Dealing with Depression

Depression can often be brought on by life stress, or by a sudden loss, such as relationship breakdown or the loss of a job.  It is characterised by low mood, pessimistic thoughts, hopelessness, poor sleep and the thought that life is not worth living.  People with depression are often also anxious; they can feel restless and irritable, worried that they have too much to do but unable to settle to any task.  They may also feel so low and unable to do anything that they stay in bed and stop doing even the smallest tasks. 

Research has shown that depressed people suffer from negative and pessimistic thoughts.  They often feel that they are bad or worthless, that their situation is hopeless and that the future will be worse.  This can make it difficult to tackle any task because one feels that one will not be successful.  For example, many sufferers will not open their post or will put off the simples household chores.  At the same time, sufferers feel too low and pessimistic to enjoy themselves. 

As in all CBT, therapy begins with a Formulation, which is developed in collaboration between patient and therapist.  The formulation helps both patient and therapist to understand what has caused the depression and what is maintaining it.

One part of Cognitive-Behavioural Therapy can involve Behavioural Activation, which involves helping the depressed person to begin a programme of more positive activities.  Initially, the therapist may ask the sufferer to keep an Activity Schedule, to see what activities are most helpful in raising their mood.   Exercise, even very moderate exercise can be very helpful, and activity also helps the sufferer to feel that he or she is achieving something.

Therapists will often ask patients to keep records of their thoughts, especially those thoughts that seem to trigger changes in mood.  Thought Records are used to understand what negative thoughts are important in maintaining the depression, and therapy can help patients to take a fresh look at these thoughts.

Depression can begin to lift after a few sessions of CBT.  As the client’s mood improves, patient and therapist can look at long-term factors that might cause depression to recur as well as client strengths and ways of preventing relapse.

CBTCounsellor Living with Anxiety

Dealing with Extreme Anxiety

Anxiety is the feeling you have when you think that something unpleasant is going to happen in the future. Other words such as feeling ‘apprehensive’,
‘uncertain’, ‘nervous’ and ‘on edge’ also provide a good description of feelings linked to anxiety.

This is completely normal and something that all human beings experience from time to time, when faced with situations that are difficult or threatening.

depression or work related stress diagnosed every
2.1 minutes Labour force

Labour force survey 2015

Almost 1 in 5 UK adults have symptoms of anxiety and depression

Fundamental Facts About Mental Health 2015

Only 7.3% of mental health research funds are spent on anxiety per year

UK Mental Health Research Funding 2015

Stress is the top health and safety concern in UK workplaces

Trades Union Congress Survey 2016

The word is often used to cover a broad range of experiences and is linked with emotions such as fear and worry. In fact, ‘fear’ and ‘anxiety’ are almost interchangeable terms.

This can at times be a helpful emotion, as it can help you to prepare for events ahead as well as improving your performance. However, anxiety can become so severe and intense at times that it becomes debilitating and starts to restrict daily routine and life as a whole. In essence, at this point, what you experience has got out of proportion and you end up feeling much more anxious than you would expect someone else to be in your circumstances. At this point, you can be said to be suffering from an anxiety disorder. There are many different anxiety disorders (phobias, Obsessive Compulsive Disorder – OCD – panic attacks, etc) that all have anxiety symptoms at their core.

This is an emotion like anger and sadness. Anxiety (sometimes referred to as stress, nerves or fear), plays an important role in the normal functioning of the body; without it we would not be able to function.
Indeed anxiety can be a helpful emotion as it can prepare us for future events as well as improving our performance.

However, when anxiety becomes so severe, intense, disproportionate or overwhelming that it starts to restrict daily routine and life as a whole, it is then anything but helpful and can be disabling and life changing.

When this point is reached, those affected can be said to be living with an ‘anxiety disorder’ of which there are many different types including: panic disorder, social anxiety disorder, agoraphobia, obsessive compulsive disorder (OCD), phobias and post traumatic stress disorder (PTSD).

Despite the numerous forms of anxiety disorder, all have elements in common including physical, psychological and behavioural responses.

