Feeling More Confident

In this section, we will talk about what anxiety is, how it is caused and maintained, and how we can manage it so that we can feel less anxious and more confident.

Lewis’s Story

Hi, my name is Lewis and I am 15 years old. I was born with a bathing trunk naevus and many smaller satellites.

When I was younger my birthmark bothered me a lot and I wasn’t very confident and didn’t really like people seeing it. In the summer I used to wear long shorts and never took off my t-shirt. Even when swimming I would wear a t-shirt or vest to hide my CMN. And when changing for PE at school I would try to hide myself or get changed in the corner. There were times when I would ask ‘why me?’ or ‘can it be taken away?’, but then I met other people with CMN at a family weekend and I realised that I wasn’t alone and it allowed my parents to connect with other parents in the same situation.

I did have a larger satellite removed from my left cheek when I was still in primary school. It was about the size of a 50p coin and made me feel more conscious – that was something that I couldn’t hide.
I remember once being in a supermarket and an elderly man said ‘what’s that horrible thing on your face?’. I was perhaps only 6 or 7 years old at the time and it made me feel very upset. How could an adult be so rude and horrible to a small child!

As I have grown older I have become a lot more confident with my CMN and although I know that people still stare, it doesn’t really bother me anymore.
I think my confidence has grown a lot since joining secondary school. I have a good group of friends around me who all know about my CMN and are very supportive. I am part of a football team and cricket team and I am not afraid to get changed in front of my team mates.

Just the other day an adult that I play cricket with saw the mark at the top of my leg and asked if it was a bruise – I explained what it was, they asked a few questions and that was that. I am now happy to swim without a t-shirt and show off the skin that I was born with. I have realised that CMN will not impact my life and stop me from doing the things that I enjoy.



Anxiety is a natural response to stress that humans have had for hundreds of thousands of years. Many years ago, there were threats from predators that humans had to react to in order to survive. When they saw a threat, a chain reaction was set off which caused a hormone called adrenaline to quickly pump through their bodies. This gave them a burst of energy, which was needed to either fight or flee (run away) from an enemy. This is called the fight or flight response.

Fight or flight text
Fight or flight
Modern worries

In society today, we rarely see threats in our everyday lives that would need all this energy and activate fight or flight. However, we still have this response, and it can be triggered when we perceive threats. It can even be triggered when these threats are just imagined. When things worry us and feel threatening, like deadlines, exams, and social situations we still have the same adrenaline response in our bodies. However, none of these things require us to put up a fight or run away.

What are some of YOUR warning signs that you are experiencing anxiety? Remember, you might only experience a few of these effects, but it can be helpful to know which are your warning signs so that you can identify them when you are feeling anxious. You might even experience some sensations that aren’t on the list below.

warning signs

Negative Thoughts

Our brain wants to keep us safe and, as we saw above, it is looking out for anything that could be threatening so that we can act quickly and protect ourselves. The problem with having a brain that prioritises noticing threats over things that are safe is that, when our mind wanders, we can end up having negative automatic thoughts. It is common to have negative thoughts every now and then about things in our day-to-day lives. Everyone experiences negative thoughts at times, about lots of different things, big or small.

Negative thoughts

These thoughts can be really unhelpful and upsetting because they make us feel bad about ourselves and stop us from doing things that we want to do. Most of the time, they aren’t even true! However, thoughts like this are ‘automatic’ – they come to us straight away and by the time we realise, we have already had the thought. So why have them? Basically, we are imagining potential threats and problems so that we can solve them before we get into trouble. Our thoughts are trying to be helpful but they’re really causing more problems for us!

People who have CMN might have these negative thoughts about their CMN or the way they look. Can you think of any examples of negative thoughts that you might have experienced?

CBT model

The Hot Cross Bun model

It seems crazy that a single thought – which may not even be true – can hold us back from doing things that we enjoy. The reason these thoughts can be so powerful is because a thought can trigger a chain reaction in our minds and bodies that can cause a vicious cycle, making things worse and worse.

This model is called the Cognitive Behavioural model, or hot cross bun, and it shows the interactions between thoughts we have, the way we feel, how we behave and the feelings that we have in our bodies.



