Compassion Focused Therapy (CFT)

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I just read an interesting piece on mental health and compassion focused therapy (CFT) in the Independent…

http://www.independent.co.uk/news/long_reads/mental-health-depression-anxiety-new-year-resolutions-advice-a8142476.html

…so I thought it would be useful to dig up an article I wrote on this topic for the Eating Disorders Faculty of the Royal College of Psychiatrists some time ago.

I completely understand the fact that people may have reservations about this therapy and that was the main reason for my writing it. The first half talks about CFT in general and the second half about its’ use with eating disorders.

I initially heard about compassion focused therapy (CFT) from a friend working in perinatal psychiatry. While she was enthusing about this therapy and detailing ways of gaining some expertise in this, I found myself really quite surprised at her enthusiasm. The word “compassion” had triggered the sceptical part in me. After all, how effective could a therapy be that centred around kindness? This just sounded like some new fangle, such as Neuro-Linguistic Programming.

In fact, scientific study has shown that the crux of compassion lies in the virtue of courage. “The courage to be compassionate lies in the willingness to see into the nature and causes of suffering – be that in ourselves, in others and the human condition” (Compassionate Mind Foundation).

Now, after more research into CFT, I find myself in this very same position as my friend – enthusiastic to learn more about CFT and wanting to enthuse others about the great potential this therapy offers in helping patients suffering from the whole gamut of eating disorders.

What is Compassion Focused Therapy (CFT)?
CFT is an integrated therapy seated in social, developmental, evolutionary and Buddhist psychology, as well as neuroscience. It combines Western and Eastern approaches to help people change. The CFT approach views the therapeutic relationship as a pivotal component.

Paul Gilbert, Professor of Clinical Psychology at the University of Derby, has spent the last twenty years developing CFT. His initial use of this therapy was in helping people with high levels of shame and self-criticism, factors which have been associated with the development and maintenance of a variety of mental health problems, notably depression.

CFT aims to train the mind to enable an individual to experience compassion, both for themselves and others, to improve the capacity to self-sooth and affiliate with others, and to harness an individual’s courage and wisdom needed to effectively manage difficult life events, memories or emotions.

Compassion Focused Therapy for Eating Disorders (CFT-E)
There has been a recognition in recent years that transdiagnostic treatments may be beneficial in eating disorders. Therefore, Compassion Focused Therapy for Eating Disorders (CFT-E) has been developed as a transdiagnostic approach to eating disorders, especially to tackle affect regulation difficulties, shame, self-directed hostility, and pride in eating disorder behaviour.

There are two fundamental assumptions of CFT-E:
(i) Eating-disordered clients share transdiagnostic psychological processes, and
(ii) Biological starvation must be addressed during treatment.

CFT-E provides a structured way of helping patients achieve control of their chaotic eating habits and to work on the cognitive and behavioural mechanisms behind these. It consists of four distinct stages:
(i) Psychoeducation and motivational enhancement
(ii) Developing self-compassion skills
(iii) Recovery and
(iv) Maintenance

CFT-E was pioneered by one of Paul Gilbert’s students – Ken Goss. Dr Goss is a consultant clinical psychologist and currently head of the Eating Disorders Service in Coventry.

The Compassionate Mind Foundation was founded by Paul Gilbert in 2006 and aims to advance research in the field of CFT and provide resources for individuals looking for help in this area.

I hope this article has piqued the interest of some of you to find out more about CFT in general. Whether we are treating a patient dealing with anorexia nervosa or obesity, CFT-E is a valuable addition to the array of psychotherapeutic techniques we can offer our patients suffering from a host of eating disorders. It will be interesting to see the body of research grow in this fascinating area.

References
Compassionate Mind Foundation (web access 2016) http://compassionatemind.co.uk/about-us
Gilbert P (2009). Introducing compassion-focused therapy, Advances in Psychiatric Treatment, 15 (3) 199-208
Goss K and Allan S (2010). Compassion Focused Therapy for Eating Disorders. International Journal of Cognitive Therapy: Vol. 3, Special Section: Compassion Focused Therapy, pp. 141-158
Goss, K. and Allan, S. (2012) An Introduction to Compassion-Focused Therapy for Eating Disorders (CFT-E), in Eating and its Disorders (eds J. R. E. Fox and K. P. Goss), John Wiley & Sons, Ltd, Chichester, UK

*If you’re interested in eating disorders, here’s the link to the Eating Disorders newsletter this article was originally printed in. These newsletters provide great updates on the work that’s done by the Eating Disorders Faculty of the Royal College of Psychiatrists.

https://www.rcpsych.ac.uk/pdf/EatingDisorderNewletterJuly2016.pdf

 

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BOUNDARIES…

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When you mention the word “boundaries”, this initially conjures up the idea of physical boundaries. In this blog, I want to highlight some of the psychological boundaries that are really important for us to improve on for better emotional wellbeing and self-esteem.

