Dr Marianna Szabo

Starting the year with good mental health

Dr Marianna Szabo
5 min read
The beginning of a new year is often the time to make changes towards a happier, healthier self. But what constitutes a healthier life when it comes to mental health?

According to the World Health Organisation, “mental health is more than the absence of mental disorders” 1 . We do not only want to survive; we want to thrive. Once our basic needs are met, we want to cultivate the best version of ourselves and a meaningful life.

Doing so can increase our resilience at those times when we face life’s inevitable adversities.

Martin Seligman, Professor of Psychology at the University of Pennsylvania, motivated a lot of research into psychological well-being and coined the term ‘positive psychology’. According to Seligman’s theory of well-being, there are five ‘building blocks’ towards a fulfilling life. If we apply our strengths to cultivate these five building blocks, we are moving in the direction of ‘flourishing’ 2 . Each of these five building blocks can be more or less important to a person, depending on their values, talents and interests. Each can also be cultivated and strengthened, using various techniques suggested by positive psychology.

What are the building blocks for a fulfilling life, according to positive psychology?

Positive emotions 

Naturally, a person who tends to experience anger, anxiety, or sadness more often than positive emotions, is unlikely to have a satisfying life. We differ in our tendency to experience positive emotions, even when we are going through the same experiences. If you are someone who tends to focus on the negative, remember that positive emotions can in fact be cultivated. We can train ourselves to pay attention to small pleasures in everyday life: a child’s smile, a beautiful tree, the smell of our morning coffee, the feel of clean sheets at night. Intentionally savouring such small pleasures goes a long way to balance out the natural tendency of our minds to seek out negative information.

Some people are drawn to high-energy positive emotions like excitement or enthusiasm, while others enjoy low energy positive emotions like calm, gratitude, awe, or peace. Find out what positive emotions contribute to your wellbeing and practice seeking these out every day, in small ways.

If we work on strengthening  the other ‘building blocks’ described below, they will also add to our overall experience of positive emotions.


Have you ever been so absorbed in an activity that you were barely aware of your surroundings, as if time stopped? It occurs when we fully concentrate our skills and attention on a challenging task, while being free from distractions 3 . It is also called ‘flow’, or more colloquially ‘being in the zone’. This kind of positive engagement is intrinsically enjoyable, and is often experienced by musicians, artists, and sports people.

On the less creative side, the attraction to computer games is also partly an expression of our intrinsic enjoyment of using our skills to master a challenging task. Other (perhaps less addictive), ways to experience flow may be by having a good conversation with an interesting person, reading an engaging book, writing, learning a new language, renovating or fixing things, gardening, playing sport, doing arts and crafts, and so on.

Of course, if you experience flow during your work tasks, you probably found a well-fitting vocation. If not, finding a hobby or other interests where you can experience this type of engagement would help increase the amount of positive emotion and satisfaction in your life.


Humans evolved to be social beings: connecting with others increased our very chance of survival. This has not changed over the millennia: having supportive relationships promotes well-being and helps us cope with difficult times. Loneliness, on the other hand, has been shown to be associated with both mental and physical ill-health.

Again, people differ in the amount, intensity and nature of social relationships they need. Extroverts find large social gathering invigorating and need these to feel more alive. Introverts prefer more quiet social encounters with fewer people, and find they need time alone to re-energise. A lot of people are somewhere in the middle between these two ends of the introversion-extroversion dimension.

Not only do we need others to rely on for support, we also feel better if we act kindly towards others, be they family, friends, or perfect strangers. Doing small acts of kindness for others produces an increase in well-being. If you feel that your life is lacking the kind of connections you need, you may want to put some effort into this ‘building block’ in 2023. Volunteer, join a club, make an effort to reconnect with long-lost friends: the resulting sense of belonging, compassion, kindness, empathy, teamwork, cooperation and camaraderie will add to your sense of well-being.


Many of us have asked the question of “why”: why am I doing this, why am I here, what is the purpose of my life?

Having a sense of purpose puts everything into context and adds a sense of positive energy to life, from work to relationships to many other pursuits.  Finding meaning is learning that there is something greater than yourself.

A sense of meaning can often come from spiritual beliefs and from a sense of belonging to a spiritual or religious community. For those without such beliefs, a sense of purpose can be derived from commitment to family or to a larger community, or to a cause. An active involvement in politics, work organizations, social justice, the environment, animal welfare, or any other cause that you feel is important beyond your everyday concerns will add meaning to your life.

Whatever it is, if you live according to your values, a sense of increased well-being can result.


All building blocks of a satisfying life interact with each other. For example, when we use our strengths towards success and mastery, our accomplishments can also increase positive emotions, such as pride. Conversely, a sense of accomplishment can be derived from our relationships, community engagements, or from our hobbies.

While accomplishments are important, they are probably the most ‘overrated’ aspects of life in our competitive societies.

If, looking back on your life so far, you notice that your achievements, or the pursuit of them, got in the way of taking care of other aspects of your life, such as relationships, flow, or meaning, it might be time to re-evaluate.

A balance among the five ‘building blocks’ is necessary to create a sense of fulfilment in life.

Of course, mental well-being does not mean that we are constantly happy, optimistic and confident. Negative emotions, self-doubt and loss are also a part of the human condition. To live an authentic life, we need to be able to acknowledge and fully experience negative emotion, while also keeping a ‘big picture’ view of our accomplishments, our relationships, and the values that give meaning to it all.



