1. Rating your self or your you-ness is an overgeneralization and is virtually impossible to do accurately. You are (consist of) literally millions of acts, deeds, and traits during your lifetime. Even if you were fully aware of all these performances and characteristics (which you never will be) and were able to give each of them a rating (say, from zero to one hundred) how would you rate each one?; for what purpose?; and under what conditions? Even if you could accurately rate all your millions of acts, how could you get a mean or global rating of the ‘you’ who performs them? Not very easily!

2. Just as your deeds and characteristics constantly change (today you play tennis or chess or the stock market very well and tomorrow quite badly), so does your self-change. Even if you could, at any one second, somehow give your totality a legitimate rating, this rating would keep changing constantly as you did new things and had more experiences. Only after your death could you give your self a final and stable rating

3. What is the purpose of rating your self or achieving ego aggrandizement or self-esteem? Obviously, to make you feel better than other people: to grandiosely deify yourself, to be holier than thou, and to rise to heaven in a golden chariot. Nice work, if you can do it! But since self- esteem seems to be highly correlated with what Bandura (1977) calls self-efficacy, you can only have stable ego-strength when (a) you do well, (b) know you will continue to do well, and (c) have a guarantee that you will always equal or best others in important performances in the present and future. Well, unless you are truly perfect, lots of luck on those aspirations!

4. Although rating your performances and comparing them to those of others has real value because it will help you improve your efficacy and presumably increase your happiness rating your self and insisting that you must be a good and adequate person will (unless you, again, are perfect!) almost inevitably result in your being anxious when you may do any important thing badly, depressed when you do behave poorly, hostile when others out-perform you, and self- pitying when conditions interfere with your doing as well as you think you should. In addition to these neurotic and debilitating feelings, you will almost certainly suffer from serious behavioral problems, such as procrastination, withdrawal, shyness, phobias, obsessions, inertia, and inefficiency (Bard, 1980; Ellis, 1962, 1971, 1973; Ellis and Becker, 1982; Ellis and Harper, 1975; Ellis and Knaus, 1977; Grieger and Grieger, 1982; Miller, 1983; Walen, diGiuseppe and Wessler, 1980; Wessler and Wessler, 1980).

For these reasons, as well as others that I have outlined elsewhere (Ellis, 1962, 1971, 1973, 1976, 1988), rating or measuring your self or your ego will tend to make you anxious, miserable, and ineffective. By all means rate your acts and try (undesperately!) to do well. For you may be happier, healthier, richer, or more achievement- confident (confident that you can achieve) if you perform adequately. But you will not be, nor had you better define yourself as, a better person

If you insist on rating your self or your personhood at all which REBT advises you not to do, you had better conceive of yourself as being valuable or worthwhile just because you are human, because you are alive, because you exist. Preferably, don’t rate your self or your being at all and then you won’t get into any philosophic or scientific difficulties. But if you do use inaccurate, over-generalized self-ratings, such as ‘I am a good person,’ ‘I am worthwhile,’ or ‘I like myself,’ say ‘I am good because I exist and not because I do something special.’ Then you will not be rating yourself in a rigid, bigoted, authoritarian, that is, fascistic manner.

‘No one can go back in time, but you can revisit things and view them in a different light. This was, I suppose the basic idea behind my therapy sessions with Matt when we started looking at my past. I was physically abused as a child. Fact – I can’t change that. What I can change however, is how I deal with the memories I have from that, and how I can view my future differently, more positively. Through using imagery and grounding skills in my sessions with Matt, I learnt how I could not change the past, but change the way it affects me in my day-to-day life. I no longer live in fear and my nightmares are history. I live a life I never thought I could and am happier than ever. So thank you Matt, for everything

• Serious road accidents
• Military combat
• Violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
• Being taken hostage
• Terrorist attack
• Being a prisoner-of-war
• Natural or man-made disasters
• Being diagnosed with a life-threatening illness