These are important psychological boundaries:

  • Mental Boundaries
  • Emotional Boundaries
  • Sexual Boundaries
  • Spiritual Boundaries

If you can improve on these “MESSy” boundaries, you’ll start to feel a bit more in control of your life.

Mental Boundaries: This refers to your thoughts and ideas. If somebody gives you their opinion about a topic, what happens to your own opinion?

Do you either tend to lose sight of your own viewpoint and overhaul it to that person’s slant, or do you firmly stick to your viewpoint throughout the discussion and interrupt the person as they are speaking, so as to defend your own thoughts on the matter? If you fall into either of these two groups, there may be work to be done on weak mental boundaries.

To be able to listen to another viewpoint objectively shows strong mental boundaries.

Emotional Boundaries: This refers to your feelings about yourself and others.

For example, if your line manager continuously finishes work late and also expects you to also consistently finish work late (despite the fact that you’ve been working hard during the day), do you feel you need to leave work late just to please your manager? If so, you need to be mindful of your susceptibility to being manipulated by others.

Of course, there are days you may decide that there is a real need to stay at work later to complete certain tasks but to consistently feel under pressure to comply with your manager’s wishes – whether that’s consciously or subconsciously – is not a healthy mindset to be in.

You need to control your emotional boundaries and try to limit the effect other people, as well as situations, have on your emotional wellbeing.

Sexual Boundaries: I won’t go into length here about these sets of boundaries but it’s important that whatever your level of boundaries are here, that you are not coerced into changing these. If your level changes, that should be your decision.

These boundaries can be easily influenced by alcohol and drugs and when this happens, your self-esteem can take a big dent after this, so this is an extremely important boundary to be aware of.

Spiritual Boundaries: This refers to our core set of values, our belief systems, our ethics. This is the key to how we lead our lives and determines how our personalities and characters are shaped.

For example, if you normally deliver work at a high standard but your company asks you to lower these standards to increase their profit margin, without informing their clients, this undermines your spiritual boundaries. The choice to continue in such a situation erodes at your inner values and leads to an uncomfortable psychological “distress state” called cognitive dissonance. (You can read more about this topic of cognitive dissonance in my blog “Excuses, excuses, excuses…” from January 2015: https://changeorgina.wordpress.com/2015/01/18/excuses-excuses-excuses/).

To resolve this inner conflict of cognitive dissonance, you would need to change your thinking around your definition of ethical behaviour. However, if you didn’t want to change your ethics, the only way to abate this flare-up of cognitive dissonance would be to leave this job.

Our core set of values, our belief systems and our ethics may not all be virtuous but when our spiritual boundaries are encroached on, this is time to assess our core beliefs and reflect on those which can be improved or abandoned outright.

FINALLY,  I hope you have a better understanding of these “MESSy” boundaries. If boundaries are too relaxed this predisposes you to being emotionally drained. If boundaries are too strict this detachment can lead to loneliness.

It may seem ironic but boundaries give you more freedom…but they have to be the right boundaries for that specific situation and for that particular person. It’s best to aim for a healthy balance of each of your “MESSy” boundaries – not too messy but neither too tidy.

 

What’s Eliza Doolittle got to do with weight loss?

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For this blog, instead of directly writing here I’ve written an article for Nutritionist Resource. It’s based on the psychological concepts in a play written by George Bernard Shaw which was then turned into the film and musical “My Fair Lady”. http://tinyurl.com/j4ugrlx

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I explain how Eliza Doolittle epitomises the concept of self-fulfilling prophecies, expand on the psychology of the Pgymalion effect and then of the contrasting Golem effect, explain their use in education, then link these concepts to weight loss and finally end with a play on words about great expectations. I hope you find it interesting!