Let’s start with a thought. This could be anything and is normally in the form of a sentence. It can be really difficult to identify a thought, and sometimes it can be hard to remember what thought exactly set the cycle off. It often helps to write a thought down as soon as possible after you’ve had it. See below for some negative thoughts someone might have about their CMN. Remember, these thoughts do not have to be true for us to think them, but they are automatic, meaning we can’t stop them.


Feelings are a little easier to identify than thoughts and can normally be described in one word, for example, ‘sad,’ ‘anxious,’ ‘worried,’ ‘disappointed,’ ‘defeated’, ‘excited.’ You can have more than one feeling at once, and some of them you may feel more or less strongly.

Physical Sensations

Physical sensations are all the physical things that are happening to and inside your body, for example your tummy rumbling when you’re hungry, or feeling weak when you’re tired. It is amazing how much your body can respond to stressful thoughts, they can cause you to sweat, shake, breathe quickly and can even make your heart pound. All these things together can even cause a panic attack. Remember the fight or flight response? Your physical sensations are where you can experience the direct effects of all that adrenaline that your body has created.


This refers to what we do and how we act in a certain situation. When we are having uncomfortable thoughts, feelings and/or bodily sensations, it can feel really overwhelming and cause us to avoid a situation completely. We might get up and leave a classroom, make up an excuse about not going to a party, or act strangely around others.

It’s important to note that any of these four parts of the model (thoughts, feelings, physical sensations and behaviour) can affect any other. For example, avoiding a social situation (behaviour) could make us feel disappointed or left out (feeling). Or, a physical sensation such as your heart beating too fast might make you think “I’m not going to be able to cope”. When you start to realise how easily each of these four parts can affect each other, it’s much clearer to see how a single thought could set us off on a downward spiral, feeling more and more anxious.
But how can we change this cycle so that we feel less anxious? Luckily there are some things we can all do to feel less anxious. They take a bit of practice, but they can help us feel better and stop anxiety getting in the way of having fun and doing the things that we enjoy or are important to us. To do this, we need to focus more on two parts of the hot cross bun – what we think and what we do.

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Thought Challenging

Although negative thoughts can automatically pop into our heads, we can learn to notice them and stop them making us feel bad. One method of doing this is called Catch it, Check it, Change it. This technique teaches you to spot a negative thought, think about if it’s true and replace it with a more balanced thought. This can take a bit of practice!

Often, these negative thoughts will happen when you are out and about. This means it might not always be possible to start the activity straight away. If you can, write down the negative thought on a piece of paper or your phone straight away so that you can come back to it later.
After a bit of practice, you should be able to do this in your head without having to write it down, and spotting unhelpful or negative thoughts should become much easier.

Note: have a look at these thinking traps and see if your thoughts fall into any of them!

Negative thinking

Thinking traps

There are lots of ‘traps’ that we can fall into when we have negative thoughts. Once you learn what these are, it can help you to identify when thoughts are unbalanced or unhelpful.

1. Mind reading
When we assume we know what others are thinking. For example, ‘They think I’m weird’

2. Fortune telling
When we predict things will go wrong. For example, ’Everyone will stare at me’

3. Black-and-white thinking
When we see things as good or bad and there is no middle ground. For example, ‘I stuttered during my speech, the whole thing is ruined’

4. Filtering
Focusing on only the negative and ignoring the positive. For example, thinking ‘I didn’t make any friends’ because there was 1 person that I didn’t get along with, even though there were many others I did.

5. Catastrophising
Imagining the worst possible thing that could happen and thinking about how you wouldn’t be able to cope, such as ‘Everyone is going to hate me and I will have to change schools and will be disowned by my parents’

6. Proving
Using one bad experience as ‘proof’ that you will always have bad experiences. For example, ‘They didn’t invite me over after school, I’ll never make any friends’

7. Labeling
Attaching a negative label about yourself instead of realising it was a single event or mistake. For example, thinking ‘I’m a failure’ is labelling yourself as a failure, when really you just make one mistake.

8. Personalisation
Thinking that things that happen are directly related to you. ‘She seems annoyed, it must be because of me’.

