Guest Post: The Efficacy of Online Cognitive Behavioural Therapy- CBT by Dr Stacey Leibowitz- Levy

~ Eleanor Segall ~ 1 Comment

We are delighted to have Dr Stacey Leibowitz-Levy, psychologist writing about Cognitive Behavioural Therapy for us. As with any therapeutic practice, it is very much individual as to whether it will work for you and CBT will not work for everyone- but has been proven to work for many. Here Dr Leibowitz-Levy explains how it can work online.                        

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Online counselling is a growing field with more and more people turning to the internet to seek out counselling help. Counselling services offered online incorporate the range of therapeutic approaches that have been developed within the field of psychology. Approaches to understanding mental ill health and treatment include therapeutic approaches such as logo therapy, psychodynamic therapy, systemic therapy, psychodynamic therapy and Cognitive Behavioral Therapy (CBT). How do these therapeutic modalities translate to the online environment? This article will address the compatibility of CBT in particular as an online counselling approach.

CBT is a widely-utilised mode of therapy that focuses on an awareness of the relationship between thoughts, feelings and behaviour. The aim of CBT is to address difficulties through modifying distorted thoughts, unhelpful behaviour and unpleasant emotions. In order to achieve this end, the client works collaboratively with the therapist in building awareness and understanding of his/her condition, and an accompanying skill set for evaluating and changing distorted beliefs (as well as modifying dysfunctional behavior). The therapist develops clear objectives and a treatment plan that requires active participation from the client during sessions, and follows through on homework assignments between sessions.

This form of therapy is characterized by a structured, time limited and outcome focused approach to managing mental health challenges. Often CBT is focused on a specific issue such as anxiety or managing depressive thoughts and, as such, many CBT interventions are available in a protocol format. CBT offers a delineated and clearly defined intervention that is largely directed by a clearly defined process and structure. This is in contrast to many other therapeutic approaches that have less defined parameters and take their cue on a session to session basis from the client.

The format and approach of CBT lends itself to an online format in that the structure and process are not only defined and constrained by the relationship between therapist and client but are also defined by a clearly delineated therapeutic procedure. This procedure offers a framework within which to deliver support which can easily be translated to an online process. CBT follows a set format. It is driven by the imperative of building an understanding of the issues the client is experiencing and imparting a certain skill set to assist the client in managing his/her mental health issues. CBT is thus based on specific content and has a strong psychoeducational aspect, which means that delivery online can be located in tangible and clear cut content and outcomes for the client.

This also allows for versatility in the delivery of CBT online. While face to face time with a therapist may be desirable for some clients, the option of online delivery of psychoeducational as well as skills based elements in other formats also works well. For instance, the psychoeducational aspect could be communicated very effectively through a video delivery. CBT lends itself to the format of online courses where clients are guided through a process of identifying and understanding their particular issues and developing the skills to manage them. Interspersing this with face to face time or the opportunity to clarify or ask questions in a chat or e-mail format makes for a very effective online intervention.

While many of the issues addressed in CBT are personal to the client, the possibility of locating these issues within a more general format is very much part of the CBT approach. There is a set way of getting information from, and accessing and understanding the client’s experience, with the client having to act on this information between sessions. This more “scientific” process also makes for an approach that lends itself to an online format.

The efficacy of CBT as an online intervention is borne out by the number of sites specifically offering online CBT in a variety of formats (for some examples, see here and here). The online availability of this well researched and well-verified approach to managing mental health problems offers increased affordability, accessibility and greater choice for mental health consumers.

Dr. Stacey Leibowitz-Levy is a highly-experienced psychologist with a Master’s Degree in Clinical Psychology and a PhD in the area of stress and its relation to goals and emotion. Dr. Stacey has wide ranging skills and expertise in the areas of trauma, complex trauma, anxiety, stress and adjustment issues. Stacey enjoys spending time with her husband and children, being outdoors and doing yoga.

