Apps Which Help

mobilephone

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Since I can’t be with my clients 24/7, I usually suggest a few apps that they can put on their smart phones to use throughout the day. Here are a few of the ones that I suggest (unless otherwise stated, you can find them for both iPhone and Android):

1. Mindshift – an app which is useful for those suffering from anxiety issues. http://www.anxietybc.com/mobile-app (free)

2. Positive Discipline – for all your parenting needs. This app has a set of cards to help you think through possible parenting solutions.
http://www.positivediscipline.com/positive-discipline-iphone-app.html (not free)

3. Relax Melodies – great for when you need a bit of help falling asleep. You can set a timer for the soft sounds which is a bonus. (free)

4. Breathe2Relax – useful for learning to slow down your breathing
http://t2health.dcoe.mil/apps/breathe2relax (free)

5. Depression Check – helps you check the symptomology and whether they are getting better or worse. iPhone only.
https://itunes.apple.com/us/app/depressioncheck/id398170644?mt=8 (free)

6. Depression CBT Self-Help – an Android only app that gives you the CBT tools for depressive symptoms. Android only.
https://play.google.com/store/apps/details?id=com.excelatlife.depression&feature=search_result#?t=W251bGwsMSwxLDEsImNvbS5leGNlbGF0bGlmZS5kZXByZXNzaW9uIl0 (free)

7. Recovery Record – a useful app for those who are in recovery from an eating disorder or who are struggling with disordered eating/emotional eating. http://www.recoveryrecord.com (free)

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A little self-help

I’ll admit it.  I’m on a diet and have been since November.  But not a diet like one you might imagine.  I am not restricting myself to 1200 calories (far too low for most people).  I have no cut out carbs or sugar or fats.  It doesn’t have a ‘name’. I still drink beer & wine.  I eat chocolate.  And I love it.  My diet is one that I can follow for life.  I don’t feel deprived, don’t feel like binging and I’m losing weight, albeit slowly.  Very slowly.  In our world of fast movement and lack of patience, my diet has been one that has tested my resolve.  BUT, I’m seeing results.  Yay!  If you want to do something similar to me, then here are the resources I’m using:

  • MyFitnessPal -(MFP)  this is a website where you can post your food input and figure out if you are eating the right ‘macros’ (amounts of certain food elements, such as protein).  I’m focusing on eating under my calories and eating enough protein to protect my muscles.  What I like about it is that you can manipulate the numbers to your own needs.  I do NOT go by their numbers as they tend to give people too low calorie needs.  Most people also try to lose 2lb a week which is FAR TOO QUICK (unless you are about 100 lb overweight).  I also LOVE the forums.
  • Scooby Workshop – I use the TDEE method of losing/maintaining weight.  In this method, you figure out how many calories to eat daily based on your activity level.  I use an activity level of moderately active (between 3-5 hrs) as I lift 3x a week, run 2x a week, have a 2 hr field hockey practice, play 1x a week and walk a lot.  It is suggested that you do a deficit of between 15-20% – you’ll be better able to maintain your lean muscle mass (a good thing).  I do a 10% deficit as I’m close to my goal weight.  It’s suggested that the closer you get to your goal weight, the less you try to lose per week.  What’s good about doing this method is that you learn how to eat the way you should for life.
  • Eat More to Weigh Less  – I spent my teens and 20s doing crash diets and restrictive diets.  I was not healthy.  I was skinny but had a much higher body fat percentage as I had lost a lot of my lean body muscle.  I wish that this website has existed back then (well, actually the internet didn’t really exist to the same extent).  I’ve learned so much about how to eat at a healthier level, do the right things for my body and get the support I need.  They also have a group on the MFP website.
  • Stronglifts 5×5 – I have always done a bit of weight lifting.  But I used to use machines as they felt more ‘comfortable’.  They helped but I wasn’t seeing the gains I had hoped for.  And then I was introduced to the Stronglifts programme.  It’s changing my body.  It’s early days but I can see the muscles below my body fat.  And my body fat is starting to come off even though I’m eating around maintenance.  I’d rather get tighter, stronger and stay the same weight.  NO, I’m not getting bulky – while I do have a genetic gift to gain muscle more than many women (more testosterone I believe), I’m not getting big – I’d have to take drugs to do that.  It takes guys, who have a lot more testosterone years to build muscles naturally.  So lift weights!  Lift BIG weights and you’ll never regret it!

