CBT Newsletter December 2011

1CBT in the City Ltd Registered company in UK:6709268. CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited

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CBT made a difference for his problem with Body Dysmorphic Disorder by Trent

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Striving for Slumber-How to get the zZzz

Andy and how he worked hard to overcome his sleeping problem


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Contents

Wishing you a Merry ChristmasMatt Broadway-Horner P3

What is REBT? This being one of the older approaches developed with the CBT tradition and is it still relevant?Matt Broadway-Horner

STRIVING FOR SLUMBERPhoebe Doyle P6 Testimonial on his battle with Insomnia Andy P8

Case 2 Testimonial on her battle with Insomnia Natalie P8

CBT made a difference! Body Dysmorphic DisorderTrent P9

2011 CBT in the City Ltd Registered company in UK:6709268.

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all at the clinic wishesyou a merry christmasfrom Matt and the team

Well its that time of year and what a year it has been. I have enjoyed opportunities to teach, supervise and treat individuals. This is growing over time and it is our hope that we can help many more individuals to find recovery and an increased quality of life. In order to do this I now have the pleasure to announce a clinic operating in Essex and in Norwich. 2 Cognitive Behaviour Therapists in each location. My hope is that we will be able to treat many more individuals using the

various levels of service. All referrals will be processed through head office: 10 Harley Street, London W1G 9PF and then processed through to the identified location. I wish you all a Merry Christmas and a happy new year.

Remember the season mixed in with a little bit of flexibility, forgiveness, warmth, acceptance, tolerance, and a whole lot of fun can help you enjoy the season and it might be more improved than planning/controlling the festivities.

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what is insomnia?a sleeping diagnosisBy Matt Broadway-Horner

Insomnia is defined as difficulty initiating sleep, maintaining sleep, awakening in the morning that occur much earlier than desired or sleep that is not able to be regained and is of poor quality and result in impairment in daytime function. However there is hope, there are many treatments options for

insomnia including: behavioral therapy, non-pharmacological interventions such as relaxation therapy, biofeedback, exercise, dietary changes,phototherapy and medications

The sleep routine can be resumed with some hard work, the rewards are many and life can feel very normal again with intervention sort sooner rather than later.

what is rational emotive behaviour therapy?an approach within the cbt traditionBy Matt Broadway-Horner

REBT until recently was previously named Rational Therapy and Rational Emotive Therapy with the field of practicing Cognitive Behaviour Therapy (CBT). It is the practice of comprehensive, active-directive, philosophy and an empirically based psychotherapy which does focus on resolving personal emotional and behavioural problems and disturbances thus enabling the patient to proceed toward and happier more fulfilling lifestyle.

One of the core fundamentals of REBT is that many people and human beings in general do not get stressed and upset with regards to unfortunate adversities but its how they conduct their mind and views of reality via their language, evaluation beliefs, meaning and philosophies about the world and people other than themselves that creates the disturbance.

A popular REBT framework thus assumes that people have both an innate rational (meaning, self- and social-helping and constructive thoughts) and irrational (meaning, self- and social-defeating and unhelpful thoughts) tendencies and leanings. It is the skill of the therapist that helps point the individual to this self help.

REBT may be used for the treatment of anger, addiction (and

withdrawal), anxiety, avoidance, hurt, guilt or shame, self-blame, self-pity, depression and for repetitive behaviours and behaviour tendencies like procrastination, over-compulsiveness. So an example may go like the man who felt rejected and then he demanded that he must not be rejected for if he was then this will mean that he is useless and then feel Anxious/Hurt and along with this emotional consequence are the behaviours of rumination, avoidance to engage in the act of dating or indeed the build up. The thinking consequences are that ‘I am no good’ ‘no one will like me’. Here the attitude is very much one that

demanding thinking places pressure on self that the natural process of selection in dating only goes one way and it will be awful if another outcome takes place. If this type of thinking continues then this could lead to a reduction in lifestyle and feeling stuck to carry out his Valued Direction of wanting to be remembered as a man who wants to love and be loved by someone special. The Value if not being met will then lead the man to not only feel Anxious but Depressed about what he has lost

For more information regarding REBT please contact us for more [email protected]

‘So an example may go like the man who felt rejected and then he demanded that he must not be rejected for if he was then this will mean that he is useless and then feel Anxious/Hurt’

Matt Broadway-Horner

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http://www.cbtinthecity.com/cbt-clinics-london.html

mailto:[email protected]

mailto:[email protected]


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Research consistently concludes that a lack of sleep can have a detrimental effect on our health and overall well-being. Phoebe Doyle looks at ways to help our sleep deprived bodies and our stressed out souls.

