Cognitive-Behavioural Therapy

Those who work in the field of healthcare have known for some time that a connection exists between our underlying beliefs and thoughts and the functioning of our bodies. Dr. Herbert Benson, in his 1970’s landmark book, The Relaxation Response, articulated the concept that stressors can trigger a “fight or flight response”, an inner startle response that indicates we are about to experience an unpleasant event. Although there is a healthy fear that protects us from harms way, many times how one interprets stressful events and one’s ability to manage it, can affect the immune systems functional capacity. There is now sufficient research to validate Benson’s work, that relaxation techniques such a meditation, can have a direct link to minimizing the effect of a wide range of disorders such as high blood pressure, irritable bowel syndrome, back problems, neurological pain, and headache problems. Relaxation strategies calm the sympathetic nervous system, making it easier for the body to heal.

In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health. 

 Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”

 Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.” 

Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain

The following ideas are some guidelines for managing pain more effectively

·         Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?

·         Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish

·         Use various activities to refocus away from your pain. Dwelling on pain makes it more    painful. Stretching, music, swimming, meditation, and other activities are important

·         Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management

·         Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments

·         Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.

Anxiety disorders are one of the most common psychiatric illnesses affecting both children and adults.  There are about 40 million known cases in the United States alone.  These disorders usually develop from a complex set of risk factors which may include personality, brain chemistry, genetics, and life events.  Though anxiety disorders may be derived from so many factors, they are highly treatable.  However, perhaps because of the stigma attached to anxiety disorders, only about one in three people afflicted actually receive any type of treatment.

It is important to know that the phrase “anxiety disorder” is an umbrella term for more specialized disorders including Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Posttraumatic Stress Disorder (PTSD), Social Anxiety Disorder (Social Phobia), and Specific Phobias.  Regardless of what specific anxiety disorder a person has, they can be quite debilitating with a variety of symptoms.  In most cases, anxiety disorders present themselves with other mental disorders such as depression.

The symptoms of anxiety orders may manifest themselves at an early age or start suddenly, perhaps after a triggering event.  During high stress periods, anxiety disorder symptoms may present themselves more frequently or with greater severity.  Symptoms include sweating, headache, muscle spasms, hypertension, palpitations, fatigue, and exhaustion to name a few.

As mentioned, anxiety disorders are highly treatable.  Patients suffering from anxiety orders may be treated by psychosocial therapies, medication, or a combination of both.  Psychosocial therapies are usually attempted first and include Cognitive-Behavioral Therapy (CBT), anxiety management, relaxation therapies, exposure therapy, and psychotherapy.  These therapies always involve working closely with a mental health professional, usually a psychiatrist, psychologist or social worker.  During such therapies, patients and professionals discover what the source of the anxiety disorder is and how to deal with it.

Cognitive-Behavioral Therapy is one of the most useful of the therapies for anxiety disorders.  CBT actually helps people change their thinking patterns so that their reactions to anxiety-provoking situations become less severe.  Successful CBT can make patients understand that their panic or anxiety attack is not really a heart attack

Many times, anxiety disorders are treated with not only psychotherapies but also with medications.  The drugs most commonly associated with anxiety disorder treatment include SSRIs, which are selective serotonin reuptake inhibitors, beta blockers, benzodiazepines, tricyclic antidepressants, and MAOIs, which are monoamine oxidase inhibitors.  Medication alone will not cure anxiety disorders, but will help keep them under control.

The most successful treatments of anxiety disorders involve the combination of medication and psychotherapy.  Many doctors will prescribe medication shortly after diagnosis so that the symptoms are alleviated quickly (usually within 4 to 6 weeks) and allows the psychotherapy protocol time to become effective.

 Definitions & clinical picture:

The characteristic features of obsessive compulsive disorder (OCD) are the presence of obsessions and compulsions which interfere with the patient’s ability to cope with their daily life.

