Introducing Cognitive Behavioural Therapy (Introducing...) (21 page)

Recovery from any kind of mental health problem is always a bumpy process! Expecting and preparing for setbacks will help you to learn from them.

Practice being ‘mindful’

In
Chapter 6
we described an exercise based on the concept of
mindfulness
. Mindfulness has become quite trendy in mental health over the past few years, but it’s in fact based on ideas within Buddhist traditions going back hundreds of years. The basic idea of mindfulness is a very simple one – it’s the process of becoming aware of what is going on inside our minds, of stepping back and observing the way in which our minds work and becoming aware of our thoughts. Getting the hang of observing your thoughts without necessarily becoming caught up in them, or needing to react to them, can be very helpful in managing your mood. Remind yourself that:

• Thoughts are simply mental events taking place in our minds
  
• They are not facts
  
• They may or may not be true
  
• They may or may not be helpful to us
  
• We can choose which thoughts we hold on to and act upon and which we simply let go.
  

When people meditate they practice this technique of mindfulness – letting go of thoughts and simply watching them from a distance. The resources section in
Chapter 9
tells you where you can find out about mindfulness.

Tackle underlying negative beliefs

Earlier we looked at the way in which negative beliefs about ourselves, the world and other people can make us vulnerable to mental health problems such as depression or anxiety. Sometimes even when we recover from these difficulties, these underlying negative views still remain, just waiting to be re-activated when we face difficulties in our lives, so they can trip us up all over again. When you have recovered from a mental health problem and are feeling well, this can be an excellent time to work on altering some of these negative ways of viewing the world. Low self-esteem or lack of confidence can make us much more vulnerable to mood problems. Spend some time thinking about your beliefs about yourself. Then start to plan how you can test out those beliefs – perhaps using the behavioural experiment ideas discussed in
Chapter 4
. Allow yourself to recognize the good things about both you and your world. The more you build up a positive view of yourself, other people and the world in general, the less weight those negative beliefs will carry, reducing their chances of damaging your mood.

Look after your relationships

We all lead busy lives. It can be very difficult to prioritize our relationships with other people. However, research shows such relationships are really important in improving everyone’s mental health. If we try getting close to others only when we need them, we are likely to find that they’re unavailable. Spend time on a regular basis with the people who are important to you.

Get the balance right

Frequently, people with problems have very little balance in their lives. Think of the over-worked executive doing a 60 hour week, seldom seeing his family; the plumber so focused on keeping his business afloat that he never has time to slow down, relaxing with friends. Then there is the office-bound employee with no time for physical exercise or the exhausted mother with 3 small children who hasn’t had an adult conversation for what feels like months. Though these are stereotypes, nonetheless they’re often the kind of people who end up at their GP’s surgery with mental health problems. Take a look at your own life and daily routines. What’s important for you to build in if you are to keep yourself as mentally well as possible? What needs to change? Small changes which keep your life in balance can make all the difference to your mental health.

So, what could Agata from our case study earlier have done differently following her period of depression to have reduced the chances of it happening again? Agata’s done all the right things to help herself get over her depression. She’s worked on her thinking patterns, become less self-critical and started including things in her routine to lift her mood. She’s tested out some of her negative beliefs and gathered evidence that questioned her depressed view of herself and which helped her both feel and act in more positive, helpful ways.

However, she didn’t recognize how important it would be to keep these things going both when she was well and, particularly, during stressful times. Agata also didn’t deal with her underlying low self-esteem, leaving her still vulnerable to depression. Another factor is that she and her husband hadn’t discussed how to work together to prevent a relapse in her mood. Finally, she hadn’t really altered her view of her role in the relationship, not recognizing how important it is for her to feel good about her role as wife and mother, even though this doesn’t include increasing the family’s income. She certainly hasn’t taken onboard how much she does which otherwise the family would have to pay someone else to do.

The good news? It’s never too late. After this second period of depression, Agata learns from her relapse. She ensures she devises structures that will stand firm in both good and stressful times, and makes an agreement with her husband about this. She also works hard developing her self-esteem. Agata learns to recognize the good things she’s doing, begins to appreciate her contribution and spends time developing skills which she knows she does have, which she can feel good about. The result? Agata feels better about herself, and is better equipped to manage when the inevitable stresses of family life come along.

Most important of all, Agata gains strength from reminding herself of a phrase that helps her get through difficult times. Remember, if you too find yourself re-experiencing problems you thought you had completely overcome, then, like Agata, it’s worth reminding yourself of that same phrase:

This, too, will pass
.

