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The Big Secret of Successful Mental Health Recovery

Luke Woodley is now the Chief Executive Officer of Walnut Tree Health and Wellbeing C.I.C based in the UK.

He is passionate about changing outdated and mediocre practices surrounding mental health treatment. He comes from the perspective of lived-experience and years of cutting-edge research. He is determined people shouldn’t have to suffer even more because of the lack of adequate and appropriate mental health care.

What follows is part of his story. Here he describes a major turning point in his recovery.

I was first diagnosed with PTSD in 1994 whilst still serving in the Coldstream Guards. The army was all I knew. I’d joined at 16 and at 18 had signed on for 22 years service. Medical discharge had not featured in my career plan! My battalion did all it could to support me when I became unwell. My commanding officer made sure I got my war pension and other such entitlements. However I received no treatment for my mental health, simply a diagnosis and medical discharge.

At first my only priority was to find a home for my family and a job to pay for it. This massive life change turned my world upside down. As time went on my mental health got worse. I lost my business and my marriage ended. I just wanted to run and hide from the world. My drinking increased and I made a couple of attempts to end my life. Relationships never worked as I was emotionally detached and shut down, always angry and always drinking.

Many years later, in 2005 I found myself sat in the waiting room at King Fisher House at Hellesdon Hospital, Norwich run by Norfolk and Suffolk NHS Foundation Trust. In the years that had passed I’d become an alcoholic, drinking to self-medicate, homeless, divorced and having made attempts to end my life.

As I sat there my inner critic piped up, as it often did: “ Look at what you’ve become, you should be ashamed of yourself” The voice in my head never seemed to have anything but scorn, disgust and condemnation for me.

Suddenly I became aware of my name being called. I looked towards the doorway and saw a slim man dressed smartly in shirt and well-pressed trousers. I figured him to be about my own age. He fixed me with good eye contact and introduced himself confidently as Roger. His handshake suggested he was confident in his own skin. As we walked to the consulting room all I could think was “say nothing”! I had met plenty of ‘professionals’ during those wasted years and nobody seemed capable of believing me, understanding me or in most cases really listening to me.

Roger asked question after question, the thing that struck me most was how he listened, I mean truly listened! No rush to fill the gaps if I paused, always giving me the opportunity to finish if I was just pausing to gather my thoughts. After my initial consultation Dr Kingerlee reassured me I would be getting treatment. He advised me I would receive an appointment to start treatment in six weeks time.

I drove home feeling that for the first time in a long time I had hope. This psychologist was very different from any clinician I’d every met. Roger was true to his word and time came round and I started treatment but this was not what I expected at all. Roger gave me things to read, suggested books and challenged my thinking. He challenged and pushed me to try new coping strategies, to train in them till I could do them without thinking. Yet when thing’s were bad this mild mannered, one might say a little introverted, but genuinely kind psychologist, seemed to swoop in like Superman. Safe guarding was always strong but with flexibility so as to not stifle recovery.

Letters of support and instruction were dispatched, helping make my life easier. When I had no place to go, he found me a space at a really nice hostel. It seemed he could move mountains! Sometimes I would smile to myself and think Roger was another reincarnation of Clark Kent.

I trusted and respected Roger, as treatment moved on from CBT to EMDR always accompanied by Rogers cutting of mental health stories from the news papers or copies of medical articles, treatment moved from Hellesdon Hospital to my GP surgery and finally Roger would see me at home. Sadly before the work was complete the mental health trust set about a major restructure, Roger was assigned to a different area. However his reaction to this turned out to be the positive force that kick-started my recovery. Roger didn’t hide behind a letter, on his last visit to my home he told me face to face, with compassion and dignity that our therapeutic relationship would have to come to an end.

The news I would have to pick up with a new psychologist some how didn’t matter, I wasn’t going to do it and the fact that Roger had told me face to face made me realise time had come to leave services and put all he had taught me into practise. What came next was a journey of discovery beyond my wildest dreams that unbeknown would prove beyond a shadow of a doubt, that this mild mannered psychologist, this Clark Kent really did have Superman qualities. He had given ‘me’ back to ‘me’ albeit in a different guise due to the circumstances I had been through. I had my advocacy back and the motivation to go on to experience post traumatic growth .

However dark your days, never give up. Keep looking for the man or women or group that have your best interests at heart. There are superheros out there you just have to look out for them.