The Anxiety Wave: On waking up with anxiety

~ Eleanor Segall ~ 8 Comments

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In previous posts about my mental health journey, I have mentioned having an anxiety disorder. Anxiety disorders are triggered in the brain and can be very hard to keep under control. Thankfully, most of the time, I can function at optimum health. Yet, sometimes stressors come along and throw me a little off course.

The main anxiety issue I have is usually morning anxiety. This is when you wake up and almost freeze from fear- you feel like you can’t do anything or enjoy the day, panic floods the body. Sometimes, after a few hours this form of terror dissipates. You can distract yourself and it goes – but sometimes it takes a little longer for it to go and it causes exhaustion. This is due to the hormones adrenaline and cortisol which are triggered pre or during a panic attack.

I am still learning to ride the anxiety wave- it can make you feel very tired and far less productive. For me, it often happens after I have had time away from work or a disruption to my routine, the anxious thoughts and feelings will flood back, making life that little bit harder again.

It is not easy nor straightforward dealing with this. I have to be kind to myself and know it will pass. Breathe, and distract my mind. Try and use meditation techniques to keep it under control.

Changes: Hopes and New beginnings

~ Eleanor Segall ~ Leave a comment

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Sometimes in life, changes occur rapidly and you have to just go with them and the flow. These past few weeks I have been having a lot of positive changes in terms of employment and meeting new people. Its this that can provoke positive mindset but also fears and worries too. Change can be the most wonderful motivator or you can sink under pressures.

I am lucky that in my work, I have a good support network. Additionally, as Spring is here and the sun shines more, with lighter evenings, it is a very hopeful time.

I was reminded this week that Hope truly is the most important factor. Without hope, we are nothing. I have also found that getting adequate rest and relaxation time is key in keeping me feeling well and able to cope with lifes challenges.

Looking forward to a peaceful, sunny  weekend.

Guest post by Lucy Boyle: What you need to know about Burnout Syndrome

~ Eleanor Segall ~ Leave a comment

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Stress and pressure are a part of everyday life. Our jobs often bring a fast pace; we may have to meet deadlines, complete projects in a certain timeframe, or put up with stressful environments. No matter who you are or what you do, there’s a certain amount of stress that just “comes with the job”.

However, there are times when the pressure gets to be too much. You may have been dealing with days, weeks, months, or even years of too much work and not enough downtime. The stresses of the job may be piling up with the stresses at home. Eventually, you run the risk of what is known as “burnout syndrome”.

Burnout syndrome, also known as occupational or job burnout, is defined as “a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress.” The symptoms of burnout include:

  • Exhaustion and fatigue
  • Frustration and negative emotions
  • Lack of motivation
  • Attention and concentration difficulties
  • Reduced performance on the job
  • Lack of personal care, unhealthy coping mechanisms (eating, smoking, drinking, etc.)
  • Interpersonal difficulties, both on the job and at home
  • Preoccupation with work, even when you’re not working
  • Chronic health problems
  • Illness (the result of chronic stress)
  • Headaches
  • Decreased satisfaction with the quality of your life

If you’re noticing these symptoms in your life, you may be suffering from or getting close to burnout.

But what causes burnout syndrome? How does it get from “I’m having a bad day at work” to the feeling of being overwhelmed, overburdened, and emotionally drained? There are a lot of things that can contribute to the feelings of burnout.

  • Interpersonal relationship problems at work, with coworkers, employees, or employers.
  • A lack of control in your life, feeling like you have no say in anything that goes on at work or home.
  • A lack of clarity in your job description or burden of responsibilities.
  • Monotony or chaos in your job—both can require a lot of energy to remain focused.
  • Company ethics, values, or methods of handling feedback, grievances, or complaints that are not aligned with yours.
  • A job that doesn’t fit with your skills or interest.
  • Isolation at work or home; you may feel like your social support is lacking.
  • An imbalance in your work-life routine, usually too much time spent at work and not enough at home.

All of these factors can add to your feelings of stress and anxiety. Over time, they simply INCREASE until you feel like the burden of your job is too much to bear.

