We have seen from other articles published on this site that many forms of childhood abuse/trauma can put as at an increased risk of developing problems controlling our anger as adults, particularly if the abuse/trauma that we have suffered has been serious enough to result in us developing a serious psychological condition such as borderline personality disorder or complex posttraumatic stress disorder.
Steven Stosny, author of the excellent book Treating Attachment Disorder, proposes that the act of getting angry may function, at times, to reduce the level of psychological pain we are feeling (it is known that borderline personality disorder can cause intense mental suffering, even agony).
How Can Anger Alleviate Mental Suffering?
According to Stosny, anger may lessen mental suffering by the chemical changes it produces in the brain, in particular by increasing levels of the neurotransmitter called norepinephrine.
Stosny further states that the mental pain our anger may help to soothe is pain that is linked to our ‘core hurts‘ ; these are the painful feelings that we carry around with us that are linked to our childhood trauma / abuse and may include those of :
– being ‘unlovable‘
– being an ‘outcast’
Anger As A Kind Of Addictive Drug :
If, then, as Stosny suggests, the act of getting angry, by producing chemical changes in the brain that serve as a psychological analgesic (i.e. pain-killer / self-soothing agent), it is possible that, just as we can become addicted to other pain-killing drugs such as morphine, that some of us may become addicted to anger as a means of coping with unbearable mental anguish.
Any Benefit Of Anger Likely To Be Short-Term :
However, the possible analgesic effect of anger are likely to be ephemeral. This is because, after the initial boost of norepinephrine, we are likely to regret, and feel guilty about, our behavior and find that, in the longer termm it has merely served to compound our already not inconsiderable problems.
David Hosier BSc Hons; MSc; PGDE(FAHE).
THE MIND-BODY CONNECTION :
We have seen how the experience of significant and protracted childhood trauma increases our risk of developing both serious psychological and physical problems as adults – e.g. see the Adverse Childhood Experiences (ACE) Study.
Therefore, therapies for those who, as adults, are suffering the effects of childhood trauma – in the most serious cases in the form of cPTSD (complex posttraumatic stress disorder) – include not only treatments for the mind, but also ones for the body. (And, because the mind and body are interconnnected, treatments for the body will also, to varying degrees) benefit the mind.
THE FIGHT/FLIGHT/FREEZE STATE :
If we have grown up in an environment in which we were frequently made to feel afraid or threatened (physically, psychologically or both) it is possible the early physical development of our brain has been disrupted in such a way that now, as adults, we find ourselves perpetually, tense, anxious and hypervigilant, or, in other words, continuously in the fight/flight/freeze state.
One result of this is that it can cause us to store up a vast amount of physical and muscular tension.
EXCESSIVE AND CHRONIC TENSION IN THE PSOAS (‘Fight or Flight’) MUSCLE :
A main location in the body where muscular tension accumulates is called the PSOAS muscle (sometimes also referred to as the ‘fight or flight‘ muscle ; it connects the lumber spine to the legs.
It is sometimes called the fight/flight muscle because when we feel threatened, anxious or fearful, or in response to significant loss, it becomes energized in preparation to assist us with the actions of running away or fighting.
And, if, during childhood, we have frequently been in the fight/flight state this muscle may have become perpetually tensed up to the extent we have habituated to this feeling of tension to such a degree that we no longer register it as abnormal; notwithstanding this, it is an indication that we are still being adversely affected by painful emotions linked to our traumatic childhood (if only on an unconscious level).
TRAUMA RELEASE EXERCISES (TRE) :
Bercelli, PhD, devised six trauma release exercises designed to alleviate this stored muscular tension. The idea is that the tension is released by a ‘muscular shaking process’ known as ‘neurogenic tremors’ and its purpose is rid us of our deep-seated, chronic, early life trauma-related bodily tension.
RESOURCE : You can learn much more about TRE by visiting Dr Bercelli’s website – click here.
David Hosier BSc Hons; MSc; PGDE(FAHE).
A major symptom of CPTSD / PTSD is nightmares. I myself have suffered from these and they have led to frequent waking during the night, sheets and pillow cases damp with sweat, thrashing around in my sleep to the extent that I have, on several occasions, knocked the lamp (and several other items, such as piles of books, the alarm clock, cups of cold, unfinished tea etc) off my bedside table with arms wildly flailing about like those of a crazed and demented windmill and, even, falling out of bed a few times. I have also woken myself up shouting and, even, screaming, more than once.
