Our not so realistic reality

Not so real reality

Not so real reality

The basis of any anxiety or panic problem is a personal belief about something that in reality is not true. Whatever your individual fear may be, the chances are that it is completely illogical and not at all rooted in real facts. Living a life based entirely on thoughts and feelings which we know don’t reflect reality is one of the strangest experiences a person can have, and yet so many of us live this way every day, sometimes without even realizing they’re wrong.

Myself, I could say with total conviction that I know my anxious thoughts are incorrect. My logical brain is well aware that a panic attack will do me no harm; I’ve had more than enough to factually confirm that. However, there is still that thought, a voice so to speak, which convinces me to avoid any situation that could cause a panic attack because there is always a “what if?”. This makes my anxiety very difficult to explain to others, and I know I’m not alone. People will say “there’s nothing to worry about, you’ll be fine” and you can’t help but answer “I know I will”. They ask why you’re so scared if you know you’re going to be safe, and unfortunately you’re left with no real answer. It is simply a feeling which guides you through your day, and although this may only make up 1% of your thoughts, that 1% is stronger than all of your logical thoughts combined.

It seems mad, on paper, to allow something you know is wrong to dictate everything you do. From what you eat, to where you go, to who you go there with, this one small sensation, which tells you that maybe this time will be so much worse than all the others, is in control of your life. It doesn’t take long to collect a full repertoire of symptoms and side effects of anxiety, from heart palpitations to nausea and full panic attacks. You become familiar with each one, you’ve experienced them all at their very worst and still survived to tell the tales, but still you continue to avoid and fear situations which may cause them again, all because of one tiny voice.

Imagine a world where this voice, this feeling, is the minority. Where you consider that maybe there is a risk, a small “what if?”, but you don’t allow it to control you because you truly do believe that those anxious thoughts are nothing but lies. Simply knowing that your paranoid brain is wrong is just step one, and while it’s an excellent step, it doesn’t change the fact that there is still a part of you which refuses to commit to the belief entirely. There is so much more freedom and liberation which comes with fully accepting and internalising the idea that these thoughts you have are only there to hold you back, and in no way reflect what life is really like. You first have to realise that you’ve seen it all before, you have the wisdom and benefit that comes with experience. You have been through the worst of it and you are still standing, and that should suggest that maybe, just maybe, some part of your way of thinking is very, very wrong.

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To see ourselves as others see us

I don’t know about you but there have been times in my life when I have been acutely sensitive to the gaze of others. I am not immune even now, although I am better at managing how it makes me feel.
Which is why I found this video interesting and I thought you might also. It shows how different our own impression of ourselves can be to that of others.
It is like having a window into the subtle ways we see ourselves (not the good ways) and how that can distort everything else we feel.

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How To Combat Anxiety

How to Combat Anxiety

In the previous video I explained how a terrible event that may have no actual connection to you can increase your sense of threat. A feeling of threat, without an obvious tangible focus for the threat can cause anxiety. If you find that after Paris you are more anxious then you may find the tool I share with you in this video helpful. I have used this with many clients and the simplicity of it comes from the fact that it uses the same processes and the same neuro-chemicals as anxiety but it transforms what they are used for. Turning fear into excitement.

You don’t have to live with anxiety you can choose to do something about it.

Stop being anxious

A link to the previous film

 

 Get the Panic Pit Stop app here

About Dr David Purves

Dr David Purves is a Reading based psychologist providing private CBT in Reading, Berkshire. Dr Purves is the clinical Director of The Berkshire psychology service and former Consultant Psychologist and Head of the NHS Berkshire Traumatic Stress Service. He treats trauma and PTSD at his clinic and writes and speaks internationally on matters of terrorist related trauma.

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After Paris does the world feel more dangerous and do you feel more anxious?

Terrible things do happen.

Terrible things that happen without warning can make you feel more vulnerable and anxious. The media play and replay their footage, with comment and analysis. All of this can have the the effect of making the terrible event seem more likely to happen to you or the people you love. Your brain is genetically tuned to detect threats to you. Indeed it is highly sensitive to any situation that may even turn threatening. So when a threat is perceived but there is no obvious focus for the threat your brain often goes into a worry loop.

If you find that the terrible events in Paris have caused you to be more anxious but you’re not sure why then watch my video. I will explain how worry gets started and why anxiety goes up.