Luke Woodley is founder, CEO and motivational speaker at Walnut Tree Health and Wellbeing C.I.C headquartered in Norfolk, UK. You can read Luke’s story here - https://www.walnuttreehealthandwellbeing.co.uk/ceo/ He is passionate about changing the way we treat those with complex mental health conditions and believes a better way of life is possible.

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Mental Health Recovery: you can’t always stop the symptoms but you can choose how to respond.

Burning rage

The other day I was discussing my own complex Post Traumatic Stress Disorder (PTSD) with some mental health nurses. One commented: “You have PTSD? But you always look so well and keep so busy”. “It wasn’t always that way and still it’s never easy”, was my reply.

The reality is I was diagnosed with severe, chronic and complex PTSD. I’ve had secondary depression and battled psychosis, including making three attempts to take my own life. Thankfully with the help of Dr Kingerlee (a clinical psychologist with a keen interest in complex trauma) and a lot of hard work, life’s a lot better but it’s not perfect. By training in new coping strategies and educating myself about PTSD and mental health, I now control my PTSD, it doesn’t control me.

Now I control my PTSD, it doesn’t control me.

Take yesterday for example: I woke with very low mood. I didn’t want to get out of bed. So, I took my time getting ready, cancelling a few things that were not so important. Went into the office, paced myself and did what I had to do. Went home had a soak in the bath, a cheeky takeaway and an early night.

Today I woke — and anger does not come close, to the rage I was feeling. Pure rage pulsing through my body. Recognising Hulk Mode, but not kicking against it, I welcomed my old friend. As I looked in the bathroom mirror I said “Hello old friend, I’ve got a job for you”. I headed straight to the gym and took it for a workout. I smashed it; channeling all that aggression and rage into my workout. It worked for me! I set a new PB and I am now sat with very tired arms and legs but with feel-good endorphins firing off in my head.

I am smiling eating my porridge feeling very chilled out. You can’t stop the symptoms, but you can choose how you deal with them. #BeSmartGetHelp

Luke Woodley is founder, CEO and motivational speaker at Walnut Tree Health and Wellbeing C.I.C headquartered in Norfolk, UK. You can read Luke’s story herehttps://www.walnuttreehealthandwellbeing.co.uk/ceo/#luke He is passionate about changing the way we treat those with complex mental health conditions and believes a better way of life is possible.

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When I was heard, I knew there was hope

“When a person realises he has been deeply heard, his eyes moisten. I think in some real sense he is weeping for joy. It is as though he were saying, “Thank God, somebody heard me. Someone knows what it’s like to be me” ~ Carl Rogers

After two years of chronic pain that took away my sleep, I slipped ungraciously into clinical depression. The attitude of my employers to this most unfortunate situation was, to assist me by heightening my levels of anxiety.

Being both anxious and depressed is a tremendous challenge. Clinicians have noted that when anxiety occurs with depression, the symptoms of both depression and anxiety are more severe compared to when each disorder presents alone. In this situation, the symptoms of depression take longer to resolve, making the illness more chronic and more resistant to treatment.

Finally, depression exacerbated by anxiety has a much higher suicide rate than depression alone. In one study*, 92% of depressed patients who had attempted suicide were also plagued by severe anxiety. Like alcohol and barbiturates, depression and anxiety can be a deadly combination when taken together.

Anxiety and depression affect everyone differently — but dealing with both is more common than you think.

I knew I was sinking. Although it was to be a long recovery period, I sought help early. A newly qualified GP, arranged to see me as often as I needed. Scheduling me at the end of morning surgery so we had time to talk. Well, I did most of the talking; he, most of the listening.

After one of these sessions, and with great compassion, he looked directly at me and with unbounded kindness, he said:

“I will give you every support I can, but you have to accept you are in a hole and you are the only one who can get yourself out. If you struggle you will go deeper. Now is the time to dig deep. You have the wherewith-all to recovery from this, if you focus on this and start now.”

My GP had administered the greatest service in my hour of need. I had been heard and because of this new understanding that now lay between us, I had gained hope. I hadn’t been judge. I had been believed (my suffering was genuine) and I was no longer alone. Most importantly, he had delivered his prognosis with a huge pile of reality.

My recovery journey was long, but I always had this hope. The self-belief that things would change, they would get better but I couldn’t always see it and I didn’t know when it would come. Sometimes my hope was strong like a roaring fire, sometimes it was a mere occasional flicker of light. On my travels some of my days were dark, dank and difficult.