2 Seligman, M. (2012). Flourish – A new understanding of Life's Greatest Goals- and what it

takes to reach them. William Heinemann Australia. (1st ed)

3 Csikszentmihalyi M (1997). Finding Flow: The Psychology of Engagement with Everyday

Life. New York: Basic Books. (1st ed.).

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness, and a Senior Lecturer in Psychology at the University of Sydney.

Her research primarily focuses on mental wellbeing, mindfulness, and other meditation practices.

Marianna is part of the Good Mood Dudes network of experts available to support your wellbeing program. If you want to soundboard your wellbeing plan or hear how we’d get your program up and running, get in touch with our team for a complimentary strategy call today. 

Am I a good friend to myself?

On World Mental Health Day on 10/10/2022, the World Health Organisation (WHO) launched a campaign to “make mental health & well-being a global priority for all”, envisioning a world where mental health is “universally valued, promoted and protected”.

We have lived through very serious challenges to mental health during the past three years. The COVID-19 pandemic, major climate events, a war in Europe, and economic uncertainties have all added a series of long-term stresses to our lives. Chronic stress can undermine the mental health of many.

On World Mental Health Day, therefore, it is timely to pause and reflect on what we can do to “value, promote and protect” our own mental health, as well as the mental health of those around us.

In Australia and other economically developed nations, mental health is becoming increasingly accepted as a serious issue that needs discussion. Taboos around mental health struggles have been lifted by those who speak out about it, including famous sportspeople, actors and musicians. The positive contribution of these people to our ability to talk about mental health is immense.

So perhaps the most important thing we can do to protect our mental health is to start talking about it. Much like our physical health, mental health exists on a continuum. Sometimes we only need a little rest and support to get better, and other times we need assistance from a professional. When we feel a little more stressed or anxious than usual, turning to friends and family, someone who can listen and be present for us, can help a lot. But when we struggle with severe challenges, we need a specialist to help us get through.

Once we decide to seek help, the variety of mental health professionals available can be confusing. Where to start?

The best point of contact is your GP. Your GP can provide an initial assessment and a mental health care plan and refer you to a mental health professional supported by Medicare, usually a psychiatrist, a clinical psychologist, or a general psychologist.

What is the difference between these professions?

Psychiatrists are medical doctors who specialise and obtain further training in mental health. As such, they often use medication to treat mental health disorders. They usually see people with complex conditions that respond well to medication, such as schizophrenia or bipolar disorder (also known as manic depression).

Clinical psychologists have at least 6 years of education in psychology followed by a two-year psychology registrar program. They receive specialised training at the Master’s or PhD level in diagnosing and treating mental health conditions using a variety of psychotherapeutic techniques. Importantly, clinical psychology training programs are required to include treatments that are empirically supported: that is, several research studies have shown that the treatment works better than a placebo control condition. Clinical psychologists treat the whole range of mental health problems, but they do not prescribe medication.

General psychologists also have 6 years of education, but they have not completed a formal Master’s or PhD degree in clinical psychology. After studying psychology for 4 or 5 years at university, they usually obtain a Bachelor’s degree and further training through professional placements.

These professions are registered and regulated by the Australian Health Practitioner Regulation Agency (AHPRA), a government organisation that oversees health professionals’ training and professional standards to ensure the quality of care received by the public.

Other options to look after your mental health with the help of a professional include seeing a counsellor or a psychotherapist. In general, counsellors and psychotherapists provide services for people with problems and stresses in everyday living, rather than more serious concerns about mental health. Their services are not regulated by AHPRA, Medicare rebate is not available, and a doctor’s referral is not necessary.

‘Counsellor’ and ‘psychotherapist’ are titles that are not legally protected in Australia. This means that anybody can call themselves a counsellor or psychotherapist, irrespective of their background, level of education, or experience. If you decide to see a counsellor or psychotherapist (rather than an AHPRA-registered psychiatrist or psychologist), finding someone who is a member of one of their own accrediting associations, for example, the Psychotherapy and Counselling Federation of Australia (PACFA) would be advisable. These associations require their members to meet certain educational and professional standards. This would help to ensure that you see a person with an accepted level of education and professional experience in counselling and psychotherapy.

It’s worth mentioning that many employers provide Employee Assistance Programs (EAPs), which can include a limited number of sessions with a mental health professional. This may be with a counsellor, psychotherapist or psychologist, so it’s helpful to understand the differences.

Of course, prevention is often better than treatment, regarding both physical and mental health. There are many ways to look after our mental health, from making sure that we eat well, rest well and exercise well to nurturing or seeking out reliable, supportive, healthy social connections. A lack of social support is one of the best predictors of poor mental health in adults.

In general, however, a good way to look after our mental health is to ask ourselves whether we are our own best friend? Perhaps notice when you criticise yourself or berate yourself for a mistake, or when you tell yourself that you need to keep working even though you are running on empty.

Ask yourself: if my best friend, someone I care about and feel responsible for, were in this situation, what would I say? Would I criticise them? Would I berate them, would I push them, would I give them the same advice I am giving myself? Would I do this to my child?

If the answer is ‘no’, it is time to take notice of our self-talk and to develop an inner voice that is kinder and more understanding towards our own struggles. Becoming our own best friend is a great first step towards taking care of our mental health.


Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.

Everything You Need to Know About Procrastination

“Procrastination is the Thief of Time” (Edward Young, 1683 – 1765)

Procrastination is a common human tendency. We all have, on occasion, postponed tasks despite the negative effects caused by the delay.