Psychological aspects

The release of adrenaline that is triggered by anxiety also causes psychological symptoms that affect thoughts and feelings. In addition to preparing the body for physical action, adrenaline also motivates people psychologically by prompting specific patterns of thinking. These psychological effects can be seen as what people think, feel and say to themselves when anxious.

Below is a list of common thoughts and feelings experienced by people when anxious:

  • Feeling frightened and panicky
  • Worrying about losing control/going mad
  • Worrying that they might die
  • Worrying that they might have a heart attack/
    be sick/faint/ have some other illness
  • Feeling that people are looking at them
    and are observing their anxiety
  • Feeling generally as if things are speeding up
  • Feeling detached from their environment and
    the people in it
  • Feeling like wanting to run away/escape from
    the situation and the people in it
  • Generally feeling on edge
  • Clock watching

Many of the above thoughts could be summarised as ‘What If’ thoughts. What if this happens? What if I do this? . . .

Low Self-esteem

Low Self-esteem – I accept myself because I’m alive and have the capacity to enjoy my existence. I am not my behaviour. I can rate my traits and my behaviour, but it is impossible to rate something as complex as my ‘self.’

Self-esteem refers to how good we feel about ourselves.  Most people feel that they do reasonably well most of the time, though self-esteem can fall with a mistake or failure in some particular area.  However, some people suffer with low self-esteem, the feeling that they are of lesser worth than others.

They tend to focus on their failures and weaknesses, and if they succeed at something, they find reasons to think that their success is not very important.  People with low self-esteem have often had difficult childhoods and sometimes suffered trauma; they are at risk for depression, though low self-esteem can also affect them when they are not depressed.

CBT has developed techniques to help those with low self-esteem hold a more balances view of themselves.  The process starts with a Formulation, a model that patient and therapist design together that explains how low self-esteem started and why it persists.  Self-critical thoughts are explored using a Thought Record, and Behavioural Experiments carried out to see if acting in a different way can have an effect on self-esteem.

Self-esteem/Self-Worth – What it is, and is not

If you feel (I did not say think) that you are worthless, you may be and probably are a victim of a culture that has told you that your worth depends on your achievements and the judgments of others. The feeling of worthlessness besets and enervates men and women, but in different ways.

For women it can be a devastating experience, especially for those who experience depression after a loss of love or approval. The same society which supports organized brutality in the form of football and boxing, assigned them second-class citizen status-a promotion from the third-class status of only 30 years ago. They are vulnerable, they are moving targets.

And men? David Burns, in his wonderful book, Feeling Good, wrote that men are even more vulnerable than women to feelings of worthlessness. He points out that men have been programmed since childhood to base their worth on their accomplishments. They must deal with unrealistic expectations assigned to them by the society in which they live.

Winners are enshrined: all others are ‘losers,’ and are forgotten. Our culture tells us that what we do is important. What we are is not. That’s wrong, dead wrong.

At the end of therapy a long-term plan is devised to help the sufferer continue to do those things that boost her self-esteem.



Trauma or PTSD is an anxiety disorder which may develop following exposure to any one of a variety of traumatic events that involve actual or threatened death, or serious injury.

The event may be witnessed rather than directly experienced and even learning about it may be sufficient if the persons involved are family members or close friends. Typical traumatic events which may trigger

Trauma/PTSD are:

  • Serious physical assault
  • Sexual assault
  • Kidnapping
  • Motor accidents – the most common trigger of PTSD
  • Torture
  • Child abuse – especially when the stress endured is prolonged
  • Fire, flood, earthquake, plane crash
  • Battle experiences

Cognitive Behaviour Therapy (CBT) for Trauma

CBT currently has the largest amount of research carried out on its effectiveness. CBT/REBT focuses on what people think, how those thoughts affect them emotionally and how they ultimately behave.

When someone is distressed or anxious, the way they see and evaluate themselves can become negative. CBT/REBT therapists work alongside the person to help them begin to see the link between negative thoughts and mood. This empowers people to assert control over negative emotions and to change the way they behave.