A dozen good reasons to start your day on an egg

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Eggs

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  1. The egg white provides a high quality protein – otherwise known as a complete protein. This means it provides all the 9 essential amino acids your body needs to make protein. There’s no other place apart from our food that our bodies can get these essential amino acids. Protein is vital for our children’s growth. Adults need protein to maintain their muscle bulk but also for healthy skin, hair and nails. Protein also keeps you feeling fuller than other macronutrients so you won’t be at risk of reaching out for that mid-morning chocolate bar or cookie.
  2. An entire blog could be written about the high quality protein as found in eggs but just one further fact about this protein – it’s recently been discovered that this stimulated particular cells in our brain (orexin-hypocretin neurons) which helped people feel more alert and have more energy.
  3. The egg yolk provides one of the few natural sources of vitamin D, which is needed to absorb calcium and phosphorus so our bones, teeth and muscles are kept healthy.
  4. The egg yolk also provides a great source of B vitamins, especially vitamin B12, which helps produce red blood cells, is involved in energy metabolism, and supports both the immune and nervous systems. Eggs are important to include in a vegetarian diet as vitamin B12 tends to be found in meat rather than plant sources.
  5. Egg yolks are one of the best ways to get essential omega-3 fatty acids naturally. These essential fats help in reducing fat found in your blood (triglycerides), inflammatory conditions such as asthma, heart disease and rheumatoid arthritis, and are crucial for the development of a healthy neurological system and good vision in babies.
  6. Eggs are high in selenium – an antioxidant which supports the immune system and thyroid function.
  7. Eggs are good source of iodine – involved in thyroid hormone function and normal energy metabolism.
  8. Have you heard of the nutrient choline? Well, eggs are a source of this essential nutrient which is critical for a wide range of functions, such as cell structure, lipid transport and synthesis of neurotransmitters. It’s important in the brain and memory development in the unborn child and may reduce the risk of neural tube defects, so it’s particularly important in pregnant and lactating women.
  9. Eggs are naturally gluten-free so it’s great for people who suffer from Coeliac disease or gluten sensitivity.
  10. A medium-sized egg contains about 70 calories – hardly a dent in the calorie stakes if the calorie intake for an average woman is 2,000 calories and for an average man is 2,500 calories.
  11. Eggs are so versatile – you can have them boiled (soft or hard), scrambled, poached, fried, steamed, baked, as an omelette – the list goes on. There’s a different way to have your eggs for every day of the week to stop them being “boring”.
  12. There are so many reasons to start your day on an egg but if you’ve had one egg for breakfast you can still have more of this great food in the day. It’s now widely recognised that the cholesterol in our food has little impact on our blood cholesterol, so although I’m not suggesting people have a dozen eggs each day  it’s perfectly fine for most people to have a few eggs every day.

My view of Stephen Mangan’s “24 hours on my plate”

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I really like reading Waitrose’s weekend newspaper as  not only does it cover food and drink from lots of different angles but it also gives us information about films, books, things to do etc. and the people behind these films, books, things to do etc.

In last week’s copy there was interesting information about Nick Frost’s background, a Q&A section about Ana Matronic from the Scissor Sisters and a brief look into Stephen Mangan’s diet.

Of course, I was very much drawn to Stephen Mangan’s “24 hours on my plate” and felt that summing up his diet in three sentences didn’t do him much justice. I understand the constraints of space so felt that I could use the space on my blog to do him justice and hope you all find it useful.

Summary of food:

2 croissants, banana, flat white

2 coffees

Sushi, water and tea

2 teas, flapjack, dried apricots

Sausages, mash, onion gravy and pint of lager, glass red wine

Fluid intake: 3 coffees, 2 teas, water and possibly a green tea at lunch, a pint of lager and a glass of red wine were drunk.

Fluid Verdict: There’s too much caffeine and too little water. Depending on the strength of the lager and size of the wine glass, about 3-4 units of alcohol was also consumed.

A couple of coffees each day is fine but really these shouldn’t be the main route to hydration. It’s best to keep this to water, herbal/fruit teas and green teas. Caffeine temporarily increases blood pressure and places stress on your adrenal glands by causing them to produce stress hormones such as cortisol and adrenaline. So where possible, try and swap caffeinated coffees and teas to decaffeinated ones. Most people don’t really notice the difference in taste here. Green tea is also a good source of anti-oxidants.

If Stephen is consuming this amount of alcohol every day, he will be over the government limits of 21 units of alcohol per week for a man, so I would look at reducing this. Alcohol has numerous effects on the body, including raising blood pressure, affecting how well food is absorbed from the gut and disturbing the quality of sleep. People also forget that alcohol also contains a fair bit in calories.