If you are an emotional eater like many of us (yup, I’ve been there), then I would love to share with you a few worksheets that have helped my clients and myself with all those negative thoughts that seem to come into our mind (and which we might not even recognise may change how we feel and behave):

http://www.getselfhelp.co.uk/docs/ThoughtRecordSheet7.pdf 

http://www.getselfhelp.co.uk/docs/ABC.pdf 

http://www.getselfhelp.co.uk/docs/CravingsDiary.pdf 

http://www.getselfhelp.co.uk/docs/FoodDiary.pdf 

http://www.getselfhelp.co.uk/docs/CriticalVoiceTRS.pdf

No one worksheet is going to be the end all. If things are really bad, I’d suggest seeing a therapist, particularly one who uses CBT. But it’s a good start!

Comfort Eating

Like many women, I’ve struggled with issues around food in my past.  It’s a tough thing because we need food to survive, but at the same time, we get so many conflicting messages around it from society, our families and media.  A lot of times, food has been used as comfort as a child – even doctors would sometimes give me a sweet treat (lolly) when I was given a shot and upset.  And if you had a bad day at school? Out would come the cookies.  Having spoken to many women about this, with similar stories, it’s no wonder that we may come to equate food with dealing with our emotions.  And note, this isn’t just a problem for women.  Many men also bury their emotions and choose food as their ‘weapon of choice’.

But, this can become a problem, particularly if you start to use food all the time instead of dealing with your emotions.  Overeating can lead to a bad cycle:  feel a “bad” emotion – eat food – feel badly about overeating or eating something that you have labelled as ‘bad’ – eat more, etc, etc, etc.  Instead of facing the emotion, you may end up gaining weight and feeling worse and worse.

So, how do you get out of the cycle.  Here are a few tips from Dr. Sonia Greenidge as reported by Psychologies in their Feb 2014 issue:

1.  Before you eat something, ask yourself if you are truly hungry or if you are upset about something.  Physical hunger is felt in the stomach, while emotional hunger is usually felt in the mouth, with specific cravings.  Rate your hunger level from 1 (very hungry) to 10 (very full).  If you are below a 5, then it may mean that you are dealing with physical hunger…otherwise, it may just be emotional hunger.

2.  If you are emotionally hungry, sit with the emotions.  What is going on for you right now?  What are your feelings?  Your thoughts?  Your bodily reactions?  Do you have any images in your mind that relate to that feeling?  Accept the feelings.  You can also write them down and see if the thoughts you have are helpful or not.  Use a thought record and see if you can come up with a more helpful thought.

3. Figure out what triggers your emotional eating.  For me, it was around boredom and feeling out of control.  I would begin to focus on my negative thoughts and just want to bury them.  But once I began to recognise the triggers, I also could stop the thoughts and grab a water or do something instead.

4. Challenge your typical behaviours by placing reminders around to question what is going on.  One idea is to place the question, What am I feeling?, on your fridge.  Think about short-term gains versus long-term aims.

If you feel that you are overwhelmed by all of this, seek out some support.  A CBT therapist, like me, can be really useful in figuring it all out and getting at the root of why you feel the way you do.  Or join a group, like Overeaters Anonymous.

It’s a long journey sometimes to figuring out what’s going on with you and food.  You can do it.  You are worth it.  Yes, you truly can do it.

My comfort food of choice

The Power of Finding Positives About Yourself

When working with a client using CBT, one of the things we try to do is understand the person’s core belief(s).  Core beliefs are the very essence of how we see ourselves, the world and the future.  These tend to develop over time through our experiences.  They are strongly held, rigid and inflexible.  We tend to maintain them by focusing on information that supports the belief and filtering out that which doesn’t.

Here is an example:  Jane has grown up with the core belief of, “I am unlovable.”  Jane really focuses on those moments when she feels unlovable, like when her flatmate says something about how Jane forgot to do the dishes, but doesn’t pay attention to the fact that the flatmate also said that Jane did a great job of cleaning the bathroom.