Obsessions: are unpleasant or distressing thoughts, images or impulses that come to mind over and over again despite conscious efforts to stop them. We all become preoccupied by particular thoughts at times, or have the experience of an irritating tune running again and again through the mind. These normal thought processes are distinguished from obsessional thoughts because it is possible to distract oneself by thinking or doing something else, and because the thoughts do not interfere with normal functioning. In OCD obsessional thoughts are rarely this innocuous. Common themes for the thoughts include violence, sex, contamination and blasphemy. Obsessional images may be of violent or gory scenes that come vividly to mind again and again, and cannot be ignored or suppresses. An obsessional impulse might be a recurrent impulse to hurt someone, usually someone the sufferer would not consciously wish to hurt. For example, a man might have the obsessional impulse to stab his wife, despite having no wish to harm her and finding the impulse distressing. It is uncommon for people to act on obsessional impulses. It is important to distinguish obsessional thoughts from thought insertion, a first rank symptoms of schizophrenis, in which the patient believes they are experiencing thoughts that are not their own. In contrast, obsessional thoughts are always recognized as arising from the patient’s own mind (ego-syntonic vs. ego-dystonic).

Compulsions: are the behavioural counterparts of obsessions, with a strong urge to perform an action or complex serious of actions (overt or covert) repeatedly, even though they are recognized as unnecessary. Compulsions can often be resisted for a short periods, but that can only be relieved by performing the compulsive act. Compulsions can take very many forms, but the commonest are:

Complex rituals incorporating many of these compulsive acts may be developed and can be very handicapping (may take up to 12 hours a day!)

The clinical picture n OCD is very variable. Patients may have obsessions only, compulsions only, or combination of both. There is a very close relationship with depressive disorders. About 70% have at least one episode of depression at some time in their life, and the two disorders can co-exist (comorbidity). More commonly, patients with depressive disorder can develop obsessional symptoms without having the full blown OCD. In these cases treatment of the depressive disorder is usually enough to resolve the obsessional symptoms completely without other more specific treatments.

Epidemiology:

OCD is relatively common, with a lifetime prevalence of 2 to 3 %. Unusually for the neurotic disorders it is equally common in men and women. It tends to begin in adolescence and occasionally in childhood.

Aetiology:

There are many theories about the aetiology of OCD but like other mental illnesses it is properly multi factorial and bio-psycho-social:

Management:

A full psychiatric history, mental state examination, rating scales (the Yale-Brown), physical examination and investigations are required in all cases. Some differential diagnoses are: (‘psychiatric’ or ‘organic’)

1. Pharmacological treatment:

Antidepressant which act on serotonin, such as SSRIs and the tricyclic clomipramine are effective in some cases, even if there is no depression. If one SSRI fail, one could try a different one (unlike depression). Also unlike depression, it takes usually longer time and higher doses for the medications to work.

2. Psychological treatment:

It is often helpful to begin first with drug treatment before embarking on psychological treatments, as it may allow the patient to work more effectively with the therapist.

Despite the psychoanalytical theories about aetiology of OCD, psychodynamic psychotherapy is generally of little benefit (lack evidence based support). Cognitive behavioural therapy; on the other hand; has a strong evidence based support and despite that it is not as effective as in depression or anxiety disorders, it is still has a good response rate.

3. Psychosurgery:

Still an option in severe cases. Done in specialized centers. Extremely sophisticated and use laser and Gamma knife in very specific and targeted brain areas. Can be life saving, improve quality of life dramatically. Rarely used.

4. Social treatment:

OCD can be a chronic and very disabling condition that can result in social isolation, unemployment and financial problems. It is important to consider these issues, and where appropriate involve an occupational therapist or social worker in patient’s care.

Course & prognosis:

OCD tends to be a chronic illness, with fluctuations in severity. If treatment is effective it is important to consider the long-term prevention of relapse. Education of the patient and their family about the disorder, and identification of the early signs of relapse with rapid reintroduction of treatment is helpful.

References:

1. Stevens L, Rodin I, Psychiatry: An illustrated colour text, Churchill Livingstone 2001

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

CBT stands for Cognitive Behavioural Therapy and it is a set of psychotherapeutic treatments that seek to counter a wide range of psychological difficulties and disorders and, more generally, encourage better living through mental health education and promotion.

