WELCOME TO 'HELP'

ABOUT HELP

It has been a long time since I have taken the time to write here, Sorry. 

From as early as 2001 having finished my training as a Counsellor, with no money, a job, a beautiful new wife and hopes for the future, I set up a voluntary support service for those suffering as a result of Stress, Anxiety, Trauma, Panic Attacks, Bullying and False Allegation in the workplace and life in general.  20 plus year laters I am still here. Happily married, a father, fatter, balder and I would say wiser but lets say more understanding of the world, which sounds better better than miserable cynic.😉  

In 2002, when blogging was a new and exciting way of sharing knowledge I set up this site, and it was free. The hope then as always, was to try and help those in need.  I still don't have all the answers but will do my best to support people to find their own answers and way through their difficult times.

 "The impact of stress can be felt at all levels and within every walk of life. The negative influences of stress are damaging not only to ourselves, our families, loved ones and business but also to the fabric of society and will continue to do so until this issue is taken more seriously by all who can affect change"

                                                                        M. Reddy Irish Independent 2002 

 Stress is essentially reflected by the rate of all the wear and tear caused by life. although we cannot avoid stress as long as we live,we can learn a great deal about how to keep its’ damaging side-effects, distress, to a minimum.”
Hans Selye, M.D.


Mark Reddy M.Sc.  Psychotherapist, Psychologist, Mediation and Conflict Resolution,  Consultancy and proud Mental Health Advocate. 

email:mark.reddy1@gmail.com 
www.gardasupport.ie

Anxiety Treatment Strategies

When anxiety or stress threatens to throw you off kilter, it's time to come to your own emotional rescue.

Step 1:
Accept that stress and anxiety are a natural part of life. If you give yourself permission to experience and accept uncomfortable feelings, you'll be able to tolerate them better, explains Washington, D.C.-based psychotherapist Jerilyn Ross, M.A., president and CEO of the Anxiety Disorders Association of America and author of One Less Thing to Worry About: Uncommon Wisdom for Coping With Common Anxieties.

Step 2:
Consider what's really bothering you. When you begin to feel tense or anxious, take a deep breath and ask yourself, "What am I really anxious about?" That's when a journal can really come in handy. "To help you see patterns between your thoughts, your activities and your anxiety, it can help to write down what's making you anxious in a diary," Ross says.

Step 3:
Seize control over what you can. Consider what actions you can take to ease your anxiety level. "If you constantly worry about being late to work, get up 15 minutes earlier so you're not rushing so much in the morning," Ross suggests. "Focus on what you can do, rather than on what you can't do."

Step 4:
Change your negative thoughts. If you catch yourself thinking, "I can't meet this deadline," Ross recommends removing the "T" and restating the thought more positively: "I can meet this deadline. I just need to organize my time." This makes the task ahead of you seem possible and less daunting.

Step 5:
Be present-minded. "Stay rooted in the here and now," says Ross, "and focus on the information you have rather than on the 'What-ifs?' that often accompany anxiety." If you have trouble stopping the "What-if" habit, pinch yourself and say "Stop!" or visualize a stop sign, then consciously turn your attention in a more constructive direction.

These strategies may not solve all your problems, but they can help you change the way you interact with anxiety, worry and stress-and they can be remarkably effective at helping to

Panic Disorder, Your Questions Answered

Answers to Your Questions About Panic Disorder

Panic Disorder is a serious condition that around one out of every 75 people might experience. It usually appears during the teens or early adulthood, and while the exact causes are unclear, there does seem to be a connection with major life transitions that are potentially stressful: graduating from college, getting married, having a first child, and so on. There is also some evidence for a genetic predisposition; if a family member has suffered from panic disorder, you have an increased risk of suffering from it yourself, especially during a time in your life that is particularly stressful.