A particular torment of nightmares is, of course, that after a day spent in mental anguish in a state of wakefulness, they prevent one from escaping this mental pain even in sleep so there is no respite from one’s suffering. Indeed, when one has intense and terrible nightmares, one fears going to sleep ; for us, it is not a time of mental recuperation, but of continued psychological torture. This can be so devastating to the morale that one may fear one will go permanently and irrevocably insane.
According to the Harvard psychologist, Dr D Barrett, an expert on dreaming and dream analysis, PTSD nightmares tend to contain the following types of themes / symbols :
The Themes And Symbols Of PTSD Nightmares
– being chased
– being in danger
– being punished
– being isolated
– being powerless
– being trapped
– physical injury
Nightmares, Suppression, Repression And Dissociation :
If we have extremely painful memories relating to our traumatic childhood then we may, as a means of psychological self-protection, cut off from them mentally.
In order to achieve this we may suppress the memories (i.e. try to put them to ‘the back of our minds’). This takes conscious effort and can be counterproductive – see The Rebound Effect below).
Alternatively, we may repress the memories ; this is an automatic / unconscious process that stores the memories away so deeply in the mind that they become inaccessible to conscious awareness. Mentallly cutting ourselves off from painful memories in such a manner is known as dissociation.
Processing Of Traumatic Memories
However, because these memories are dissociated, they remain unprocessed by the brain and a leading theory as to why dreams/nightmares occur is that they represent the brain’s attempt to process the dissociated memories.
Barrett’s research has led her to the view that, immediately following traumatic events, a person’s nightmares about them tend to quite closely reflect what actually occurred. However, as the traumatic events that triggered the nightmares recede further and further into the past, the PTSD nightmares relating to them become increasingly symbolic.
What Can We Do To Alleviate Nightmares?
If our nightmares do not result in effective processing of our traumatic memories they can become ‘stuck’ ; this can lead to recurring nightmares that tend to centre upon the same themes.
To alleviate such nightmares, it is necessary to attempt to process the traumatic memories in our waking lives (assuming they have been suppressed rather than repressed – see above).
We can attempt to process the material contained within our nightmares in the following ways :
– by keeping a written record of the nightmares (e.g. by recording our recollections of them or writing these down using a pen and pencil kept by the bed etc)
– by describing our nightmares to another person (who is emotionally supportive, such as a therapist) and trying to work out what their themes and images may represent.
– going through the nightmare in our minds when awake but changing its ending to a positive one – then mentally replaying/rehearsing this new, positive ending. It is then helpful to write out what happens in the nightmare, including writing out the new, positive ending. Alternatively, we could draw a series of pictures representing the nightmare, but, again, incorporating the new, positive ending.
– by imagining, when awake, carrying out a simple action in our dream, such as taking a single step, and saying to ourselves : ‘You are completely safe, this is just a dream’. If we then mentally rehearse this before we go to sleep we may find this action, carried out in our dream, will cue the comforting and reassuring thought (the action that is to act as the cue can be anything simple that is likely to recur in the nightmare).
Nightmares And The Rebound Effect
In relation to some of what has been said above, it is useful to look at a psychological phenomenon known as the rebound effect :
If we try very hard not to think about something, this, paradoxically, frequently increases the probability that we will think about it. The classic example that is given to first year psychology undergraduates is the instruction NOT to think about a pink elephant for the next minute. Of course, this instruction is impossible to carry out (try it if you don’t believe me!).
This is known as the rebound effect and research suggests the phenomenon may apply to nightmares, too. One possible technique to reduce the probability of having a nightmare is, therefore, to actually think about whatever it is the nightmare represents (if this has been inferred from reflection / dream analysis) for a few minutes before going to sleep as trying not do so, because of the rebound effect, may actually increase the chances that the nightmare will occur, however counterintuitive this may sound.
Stop Recurring Nightmares / Dreams | Hypnosis Downloads. Click here for more information.
David Hosier BSc Hons; MSc; PGDE(FAHE).
What Is Dissociation?
I have already discussed the phenomenon of dissociation in the article : Always Zoning Out? Dissociation Explained ; to recap very briefly, dissociation is a biopychological process that operates as a defense mechanism to prevent disturbing thoughts/memories/experiences from penetrating consciousness due to the unbearable burden of stress they would bring about were this mechanism not in place.