Food intake: The day starts with refined carbohydrates in the form of 2 croissants, healthy sushi for lunch, a sugary snack in the form of a flapjack and a rather processed, fatty evening meal with sausage and refined carbohydrates in the form of mash. Fruit intake consists of banana and apricots.

Food Verdict: Stephen probably had energy highs and lows throughout this day as his blood sugar would have been going up and down. This would have been due to the amount of refined carbohydrates in his diet and the insufficient protein in the day. Keeping blood sugar levels steady not only helps energy, but reduces a person’s irritability and decreases their risk of getting diabetes, as the pancreas is not being overworked.

A protein-rich breakfast to keep blood sugar levels steady would be preferable, so having egg with brown toast or porridge would be a good start to the day. Sushi is a fairly good lunch with a combination of carbohydrates (although this is in the form of refined white rice) and good quality protein. Oats are good for lowering cholesterol but eaten in the form of a processed flapjack is mixed with quite a bit of sugar. There are sugar-free flapjack alternatives that you can buy or a good quality high protein, low-sugar yoghurt with some berries and seeds added to it would make a great afternoon snack, as would some carrot with a small amount of hummus. The evening meal could have contained better quality protein such as chicken. To prevent a further sugar rush in the evening, eating wholegrain carbohydrates such as brown rice, pasta, noodles or spaghetti would be better.

In terms of fruit and vegetables, there are only 2 portions of fruit (banana and apricots). More vegetables at both lunch and dinner would improve Stephen’s intake of vitamins, minerals, anti-oxidants and fibre, helping him feel fuller for longer and improving the workings of his digestive system. So having some edamame beans with his sushi would be good and either lots of cooked vegetables or salad with the evening meal would also be beneficial.

Overall Comment: This particular day’s food was not really packed with good nutrition but it’s difficult if you’re on the go like Stephen. However, as this is Stephen’s way of life, it would be worth him thinking ahead of how he could make healthier choices when he’s away from home and filming.

 

 

Stop the labelling

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Have you ever made a silly mistake and then said to yourself “I’m so stupid!” I guarantee that all of you have. Of course, there’s no problem in saying that to yourself on the odd occasion.

However, the problem starts when you repeatedly do this, be it for a fundamental mistake or for a tiny slip-up you’ve made. What’s happening here is that you’re labelling yourself.

Other common labels people give themselves include, “I’m so ugly,” “I’m so fat”, “I’m so lazy”, “I’m such a loser”. Labels are really unhelpful. They’re really generic.

Let’s take the example of somebody trying to eat a healthier diet. If that person later that day succumbs to a biscuit, he might call himself a loser for not resisting the temptation of a biscuit. But really, is he a loser for eating one measly biscuit? One measly biscuit? Of course he’s not a loser.

However, if that person calls himself a loser, that idea sticks in his head, “I’m a loser, I’m a loser, I’m a loser!” This idea of being a loser just ruminates and ferments in his head and that’s all he can hear. Isn’t that all you can hear now?…”I”m a loser!”

If all that person can hear is that he’s a loser, then it goes without saying that in that mindset you can see why he would think that he might just as well eat the whole packet of biscuits – isn’t that what a loser does? When he’s devoured that whole pack, he now really believes he’s a loser. He may go on to eat even more biscuits and more junk food; or he may not. Either way, he feels in a far worse off state than if he had just had that one measly biscuit.

If he hadn’t labelled himself a loser at the stage of one measly biscuit and maybe thought that this was just a “blip” in his new healthier lifestyle, undoubtedly he could have stopped eating any more biscuits, or at least he wouldn’t have had the whole pack.

You can see why labelling isn’t a good thing. It’s our mind having negative thoughts – distorting the truth. In psychological terms, this concept is known as a cognitive distortion.

Most people wouldn’t think a person is a loser for having one measly biscuit but there might be others thinking a person is a bit of a loser having a whole pack of biscuits. Labelling in either of these scenarios isn’t helpful for this person.

Labelling is sometimes referred to as name-calling. This idea of name-calling conjures up images of children teasing each other in the playground with rather spiteful names. It’s basically emotional bullying. You can imagine that in this playground situation, there’s a teacher intervening somewhere.

Now, we don’t really associate adults doing this, name-calling each other…but when we label ourselves, we’re name-calling ourselves. We’re being our very own emotional big bullies.

By being a bully to yourself, you’re essentially being an enemy to yourself. It makes me think of the saying, “With friends like these who needs enemies?” Throws a different spin on things, doesn’t it?