Cognitive Behavioural Therapy is built on the pragmatic notion that what people think can and does affect how they feel and how they behave. It is a powerful, simple and self-evidently sensible idea. CBT is an evidence based wholistic model in the truest sense – it is about encouraging positive change across the whole self.

The origins of the cognitive-behavioural model of applied psychology can be traced back to the early operant conditioning work of Watson and Raynor (1920), and it was certainly informed if not hastened by the innovative Rational Emotive Therapy (RET) work of Dr Albert Ellis in the mid-1950’s, but it was not until Dr Aaron Beck developed his approach called Cognitive Therapy in the 1960’s that modern Cognitive Behavioural Therapy, as it is understood today, started to take a more identifiable shape.

Cognitive Behavioural Therapy works by encouraging individuals to intentionally challenge the perceived ferocity, integrity and legitimacy of disempowering belief constructs; individuals are encouraged to look at negative beliefs and actively deconstruct them. Negative belief structures, for example, are rearranged, probed, prodded and dissected in the pursuit of ownership – thoughts are deemed to be “just thoughts” ultimately.

In a nutshell, Cognitive Behavioural Therapy seeks to help instil an empowering mindset over and above the self-limiting, helpless mindset and provide a set of coping skills to support cognitive-behavioural realignment where applicable. CBT is a science-based, short-term psychological model of change management that continues to evolve and grow in the light of the empirical evidence base that both informs and supports it. Change is a choice too, CBT reminds us.

This is a standard British English (BrE) document.

ANXIETY

Everybody experiences anxiety at some time in their lives.  Anxiety is a normal reaction to stress. It can help you deal with a tense situation, study harder for an exam or keep focused on an important speech.

In general, it helps you cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder. There are some disorders and phobias for which anxiety is the main symptom.

They are:

Generalised Anxiety Disorder

GAD is a long term anxiety disorder that can make you feel anxious about anything and everything rather than focusing on just one issue.  People suffering from this disorder will feel anxious most of the time and will have difficulty relaxing

Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is an anxiety related condition that affects three in every hundred people regardless of age and gender.  People often remain undiagnosed for long periods of time but OCD is curable and responds very well to Cognitive Behavioural Therapy (CBT).

Social Phobia

Social phobia, also called social anxiety disorder, involves overwhelming anxiety and excessive self consciousness in everyday social situations.  People with social phobia have a persistent, intense and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions.  Their fear may be so severe that it interferes with work or school, and other ordinary activities.

Post Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that can develop following a terrifying event.  Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to.  PTSD was first brought to public attention by war veterans, but it can result from any number of traumatic incidents.

Panic Disorder

People who experience panic attacks have feelings of terror that strike suddenly and repeatedly with no warning.  They cannot predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike.

Panic Attacks can cause the following symptoms:

Depression

Depression is one of the most frequent mental health problems which lead to suicide.  Suicide is likely to occur when people are without hope or empty.  The only answer to their problems as they perceive it is suicide.

Everyone feels ‘down in the dumps’, sad or ‘low’ at some time in their lives. It wouldn’t be normal for everyone to be happy all of the time. Sometimes people describe themselves as having depression when in fact they feel a bit low or fed up.  However, when the symptoms persist for more than a couple of weeks or if you feel suicidal, medical attention should be sought.

Signs and Symptoms of Depression:

In severe cases, have thoughts that life is not worth living and consider suicide

