Total 43 News Articles

  • 31 Dec
    eWellness Expert

    what is cognitive behaviour therapy?

    cognitive behaviour therapy

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    If you or someone you care about experience an emotional problem it won’t be long before you hear that cognitive behaviour therapy, or CBT, is probably the treatment of choice.

    Research over the last 40 years or so has found CBT to be helpful for all manner of problems, including anxiety, depression, insomnia, pain, anger, sexual problems, and the list goes on. But what exactly is it?

    CBT is probably best understood by what it is trying to achieve. The main premise of CBT is that problems develop as a consequence of learnt ways of thinking (cognition) and behaving, and that learning new ways of thinking and behaving will have more helpful impacts on emotions and well-being.

    Cognition: the C in CBT

    The cognitive element of CBT refers to our thoughts, mental images, self-talk and core beliefs about ourselves (I’m ok, or I’m not), other people (they are generally friendly or they’re not) and the world around us (the future is bright or it’s not).

    The more threatening our thoughts (I’m going to be criticised), the more anxious we will feel. The more hopeless we believe the future is (there’s no point), the more depressed we will feel. The more strongly we believe things should be different (the world must not be this way!), the more frustrated and angry we will feel.

    The way we think is guided by what we pay attention to (a tendency to focus on negative things?), the way we interpret what is happening around us (seeing the glass half-full?) and the experiences we are most likely to remember (such as the times things went bad rather than the times things went well).

    We all use particular styles of thinking from time to time that can get us into trouble. We are “catastrophising” when we blow things way out of proportion (things are rarely that bad). Using words like “never” and “always” is a good sign we’re thinking in an overgeneralised way (most bad things happen somewhere between never and always).

    It’s important to remember that thoughts are, well, just thoughts. They are not immutable facts.

    Most of the thoughts we have throughout the day are random streams of consciousness that are simply the output of creative minds. And many people can interpret exactly the same situation in many different ways.

    Behaviour: the B in CBT

    The behavioural aspect of CBT is based on learning theory. If you’ve heard of Pavlov’s dogs then you know about classical conditioning. Pavlov rang a bell just before he gave his dogs some food. Eventually the dogs started to salivate when they heard a bell ring (even if no food was given). They learnt that the bell signalled food. (Voila! Classical conditioning.)

    Emotional responses can be classically conditioned in a similar way. As a simple example, someone with a dog phobia might recall being bitten as a child (perhaps by one of Pavlov’s dogs?). A cognitive behaviour therapist might speculate that the child developed a classically conditioned fear response to the dog.

    Just like the bell triggered Pavlov’s dogs to salivate, an image or thought of a dog can trigger fear (even if the dog has no intention of biting).

    Pavlov found that if he repeatedly rang the bell without providing food eventually the dogs stopped salivating when they heard the bell. They learnt that the bell no longer signalled food.

    Similarly, if we repeatedly expose someone with a dog phobia to dogs without them being bitten, then they will learn that dogs are not dangerous and the fear response will stop being triggered. It turns out that repeated exposure to any feared object or situation (in the absence of the fear coming true) can effectively diminish the fear response.

    cognitive behaviour therapy
    When someone learns from experience that dogs are not dangerous, the fear response will stop being triggered. Uwe Mäurer/Flickr, CC BY-NC-SA

    A cognitive behaviour therapist is interested in all the things we do (or avoid doing) to manage the difficulties life throws our way. This might include unhelpful behaviours such as always avoiding the things we fear, excessively using drugs or alcohol, being controlling or violent towards others, and the list goes on.

    Avoidance denies us any chance to challenge our fears and build confidence that we can cope. Alcohol and drugs might feel good and distract us in the short term, but ultimately our problems still exist and might be even worse in the longer term.

    Being controlling towards others might help us feel powerful and in control in the short term, but this can conceal an underlying core belief of vulnerability (if I don’t control my environment, then perhaps it will control me).

    These problems are only likely to be resolved when the fears driving these unhelpful behaviours are directly challenged and modified.

    Therapy: the T in CBT

    Cognitive behaviour therapists help clients better understand why they might have developed particular problems and, more importantly, what vicious cycles are maintaining them.

    The most important questions for treatment are:

    1. How do our thoughts, behaviours, physiology, interpersonal relationships and emotions interact to maintain problems in our lives?

    2. How can we break these cycles?

    Here are some things you can expect from a competent cognitive behaviour therapist.

    A strong therapeutic relationship: Cognitive behavioural therapists appreciate that therapy can be emotional and difficult. They know their client needs to trust them before they will be able to work effectively together. Empathy, genuineness, unconditional positive regard and warmth need to be there in spades.