CBT/REBT can be delivered at a number of levels of intensity, meaning it can be useful to those who have only just started feeling anxious as well as those with longstanding anxiety problems. CBT/REBT is delivered by a trained therapist, usually in a clinical setting.

This form of therapy focuses on the ‘here and now’ and is not overly concerned with finding the initial cause of anxiety. Once the problem has been explored, the therapist will help you examine your thought and behaviour patterns and help you to work on ways of changing these.

Eating Disorders


Abnormal attitude to food

They tend to focus exclusively on their fat leading to making unhealth choices with damaging results

Types of Eating disorders

Starving and excessive Anorexia – keep weight low

Bulimia – Control body weight by binge, vomiting, purging laxatives.

Binge Eating – Compulsion to overeat

Unhealthy Beliefs 

How is problem being maintained.

Unhealthy beliefs are prominent feature

Regarded as being at the heart of psychotherapy.

UHB regarding shape and Weight are indicative of eating disorders.

Self-value – based on body shape and weight is also at the core of eating disorders

Most Important Components of Eating Disorders

Strict dieting – low weight and binging

Low weight – extreme hunger and binging

Binging – trigger for UHB and UNE

Compulsory behaviour leads o dieting which causes hunger, low weight, binging and more dieting.


4 Components trigger an interacting system of

  • Behaviour
  • Emotions
  • Beliefs
  • Personality traits
  • Psychological problems

This system is responsible for most important symptoms

One can argue that eating disorders are Cognitive disorders


Social pressures often blamed but its more complex

Could be biological or influencing factors combined with experience that may provoke the disorder.

Other factors

Risk factors.

Family history – eating disorders depression substance abuse

Criticism – for their eating habits, body shape and weight

Overly concern – combines with pressure to be thin/slim

Obsessive Personality – anxiety disorder, low self-esteem or being a perfectionist.

Sexual or emotional – or death of someone

Difficult relationship – with family or friends

Stressful situation – problems at wok, school etc



Well-established research suggests that a large majority of people sometimes experience unwanted, intrusive thoughts (OCD).  Most people are able to ignore such thoughts, but for some they can cause difficulties.  In such a case we speak of obsessional thoughts or obsessions. 

A common thought is that the sufferer, either through carelessness or deliberately, might harm someone, perhaps someone he loves.  People will generally find these thoughts distressing and, needless to say, in such cases the person is not actually going to harm anyone. 

Often the sufferer will fear such thoughts and try not to think about them, but this can often make things worse.  He may try to do something to prevent the harm from happening.  This might be something mental, such as repeating a certain phrase for a number of times, or some action, such as checking the gas taps repeatedly.  We speak of these actions as compulsions; the problem with them is that they often prolong the sufferer’s distress.  Someone might check their gas taps or front door numerous times or clean their kitchen surfaces many times a day with strong chemicals. 

Such actions can be thought of as Safety Behaviours; they don’t usually make harm any less likely, but they can cause real difficulties for the sufferer.  In CBT treatment patient and therapist will first devise a Formulation and look at Maintenance Cycles, to see how the obsessional problem is maintained.  Thoughts about harm and possible bad outcomes are carefully evaluated, to help the sufferer think about risks in a more realistic manner. 

Behavioural Experiments can then be devised to check and modify risk beliefs.  Collaboration is used, so that the sufferer does not feel pressured to change but can modify her evaluation of both obsessions and compulsions at her own pace.

IBS treatment from


Irritable Bowel Syndrome

IBS is a condition whereby the intestines squeeze too hard or not hard enough and cause food to move too quickly or too slowly through the digestive system. This is not a disease, but rather a collection of symptoms shared by many people. It is because this is such a varied condition that
there is no single solution for everyone.

However, it is important if you think you may be suffering to get a clinical diagnosis from a gastroenterologist in order to rule out other serious illnesses such as Crohn’s disease or ulcerative colitis. There is no specific test for IBS so diagnosis is based on exclusion of other conditions and centres around the experience of particular symptoms.

What are the triggers for IBS?