What Does Being In A State Of Dissociation Feel Like?
Feelings of dissociation can be seen as lying on a continuum : relatively mild dissociation involves feeling mentally ‘hazy’,’foggy’ ‘ numb’ and somehow ‘not fully present’ nor fully engaged with reality ; at the other end of the continuum, dissociation can involve complete loss of conscious memory of a highly traumatizing event / series of events / periods of one’s life (I describe my own experiences of dissociation in the article linked to above).
Depersonalization And Derealization :
Two important types of dissociation are :
a) DEPERSONALIZATION : this state involves cutting off from one’s own thoughts and feelings so that they do not feel like one’s own but those of somebody else. Individuals in this state can feel like an ‘observer of themselves’, as if they were watching themselves on a film screen.
b) DEREALIZATION : as the word implies, this refers to a feeling of ‘unreality’ – as if what is going on around one is unreal, surreal or dreamlike even when it is, objectively, ordinary and quotidian.
Overcoming Feelings Of Dissociation :
According to Dr Harold Kushner, author of Healing Dissociation, in order to overcome feelings of dissociation / dissociative disorders it is necessary to :
– gradually, as part of a therapeutic process, to come to terms with, and accept, the reality of one’s traumatic childhood experiences (as opposed to being in denial about this, repressing it or suppressing it)
– firmly recognize the traumatic experiences are now over and in the past
– firmly recognize that because the traumatic experiences are over and in the past, how one feels, behaves, thinks and acts no longer has to be constricted by these experiences – one is free to start making fresh choices and take on a new, more positive approach to life
– come to an acceptance that injustice, pain and suffering are inevitable parts of life and that what is of greatest importance is how one responds adapts to this inescapable fact.
– find meaning in one’s experiences of suffering, such as how it has developed one as a person and how it can lead to posttraumatic growth.
David Hosier BSc Hons; MSc; PGDE(FAHE).
What Are The Factors That Put Us At Risk Of Complex PTSD?
We have seen from other articles published on this site that if we have experienced significant and protracted trauma in childhood, we are at risk of developing complex PTSD as adults. However, there are many different factors at play which help to determine whether or not we actually will develop complex PTSD following a disturbed and dysfunctional childhood; I list and explain these factors below :
FACTORS THAT HELP TO DETERMINE WHETHER OR NOT WE DEVELOP COMPLEX PTSD :
- GENETICS: There is no gene for complex PTSD but research suggests that some individuals may be biologically predisposed to suffering from anxiety which, in turn, may make them more likely to suffer from complex PTSD as a result of growing up in a stressful environment.
- IN-UTERO EFFECTS : Research has shown that if a mother is under severe stress whilst pregnant her baby is at risk of being born with elevated levels of CORTISOL (a hormone involved with the stress response).
This hormonal imbalance can lead to the baby being difficult to calm and soothe whilst distressed which, in turn, can lead to difficulties regulating emotions in later life and ultimately increase susceptibility to development of complex PTSD.
- THE DURATION, SEVERITY AND TIMING OF THE TRAUMATIC EXPERIENCE :
It will come as no surprise that :
a) the longer the time period/s over which the traumatic experience/s persist
b) the more severe the experiences, the greater the probability is that the affected individual will go on to develop complex PTSD
Also, at which stage/s of one’s young life the traumatic experience/s occur are also of great significance. Two stages of life during which the individual is at particular risk of psychological damage are :
a) From birth until about the age of three years – this is such a vulnerable stage as our nervous systems are particularly delicate and fragile during this period and the way in which our brains physically develop at this very young age is particularly vulnerable to the adverse effects of environmental stress.
b) Adolescence : we are especially vulnerable to psychological damage during this period of our lives as it is the stage at which we are forming our identity.
- FAMILY DYNAMICS : Parents interact with different children within their families in different ways. For example, in a family with two children, one may be the favoured child whilst the other is treated as the family scapegoat. In my own case, my stepmother used to lavish attention upon her own biological son, whilst ignoring me ; indeed, step -families are at particular risk of having dysfunctional, inter-familial dynamics.