Panic Attacks: The Hallmark of Panic Disorder

A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience. Symptoms of a panic attack include:

racing heartbeat
difficulty breathing, feeling as though you 'can't get enough air'
terror that is almost paralyzing
dizziness, lightheadedness or nausea
trembling, sweating, shaking
choking, chest pains
hot flashes, or sudden chills
tingling in fingers or toes ('pins and needles')
fear that you're going to go crazy or are about to die
You probably recognize this as the classic 'flight or fight' response that human beings experience when we are in a situation of danger. But during a panic attack, these symptoms seem to rise from out of nowhere. They occur in seemingly harmless situations--they can even happen while you are asleep.

In addition to the above symptoms, a panic attack is marked by the following conditions:
it occurs suddenly, without any warning and without any way to stop it.
the level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated.

it passes in a few minutes; the body cannot sustain the 'fight or flight' response for longer than that. However, repeated attacks can continue to recur for hours.
A panic attack is not dangerous, but it can be terrifying, largely because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild word or social impairment to a total inability to face the outside world.

In fact, the phobias that people with panic disorder develop do not come from fears of actual objects or events, but rather from fear of having another attack. In these cases, people will avoid certain objects or situations because they fear that these things will trigger another attack.

How to Identify Panic Disorder
Please remember that only a licensed therapist can diagnose a panic disorder. There are certain signs you may already be aware of, though.
One study found that people sometimes see 10 or more doctors before being properly diagnosed, and that only one out of four people with the disorder receive the treatment they need. That's why it's important to know what the symptoms are, and to make sure you get the right help.

Many people experience occasional panic attacks, and if you have had one or two such attacks, there probably isn't any reason to worry. The key symptom of panic disorder is the persistent fear of having future panic attacks. If you suffer from repeated (four or more) panic attacks, and especially if you have had a panic attack and are in continued fear of having another, these are signs that you should consider finding a mental health professional who specializes in panic or anxiety disorders.

What Causes Panic Disorder: Mind, Body, or Both?

Body: There may be a genetic predisposition to anxiety disorders; some sufferers report that a family member has or had a panic disorder or some other emotional disorder such as depression. Studies with twins have confirmed the possibility of 'genetic inheritance' of the disorder.

Panic Disorder could also be due to a biological malfunction, although a specific biological marker has yet to be identified.

All ethnic groups are vulnerable to panic disorder. For unknown reasons, women are twice as likely to get the disorder as men.

Mind: Stressful life events can trigger panic disorders. One association that has been noted is that of a recent loss or separation. Some researchers liken the 'life stressor' to a thermostat; that is, when stresses lower your resistance, the underlying physical predisposition kicks in and triggers an attack.

Both: Physical and psychological causes of panic disorder work together. Although initially attacks may come out of the blue, eventually the sufferer may actually help bring them on by responding to physical symptoms of an attack.

For example, if a person with panic disorder experiences a racing heartbeat caused by drinking coffee, exercising, or taking a certain medication, they might interpret this as a symptom of an attack and , because of their anxiety, actually bring on the attack. On the other hand, coffee, exercise, and certain medications sometimes do, in fact, cause panic attacks. One of the most frustrating things for the panic sufferer is never knowing how to isolate the different triggers of an attack. That's why the right therapy for panic disorder focuses on all aspects -- physical, psychological, and physiological -- of the disorder.

Can People with Panic Disorder lead normal lives?
The answer to this is a resounding YES -- if they receive treatment.
Panic disorder is highly treatable, with a variety of available therapies. These treatments are extremely effective, and most people who have successfully completed treatment can continue to experience situational avoidance or anxiety, and further treatment might be necessary in those cases. Once treated, panic disorder doesn't lead to any permanent complications.

Side Effects of Panic Disorder
Without treatment, panic disorder can have very serious consequences.
The immediate danger with panic disorder is that it can often lead to a phobia. That's because once you've suffered a panic attack, you may start to avoid situations like the one you were in when the attack occurred.

Many people with panic disorder show 'situational avoidance' associated with their panic attacks. For example, you might have an attack while driving, and start to avoid driving until you develop an actual phobia towards it. In worst case scenarios, people with panic disorder develop agoraphobia -- fear of going outdoors -- because they believe that by staying inside, they can avoid all situations that might provoke an attack, or where they might not be able to get help. The fear of an attack is so debilitating, they prefer to spend their lives locked inside their homes.
Even if you don't develop these extreme phobias, your quality of life can be severely damaged by untreated panic disorder. A recent study showed that people who suffer from panic disorder:

are more prone to alcohol and other drug abuse
have greater risk of attempting suicide
spend more time in hospital emergency rooms
spend less time on hobbies, sports and other satisfying activities
tend to be financially dependent on others
report feeling emotionally and physically less healthy than non-sufferers.
are afraid of driving more than a few miles away from home

Panic disorders can also have economic effects. For example, a recent study cited the case of a woman who gave up a $40,000 a year job that required travel for one close to home that only paid $14,000 a year. Other sufferers have reported losing their jobs and having to rely on public assistance or family members.

None of this needs to happen. Panic disorder can be treated successfully, and sufferers can go on to lead full and satisfying lives.

How Can Panic Disorder Be Treated?
Most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases.

The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they're 'going crazy' or that the panic might induce a heart attack. 'Cognitive restructuring' (changing one's way of thinking) helps people replace those thoughts with more realistic, positive ways of viewing the attacks.

Cognitive therapy can help the patient identify possible triggers for the attacks. The trigger in an individual case could be something like a thought, a situation, or something as subtle as a slight change in heartbeat. Once the patient understands that the panic attack is separate and independent of the trigger, that trigger begins to lose some of its power to induce an attack.

The behavioral components of the therapy can consist of what one group of clinicians has termed 'interoceptive exposure.' This is similar to the systematic desensitization used to cure phobias, but what it focuses on is exposure to he actual physical sensations that someone experiences during a panic attack.

People with panic disorder are more afraid of the actual attack than they are of specific objects or events; for instance, their 'fear of flying' is not that the planes will crash but that they will have a panic attack in a place, like a plane, where they can't get to help. Others won't drink coffee or go to an overheated room because they're afraid that these might trigger the physical symptoms of a panic attack.

Interoceptive exposure can help them go through the symptoms of an attack (elevated heart rate, hot flashes, sweating, and so on) in a controlled setting, and teach them that these symptoms need not develop into a full-blown attack. Behavioral therapy is also used to deal with the situational avoidance associated with panic attacks. One very effective treatment for phobias is in vivo exposure, which is in its simplest terms means breaking a fearful situation down into small manageable steps and doing them one at a time until the most difficult level is mastered.
Relaxation techniques can further help someone 'flow through' an attack. These techniques include breathing retraining and positive visualization. Some experts have found that people with panic disorder tend to have slightly higher than average breathing rates, learning to slow this can help someone deal with a panic attack and can also prevent future attacks.

In some cases, medications may also be needed. Anti-anxiety medications may be prescribed, as well as antidepressants, and sometimes even heart medications (such as beta blockers) that are used to control irregular heartbeats.

Finally, a support group with others who suffer from panic disorder can be very helpful to some people. It can't take the place of therapy, but it can be a useful adjunct.

If you suffer from panic disorder, these therapies can help you. But you can't do them on your own; all of these treatments must be outlined and prescribed by a psychologist or psychiatrist.

How Long Does Treatment Take?
Much of the success of treatment depends on your willingness to carefully follow the outlined treatment plan. This is often multifaceted, and it won't work overnight, but if you stick with it, you should start to have noticeable improvement within about 10 to 20 weekly sessions. If you continue to follow the program, within one year you will notice a tremendous improvement.

If you are suffering from panic disorder, you should be able to find help in your area. You need to find a licensed psychologist or other mental health professional who specializes in panic or anxiety disorders. There may even be a clinic nearby that specializes in these disorders.

When you speak with a therapist, specify that you think you have panic disorder, and ask about his or her experience treating this disorder.

Keep in mind, though, that panic disorder, like any other emotional disorder, isn't something you can either diagnose or cure by yourself. An experience clinical psychologist or psychiatrist is the most qualified person to make this diagnosis, just as he or she is the most qualified to treat this disorder.