The truth is that occupational burnout is incredibly common, especially among human service professions. ER physicians, nurses, social workers, teachers, engineers, lawyers, police officers, and customer service reps are all at a very high risk of burnout. The high-pressure environment and occupation add to the emotional demands of the job. Eventually, everything becomes too much to bear and you suffer from burnout.

So what can you do if you’re feeling burned out? How can you cope with the mounting stress and pressure that may eventually become too much to bear?

Engage socially. Social interaction and connection is one of the most effective antidotes to depression, anxiety, and stress. Spending time with family, friends, and coworkers can help you to feel better. Making friends at work can change the environment positively, making work seem less stressful because of you have a social support framework in place. Open up to people and share your feelings. It can release some of the pressure building inside you and encourage better connection with others.

Reframe your perspective. Instead of seeing work as a bore, a chore, or a stressor, try to find value in what you do. Your job benefits someone, so look at what you do as providing an invaluable service.

Evaluate your priorities. What’s more important to you: work or home life? If your career is important, find ways to focus on it without adding to your stress. Work on a better work-life balance. Take more time off work, even if it means someone else gets the promotion you wanted. Set boundaries on your time and availability. Set aside time to relax and unwind, both in the middle of and at the end of the day. Stop rushing around so much—from home to work and back home again. Focus on what matters: your health and happiness!

Change your lifestyle. Get more sleep. Eat better. Exercise more. Drink less coffee and alcohol. Read more books. Walk in the park more. Take a nap in the middle of the day. Move around more. Quit smoking. Improve your lifestyle, and you’ll find your body and mind better able to cope with the feelings of stress that could lead to burnout.

In the end, YOU are the one in control of your life. Make the decisions that will reduce stress, not add to it. Take care of your body, mind, and emotions, and you’ll avoid those feelings of burnout!

Lucy Boyle (@BoyleLucy2), is a full-time mother, blogger and freelance business consultant, interested in finance, business, home gardening and mental health.

Peer Support Work: A New Adventure

~ Eleanor Segall ~ Leave a comment

I very much felt inspired to write today because its Friday and on Monday I begin my new job role as a Peer Support Worker for a mental health charity here in the UK.

Peer support takes people like me who have lived experience of mental health issues and are in recovery, and able to promote or assist wellness and recovery in others. This can be done through therapeutic groups, talking to service users and working in a collaborative team of occupational therapists, social workers and mental health coordinators. A lot of the work I will be doing is confidential so I won’t be able to disclose it here.

Its such an amazing- yet strange turn of events to be on the ‘other side’ (i.e. not a service user myself). I am embarking on a very new and exciting journey and very thankful to be able to help others.

I also just wanted to say a big thank you to everyone who reads, likes, follows my blog. I will continue to blog and share mine and others stories.

Guest Post by Diamond EhealthInformer: Can some Mental Health Problems be treated with Technology?

~ Eleanor Segall ~ Leave a comment

As we move into 2017 going full steam ahead, we can see how far technology has come in recent years. I wanted to set myself the task of finding out how far this tech had come in terms of treating mental illnesses, as there is some speculation and fogginess to the science and results that people are supposedly getting.

It turns out that there are multiple useful and FDA approved technologies that do indeed help treat mental health problems. In this article, I aim to uncover some actionable, useful data and solutions that will aid sufferers of various mental health issues.

Crisis Centres

This solution may surprise you, but it utilizes technology and has proven to be very effective in serious circumstances. When people feel pushed to the end of their tether with anxiety and depression, they need to be talked to, supported and experience a sense of connection to alleviate the feeling of alienation. Sometimes your best friends and family members aren’t available or you don’t feel like talking to them. You want something completely confidential, which is why text and call centres are so effective.

They’re always open and running, plus the staff are fully trained for both mild and severe cases of anxiety and depression and other mental illnesses. You can always rely on someone picking up at the other end that will know how to talk to you and do their best to bring you back to a state of calm through grounding techniques.

Having the option to text message or call is also beneficial for those who prefer to communicate in different manners. Some sufferers may not feel like talking, but texting will work for them and their mood at that given time. On the contrary, hearing a soothing and reassuring voice on the other end of the line may be more effective for certain sufferers. Both options are there to use, whenever and wherever a person may need them.