- ADHD : A child with ADHD is at greater risk of being abused by his/her parents as the behaviors that are symptomatic of his/her condition may be misinterpreted (in a negative way) by them causing them to treat the child with ADHD negatively and damagingly rather than with understanding and compassion.
It should also be noted that if children who do not currently have ADHD are abused by their parents they are more likely to go on to develop it due to the adverse effects the stress of the abuse has on the physical development of their brains.
- FAMILY CYCLE OF ABUSE : If a child is mistreated by a parent and this makes him/her feel threatened (physically, emotionally or both) the child’s fight/flight response may be repeatedly triggered. If this results in the child acting aggressively towards the parent/s (a completely normal defense mechanism) this may provoke the parent further thus setting up a vicious cycle.
- RESILIENCE : If a child is mistreated within the immediate family but has solid, dependable emotional support from a non-abusive family member (e.g. aunt, grandparent etc) or from outside the family, such as a youth leader or counselor, s/he is likely to be more resilient to the adverse psychological effects of this mistreatment.
To read my article on complex PTSD treatments, click here.
David Hosier BSc Hons; MSc;PGDE(FAHE)
How Useful Is Right Brain Therapy For Trauma Survivors?
Why is it that right brain therapy may be more appropriate for trauma survivors as opposed to therapies that concentrate largely upon the left brain?
Right Brain And How We Relate To Others :
One of the main symptoms of complex posttraumatic stress disorder (from which we may suffer if we experienced significant and protracted childhood trauma) is having problems relating to others.
The brain is made up of two halves, called hemispheres : the left hemisphere (or, left brain) and the right hemisphere (or, right brain). It is the right brain that plays a vital role in how we relate to others because it is intimately involved with many functions that affect how we get along, or, don’t get along, with other people. These functions include :
– our ability to empathize with other people
– our ability to trust others
– our ability to identify with others
– our ability to read the emotions of other people from their facial expressions
– our ability to form healthy attachments with others
– non-conscious communication
Because these functions can be impaired if we have complex PTSD, and because they are controlled largely by the right brain, it follows logically that therapy to restore these functions to their optimum levels should, too, concentrate on the right brain.
Why Do These Functions Reside In The Right Brain?
This is because, in the first two years of life, according to psychodynamic theory, our interactions with our primary caregiver very significantly lay the foundations of our emotional life, including our expectations regarding relationships with others ; these expectations are encoded, on an unconscious level, in the right brain.
Right Brain Therapy And Self-Esteem :
Those with complex PTSD also frequently have significant problems in relation to their sense of self-esteem and therapy for this, too, is also likely to be especially effective when it concentrates upon the right brain. Again, according to psychodynamic theory, this is because the foundations of our self-esteem are (and it is worth repeating) acquired in our first two years of life and are encoded, on an unconscious level, in the right brain.
It follows, therefore, that if our interactions with our primary caregiver in the first two years of our lives are dysfunctional in a way that leads us to believe others do not regard us as of value and worth, we are at high risk of developing into adults who have an ingrained, deeply embedded, unconscious set of negative expectations with regard our relationships with others and our self-esteem.
In other words, such poor expectations regarding our relationships with others and low self-esteem have their foundations in a set of unconscious beliefs, stored in the right brain, that were laid down during the first two years of our lives.
Right Brain And Our Sense Of Safety :
Another feature of complex PTSD is that of a constant feeling of being unsafe and under threat. Research conducted by Schorre (2003) suggests that the sense of how safe, or unsafe, we feel is largely dictated by the right brain.
How Does Right Brain Therapy Work?
Right brain therapy can work by modifying behavior patterns encoded on an unconscious level in the right brain.
Right Brain And Implicit Memory :
Memories stored in the right brain before the age of about two years are known as IMPLICIT memories. This means we are unable to articulate them in words as they are not stored at a linguistic level. Therefore, such memories can only make themselves known to us in ways that are non-verbal (e.g. via our feelings, body sensations and mental imagery).
However, when these memories are triggered and give rise to these feelings, body sensations and mental images we are unaware of their origin for the very reason that they derive from these unconscious/implicit memories in the right brain.
Only right brain therapy then, that can modify these implicit memories on an unconscious level, may be truly effective as left brain therapy, relying on language, is unable to effectively connect with such non – linguistically stored memories.