9. What now? Further helpful resources

We hope that you’ve found this book useful and interesting. However, there are many other resources out there which can assist you even further in overcoming difficulties or making the life changes you would like to make. Most people benefit from multiple sources of help. This chapter contains our recommended resources for accessing additional help if you are facing anxiety, depression or other emotional problems. We have also included resources for people facing relationship difficulties or managing physical health conditions or chronic pain. The resources range from people in your immediate circle, to professional and voluntary services, to additional self-help alternatives. Most of these resources tell you about other sources of CBT help but we have included some that offer alternative types of help as well. Following on from this book, you may find it extremely helpful to explore the many other excellent books, websites, CDs and DVDs that are available.

What’s right for you?

Take a quick browse through the range of resources that follow. In the following table, write down the ones you are going to try. You might want to add additional resources you have discovered to the table, and even make notes of what you find when you try them out.

Family and friends

Almost everyone turns to friends or family for help from time to time, and we certainly encourage you to do so. Although your friends and family probably don’t have the expertise to do more than support and listen to you, this can be invaluable at stressful times. There are plenty of organizations providing support and information to your family and friends too, if they want to support you but aren’t sure how. Encourage them to find information from the sources suggested.

Avoid trying to make your loved ones feel responsible for your mental health. Doing so may jeopardize your relationship and is unlikely to help you in the end. You must take ownership of the task of dealing with your difficulties, getting better, maintaining improvements and coping with any relapse. Alternatively, do ask for professional help if you feel you can’t do this by yourself.

Finding professional help

There are many ways to access professional help for your difficulties. Many of the types of professionals mentioned here will offer CBT; some may offer different types of psychological therapy. We would recommend that before you start work with a professional you ensure that they are trained in those treatments that have a sound evidence base and are recommended by the National Institute of Clinical Excellence (NICE) for your condition. The NICE website at
www.nice.org.uk
will give you more information about this. It is always a good idea to inform yourself about the types of treatment you might find helpful. Don’t be afraid to ask for what you think you need – but do also be open to changing your mind if you are offered advice that a different approach would be best for you.

The National Health Service (NHS)

There is always the possibility that your anxiety, depression or other emotional difficulties are due to physical health problems. Your GP is the person to rule this out and then refer you on to the most appropriate mental health professional if necessary. It’s therefore normally a good idea to go to see your GP in the first instance.

Your GP is the first point of access to psychological services and will be able to assess your symptoms and advise you on services in your area. Services do vary from area to area in terms of the types of treatment provided, waiting times and the number of sessions which can be offered. Many GP surgeries have in-house counsellors who may work in a variety of ways, perhaps including CBT. Additionally, if you are over 18, in many areas of the UK your GP will have access to new services called IAPT services (IAPT stands for ‘Improving Access to Psychological Therapies’). See
www.iapt.nhs.uk
for more information. All IAPT services will offer CBT as one choice of treatment. If you are particularly interested in CBT you should let your GP know this.

Some IAPT services will allow you to self-refer. You can usually find these by searching the internet for IAPT services in your area. They will often also offer appointments outside of normal working hours in order to make help more accessible for working people.

If you are under 18 your GP will be able to refer to sources of help specifically for young people and their families.

If your GP feels your difficulties are somewhat more severe he may recommend that you are referred to a Community Mental Health Team (CMHT). These teams are generally made up of psychiatrists, psychiatric nurses, clinical psychologists, occupational therapists and social workers. They may also have some mental health support workers. Any of these professionals might be involved in your care. The clinical psychologists within these teams will often be able to provide CBT.

Clinical psychologists may also work in primary care in some areas. They have a doctoral qualification, for which they’ve undertaken extensive training in the understanding and treatment of mental health problems. They primarily utilize psychological therapy, which involves one-to-one or group sessions where you work together on overcoming your difficulties. For the best results, make sure your psychologist is familiar with scientifically validated therapies and if you are specifically interested in CBT then ask about this. If you particularly want to see a clinical psychologist then do ask your GP about this.

A word about medication – your GP may feel that you should try medication for your condition. They may also ask you to see a psychiatrist so as to get a more expert opinion on what medication might be right for you. Psychiatrists are doctors who specialize in illnesses of the mind rather than the body. They have extensive training in diagnosing and treating mental disorders. Most psychiatrists primarily use medication in treating these disorders and can help you to manage any side effects the medication may cause. Many people feel very worried about taking medication. However, we would recommend that you don’t automatically rule this out. Medication can be very helpful to people and can sometimes work well alongside psychological therapies (although this may not be true in the case of anxiety – see
Chapter 4
). We have talked about medication elsewhere in this book so do look at
Chapter 6
for more information about this. Your doctor will be able to discuss all your questions with you. There is also a wealth of information available on the internet but do be selective about what you read. The Royal College of Psychiatrists has some useful information on medication on their website at
www.rcpsych.ac.uk
.