When procrastination becomes a habit, it can have serious consequences in life. We don’t only procrastinate at work or in education: we may also avoid obligations such as completing tax returns, delaying making medical appointments, or failing to keep promises towards friends and family. Feelings of guilt, anxiety or depression about the delays can then follow. Unsurprisingly, research has shown that chronic procrastination is associated with lower achievements in education, slower job promotions, and poorer mental and physical health.1

Why do we procrastinate, and how can we overcome this habit?

Procrastination can be caused by a large variety of factors2, which can be grouped into three domains:

1/ task characteristics (e.g., the unpleasantness of the task, unclear instructions or feedback)

2/ environmental factors (e.g., incentives for success, accountability, external distractions)

3/ personality facets (e.g., negative mood, avoidant coping style, poor emotion regulation)

Task characteristics

We often avoid tasks because they are unpleasant (for example, going to the dentist), or they are overwhelmingly large (for example, completing a major project or losing a lot of weight).

Environmental factors

Procrastinators usually do something else instead of the required task. The more available and pleasant that ‘something else’ is compared to the task, the easier it is to procrastinate. This is especially the case if the task does not result in outcomes that are worth the effort (for example, the task seems to have little meaning or value, or you expect that your achievements will not be recognised by others).

Personality facets

Not everybody will procrastinate to the same extent, even if the task is unpleasant. Several personality characteristics make us more likely to procrastinate, given the same task and environmental factors.

Briefly, procrastination can be seen as an attempt at emotion regulation in the face of stress. This attempt is usually successful in the short term but has serious negative consequences in the long-term.

For example, a person may consider the task too overwhelming, boring, or lacking in real value and interest. These perceptions can cause feelings of stress, anxiety, resentment, or other negative emotions. Procrastinators tend to have a lower ability to tolerate and set aside these emotions and concentrate on the task. Instead, the quickest way to reduce these feelings is to walk away from the task, do something else, and even convince ourselves that the other task is just as important.

Unfortunately, the deadline will eventually be so close that avoiding the task is no longer possible, and the procrastinator will finish the job at the last minute, often not having enough time to check for mistakes or create a polished product. If then the feedback is less than positive, the procrastinator may feel guilty (a negative emotion that can lead to more procrastination), or they may be able to maintain self-esteem by telling themselves that they could have done a better job “if only they had more time to do it”. Indeed, this ‘self-handicapping’ behaviour is quite common among people with low confidence in their abilities.

How to reduce procrastination?

Reconsider how you view the task. Procrastinators often focus on the unpleasant or anxiety-provoking aspects of the task. To reduce procrastination, it is important to make sure that all aspects of the task are considered and put into perspective. For that, we need to slow down and think about the task in a different way.

For example, if the task is overwhelming, we may decide to focus on achieving small parts, step by step. Deciding to focus on the time spent working on the task can be helpful. One may set a very rigid schedule: work on the task for exactly 45 minutes, then have a break for exactly 15 minutes and do something to reward yourself. Repeat, rigidly, until you have spent 4 hours working on the task. Have a longer break, then start again.  The most important point is to divert attention from how large and scary the task is and focus on the small achievements. They will add up and the task will be finished.

If starting is particularly difficult, again, take tiny steps. Make it easier on yourself.  Tell yourself: “I’m just going to open the document and read one page. That’s all.” Or, “I’m just going to put on my running shoes and take a walk around the block.” Or, “I’m going to find my tax expense receipts for just one month”. While it may sound like doing such small tasks is ‘not worth it’, they are a whole lot better than not doing anything! Most importantly, they will help you refocus your attention from your perception of how unattainable the task is. This may allow you to reduce your negative emotions about the task and make a start.

Change the task environment. We all know that limiting intrusions and distractions is important to stay focused. Turn off social media reminders.  If needed, put on an email notification saying that you are away from email for a couple of hours.

However, distractions are only a part of the total work environment. The positive and negative consequences associated with the task itself are very important. Were the expectations for the task clearly communicated to you? Do you feel supported, can you turn to someone for advice? Are your achievements recognised by your workplace? If you feel alone, unsupported, and unsure of what it is you need to do, procrastination is more likely.  A conversation with your supervisor may help if your workplace is open to feedback.

Consider your personality and coping style. Empirically supported treatments for chronic procrastination tend to emphasise the development of more effective emotion regulation skills3. People can learn a variety of emotion regulation techniques, such as deep breathing, positive self-talk, or setting up positive experiences as rewards for achieving small steps. Observing and changing one’s own thinking habits and emotion regulation styles is difficult, though. Procrastination is often associated with long-held beliefs (for example, a deep-seated feeling of not being good enough despite evidence for the contrary; or a belief that one needs to cope with everything without asking for help) that are so automatic that we are rarely aware of them. Reading a self-help book about procrastination or seeking professional assistance may be helpful in these cases4.


1Steinert, C., Heim, N., Leichsenring, F. (2021). Procrastination, perfectionism, and other work-related mental problems: prevalence, types, assessment, and treatment. Frontiers in Psychiatry, 12.

2Steel, P. (2007). The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychology Bulletin, 133, 65–94. doi: 10.1037/0033-2909.133.1.65

3Malouff, J.M., Schutte, N.S. (2019). The efficacy of interventions aimed at reducing procrastination: a meta-analysis of randomized controlled trials. Journal of Counseling and Development, 97, 117–127. doi: 10.1002/jcad.12243

4Steel, P. (2010). The procrastination equation: how to stop putting things off and start getting stuff done. Random House Canada.


Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.



Understanding Burnout

After nearly three years of living with the COVID-19 pandemic and other worrying developments in the world, more and more of us feel ‘burnt out’.

But what is burnout? How is it different from being generally stressed or tired? What causes it, and how can we prevent it?

What is burnout?
The World Health Organisation defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. It refers specifically to experiences in the occupational context, rather than in other areas of life. Of course, if chronic stress is present in other areas of life, workplace stress will be more difficult to manage, and vice versa.

Burnout was first described by psychologist Christina Maslach and her colleagues in the 1970s. They identified this issue among professionals working in human services, such as doctors, nurses, or counsellors. Their research suggested that burnout has three distinct aspects: emotional exhaustion, depersonalization and a reduced sense of personal accomplishment.

Emotional exhaustion refers to a state of feeling overextended, constantly tired, and having a sense of depleted energy, or ‘running on empty’.

Depersonalization, which is sometimes also referred to as cynicism, is the interpersonal dimension of burnout. It is a negative, detached, insensitive, uncaring attitude to work and especially towards one’s clients.

Low personal accomplishment refers to a diminished sense of professional competence, and reduced productivity at work. The Maslach Burnout Inventory is a widely used questionnaire to assess these three aspects of burnout.

Burnout itself is not classified as a medical condition or psychological disorder. There is no ‘cut-off’ point on the questionnaire above which one can be called ‘burnt out’. Instead, high scores on a burnout questionnaire indicate that all is not well: you are exhausted, you don’t care about your clients, and you constantly feel that you are not doing a good enough job.

Burnout is associated with serious physical and psychological health conditions, such as depression, insomnia, chronic pain,
increased susceptibility to respiratory infections, gastrointestinal problems, and cardiovascular diseases.

So, if you do feel burnt out, it is time to look at the causes and to begin doing something to improve the situation.

What causes burnout?
Christina Maslach’s original research showed that burnout was most likely to develop in people who had been suffering from chronic work stress. When a stressful event occurs, the body responds with the activation of a characteristic stress response, called the fight or flight response.

During evolution, the threats we faced were usually physical. We needed to run away or face a potential predator (flight or fight). Even though nowadays we are rarely in such physical danger, our biological system still reacts with the same flight or fight response to social stress, such as an unpleasant encounter at work.

When this response is activated, both body and mind increase preparedness to deal with a potential threat. For example, blood pressure increases, breathing patterns change, blood flow increases towards the large skeletal muscles and away from the guts.

This activation reduces processes needed for rest and recuperation, such as digestion or sleep. Importantly, these bodily changes are accompanied by changes in the mind: you become more vigilant for negative information, and it becomes more likely that you interpret ambiguous information as threatening. In other words, your thinking becomes more negative.

Humans evolved to deal with short term (acute) stress very well. When the stressful event ends, the body returns to its normal state, and it can rest and recuperate. However, if stress is ongoing (chronic), that rest and recuperation can not happen. The constant activation of the stress response can eventually cause physical and psychological health problems, including burnout.

We know that several work circumstances can increase employee stress. These include:

  • unreasonable time pressure
  • an unmanageable workload
  • a lack of role clarity
  • a lack of control and autonomy
  • a lack of communication and support from managers
  • unfair treatment from managers, clients, or co-workers.

However, not everybody reacts to stressful situations the same way.

Personality traits, strongly held beliefs and values, and certain thinking patterns can contribute as well. For example, people who are highly perfectionistic tend to experience more stress, which can then lead to burnout. Strong individual values placed on achievement can also cost personal wellbeing if they are not balanced with a sense of self-care and compassion. Sometimes underlying such tendencies for perfectionism and high achievement orientation is a deep-seated feeling that something is about to go wrong, and one needs to be constantly in control to stave off disaster – even if the nature of that disaster is not always clear in your mind.

What can we do about it?
As most of us are already aware, to avoid burnout, we must reduce chronic stress or manage stressful situations better. If the workplace is open to creating a healthier work environment, talking to a supervisor may solve the problem. Simple self-care strategies, like eating a healthy diet, getting enough exercise, social support, improving your sleep quality, and regular breaks from work may also help to fend off the effects of high-stress jobs. Sometimes a change of position or job is an option.

However, such strategies are often ineffective if one’s personality, beliefs or thinking are at least partially responsible for a tendency towards experiencing chronic stress. No amount of fresh green vegetables and lavender oil will solve the problem for a person whose thinking is habitually negative or self-critical, who keeps putting others’ needs ahead of their own, or who has difficulty relaxing control over minor aspects of life.

If you are that kind of person, start watching your thinking and asking yourself whether a healthier thinking pattern would also be helpful. It is hard work, but it is possible to change our thinking.

If you are experiencing chronic stress or burnout and you’re having difficulty finding your way out, it may be a good idea to seek professional support. Talking to a mental health professional can help clarify the problem and identify strategies to solve it. You deserve to feel your best.

References and further reading

  1. World Health Organization. (2019). ICD-11: International classification of diseases (11th revision).
  2. Maslach, C. and Jackson, S.E. (1981), The measurement of experienced burnout. Journal of Organizational Behavior, 2, 99-113. (full text)
  3. Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. (2017) Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One. 12(10):e0185781. doi: 10.1371/journal.pone.0185781. (full text)
  4. Renzo B, Guadalupe MG, Jean-Pierre R. (2021). Is burnout primarily linked to work-situated factors? a relative weight analytic study. Frontiers in Psychology, 11. (full text)

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.  