The following article looks at “demanding” and “preferring”. Understanding the difference between these types of irrational and rational thinking is key to Mental Toughness. Demands are rigid thinking patterns and rules, where we insist that others, the world and ourselves must be a certain way, in order for us to be happy. Albert Ellis, who pioneered Rational Emotive Behaviour Therapy (REBT), called this rigid thinking “demandingness”.Demands are rigid and inflexible rules about how other people, ourselves and life must or must not be, in order for us to be happy. Having rigid beliefs and rules can make us anxious, frustrated and depressed. Demands will often contain the words “must” and “should”, such as:”Everyone must like and approve of me”.”I must be absolutely competent in everything I do”.”The world should always be a fair place”.Preferences are flexible ideas regarding how we would like things to be, without demanding and insisting that they must always be that way, such as:”It would be nice if everyone liked and approved of me, but they don’t have to”.”I want to be competent in everything I do, but I don’t have to be.”"I would like the world to be a fair place, but unfortunately it doesn’t have to be the way, that I want it to be”.Having preferences rather than demands does not mean that we shouldn’t have high values or standards; the point is whether our demands are pragmatic and helping us in our aims and objectives, or are rigid, unrealistic and impractical. The key is to be flexible and accept that people and things will not always go our way and that having rigid and fixed rules is unhelpful and irrational. Here’s an example regarding perfectionism. Let’s suppose that I have a demanding rule that “I must give an absolutely, perfect presentation or I will look hopeless and inept”. If I hold on to this irrational belief, the consequences are likely to be that I will be unnecessarily anxious, and my worry will cause me to lose sleep. I will over-prepare and have too many notes, which will cause further worry as to how I will cram all the material into a set presentation time. I will be over-nervous and worry that I will freeze and my mind will go blank. I may predict catastrophe, attach too much importance to the presentation and imagine I will lose my job. Alternatively, I can hold a preference such as “I would like to do a perfect presentation, but it does not have to be 100 per-cent perfect”. In this case I am more likely to focus on covering the essential points rather than worrying about trying to be perfect, and further realise that there is no such thing as a “perfect” presentation. And besides, it is unrealistic to expect that all of the audience will be paying attention, all of the time. If the audience are students, it is likely that they will have hangovers or be tired.Here’s another example for anyone visiting or living in London and using the Tube trains; where we are expected to let passengers off of the train before boarding. If I have the demand that “people must always let me off the train first, before they start getting on” then I am going to be upset and annoyed on a regular basis, as often people will start getting on in order to get a seat. Of course, a lot of the time people will wait for me to get off, before they get on, but because I have such a rigid and demanding rule, I will still feel tense in the anticipation that my rule will be broken at any second.Alternatively, rather than have such a rigid and demanding rule, I can hold a preference such as “I would prefer it if people let me off first, but in reality this will not always be so”. By holding a preference rather than a demand, I am being realistic and can accept that others do not have the same rules. By holding a flexible preference I am less likely to become angry or upset.Often we seek to change other people and become frustrated in our attempts, however we can change ourselves and how we react to other people and events; we can remain in control and fully responsible for our actions, thoughts and emotions.Being flexible and able to adapt is key to Mental Toughness. Regards

Phil Pearl

The word ‘trauma’ originates from the Greek ‘wound’, and it is commonly defined as being of psychological or physical nature. Trauma occurs as a result of an event, and it has deep roots in various levels of the human mind and behaviour. In a world with excessive reasons to experience a traumatic event, understanding this condition may be the key approach to combat its symptoms.The Causality of Trauma

Psychological trauma is a broad concept, and its origins are co-related with two well-know mechanisms of the human mind: stress and memory. In order to fully understand this relationship, we’ll briefly explain these two processes:

Stress

Albeit commonly associated with negativeness, stress is an evolutionary advantage. The stress triggering mechanism allows most people to react to dangerous situations prior to consciously detecting it. The level of a stress response generally dictates the intensity of psychological trauma in an individual.

Primarily, the Hypothalamus (region of the brain responsible for controlling the Autonomic Nervous System) identifies a stressor (an event which triggers stress) and automatically prepares the body to react to that event. This is done through sending signals to both the ANS and the Pituitary Gland (limbic system) – which in turn, activate a ‘response mechanism’ by stimulating body organs to change their regular activity.

This response mechanism is identified by: increase of blood pressure, heart rate, sugar levels and re-direction of blood flow to major organs. The body also improves respiration by dilating air passages, stopping digestion in order to direct focus (energy) to other parts of the body and increasingly producing adrenaline (epinephrine).