So, if you’re aware that you’re prone to a bit of labelling and this mindset is sabotaging you from where you want to get, a stop to the name-calling is a good move. You need to be the teacher here and intervene at this stage. This will stop you from spiralling into more negative thoughts and dipping lower in mood.

Acknowledging that you’ve made a “blip” or not done as well we you would have liked will suffice. There’s no need for you to go on teasing and tormenting yourself with nasty names. Just stop bullying yourself. Stop the name-calling. Stop the labelling.

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A sublime jog…

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Something I heard yesterday got me really irritated. It was a piece of fairly important news that a particular person should have told me about – literally more than a month ago.

To try and understand the complexities of this person’s mind for concealing such information would require another blog…or really another 10 blogs.

Anyway, I was pretty annoyed yesterday. I felt this pressure in my chest rising up my neck. No, it wasn’t a heart attack…it was basically anger starting to take a foothold of my body – surges of anger continuously pulsing away.

Now, some may think as a psychiatrist I shouldn’t be prone to anger and should be (a) able to control my anger and (b) maybe not even get angry in the first place. Well, yes and no.

Looking at the actual anger itself first of all…Anger is a basic human instinct that we all possess. If your phone was stolen, containing all your personal texts and photos/videos (those photos/videos you hadn’t quite managed to getting around uploading elsewhere), and you found out that a bill of £500 had been run up on it that you had to pay, I would applaud you if there wasn’t even a hint of anger starting to take seed inside you. It’s natural to be angry here.

Now, looking at being able to “control” anger is a different story. In the scenario above, most of us would have this seed of rage planted inside us. However, some people let this seed of rage take root and allow it to grow. Some let it grow into something small and manageable, maybe a few angry outbursts – that’s it. Others let it grow a bit bigger, maybe several angry outbursts.

However, others let this seed of rage grow quickly into something quite huge and sprawling, something they can’t control; this untameable beast of rage and wrath that consumes everything around it that there’s no growth for anything else – not even a little cheerful daffodil. This a toxic and dangerous situation to be in.

So back to my surges of anger. This seed of rage was there but I wanted to get rid of this ugly weed. So I decided to go for a jog. I’m not going to lie and say it was this energetic sprint. It was a good half hour jog – enough to act as a decent herbicide. I was able to turn my harmful impulses of anger into something less harmful, a jog – with added benefits to my fitness levels.

This act of changing basic impulses (such as anger, lust, jealousy etc) when we don’t want them, or they are inappropriate in a situation, into something that is socially acceptable is known as “sublimation”. These impulses (anger, lust, jealousy etc) create this energy within us. If this energy remains pent up we can end up doing something we later regret…I think we’ve all been there. A common example would be wanting to send an angry email to somebody in the heat of the moment. How many of you wished that you never hit that return button literally seconds after you did?

If you could have distracted yourself by doing a positive and constructive act, such as speaking to a friend, reading a book, jogging, cooking, whatever else activity apart from writing and sending that email, that’s sublimation. Note that doing negative things such as eating a tub of ice cream, drinking a bottle of wine, smoking a pack of cigarettes etc instead of sending that email don’t constitute sublimation.

Sublimation is the act of taking this unwanted, unacceptable pent up energy and turning it into something that’s more acceptable.  Sublimation is a type of “defence mechanism”.

Freud came up with this idea of defence mechanisms. In fact, he came up with quite a list of defence mechanisms. They can be divided into a few groups, with sublimation falling into the group of “mature defence mechanisms”. This essentially means that sublimation is a grown-up way of dealing with problems in life.

Now, I admit that I’m not always so constructive in managing my anger as I was yesterday. However, the more I sublimate like I did, the more automatic a sublime jog will be for me.

So, next time you have this seed of anger in you, sublimate. Speak to a sublime friend, read a sublime book, go for a sublime jog, cook a sublime meal…just do something sublime!

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What motivates you?

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To answer this question, let’s first turn to the famous Abraham to find out his thoughts on the matter. Now, I’m not referring to Abraham Lincoln but rather to another famous Abraham – Abraham Maslow.

I need to pre-warn you that this blog is rather long. I got a bit carried away with describing Maslow’s idea. So if you only want to read a few paragraphs, I would say jump to bullet point 5 and read a couple or so of paragraphs there, then jump to the last few paragraphs of the blog (after the grey picture) and read those paragraphs. Hopefully, just reading those bits will make you jump back to here and read the whole blog!

Who’s Maslow?

Well, Maslow was a psychologist who’s famous for a concept that is known worldwide as Maslow’s hierarchy of needs. He published this theory in the 1940’s in a paper called “A Theory of Human Motivation”. This outlined the needs of human beings in order of importance. It’s commonly depicted with the following pyramid:

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There are essentially 5 levels to this pyramid. Although others later added a few more levels, these 5 levels are the heart and soul of Maslow’s concept.

I’m just going to start looking at each of these individual levels in a bit of detail before summing up my interpretation of this hierarchy. So, let’s begin by looking at the bottom of this pyramid and work our way up.

1. Physiological needs: Maslow believed that our greatest human needs start here. Once you’ve achieved those physiological needs, you’re then motivated to achieve the things on the next level…and so on and so on with each level.

Essentially, Maslow felt that you couldn’t be motivated to reach the next level until you had achieved the goals of the previous one.

So if you look at the things in the physiological needs, if you don’t have those, then you’re basically going to die. Time of death will vary between a few seconds (no air) to a few days (no water) to several days (no food).

If you look at one other particular need in this level, some of you may argue the essential nature of sex and some the opposite. What Maslow is referring to here is that sexual reproduction is vital to continue the human species, rather than it being a life or death thing for an individual.

2. Safety needs: Moving onto the next level of safety, we’re looking at a variety of things, not just literally living in safety. Of course, safety includes not living in a war-zone, having a roof over your head, not living in a place where there’s domestic violence etc. Any one of these situations can ultimately lead to death – being gunned down / freezing to death / being horrifically beaten.

However, safety also includes things like a child growing up in a stable home environment. Children don’t feel safe when two parents are constantly warring with each other and the threat of divorce is always looming in the air. The same is true for children moved from foster home to foster home – how can they possibly feel safe?

Included in the level of safety is having your health. If you’re suffering from a disease that affects your everyday living, such as severe coronary heart disease, then even taking a few steps causes you chest pain or shortness of breath. If you’re living like this it’s extremely difficult to think about much else. Obviously, there’s a spectrum to the severity of an illness but I’m just exaggerating here to get my point across.

Another important aspect at this level of safety is our need of having a job or some source of income. This is undoubtedly important. Without money, you’re not going to get very far.

3. Love and belonging needs: So half-way up the hierarchy we cross the level of love and belonging. This level not only includes your need to both give and receive love and affection with family, friends and work colleagues but also extends to feeling part of a group or community. It could mean you being a member of a football club or a golf club, attending your local art class, playing in a band, singing in a choir, being part of the Twitter community, engaging with your blogging community etc…basically connecting with others.

Now unlike the previous two levels of physiological and safety needs, if you don’t have your belonging and love needs met you’re not at risk of having a physical death as such. However, without your love and belonging needs met, it’s a pretty miserable existence, pretty lonely really.

Some people in the Western world struggle to move on up from this level but it’s really at the next level that many of us tend to reach a plateau.

4. Esteem needs: This level has two components. The first includes your need for others to recognise and respect your skills and talents. So if we’re talking about jobs, it’s about others acknowledging that you’re good at your job. It’s neither here or there what job you do. You could be a cleaner, a therapist, a housewife, a banker – it really doesn’t matter. It’s about having others recognise that you’re a trustworthy cleaner, a really empathetic therapist, a fantastically organised housewife, a really lucrative banker – I know that last bit might sound like an oxymoron (aren’t all bankers lucrative?)…but you get the idea.

The second part to the esteem level is about you, about you needing self-esteem – a sense of self-worth, achievement, mastery, status, really about you having pride in yourself. Some of you may have read that last sentence with a bit of a heavy heart, as you may have struggled with your self-esteem for literally years and are still struggling. You’re not alone – you’re really not.

This penultimate level of esteem (both others and yours) is the stumbling block for most people. Actually, it’s more like a 10 foot hurdle than a stumbling block.

If we’re truly honest, we do want some recognition from others. It doesn’t have to be massive crowds of people exclaiming “Wow, you’re so amazing at this or that!” but just simple, quiet, positive acknowledgement from others to let us know that they think, or even know, that we’re pretty good at something can suffice.

However, the matter of self-esteem is a totally different ball game. Self-esteem starts from your baby age…and goodness knows how many knocks and bumps people have had on the way up to the grand old age of now. No wonder so many people never reach the final stage of the hierarchy, what I sometimes like to refer to as “enlightenment”.

