it's something that gives you control. It doesn't hurt, there's no injections. It's brilliant. Talk to people, I think is the key thing, not least your doctor, because obviously that's a private conversation. But again, as working in a GP surgery, I know that majority of health issues that come through the door, there's always an in for therapy. There's always a little bit of whatever they've come in with. Do you know what therapy could help that? It should be the crux of everything. You know whenever a patient comes to see me, I can't think of many situations where I don't say, do you know what would help? Drinking more water. I feel like it's just as important as that in terms of you can't fix something up here if you don't get your foundation and your foundation is nourishment and happiness and the therapy made me happier because I had more control, and was less anxious and more relaxed and, you know, just chill. So I think just talk to people, not least your GP, if you don't want to talk to someone personally.

Helen: From my point of view, that's a great message, Sarah. Thank you so much for sharing that with us. And what I'm going to do now is I'm going to ask Sally, just to talk a little bit, I could see, I know our listeners can't see our faces, but I could see Sally smiling when you were saying some of the things that she told you to do. And I'd be really interested to hear Sally's reflections on her therapy with you and how you work together.

Sally: Yeah, absolutely. It was brilliant working with Sarah and I think it's really nice to see where she's at now and also the fact that she's still using a lot of those tools that she learned and that she put into practice and, I think one of the things that was really good is that Sarah was ready. She was ready to engage. She wanted to do, you know, she wanted to do all of the things. She wanted to practice everything. She was ready there with the notebook, every session kind of, you know, making notes, taking it all in. And that's brilliant because that's what you need in CBT is really just to come with an open mind and just think about things in a different way. So that was really good. And I think as well, one of the things we discussed before we started the therapy was, time away from the baby. So this was Sarah's time, you know, this was an hour a week where, Sarah's husband or mum would look after the baby and this would be Sarah's hour where it's just about Sarah and it's just about this therapy and the CBT and so it was really important that she had that time and that space with no distractions. And so that I think that worked really well. We did some face to face and some remote via Teams sessions together. And I think one of the, one of the sort of challenges initially, as Sarah's mentioned before, Sarah's problem was that she couldn't sleep, that's what Sarah came with, it was a sleep problem. And it took us a little bit of time to sort of think about that together and unpick it together and go, actually, do we think it might be a symptom of a bigger picture, something else that's going on. And so we talked a bit over time and agreed as Sarah mentioned that actually it probably feels like more of a generalized anxiety and worry problem that was going on that was then impacting on the sleep. We spent quite a bit of time just exploring that and we did some fun experiments and things as the sessions went on, which is probably what I was smiling along to because I know it's not always easy for clients to, to sort of do those things and want to drop things like reassurance seeking. It's a safety net. And it's hard to drop that sometimes.

Helen: Thanks, Sally. You've just said two things there that I would really like to explore a little bit more. You said fun experiments and reassurance seeking. So can you explain what you mean by those please?

Sally: Of course. So, suppose I say fun because experiments are quite fun, aren't they sometimes. I know it's not easy to push yourself out of your comfort zone but I think we, me and Sarah had a bit of a laugh about some of the things that, you know, in the session, once we'd sort of sat down together and said, okay, so you're asking all of these other mums, for example, you know, what would they do in this situation, or like Sarah mentioned, what does it mean that my baby is this colour or that this is here and, you know, as we sort of broke it down together we could sort of see that, oh, actually, yeah, that they don't know. They're not going to be able to tell me this. My husband doesn't know if I'm going to be able to sleep tonight or not. So I'm asking this, but actually it's not getting me anywhere. So I suppose we almost got to a point where we could sort of see the funny side to those questions. And actually that helped, I think a little bit with then, right. How do we drop these things? How do we experiment with them? How do we move forward? And that really started to increase Sarah's confidence. And I could see that from session to session, you know, she wasn't asking other people, she was just allowing herself to rely on her own thoughts and her own experiences. And that worked really well for her.

Helen: So there's something quite important about testing things out, finding out for yourself really having the experience of what it's like to do something differently and check whether that works in your particular situation.

There was another phrase that Sarah used as well, which was positive reinforcement. I think we should just mention that's about essentially what reward you get or what is it that happens that makes you more likely to do something again. And that's what positive reinforcement means. It's just something that happens after we've done something that makes it more likely we'll do it again. And, to me, it sounds like one example of that was making it fun, testing these things out and actually getting something rewarding out of it was part of that journey.

Sally: Yeah, absolutely. I think that's a big part of it.

Helen: And one of the things that made me smile when you were speaking, Sarah, was when you were talking about what Sally told you to do. And what things you ended up trying out for homework and those sorts of things, the way Sally's talked about it was deciding together, discussing it. I'd be really interested to hear a bit more about do you get told what to do in CBT or is it more you end up in a position where you've decided to do it?

