What is CBT (Cognitive Behavioural Therapy)?
CBT is an evidence-based short term therapy for the treatment of psychological problems including anxiety, depression, panic disorders, agoraphobia and other phobias, social anxiety, health anxiety, Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), anger management, stress, low self-esteem, Chronic Fatigue and eating disorders.
CBT is a way of understanding how thoughts, feelings and behaviour affect each other, and how to develop strategies to better manage the way you think and feel about yourself, others, and the world around you. We will break each problem down into its separate parts. To help this process, you may be asked to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions. Together we will look at your thoughts, feelings and behaviour to work out if they are unhelpful, and how they affect each other. You will then be helped to work out how to change unhelpful thoughts and behaviour. You might start to question a self-critical or upsetting thought and replace it with a more balanced one that you have developed in CBT. You might also recognise when you are about to do something that will make you feel worse, and instead, do something more helpful.
The number of sessions will normally range from 6 to 12 sessions, depending on the nature of the problem, but sometimes therapy can take longer. Everyone is different so it is not always possible to say how many sessions are needed. In the first session we will explore current problems that you experience and the background of these difficulties. We will talk about how the problems developed, how they affect you and if you already have strategies that are helpful for you to cope with your difficulties; together, we will then set goals for therapy. Although CBT concentrates mainly on the present, it may be relevant at times to talk about the past as this will help understand current difficulties.
We will work together in an atmosphere of transparency, aiming to create a collaborative relationship. There will be a safe and non-judgmental space in which to explore whatever you may wish to bring to therapy. Any therapy plan will focus on your unique situation.
Research has shown conclusively that CBT is effective for the treatment of many psychological problems. CBT is recommended by the National Institute for Clinical Excellence (NICE) in their guidelines for the treatment of most mental health problems.
I also work with CFT (Compassion Focussed Therapy). This therapy is used to treat problems associated with self-criticism, shame and self-hate, which can be features of anxiety, depression, psychosis and is associated with childhood trauma. Compassion mind training helps people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion. It is not our fault when we get caught up in self-criticism, self-hate and feel shame. The brain, human nature and our life experiences all influence the way our minds work. It is not our fault, and we just do the best we can.
Mindfulness is about learning to pay attention, in the present moment, without judgment, to things as they actually are. In mindfulness we start to see the world as it is, not as we expect it to be, how we want it to be or what we fear it might become. When we are mindful we don’t worry about the past or the future, but instead become aware of the present. Mindfulness helps to increase of sense of well being and being at peace, and is helpful in overcoming many mental health difficulties such as depression, anxiety, OCD and trauma. It is also used in compassionate mind training.
What is EMDR (Eye Movement Desensitisation Reprocessing)?
EMDR is a psychological treatment to help people deal with distressing events. EMDR aims to change how people with PTSD feel about the traumatic memories, and helps them to develop more positive emotions, behaviour and thoughts. It enables people to recollect the original traumatic experience as a memory that sits in the past but is no longer disturbing.
Treatment will only start after a careful psychological assessment to establish whether EMDR is suitable for the person involved and the problems presented.
During EMDR you will be helped to examine your memories of a trauma, including all negative thoughts, feelings and sensations experienced at the time of the trauma. While doing this, the therapist will assist you in making guided eye-movements which stimulates powerful brain activity. After each set of eye movements you will be asked what you have noticed, and subsequently instructed to uncritically follow your thoughts and associations. This often leads to retrieval of old memories, rapid insights, and a systematic letting go of the traumatic event and the symptoms associated with it.
EMDR can cause the brief experiencing of high levels of emotion which are associated with the traumatic memories. It is important that you have the necessary skills to cope with this, and we will spend some time ensuring that these are in place before treatment starts.
If you have had a single incident, e.g. a recent car accident leading to fear of driving, the average treatment can be 6 to 8 sessions of EMDR, possibly combined with some sessions of CBT. EMDR is also remarkably effective in the treatment of people who have suffered trauma such as ongoing childhood abuse, although this may require more extensive therapeutic time.
The National Institute for Clinical Excellence (NICE) recommends EMDR and CBT where PTSD symptoms have been present for over 3 months after a traumatic incident. The American Psychiatric Association Practice Guidelines (2004) has placed EMDR in the category of highest level of effectiveness.