Examples Of Right Brain Therapy :
These include :
– Art therapy
– Play therapy
– Self-hypnosis / Hypnotherapy
– Mental imagery
David Hosier BSc Hons; MSc; PGDE(FAHE)
What is the best complex PTSD treatment?
The NHS (UK) recommend that those suffering from complex PTSD undergo three stages of treatment. These are as follows :
2) TRAUMA-FOCUSED THERAPY
Let’s look at each of these a little more closely :
NHS guidelines suggest that during the first stage, stabilsation, the individual being treated for complex PTSD may wish to focus on:
– redeveloping an ability to trust others
– reestablishing an emotional connection with friends and family
– learning to live in the present again (as opposed to staying trapped in the past ). This normally involves learning to feel safe again and reducing the level of fear that traumatic memories have hitherto provoked (often manifested in the disturbing form of nightmares and flashbacks).
The aim of this first stage of treatment is to improve the individual’s level of functioning to the point whereby s/he is able to start functioning again on a daily basis, no longer paralysed by anxiety.
These include :
(The importance of engaging with an appropriately trained and experienced professional if considering these treatments is emphasized.)
- i.e. reintegration into society and the development of improved, more trusting relationships with others (one of the hallmarks of complex PTSD is to avoid others and self-isolate, leading to a vicious cycle driven by operant conditioning and loss of confidence).
What About Medication?
In cases whereby psychotherapy is not helpful or appropriate, the NHS (UK) suggest that antidepressants may be of benefit to some individuals.
For those who would like extremely detailed information relating to ISTSS ‘s guidelines for the treatment of complex PTSD, it is possible to download the relevant PDF from this here.
The main NHS (UK) website can be found by clicking here.
The above eBook is now available from Amazon for instant download. Click on image or here.
David Hosier BSc Hons; MSc; PGDE(FAHE).
EGO STATE THERAPY is an approach to treating complex posttraumatic stress disorder (cPTSD) and is sometimes referred to as ‘parts work.’
In particular, this therapy is designed to help treat symptoms of CPTSD which come under the headings of :
- avoidance symptoms
- intrusive symptoms
- depressive symptoms
Let’s briefly look at each of these three types of symptoms :
AVOIDANCE SYMPTOMS :
These include avoiding places, people, events and situations which remind one of one’s past trauma. However, individuals often employ psychological defenses (usually unconsciously) as a way of avoiding accepting the reality of their childhood traumatic experiences; these psychological defenses include :
- idealization of parents
- minimization of adverse effects upon the self of one’s childhood
Finally, people who have suffered traumatic childhoods may use dysfunctional coping strategies to avoid their emotional pain which, in turn, can lead to addictions such as :
- addiction to alcohol
- addiction to drugs (both illegal and prescribed such as sleeping tablets and tranquilizers)
- addiction to gambling
- sex addiction
- comfort food / carbohydrate addiction
- excessive exercise
- addiction to self-cutting / self-harm with short-term effect of relieving unbearable stress/anxiety
INTRUSIVE SYMPTOMS :
These include nightmares, flashbacks, hypervigilance, anxiety, feelings of aggression and irritablity ; such symptoms can also be categorized as high-arousal symptoms.
DEPRESSIVE SYMPTOMS :
These include despair, shame, inadequacy, unworthiness, hopelessness, helplessness and a sense of being trapped in a tormenting frame of mind, with no escape route (this is sometimes referred to as ‘learned helplessness.’
Feeling one has no hope is a particularly invidious symptom as it is known that feelings of hope, even when highly distressed over long periods, lowers the probability of suicide attempts; logically, therefore, the opposite holds true.
Depressive symptoms can also be categorized as low-arousal symptoms.
‘PARTS’ WORK :
Ego states theory involves a technique known as parts work.
Parts work is based upon the theory that as a psychological defense we unconsciously ‘compartmentalize’ different aspects of our personalities to enable us to ‘mentally partition-off’ the ‘parts’ of ourselves that we find unacceptable, and/or that contain intolerable memories, from the more acceptable ‘parts’ of ourselves that allow (at least a semblance of) day-to-day functioning.
These ‘parts’, or ego states, that hold we find unacceptable and/or hold distressing memories frequently reflect earlier developmental phases in our lives that occurred during our traumatic childhood and that are therefore related to traumatic memories.
How Can These Parts That Reflect Earlier Developmental Phases Manifest Themselves Now We Are Adults?