Time and time again here at the Walnut Tree, people who come to see us say that they feel truly heard and understood for the first time. This in itself can visibly relax both the shoulders and the mood albeit temporarily. However, it does provide a point from which to start.

Many have been trying for years to find their hope. Often it has been completely shut down by other peoples’ agendas, lack of compassion, or highly inflated egos; to the point that their lives have been completely obscured.

Just as we sense when we are being looked at from afar, we humans know when we are being heard. Even in our darkest hours we feel when someone is merely paying us slip service, compounding our original hurt. Layer upon layer.

When we are truly heard and hope is restored, our personal recovery journey is in sight. With appropriate support, self-belief is rekindled and the hard work begins.

It can be done. At Walnut Tree Health and Wellbeing, we have a smorgasbord of lived-experience and we are ready and able to pass the hope on.

Reference *PubMed, Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care: http://www.ncbi.nlm.nih.gov/pubmed/9989117?dopt=Abstract

Sue Wright is Director, Operations and a Wellbeing and Recovery Coach at walnuttreehealthandwellbeing.co.uk, headquartered in Norfolk, UK. She served with the Royal Navy and is now studying for an MSc in Mindfulness Studies at University of Aberdeen. Sue is powered by tea.

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Here’s a simple way to defeat your self-critical mind

Over the past couple of weeks I’ve been grappling with what seemed an intractable problem. Part of the difficultly around ‘fixing’ or ‘solving’ it was due to my inability to recognise and accept the current situation. The other part of it was I was being very self-critical over not being able to ‘deal with it’. After all in my line of work it should be a piece of cake, right? No, wrong.

Self-criticism and its sibling Shame, hold a huge amount of energy, and if we can find a way through them, we can build skilful ways of working with these two devils.

No matter who you are or what you do, you have to have a variety of skills you can call upon in these frustrating everyday life occurrences.

In order to break this deadlock, I reminded myself of a simple exercise I learnt during compassion training (yes, it’s a thing, and a good thing at that). So here is my go-to version of the self-compassion break:

Place one hand into the palm of the other (this is an anchor that reminds the brain we are in ‘soothing mode’. The more you do it, the more the association is logged in your brain and you can do this any where — like a your own built in app).

Take a few, conscious deeper breaths in and out (no hyperventilation please)

Say to yourself (in your own head or you might frighten other people in your train carriage or supermarket) “Difficulties are part of everyone’s life. I am not alone.”

Move onto “May I treat myself with kindness, as I would a good friend (a small puppy, a newly born baby, my childhood teddy, Captain of the English Rugby team — insert your own focus here. One that conjures up a warm and compassionate feeling).

You might find these phrases are just the job, but it is worth playing around with them to see if you can find the wording that works best for you.

Once you have settled on your particular set up, why not write them on a small card or add them into your phone. Then, the next time the old self-critic pops up to give you a hard time, you can give it a run for it’s money.

It really is a handy tool to help soothe and calm troubled states of mind.

Why not let me know how you get on? Leave a message below and don’t forget to give this piece a clap (see little hands image below) — I really can’t rely on myself all the time to keep my spirits up. I’m human after all.

Sue Wright is Director, Operations and a Wellbeing and Recovery Coach at walnuttreehealthandwellbeing.co.uk, headquartered in Norfolk, UK. She served with the Royal Navy and is now studying for an MSc in Mindfulness Studies at University of Aberdeen. Sue is powered by tea.

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Mindful and military: Why mindfulness training is a crucial tool for veterans

“Mindfulness is a universal human capacity — a way of paying attention to the present moment unfolding of experience — that can be cultivated, sustained and integrated into everyday life through in-depth inquiry, fuelled by the ongoing discipline of meditation practice. Its central aim is the relief of suffering and the uncovering of our essential nature.” ( Santorelli, Heal Thy Self, 2010)

After the battle is over, the fighting starts The mental health needs of military veterans continue to be the focus for numerous research studies and of concern to the general public.

The estimated demand for services varies widely and the impact of these conditions on individuals, which lie behind the statistics, are frequently downplayed by defence departments in their general purpose communications:

“Fortunately, the rates of conditions like Post-Traumatic Stress Disorder (PTSD) in our people remain low…” (Ministry of Defence, 2017, p.5).