Are you anxious?

 

The link to the next film

About Dr David Purves

Dr David Purves is a Reading based psychologist providing private CBT in Reading, Berkshire. Dr Purves is the clinical Director of The Berkshire psychology service and former Consultant Psychologist and Head of the NHS Berkshire Traumatic Stress Service. He treats trauma and PTSD at his clinic and writes and speaks internationally on matters of terrorist related trauma.

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CBT for Insomnia

Young woman cannot sleep

An email from Peter prompted me to write this page about CBT and Insomnia for all of you who are struggling with sleep issues.

Dear Dr Purves

I’ve never been a brilliant sleeper but when I started working at a cinema when I was 16 and quickly got used to working late nights. I worked there for four years often getting home between 1am and 2am and once home I found I needed time to unwind before I could get off to sleep. I didn’t find it a problem at the time because once asleep I managed to stay asleep for about eight hours.

When I left the cinema I took an office job where the hours were completely different. I needed to be at work by 9am as the hours were 9-5. I thought that I’d adjust and naturally need to go to bed earlier but no matter how I tried I couldn’t get to sleep before 2am which meant I was averaging about 5 hours sleep a night. It wasn’t great but I could just about cope.

I’ve been working in an office now for about eight years and my sleep hasn’t adjusted, in fact it’s worse. I play on my Xbox to try to relax before I turn in but these days when I finally go off to sleep I find myself waking randomly for at least an hour or so in the middle of the night. I feel wide awake for a while, get really frustrated that I’m awake, and then eventually I fall back to sleep. When the alarm goes off it’s agony to get up and I feel like a zombie all day. Usually I’m so tired on week days that I have a nap when I get in at 5. At weekends I often sleep in until midday.

My wife has suggested I cut back on caffeine as I drink a fair bit of coke throughout the day but I don’t know how I’d get through without it. I’m knackered at the best of times.

I wondered if I should see my doctor and ask for some sleeping tablets but I’m not keen to have medication really.

Do you have any suggestions?

Many thanks

Peter 

CBT for Insomnia: Cognitive-Behavioural Therapy

If you have insomnia then you have problems getting to sleep, staying asleep or experiencing a restful sleep. CBT therapy is one way to treat insomnia. Yes, really. In fact, Peter has mentioned many things in his letter which can typically be addressed with CBT.

If you’re a regular visitor to the site you’ll already be familiar with cognitive behaviour therapy. CBT is a talking therapy which can be used to challenge and change thoughts, feelings and behaviours.

I would recommend that Paul and anyone else suffering with persistent sleep issues seeks out a CBT therapist.

CBT for Insomnia: How can CBT help with sleep issues?

So how can CBT help with sleep issues? Well, CBT will help you by identifying the causes of your sleep issues with the aim of changing at your sleeping habits and attitudes to sleep.

CBT for Insomnia: Treatment

If I was Peter’s CBT therapist I would suggest that the first thing he needs to do is keep a sleep diary for one to two weeks, recording how many hours sleep he manages to get a night, when he goes to sleep, when he wakes up and the amount of times he wakes up during the night and for how long.

As his therapist I would then need to review the diary and would suggest restricting sleep which would involve cutting out the naps Peter takes and making sure he gets up early, even on weekends for around six weeks. Yes, if you try this you will feel worse to start with. But the goal is that Peter will begin to feel tired earlier and will then be able to work his bed time backwards, under supervision.

CBT for Insomnia: Education and Lifestyle changes

Peter states that he drinks caffeine. He needs to restrict this to mornings. Alcohol and cigarettes also need to be cut out at bedtime.  If I was treating Peter I would take a wider look at his habits and identify anything which may be interfering with his sleep.

Playing computer games right up until bedtime can interfere with sleep because it’s stimulating.  Peter really needs to be relaxing before he goes to bed.

In order to make these changes you need to understand why you’re doing so, so treatment would include an element of education where we would look at sleep cycles and how your sleep is affected by a range of things.

CBT for Insomnia: Relaxation

Peter doesn’t say if he’s particularly stressed at the moment or if he generally has problems relaxing but learning to actively relax is important.  I work through muscle relaxation exercises with my clients and many have also felt the benefit of mediation and hypnosis.