This Article is designed to answer your basic questions about panic disorder; a qualified mental health professional will be able to give you more complete information.

Panic disorder does not need to disrupt your life in any way, you are not alone and there are both those who can help and those who understand. Contact me for information on a No Panic Service offered both in Ireland and the UK

Anxiety Overview

IMPORTANT INFORMATION:

As with all articles on this site this article is a brief overview of Anxiety, Medication, and Interventions. It is meant as an insightful article giving further understanding and awareness of issues that might be affecting you. At all times medical advice and intervention should be sought if you are in need or just want to talk, medical interventions are always changing and the information in this article may need updating.

Anxiety Overview

Anxiety is a feeling of apprehension, fear, or worry. Some fears and worries are justified, such as worry about a loved one. Anxiety may occur without a cause, or it may occur based on a real situation, but may be out of proportion to what would normally be expected. Severe anxiety can have a serious impact on daily life.

Anxiety can be accompanied by a variety of physical symptoms. Most commonly, these symptoms are related to the heart, lungs, and nervous system. You may feel as if you are having a heart attack.

Anxiety Causes

Anxiety may be caused by a mental condition, a physical condition, the effects of drugs, or from a combination of these. The doctor’s initial task is to see if your anxiety is caused by a medical condition.

Common causes of anxiety include these mental conditions:

Panic disorder: In addition to anxiety, common symptoms of panic disorders are palpitations (feeling your heart beat), dizziness, and shortness of breath. These same symptoms also can be caused by coffee (caffeine), amphetamines ("speed" is the street slang for amphetamines when they are not prescribed by a doctor), an overactive thyroid, abnormal heart rhythms, and other heart abnormalities (such as mitral valve prolapse).

Generalized anxiety disorder
Phobic disorders
Stress disorders
These common external factors can cause anxiety:
Stress at work
Stress from school
Stress in a personal relationship such as marriage
Financial stress
Stress from an emotional trauma such as the death of a loved one
Stress from a serious medical illness
Side effect of medication
Use of an illicit drug, such as cocaine
Symptom of a medical illness

Lack of oxygen - In circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism (a blood clot with the vessels of the lung)
The doctor has the often-difficult task of determining which symptoms come from which causes. For example, in a study of people with chest pain that could be heart disease but turned out not to be heart related, 43% were found to have a panic disorder—a common form of anxiety.

Anxiety Symptoms

Panic disorders - Separate and intense periods of fear or feelings of doom developing over a very short time frame—10 minutes—and associated with at least 4 of the following:

Palpitations
Sweating
Trembling
Shortness of breath
Sense of choking
Chest pain
Nausea
Dizziness
A feeling of being detached from the world (derealization)
Fear of dying
Numbness or tingling
Chills or hot flushes

Generalized anxiety disorder - Excessive and unrealistic worry over a period of at least 6 months associated with 3 of the following:

Restlessness
Easy fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances

Phobic disorders - Intense, persistent, and recurrent fear of certain objects (such as snakes, spiders, blood) or situations (such as heights, speaking in front of a group, public places). These exposures may trigger a panic attack.
Stress disorders - Anxiety (also known as post-traumatic stress disorder) caused by the exposure to either death or near-death circumstances such as fires, floods, earthquakes, shootings, automobile accidents, or wars, for example. The traumatic event is re-experienced in thoughts and dreams. Common behaviors include the following:

Avoiding activities, places, or people associated with the triggering event
Difficulty concentrating
Difficulty sleeping
Being hypervigilant (you closely watch your surroundings)
Feeling a general sense of doom and gloom with diminished emotions such as loving feelings or aspirations for the future

Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness generally should not be attributed to anxiety and require evaluation by a doctor.

When to Seek Medical Care

Call your doctor when the signs and symptoms of anxiety are not easily, quickly, and clearly diagnosed and treated.