However, a recent systematic review and meta-analysis from Sharp et al (2015), indicates that the prevalence of any mental health disorders in both serving and military veterans is in the region of 37%. Of this group, they report that between 40–60% of these individuals don’t seek help. It is speculated that this is due to the ‘macho’ culture of the military and the stigma of being consider weak if presenting with a mental health issue. It is reported that of those who do come forward for treatment, 60–70% do not receiving adequate help and that they continue to suffer.

It is reported that of those who do come forward for treatment, 60–70% do not receiving adequate help and that they continue to suffer.

Behind these statistics are the often forgotten families and loved ones who become primary carers for these very troubled individuals and therefore, the overall impact of PTSD, for example, should never be underestimated (Beks, 2016). The suffering reaches far and wide as family members become at high risk of developing their own mental health issues due to the burden they carry. It was also recommended, many years ago, that they too should receive appropriate interventions (Gaskell, 2005). Two reasons why The Walnut Tree will be unveiling a new, unique ‘affected others’ course in Spring 2018.

Although PTSD is less prevalent in military veterans than other common mental health conditions at 4% vs 19.6% (MacManus et al, 2014), PTSD provides an interesting focus when considering Mindfulness Training (MT), because of the involvement of a range of behavioural symptoms. For ease of diagnosis these are grouped into four main clusters namely:

Re-experience Spontaneous memories of trauma, recurrent dreams associated with trauma, flashbacks, periods of prolonged psychological stress Area of brain affected: Hippocampus and Amygdala

Avoidance (of) Distressing memories, thoughts, feelings, or external reminders of traumatic events Area of brain affected: Hippocampus

Negative cognitions and mood A range of feelings including persistent and overwhelming distorted sense of blame of self and others. A significant loss of interest in activities, with estrangement from loved ones and others. Inability to remember key aspects of traumatic event Area of brain affected: Hippocampus and Pre Frontal Cortex (PFC)

Arousal Displays as aggression, reckless behavioural, sleep disturbance, hypervigilence Area of brain affected: Amygdala

There is also a PTSD subtype of disassociation: experiences of feeling detached from mind or body, or experiences in which the world seems unreal, dreamlike or distorted. Area of brain affected: Hippocampus (Adapted from American Psychiatric Association, 2013, p.2)

A unique programme providing the help required The Veterans’ Stabilisation Programme (VSP) is a unique evidence based programme from Walnut Tree Health and Wellbeing C.I.C in conjunction with Norfolk and Suffolk Foundation NHS Trust. It was conceived by army veteran Luke Woodley, who himself suffered from PTSD, and failed over many years to find appropriate help (NSFT, 2017). In conjunction with clinical psychologist Roger Kingerlee PhD and John King, a mindfulness practitioner, Woodley, using his lived-experience and extensive research, set about redressing this paradigm for veterans suffering mental ill-health as a result of complex trauma (Kingerlee et al, 2016). The VSP provides veterans with the discipline and skills to manage every day life. This cognitive based group training helps to:

recognise current mindset and develop skills to change it

understand the psychology behind PTSD to gain a greater sense of control

manage and understand difficult thoughts and feelings

reduce dependance on alcohol and drugs

improve relationships

teach the discipline and tools of mindfulness

Mindfulness, when delivered appropriately, is so much more than any of the recent ‘McMindfulness’ pejorative tags. The research literature suggests, it can have profound and far-reaching positive effects as indicated by some of the latest research for example: cultivation of compassion for self and others (Khoury et al, 2015), reduction in stress, anxiety and depression (Khoury et al., 2013) and increase in positive moods (Eberth & Sedlmeier, 2012). Such evidence would suggest that MT has earned its place in the psycho-education of veterans to help them better self-manage their mental health issues (Khusid et al, 2016).

The brain’s most important job and how it is affected by PTSD Current research is particularly useful in improving our understanding of what happens to the human brain that is ‘suffering’ the effects of PTSD. The work of Mahan and Ressler (2012), reviews how the neural pathways associated with PTSD in humans is linked to the neural pathways relating to fear.

These pathways belong to the limbic system synonymous with emotional processing. The three brain areas most affected by PTSD are the amygdala, the hippocampus and the prefrontal cortex (PFC).

Source: Mahan, A. L and Ressler, K. J., (2012) A schematic of the human brain showing how the limbic system is involved in PTSD. In: Fear conditioning, synaptic plasticity and the amygdala: implications for post traumatic stress disorder. Trends in Neuroscience

The most important job of the brain is to ensure survival at all costs.