In CBT, we try to figure out what the core belief is, what is maintaining it and feeding it, and then work to change the self-belief.  One of the ways we do this is to come up with a new core belief that the client would like to have.  So in Jane’s situation, she might come up with a new core belief of “I am lovable.”  Because her view of the world and others is so skewed toward the negative, we have to start having her find positive evidence about this belief.  It’s not easy, but it’s doable.  One way of doing this is to use a Positive Personal Qualities worksheet.

As you can see, you are looking for situations where positive things about the person have happened.  We tend to start in the sessions as people will filter out info, so that they can practice seeing themselves in a positive light.   Over time, as you filter out the negative and focus on the positive, you will eventually start to develop a new core belief.  There is power in finding positives!

Using Thought Records

One of the most useful tools in CBT is a thought record. Why would this be helpful? In CBT, the belief is that thoughts, feelings/emotions, behaviours and physical symptomology are all tied together and influence each other:

Unhelpful thoughts can trigger unhelpful behaviours, emotions and physical symptoms. So if you change those unhelpful thoughts (sometimes called irrational thoughts), you will end up changing your emotions, behaviours and physical symptoms.

In the beginning of CBT, most therapists will ask a client to fill out a simple thought record. Here’s an example:

By filling this out, the therapist will get to have an idea of what unhelpful thoughts a client has.  Then in session, they may begin to work with these thoughts and see if there are more helpful alternatives.  Here’s an example of an unhelpful thought that I had the other day (because, honestly, we all have them…but they may not be so bad or so numerous as to influence our mental state): “I am so clumsy.” It was not helpful as it didn’t add anything to my life but it made me feel slightly less good about myself. I had tripped and the thought came to mind. It wasn’t a huge deal as it was just one random thought and after I thought it, I countered it with something else (which I can’t remember, but was probably something along the lines of ‘yup, and that’s okay cause you’re still good at sports’.)

As the client gets practiced at it in session, the client will then be asked to fill out a more intensive form and do the work on their own, trying to find evidence for and against the thought, and then coming up with a more helpful thought.

Even if you are not doing CBT with a therapist, you can use these forms to help yourself. There are several self-help websites, but the one that I’ve found most helpful is http://www.get.gg/. If you are really struggling, I would seek out a professional to help you with your issue. But if the problem seems to have just begun or you are in a long wait for a therapist, you could use these resources to start looking at how your thinking might be influencing your life in a not so great way. Another fabulous resource is a book called “Mind Over Mood” by Greenberger & Padesky. It’s a book that I’ve suggested to clients who I can only see for a few sessions so they can continue to work on their issues on their own.

Oxford

As you might recall, I’ve joined a postgraduate programme in CBT at Oxford, in order to become a more skilled therapist.  It’s been fascinating and I’m learning a LOT.

One of the things about the learning process that you don’t really think about before going into it is that you have to lose your ego.  I’ve seen myself as a good counsellor for a few years and yet in this programme, I’m learning that I have a long way to go before I truly am as good as I’d like to be (in a CBT practitioner way).  The feedback on my first recording I turned in was positive, but there are things to focus on.

The first thing I’ve been asked to focus on is to become less directive.  In CBT, one must be collaborative with the client so that they can learn and discover on their own.  I have a tendency to try to bring things out and so direct.  After learning about this, I’ve caught myself a few times.  It’s a difficult habit to break and I think it will take a couple of months to really do it justice.  I see the point but undoing past learning is hard.

The second thing I have to focus on is really sharing what we call the formulation with the client.  A formulation is the blueprint of therapy.  It helps guide you and your client in their work.  A formulation allows you to take the information you gather and put it into a more concise pattern or drawing, which you share with your client.  Within the formulation, you put the historical data, critical events, the beliefs a person might have (if…then statements), the current situation, what happens during that situation and how you are stuck/what maintains your thought patterns.  As you share this info, you are more able to help them understand inappropriate (for now) thought patterns and behaviours…and thus make changes.

All of this is a challenge and new to me.  But I’m trying to let go of the sense that I should be better (“should’s” being a bad thing) and allow the process to happen.  I’ll get there in the end!  It’s a good lesson for all of us – you are not going to do something the first time perfectly and that’s okay.  And, in fact, you should hope that you will never be perfect, as that means you no longer have the cool opportunity to become better and learn more!