Even hearing about an unexpected injury or violent death of a family member or close friend can start PTSD
When does PTSD start? The symptoms of PTSD can start after a delay of weeks, or even months. They usually appear within 6 months of a traumatic event

What does PTSD feel like? Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms produced by such an experience:

1. Flashbacks & Nightmares You find yourself re-living the event, again and again. This can happen both as a “flashback” in the day, and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind, but may also feel the emotions and physical sensations of what happened – fear, sweating, smells, sounds, pain

Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback

2. Avoidance & Numbing It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crossword or jigsaw puzzles. You avoid places and people that remind you of the trauma, and try not to talk about it

You may deal with the pain of your feelings by trying to feel nothing at all – by becoming emotionally numb

You communicate less with other people, who then find it hard to live or work with you

3. Being “On Guard” You find that you stay alert all the time, as if you are looking out for danger. You can’t relax. This is called “hyper vigilance”. You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable

Other Symptoms Emotional reactions to stress are often accompanied by:

• Muscle aches and pains
• Diarrhoea
• Irregular heartbeats
• Headaches
• Feelings of panic and fear
• Depression
• Drinking too much alcohol
• Using drugs (including painkillers)

What makes PTSD worse?

The more disturbing the experience, the more likely you are to develop PTSD. The most traumatic events:

• Are sudden and unexpected
• Go on for a long time
• You are trapped and can’t get away
• Are man-made
• Cause many deaths
• Cause mutilation and loss of arms or legs
• Involve children

How can I tell if I have PTSD?

Have you have experienced a traumatic event of the sort described at the start of this leaflet? If you have, do you:

• Have vivid memories, flashbacks or nightmares?
• Avoid things that remind you of the event?
• Feel emotionally numb at times?
• Feel irritable and constantly on edge but can’t see why?
• Eat more than usual, or use more drink or drugs than usual?
• Feel out of control of your mood?
• Find it more difficult to get on with other people?
• Have to keep very busy to cope?
• Feel depressed or exhausted?

If it is less that 6 weeks since the traumatic event and these experiences are slowly improving, they may be part of the normal process of adjustment

If it is more than 6 weeks since the event, and these experiences don’t seem to be getting better, it is worth talking it over with your doctor

For more information visit CBT for Post Traumatic Stress Disorder (PTSD)

Well-being coach Dan Roberts (www.danroberts.com) says; “Insomnia is increasingly common in our over-stimulated, always-on, stressed-out modern world. But a lack of sleep can profoundly affect your mind function, decision-making and memory – all of which are crucial in fitness performance. A sleep deficit also has a powerful effect on your mood, so can be a key factor in stress, anxiety, depression or just feeling flat and uninspired.” These negative emotions will interfere with the commitment and energy that are required for working-out

How much sleep?

The right amount of sleep varies from person to person, but the average is about seven hours. Dan says that consistency is key too; “there’s no point getting five hours a night on weekdays and catching up with a 10-hour sleepathon at weekends. Your body needs downtime to repair damage caused during the day, while your mind needs night-time inactivity to process the day’s events (which is why we dream)”

Exercise can help you sleep

Dan explains how powerful exercise can be when it comes to easing you into slumber; “taking regular cardio exercise like running, spin classes, cycling or tennis for instance can help you to get a better night’s sleep. So too can calming, meditative exercise like yoga or tai chi

“With Cardio-Vascular exercise you can actually burn off stress and anxiety. CV makes you physically tired, in a good and healthy way. More calming exercise, like Yoga, deactivates your stress response and activates your relaxation response.” If you are struggling with getting to sleep though it’s advisable to not do your workout too close to bedtime as this may make you too warm and too energised to sleep