Using Apps for Improved Mental Wellness

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There are thousands of mental health apps available for both iOS and Android phones. That being said, it’s important that before you download anything, that you do your research. Given the fact that there are so many apps to choose from, you can take an educated guess and see that a lot of them won’t be very effective.

Also, be sure to check the privacy settings for the apps you’d like to download, as you’ll most likely be entering personal information and data into them. You can always protect your information using privacy tools, removing some of the worry and stress from using specific apps.

Apps such as Pacifica help to monitor and alleviate stress levels so that individuals can work out and reduce anxiety symptoms through cognitive behavioral therapy and relaxation techniques. By using an app such as Pacifica, you can prevent your symptoms from worsening and control your stress levels to produce a healthy state of mind.

Spire

 

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Spire works through wearing a clip-on device that measures your emotions, sending signals through to your smartphone which will alert you as to what your body is currently experiencing. I know this may sound a little “out there,” but Spire has been proven to reduce stress levels by up to 50 percent in certain scenarios. When emotions are detected, the device will send signals to your phone, which then pop up on your screen telling you how you can improve your mood and emotional well-being.

The nifty device is easily clipped to a belt or bra for completely anonymous use. Repetitive high-stress levels can lead to physical health issues affecting the digestive and reproductive system (as well as other areas of the body). Stress can leave you feeling drained and lethargic, so having a device that alerts you to your emotional wellbeing and gives you advice and tips on how to reduce those stress levels is very useful.

 

Conclusion

I set out to discover whether technology really could help to treat mental health problems and to see what some of the most effective and accessible treatments available are. I think it’s fair to say that there are many ways in which technology can aid sufferers of various mental illnesses. Using apps, crisis centres, and body measuring devices we can stay on top of our stress levels, and use signals to prevent our conditions and symptoms from worsening.

I feel that using these technological solutions will work best in collaboration with any existing treatment a sufferer is undergoing- with a supportive medical team. Through using medication and counseling, these modern alternatives can provide additional beneficial results that could  boost the recovery of a patient.

The Serenity Prayer, Hope and Manifestation

~ Eleanor Segall ~ Leave a comment

Whenever I have felt unwell, low, hopeless and like nothing would ever change (often after experiencing a low or high bipolar episode and being unemployed/ feeling very alone), I have found that certain prayers and ideas have comforted me and helped me grow and have hope.

One of these (as well as many Jewish prayers) is the Serenity prayer. Its words give me comfort. They have even been put to a song by India Arie, whose music aims to heal others struggling with difficulties, broken hearts, stress, sadness.

So today I thought I would share it with you. I would say I am quite a spiritual person and I believe that prayers really do manifest if they are meant for you- your heart is listened too. At times when I have felt hopeless, I turned to God (if you don’t believe in God replace with the universe). And even if my prayers didn’t manifest directly at that exact moment- they often do manifest – even if it takes a year or two.

I hope this will help you feel a little comforted or healed, like it always does for me. Serenity is so important, even if it takes a long time to reach

Have hope :

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Living with Uncertainty- Life and Journeys with Mental Illness

~ Eleanor Segall ~ Leave a comment

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*Trigger warning- talks about severe depression. Please be careful when reading*

There is so much I want to write on here that I havn’t yet written. Some topics  are too deep or painful for me to address- particularly surrounding certain aspects of previous hospitalisations. I hope one day I can share these with you. However, as a writer, I often get into the flow and just want to spill whats in my heart. So, this blog is about what living with mental illness can mean- its uncertainty and coming to terms with my own brain.

As most of you know, I was diagnosed with bipolar affective disorder, a mood disorder, as a teenager. I was poorly with depression and a mixed state in hospital when diagnosed and I don’t think fully came to terms with what the diagnosis meant until a few years later.