Stress seems to be the major trigger with many sufferers reporting that their symptoms began during periods of major life stresses such as divorce, bereavement, etc.

However, in addition to this, others find that their symptoms began during or shortly after recovering from a gastrointestinal infection or abdominal surgeries. Some people also find their IBS begins after eating certain foods to which they are sensitive.

There is no specific type of food which triggers IBS. Indeed, different foods will trigger IBS symptoms in different sufferers. Occasionally, a flare-up of IBS may be triggered by all of the above or for no apparent reason.

Treatment of IBS Diet plays a very important role in managing IBS and it is important to eat high fibre foods, drink plenty of water and avoid foods that worsen the problem. It is also very important for IBS sufferers to find ways of managing their stress.

Cognitive Behavioural Therapy (CBT)

A large proportion of the fear associated with having an ‘accident’ is a direct result of negative thinking.

For example, thoughts such as ‘I will be unable to reach the toilet in time’, ‘I may embarrass myself by having an ‘accident’’ or ‘I must restrict what I am eating or else I will not be able to control my bowels’ are common.

Therefore, cognitive behavioural therapy is particularly useful as it addresses these negative thought patterns and looks at the behaviours which can keep the fears going (or even make them worse).

Social Anxiety

Social anxiety/phobia refers to an excessive anxiety about social situations.  Someone with social phobia might be afraid of blushing or stammering in conversation, and believe that if he does these things, others will judge him harshly, or he may believe that he seems boring or unattractive to others.  Sufferers often describe a vivid image of themselves as seen by others, with all their faults exaggerated.

A sufferer might employ Safety Behaviours; for example, someone with fear of sweating might always wear loose, cool clothing, or a person who fears to be thought boring might always say as little as possible.  CBT techniques can help the sufferer to evaluate her thoughts more realistically, and Behavioural Experiments can help her to form a more realistic view of how others might judge her.

Anger Management

Is your temper taking over your life? 

Anger is a normal, healthy emotion, neither good nor bad. Like any emotion, it conveys a message, telling you that a situation is upsetting, unjust, or threatening. If your knee-jerk reaction to anger is to explode, however, that message never has a chance to be conveyed. So, while it’s perfectly normal to feel angry when you’ve been mistreated or wronged, anger becomes a problem when you express it in a way that harms yourself or others.

You might think that venting your anger is healthy, that the people around you are too sensitive, that your anger is justified, or that you need to show your fury to get respect. But the truth is that anger is much more likely to have a negative impact on the way people see you, impair your judgment, and get in the way of success.

If you have a hot temper, you may feel like it’s out of your hands and there’s little you can do to tame the beast. But you have more control over your anger than you think. With insight about the real reasons for your anger and these anger management tools, you can learn to express your emotions without hurting others and keep your temper from taking over your life.

Fears Phobias from


Phobias are an excessive fear; sometimes it is focused on an object like spiders, or situation, like going to the dentist; sometimes, as in social phobia, it involves a fear of social situations, and sometimes people with a phobia will also suffer from panic attacks.  Having a phobia can be very embarrassing, and many sufferers will go to great lengths to conceal their phobia from others.

As with all forms of CBT, therapist and client will first create a Formulation.  It will explore the history of the problem, but also look at factors in the present that maintain it.  Often thoughts of threat and danger are key.  People with phobias often have a vivid image of the danger that they fear, and far less fear of many other things that are more dangerous.  Fear of flying is a good example; driving is much more dangerous than flying, but fear of flying is much more common.

Actions are often the key factor maintaining a phobia.  Many people with phobias engage in Safety Behaviours; these are actions that make them feel safer, without actually being safer.  Exploring these thoughts, actions and images helps to understand the phobia.  Therapy will often the proceed with Behavioural Experiments, in which the client, either with the therapist of by himself, is able to learn more about how dangerous the thing he fears actually is.

These behavioural experiments will be carefully devised by client and therapist, working in collaboration, to make sure that the client can do them, and that the client will learn important new information from them.  Many phobic clients are amazed at how quickly they can make progress thought CBT.