Sarah: No, you don't get told what to do. Of course. It's all very, like Sally says, you talk about it and then together decide what might be the best experiments is a good word. Cause everyone's different. Obviously, my exact path of how we got from A to B probably might not work for somebody else. Like Sally says, I came with a notebook, wrote everything down, did homework, because that works for me. No, she didn't tell me what to do. And what was funny as well was Sally's very good at just sitting back and letting you talk, which works because I talk a lot. So she sits back and she's very good at just sort of nudging you to realisations on your own, because if someone tells you that you think something or that you should do something, it doesn't really mean much. If you think it through yourself, because someone's supported you towards that thought process, you believe it more. It makes more sense. And you're like, ah, you know, the cogs go a bit slower, but then you get there. And so over the weeks I would be reflecting on what I'd been doing for Sally, myself, but with the homework. And she'd just go, and so do you think, and what do you reckon? And then I'd go off on another blah, blah, blah, and come back to a realisation that, and she'd have this sort of pleasing grin on her face, of yes that's where I was hoping you'd get to, but you need to get there yourself, obviously. And I was just like, really proud of myself, but also proud of, chuffed for her that it was going in the right direction, it was working.

Helen: It's good to hear that you are proud and also it's good for me here listening to you both talk about this because we do talk in CBT about guided discovery and that's exactly what you've just described to us is that idea that it's you that's looking at what's happening And the therapist is perhaps asking you some well-placed questions, but it is about you and what you need and your process and drawing your conclusions from what you've discovered. It's good to hear you talking about that experience. And I'm just thinking about, at the beginning, we did mention that getting active, getting out into nature and things to do with moving more were an important part of the therapy and I'd really like to bring Leanne in as well to talk about how getting active, getting out into nature might be an important part of that therapy journey.

Leanne: Oh, lovely, yeah it's something that Sally and I do a lot in our CBT because we recognize that the cognitive behavioural therapy has a really strong evidence base. There's a lot of research that says that it works and it's useful for lots of common mental health problems. But we also know that there's a really strong evidence base for exercise. Exercise is known to be one of the best antidepressants. And there's research as well that says that being in nature has a massive mood boosting effect. And if you pull all those three things together, then surely the outcome can only be brilliant if you've got lots and lots of really good evidence to say that, you know, any one of these variables on its own is going to help you, but let's combine the three. So, so we are huge advocates of including that in the work that we do as much as possible for lots and lots of different reasons, but you know, that sits underneath it all. It can be so good for mood. And also from our own experience I know I feel better when I've blown the cobwebs off, or we've got outside, or I felt the wind on my face, or I've been in nature. I've just moved a little bit. So from personal experience, both Sally and I can say it works.

Helen: That's really good to hear, Leanne. And I'm just thinking, I can hear the enthusiasm in your voice and certainly we do know about that effect on wellbeing on getting out in the fresh air, moving more, and how important that is. And without taking away from how important that is, Sarah was talking about she just had major surgery. A caesarean section is actually quite a big operation. She's also got a tiny baby, so at least in the immediate short term, it would have been really difficult for her to move much or get out in the fresh air very much. And it might be the case not only for people who've recently had a baby, even without the surgery, it can have quite a big impact on your body but also perhaps for people with other challenges to getting out and about and moving and I'm just wondering, how can people still benefit from combining getting more active with things that might help say anxiety and depression when they do have challenges about getting out and about?

Leanne: I think the first thing that comes to mind is to get medical guidance to kind of find out from somebody who knows your body as well as you do about what's appropriate and what's doable, before you start leaping into exercise or doing anything. And I think it's about trying to find ways just to move a little bit, whether that's, you know, stretching or things like chairobics or chair yoga, those kinds of things can be things that people do at home when they have limitations or pain or, you know, anything like that, but within the realms of, I suppose you've got to pace it within your capabilities and what's appropriate for you.

But things like connecting with nature. I was looking into this prior to was talking today and things like birdwatching and looking out of the window or doing a little bit of gardening or tending to window boxes and those kinds of things can give you the same powerful effects of connecting with nature and a bit of activity too. It's not about, I suppose when we think about exercise and we think about movement, we often think about the Olympics and we think about marathon runners and we think about going to the gym and lifting really heavy weights over your head. And it doesn't have to be like that. It can be small things often and Sally and I were talking about this before about, the NHS recommendations and we worked out that it's about 20 minutes a day of movement that's helpful. And also, if you add 20 minutes a day in nature so you do 20 minutes moving around in nature every day, that's going to have a huge effect. So if you can find a way to, to do a little bit, a little walk, a little stretch, look out the window, even watch a nature documentary, that has a massive effect on your mood as well, because it's connecting with nature but in a different way, you don't have to leave the house for that. How does that answer your question Helen?