So many of us are stuck at the esteem level. So many of us suffer psychological problems in trying to grapple with aspects of this level; psychological problems ranging from anxiety, stress, neuroticism and depression.

Now just like the level of love and belonging needs, you’re not going to have a physical death per se if you don’t achieve your esteem needs. However, I do want to really emphasise that living with psychological problems isn’t nice. It can be pretty tormenting and tortuous. Being continuously plagued by your own stream of negative thoughts isn’t necessarily a life or death situation, depending on the severity of those thoughts…but it would be great if brain space could be used for thoughts of a more pleasant and constructive nature. Anyway, things can get so bad for some people that they eventually contemplate suicide. Unfortunately, some people manage to actually go through with the act and complete it. Very sad.

Now, let’s move on to the final stage of Maslow’s hierarchy.

5. Self-actualisation needs: What on earth does this mean?

Well, Maslow defined self-actualisation as “the desire for self-fulfillment” and “becoming everything one is capable of becoming”. This basically means reaching your maximum potential. This is what Maslow strongly believed was the ultimate goal of all human beings – for us to reach our full potential in our own unique way.

Now, how many people do you think are self-actualisers?

Not many. Not many at all. Only 1-2% of all of us reach this “peak” of self-actualisation. Like I said, so many people in the Western world get stuck at the level of esteem.

Now, reaching self-actualisation can be all sorts of goals, such as wanting to be very athletically fit, being a good mother/wife/dad/husband etc, being great at art/music/dance etc. This shouldn’t be confused with actually being the most athletically fit, the best mother/wife/dad/husband or being the most talented artist/musician/dancer. It’s about you striving to be the best in whatever you want to be great at, given the set of attributes unique to you.

To reiterate, self-actualisers make the most of what they’ve got – whether they’ve got a lot or very little.

Is there a better way of thinking about Maslow’s hierarchy?

Well, I think there is.

Maslow believed that when our human needs aren’t met, we basically feel stressed and can’t be motivated to progress up the levels until the goals in said level are achieved.

Now, there’s quite a bit of debate as to how Maslow originally conceived his concept. Putting that aside, it’s also been argued that this model is quite rigid, which I agree with.

For example, even though a person could be suffering from domestic violence (safety needs) they could still be motivated to belong to a group (love and belonging needs) and aim to be the best parent to their child (self-actualisation).

I personally believe that people can be motivated to achieve bits of each level at the same time. I prefer the reconstituted version of Maslow’s concept, as shown below. The text is blurred in the picture but you get the gist.

Rather than all these “levels” of needs existing in some sort of linear fashion, they actually co-exist.

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Picture by jvleis is licensed under a Creative Commons Attribution 4.0 International License.

Of course, you don’t need to have or even need to aim for self-actualisation to survive on this planet. However, to have a meaningful and purposeful life, mastery of self-actualisation, as well as of the other needs, is key. For example, someone could be born into extreme wealth but still lead an unhappy life if they’re not feeling fulfilled.

To have drive really gives us a sense of direction in life, especially when things are tough. It gives us a meaning to our existence. After all, our existence is just that….we exist for really only a fraction of time (when you consider the whole universe), then we’re gone forever. So it’s really important to make our time on this planet really count.

If you think about how you can achieve all those needs (your physiological, safety, love and belonging, esteem and self-actualisation needs), that’s going to focus your mind on being motivated to lead a great, colourful and exciting life.

If you take that a step further and not just think about your needs – but actually get pen to paper and map out those needs – that really will be a great motivational tool, all personalised for you.

So go now and start being the creator of that amazingly wonderful map – that map of your life. It might take a bit of time to draw it up but it’s worth it. After all, it’s going to be a great journey – the journey of your life! Bon voyage!

I was too hasty – let me tell you why I’ll give kale another chance…

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I’ve actually been meaning to write a little ranting, rather negative blurb about kale. Ironically the impetus for this blog has actually been another blog which talked about how to make a fantastic sounding vegetarian Thai curry containing kale; the pictures on the blog also swayed me.

http://brightyoungfood.com/2015/01/21/ultimate-thai-green-curry/

This recipe has thrown a different light on kale, forcing me to re-evaluate that maybe, just maybe, I was rather hasty a couple of weeks ago, in vowing that I wouldn’t try kale again.

Now, don’t get me wrong, kale has a great nutritional profile. For those of you who don’t know what it is, kale is a vegetable – a “dark, green leafy type”.