Worries about family and work are apparently the aspects of our lives most likely to keep us anxiously awake into the early hours. “Sleep is one of the first things affected by any form of psychological problem, such as stress, depression or anxiety. As all three are increasingly widespread, it’s no surprise our sleep is suffering”, says Dan Roberts (www.danroberts.com) of The Wellbeing Coach. He explains just how sleep becomes disturbed; “when people are stressed they often find both the length and quality of sleep is affected. Because your system is over-revved by stress hormones including cortisol and adrenaline, your mind races as you lie there, tossing and turning.”

“Now approximately 10-15% of us, suffer with our sleep”, says Matt Broadway-Horner a Cognitive Behavioural Therapist from CBT In The City (www.cbtinthecity.com) , and what’s more this problem is more common in women than men. Matt says; “half of sufferers report severe symptoms occurring nightly; they take 2 hours or more to fall asleep initially and 1 hour or more waking during the night.”

Quantity and QualitySo how much sleep do we need? Really, the answer is that

you need enough sleep to feel like you can get through your everyday life! Chris Idzikowski, Director of the Edinburgh Sleep Centre insists; “we actually need as much as we think we need. Anywhere between 5.5-9.5 hours is fine. More or less may still not be much of a problem. Some people are short sleepers - if you feel sleepy, tired or unwell during the day after a short sleep then you're not a short sleeper!” Most adults claim to get between 5 and 10 hours each night and generally people start sleeping less as they get older.

When sleep is broken, it reduces the quality; “when people are stressed they often wake up and worry in the middle of the night – that awful 3am thinking when everything seems far worse than it really is – then they can’t get back to sleep. Bad dreams and nightmares, and non-restful sleep (where you wake up still feeling exhausted) are also common stress-related symptoms”, says Dan.

How Can We Switch Off – Top Tips for a Good Nights Kip

Whilst sleeping tablets are often prescribed for severe insomnia they can have pretty unpleasant side effects, such as confusion, forgetfulness and feeling lousy the following day. In fact some report feeling worse than if they’d not slept at all! Sleeping pills and sleep medications should be used only for short-term situations, and sparingly at that. Their effects are short-lived and so when used to treat long-term sleep issues there are serious concerns.

Thankfully though, there are many less intrusive methods to explore:

Don’t let your bedroom become your office – working on a computer in your room, or stressing over files is not conducive in the creation of an atmosphere fit for sleep. Matt says a client of his did just this; “she had to work hard to change her associations in the bedroom from working with document papers and her computer to a place fit for the purpose of sleep” Matt explains. Dan is keen for us to remove all technology; “only use your bedroom for sleeping and sex. No TVs; no laptops/smartphones in bed; keep your room cool and as dark as possible, with no ambient light and get as good a bed as you can afford, especially if you have back trouble (a common cause of insomnia).”

Try it tonightBan the box! Remove all TVs and laptops, remember

bedrooms are for beds! Good quality, fresh bed linen can help make sleep more inviting too. So treat yourself and splash out!

Get yourself into a routine – try to go to bed at the same time each night and get up at the same time too, and yes I’m afraid this means even on weekends. If you have a bad night resist the urge to sleep in the day as this will upset the routine. Chris says, “It’s probably not a good idea for poor sleepers to nap during the day. However, there is also evidence to show that good sleepers - are precisely that, they can have a nap during the day without much effect the following night.” Chris believes the key’s in training your biological clock; “the clock provides a window of opportunity each night for sleep to occur. A regular routine - going to bed and getting up at the same time helps keep the 'biological clock' running to a good schedule.”

Try it tonightGive yourself a bedtime! Don’t make it too early though, if

you aren’t tired enough to sleep you may lie awake feeling anxious.

Have a warm shower or bath – a hot bath will raise your body temperature but it’s the drop in temperature that follows this which should help you to snooze. Dan firmly believes in the power of; “a long hot bath before sleep”, it serves to relax you as well as to prepare your body temperature. Chris explains the biology at play; “your body’s natural rhythm means that your body temperature should go down late evening and during the early part of the night. One of the reasons this happens is because the blood vessels in the hands and feet, and also the face, open up to release heat. If the vessels are too constricted by cold then this may not happen. A warm bath helps to open up the blood vessels.”