The most important job of the brain is to ensure survival at all costs. To be able to do this effectively it needs to be able to achieve the following:

signal what the body requires moment to moment eg: food, sleep, sex

develop a ‘map of the world’ to know where to safely find what will satisfy

create the appropriate action and energy to get there

highlight threats and opportunities along the way

modify actions to suit current situation

Each structure in the brain works towards one or more these aims. The primitive, reptilian (bottom) part of the brain is responsible for all the life sustaining activities of a human being; for example eating, sleeping and breathing. It is responsible for maintaining an internal balance called homeostasis. Any one of these myriad of functions can become unbalanced and cause psychological problems.

Above the primitive brain sits the limbic system which is common to all animals that nurture their young and live together in groups. This is the seat of preferences (likes and dislikes), emotions and the centre of dealing with the rigours of living in complex social settings. The reptilian brain and the limbic system form ‘the emotional brain’. It acts like a welfare officer, looking out for threats and acting accordingly without any reference to the ‘thinking’ part of the brain called the neocortex.

When under a perceived threat, it will automatically run ‘preset’ programmes like the flight, freeze or fight responses. It is in these parts of the brain where the amygdala and hypothalamus can be found (see diagram).

The amygdala acts like the body’s alarm system, monitoring stimuli picked up via the body’s sense organs. If the thalamus has failed to make sense of these sensations, as it does in PTSD, and allows them to become fragmented, the hippocampus, which is responsible for normal memory processing breaks down, causing time to ‘freeze’ giving the impression that the incoming danger will last forever. The alarm is triggered. Heart rate is increased and blood pressure rises, the body could already be on the move before the rational brain has had time to think. The body is now awash with potent stress hormones, including adrenaline and cortisol. Under normal circumstances, when the threat is over the body returns to a state of homeostasis.

The prefrontal lobes of the neocortex (PFC — top brain), which sits upper most in the brain, is the site of humans’ ability to reflect, plan, imagine and empathise with others. It is here that the fine edge between impulsive behaviour and acceptable behaviour occurs — this is where choice is made. It plays a ‘command centre’ role. It is the place of discernment. If fear is felt and smoke is detected, this allows for rational thought to occur around is there immediate danger in the home or has a neighbour just lit a bonfire. In PTSD, the amygdala is hyper-responsive and the hippocampus and the PFC show reduced activation, the balance has shifted and the symptoms of PTSD start to show. If balance is to be restored there are two options, work on regulating from the top-down or the bottom-up. For Bessel Van Der Kolk, one of the world’s leading experts on traumatic stress, “mindfulness… is a cornerstone of recovery from trauma.” (Der Kolk, 2014, p.96) If the PFC is to be strengthened (top down) working with mindfulness to become more aware of the body’s sensations is a good place to start. Formal practices around the body scan and mindful movement can be helpful here (Farb et al, 2007).

Bottom up regulation via the ‘emotional’ brain can again call upon mindfulness to assist, for example via breathing practices as the breath is both under the influence of both the conscious and autonomic control (Taren et al, 2015).

Christine Forner, a registered clinical social worker with over 17 years of working with complex trauma, takes the importance of mindfulness in the recovery of traumatised individuals one stage further. She postulates that a traumatised brain functions mindlessly or at least is absent of mindfulness. She regards a well functioning medial prefrontal cortex (mPFC) as the epitome of mindfulness. This is based, in part, on Siegel’s work The Mindful Brain (2007) around the nine functions of the mPFC:

body regulation

attuned communication

emotional balancing

response flexibility

empathy

insight

conditioned fear modulation

intuition

morality

It appears that Forner doesn’t just want to return her clients to where they were, but sees the opportunity for growth through trauma informed mindfulness practices. Experience at The Walnut Tree would support this. “It is knowing how hard it is to become mindful when someone has been dissociating that we can figure out how to help our clients get back on track and find within themselves the place of mindful contentment.” (Forner, 2017, p.41)

Through understanding of what is happening in the various areas in the brain when under the influence of PTSD, those who specialise in the alleviation of trauma can begin to align MT appropriately. In short, different mindfulness practices can be targetted to work on the various affected parts of the brain and this should be a major consideration in any design of a MT course.