If the symptoms are so severe that you believe medication may be needed
If the symptoms are interfering with your personal, social, or professional life
If you have chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness
If you are depressed and feel suicidal

When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting worse rapidly), you may be able to make an appointment with your doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may represent a serious medical illness that needs immediate evaluation and treatment in a hospital’s emergency department.

Exams and Tests

The doctor will take a careful history, perform a physical examination, and order laboratory tests as needed.

If you have another medical condition that you know about, there may be an overlap of signs and symptoms between what is old and what is new.
Just determining that anxiety is psychological does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, or other mental health professional.

Anxiety Treatment

Self-Care at Home

In certain cases, you may treat anxiety at home without the involvement of a doctor. These are limited to anxiety attacks of short duration in which you know the cause, the anxiety is short, it goes away by itself, and the cause can be eliminated. For example, you may be anxious over an upcoming public performance, a final exam, or a pending job interview. In such circumstances, stress may be relieved by such actions as these:

Talking with a supportive person
Meditation
Watching TV
Taking a long warm bath
Resting in a dark room
Deep breathing exercises

Medical Treatment

Treatment depends on the cause.
When the cause of anxiety is a physical ailment, treatment is directed toward eliminating that ailment. For example, if your thyroid gland were overactive and causing anxiety, the treatment might involve surgery and various thyroid-regulating medications.

When the cause is psychological, the underlying cause needs to be discovered, and, if possible, eliminated or controlled. For example, if the cause is difficulty in a marriage, the doctor may suggest marital counseling.

Sometimes, the cause cannot be identified. In such cases, the only treatment option is control of symptoms.

In the past, anxiety was treated with drugs in a class known as benzodiazepines. These include familiar names:
Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)
A newer anti-anxiety drug is buspirone (BuSpar).
More recently, drugs of the SSRI class (selective serotonin reuptake inhibitors, often also used to treat depression) are prescribed and include the following:
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Venlafaxine (Effexor)
In addition, psychotherapy may be useful. Combinations of medication and counseling are usually advisable.

Next Steps

Follow-up

Anxiety should be addressed and treated with your doctor. Establish an ongoing relationship. By knowing your own doctor and by having follow-up on a regular basis, you may cope with your problems and resolve them more effectively. These steps may also help you deal with medical conditions that might otherwise go undiagnosed and untreated.

Prevention

Prevention of anxiety essentially involves an awareness of life's stresses and your own ability to cope with them. This can often be a difficult task in our busy and hectic 21st century.

In essence, you might develop coping mechanisms for all of life's stresses.
Strategies might include these:
Exercise
Meditation
Relaxation exercises including deep breathing
Visualization

Interpersonal skills in dealing with difficult people and situations or parenting skills training in dealing with your children

Prevention also includes diet, regular exercise, rest, and the basics in terms of preventive health care maintenance. Diet is a large factor. Caffeine, stimulants, lack of rest, and lack of exercise all are factors that influence anxiety.

Outlook

When the cause of anxiety is identified and treated, complete recovery is often made. Where no cause can be readily identified, you may feel anxiety for a long time, perhaps your entire life. Excellent medications are available to help many of the symptoms. Counseling with mental health professionals can be highly successful.

Cognitive Behavioural Therapy CBT

CBT is a short-term talking treatment that has a highly practical approach to problem-solving. It aims to change patterns of thinking or behaviour that are behind people’s difficulties, and so change the way they feel. This booklet is for anyone interested in knowing more about CBT. It explains who and what it's for, and how to find a therapist.

What is cognitive behaviour therapy?

Cognitive behaviour therapy (CBT) describes a number of therapies that all have a similar approach to solving problems, which can range from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing people's attitudes and their behaviour. The therapies focus on the thoughts, images, beliefs and attitudes that we hold (our cognitive processes) and how this relates to the way we behave, as a way of dealing with emotional problems.

An important advantage of CBT is that it tends to be short, taking three to six months for most emotional problems. Clients attend a session a week, each session lasting either 50 minutes or an hour. During this time, the client and therapist are working together to understand what the problems are and to develop a new strategy for tackling them. CBT introduces them to a set of principles that they can apply whenever they need to, and which will stand them in good stead throughout their lives.