    Collaboration: CBT involves a close working relationship between the client and therapist. The client is seen as an expert in their lives and the therapist is seen as an expert in evidence-supported treatments. Both forms of expertise are equally important to achieve a good outcome.

    Goal-setting: CBT aims to be an efficient and time-limited form of therapy. A cognitive behavioural therapist will be very interested in what you would like to achieve from therapy. Together you will plan how to get there and how long it should take.

    There is some flexibility if progress is slower than expected, but for most problems the therapist thinks in weeks or months rather than years.

    Monitoring and evaluation: Cognitive behavioural therapists don’t rely on their own judgement about when clients' problems have resolved; the therapist might be wrong. Rather, they measure change from the client’s perspective.

    The therapist might ask the client to complete some monitoring or questionnaires during therapy so that progress can be tracked.

    Cognitive behavioural therapists don’t blame the client if the problem isn’t improving. The therapist takes responsibility for changing what is done in therapy to ensure things get back on track.

    Practical skills: CBT aims to teach clients to relate differently to their thoughts, physical sensations, emotions and behaviours so that they don’t get caught up in them in problematic ways.

    One technique might involve identifying negative thoughts and challenging them by recognising when they are overly catastrophic and generating more realistic and helpful alternatives.

    The techniques covered in CBT will depend on the nature of the problem, but you can expect to leave therapy with a toolkit full of helpful skills.

    Between-session tasks: Clients never come to therapy just to feel good for the hour they are in the therapists’ office. They come to improve their lives out in the real world. For this reason, cognitive behaviour therapists encourage clients to apply their new skills between sessions and report back on how it went. This is where much of the hard work, learning and changes occur in CBT.

    Here and how focus: CBT acknowledges the role that past experiences play in shaping who we are, but at the same time recognises that little can be done to change what has already occurred.

    Instead, CBT focuses on identifying what is left behind from these experiences in the form of core beliefs about ourselves, others, and the world, and how these beliefs impact on present-day experiences.

    Modifying these core beliefs can change our emotional responses to memories of earlier negative experiences, and can change the way we respond to challenges in our lives now and into the future.

    The process of therapy is challenging and takes courage. A cognitive behavioural therapist’s role is to guide, support and cheer-lead when required. CBT’s overarching aim is to increase clients’ coping self-efficacy – their confidence in their own ability to manage their problems on their own.

    If a cognitive behavioural therapist has done a good job, the client should leave therapy knowing that they are responsible for the benefits they have achieved from therapy and that they can continue to build on these gains well into the future.

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  • 30 Dec
    eWellness Expert

    What is Bipolar Disorder?

     

    3 face of bipolar disorder

    Definition

    Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

    There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

    • Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
    • Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
    • Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
    • Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

    Signs and Symptoms

    People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.


    People having a manic episode may:

    People having a depressive episode may:

    • Feel very “up,” “high,” or elated
    • Have a lot of energy
    • Have increased activity levels
    • Feel “jumpy” or “wired”
    • Have trouble sleeping
    • Become more active than usual
    • Talk really fast about a lot of different things
    • Be agitated, irritable, or “touchy”
    • Feel like their thoughts are going very fast
    • Think they can do a lot of things at once
    • Do risky things, like spend a lot of money or have reckless sex
    • Feel very sad, down, empty, or hopeless
    • Have very little energy
    • Have decreased activity levels
    • Have trouble sleeping, they may sleep too little or too much
    • Feel like they can’t enjoy anything
    • Feel worried and empty
    • Have trouble concentrating
    • Forget things a lot
    • Eat too much or too little
    • Feel tired or “slowed down”
    • Think about death or suicide

    Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

    Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.

    Diagnosis

    Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. Talking with a doctor or other licensed mental health professional is the first step for anyone who thinks he or she may have bipolar disorder. The doctor can complete a physical exam to rule out other conditions. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

    Note for Health Care Providers: People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to ensure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania. They may, however, experience some manic symptoms at the same time, which is also known as major depressive disorder with mixed features.

    Bipolar Disorder and Other Illnesses

    Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make a diagnosis. In addition, many people have bipolar disorder along with another illness such as anxiety disorder, substance abuse, or an eating disorder. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

    Psychosis: Sometimes, a person with severe episodes of mania or depression also has psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:

    • Someone having psychotic symptoms during a manic episode may believe she is famous, has a lot of money, or has special powers.
    • Someone having psychotic symptoms during a depressive episode may believe he is ruined and penniless, or that he has committed a crime.

    As a result, people with bipolar disorder who also have psychotic symptoms are sometimes misdiagnosed with schizophrenia.

    Anxiety and ADHD: Anxiety disorders and attention-deficit hyperactivity disorder (ADHD) are often diagnosed among people with bipolar disorder.

    Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems, or perform poorly in school or at work. Family, friends and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder.

    Risk Factors

    Scientists are studying the possible causes of bipolar disorder. Most agree that there is no single cause. Instead, it is likely that many factors contribute to the illness or increase risk.

    Brain Structure and Functioning: Some studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. Learning more about these differences, along with new information from genetic studies, helps scientists better understand bipolar disorder and predict which types of treatment will work most effectively.

    Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder than others. But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always develop the disorder, despite the fact that identical twins share all of the same genes.

    Family History: Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of the disorder. However, it is important to note that most people with a family history of bipolar disorder will not develop the illness.

    Treatments and Therapies

    Treatment helps many people—even those with the most severe forms of bipolar disorder—gain better control of their mood swings and other bipolar symptoms. An effective treatment plan usually includes a combination of medication and psychotherapy (also called “talk therapy”). Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment helps to control these symptoms.

    Medications

    Different types of medications can help control symptoms of bipolar disorder. An individual may need to try several different medications before finding ones that work best.

    Medications generally used to treat bipolar disorder include:

    • Mood stabilizers
    • Atypical antipsychotics
    • Antidepressants

    Anyone taking a medication should:

    • Talk with a doctor or a pharmacist to understand the risks and benefits of the medication
    • Report any concerns about side effects to a doctor right away. The doctor may need to change the dose or try a different medication.
    • Avoid stopping a medication without talking to a doctor first. Suddenly stopping a medication may lead to “rebound” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
    • Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch  or by phone at 1-800-332-1088. Clients and doctors may send reports.

    For basic information about medications, visit the NIMH Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website .

    Psychotherapy

    When done in combination with medication, psychotherapy (also called “talk therapy”) can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

    • Cognitive behavioral therapy (CBT)
    • Family-focused therapy
    • Interpersonal and social rhythm therapy
    • Psychoeducation

    Visit the NIMH Psychotherapies webpage to learn about the various types of psychotherapies.

    Other Treatment Options

    Electroconvulsive Therapy (ECT): ECT can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make taking medications too risky. ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. People with bipolar disorder should discuss possible benefits and risks of ECT with a qualified health professional.

    Sleep Medications: People with bipolar disorder who have trouble sleeping usually find that treatment is helpful. However, if sleeplessness does not improve, a doctor may suggest a change in medications. If the problem continues, the doctor may prescribe sedatives or other sleep medications.

    Supplements: Not much research has been conducted on herbal or natural supplements and how they may affect bipolar disorder.

    It is important for a doctor to know about all prescription drugs, over-the-counter medications, and supplements a client is taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

    Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a client and doctor work closely together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help clients and doctors track and treat bipolar disorder most effectively.

    Finding Treatment

    • A family doctor is a good resource and can be the first stop in searching for help.
    • For general information on mental health and to find local treatment services, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357).
    • The SAMHSA website has a Behavioral Health Treatment Services Locator  that can search for treatment information by address, city, or ZIP code.
    • Visit the NIMH’s Help for Mental Illnesses webpage for more information and resources.

    For Immediate Help

    If You Are in Crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.

    If you are thinking about harming yourself or thinking about suicide:

    • Tell someone who can help right away
    • Call your licensed mental health professional if you are already working with one
    • Call your doctor
    • Go to the nearest hospital emergency department

    If a loved one is considering suicide:

    • Do not leave him or her alone
    • Try to get your loved one to seek immediate help from a doctor or the nearest hospital emergency room, or call 911
    • Remove access to firearms or other potential tools for suicide, including medications

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  • 30 Dec
    eWellness Expert

    Motivational messages boost health of arthritis patients

    arthritis counselingLondon, Jun 12 (PTI)|2016

    • Acombination of text messages and individual counselling sessions to motivate patients with rheumatoid arthritis may lead to improved patient outcomes, scientists have found for the first time.

      This type of behavioural intervention was effective at reducing daily sitting time by an average of more than two hours in rheumatoid arthritis (RA) patients, and also reduced their cholesterol levels.

      Due to their disease, patients with RA tend to be more sedentary than the general population, which can have serious health consequences, including an increased risk of cardiovascular disease and premature death.

      Patients with RA already have an increased risk of cardiovascular disease and premature death, partly caused by the chronic inflammatory rheumatic disease itself, and partly by traditional risk factors, such as hyperlipidaemia.

      lthough exercise is known to have a positive effect on pain and physical functioning in patients with RA, pain often acts as a barrier against maintenance of a physically active lifestyle.

      more feasible approach for improving health and well-being in RA patients would therefore be to focus on reducing sedentary behaviour and increasing light intensity activity, rather than solely concentrating on increasing moderate and vigorous physical activity.