Sleep your way to better performance

So exercise can help you sleep – but sleep can help your exercise? Personal Trainer, Gavin Walsh
www.thebootcamp.co.uk believes that to reach your goals for physical fitness you need to be mentally fit too and that sleep is key, he explains; “Sleep is an often over-looked fitness tool. However, it is highly important, and should not be ignored if you don’t want performance to suffer. You’re more likely to achieve a Personal Best if you’ve had 7 hours + sleep”

If we don’t sleep enough we just won’t be at our peak in terms of health and fitness levels. In fact sleep deprivation studies on mice have demonstrated that if you’re kept awake long enough, in time your immune system and overall well-being simply breaks down

If we don’t sleep enough we just won’t be at our peak in terms of health and fitness levels. In fact sleep deprivation studies on mice have demonstrated that if you’re kept awake long enough, in time your immune system and overall well- being simply breaks down

“Lots of studies show lack of sleep can lead to impaired reaction times and decreased endurance”, says Fitness expert Nick Critchley. He believes that performance suffers when sleep is lost; “sleep-time is when we replenish our neuro- transmitters as well as being a time for repair and regeneration of tissues used during intense exercise”

Sleep for focus

Gavin says research demonstrates that it can take up to 7-8 hours of sleep for our bodies to process the toxins we accumulate on a daily basis. “These toxins can help reduce focus as they interfere with our mind-set. The toxins include processed foods, alcohol, air pollution and even poor quality water. The accumulation of these toxins and sleep deficit can throw our hormones to play havoc. For example, cortisol, a stress hormone increases with a lack of sleep which can further take-away from our focus on our sport or fitness activity”

Sleep and Diet

Eating the wrong foods, putting on weight or just feeling more sluggish can have a hugely detrimental effect on our ability to exercise. Sleep, or lack thereof, can lead us into negative eating patterns, Dan explains; “If you struggle with food cravings or binge eating, one of the key triggers is being over-tired. When we are exhausted our strength is depleted and our willpower is low, so it’s much easier to succumb to cravings – especially for the kinds of sweet, sugary foods we crave during periods of low energy. You may also crave carbohydrates like crisps, pasta or rice or caffeinated drinks because your brain thinks you need quick, easily digested sources of energy. Getting the right amount of sleep will help keep these cravings at bay”

Sleep and Injury Risk

Gavin tell us that not getting enough sleep can increase the risk of getting injured because you won’t be paying enough attention to form; your stride and posture may suffer and this in turn can lead to twists and strains. He says, “If you’ve had a poor night’s sleep, then there is less chance that you’ll be working to your full strength during training. This lack in power and focus will have a damaging effect on how you move and your posture. All of this is crucial when at the gym performing highly demanding technical lifts; your risk of injury will certainly be increased.” Gavin acknowledges that it’s not just down the gym that problems might arise; “when running or taking part in any sport, if you’re feeling tired you’re much more likely to end up with an injury, and this could see you out of action for months”

Well-being CBT therapist Matt Broadway-Horner gives some tips for the perfect night’s sleep..

Do…

• Develop good ‘sleep routine’. So make sure your bedroom is cool, quiet and dark (use a blackout blind if you have to – even a small amount of ambient light interferes with the body’s sleep-controlling mechanisms)

• Switch the TV off an hour before bed and read, listen to soothing music or take a long, hot bath

View our CBT Newsletter March 2012

Lets start with assessing them….

People who are depressed typically think in a biased negative way. They have negative views of themselves (eg I’m no good), the world (eg Life has no meaning) and the future (eg I will always feel this way). People who are anxious typically think in a catastrophic way (eg I am going to die), the world (eg The World is unsafe) and the future (eg I will never cope). As you progress in therapy, you will learn to identify other patterns of thinking that affect the way you feel such as extreme anger, jealousy, envy, shame, embarrassment and other emotions

Automatic Negative Thoughts are the most basic form of thoughts. We are not trained to identify them. In the course of therapy, one of the most important aspects of therapy is to identify these automatic thoughts

They have several characteristics which are:

Automatic – they just pop into your head without any effort on your part

Distorted – they do not fit in with all the facts

Unhelpful – they keep you feeling the extreme feelings that you experience, make it difficult to change and stop you getting what you want out of life

Plausible – you accept them as facts and it does not occur to you to question them Involuntary – you do not choose to have them and they can be very difficult to switch off

These thoughts can trap you in a vicious circle and maintain the way you feel. For example, the more depressed you become the more automatic negative thoughts you have and the more you believe them and this in turn makes you feel more depressed. The main goal of Cognitive Behaviour Therapy is to help you break out of this vicious circle by helping you develop the skills in dealing with these Negative Automatic Thoughts

Initially you may find it not easy to identify your automatic thoughts and deal with them. Challenging Automatic Negative Thoughts is like any other skill and it takes time and regular practice to be able to do it with ease. Your therapist will highlight the importance of dealing with Negative Automatic Thoughts. Don’t be discouraged if you have difficulties. In sessions, your therapist will help you to identify them and you will be set these as your homework so you will have opportunities to practise on your own. The more you do, the easier it gets and challenging your automatic negative thoughts will become natural to you

The first step in challenging your Automatic Negative Thoughts is to become aware of your thoughts and of their effects on you

These thoughts have an effect on you and make you feel bad, anxious, sad, depressed, hopeless, guilty and angry. Instead of becoming overwhelmed by these emotions, you can learn to use them as a cue for action. Notice when your mood changes for the worst and look back at what was running through your mind at the moment. Over the course of a few days, you will become more sensitive to changes in your feelings and to the thoughts that spark them off. You may find that the same thoughts (and beliefs) occur again and again

How to do it
The best way to become aware of your automatic thoughts is to write them down as soon as they occur. You can do this on the ABC Form

Step 1
Write down the emotion you experienced at C (Consequences) eg, anxiety, depression, guilt, hurt, shame, anger, jealousy. Rate the intensity of your feeling 0 – 100%

Step 2
Write down you actions at C, eg escape, becoming withdrawn, aggression, reassurance seeking, taking drugs, avoidance, safety behaviour etc

Step 3
Write down what triggered off your thoughts and feelings in the column marked A (Activating Event). Activating Events can be past, present or future events. Places, memories, people objects, images and physical sensations can all be Activating Events

Step 4
Write down your Negative Automatic Thoughts and beliefs about A. This should include your perceptions of the situation and what it meant to you

Step 5
Dispute D your negative thoughts and beliefs. Use the questions at the bottom of the ABC Form to help you. Label the thinking error for each distorted thought and belief

Step 6
For EACH of the original thoughts and beliefs at B, generate a balanced and realistic response. Write them down in the D column

Step 7
Re-rate the original emotion you noted down at C and put this down at E (Effect of alternative thoughts and beliefs)

Step 8
Write down at E, a plan for a more constructive behaviour in the future. This might be a different way of managing a situation or an experiment to test out a thought. Try to be as clear and specific as you can

There may be times when you cannot identify any thoughts or images as such. If so, then ask yourself what the meaning of the situation is. What does it tell you about yourself, the situation and your future? This may give you a clue as to why the situation is so depressing or what is making you angry, anxious etc. An argument, for instance, might mean to you that a relationship may be at an end with somebody or even that you may never be able to have a proper relationship with anyone

In the course of therapy, your therapist will help you develop other skills as the downward arrow to help you identify beliefs and meanings attached to situations. That is why it is important to complete your ABC Forms

Common problems in Recording Negative Thoughts
Ideally, it is best to record your thoughts and feelings immediately they occur. But of course, this is not always possible

It would be difficult to record your thoughts in the middle of a meeting. In this instance, it is often useful to record the thoughts on a piece of paper. Set aside time each day to do your ABC Forms, say, 30 minutes each evening to complete your homework. Run through an action replay and recall as much detail as possible of what happened, what was the situation (A), what your thoughts were (B), what you were feeling and your behaviour (C)