CBT is a combination of psychotherapy and behavioural therapy. Psychotherapy emphasises the importance of the personal meaning we place on things and how thinking patterns begin in childhood. Behavioural therapy pays close attention to the relationship between our problems, our behaviour and our thoughts.

What's the history of CBT?

In the 1960s, a US psychiatrist and psychotherapist called Aaron T. Beck observed that, during his analytical sessions, his patients tended to have an 'internal dialogue' going on in their minds, almost as if they were talking to themselves. But they would only report a fraction of this kind of thinking to him. For example, in a therapy session the client might be thinking to him- or herself: 'He (the therapist) hasn't said much today. I wonder if he's annoyed with me?' These thoughts might make the client feel slightly anxious or perhaps annoyed. He or she could then respond to this thought with a further thought: 'He's probably tired, or perhaps I haven't been talking about the most important things'. The second thought might change how the client was feeling.
Beck realised that the link between thoughts and feelings was very important. He invented the term 'automatic thoughts' to describe emotion-filled or 'hot' thoughts that might pop up in the mind. Beck found that people weren't always fully aware of such thoughts, but could learn to identify and report them. If a person was feeling upset in some way, the thoughts were usually negative and neither realistic nor helpful. Beck found that identifying these thoughts was the key to the client understanding and overcoming his or her difficulties.

Beck called it cognitive therapy because of the importance it places on thinking. It's now known as CBT because the therapy employs behavioural techniques as well. The balance between the cognitive and the behavioural elements varies among the different therapies of this type, but all come under the umbrella term cognitive behaviour therapy. CBT has since undergone scientific trials in many places by different teams, and has been applied to a wide variety of problems.

What's so important about negative thoughts?

CBT is based on a 'model' or theory that it's not events themselves that upset us, but the meanings we give them. Our thoughts can block us seeing things that don't fit with what we believe is true. In other words, we continue to hold on to the same old thoughts and fail to learn anything new.

For example, a depressed woman may think, 'I can't face going into work today: I can't do it. Nothing will go right. I'll feel awful.' As a result of having these thoughts – and of believing them – she may well ring in sick. By behaving like this, she won't have the chance to find out that her prediction was wrong. She might have found some things she could do, and at least some things that were OK. But, instead, she stays at home, brooding about her failure to go in and ends up thinking: 'I've let everyone down. They will be angry with me. Why can't I do what everyone else does? I'm so weak and useless.' So, that woman probably ends up feeling worse, and has even more difficulty going in to work the next day. Thinking, behaving and feeling like this may start a downward spiral. This vicious circle can apply to many different kinds of problems.

How does this kind of problem start?

Beck suggested that these thinking patterns are set up in childhood, and become automatic and relatively fixed. So, a child who didn't get much open affection from their parents but was praised for school work, might come to think, 'I have to do well all the time. If I don't, people will reject me'. Such a rule for living (known as a 'dysfunctional assumption') may do well for the person a lot of the time and help them to work hard. But if something happens that's beyond their control and they experience failure, then the dysfunctional thought pattern may be triggered. The person may then begin to have 'automatic' thoughts like, 'I've completely failed. No one will like me. I can't face them'.

CBT acts to help the person understand that this is what's going on. It helps him or her to step outside their automatic thoughts and test them out. CBT would encourage the depressed woman mentioned earlier to examine real-life experiences to see what happens to her, or to others, in similar situations. Then, in the light of a more realistic perspective, she may be able to take the chance of testing out what other people think, by revealing something of her difficulties to friends.

Clearly, negative things can and do happen. But when we are in a disturbed state of mind, we may be basing our predictions and interpretations on a biased view of the situation, making the difficulty that we face seem much worse. CBT helps people to correct these misinterpretations.

What form does treatment take?