Do I have adult ADHD?

Until recently, Attention Deficit Hyperactivity Disorder (ADHD) has been considered primarily a childhood disorder, with only a minority of children continuing to have symptoms in adulthood. A surge in adult ADHD diagnoses occurred in recent years after changes to the diagnostic system made it easier to detect ADHD in adults. This increase has been accompanied by a lot of media
interest, with #ADHD trending on TikTok and other social media platforms as well.

Many people may have now encountered messages such as this:

  • Are you someone who can focus on some projects or activities so intensely that you completely lose touch with time?
  • At the same time, are you also a person who keeps forgetting appointments, can’t pay bills on time, is always late, can’t get organized, and can’t concentrate on unexciting projects, despite your best efforts?
  • Have you often wondered why you find “adulting” so difficult?

If you answered yes to these questions, you may have adult ADHD.

As usual, however, the story is more complicated.

How is ADHD diagnosed in adults?

What are the symptoms?

The diagnostic criteria for ADHD are essentially the same for adults and children. The current diagnostic manual lists 9 symptoms of inattention and 9 symptoms of hyperactivity. Children need to report 6 out of the 9 symptoms of either inattention or hyperactivity to receive a diagnosis of ADHD. Adults need to report only 5 out of the 9 symptoms in either group.

An example of an inattention symptom is “Often fails to give close attention to details or makes careless mistakes at school, work, or during other activities (e.g., overlooks or misses details, work is inaccurate”.

An example of a hyperactivity symptom is “Often blurts out an answer before a question has been completed (e.g., completes people’s sentences, can not wait for turn in conversation).” (DSM-5, APA, 2013)

Adults and females of all ages are more likely to have inattention, rather than hyperactivity symptoms.

However, saying ‘yes’ to 5 or more symptoms is not enough for a diagnosis. To have a clear picture, we need to ask further questions.

Do these symptoms interfere with important life functions?

We all become inattentive, unfocused, forgetful, or impatient sometimes. To receive a diagnosis of ADHD, the symptoms need to directly cause serious problems in the person’s life. For example, do these symptoms result in lower achievements at work or in education? Do they increase social and family problems? Could they be responsible for accident proneness, legal difficulties, or substance misuse in the person’s life?

Do the symptoms occur in several different situations?

If a person is hyperactive or inattentive in some situations (e.g., at work) but not in others (e.g. with friends or family), it is possible that the situation itself is responsible for the problem, not the person.

However, people are not always aware of the problems that their symptoms cause. It can be helpful to consult others in different settings (e.g., friends, spouses, co-workers) to find out whether they see any substantial, ongoing signs of inattention or hyperactivity in those settings.

Have the symptoms been present before age 12?

ADHD is a neurodevelopmental disorder. Therefore, it must have already been present in childhood. Because recall of childhood memories tends to be unreliable, it is important to consider family history very carefully and to find informants or school records to confirm that ADHD caused problems in several different settings (school, home, social situations) before age 12.

Is there an alternative explanation for these symptoms?

This question is perhaps the most important, but also the most difficult to answer.

Sometimes apparent symptoms of ADHD are better explained by another psychological condition or disorder. This other condition may have been with you since childhood. For example, anxiety, stress, depression, and adverse childhood experiences (i.e., family discord, mental health or substance use problems in the family, emotional or physical abuse or neglect of a child) can all cause attention and concentration problems, forgetfulness, impatience and impulsivity both in adults and in children. In those cases, a diagnosis of ADHD would not be helpful, and could in fact be harmful.

Only a very careful clinical assessment can disentangle the cause-and-effect relationships among these symptoms and disorders.

In summary

Symptoms need to be understood in the wider context of the person’s life, rather than just being a shopping list of items to be ticked off. Mental health professionals following best practice guidelines take a very thorough family history and, if possible, seek information from family, friends, significant others, and previous written records (with the client’s informed consent, of course). Therefore, establishing a diagnosis of ADHD with some certainty can be a lengthy and difficult process.

If you think that you have symptoms of ADHD

Don’t jump to conclusions. You may want to start with a well-validated screening questionnaire, such as this. Consider if your symptoms have been present since childhood and whether they are possibly better explained by other problems, such as anxiety, depression, stress, or adverse childhood experiences.

If you think that your experiences fit the diagnosis of ADHD, seek a full assessment from a clinical psychologist or a psychiatrist. Ideally, your mental health professional will follow best practice guidelines to make sure that they do not miss a diagnosis of ADHD, but also that they do not diagnose ADHD when the problems stem from alternative causes, such as anxiety, depression, stress, or early trauma.

Because the most effective treatment for ADHD is stimulant medication, we need to exercise extra caution about potential misdiagnoses. The prescription of stimulants for adults who do not in fact have ADHD can have many far-reaching consequences for the person and society.


References and further reading


Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.  

Goal Setting for the New Year and Beyond

Goal Setting for 2022

As the year ends, many of us begin to think about our goals for the new year and beyond. Many of us will also fail to keep some of our resolutions and achieve our goals. 

Do not fear, this is perfectly normal. Psychologists use several approaches to help you in changing and sustaining a new behaviour. One such approach is the use of SMART goals. SMART goals are said to be achievable because they are 

  • S – Specific 
  • M – Measurable 
  • A – Achievable 
  • R – Relevant 
  • T – Time-bound (or Trackable).