Now, I’m a huge believer in the mantra that variety is the spice of life. So in the spirit of this mantra, I decided to expand my repertoire of dark, green leafy vegetables and dared to reach out for a bag of curly kale the other week at the supermarket.

As I do with all new foods I buy, I adhere religiously to the cooking instructions on the packaging. Boil for 8 minutes it said – that’s exactly what I did. I cooked the kale in the most basic way – unadulterated – not even a pinch of salt was added to the water.

The two words that dominated my thoughts and subsequent verbalised opinions after two big good mouthfuls of kale were “yuk” and “disgusting”, as well as the phrase “I’m never going to have that again!”

I do like trying foods in their pure state so I have an idea of their natural flavour. I’m glad I didn’t take this a step further and try the kale in its glorious raw form, as I might have easily violated my taste buds. Admittedly, I did accompany the second mouthful of kale with some salmon, hoping to better its taste (or mask it) but really this didn’t help. This extra mouthful just strengthened my conviction of not allowing kale into my kitchen again. I convinced myself that I didn’t need kale in my life and that there were plenty of other dark green leafy vegetables to take its place.

Now, kale is fantastically rich in vitamins A, C and K, so similar to Brussel sprouts in being full of vitamins C and K. (In one of my blogs in December 2014 I talked about how great Brussel sprouts were and went into some detail about the wonders of vitamins C and K.) The difference with kale is that it also contains vitamin A, so I liked to refer to it as the vegetable full of vitamin “KAC”, seeing how to me it was such a foul-tasting vegetable.

Yes, it’s true that spinach, broccoli, romaine lettuce, Swiss chard, collard greens and mustard greens are alternatives to kale as dark, green leafy vegetables to provide vitamin “KAC”. All these dark, green leafy vegetables also contain lots of lutein and zeaxanthin.

You may well ask what the hell are those – lutein and zeaxanthin? Well, these are carotenoids. And again, you may ask what the hell are carotenoids? Well, carotenoids are amazingly powerful antioxidants and so can help in preventing conditions such as cancer and heart disease.

What’s so special about these antioxidants lutein and zeaxanthin is that they may help in reducing the risk of certain eye disease, such as cataracts and age-related macular degeneration (AMD). In fact, kale tops all the dark, green leafy vegetables in having the highest amount of these antioxidants. In the Western diet, many of us don’t get enough of lutein and zeaxanthin. So, it’s worth considering having some kale in your life.

It’s interesting that the nutritional profile of a food changes depending on how you eat it. So if you ate kale raw, you would be eating double the amount of lutein and zeaxanthin than if you cooked the kale. However, just allowing kale back into my life is a step in the right direction. Raw kale for me is just too hard core. I think I might just veer to having it as one of a number of cooked ingredients in a nice warm Thai curry in this cold month of January.

A fact to note is that the bitter taste of kale gets stronger the longer it is kept, so try and eat it within a couple of days of buying. This may well have been one of the reasons for it tasted particularly bitter to me as I had left my pack languishing at the bottom of the fridge for some days.

A small cautionary note for those with an underactive thyroid (aka hypothyroidism) is that dark, green leafy vegetables contain compounds called goitrogens. So what? Well, goitrogens tend to reduce how much iodine you absorb. So what? Well, iodine is a very important mineral that your thyroid gland needs.

What is the thyroid gland? The thyroid gland is a small organ found in your neck which makes thyroid hormones. These regulate your metabolic rate and are also involved in making sure that other parts of your body, like your heart, gut, brain and bone, are working correctly. Eating goitrogens reduces your body’s iodine levels…which then reduces the amount of thyroid hormones produced by your thyroid gland…and so your body literally slows down – your metabolic rate decreases and various parts of your body don’t function at the normal rate they should.

So for those people who already have an underactive thyroid they should not eat an excess of dark, green leafy vegetables, just a normal amount. They shouldn’t avoid them, as they’re are full of great nutrients. Also, by cooking these vegetables, most of the goitrogens are destroyed.

Bottom line – people with hypothyroidism should not eat excessive amounts of dark, green leafy vegetables and should try and have them cooked. 

Now, enough biology, go and try some kale! Also, just to say that I’ll still refer to Kale as containing vitamin “KAC” but another fonder nickname I now have for it is Special K, seeing that it contains such huge amounts of the special antioxidants lutein and zeaxanthin, all the better to see you with!

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Photo by Rogier Noort (A Kilo of Kale) is licensed under a Creative Commons Attribution 4.0 International License.