      "We know that behavioural approaches are effective in reducing sedentary behaviour in healthy populations," said Tanja Thomsen of the Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases in Denmark.

      "Our findings support the introduction of behavioural approaches as an effective way to improve the health of rheumatoid arthritis patients, which may also be applicable in other populations with chronic disease and limited mobility," Thomsen added.

      As many as 75 adult RA patients with a self-reported daily sitting time greater than five hours and Health Assessment Questionnaire score less than 2.5 underwent a 16-week individually tailored, behavioural intervention that included three individual motivational counselling sessions with a health professional and regular text messages aimed at improving motivation to reduce daily sitting time and replacing it with light intensity physical activity.

     

  • 30 Dec
    eWellness Expert

    Online therapy may better treat depression, anxiety

     online counseling

    Washington, May 14 (PTI)|2016

    • Providing an online therapy may be a more effective treatment for anxiety and depression than usual primary care, scientists have found.

      Researchers at the University of Pittsburgh in the US enrolled 704 depressed and anxious patients who were between 18 to 75 years old.

      They showed that providing an online computerised cognitive behavioural therapy (CCBT) programme both alone and in combination with Internet Support Groups (ISG) provided better outcomes for patients.

      The participants were randomised to one of three groups: care manager-guided access to the eight-session Beating the Blues CCBT programme; care manager-guided access to both the CCBT programme and a password-protected ISG patients could access 24/7 via smartphone or desktop computer; or usual behavioural health care from their primary care physician.

      Over the six-month intervention, 83 per cent of patients randomised to CCBT started the programme, and they completed an average of 5.3 sessions.

      Seventy-seven per cent of patients assigned to the ISG logged into the site at least once, and 46 per cent provided one or more posts or comments.

      Six months later, those patients randomised to CCBT reported significant improvements in their mood and anxiety symptoms and the more CCBT sessions patients completed, the greater the improvement in mood and anxiety symptoms.

      Although patients randomised to both CCBT and ISG had similar overall improvements in mood and anxiety symptoms compared to patients randomised to only CCBT, secondary analysis showed those who engaged more with the ISG tended to experience greater improvements in symptoms.

      ISG that enable individuals with similar conditions to access and exchange self-help information and emotional support have proliferated in recent years, but benefits have yet to be established in randomised trials, researchers said.

      "Our study findings have important implications for transforming the way mental health care is delivered," said Bruce L Rollman, professor at the University of Pittsburgh.

      "Providing depressed and anxious patients with access to these emerging technologies may be an ideal method to deliver effective mental health treatment, especially to those who live in areas with limited access to care resources or who
      have transportation difficulties or work/home obligations that make in-person counselling difficult to obtain," he said.

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  • 30 Dec
    eWellness Expert

    'Parents need lessons for children's mental health'

    parent

    BBC News|15 June 2016|From the sectionUK

    Parents should have lessons provided by the government on how to raise their children, Britain's leading public health expert has said.

    Professor John Ashton, outgoing president of the Faculty of Public Health (FPH), said children were neglected by some schools and parents.

    He said the state should help stop children being crippled by conditions such as anxiety, anorexia and obesity.

    The FPH has released a report calling for mental health improvements.

    It says: "Mental, emotional or psychological problems account for more disability than all physical health problems put together.

    "Although we cannot say yet exactly how much of the burden of mental illness could be prevented, we know prevention is possible."

    Human cost

    One in 10 children aged five to 16 years had a mental health problem that warranted support and treatment, the report said.

    And the quality of the parent-child relationship and parenting more broadly played a primary role.

    Prof Ashton said that, given the huge financial and human cost of mental health problems, more should be done to tackle their causes.

    He said: "We've done well in terms of producing live, healthy babies over the last 60, 70 years, but, by the time children are leaving school, between 10% and 15% of them are in trouble emotionally or mentally, and suffer from things like obesity, eating disorders, anxiety and stress.

    "Having produced healthy babies we then set about neglecting them."

    Prof Ashton suggested parenting advice and support could be provided by investing in existing networks - such as health visitors and schools. And by using social media to reach parents and setting up 24/7 helplines - for example for people raising adolescents.

    Parenting key

    Prof Sarah Stewart-Brown, who produced the report, said diet and activity played a role in mental health but "supporting parenting is key. The first 1,001 days of a child's life are particularly important.

    "Over three-quarters of all mental health problems emerge in childhood and adolescence."

    Programmes based in schools, workplaces, doctors' surgeries, and in the community could help, she said.

    The Faculty of Public Health sets standards for public health specialists in the UK and covers 3,300 professionals.

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