For example, if you don’t get any exercise and would like to improve your fitness, instead of setting “become more fit” as a goal, try to use the SMART goal of “walk 7000 steps at least 3 times a week” as your initial aim – of course it needs to be achievable considering your current level of fitness, and you can adjust it as your fitness improves. 

However, no matter how SMART our goals are, some of us fail to achieve them. Part of the problem may be that we have too many different goals that end up overwhelming us, so we soon give up. Another, deeper problem may be that the goals we set do not align with our authentic values; we pursue them without questioning whether this is really what we want to do with our lives.

Indeed, one important (and sometimes ignored) aspect of SMART goal setting is “Relevance”. 

Is this goal relevant to how I want to live my life? Is it aligned with my authentic values?  Considering our values are also important when we have many different goals, and we need to prioritise and direct our attention to the most important ones. 

How do we know if our goals are aligned with our authentic values? 

Psychology Professor Steven Hayes, the creator of Acceptance and Commitment Therapy (ACT) suggests that there is an important difference between goals and values. Goals are things we want to achieve. We may want to run a marathon, get married by a certain age, have 3 children, earn a certain amount of money, have a house in a certain suburb, etc. 

Goals can be seen as signposts on a certain path we travel in life. 

However, what is the direction of that path? The direction is given by our values. When we set goals that are consistent with our values, their purpose is meaningful to us. 

Keeping our values in mind helps even when, for whatever reason, we do not achieve our goals. For example, we might say that having loving, loyal, kind relationships is an important value to us. Our goals may never materialise: maybe we won’t get married, maybe we won’t have children, either by choice or because of reasons outside of our control. But we can still have loving relationships in our lives. We can choose to act in a loving way right now with our friends or with our family of origin. We can choose to be patient and kind to the stranger who slows us down in traffic. We can live consistent with our values, irrespective of whether we meet our set goals or not.  

Keeping our values in mind helps us travel the path we chose without the pressure and stress that sometimes can result from living our lives from one goal to another. It frees us from defining our lives in terms of a series of successes and failures and helps us keep the ‘big picture’ of who we want to be in mind. 


Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney. 

End of Lockdown Anxiety

After the seemingly endless days spent on repeat at home, many people are enjoying the end of lockdowns and the beginning of our new ‘COVID-normal’ lives. A lot of us, however, experience a mixture of excitement and anxiety. We welcome the ability to see our friends and family and to go to a café or the movies, but we also worry about the possible consequences of opening up to the new normal.

Now that we are no longer able to stay at home and avoid contact with others, some of us worry about the possibility of getting infected with coronavirus (SARS-COV-2) and getting seriously ill from COVID-19. Psychology research has shown that in general, our level of anxiety is primarily determined by two subjective judgments: the perceived likelihood of something bad happening, and the perceived harmfulness of that outcome. People who are very anxious tend to overestimate either the likelihood or the harmfulness (or both) of what they fear. Therefore, these judgments need to be adjusted to reflect reality, rather than our own subjective (over)estimations. 

We have lived with daily reminders of the possibility of serious illness or death from COVID for nearly two years. Understandably, some of us may be reluctant to risk that possibility and do not welcome the idea of going back to the office or sending children back to school. However, it is now important to reset our mental image about COVID and to remind ourselves that vaccinations greatly reduce the possibility of becoming seriously ill, as well as the possibility of getting infected with the virus. In other words, both the likelihood of a bad outcome (getting infected) and its harmfulness (getting seriously ill as a result of an infection) is now greatly diminished. That reminder should allow the more nervous amongst us to slowly get used to the idea that we need to live with the virus circulating in the population, and that we can adjust to the new normal while taking reasonable precautions to avoid infection. 

Of course, we need to enter our new COVID-normal life at our own pace. While some are happy to jump into socialising again, others might be less keen. Indeed, for those of us on the introverted end of the introversion-extroversion spectrum, the lockdown may have provided a welcome reprieve from the pressures of a busy social life. Introverts may enjoy social functions, but they also need to spend time alone to recharge. Now, as we no longer have the lockdown as an excuse to prioritise our own time and say no to social invitations, we need to learn to set boundaries. It is indeed ok to have fewer social engagements and to enjoy the quieter periods that the lockdown allowed us to have. If you enjoyed your alone time during the lockdown, there is no reason why you should give in to the pressures of social expectations and say yes to all invitations. Take your time. 

Perhaps an important experience for many of us who were able to take time to reflect on our lives during the COVID years was a rethinking of our values and priorities.  You may have found that the time spent with family and children, or the attention given to your own health and well-being during the lockdown was a welcome change from your previous life. Trying to remember those priorities and resisting pressure to jump back into a more frantic, high-pressure life we lived previously may be an important challenge in the coming months.

Whatever the challenge you find yourself facing, it is important to take your time. We are in uncharted territory. Having compassion towards yourself and towards others who are struggling to navigate these unprecedented, uncertain times is the most important attitude we need to carry forward from our two years of living with COVID.


Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney. 

What is Cognitive Behavioural Therapy?

Have you ever considered the idea that it is not your outside circumstances that determine how you feel? It’s not the traffic in the morning that makes you feel angry, or the person who stands you up on a date that makes you feel unlovable, or the presentation at work that makes you feel anxious.

There’s something else at play, and this is a good thing!

Once we stop focusing on the things that we can’t control, like the traffic or other people’s behaviour, we can begin to look inward at ourselves. This allows us to change what we can control – how we think, how we perceive things, our behaviour and how we respond to difficult situations. Ultimately, this can change how we feel.