All these processes transpire in a few seconds – and they were particularly ‘designed’ to increase survival chances either by challenging a situation, or by escaping from it.

Memory

Memory and trauma are interrelated processes – without the memory of a traumatic event, psychological trauma is inexistent. In addition, memory also plays an active role in the incidence and intensity of stressful responses.

Once stress is triggered by an event (a stressor), the prefrontal cortex (region of the brain responsible for decision-making) promptly receives a message from the limbic system. This process instigates the assessment of the situation by higher functions of the mind.

If the situation does not constitute danger, the stressing mechanism will gradually shut down and the body will return to normal functioning.

If the situation reflects danger, the individual will need to decide what to do – and in that process – the amygdala (a part of the limbic system which plays a key role in human emotions, particularly fear) directs the hippocampus (a central region of human memory) to imprint that information differently from other events. This long-term storage of the memory is explained by its emotionally attached significance.

Such mechanism is another ’smart’ human feature. Next time the same stressor (or similar) is identified, that memory will be instantly retrieved in order to assist in the individual’s reaction. At a subconscious level, there will be an overstressed response to the event. At a conscious level, comparison and previous experience will induce better decision making.The Effects of Trauma

Trauma is inevitable in our lives. From the birth of a child, to all stages of its development – traumatic events are common and also part of the ‘human experience’. However, the level of trauma caused by an event dictates the short and long-term effects of that occurrence.

For instance, trauma can be related to several mental illnesses. Conditions such as Schizophrenia, Depression, and Bipolar Disease can be triggered by traumatic events. One condition in particular, is directly related to trauma: Post Traumatic Stress Disorder (PTSD).

Post Traumatic Stress Disorder

PTSD occurs when an individual develops a set of behaviours and reactions based on a traumatic event. The traumatic experience interferes with normal functioning, causing the affected person to present avoidance behaviour (avoid activities, people, context, or other things that can associate with the trauma).

This condition can occur at any age and traumatic stress can be cumulative over a lifetime. Responses to trauma include feelings of intense fear, helplessness, and/or horror. This condition has roots in the relationship between stress, trauma and memory.

It is perceived that PTSDs are originated from a ‘defect’ in the brain memory processing functions. As previously described, emotionally attached events are stored differently (at a ‘deeper’ level). These memories include stressful and traumatic events, particularly those which resulted in some kind of harm and emotional distress to the person.

Upon the identification of the same stressor (or similar) that caused a reaction for the previous situation, the body would instantly trigger an overstressed response. However, in most cases, the new event will not constitute a threat. For instance, a noise could be a stressor from a situation in which a person ended up being assaulted. The same noise, or something similar, could occur in other situations which are harmless. Unless that stressor is reinforced (results in danger overtime), your brain will adapt to the stimulus and gradually reduce the stressful response. This process is called ‘extinction’ (Pavlov’s theory).

If extinction fails to take place, the individual will continue to react (stressfully) to the original stimulus, or similar ones. This is the case for PTSD sufferers. Because the human body is not prepared to maintain stressful status continually, side effects will appear. These effects are both physiological (Coronary Heart Disease, ageing acceleration, etc) and psychological (fear, avoidance, etc).

This explains the occurrence of PTSD in war veterans (individuals who were exposed to stress over a long period of time) and accident survivors (individuals who were exposed to a highly stressful and traumatic situation).Combating Trauma: Current Treatments

The effects of trauma may vary greatly among people. The extent, frequency and intensity of each event are presented according to each person’s mind frame and previous experiences – and because traumatic events are cumulative over life, it can be quite difficult to provide a treatment that comprises all problems derived from separate traumas.

Most people adapt to trauma in their lives, and through the extinction process, do not experience much psychological harm derived from past events. However, for patients with PTSD, and other stress-triggered conditions, the situation requires further attention.