CBT differs from other therapies because sessions have a structure, rather than the person talking freely about whatever comes to mind. At the beginning of the therapy, the client meets the therapist to describe specific problems and to set goals they want to work towards. The problems may be troublesome symptoms, such as sleeping badly, not being able to socialise with friends, or difficulty concentrating on reading or work. Or they could be life problems, such as being unhappy at work, having trouble dealing with an adolescent child, or being in an unhappy marriage. These problems and goals then become the basis for planning the content of sessions and discussing how to deal with them.
Typically, at the beginning of a session, the client and therapist will jointly decide on the main topics they want to work on this week. They will also allow time for discussing the conclusions from the previous session. And they will look at the progress made with the 'homework' the client set for him- or herself last time. At the end of the session, they will plan another assignment to do outside the sessions.

Doing homework

Working on homework assignments between sessions, in this way, is a vital part of the process. What this may involve will vary. For example, at the start of the therapy, the therapist might ask the client to keep a diary of any incidents that provoke feelings of anxiety or depression, so that they can examine thoughts surrounding the incident. Later on in the therapy, another assignment might consist of exercises to cope with problem situations of a particular kind.

The importance of structure

The reason for having this structure is that it helps to use the therapeutic time most efficiently. It also makes sure that important information isn't missed out (the results of the homework, for instance) and that both therapist and client think about new assignments that naturally follow on from the session. The therapist takes an active part in structuring the sessions to begin with. As progress is made, and clients grasp the principles they find helpful, they take more and more responsibility for the content of sessions. So by the end, the client feels empowered to continue working independently.

Group sessions

CBT is usually a one-to-one therapy. But it's also well suited to working in groups, or families, particularly at the beginning of therapy. Many people find great benefit from sharing their difficulties with others who may have similar problems, even though this may seem daunting at first. The group can also be a source of specially valuable support and advice, because it comes from people with personal experience of a problem. Also, by seeing several people at once, service-providers can offer help to more people at the same time, so people get help sooner.

How else does it differ from other therapies?

CBT also differs from other therapies in the nature of the relationship that the therapist will try to establish. Some therapies encourage the client to be dependent on the therapist, as part of the treatment process. The client can then easily come to see the therapist as all-knowing and all-powerful. The relationship is different with CBT.

CBT favours a more equal relationship that is, perhaps, more business-like, being problem-focused and practical. The therapist will frequently ask the client for feedback and for their views about what is going on in therapy. Beck coined the term 'collaborative empiricism', which emphasises the importance of client and therapist working together to test out how the ideas behind CBT might apply to the client's individual situation and problems.

What kind of people benefit?

People who describe having particular problems are often the most suitable for CBT, because it works through having a specific focus and goals. It may be less suitable for someone who feels vaguely unhappy or unfulfilled, but who doesn't have troubling symptoms or a particular aspect of their life they want to work on. It's likely to be more helpful for anyone who can relate to CBT's ideas, its problem-solving approach and the need for practical self-assignments. People tend to prefer CBT if they want a more practical treatment, where gaining insight isn't the main aim.

CBT can be an effective therapy for a number of problems:

anger management
anxiety and panic attacks
child and adolescent problems
chronic fatigue syndrome
chronic pain
depression
drug or alcohol problems
eating problems
general health problems
habits, such as facial tics
mood swings
obsessive-compulsive disorder
phobias
post-traumatic stress disorder
sexual and relationship problems
sleep problems

CBT does not claim to be able to cure all of the above problems. For example, it does not claim to be able to cure chronic pain or disorders such as chronic fatigue syndrome. Rather, CBT might help people with, for example, arthritis or chronic fatigue syndrome, to find new ways of coping while living with the disorders.

There is a new and rapidly growing interest in using CBT (together with medication) with people who suffer from hallucinations and delusions, and those with long-term problems in relating to others. It's less easy to solve problems that are more severely disabling and more long-standing through short-term therapy. But people can often learn principles that improve their quality of life and increase their chances of making further progress. There is also a wide variety of self-help literature. It provides information about treatments for particular problems and ideas about what people can do on their own or with friends and family.