These parts may manifest themselves when we are under stress in the form of regressive behaviors.
For example, under extreme stress we may display child-like tantrums or behave in an aggressive, rebellious manner like that of a young teenager. Or, when upset, we may curl up on our beds clutching a soft toy.
Internalized Parts :
We may, too, possess ‘parts’ of ourselves that we have internalized from emotionally significant others (usually parents or primary-carers) during our childhood.
For example, if we had a parent who was highly critical of us when we were children, we may find we are prone to judging ourselves with a very unforgiving and self-lacerating attitude, constantly feeling that we failed to meet the exacting standards that we’ve set ourselves.
Or, if we had a parent / primary-carer who was highly religious and regarded us as fundamentally flawed and sinful, we may, as adults, find ourselves tormented by fears of ‘eternal damnation’.
INTERNAL FAMILY SYSTEMS (IFS) THERAPY:
IFS therapy is perhaps the most well known therapy to incorporate ‘parts work.’ It is based on the idea that the individual has three types of parts; these are as follows :
- Exile parts
- Manager parts
- Firefighter parts
Let’s briefly look at each of these in turn :
EXILE PARTS :
As the name suggests, these are the parts of ourselves that developed as a result of the damage done to our personalities by our childhood trauma and which we largely keep banished and cut off from conscious awareness / repressed / suppressed.
The exile parts are kept closed off from conscious awareness as a means of psychological self-protection as these parts contain distressing memories and painful emotions such as neediness/dependency, intense anger, grief, fear, shame, loneliness and vulnerability.
MANAGER PARTS :
These are the parts of ourselves that try to keep us in control and allow us to function on a day-to-day basis and keep extreme/distressing/counterproductive emotions at bay. Frequently, too, these parts are extremely self-critical.
FIREFIGHTER PARTS :
These parts attempt to protect us from the emotional pain the comes upon us when our exile parts start to break through and impinge upon our consciousness and behavior (as may happen,for instance, during periods of intense stress and/or when we are reminded – either consciously or unconsciously – of our childhood trauma).
However, they do this by causing us to behave in impulsive, and, in the long-term, self-destructive ways such as excessive drinking, abuse of narcotics, workaholism, risky, promiscuous sex, gambling and overeating.
To learn more about IFS therapy and how it works, click here.
Above eBook now available on Amazon for instant download. Click here.
David Hosier BSc Hons; MSc; PGDE(FAHE).
Severe emotional distress and trauma can lead to a psychological defense known as psychic numbing.
Psychic numbing occurs when our conscious experience becomes so overwhelmingly, mentally painful that our feelings, in effect, ‘switch themselves off;’ the result is a kind of psychological ‘escape from reality’ – a reality which has become too terrible to tolerate.
Those who experience psychic numbing may use metaphors in an attempt to describe their condition such as : ‘It’s as if I’ve turned to stone,’ or, ‘it’s like my heart’s become made of stone.’ Sadly, in this state, the person may feel s/he no longer cares about him/herself or others – even close family members / previously close friends.
This may sound a distressing state to be in in itself, but part of the condition of psychic numbing means, too, that the person may also not care that s/he doesn’t care.
How Long Does Psychic Numbing Last?
The condition may be a relatively transient response following a severely traumatic incident or it may become a long-term in response to protracted exposure to traumatic conditions especially, for example, if one has developed complex posttraumatic stress disorder as a result of a traumatic childhood. In such cases, the sense of psychic numbing may persist (in the absence of effective therapy) for years or even decades.
Are Both Good And Bad Feelings Affected?
Generally, yes. Whilst the condition may arise as a defense against bad feelings, the ability to feel anything good tends also to greatly diminish, including the loss of the ability to gain pleasure from food and sex (for more about the inability to experience feelings of pleasure, see my article about anhedonia).
The Sense Of ‘Anesthesia.’
When one is in the grip of psychic numbing, it can feel not only as if one has been given an ’emotional anesthetic’, but, sometimes, too, as if one has also been physically anesthetized as the body itself can become relatively numb to the sense of pain.
Research Into Posttraumatic Stress Disorder (PTSD) And Psychic Numbing :
Some researchers have suggested that the symptom of psychic numbing is intrinsically bound up in the biological responses which form the foundation of PTSD.
Click image above for details.
David Hosier BSc Hons; MSc; PGDE(FAHE).