CBT Newsletter December 2010

CBTMONTHLY December 3rd 2010

What is Insomnia and is there hope?

What is REBT and is it still relevant?

Trent talks about how CBT made a difference for his problem with Body Dysmorphic 1Disorder.

CBTMONTHLY December 3rd 2010

This month What is Insomnia?

Matt Broadway-Horner

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

Matt Broadway-Horner

Overcoming Insomnia using CBT. Matt Broadway-Horner Testimonial on his battle with Insomnia Andy Case 2 Testimonial on her battle with Insomnia Natalie

CBT made a difference!

Body Dysmorphic DisorderTrent

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all at the clinic wishes you a merry christmas

By Matt Broadway-Horner

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

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

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

CBTMONTHLY December 3rd 2010

what is rational emotive behaviour therapy? an approach within the cbt tradition

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

By Matt Broadway-Horner

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

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

A popular REBT framework thus assumes that people have both an innate rational (meaning, self- and socialhelping and constructive thoughts) and irrational (meaning, self- and socialdefeating and unhelpful thoughts) tendencies and leanings. It is the skill of the therapist that helps point the individual to this self help. REBT may be used for the treatment of anger,

Matt Broadway-Horner

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

what is insomnia? a sleeping diagnosis

By Matt Broadway-Horner

For treatment then contact the clinic on 0207 558 8894 and a Therapist can be booked matt@cbtinthecity.com

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

that demanding thinking places pressure on self that the natural process of selection in dating only goes one way and it will be awful if another outcome takes place. If this type of thinking continues then this could lead to a reduction in lifestyle and feeling stuck to carry out his Valued Direction of wanting to be remembered as a man who wants to love and be loved by someone special. The Value if not being met will then lead the man to not only feel Anxious but Depressed about what he has lost For more information regarding REBT please contact us for more information-matt@cbtinthecity.com non-pharmacological interventions such as relaxation therapy, biofeedback, exercise, dietary changes,phototherapy and medications The sleep routine can be resumed with some hard work, the rewards are many and life can feel very normal again with intervention sort sooner rather than later. Contact CBT specialists today!

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CBTMONTHLY December 3rd 2010

CBTMONTHLY December 3rd 2010

overcoming insomnia with cognitive behaviour therapy. a sleeping problem

By Matt Broadway-Horner

Apporximately 10-15% of the genral population, with an increased prevalence in women and older adults. Half of these report severe symptoms occurring nightly, these being that it takes 2 hours or more to fall asleep and 1 hour or more waking during the night. Many groups of people suffer from chronic insomnia, both the people with medical conditions and mental health conditions suffer and according to research the data show this population to be upto 20%. The other group is related to stress which can lead to a lifestyle that is not conducive to a good sleep pattern, these behaviours might include different times for going to bed, staying awake in bed and carrying out stimulating tasks like working on the laptop, reading etc. when waking during the night the routine might be to have a cigarette and watch TV till feeling sleepy which all contributes to long well established self defeating behaviours leading to Insomnia.

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

However there is hope, there are many treatments options for insomnia including: behavioral therapy, non-pharmacological interventions such as relaxation therapy, biofeedback, exercise, dietary changes,phototherapy and medications CBT seeks to change poor sleep habits and unhelpful thoughts and attitudes about sleep and promote good sleep.

The CBT interventions include sleep restriction, stimulus control, relaxation techniques, education and sleep hygiene CBT is as successful as medications in the acute treatment (4-8 weeks) of insomnia and on average of 50-60% improvement for those treated by a CBT. Most suitable for patients who are preoccupied with the potential consequences of their insomnia or for patients who complain of unwanted intrusive thoughts or worry. Serves to deconstruct patient’s negative thoughts and attitudes about their condition which is thought to decrease the anxiety and arousal associated with Insomnia.