The VSP does not sit in glorious isolation at Walnut Tree Health and Wellbeing. The organisation has been built on a foundation of mindfulness and compassion for ourselves and others. Mindfulness meditation is practised by all the directors and there is a non-judgmental and compassionate culture. As the statistics show many of those suffering from trauma will not present unless the environment is perceived as welcoming.

The definition of mindfulness that is used on the course highlights that mindfulness is a skill that can be learnt. It ‘promises’ a way of coping with upcoming experiences. An emphasis is place on this new found practice as being a part of daily life, it stresses that it is a discipline — an attitude that is highly understood by military personnel.

It explains the purpose of mindfulness training — the relief of suffering.

Sue Wright is Director, Operations and a Wellbeing and Recovery Coach at Walnut Tree Health and Wellbeing C.I.C, headquartered in Norfolk, UK. She served with the Royal Navy and is now studying for an MSc in Mindfulness Studies at University of Aberdeen. Sue is powered by tea.

Bibliography AMERICAN PSYCHIATRIC ASSOCIATION (APA), (2013), Post Traumatic Stress DisorderVirginia : APA. BEKS, T. A., (2016). Walking on Eggshells: The Lived Experience of Partners of Veterans with PTSD. The Qualitative Report, (21)(4), pp. 645–660. DER KOLK VAN, B., (2014). The Body Keeps The Score. St Ives: Penguin Random House UK.

EBERTH, J. & SEDLMEIER, P. (2012). The effects of mindfulness meditation: A meta-analysis. Mindfulness, (3), pp.174–189.

FARB, N. A., SEGAL, Z. V., MAYBERG, H., BEAN, J., MCKEON, D., FATIMA, Z. and ANDERSON, A. K., (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience, (2)(4), pp. 313–322.

FORNER, C.C., (2017). Dissociation, mindfulness and creative meditations. New York: Routledge.

GASKELL, A., (2005). Post traumatic stress disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. NICE Clinical Guidelines, (26) (11), [Available from: https://www.ncbi.nlm.nih.gov/books/NBK56486/].

KHOURY, B., LECOMTE, T., FORTIN, G., MASSE, M., THERIEN, P., BOUCHARD, V., HOFMANN, S. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, (33), pp.763–771.

KHOURY, B., SHARMA, M., RUSH, S., & FOURNIER, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, (78), pp.519–528. KINGERLEE, R., WOODLEY, L and KING, J., (2016) Developing male-friendly interventions and services. Clinical Psychology Forum, (285), pp.41–47.

MACMANUS, D., JONES, N., WESSELY, S., FEAR, N.T., JONES, E. and GREENBERG, N., (2014) The mental health of the UK Armed Forces in the 21st century: resilience in the face of adversity. Journal of the Royal Army Medical Corps (0), pp.1–6.

MAHAN, A.L and RESSLER, K. J., (2012) Fear conditioning, synaptic plasticity and the amygdala: implications for post-traumatic stress disorder. Trends in Neurosciences (35)(1), pp.24–35.

MINISTRY OF DEFENCE (MOD), (2017), Defence People Mental Health and Wellbeing Strategy 2017–2022 London: OCL.

NORFOLK AND SUFFOLK FOUNDATION NHS TRUST (NSFT), (2017), Veterans’ Stabilisation Programme. Norwich: NSFT.

SANTORELLI, S., (2010). Heal Thy Self: Lessons on Mindfulness in Medicine. New York: Bell Tower (Kindle edition).

SHARP, M., FEAR, N.T., ROMA, R. J., WESSELY, S., GREENBERG, N., JONES, N. and GOODWIN, L., (2015) Stigma as a Barrier to Seeking Health Care Among Military Personnel With Mental Health Problems, Epidemiologic Reviews, 37(1), pp.144–162.

SIEGAL, D. J., (2007). The Mindful Brain in Human Development: Reflection and Attunement in the Cultivation of Well-being. New York: W. W. Norton & Company. TAREN, A. A., GIANAROS, P. J., GRECO, C. M., LINDSAY, E. K., FAIRGRIEVE, A., BROWN, K. W., ROSEN, R. K., FERRIS, J. L., JULSON, E., MARSLAND, A. L., BURSLEY, J. K., RAMSBURG, and CRESWELL, J. D., (2015). Mindfulness meditation training alters stress-related amygdala resting state functional connectivity: a randomized controlled trial. Social Cognitive and Affective Neuroscience, (10)(12), pp. 1758–1768.