Currently, most treatments for PTSD are based in psychotherapy, introspection and conditioning. These treatments attempt to identify the major traumatic events or associations which are predominant in the individual’s life:

Cognitive Behaviour Therapy

CBT is a form of psychotherapy which works in the perspective of the individual towards a memory and traumatic event. By working the way the person perceives that event, therapists believe that the trauma can be coped with. This form of treatment is recommended by the World Health Organisation and it is widely used to combat PTSD symptoms.

Debriefing

A single section-based treatment which occurs shortly after the traumatic event. The debriefing process evolves on the ‘traumatized’ individual’s verbal expression of the event. It is suggested that by ‘letting out’ those memories and feelings, the person is more unlikely develop suppressed emotions, which reduces the effects of trauma. Debriefing is widely used for professionals that deal with traumatic events on a daily basis (e.g. paramedics).

Eye Movement Desensitisation and Reprocessing

This treatment is based in a psychophysiological approach. According to the theory, the overload of emotions derived from traumatic events interferes with the individual’s information processing episode. That interference, in a physiological level, produces ‘flawed’ pathways of memory retrieval, which in turn, results in the non-logical perception of the event. For instance, a victim of rape, albeit aware that the fault was of the perpetrator, continually invokes self-blame for the incident. The process of desensitisation and reprocessing would serve to reprogram those pathways, resulting in the extinction or partial extinction of negative symptoms.Combating Trauma: A New Approach

The issue of trauma has generated several different treatment approaches. While some researchers focus in the psychological processes, such as psychotherapy and conditioning, others are studying the possibility of tackling the problem at a physiological level. This division of focus has caused much discussion in this field, and each individual’s pool of experience complicates the process of targeting the causes of a trauma, and particularly to define the extent of one single event.

A new proposition attempts to provide the solution at a molecular level. Increased research in the field of memory, particularly the formation and storage processes, is instigating scientists to develop this new approach. This time, instead of taking a passive stance towards the development of a trauma, researchers are intending to eliminate the most prominent element of the trauma: the event itself.

The idea is to administer beta-blockers to act in the molecular level of memory formation. Beta-Blockers are commonly used drugs to control blood pressure (hypertension). They block the action of epinephrine (adrenaline) and norepinephrine, which slows the heart rate. This effect seems to dissociate stress with traumatic memories by ‘reducing’ that memory to a regular response level.

This ‘reduction’ would result in a varied pathway to access a particular memory, invoking altered production of substances such as epinephrine and, in the end, a memory which does not cause overstressed responses in an individual suffering from PTSD.

However, this research, along with other similar methods of combating PTSD at a molecular level, is still in its infant stages. It has been suggested that this procedure could affect other memories or memory retrieving processes and scientists have not been able to deny that possibility.

Much discussion is expected for the next few months. According to Richard Glen Boire from the Center for Cognitive Liberty and Ethics (New Scientist – 03/12/2005), these kind of drugs should be available within 5 to 10 years. Further research in the field of memory and general neuropsychiatry should also play a major role in refining and expanding current evaluation of beta-blockers and their effects in the human mind. The “Human Connectome” project – a worldwide project which aims to create a 4-dimensional map of neuronal connections in our brain – is an example of those.Subscribe to our FREE eZine.

“Therapy (in Greek: θεραπεία) or treatment is the attempted remediation of a health problem, usually following a diagnosis.” (WIKIPEDIA)

In the context of mental health, therapy has vastly changed over time. Long before the scientific approach to the treatment of mental health prevailed, attempts to discover the underpinnings of the human mind produced a wide range of therapies and theories. For many centuries, the therapeutic approach to the human mind was mostly based on supernatural and religious beliefs.

This approach began to change when Phillipe Pinel, in 1793, introduced his methods in Paris. Pinel believed that switching from a commonly violent and medicine-based treatment to a strictly non-violent and observational approach could produce a better outcome for patients. At this point, the history of the counselling therapy had begun to be shaped.Therapy in Counselling

The general concept of therapy has its differentiations from the counselling approach to therapy. In counselling, providing therapy does not mean providing a cure to a patient’s illness. Counselling’s general objective is to help improve the client’s quality of life, and in many instances that could mean to simply explore a relationship issue or the perception towards oneself. The varied types of counselling therapies reflect many approaches to solve similar issues – and these approaches can work differently depending on the individual. In order to better understand this concept, we’ve gathered some information about some counselling treatments used nowadays.Cognitive Behaviour Therapy

CBT is an insight-focused therapy that emphasises recognising and changing negative thoughts and maladaptative beliefs. The approach is based on the theoretical rationale that the way people feel and behave is determined by how they perceive and structure their experience. CBT proposes that change comes about by changing the client’s thinking about the situation. Once the client has converted his/her point of view, the problem-perception switches to a clearer context. Some basic concepts within the CBT schools of thought include:

Arbitrary Inferences: refers to making conclusions without supporting and relevant evidence. This includes “catastrophising”, or thinking of the absolute worst scenario and outcomes for most situations.

Selective Abstraction: consists of forming conclusions based on isolated details of an event (and ignoring other information).

Overgeneralisation: a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings. Personalisation is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection.

Labelling or mislabelling: involves portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define one’s true identity.The Gestalt Therapy

An existential/phenomenological approach based on the premise that individuals must be understood in the context of their ongoing relationship with the environment. Gestalt proposes that change comes about by the client being aware of what he/she is experiencing and resolving the situation. Gestalt promotes direct experience and testing in order to adapt to the environment; express different behaviour; and instigate awareness of action and further responsible recognition of the results. Some basic concepts of the Gestalt approach include:

Holism: all nature is seen as unified and as a coherent whole, and the whole is different from the sum of its parts.

Field Theory: the organism must be seen in its environment, or in its context, a part of the constantly changing field.

The Field-Formation Process: it describes how the individual organises the environment from moment to moment. The figure-formation process tracks how some aspect of the environmental field emerges from the background and becomes the focal point of the individual’s attention and interest.

Organismic Self-Regulation: The figure-formation process is intertwined with the principle of ‘Organismic self-regulation’, a process by which equilibrium is ‘disturbed’ by the emergence of a need, a sensation, or an interest. Gestalt therapists direct the client’s awareness to the figures that emerge from the background during a therapy session and use the figure-formation process as a guide for the focus of the therapeutic work.Person-Centred Therapy

Person-Centred Therapy is “an approach to helping individuals and groups in conflict. A clearly stated theory (developed by psychologist Carl R. Rogers), accompanied by the introduction of verbatim transcriptions of psychotherapy, stimulated a vast amount of research on a revolutionary hypothesis: that a self-directed growth process would follow the provision and reception of a particular kind of relationship characterised by genuineness, non-judgemental caring, and empathy.” (Corsini 1995).

In Person-Centred therapy, the focus is on the client. The objective is to achieve progress by self-directed growth, emphasizing on the ‘here-and-now’ of the individual’s life. This emphasis on the present replaces the diagnostic perspective in counselling. Here, individuals are not products of their past experiences – instead, they are able to determine what is right for them (self-diagnosis and remediation). The person-centred approach is intrinsic to most therapies as it aims to establish an affective relationship between client and counsellor.Solution-Focused Therapy

This therapeutic focus is on exploring the client’s perspective towards a problem. The client is assisted to develop a different perspective towards the future, and through that perspective, work on their current situation. The goal-driven process is similar to coaching – the counsellor’s role is to build initial rapport and then use questioning techniques to direct the process of therapy (in order to enhance the client’s understanding of his/her strengths and successes in already overcoming his/her problems). The solution-focused approach can be defined in five different stages: describing the problem, developing well-formed goals, exploring for exceptions, end-of-session feedback, and evaluating client progress.Subscribe to our FREE eZine.

If you are looking for online help for depression, you will know there are many different resources available to you. But with so many choices it can be bewildering to know what the best option is.

So here are 3 tips to look for when seeking the best help for depression online.

1. Avoid the use of pills and medication If you find a resource online that recommends using certain medication, it is worth avoiding. Any recommendations for medication to treat depression should come from someone properly qualified to do so. When the recommendation comes from someone online, it is very difficult to be certain that it is coming from someone qualified to give this advice.