Being diagnosed so young instilled a lot of fear in me and a lot of avoidance. I decided not to drink alcohol or try drugs- as I didn’t know their effect on my brain and I was already  pretty anti drugs for many reasons. I knew my illness meant that the chemistry in my brain wasnt the same as everyone else without it- I had either too little seretonin causing depression, or too much causing hypomania and manic episodes. I felt often that despite taking mood stabilising medication and anti depressants and tablets to help PMS- that everything was uncertain. I had no idea when the next episode would strike- or if I would  be well enough recognise it.

I am lucky. My illness is very severe when it happens. Yet, I went 10 years without a manic episode or hospitalisation, though I suffered from acute depression that got truly so bad I didn’t want to be here anymore- which is quite a common side effect of being depressed. I was able to be supported at home and with my psychiatrist. I knew it was my depressed thoughts and not me- but this uncertainty  was incredibly stressful to myself and my family. I spent years being depressed and anxious and trying (and failing at times) to function- because my medication wasn’t holding me and my brain correctly.

Despite the uncertainty of so many things- dating, the effect of stressors in my life, work, etc- I am doing well at the moment. However, the uncertainty of the illness makes you worry that you could suddenly get ill again.

I practise a lot of self care- try to get to bed early, eat well, take my medication, tell my family or friends if feeling low etc. However, I always live with the knowledge that my Bipolar may pop up at different times in my life- and important times.

Due to having had this for 13 years- I am used to living with the chronic nature of my mental health condition. It can still be frightening and distressing and down right annoying. Yet, with the right support network and medical team, I know I can stay well for as long as my brain allows me- and I can get well and recover.

Recovery makes you stronger, Living through the pain makes you stronger, Surviving an episode makes you stronger.

You are not alone.

Guest Post by Juno Medical: 9 Things People with Anxiety Disorders Would Rather not Hear You Say

~ Eleanor Segall ~ Leave a comment

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Anxiety disorders include generalized anxiety disorders, panic disorders, and social anxiety disorders. 1 in 12 people suffers from anxiety globally, and women are twice as likely as men to experience anxiety.

If you feel overwhelmed by the behaviour of a person with anxiety, try to put yourself in their shoes, and show understanding, not stigma.

For more see www.junomedical.com

 

Full Circle- From Bipolar and Mental Illness to Recovery

~ Eleanor Segall ~ Leave a comment

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It was summer 2014. I sat on a sadly impersonal green NHS couch in a quiet side room , my feet dangling over the edge, holding my wordsearch book and counting down the hours until I could leave the Day Unit. I had been feeling exhausted from my new medication, wobbly, teary and lacking in confidence all day and I had just started taking Lithium as a therapeutic medication. As such I had weekly blood tests as the Lithium level in my blood fluctuated between 0.4 and the optimum dose of 0.8, where you start to feel much better.  Lithium has to reach a certain amount in the blood to work on your brain (where it stops or tames mania and mood disorders).  They also had to check it didn’t become toxic in my blood and so weekly tests were needed which were exhausting at the time.

I had just received test results that day informing me that I was feeling a bit fragile because the Lithium was only at 0.4 in my blood. All I wanted to do was hide away from the rest of the therapy group in that little room, peacefully colouring in photos and doing wordsearches to keep me occupied. All I really wanted to do was go home, to where I felt safe and I didn’t have to face the reality of being ill.

This was at the beginning of my recovery journey in 2014. I had left hospital as an in patient after a manic episode and was a voluntary patient at an Acute Day Unit specialising in group therapies. Eventually, I grew to love it and the other people there- although I always wanted to leave faster than the Doctors thought I was ready! I stayed there 3 months in total and some people stay there 2 weeks. I very much needed the healing nature of the therapies even though I didn’t feel it at the time.

I realised these past few weeks how far I have come in my journey- from ill service user needing the support of my psychiatrist, nurses and OTs, to not needing that support currently (on 6 monthly psychiatrist meetings) and helping others in a similar setting in my new job.

I really have come full circle. There may be times when I am ill again in the future or not feeling at my best. I may need more support again. I may get panic attacks or mania or depression. However, for now I am feeling positive and hoping I stay well for a long time on my medication.

Recovery is possible. I am so thankful to all who have helped me on my journey and continue to provide guidance and love.