Intended for healthcare professionals

Head To Head Maudsley Debate

Is emotional restraint a healthy response to adversity?

BMJ 2014; 349 doi: (Published 05 November 2014) Cite this as: BMJ 2014;349:g6607
  1. Kathryn Ecclestone, professor of education, University of Sheffield, Sheffield S10 2TN, UK ,
  2. Ben L Robinson, core trainee CT3 in psychiatry, National Psychosis Unit Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham BR3 3BX, UK,
  3. Sarah Wheeler, founder of Mental Fight Club, Dragon Café, London, UK
  1. Correspondence to: K Ecclestone, k.ecclestone{at}, B L Robinson benjamin.robinson{at}

Kathryn Ecclestone worries about inappropriate educational interventions that promote emotional openness and pathologise normal responses, but Ben Robinson and Sarah Wheeler point to evidence showing better outcomes in patients who have been encouraged to express what they are feeling

Yes— Kathryn Ecclestone

An unchallenged consensus exists across health and education professions and among many parents and policy makers of all persuasions that the mental health of young people is in crisis. A growing preoccupation with “vulnerability” has turned emotional expression and management into a non-negotiable foundation for educational and life success.1 2

Many in the mental health and medical professions seem unaware of the extent to which this view has shifted from specialist psychological interventions for a minority of young people with mental health conditions or special educational needs into classroom based programmes for everyone, administered by teachers and other non-specialists. These include circle time (where children are encouraged to share and express emotions about diverse experiences), mindfulness lessons, nurture groups, resilience training, and “mental toughness” training.3

Evidence is missing or flawed

Drawing randomly on cognitive behaviour therapy, rogerian counselling, positive psychology, self help, and psychodynamic therapy, a powerful orthodoxy that emotional restraint is dysfunctional now pervades the education systems of the United Kingdom, the United States, and growing numbers of European countries, including Sweden and Finland.

Interventions based on cognitive behaviour therapy are especially popular. Based on the notion that individuals can develop skills in cognition driven emotional restraint, cognitive behaviour therapy has proved effective for many mental health problems. Yet it is being co-opted increasingly by non-specialists in interventions for which it was never intended and for those with no identified mental health problems.

For example, Birmingham local authority has introduced Promoting Alternative Thinking Strategies (PAThS), a widely used US programme derived from cognitive behaviour therapy and positive psychology, to all its primary schools. …

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