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Although these thoughts can be really distressing, it’s important to remember that it’s really normal to have them every now and then. Remember, you can’t help having them as they’re automatic, kind of like a reflex. Look below to see how some negative thoughts about CMN might fall into the same traps:

1. Mind reading: “They are looking at me, they must have noticed my CMN” –> you don’t know what other people are thinking! They might just be looking at you the same way you would look at someone else and even if they have noticed your CMN, that doesn’t mean that they are thinking about it in a bad way.

2. Fortune telling: “If I wear shorts that show my CMN to the party, everyone will avoid me” –> You can’t tell what is going to happen in the future. If you wear the shorts, people might not even notice your CMN. Also, you do not know that people won’t hang out with you just because you are wearing shorts.

3. Black-and-white thinking: “If my CMN is hidden then I won’t be noticed/If it’s visible then I’ll be in the spotlight” –> This is too black-and-white, thinking you’ll either be ignored or totally in the spotlight. It ignores all of the possibilities in the middle!

4. Filtering: “I don’t want to go swimming again because I was embarrassed” –> Although you did feel embarrassed when you first arrived at the pool, you felt much better after you had been there for a while and really enjoyed yourself. It can be easy just to focus on the things that were bad, but often there were lots more good things that need to be remembered.

5. Catastrophising: “I don’t want to start my new school because everyone will stare at me and nobody will want to talk to me” –> starting a new school can be a bit scary. You might notice some other children looking at your birthmarks but lots of people might not even notice them and it doesn’t mean people will treat you any differently. You don’t know the new people at your school yet, but after a few weeks they won’t be strangers anymore.

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6. Proving: “Last time I wore shorts I noticed someone staring, so I can never wear them again” –> just because you noticed one person looking at your CMN when you wore shorts doesn’t mean that everyone will. Also, just because someone looked at your CMN doesn’t mean that they were thinking about it in a bad way.

7. Labeling: “I found it hard to speak up in class today. I’ll always be shy’. Just because you felt shy for a moment or even a day, doesn’t mean that you can’t feel confident in other situations.

8. Personalisation: “John didn’t come and sit on our table, I think it’s because he thinks I’m weird” –> There are many reasons why John might have sat somewhere else and you don’t know that it has anything to do with you at all! Perhaps he just wanted to be closer to a window, next to someone who he wants to ask a question to, or near the door because he has to leave for a doctors appointment.


Changing Behaviour

Unlike thoughts, feelings and physical sensations, our behaviour is something that we have a bit more control over. However, we’ve all been in situations where we wish we could just behave differently. If the reason we are (or aren’t) doing something is because it feels really overwhelming, it’s not quite as simple as telling ourselves to ‘just do it’.
However, noticing that our behaviour is unhelpful and making changes can help us to break out of the negative cycle. Imagine you had a friend who was terrified that if they went outside, a giant dragon would fly down and eat them. This dragon can’t be seen anywhere, but there’s nothing you can do to convince your friend that their fear isn’t true. What do you think would be the best, and maybe the only, way to show them that it’s safe?

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If they could find the courage to step outside for a few minutes, they would soon realise that there is no dragon and that there was nothing to worry about. The same thing applies when we are so worried about situations that we decide to avoid them. Here’s an example below:

This term, Alex has school swimming lessons every Tuesday. Alex really enjoys swimming and wants to be involved with the whole class having fun. Alex has CMN on her stomach and arms and is worried about other kids seeing her birthmarks when she wears a swimming costume. Although Alex loves swimming, these worries are making her not want to go. If Alex did go swimming, she would probably be surprised that it wouldn’t be as bad as she had originally thought, and she would actually enjoy herself and not worry about other people. However, this is easier said than done and sometimes the worries can take over and it can be too overwhelming.

Fear Ladder

What we can do in this situation is break down the things we want to do into smaller, more manageable steps. That way, you never have to do anything that’s too scary and you can work your way up slowly. This technique is called ‘Fear Ladders’. Check below to see how Alex might use a fear ladder to help her to overcome her fear and have fun in the pool!

Remember, it’s really important that you have someone you trust who knows you are trying this and can help you. It can be really difficult and the most important thing is that you work your way up slowly and don’t try to take too big of a jump. Don’t try anything you’re too uncomfortable with. If you need any help, please speak to Hannah who will be able to assist you.

Need help?

If you are struggling with this or would like some advice on how to use this resource, please contact our Support Pathway Practitioner, Hannah, who will be able to help you.

Email Hannah

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