Can cognitive behavioural therapy really change our brains?

The BBC website recently posted an article about the above title. It’s a good article about CBT so I thought I’d share it below.

What is cognitive behavioural therapy?
CBT is based on the idea that problems aren’t caused by situations themselves, but by how we interpret them in our thoughts. These can then affect our feelings and actions.

Situation affects thoughts, which then affect feelings and actions The way we think about a situation can affect how we feel and how we act
For example, if someone you know walks by without saying hello, what’s your reaction?

You might think that they ignored you because they don’t like you, which might make you feel rejected. So you might be tempted to avoid them the next time you meet. This could breed more bad feeling between you both and more “rejections”, until eventually you believe that you must be unlikeable. If this happened with enough people, you could start to withdraw socially.

But how well did you interpret the situation in the first place?

Common errors in thinking style
Emotional reasoning – e.g. I feel guilty so I must be guilty
Jumping to conclusions – e.g. if I go into work when I’m feeling low, I’ll only feel worse
All-or-nothing thinking – e.g. if I’ve not done it perfectly, then it’s absolutely useless
Mental filtering – e.g. noticing my failures more than my successes
Over generalising – e.g. nothing ever goes well in my life
Labelling – e.g. I’m a loser

CBT aims to break negative vicious cycles by identifying unhelpful ways of reacting that creep into our thinking.

“Emotional reasoning is a very common error in people’s thinking,” explains Dr Jennifer Wild, Consultant Clinical Psychologist from Kings College London. “That’s when you think something must be true because of how you feel.”

CBT tries to replace these negative thinking styles with more useful or realistic ones.

This can be a challenge for people with mental health disorders, as their thinking styles can be well-established.

How do we break negative thinking styles?
Some psychological theories suggest that we learn these negative thinking patterns through a process called negative reinforcement.

Spider Graded exposure can help people confront their phobias:
For example, if you have a fear of spiders, by avoiding them you learn that your anxiety levels can be reduced. So you’re rewarded in the short term with less anxiety but this reinforces the fear.

To unlearn these patterns, people with phobias and anxiety disorders often use a CBT technique called graded exposure. By gradually confronting what frightens them and observing that nothing bad actually happens, it’s possible to slowly retrain their brains to not fear it.

How does cognitive behavioural therapy work on the brain?
Primitive survival instincts like fear are processed in a part of the brain called the limbic system. This includes the amygdala, a region that processes emotion, and the hippocampus, a region involved in reliving traumatic memories.

“It seems that CBT really can change your brain and rewire it.”
Dr Paul Blenkiron, Consultant Psychiatrist

Brain scan studies have shown that overactivity in these two regions returns to normal after a course of CBT in people with phobias. What’s more, studies have found that CBT can also change the prefrontal cortex, the part of the brain responsible for higher-level thinking. So it seems that CBT might be able to make real, physical changes to both our “emotional brain” (instincts) and our “logical brain” (thoughts). Intriguingly, similar patterns of brain changes have been seen with CBT and with drug treatments, suggesting that psychotherapies and medications might work on the brain in parallel ways.

How effective is cognitive behavioural therapy?
Of all the talking therapies, CBT has the most clinical evidence to show that it works. Studies have shown that it is at least as effective as medication for many types of depression and anxiety disorders. But unlike many drugs, there are few side effects with CBT. After a relatively short course, people have often described long-lasting benefits.

“In the trials we’ve run with post-traumatic stress disorder [PTSD] and social anxiety disorder, we’ve seen that even when people stop the therapy, they continue improving because they have new tools in place and they’ve made behavioural and thinking style changes,” Dr Wild explains.

CBT may not be for everyone, however. Since the focus is on tackling the here and now, people with more complicated roots to their mental problems which could stem from their childhood, for example, may need another type of longer-term therapy to explore this. CBT also relies on commitment from the individual, including “homework” between therapy sessions. It can also involve confronting fears and anxieties, and this isn’t always easy to do. Ultimately, as with many types of treatment, some people will benefit from CBT more than others and psychologists and neuroscientists are beginning to unravel the reasons behind this.

