Dr. Julie Smith: “Mental health is no different from physical health. No one is safe’ | Psychology
Dr Julie Smith, 37, is a clinical psychologist who has a private practice in Hampshire and spent 10 years working for the NHS. In November 2019, she started make TikToks containing clear and engaging advice on various mental health issues. She has more than 3 million followers and in January published her first book, Why hasn’t anyone told me this before?which spent four weeks at the top of bestseller lists.
There are many self-help books published; why do you think yours struck a chord?
I think people like that it’s evidence-based. I’m a clinical psychologist, so the things I put in there have been vetted with the latest research and they’re things that are taught to people in therapy, depending on why they’re going to therapy. These are also life skills that we can all use.
Everyone has had days when their mood is lower than they would like or days when they deal with more stress, grief or anxiety – all those normal human feelings that can hold us back or be difficult. to manage if we don’t have the right skills. Also, we just went through a pandemic and I think a lot of people are asking, “How can I get out of this?”
How did you transition to social media and TikTok?
When I offered psychological therapies, I found that many people were unaware that part of the therapy was educational. You talk a lot and work through your problems, but you also learn a bit about how your mind works, how you can influence your mood and emotional state, and how you can then affect your mental health on a day-to-day basis.
People found this educational aspect so empowering that there was a change in their ability to manage their mental health on a day-to-day basis. So I would come home and say to my husband that this stuff should be more available, that people shouldn’t have to come to me to find out the basics, and he said, “Well, come on. y, make it available. Put it on YouTube or something like that.
Giving people tools is cognitive behavioral therapy, right?
There is a mix in there. I tried to save it for everyday tools. I was very careful about this distinction: “It’s the educational element of therapy, it’s not therapy.” These are tools you can use today and tomorrow, but the book is not a therapist.
Social media is often blamed for young people’s mental health issues, especially self-esteem and anxiety…
Part of my videos were to remind people that what they see on social media isn’t always real. Being aware when they spend time with certain content of how they feel and using social media to enhance their lives rather than deprive them of it.
Social media behavior such as ghosting, trolling or blockage can be painful. What advice do you give to people who find being online quite brutal?
It’s about recognizing that you have the power to choose. You have a choice of how much time you spend online, you have a choice of who you follow and who you don’t, and what content you engage with. When you embark on a mindless scroll, you may feel like you have no choice.
So my videos are really about reminding people and helping them realize – that if it’s affecting you in a negative way, you’re one step away from something different.
There’s a line that runs often that generation Z and millennials are more prone to mental health issues than they are basically snowflakes. How about that?
It’s not something I would engage with at all. Mental health is, for me, no different from physical health. No one is immune. If you take someone and start messing with their core defenses, like sleep, routine, social connections, nutrition, and exercise, that person will become vulnerable to physical and mental health issues.
I think more and more people are starting to realize this now and it helps to fight the stigma around mental health. It’s a much healthier way to look at it.
So people are just better at naming things these days, rather than actually being more fragile?
You are not more physically fragile to talk about your physical wounds. There are no more broken legs just from being cast now. It’s going in the right direction, but you’ll always have backlash, that’s how change happens.
“Metacognition” is the key concept of your book; why is it important?
It is a kind of reflection on your thoughts. This is one of the main tools we use in therapy – being able to step back from your thought processes and observe them. By doing this, you get to see them for what they are.
People often think of therapy as changing your thoughts. In fact, you can’t decide what thoughts will pop into your head – it just happens. The little you can choose is how much airtime you give to each thought.
You seem to have a weakness for positive thinking. Is positive thinking a bad thing?
Positive thoughts are good, they are not bad. But there is this kind of movement online around only positive vibes; don’t let the negative thoughts be there. If you have this standard for yourself, as soon as negative thoughts that you cannot control begin to appear, you begin to feel like you are failing or not being positive enough. That you are not enough in general. It makes you feel worse.
So therapy is often about accepting thoughts as they come, and then making choices about what to do with them. If I spend time with these thoughts, will it help me get where I want to go? Or if I spend time with these, what different impact does it have? This allows your brain to find whatever it comes up with and then choose what to do next.
There’s a chapter in your book called “How do you get yourself to do something when you don’t feel like it?”. We have all been there. What is the answer?
There are always things you don’t want to do. There is something that is taught in a therapy called Dialectical Behavior Therapy, DBT for short, which is the opposite action. Mindfulness is a really helpful part of that, where you become aware of the urges to take action. Thus, each feeling will give you a desire to do or not to do something. And often you’ll feel the feeling and you’re going to do the thing and you haven’t really separated the want and the action – you’re doing it all at once.
But what you can do is start to become aware of a craving and start to recognize that you don’t have to act on it: you can act on the opposite of it. It becomes a tool you can use in those little moments that seem insignificant, but add up.
How do you think your content might change as we (hopefully) leave the pandemic behind us?
I don’t imagine for a minute that because the lockdowns ended the psychological fallout. People face huge losses. Not only where people have lost family members and friends, but also where they have lost their livelihoods, their jobs, their financial security, their homes, a sense of security when they go out. There are tremendous amounts of change that will continue for people.
The cost of the therapy puts it out of reach for most people and its availability is limited on the NHS. How do you reconcile that with the increase in the number of people showing up?
That’s part of why the book seemed like such a timely thing to do. I can’t give everyone individual therapy, but I can do something. I can share basic education as widely as possible.
I had no interest in being a public person or being on social media – it was really about sharing this information. And it was hard to do. I have three kids and a job and what kept me going was the feedback. It’s just overwhelming. Every day, people send a message saying, “Thank you very much. It makes a difference. It’s not an ideal world and I don’t have all the answers, but I can help.
Why hasn’t anyone told me this before? by Dr Julie Smith is published by Michael Joseph (£14.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply