Posts Tagged ‘mental health’

 

Robin Williams

The world has woken up today to the loss of one of the finest comedic talents of his generation – perhaps, of any generation – and the outpouring of words will no doubt be liken unto an avalanche.

We do not propose to add to them to any great extent, if for no other reason that others will do a better job.

But not to mark Robin Williams’ passing would be to do the man a dis-service. This is a day for many in the world to pause, and to remember a great man who gave freely to all of us of his hugely generous heart. And also to contemplate sadly the persistence, the common-ness, the vile pressure of this scourge of an illness which has now stripped him from us and which ruins so many lives, and touches uncountable others.

For him to apparently take his own life – yet another high-profile victim of depression, which afflicts so many of those creative souls who truly see into the world with clear eyes – is the ultimate cruel irony. A life spent making untold millions laugh, snuffed out in a moment of existential hollowness and hopelessness. And a life capped by triumphantly fighting a battle against addiction – so often the fellow traveller with depression – that was lost when he was determinedly sober. This is a bitter, bitter day.

For a man who gave the world so much, he will, like many others, be tragically defined to some degree by the nature of his death. His wife has already pleaded that it not be so, but it is inevitable. Our thoughts and prayers go out to his family and friends.

For the rest of us, whether battling depression or not, we are today surely reminded of the most powerful call to celebrate life – to seize life by the lapels and give it a great shake – that he ever delivered in his multi-faceted and endlessly inspiring career. He is delivering the lines of a writer, to be sure, but he was surely also speaking for himself. See it in his eyes.

Carpe Diem.

 

Amen.

 

ImageMany mental illnesses are as bad for you as smoking, research has suggested.

Life expectancy for people with mental health problems is less than for heavy smokers, experts have found.

Serious mental illness can reduce a person’s life expectancy by 10 to 20 years, when the average reduction in life expectancy for heavy smokers is eight to 10 years, according to researchers from Oxford University.

But critically, mental health has not been the same public health priority as smoking, they said.

The study, published in the journal World Psychiatry, analysed previous research on mortality risk for a whole range of problems – mental health issues, drug and alcohol abuse, dementia, autistic spectrum disorders, learning disability and childhood behavioural disorders.

The authors examined 20 papers looking at 1.7 million people and over 250,000 deaths. They found that the average reduction in life expectancy for people with bipolar disorder was between nine and 20 years, it was 10 to 20 years for schizophrenia, between nine and 24 years for drug and alcohol abuse, and around seven to 11 years for recurrent depression.

The loss of years among heavy smokers was eight to 10 years.

“We found that many mental health diagnoses are associated with a drop in life expectancy as great as that associated with smoking 20 or more cigarettes a day,” Dr Seena Fazel of the Department of Psychiatry at Oxford University said.

“There are likely to be many reasons for this. High-risk behaviours are common in psychiatric patients, especially drug and alcohol abuse, and they are more likely to die by suicide.

The stigma surrounding mental health may mean people aren’t treated as well for physical health problems when they do see a doctor.

Many causes of mental health problems also have physical consequences and mental illness worsen the prognosis of a range of physical illnesses, especially heart disease, diabetes and cancer.

Smoking is recognised as a huge public health problem.

There are effective ways to target smoking, and with political will and funding, rates of smoking-related deaths have started to decline.

We now need a similar effort in mental health.”

Dr John Williams, head of neuroscience and mental health at the Wellcome Trust, which funded the study, added: “People with mental health problems are among the most vulnerable in society.

This work emphasises how crucial it is that they have access to appropriate healthcare and advice, which is not always the case.

We now have strong evidence that mental illness is just as threatening to life expectancy as other public health threats such as smoking.”

At the Wellthisiswhatithink desk, like most people, we have had a few run ins with mental illness in the family and friends coterie. Thankfully, the stigmas associated with mental illness is reducing – albeit achingly slowly. Especially as it is increasingly understood that mental illness does not betoken “weakness” or “badness” but rather chemical imbalances in the brain that are no more the sufferer’s “fault” than, say, diabetes.

We warmly welcome this research finding and trust it is widely studied at government level. A heap of misery can be lifted off the shoulders of sufferers and their families through early intervention, prompt care and adequate treatment with “talking therapy” and medication.

Assuming Government now longer feels itself morally bound to take action (it seems simple need is the least strong motivator for many Governments worldwide now, sadly, as you can see below) then what about this thought?

mental-illness-not-contagiousJust imagine the hurricane of productivity and wealth that would be released if mentally ill people became weller, faster, and more thoroughly well, and lived that way longer.

Yes, that’s something we’d like to see in our shiny new hard-headed neo-con austere world.

Meanwhile, here’s some additional reading on how Government in rich “advanced” countries consistently fails the mentally ill:

UK: http://www.independent.co.uk/life-style/health-and-families/health-news/cuts-send-rates-of-mental-health-disorders-among-young-soaring-9392996.html

UK: http://www.theguardian.com/society/2014/mar/12/risks-deep-cuts-mental-health

Australia: http://www.theage.com.au/victoria/mental-health-funding-cuts-spark-fears-of-social-mess-20140518-38hz9.html

Australia: http://www.businessinsider.com.au/these-two-budget-charts-show-how-much-money-joe-hockey-is-cutting-from-hospitals-and-schools-2014-5

USA (four stories): http://www.huffingtonpost.com/tag/mental-health-budget-cuts/

USA: http://www.forbes.com/sites/theapothecary/2013/10/10/mental-health-loses-funding-as-government-continues-shutdown/

coupleWe heard coverage of this story on the radio a little while ago, and it struck us as terribly sad then – it’s good to see people with some clout taking it up.

We are forever depressed and angered by the way the poorest and least able to defend themselves are chewed up by “the system”, when these are the very people we should be looking after most intensively.

Regular readers will know that we are especially concerned about the fate of “vets” in particular, most obviously in the US, where 100,000+ of them languish in jail, usually for drug abuse and minor theft issues, but also in many other countries around the world including Australia. This is just one more especially tragic and completely avoidable case of a hero falling through the cracks once he’s been discarded by the services.

Homelessness is very often the result of family break-up (especially for young people), substance abuse, mental illness, (especially affecting people who were tossed out on the streets under the trendy move towards de-institutionalisation, but without anything like adequate provision for the de-institutionalised being put in place), post-traumatic stress, and other matters that a genuinely civilised system would deal with effectively.

Instead, we see an increasing reliance on anti-homelessness laws that are a weak and vindictive response that ties up the time of police who should be doing much more important work, and which victimises victims.

We must do better.

The UN Human Rights Committee says the U.S. should stop criminalising homeless people for being homeless.

Jerome Murdough, 56, a mentally ill homeless veteran, was just trying to stay alive during a New York City cold snap when he thought he found his spot: a stairwell leading to a roof in a Harlem public housing project. But that desperate act set in motion a nightmare ride through New York’s criminal justice system that would end with Murdough dying of heat stroke in a Riker’s Island jail cell. New York officials now say the system failed Murdough every which way.

When he was discovered, he should have been offered shelter.

When he was arraigned, he should not have been slapped with $2,500 bail.

When, unable to make bail, he ended up in jail, Murdough, because he was on medication for a mental condition, should have been monitored every 15 minutes, not left unwatched for at least four hours.

It was during that untended time that Murdough, as an official told the Associated Press, “basically baked to death.”

Now, as New York officials discuss the “tragedy” of last month and scapegoat one Riker’s Island guard for Murdough’s death — suspending him for 20 days — the United Nations has taken notice. Murdough is just the latest statistic in a series of needless deaths of homeless people while under arrest for “crimes” related to being unhoused, such as loitering or trespassing.

The U.N. Human Rights Committee in Geneva on Thursday condemned the United States for criminalising homelessness, calling it “cruel, inhuman and degrading treatment” that violates international human rights treaty obligations. It also called upon the U.S. government to take corrective action, following a two-day review of U.S. government compliance with a human rights treaty ratified in 1992.

“I’m just simply baffled by the idea that people can be without shelter in a country, and then be treated as criminals for being without shelter,” said Sir Nigel Rodley, chairman of the committee in closing statements on the U.S. review. “The idea of criminalising people who don’t have shelter is something that I think many of my colleagues might find as difficult as I do to even begin to comprehend.”

The Committee called on the U.S. to abolish criminalisation of homelessness laws and policies at state and local levels, intensify efforts to find solutions for homeless people in accordance with human rights standards and offer incentives for decriminalisation, including giving local authorities funding for implementing alternatives and withholding funding for criminalizing the homeless.

Those recommendations run counter to the current trends in the nation. Laws targeting the homeless — loitering laws that ban sleeping or sitting too long in one public spot, or camping in parks overnight — have become increasingly common in communities throughout the country as homelessness has skyrocketed.

The National Law Center on Homelessness & Poverty (NLCHP), a D.C.-based advocacy organization which monitors laws that criminalise homeless people and litigates on behalf of poor people regularly conducts reviews of cities criminalising homelessness and finds more and more laws banning such activities as sitting or lying in public places with each new survey.

“We welcome the Committee’s Concluding Observations and call on our government to take swift action to solve homelessness with homes, not jails and prisons,” said Maria Foscarinis, the NLCHP executive director, in a statement. The NLCHP had submitted a report to the U.N. Committee for review.

Paul Boden, executive director of the Western Regional Advocacy Project, an umbrella organization of advocacy groups in the Western U.S. that is hoping states will sign onto a Bill of Rights for homeless people, said that more and more homeless people are being arrested, prosecuted and killed for actions relating to their poverty. (See below.)

Article reproduced from Alternet.org

Meanwhile, in a tragic irony given the UN report, video has emerged in the last few days of yet another tragedy.

We warn you, this video is very distressing.

 

The shooting in Albuquerque of a homeless man dead has drawn attention to the city’s officer-involved shootings, especially those involving the mentally ill.

Since 2010, the city’s police have shot 37 people, The New York Times reports. The New Mexico Public Defender Department estimates that 75% of those shot had a mental illness, even though nationally about half of those shot by police have mental health problems.

The Albuquerque Police Department (APD) has identified the man in the recently released video as 38-year-old James M. Boyd. The Albuquerque Journal reports dispatchers informed APD officers responding to the incident that Boyd was mentally incompetent and possibly had paranoid schizophrenia.

The disturbing video from March 16 shows officers aiming their weapons at Boyd, who was camping illegally. We later learn was holding knives, but he doesn’t appear to be threatening the officers.

At the beginning of the video, Boyd gathers his bags containing his belongings.

 

Police shooting James Boyd

 

One officer then says “do it” while another throws a flash grenade that explodes as officers and a police dog charge him.

 

Albuquerque police shooting James Boyd

 

The man drops his bags and scuffles briefly with the police dog before turning his back as if to retreat, but he is immediately shot in the back.

 

Albuquerque police shooting James Boyd

 

Officers then restrain the mortally wounded man and the video reveals he has a small knife in each hand, although it is unclear from the video when he pulled the knives out.

 

Albuquerque police shooting James Boyd

 

In a press conference held shortly after the March 15 shooting, APD Chief of Police Gorden Eden said he believed the shooting was justified. According to his version of events, the man threatened APD officers with knives after they approached while he was sleeping at his illegal campsite.

Eden said officers were attempting to use non-lethal means when they threw the flash grenade. But the man pulled out two knives and threatened an officer handling the police dog, according to the police. “The officers then perceived a directed threat immediately to the canine handler who was trying to redirect the dog towards the suspect, when the shots were fired,” Eden said.

While Boyd’s actions in the video appear non-aggressive, Eden said he had not obeyed officers’ demands. “The suspect did in fact make a decision not to follow the directions that were provided to him by the officers,” he said.

According to The Times, Boyd had a history of mental illness and may not have followed the officers’ directions because he believed he was a federal agent who shouldn’t be bossed around.

The APD has a history of allegedly using excessive force during confrontations with civilians, spurring the U.S. Department of Justice to launch an ongoing investigation into the matter in November 2012. Of the 37 people shot since 2010 more than 20 were killed, according to the Albuquerque Journal.

In 2013 a judge ruled that the 2010 fatal shooting of an Iraq War veteran with post-traumatic stress disorder was not justified.

This week, an attorney announced he intends to file a class-action lawsuit against the APD over repeated shootings of people with mental health problems. The lawsuit would seek to guarantee additional training for officers to peacefully end confrontations with mentally ill people.

The video recently sparked a large demonstration in Albuquerque streets against recent APD shooting deaths, according to the Albuquerque Journal. Some community members have criticised the APD for making arrests and resorting to riot gear and tear gas during that 12-hour demonstration sparked by the shooting. Another demonstration followed, and another is set for Friday.

However, Albuquerque Mayor Richard Berry and Eden said the police actions were an appropriate response to some protesters who behaved like a mob committing illegal acts.

APD Chief Eden started at his position February 27. He previously spent eight years serving as the U.S. marshal for New Mexico in the same Department of Justice still investigating the APD. As the new ADP chief, Eden has vowed to begin improving the department before the investigation reaches its conclusion. He said his major priorities are community outreach, bolstering APD’s leadership structure and police retention. Eden also hopes to increase the department’s manpower, which currently stands at 900 officers although he said there is funding for 1,100 officers.

From Business Insider and others

Well, having viewed the video, we believe this is an unlawful or morally reprehensible killing, at best, and barefaced murder at worst. This man was clearly no threat.

The “flash-bang” is launched as he is complying with the police commands. He is further assaulted when he is clearly no threat whatsoever.

Even if he was initially considered a threat, (even though we cannot see why), why was force not used to disable him (shooting at his legs, for example) rather than to kill?

The police concerned are on “administrative leave”. In our opinion, they should be in court. As for the police chief believing the shooting was justified, well, if that’s what he calls “community outreach”, then words fail us.

Little girl isolated

Originally posted in 2012, now updated

As we hear the news that a 16-year-old Australian boy who had been bullied so much that he tried to kill himself has finally died from his injuries, and of an Ohio school student who was marginalised and bullied and who tragically took a gun to his classmates, we are again reminded of the awful dangers of bullying.

The events in Ohio are too recent and too unclear to comment upon in any detail. But we know the story of Dakoda-Lee Stainer who two years ago tried to end his own life: bullies at his Kempsey school had tormented him mercilessly for months, and on this particular day he had been accosted by a gang of teens.

He survived the suicide attempt, however was clinically dead for 30 minutes.

Dakoda-Lee suffered irreversible damage to his windpipe and was left terminally ill with severe brain damage. He was unable to speak or walk and had to eat through a tube in his stomach.

The high school student was raised in Toowoomba but moved to northern NSW in 2007.

His mother, Tess Nelson told the Toowoomba Chronicle in November: “We live every day as we can and we help him as much as we can. If his windpipe collapses it might be his last breath.”

On Valentine’s Day this year, Dakoda-Lee passed away in Caboolture Hospital. We pass our heartfelt admiration and sympathy to his carers, family and friends.

Ever since his tragic accident, his mother, has been campaigning to give a voice to her son who had lost his own.

The Facebook group ‘See justice done for Dakoda-Lee Stainer’ says “Please join my group and we can speak for him. justice must be done, criminal charges laid and compensation given. And maybe together we can help make a change.”

According to News Limited and Yahoo, Dakoda-Lee’s stepfather Bill Kelly, is suing the NSW Department of Education and Communities for damages. The family claims it breached its duty of care.

What can you do?

Re-blog this page, re-post it to Facebook, email around this article to your friends. Especially, but not exclusively, if you’re an Aussie, because on Friday 21 March, schools throughout Australia will join together to celebrate the annual National Day of Action Against Bullying and Violence.

For more information, please visit Bullying No Way or their Facebook page.

A lifetime ago, and for many years, at boarding school near London, I was mercilessly bullied.

Brutally. Repeatedly. Continuously.

In what amounted to nothing more nor less than emotional, psychological and physical torture, I was ruthlessly teased, beaten, humiliated, and marginalised.

I was picked on primarily because I was creative – a writer, singer and actor – and unusually intelligent and sensitive in a school environment that largely mistrusted those qualities. And because the pack or the mob always seems to need a victim to unite against, and because once a child at school is accorded victim status it takes an earthquake to turn things around, this lasted from the age of about 11 until about 16.

I came from a middle class home in the south of the country, most of my classmates came from working class homes in the north.

I was obviously from Welsh stock. Not very tall, and slightly overweight. (This later helped me be an effective rugby player, playing hooker in the middle of the pack, which re-aligned my community status a little.)

I missed my home and didn’t hide it.

I also had bad breath which no amount of tooth brushing seemed to cure. (In later life I discovered I have sleep apnea and have probably had it all my life from birth due to a combination of nasal and soft palate deformities – as a result my mouth would dry out at night.) Needless to say, no social or medical intervention was offered.

Teachers can be bullies, too. You know who you are.

Complaining to teachers about the treatment meted out to me was usually met with advice to “toughen up” and “fight back”, and often a sneering assumption that I was somehow responsible for my own bullying. One teacher in particular would deliberately curry favour with my pupil cohort by bullying me himself. He is probably dead now, which is a shame, as I would like to land just one mighty blow on his ugly, smug little face. I hope he rots in the deepest most lonely corner of hell. I’m sorry that those thoughts are ignoble, and beneath me. Walk a mile in my shoes.

At stages in my life, when reacting to stress, I have struggled with both depression and obsessional compulsive disorder.

(I am reasonably well at the moment, thank you, and have been for some time.) I ascribe both, in overwhelming measure, to my school experiences. I still have nightmares: I am now 54.

That I have grown, eventually, into a moderately well-adjusted adult with a working quantity of cheerfulness, stoicism and self-esteem cannot hide the scars I still carry from this experience.

I am, for example, by nature, somewhat “conflict averse”. In a conflict situation at home or at work I will commonly either over-react with anger, frustration and fear, or under-react, with acquiescence and grudging agreement. I have had to learn, step by painful step, to assert my point of view quietly and good-naturedly in these situations, and not to take any opposition personally (as it rarely is personal), and to laugh off minor setbacks. I expect to have mastered this skill by the age of about 80, which will leave me just enough time to get on well with the bossy busy-body nurses in my retirement home, and even my killjoy gerontologist when he tells me that a road-trip grape-grazing in the Yarra Valley would probably be counter-productive at my age.

I eventually managed to bring the bullying under some sort of control by one day losing my cool altogether and belting two tons of shit out of a couple of big kids who were the ringleaders.

I surprised myself. I certainly surprised them.

This didn’t fix the problem entirely, but it ameliorated it. Needless to say, this was an antiquated, barbaric response to a barbaric problem, and it should never have come to that. It was probably fortunate that I was not living in a country with free access to firearms, or the place might have been minus a few students and at least one teacher. Perhaps two, thinking back.

Many school bullies, interviewed later in life, express bitter regret at their behaviour, and talk of how they too felt isolated and frightened, and how they fell into leadership of the pack and a cycle of poor behaviour that they felt unable (or unguided) to leave. Some of them report carrying those behaviours over into adult life, causing themselves and others great sadness.

The victims of bullying frequently take their own lives, or suffer the torments of hell trying to re-establish the self-esteem and sense of safety that should never be stripped away from a child.

So what can you do?

Make the world a better place. 

At the very least, click now and get behind Bullying No Way in your school community: as a start, ask what your school is doing to participate. Consider in what ways the principles involved could be utilised in your family and workplace, too.

If you are overseas and reading this, ask your school or education authorities whether they should be running similar programs.

And above all – above all – if you’re a parent – ask your child if they are ever bullied. Including “online” bullying, now, a horrible new phenomenon. And listen to their answer with fierce attention.

Or find out if they bully anyone else.

And if either is true, do not ignore it, or hope it will go away, or brush it off and dismiss it. Work out what action to take to correct the situation. Get professional help if necessary.

Because sooner or later, bullying is a problem for all of us. And it maims – and even ends – lives.

Neil Hilborn

Neil Hilborn’s brave and impassioned poem may do more for the recognition and acceptance of the suffering of people with OCD than a thousand documentaries or text books. Well done, that man.

Poet Neil Hilborn has become an internet sensation in the last 24 hours.

His massively impressive two-minute performance-style, life as art, baring of his soul poem about his love for his girlfriend, written through the window of his OCD, is simply astonishing.

 

 

As someone who has suffered from OCD in the past, a brutal multi-layered, multifaceted illness that makes its sufferer’s lives a misery, may I just say that I find the last two lines of the poem among the most moving I have ever heard in all my life.

Listen, weep, laugh, marvel at the courage – enjoy.

Garbage in, Garbage out, people. It really is as simple as that.

Garbage in, Garbage out, people. It really is as simple as that.

In response to my article on “neuroplasticity” a couple of days ago, describing how I “cured” myself of the effects of a stroke, (with the help of my family, which I acknowledge) a couple of people have privately asked me why I specifically recommended Cognitive Behavioural Therapy as one of the things I would suggest for people wanting to work on their brain.

The answer is simple. Many years ago now, I was suddenly and fiercely struck down with an illness called “Obsessional Compulsive Disorder” (OCD). I have never hidden this from anyone who knows me, so I have no fears about revealing it in a blog. It was part of my life, I understand what triggered it, (the death of our first child), I was treated, I am recovered. And have been for some time.

So praise be to the pharmaceuticals, psychiatrists, psychologists, counsellors, family and – for a while – “CBT”. And we move on.

But at the time – and on occasions since – I found personally CBT incredibly helpful, even though I didn’t do a lot of it. In a few sessions, a therapist managed to explain to me how the brain often thinks things through wrongly, and this “wrong thinking” (and often, over thinking) lay at the heart of much stress and anxiety for many people. Essentially, we tell ourselves a load of crap (usually about emotional issues) and because we’re telling ourselves this, we tend to believe it.

Fact is, though, our brains require active management. Left to their own devices, left without any better or more deliberate instructions, they will faithfully regurgitate fears, assumptions, emotions, reasonings and learnings from our past – often our childhood – all of which (or at least some of which) may be total nonsense.

CBT triangle

Just one – just one! – example of what CBT can explain and then help you tackle – in this case the fear “What did I do wrong?” Or perhaps just the fear of mis-spelling “Anxiety” in public.

We weren’t paying attention – we weren’t “mindful” – when we laid down these reactions, and now they overtake us willy-nilly when similar situations occur. Unless – unless – we consciously choose to alter the way we respond to those situations, and the way we allow ourselves to think about them.

This is how your brain works - and how it lets you down - unless YOU control It. Not the other way round.

This is how your brain works – and how it lets you down – unless YOU control It. Not the other way round.

So when people asked “what is it?”, I went hunting for some approachable, easy to read explanatory notes. And I found them, at mind.org, which is a mental health charity in the United Kingdom.

I’m sure they won’t mind me reproducing their explanation, especially if you’re reading this and you need to know what’s in them.

I will reproduce them in full – and they’re long – so if you don’t need to know just stop reading now and wait for tomorrow’s story.

But if you think you do need to know, then read on.

And know that I have made a small donation to the charity on your behalf, to say thank you for shamelessly nicking their wisdom without asking permission.

If this stuff helps you, you might like to bung them a bob or two, too.

THE MIND.ORG NOTES – Making sense of Cognitive Behavioural Therapy

What is cognitive behaviour therapy?

CBT is a form of talking therapy that combines cognitive therapy and behaviour therapy. It focuses on how you think about the things going on in your life – your thoughts, images, beliefs and attitudes (your cognitive processes) – and how this impacts on the way you behave and deal with emotional problems. It then looks at how you can change any negative patterns of thinking or behaviour that may be causing you difficulties. In turn, this can change the way you feel.

CBT tends to be short, taking six weeks to six months. You will usually attend a session once a week, each session lasting either 50 minutes or an hour. Together with the therapist you will explore what your problems are and develop a plan for tackling them. You will learn a set of principles that you can apply whenever you need to. You may find them useful long after you have left therapy.

CBT may focus on what is going on in the present rather than the past. However, the therapy may also look at your past and how your past experiences impact on how you interpret the world now.

CBT and negative thoughts

CBT theory suggests that it isn’t events themselves that upset you, but the meanings you give to them. Your thoughts can block you seeing things that don’t fit in with what you believe to be true. You may continue to hold on to these thoughts and not learn anything new.

CBT 1

For example, if you feel low or depressed, you may think, “I can’t face going into work today. I can’t do it. Nothing will go right.” As a result of these thoughts – and of believing them – you may call in sick.

By doing this you are likely to continue to feel low and depressed. If you stay at home, worrying about not going in, you may end up thinking: “I’ve let everyone down. They will be angry with me. Why can’t I do what everyone else does?” Consequently, you may judge yourself as being a failure and give yourself more negative feedback such as: “I’m so weak and useless.”

You will probably end up feeling worse, and have even more difficulty going to work the next day. Thinking, behaving and feeling like this may start a downward spiral. It may be part of an automatic negative way of thinking.

By continuing to think and behave in this way, you won’t have the chance to find out that your thinking and prediction may be wrong. Instead, the way you think and act can lead you to be more convinced that what you are thinking is true. In CBT, you will learn to recognise how you think, behave and feel. You will then be encouraged to check out other ways of thinking and behaving that may be more useful.

How does negative thinking start?

CBT 2

Negative thinking patterns can start in childhood, and become automatic and relatively fixed. For example, if you didn’t get much open affection from your parents but were praised for doing well in school, you might think: “I must always do well. If I do well, people will like me; if don’t, people will reject me.” If you have thoughts like these, this can work well for you a lot of the time; for example, it can help you to work hard and do well at your job. But if something happens that’s beyond your control and you experience failure, then this way of thinking may also give you thoughts like: “If I fail, people will reject me.” You may then begin to have ‘automatic’ thoughts like, “I’ve completely failed. No one will like me. I can’t face them.”

CBT can help you understand that this is what’s going on and can help you to step outside of your automatic thoughts so you can test them out. For example, if you explain to your CBT therapist that you sometimes call in sick because you feel depressed, the therapist will encourage you to examine this experience to see what happens to you, or to others, in similar situations. You may agree to set up an experiment where you will agree to go to work one day when you feel depressed and would rather stay at home. If you go to work, you may discover that your predictions were wrong. In the light of this new experience, you may feel able to take the chance of testing out other automatic thoughts and predictions you make. You may also find it easier to trust your friends, colleagues or family.

Some of the work we did involved looking at the way I interacted with people, e.g. if somebody had seemed to reject me, I’d write a list of all the reasons against why the way I was thinking might be incorrect. This helped me see things from the other person’s perspective, and realise I might be wrong in my assumptions.

Of course, negative things can and do happen. But when you feel depressed or anxious, you may base your predictions and interpretations on a ‘faulty’ view of the situation. This can make any difficulty you face seem much worse. CBT helps you to understand that if things go wrong or you make a mistake, this does not mean that you are a failure or that others will see you as a failure.

What type of problems can CBT help with?

CBT can be an effective therapy for a number of problems:

  • anger management
  • anxiety and panic attacks
  • chronic fatigue syndrome
  • chronic pain
  • depression
  • drug or alcohol problems
  • eating problems
  • general health problems
  • habits, such as facial tics
  • mood swings
  • obsessive-compulsive disorder (OCD)
  • phobias
  • post-traumatic stress disorder
  • sexual and relationship problems
  • sleep problems.

CBT does not claim to be able to cure all of the problems listed. For example, it does not claim to be able to cure chronic pain or disorders such as chronic fatigue syndrome. Rather, CBT might help someone with arthritis or chronic fatigue syndrome, to find new ways of coping while living with those disorders.

There is also a new and rapidly growing interest in using CBT (together with medication) with people who suffer from hallucinations and delusions, and those with long-term problems in relating to others.

Limitations

It’s less easy to solve problems that are severely disabling and long-standing through short-term therapy. But you can still learn principles that improve your quality of life and increase your chances of making further progress.

Experts know quite a lot about how they can help people who have relatively clear-cut problems, eg if you know your problem is a fear of spiders. They know much less about how the average person may do – somebody, perhaps, who has a number of problems that are less clearly defined. Sometimes, therapy may have to go on longer to do justice to the number of problems and to the length of time they’ve been around.

CBT may be less suitable if you feel generally unhappy or unfulfilled but don’t have troubling symptoms or a particular aspect of your life you want to work on.

What happens in a CBT session?

CBT sessions have a structure. At the beginning of the therapy, you will meet with the therapist to describe specific problems and to set goals you want to work towards.

When you have agreed what problems you want to focus on and what your goals are, you start planning the content of sessions and discuss how to deal with your problems. Typically, at the beginning of a session, you and the therapist will jointly decide on the main topics you want to work on that week. You will also be given time to discuss the conclusions from the previous session. With CBT you are also given homework, and you will look at the progress made with the homework you were set last time. At the end of the session, you will plan another homework assignment to do outside the sessions.

The importance of structure

This structure helps to use the therapeutic time efficiently. It also makes sure that important information isn’t missed out (the results of the homework, for instance) and that both you and the therapist have a chance to think about new assignments that naturally follow on from the session.

To begin with, the therapist takes an active part in structuring the sessions. As you make progress and grasp the ideas you find helpful, you will take more and more responsibility for the content of the sessions. By the end, you should feel able to continue working on your own.

Learning coping skills

CBT teaches skills for dealing with different problems. For example:

  • If you feel anxious, you may learn that avoiding situations actually increases fears. Confronting fears in a gradual and manageable way can give you faith in your own ability to cope.
  • If you feel depressed, you may be encouraged to record your thoughts and explore how you can look at them more realistically. This helps to break the downward spiral of your mood.
  • If you have long-standing problems in relating to other people, you may learn to check out your assumptions about other people’s motivation for doing things, rather than always assuming the worst.

The client-therapist relationship

CBT favours an equal relationship. It is focused and practical. One-to-one CBT can bring you into a kind of relationship you may not have had before. The ‘collaborative’ style means that you are actively involved in the therapy. The therapist seeks your views and reactions, which then shape the way the therapy progresses. The therapist will not judge you. This may help you feel able to open up and talk about very personal matters. You will learn to make decisions in an adult way, as issues are opened up and explained. Some people will value this experience as the most important aspect of therapy.

Group sessions

CBT is usually a one-to-one therapy. But you may also be offered group sessions. You may find it helpful to share your difficulties with others who have similar problems, even though this may seem difficult at first. The group can also be a source of valuable support and advice, because it comes from people with personal experience of a problem.

How effective is CBT?

Clinical trials have shown that CBT can reduce the symptoms of many emotional disorders. For some people it can work just as well as drug therapies at treating depression and anxiety disorders. The National Institute for Health and Clinical Excellence (NICE) recommends CBT via the NHS for common mental disorders, such as depression and anxiety (see ‘Useful contacts’).

Comparisons with other types of short-term psychological therapy aren’t clear-cut. Other therapies, e.g. inter-personal therapy and social skills training, are also effective. The challenge is to make all talking therapies as effective as possible, and also, perhaps, to establish who responds best to which type of therapy.

I attribute the success of CBT to the skills of my therapist; my starting therapy at a time when I was motivated to change; a structured programme tailored to my individual needs; and my determination.

Is CBT for me?

CBT is more likely to be helpful to you if can relate to its ideas around thought and behaviour patterns, its problem-solving approach and the need for homework. People tend to prefer CBT if they want a more practical treatment – where gaining insight isn’t the main aim.

The importance of doing homework

The sessions provide invaluable support. But most of the life-changing work takes place between sessions. You are most likely to benefit from CBT if you are willing to do assignments at home. For example, if you experience depression you may feel that you are not able to take on social or work activities until you feel better. CBT may introduce you to an alternative viewpoint – that trying some activity of this kind, however small-scale to begin with, will help you feel better. If you are open to testing this out, you could agree to do a homework assignment, say to go to the cinema with a friend.

You may make faster progress, as a result, than someone who feels unable to take this risk.

Making a decision

If you are referred for a treatment through the NHS, (or the public health system in your country), you will usually be assessed before you are allocated a treatment or a therapist. The assessor will check out what your problems are, and can then decide with you if CBT is likely to be helpful for you.

If you choose to see a therapist privately, many will offer a free consultation, so you get a chance to discuss directly with the therapist what you want help with. You can then decide if you feel this therapy might be right for you.

Don’t be afraid to ask questions during the assessment. It will be helpful for both you and the therapist if you raise any concerns before therapy starts.

Can I learn CBT techniques by myself?

Since CBT has a highly educational component, the therapist will often suggest that you read through relevant material between sessions – there is a large selection of self-help books available. Some people find this helpful. How useful it is will depend on how severe your problem is and how long it’s been going on. There are some interactive CD-ROMs and online programmes, e.g. Beating the Blues and MoodGYM which can help with depression; and FireFighter for panic, anxiety and phobias.

MoodGYM is available from the web and is free to use. If you want to use Beating the Blues or FireFighter, you will need a referral from your GP or other service-providers. Some people may prefer them to seeing a therapist, particularly as a first step. They can help with creating useful activities and monitor your progress with graphs, which may be encouraging.

I hope you found these notes useful – Yolly

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Turn it off.

 

Decide that this day will be productive and consequential,
and it will be. Decide to rise above the petty distractions,
and you’re already on your way.

Decide that there are valuable opportunities in the
challenges, and you’ll find those opportunities. Decide to
make a positive difference, and you’ll have all that is
necessary to do so.

There are many factors in life over which you have no direct
control. And yet even with those things, you can decide how
you choose to handle them.

Fear or irritation will not help you. Patience and determination
are your friends. One step in front of another is always the way.

So decide to live and work and play from a perspective of love
and gratitude. Decide to greet each day, each single moment
and each new situation – good or bad – with a determination to
do what YOU can to make the world a better place.

Life is a continuous series of choices. Decide where you
want those choices to lead, and put yourself on your own
path to fulfilment.

When you know what you desire, you’ll find plenty of
opportunities to bring it about. Decide to live the very
best life you can imagine, and delight in making it happen.