Why do I need to do homework?

People who are willing to do assignments at home seem to get the most benefit from CBT. For example, many people with depression say they don't want to take on social or work activities until they are feeling better. CBT may introduce them to an alternative viewpoint – that trying some activity of this kind, however small-scale to begin with, will help them feel better. If that individual is open to testing this out, they could agree to do a homework assignment (say to go to the cinema with a friend). They may make faster progress, as a result, than someone who feels unable to take this risk.

How effective is it?

CBT can substantially reduce the symptoms of many emotional disorders – clinical trials have shown this. For some people it can work just as well as drug therapies at treating depression and anxiety disorders. And the benefits may last longer. All too often, when drug treatments finish, people relapse, and so practitioners may advise patients to continue using medication for longer. When patients are followed up for up to two years after therapy has ended, many studies have shown an advantage for CBT. This research suggests that CBT helps bring about a real change that goes beyond just feeling better while the patient stays in therapy. This has fuelled interest in CBT. The National Institute for Health and Clinical Excellence (NICE) recommends CBT via the NHS for common mental disorders, such as depression and anxiety. (NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.)

Comparisons with other types of short-term psychological therapy aren't clear-cut. Therapies such as inter-personal therapy and social skills training are also effective. The drive is now to make all these interventions as effective as possible, and also, perhaps, to establish who responds best to which type of therapy.

Limitations

CBT is not a miracle cure. The therapist needs to have considerable expertise – and the client must be prepared to be persistent, open and brave. Not everybody will benefit, at least not to full recovery, in a short space of time. It's unrealistic to expect too much.

At the moment, experts know quite a lot about people who have relatively clear-cut problems. They know much less about how the average person may do – somebody, perhaps, who has a number of problems that are less clearly defined. Sometimes, therapy may have to go on longer to do justice to the number of problems and to the length of time they've been around. One fact is also clear, though. CBT is rapidly developing. All the time, new ideas are being researched to deal with the more difficult aspects of people’s problems.

How does CBT work?

CBT is quite complex. There are several possible theories about how it works, and clients often have their own views. Perhaps there is no one explanation. But CBT probably works in a number of ways at the same time. Some it shares with other therapies, some are specific to CBT. The following illustrate the ways in which CBT can work.

Learning coping skills

CBT tries to teach people skills for dealing with their problems. Someone with anxiety may learn that avoiding situations helps to fan their fears. Confronting fears in a gradual and manageable way helps give the person faith in their own ability to cope. Someone who is depressed may learn to record their thoughts and look at them more realistically. This helps them to break the downward spiral of their mood. Someone with long-standing problems in relating to other people may learn to check out their assumptions about other people's motivation, rather than always assuming the worst.

Changing behaviours and beliefs

A new strategy for coping can lead to more lasting changes to basic attitudes and ways of behaving. The anxious client may learn to avoid avoiding things! He or she may also find that anxiety is not as dangerous as they assumed.
Someone who’s depressed may come to see themselves as an ordinary member of the human race, rather than inferior and fatally flawed. Even more basically, they may come to have a different attitude to their thoughts – that thoughts are just thoughts, and nothing more.

A new form of relationship

One-to-one CBT can bring the client into a kind of relationship they may not have had before. The 'collaborative' style means that they are actively involved in changing. The therapist seeks their views and reactions, which then shape the way the therapy progresses. The person may be able to reveal very personal matters, and to feel relieved, because no-one judges them. He or she arrives at decisions in an adult way, as issues are opened up and explained. Each individual is free to make his or her own way, without being directed. Some people will value this experience as the most important aspect of therapy.

Solving life problems

The methods of CBT may be useful because the client solves problems that may have been long-standing and stuck. Someone anxious may have been in a repetitive and boring job, lacking the confidence to change. A depressed person may have felt too inadequate to meet new people and improve their social life. Someone stuck in an unsatisfactory relationship may find new ways of resolving disputes. CBT may teach someone a new approach to dealing with problems that have their basis in an emotional disturbance.

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