Helen: It does thank you, Leanne. And I'm really pleased to hear you say that it doesn't have to involve buying expensive equipment or joining the gym. You don't have to live on the edges of a beautiful park or something like that. It's something that you can do whatever your living circumstances are. There's all sorts of creative ways that you can incorporate this as part of recovering, improving depression and anxiety and your mental health more generally. And I wonder whether, Sarah has any comments about that, Sarah, because you did mention how important that was to you even before you had your baby, and of course there would have been quite a big change to what was available to you immediately after you had her. Just wondered what your responses to what Leanne's just been saying about that.

Sarah: Yeah, I mean, like I said at the very beginning, my expectations of getting back to being myself were not met. And so the big things were, I actually made a list for and showed Sally of things that I'd written down saying, and I entitled it Getting Back To Me. And it was in order of, I just want to be able to make tea for my husband, walk the dog with the baby. These are all things that I just thought I'm never going to be. I don't understand how I'm going to be able to do these. And every time I did them, I was like, oh look, I'm doing that. You know, playing netball and the big one was paddle boarding, and I did it the other week and I was like, oh yeah paddle boarding. Like Leanne says, when it was very important for me as someone who's very active and I'm outdoors with the dog in the countryside all the time to get back to that. And like Leanne says though, it doesn't have to be going for a run. You know, my level of, well, what do I want to achieve was forced to be lowered, if you like, that's the wrong word, changed and because what I hadn't realized on top of taking the dog for a walk was whilst I'm there, I'm listening to the water. I'm listening to the birds. I'm feeling, I'm smelling, I'm all these things. And I didn't realise all that had been took away from me. And so that was adding to how miserable I was. And, like Leanne says, it doesn't have to be right. I need to be able to go for a run. It can just be find yourself back in something that makes you feel happy. And I think one of the techniques I wanted to just mention as well, that Sally taught me, when Leanne mentioned about you doing 20 minutes a day of being in nature or exercising, so that you make sure that you really are doing that to its fullest and you're not, you know, birdwatching whilst washing the dishes or thinking about what you need to make for tea. She taught me a five, four, three, two, one mindfulness technique, which basically is whilst you're tending to your bird box or whatever you're doing, think of five things that you can see. Four things you can hear, three things you can smell, two things you can feel, a one thing you can taste or something like that. And not only does that focus your mind for that minute on those things. It's really nice to think, Oh, I didn't know I could hear that I'm tuning into it. And then you do it again, five minutes later or as much as you want or, and it stops the thought processes that are negative as well, because you're focusing on that, but it just makes sure that when you're in the nature bit you are really soaking it all in as much as possible.

Helen: Thank you for that, Sarah. And I'm just thinking, we've had a really interesting conversation about your experience of therapy, Sarah, Sally's and Leanne's thoughts about what they're doing in therapy and what. seems to help people to benefit from it. I was wondering if I could ask each of you in turn, what's your most important message that you'd want people out there to know? So, Sally, what do you think is one key thing that you would want people out there to know?

Sally: I would say that mental health difficulties are common and it's not something that you have to sort of put up with or that you're stuck with, I suppose, for the long term, often there are a lot of quite often very simple techniques that you can practice and try and learn either with or without therapy, that can just really help to manage those, either the feelings of low mood or those anxiety feelings as well so, it doesn't have to be a major change. There's a lot out there and a lot of cost-effective things as well that you can get involved with that can just really help to boost your mood.

Helen: Thank you, Sally. Leanne.

Leanne: Oh, it's such a good question. I think what I'd really like people to think about is thinking about mental health, the way we think about fitness and physical health and spending time each day doing something that nourishes and nurtures mental fitness, let's call it. In the same way that we might, you know, drink some water, like Sarah said, take our vitamins and have something to eat and try and have good sleep, but moving in the direction of thinking about our mental fitness being on the agenda all the time so that I suppose it normalises asking for help and talking about things and looking after yourself and, and good wellbeing all round. Because I think people often really struggle, don't talk about it and then come for therapy when they've been on their own with it for a very long time.

Helen: Thank you very much, Leanne. And Sarah, what do you think you would want people out there to know, one key thing that you'd like to say?

Sarah: Probably that if you think something's not quite right or something really isn't right and you just don't, you're not sure what, you don't have to know, you don't have to be able to go to a doctor and say I've got this problem, can you fix it please? Doctors are just as, they're well trained to know when someone needs referring for therapy.

So yes, that's who you need to probably go to first in a professional manner but if you just go and say, okay, this is how I feel, blah, blah, blah. They'll pick up and know, actually, you would benefit from therapy because it sounds like this might be happening or going on and then you get referred to someone obviously who's even more specialised, a therapist, and they can sit back and listen to you just offload and say, these are the things that's happening, I'm not happy because of this, that and the other, and they'll go, right, It could be this, shall we try that?

And so, yeah, you don't have to have all the answers, I think, is my key thing. but you need to ask for them,

Helen: Fantastic. Thank you so much. All three of you have been excellent at telling us about your experience and knowledge, and I'd just like to express how grateful I am for all three of you talking with me today. Thank you.

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