Try it tonightHave a warm bath about an hour before bedtime; try

adding some sleep enhancing oils, lavender is a popular choice. Enjoy it; read a book, have some ‘you’ time.

STRIVING FOR SLUMBER.a sleeping problemBy Phoebe Doyle

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http://www.danroberts.com/

http://www.danroberts.com/

http://www.cbtinthecity.com/

http://www.cbtinthecity.com/


Don’t just lie there- if you’ve been awake for 20 minutes or more Dan recommends; “if you can’t sleep, try ‘mindfulness meditation’ – this will calm you down and has a host of health benefits. Lie on your back with your eyes closed and bring your attention to your breath as it flows in and out of your nostrils. If the mind wanders, gently bring your attention back to the breath. Do this for 10min or more and you should feel calmer, more relaxed and hopefully fall asleep!”

Try it tonightRefuse to think about anything that is stressful. Worrying

about endless paper work? Tell yourself “that’s not a thought for now” and go back to your breathing exercise. In truth, nobody reaches any sensible conclusions in the early hours anyway!

Learn to say “no” – it’s vital to stay clear of caffeine and alcohol for the 4 hours leading up to bedtime if you’re having difficulty with sleep; caffeine blocks a sleep inducing chemical (called adenosine) and alcohol may leave you snoring or desperate for the loo! Dan recommends; “no caffeinated drinks after 6pm, alcohol in moderation if at all when you’re suffering from sleeplessness, and no heavy meals close to bedtime.”

Try it tonightCamomile Tea is fantastically calming. Have a cup about

an hour before bedtime. If you aren’t a herbal tea fan, remember that old adage of warm milk before bed helping you sleep? Give it a whirl! It can relax you as well as filling you up so that you won’t get any unwanted midnight hunger pangs!

Exercise – being active can really help you sleep as it should quash feelings of restlessness. Dan explains; “both cardiovascular exercise like running, spin classes, cycling or raquet sports and calming, meditative exercise like yoga or tai chi are powerful tools to combat sleep problems. The CV exercise burns off those stress hormones, makes you healthily tired and boosts your overall wellbeing, this makes you less stressed/anxious and so aids restful sleep.

“Calming exercise deactivates your stress response and activates your relaxation response. But no vigorous exercise too close to bedtime or it will keep you awake.”

Try it todayExercising in the morning is the best time in so many ways;

you get it over with, you’ll feel ready to face the challenges of the day, and it won’t interfere with sleep. Seek out a gym that opens at 6am (some even start classes then) to ensure your schedule isn’t dictated by their opening hours!

A decent night’s kip is made up of the following elements…

Drowsiness: here you are in a relaxed state although still not fully asleep. This stage can last for 10-15 minutes.

Light Sleep: During light sleep the eye movements stop, heart rate decreases, and our body temperature goes down.

Deep Sleep: It’s during the deep sleep stage that your body releases a growth hormone for mental and physical cell repairs.

REM (Rapid Eye Movement) Sleep: During REM sleep, eye movement’s increase as does heart rate. During REM sleep we have our dreams.

Yoga teacher Fenella Lindsell believes simple Yoga exercises can help you to drift off…

Fenella tells us; “Space Breathing can be a very effective way of clearing the mind of thoughts and allowing the body to feel relaxed and calm. It’s a very productive way of preparing the body for sleep and de-cluttering the mind of thought and is equally valuable if you wake up in the middle of the night and find it difficult to get back to sleep. This is how you do it…

Breathe in and breathe out, count 1,Breathe in and breathe out, count 1,2Breathe in and breathe out, count 1,2,3Breathe in and breathe out, count 1,2,3, 4 until you have a

space between the breaths of 10 counts and then return to normal breathing.”