2. Look for proven methods There are certain methods which will have successfully cured depression and have the stats to prove it. For example, Cognitive Behavioural Therapy (CBT) is known to work successfully because of the evidence gathered showing the successful treatment of depression.

3. Seek Strategies that will work again and again Definitely worth investing in a strategy that can be used again and again to cure depression rather than one that you can only use once. So if there is a technique that once you have learned, you can call upon again if you find yourself going through depression in the future, then that technique is worth its weight in gold!

If you are looking for Online Help for Depression make sure you consider the above 3 tips to help you make an informative decision.

One of the best resources available to help you overcome the pain of depression can be found at Online Help for Depression. This resource certainly fits the above 3 tips and is centered around the highly effective CBT method of treatment for Depression.

One of the most common reasons that clients seek treatment at my NLP and CBT practice Hertfordshire is for anxiety and panic related problems, such as generalised anxiety disorder, panic attacks and agoraphobia. Often, panic attacks are associated with other conditions such as generalised anxiety, phobia or depression. In this case, the appropriate course of action is to address these underlying issues first – the panic attacks usually subside, as these other issues are resolved.
Having worked in the NHS as a senior mental Health Occupational Therapist, I tended to come into contact with people experiencing what is considered to be severe mental health problems. It is these people that the mental health system and services are geared towards supporting and rightly so. However, until entering private practice, I was unaware of the number of people living day to day with the often, debilitating effects of panic and anxiety disorders, with what appears to be, little or no support from overstretched NHS services.
NICE (National Institute for Clinical Excellence) recommends Cognitive Therapy for the treatment of anxiety, panic attacks and panic disorder. Their research has shown it to be more effective than any drug treatments. Therapies such as Cognitive Behavioural Therapy (CBT) and Neuro-Linguistic Programming (NLP) involve the patient seeing a therapist on a one-to-one basis for hour-long sessions. The total treatment course is typically between 6 and 12 sessions, with one session a week.
During NLP and CBT Herts, I work with people experiencing anxiety, panic attacks and agoraphobia, usually over an 8 week period, seeing them once a week. This is flexible, and more or less sessions are carried out depending on the unique need of the individual. Obviously reducing the cost of treatment for the client is to be aimed for, particularly as I often work with people who have stopped working due to their problem.
In between sessions the client is given homework to complete. Support and encouragement via email is provided, if required.
What will you achieve through having NLP and CBT Herts?
1. No More stinky thinking!
At CBT and NLP, Herts, people are supported to identify and change the distorted thinking patterns that maintain anxiety. Behind panic attacks and anxiety are negative thoughts. These thoughts alone cannot cause anxiety, but your belief in the truth of these thoughts, can cause anxiety. The therapist works with the client to reduce belief in such thoughts, this in turn reduces anxiety.
2.Building your hierarchy
This involves desensitizing your anxiety through gradual exposure to your feared situations. The therapist offers practical support and activities may be carried out in the community, during these sessions.
3. Learning strategies to master your anxiety and panic
Clients that come for NLP and CBT Herts are taught specific techniques that can be used and that must be practiced in between sessions. The challenge is using these techniques during times when you are experiencing heightened panic and clients are supported to become competent at this. Learning strategies can involve NLP techniques, such as sub-modality work, anchoring and clean language techniques.
4. Changing your focus
Just one of the things that you will learn is to change your focus towards what you do want, rather then what you don’t want. One of the things I have found is that people with anxiety and panic problems invest a large amount of their time trying to avoid and move away from anxiety and panic. This is understandable. However, what you will learn is that you are actually focusing on anxiety and panic, merely by the language and internal dialogue that you are using. You will be taught to focus on what you are trying to achieve and will immediately experience benefits in how you feel emotionally.
I have found that clients that are really committed to mastering their anxiety and panic can experience the change they desire, by sticking to the 8 week CBT/NLP programme in Hertfordshire. It is rewarding for me to work with people with these problems because the results are usually very positive.