Private healthcare

If you have private health insurance, this may include cover for psychological therapy. You may also choose to pay for private therapy yourself. Once again, it is often best to go through your GP but private medicine may offer a wider choice of specific therapists and of therapies, including complementary therapies. Insurance companies normally have a list of the practitioners they recognize. However, many therapists may not be on these lists but still be appropriately qualified. Various professional organizations have lists of qualified practitioners. If you are specifically interested in finding a CBT therapist then we would recommend you first look at the British Association for Behavioural and Cognitive Psychotherapies website at
www.babcp.com
. Other organizations which will have lists of qualified private therapists offering different forms of psychological therapy (sometimes including CBT) are the British Psychological Society at
www.bps.org.uk
, the UK Council for Psychotherapy at
www.psychotherapy.org.uk
or the British Association for Counselling and Psychotherapy at
www.bacp.co.uk
.

We strongly recommend that you find out about the qualifications of anyone you would like to see before making an appointment. Each professional organization’s website has a ‘practitioner search’ to help you. If someone is accredited by one of these professional bodies it means they have gained appropriate qualifications in their particular area of expertise. Any professional should be willing to discuss their qualifications and approach if you have questions for them.

Self-help books

Bookshops and libraries display a bewildering array of self-help books. It can be very difficult to know where to start! It’s important to be aware that quite a few of these books aren’t based on scientifically validated treatments. This doesn’t necessarily mean they won’t be helpful for you as an individual, but you are probably more likely to feel confident using a book that has a strong and clear evidence base. Below is a list of the books which we and our patients have found most useful. These books give solid help based on well-researched strategies for alleviating emotional distress. Most are based on CBT principles but some offer alternative approaches which we believe can work really well alongside CBT techniques. Some are quite new; some are older but still very relevant to people today. Obviously these aren’t the only good books out there but these are the ones we most frequently recommend.

Books by the authors

Overcoming Depression for Dummies
by Elaine Iljon Foreman, Laura L. Smith and Charles H. Elliott (Wiley, 2008).

Overcoming Anxiety for Dummies
by Elaine Iljon Foreman, Charles H. Elliott and Laura L. Smith (Wiley, 2008).

Anxiety and Depression Workbook for Dummies
by Elaine Iljon Foreman, Charles H. Elliott and Laura L. Smith (Wiley, 2009).

Fly Away Fear: Overcoming Fear of Flying
, by Elaine Iljon Foreman and Lucas Van Gerwen (Karnac, 2008).

Books on depression

CBT

Choosing to Live: How to Defeat Suicide through Cognitive Therapy
, by Thomas E. Ellis and Cory F. Newman (New Harbinger Publications Inc., 1996).

Cognitive Therapy of Depression
by Aaron T. Beck, A. John Rush, Brian F. Shaw, and Gary Emery (Guilford Press, 1987).

Overcoming Depression
by Paul Gilbert (Robinson, 2000).

Overcoming Low Self-Esteem
by Melanie Fennel (Robinson, 2009).

Overcoming Depression: A Five Areas Approach
by Chris Williams (Arnold, 2001).

Overcoming Depression One Step at a Time
by Michael E. Addis and Christopher R. Martell (New Harbinger Publications Inc., 2004).

Alternative approaches

The Mindful Way through Depression: Freeing Yourself From Chronic Unhappiness
by Mark Williams, John Teasdale, Zindel Segal and Jon Kabat-Zinn (Guilford Press, 2007).

Books on anxiety, phobias, panic and stress

CBT

Master Your Panic and Take Back Your Life!
by Denise Beckfield (Impact Publishers, 2000).

Mastery of Your Anxiety and Panic
by David Barlow and Michelle Craske (Oxford University Press, 2007).

Mastery of Your Anxiety and Worry
by Michelle Craske, David Barlow and Tracy O’Leary (The Psychological Corporation, 1992).

The Relaxation and Stress Reduction Workbook
by Martha Davis, Elizabeth Eshelman and Matthew McKay (MJF Books, 1995).

Overcoming Anxiety: A Five Areas Approach
by Chris Williams (Hodder Arnold, 2003).

Overcoming Anxiety Self-Help Course: A 3-Part Programme Based on Cognitive Behavioural Techniques
by Helen Kennerley (Robinson, 2006).

Overcoming Panic and Agoraphobia Self-Help Course: A Three Part Programme Based on Cognitive Behavioural Techniques
by Derrick Slove and Vijaya Manicavasagar (Robinson, 2006).

The Anxiety & Phobia Workbook
, by Edmund J. Bourne (New Harbinger Publications Inc., 2005).