‘Don’t just lie there- if you’ve been awake for 20 minutes or more Dan recommends; “if you can’t sleep, try ‘mindfulness meditation’

Phoebe Doyle

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Sleeping ProblemCase 1 :AndyTreated by Matt Broadway-Horner

34 yr old white male working in the City for a major Finance company who has been suffering from Insomnia for the last year. He could not understand why he was having this problem as he had tried all the know remedies like hot milk, at bedtime etc but the sleep disturbance continued to a point that he then felt Depressed for the last month and then presented to the GP January 2010. He was seen for individual Cognitive Behaviour Therapy for 4 months to treat the Depression initially and then go on to treating the Insomnia. In sessions he could begin to see how the Automatic Negative Thoughts (ANTs) and attitudes about his work were fear related and the continuing low security of his position at work had contributed to his high stress levels to a point where he was heavily preoccupied just before going to bed. He became Depressed as a result of continued bad sleep - Insomnia

His attitude was one of “I must work harder and if I don’t then I am a failure”, which he told himself many times over through out the last year. When he was not able to reach his ever increasing demands on himself he then experienced a chipping away of his confidence. This then would lead to his attention being biased to start finding evidence for his failures and then using these ideas to beat himself up over and over. His colleagues also worked hard around him and so he did not see that his ANTs and attitudes were a contributing factor to his sleep problem and so did not seek help sooner. He thought to himself “Just pull yourself together man!”At times he felt so low that “I considered ending my life sometimes” as the fatigue was too much to cope with at times. He viewed his problem as a failure that no one else can see and this rule he lived by til he saw the GP.

In the treatment sessions Andy worked hard to change his associations in the bedroom from working with document papers/computer etc to a place fit for the purpose of sleep and sex. Sleep restriction was used to address his imbalance time spent in bed. He would go to bed at 12am then lie awake for 2 hours til he slept. For effective treatment it was necessary to go to bed later to reduce time brooding on “why can I not sleep” along with Attentional Training exercises on his breathing and also looked at the ANTs and attitudes to find alternative helpful thoughts and attitudes which did have a knock good effect on his sleep reducing the Insomnia.

The treatment package has other aspects to it which then after 8 sessions of CBT for Insomnia brought about a change that he was happy about.

“I now feel more human and able to live life with more energy and vitality. I learned a lot about myself and could see how the way I was thinking was creating my problem”

Docs call it InsomniaCase 2 NatalieTreated by Matt Broadway-Horner

44 yr old white woman Natalie who works in the City for a big finance company presented to GP after persistent problem with Insomnia for the last 6 months and again she had tried the known remedies but to little or no effect.

Her attitude was one of “I must work harder not enough time in the day and if I don’t then I am a failure”, which she told herself many times over through out the 6 months. This then would lead to her attention being biased to start finding evidence for what she had not done and start to feel a failure and then using these ideas to beat herself up. Again like with Andy she tried to ignore the problem and thought it would go away. She thought if I can make it another day but then due to a lack of sleep she began to feel low in mood

In the treatment sessions Natalie worked hard to change her associations in the bedroom from working with document papers/computer etc to a place fit for the purpose of sleep and sex. Sleep restriction was used to address her imbalance time spent in bed. She would go to bed at 11am then lie awake for 4 hours tossing and turning til she slept. For effective treatment it was necessary to go to bed later to reduce time brooding on “why can I not sleep” along with Attentional Training exercises on her breathing and also looked at the ANTs and attitudes to find alternative helpful thoughts and attitudes which did have a knock good effect on her sleep reducing the Insomnia. The treatment package has other aspects to it which then after 5 sessions of CBT for Insomnia brought about a change that she was happy about.

“I now feel more like my old self with a slight tweaking to reduce the demanding attitudes that I have a propensity fall into- I should continue to overcome it!”

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cognitive behaviour therapy made a differencebody dysmorphic disorderBy Trent

The problem was Body Dysmorphic Disorder which manifested itself with a preoccupation with my nose. This led to being heavily preoccupied to a point that I would reduce my contact with others, losing friendships and being constantly off work and calling in sick. I feared that others were looking at me and ridiculing me which brought back memories from my childhood where I was bullied for looking different. Through CBT I now understand that my experiences of being bullied coloured my view of things and that through my prejudiced glasses I was always seeing the negative which led to problems with my relationships with others.

I worked hard to address my attentional focus away from my looks and see the bigger picture. It helped when I did CBT on the bullying using Imagery and Re-scripting which aided my recovery to a point where now I am fully at work and I have not used a sick day in 1 year. I now know that others do want to get to know me and I am enjoying myself. CBT is a practical and supportive therapy which does bring about improvement. I just want to thank my therapist for working with me.

CBTMONTHLY10 Harley Street London W1G 9PF

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CBT monthly-The EditorCBT in the City Clinics10 Harley StreetLondon W1G 9PF

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CBT Newsletter December 2011

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