5: Nurture Social Relationships

When I was in high school, I had a small group of friends. I was not popular by any means, but I had my group. They were definitely the saviours of my high school experience, as without them, I would have been dreadfully unhappy. One friend had been with me since age 7 and we just ‘got’ each other.

Having many friends is not so important to happiness as is having at least one person who understands you at a deep level. It’s not surprising that studies have found a relationship between loneliness and depression.

As we get older and are less likely to see our friends on a regular basis (school was great for that, wasn’t it), we have to work harder and harder to nuture social relationships. Technology has both helped and hindered us in this – email, Facebook, Skype, all can be used positively and negatively in maintaining friendships. The best thing one can do is schedule a time when nothing else is going on to connect to that special someone.

Anxiety & Stress

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Life can get overwhelming. Many of us have so much to juggle. And we begin to see these things as stressful or anxiety producing. Anxiety and stress can be tough to deal with, and can even be debilitating. Much of my work centres around helping people to deal with stress and anxiety.

What is stress? What is anxiety? According to the American Psychological Association, stress an uncomfortable emotional experience that comes with a physiological reaction and may lead to cognitive and behavioural changes. Anxiety is an emotion which brings about feelings of tension, bodily changes and worried cognitions.

So, how do I help people deal with stress and anxiety? In several ways, all of which include changing both body and mind reactions. The most important thing to note is that your body cannot physiologically experience stress/anxiety and relaxation at the same time, and your mind cannot hold both stress/anxiety producing thoughts as well as relaxing ones at the same time, so we work to change both. Here’s a few things that you can do to work with your stressors:

1. Deep breathing. Stress and anxiety bring about changes in your body. You may experience nausea or those butterflies in your stomach. Your heartrate will typically increase. The muscles in your neck and shoulders may tighten. And your breathing gets faster. Deep breathing is an important aspect to stress relief. Now, many people try to train you to breathe a certain way – personlly, I can’t breathe easily through my nose so I just do mouth breathing, and that’s fine. But the one thing I would encourage you to do is to breathe from your diaphram. To do this, put your hand on your tummy and breathe. You should feel your stomach going up and down rather than your chest. This is the best deep breathing you can do. It will calm down your systems and many of the symptomology will go away with time.

2. Do a visualisation. I’ve used the same visualisation with students for a long time. It can be brief or you can take your time with it. Many like to have calming music in the background, and I’ve found multiple youtube videos which have hours of music to use. Here’s my favourite visualisation: Take deep breathes and every time you inhale imagine a calming colour going into your body. Each time you exhale imagine a stressful colour leaving your body. Continue with the deep breathing until you feel that only the calming colour is left. I like to imagine the stressed out coloured air is going into a balloon and then I let it go in the end.

There’s a lot more you can do to relieve stress and anxiety. I’ll continue to talk about this as I ‘blog away’. But these are a good start.

Cognitive-Behavioural Therapy

I’m a member of the British Association for Behavioural and Cognitive Psychotherapies, and am hoping to eventually get accredited by them. So, what is CBT? According to the BABCP, CBT is a talking therapy. It has been proven to help treat a wide range of emotional and physical health conditions in adults, young people and children. CBT looks at how we think about a situation and how this affects the way we act. In turn our actions can affect how we think and feel. The therapist and client work together in changing the client’s behaviours, or their thinking patterns, or both of these.

CBT has been proven to help dramatically with depression, and I’ve used it in my own work with anxiety. There are a variety of other mental illnesses that respond well to CBT. So how does it work? CBT can be offered in individual sessions with a therapist or as part of a group. The number of CBT sessions you need depends on the difficulty you need help with. Often this will be between five and 20 weekly sessions lasting between 30 and 60 minutes each. CBT is mainly concerned with how you think and act now, instead of looking at and getting help with difficulties in your past.

You and your therapist will discuss your specific difficulties and set goals for you to achieve. CBT is not a quick fix. It involves hard work during and between sessions. Your therapist will not tell you what to do. Instead they will help you decide what difficulties you want to work on in order to help you improve your situation. Your therapist will be able to advise you on how to continue using CBT techniques in your daily life after your treatment ends.