Case 1 :Andy 34 yr old white male working in the City for a major Finance company who has been suffering from Insomnia for the last year. He could not understand why he was having this

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problem as he had tried all the know remedies like hot milk, at bedtime etc but the sleep disturbance continued to a point that he then felt Depressed for the last month and then presented to the GP January 2010. He was seen for individual Cognitive Behaviour Therapy for 4 months to treat the Depression initially and then go on to treating the Insomnia. In sessions he could begin to see how the Automatic Negative Thoughts (ANTs) and attitudes about his work were fear related and the continuing low security of his position at work had contributed to his high stress levels to a point where he was heavily preoccupied just before going to bed. He became Depressed as a result of continued bad sleep - Insomnia His attitude was one of “I must work harder and if I don’t then I am a failure”, which he told himself many times over through out the last year. When he was not able to reach his ever increasing demands on himself he then experienced a chipping away of his confidence. This then would lead to his attention being biased to start finding evidence for his failures and then using these ideas to beat himself up over and over.

His colleagues also worked hard around him and so he did not see that his ANTs and attitudes were a contributing factor to his sleep problem and so did not seek help sooner. He thought to himself “Just pull yourself together man!”At times he felt so low that “I considered ending my life sometimes” as the fatigue was too much to cope with at times. He viewed his problem as a failure that no one else can see and this rule he lived by til he saw the GP. In the treatment sessions Andy worked hard to change his associations in the bedroom from working with document papers/computer etc to a place fit for the purpose of sleep and sex. Sleep restriction was used to address his imbalance time spent in bed. He would go to bed at 12am then lie awake for 2 hours til he slept. For effective treatment it was necessary to go to bed later to reduce time brooding on “why can I not sleep” along with Attentional Training exercises on his breathing and also looked at the ANTs and attitudes to find alternative helpful thoughts and attitudes which did have a knock good effect on his sleep reducing the Insomnia. The treatment package has other aspects to it which then after 8 sessions of CBT for Insomnia brought about a change that he was happy about.

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

CBTMONTHLY December 3rd 2010

overcoming insomnia with cognitive behaviour therapy case 2 natalie

By Matt Broadway-Horner

‘Her attitude was one of “I must work harder not enough time in the day and if I don’t then I am a failure”, which she told herself many times over through out the 6 months.

This then would lead to her attention being biased to start finding evidence for what she had not done and start to feel a failure’ Matt Broadway-Horner

Case 2 Natalie 44 yr old white woman Natalie who works in the City for a big finance company presented to GP after persistent problem with Insomnia for the last 6 months and again she had tried the known remedies but to little or no effect.

Her attitude was one of “I must work harder not enough time in the day and if I don’t then I am a failure”, which she told herself many times over through out the 6 months. This then would lead to her attention being biased to start finding evidence for what she had not done and start to feel a failure and then using these ideas to beat herself up. Again like with Andy she tried to ignore the problem and thought it would go away. She thought if I can make it another day but then due to a lack of sleep she began to feel low in mood In the treatment sessions Natalie worked hard to change her associations in the bedroom from working with document papers/computer etc to a place fit for the purpose of sleep and sex. Sleep restriction was used to address her imbalance time spent in bed. She would go to bed at 11am then lie awake for 4 hours tossing and turning til she slept. For effective treatment it was necessary to go to bed later to reduce time brooding on “why can I not sleep” along with Attentional Training exercises on her breathing and also looked at the ANTs and attitudes to

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find alternative helpful thoughts and attitudes which did have a knock good effect on her sleep reducing the Insomnia. The treatment package has other aspects to it which then after 5 sessions of CBT for Insomnia brought about a change that she was happy about.

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

Matt Broadway-Horner Cognitive Behaviour Therapist for CBT in the City Clinics Head Office 10 Harley Street London W1G 9PF tel: 02075588894 or email: matt@cbtinthecity.com

CBTMONTHLY December 3rd 2010

cognitive behaviour therapy made a difference body dysmorphic disorder

By Trent

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

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

To self refer or to make a referral then please call the head office 02075588894 or email: matt@cbtinthecity.com

An appointment can be arranged at the clinic with available appointments

CBTMONTHLY 10 Harley Street London W1G 9PF

The Editor 10 Harley Street London W1G 9PF

CBTMONTHLY December 3rd 2010