So, where do we begin?!

Cognitive Behavioural Therapy (CBT) is a well-known form of therapy that combines cognitive psychology and behavioural psychology. In other words, the science of our thinking and our actions. The best thing is that it’s evidence based, which means that it has been rigorously tested and proven to be effective through scientific evaluation.  CBT has proven to be effective in the treatment of depression, anxiety, relationship problems, sleep difficulties, chronic pain, work related stress and many more conditions. But Cognitive Behavioural Therapy is equally as helpful for alleviating day-to-day stress as it is for combatting enduring psychological distress.

Changing your thoughts can help lead to behavioural changes, and vice-a-versa.

To change your thoughts, you need to look at both the cognitive (how we think) and behavioural (how we react) components of our thoughts. Both components are important in order to effect meaningful, lasting change in a person and help them manage and maintain good mental health.


Cognitive component:

1.Be aware of your negative or unhelpful thinking

We have to be aware of our mind, as often our thoughts are automatic and we respond to them without challenging them. Did you know that the average person has between 12,000 and 70,000 thoughts per day? And of those thoughts, most of them are negative and repetitive? Keeping a thought diary is a useful way of becoming more self-aware of your thinking.

2. Examine your thoughts and ask yourself if you’re engaging in a thinking error. Examples of thinking errors include:

    • Black and white thinking: Categorising things into one of two extremes, such as seeing situations as good or bad.
    • Catastrophising: Blowing things out of proportion and thinking the worst-case scenario will occur.
    • Personalising: Attributing negative external events such as a rescheduled meeting or heavy traffic to something about you or something you’ve done, when there is actually no link.
    • Jumping to conclusions: Making a judgement with no supporting information.

3. Look for the evidence and deal with the facts

Once you have acknowledged that your belief is just a thought and not a fact, try and look for evidence of what is actually going on and deal with the facts.

4. Come up with a more rational or helpful thought about the situation 

Use the evidence to come up with a more helpful and less distressing way of perceiving the situation. e.g. If a meeting has been rescheduled it is much more likely to be because of an issue with an unrelated project than it is to be about you personally.


Behavioural component:

Now that we have examined the ‘C’ in CBT, let’s look at the ‘B’ or the behavioural component. After all, CBT is action-orientated so we must find ways to practice it effectively.

1.Graded exposure

Identify those behaviours or things that you are doing that are maintaining the problem. If a behaviour is maintaining a problem it means that it is keeping the problem alive, like kindling to a fire. Did you know that avoidance is the greatest maintaining factor for anxiety? For example, the more you avoid social situations because they make you feel uncomfortable, the greater your anxiety around social situations will be. Encourage yourself to slowly engage in situations that you find difficult and make sure you start with easier situations, and build up to the more difficult ones.

2. Behavioural experiments

Create behavioural experiments or exposure tasks to challenge your unhelpful thinking. For example, if you believe that the lift will break down and you’ll be stuck for hours and unable to breathe (so you always take the stairs at work)… take the lift with a colleague and see what actually happens!

3. Activity scheduling

Schedule positive activities to gain a sense of achievement and enjoyment in your week…. from tidying your linen cupboard to texting a friend, it doesn’t need to be complicated.

4. Physiological component

The fight/flight/freeze response is our body’s automatic survival response to a perceived threat. It can include a racing heart, sweating, shaking and dilated pupils. Learning techniques to get your body to relax when there is a perceived threat is important for being able to face difficult situations that you may be avoiding.


Related techniques:

In addition to shifting unhelpful thinking and undesirable behaviours, CBT also includes the acquisition of many other skills and techniques to improve how we feel.

  • Relaxation training
  • Mindfulness techniques
  • Goal setting
  • Problem-solving techniques
  • Communication training


CBT has homework! It’s like going to the gym; you have to learn to condition your mind in a different way. You also need to start behaving differently and setting yourself behavioural tasks each day or week for effectively changing how you feel.

In practice

The most effective way to benefit from CBT is to be guided by a qualified professional, such as a psychologist. There are also many APPs available that apply the techniques of CBT, which can help you with changing your thinking and behaviour. Either way, it is empowering to know that it’s up to you to change how you feel!

What is Mindfulness?

Mindfulness-based programs have become extremely popular in the past decade. They are offered as a solution to a wide range of problems in work and health settings, in schools, and even in prisons. Considering such a huge uptake, it is important to understand what mindfulness is and to appreciate the evidence behind the claims for its usefulness. 

Mindfulness was popularised in Western healthcare by Professor Jon Kabat-Zinn in the 1970s.  A long-time practitioner of yoga and Buddhist meditation, he aimed to create a structured, secular program that would enable his patients to improve their quality of life in spite of living with chronic illnesses and pain. This initiative became the now well-known Mindfulness Based Stress Reduction (MBSR) program. 

Another important program is Mindfulness-Based Cognitive Therapy (MBCT), first offered at Oxford University by Professor Mark Williams and his colleagues in the 1980s to help people remain well after they had experienced a period of clinical depression. These two programs provided the basis for many other mindfulness-based interventions that were developed in the following decades. 

The first research study about mindfulness was published nearly 40 years ago, and a large amount of research has been conducted since then. In people without a diagnosed mental or physical health problem, mindfulness-based interventions have been found to reduce stress, anxiety, depression, distress, and burnout, and to improve quality of life in general.  As clinical treatments, these programs are effective for recurrent depression, some anxiety disorders, chronic pain, addictive behaviours, and child behaviour problems when mindfulness training is given to the parents. But what is mindfulness and how does it improve well-being in the face of life’s difficulties? 