Beware of excuses that keep you from focusing on your thoughts and feelings. Often people say “I will do it later” or “It’s better to forget all about it”. You may find that you may be unwilling to face the thoughts. Perhaps you are afraid they will overwhelm you or think that they are stupid. It is quite natural for you to avoid thinking through unpleasant experiences but doing so is the best way to combat your depression, anxiety, anger etc. If you find yourself making excuses, this is probably because you hit upon something important so make yourself write it down. You can divert yourself by engaging in distraction (alcohol, drugs etc) but this won’t help you deal with your problems as the thoughts won’t go away

As your mood improves, you will find that you have less of a focus and attention towards the automatic negative thoughts. It is still useful to continue to work on these thoughts as it will provide you with practice on how to deal with these thoughts

Should your mood deteriorate or become anxious, you have the tool to deal with it before it becomes unmanageable. The ABC Forms should be kept as they are useful in helping you deal with your automotive negative thoughts when your mood becomes low and help you challenge your thoughts. As your mood improves, you can strengthen your disputes by adding to them.

by Elspeth

I did not realise that I was suffering from OCD until I met with Matt. I knew it was anxiety but I had not told anyone about my intrusive and unwanted thoughts. They would just pop in and I hated myself for having them. I would wait for all my housemates to go to sleep before I went to bed. I had frightening images of me walking around with a knife and killing all that were dear to me

I threw out knives in the bin and I started to eat sandwiches rather than make a meal. I would ensure that my routine was in place before going to sleep. I would set up traps so that if I did wake up and harm anyone then I would trip up over things hoping that this would stop me

Matt help me see through using CBT that these were just thoughts and that I did not have to be a prisoner to them. I am now able to cook meals using sharp knives, go to bed early and at any time, have a relationship! and more importantly enjoy life

Compulsive Hoarding

Characteristics

A. Persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions*

B. This difficulty is due to strong urges to save items and/or distress associated with discarding

C. The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities)

D. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others)

E. The Hoarding Symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).

F. The Hoarding Symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder (OCD), decreased energy in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, food storing in Prader-Willi Syndrome)

*Specify if: With Excessive Acquisition: If symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space

*Specify whether Hoarding beliefs and behaviors are currently characterized by: Good or fair insight: Recognizes that Hoarding-Related Beliefs and Behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic. Poor insight: Mostly convinced that Hoarding-Related Beliefs and Behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. Absent insight: Completely convinced that Hoarding-Related Beliefs and Behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary

I learned that my perceptions on failure were not kicked up to reality and when addressed that my failure was not indeed a failure and this helped me to expand my life and take back what the Depression has taken. Also I can see the benefit of accepting certain things as a failure as they were things out of my control but it did not mean I was a failure but life cannot guarantee fairness all the time. This testimony is to encourage others to seek help and not suffer in silence as I had done for 2 years because I was afraid of what others would think

If you need help then book an appointment today

When I started the CBT it was important for my motivation to set clear and specific objectives and attach a timeline to them

Through a number of real-life experiments together with the therapist I started to re-educate my mind. The practical element was paramount as it showed me the lack of real substance of most of those beliefs that were responsible for causing states of anxiety. I soon realised that it was mainly down to me what I wanted to achieve and got rid of the erroneous conviction that the success of the therapy mainly depended on the therapist

A combination of raising-awareness discussions and real-life experiments gradually softened my mind and my approach to problems. Progressively I was taking ownership of my life whiles at the same time excessive worrying and anxiety were fading in the background

By the time I finished my 14/15 sessions over a period of 4 months I felt much better, however the full benefit of the therapy only emerged further down the line when I realised that I had gained a new, more flexible approach to my life on a permanent basis and not simply a quick win on the wave of the therapy”

For more information on treatment for worry/Generalised Anxiety Disorder call now on 020 7558 8894 or email matt@cbtinthecity.com