To define what mindfulness is, the following sentence from Jon Kabat Zinn is often quoted: “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally … “ 

In other words, mindfulness is defined as an ability to observe what is happening in each moment, with an attitude of acceptance, curiosity, and kindness. This detached awareness can include our thoughts, feelings, body sensations or behaviours, as well as the outside world.  When we engage in formal mindfulness practices, we aim to develop this ability. We choose a target for our focused awareness, (for example, the breath, the body, or a sound) and keep directing our attention to this target. At the same time, we notice that the mind wants to run off in all sorts of directions. When this happens, we notice the thought that the mind wants to engage with, then let it go and gently redirect our attention to the point of focus. Importantly, however, when quoting Kabat-Zinn’s definition of mindfulness, the second part of the sentence is sometimes ignored. The second part says,   

…  in the service of self-understanding and wisdom.” 

“Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally, in the service of self-understanding and wisdom.” (Jon Kabat-Zinn, 2017)

Professor Mark Williams also put this point succinctly: “Mindfulness is an ability to recognise and to let go of the things that stop us from living to our full potential” (Mark Williams, personal communication, International Conference on Mindfulness, Amsterdam, 2018). 

This means that our ability to pay attention whilst practicing mindfulness is not the point. It is only a means to an end. It is important to carry this ability on to everyday life: noticing when our minds are giving us potentially false projections for the future or dragging us down the path of impotent guilt or rage about the past. To be able to notice what the mind is doing and to be able to decide whether it is helpful to believe our thoughts and to act on our impulses is a central skill in mindfulness. 

To be mindful is to be able to observe our thoughts as just thoughts and our emotions as just sensations in the body. We can calmly observe our thoughts, emotions, body sensations and our urges to act, and then decide what to do. In this way, mindfulness allows us to develop a high level of emotion regulation and enables us to act in accordance with our authentic values: to respond with wisdom rather than to react too quickly to life’s vicissitudes.


Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.  

The Four Horsemen of the Relationship Apocalypse

Having a happy, supportive romantic relationship is an important source of life satisfaction for most people. However, relationships can also be hard work, and are often a source of frustration and distress. It is no wonder then that nearly half of all marriages end in divorce. But is it possible to know what predicts divorce?

Professor John Gottman at the University of Washington was one of the first psychologists who did so successfully. In several research studies, Gottman and his colleagues observed newlywed couples interacting with each other and followed them up for several years, aiming to find interaction patterns that could predict which couples would stay married and which ones would get divorced within 5-10 years.  

Among the many predictors of divorce he identified, one of the best known is what Gottman called “The Four Horsemen”, referring to the biblical “Four Horsemen of the Apocalypse” bringing destruction. Gottman’s “Four Horsemen” describe four behaviours or emotional reactions during couple conflict. They build on one another and compound each other’s negative effects, leading to a cascade of increasingly hostile interactions and emotional withdrawal from the relationship.

So what are Gottman’s Four Horsemen? 


The cascade starts with criticism. It is important to differentiate criticism from a legitimate complaint. In successful relationships, a complaint is expressed in a tactful, respectful way that concentrates on the actual behaviour to be discussed. Criticism, as one of the “Horsemen”, can be identified by harsh, broad statements that attack the whole person. It often starts with “you always…” or “you never…” or “you are so … (selfish, careless, cold, etc)“. Frequent criticism and attacks of this kind can then lead to the appearance of the next “Horseman”: defensiveness. 


Defensiveness is a common response to criticism. It is not pleasant (and usually not fair) to be attacked in such harsh, broad terms. A partner may therefore respond by denying responsibility or even shifting blame from themselves and counterattacking their partner. Of course, this then can cause their partner to feel that their concerns are not taken seriously, so they intensify their criticism. A cascade of attacks and counterattacks follows, with each partner feeling increasingly frustrated and unsupported. 


Repeated criticism of one another and responding to this criticism with defensiveness (such as shifting blame or countercriticism) can lead to a sense of contempt. At this phase of the interaction, a lack of respect is expressed by sarcastic statements about the partner, name calling, eye rolling, mockery, and hostile humour. Gottman suggests that contempt is the most destructive of “The Four Horsemen”. 


Stonewalling is a response to the first three behaviours. In the middle of a fight, some people stonewall as an instinctive self-protection mechanism. Because they feel psychologically overwhelmed, they need to shut down emotionally or remove themselves from the situation physically. They may stop responding, or they may leave the interaction. In the long term, one or both persons in the couple begin to avoid interacting with the other. Very little communication takes place, and what does take place is either reduced to talking about trivial, “safe” matters or continue to be destructive, peppered with repeated low-level expressions of criticism, counterattacks, and contempt. 

Of course, not all couples who are stuck in such destructive interaction patterns end the relationship. There are many other predictors of relationship dissolution, as well as of staying in unhappy relationships. Nevertheless, if you notice getting engaged in increasingly hostile interactions, it may be a good time to stop and consider whether there is a more helpful way to solve conflicts with your partner. 

Gottman has written several books advising couples who would like to improve their relationship.  Some of these may be helpful: 

Gottman, J.  (1995). Why Marriages Succeed or Fail And How You Can Make Yours Last.

Gottman, J. & DeClaire, J. (2002). The Relationship Cure.  

Gottman, J. & Silver, N. (2015). The Seven Principles for Making Marriage Work.


Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.