CBT for Insomnia: Worrying

Another thing I look at with my clients and would focus on with Peter is his thoughts, in particular negative thoughts, and things that might be worrying him and stopping him from falling asleep.

CBT therapy is great at helping you to identify, challenge and change negative beliefs.

CBT for Insomnia: Condition the mind

The bedroom should only be used for sleep and sex. Peter doesn’t say if he’s playing the Xbox in bed at night or in another room but as part of CBT I work with my clients so that they are not using the bedroom for any other activities. This helps to condition the mind to expect rest upon entering the bedroom.

I hope this gives you some ideas of how CBT can be used to treat insomnia. It’s not meant to be an exhaustive list. If you’re having trouble with insomnia I am available for Skype consultations.

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CBT Therapy: Do you know your personal psychological space?

CBT Therapy: Personal Physical Space

We are all aware of personal space. If someone stands too close to you it is uncomfortable, we may not be quite sure why…it just does. In the film below, as an example of personal space violations, I tell the story of some experiments where men are positioned too close to other men in the bathroom. The effects can be dramatic, odd and even disturbing.

Watch this film and learn more. But be warned it is over 18 minutes long. Some things defy a simply or superficial description and sometimes important things take a bit longer to explain. So please stick with it to the end I am sure you will find it useful.

CBT Therapy: Personal Psychological Space

In this video I am not so much interested in talking about physical space but rather psychological space. Psychological space is a concept that is barely even recognised in science. I first developed an understanding of it when I fully understood the power of self sabotage.

Everyone wants to do well in their life. No one is motivated to perform poorly …and yet many of us do perform below are reasonable expectations of ourselves. The reason for this can seem puzzling, let’s face it, it seems to defy logic! But then I understood the power of the ‘personal membrane,’ this is what I call your unique personal psychological space.

CBT-Therapy-Personal-Space-Hippos

CBT Therapy: The Personal Membrane

Your personal membrane is maintained by your existing negative beliefs about yourself. These were probably developed somewhere in your childhood when your cognitive system was less sophisticated and your understanding of the world less well developed. Nevertheless, once created it started to influence all of your decisions.

I tell the story of Tom whose personal membrane developed when he was about 10 and led to a nervous breakdown when he was 40. I describe how it influenced him and ultimately how it almost ruined his life.

CBT Therapy: Tom recovered from the depths of despair

 

Tom came to see me when he had his nervous breakdown for Cognitive Behaviour Therapy (CBT) but he only had six face to face sessions. He also used and worked through The Mood Control System. Tom overcame the destructive force of his personal membrane and in fact he changed it out of all recognition. He got his life back, he kept his job and actually started to enjoy it again and he felt normal for the first time is several years. He did great!

CBT-Therapy-Sunshine-on-Horizon

Mental Health Awareness Week

Mental Health Awareness week is coming to a close. This week of activities to raise awareness of mental health issues spurred me to tell Tom’s story (even though it is longish for a video) but really the moral of this story is:

Your personal membrane will have an influence over you no matter where you are
in your life unless you make an effort to change it.

I’m a CBT therapist and I had to make an effort to change mine and Tom definitely had to change his, if he wanted to have a satisfactory life. I did it, Tom did it and you can do it also. You just have to start to make the effort.

CBT Therapy: Free Audio Book

I have created a 53 minute audio book entitled The Active Self Help Way Out Of Depression. When you sign up for The Mood Control System before 20th May you will also receive this audio book free. The link for the download will come to with you the welcome email.

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Clinical depression treatments: Your soul has a cold (Kokoro no Kaze)

Clinical depression treatments vary tremendously depending on where you live. This comes from the fact that attitudes to depression can be very different across the globe.

Japan traditionally suffered twice the suicide rate of the USA. However, talking about depression in Japan had always been a very different matter from talking about it in Western countries. In our language, the word for depression is interchangeable with dips in landscape, economy or mood. But in Japanese the word for depression (utsubyo) was used only to describe major depressive disorders and/or mania. Indeed it was seldom heard outside psychiatric circles.

clinical-depression-treatments-in-Japan
In Japan, to talk about or express feelings, people relied on the word ki or ”vital energy.” When describing low mood people might use the word ‘Ki’ and couple it with expressions of sadness because their Ki was sluggish, blocked or leaking.

Moreover there had always been a keep it to yourself (KITY) social norm in Japan where there was merit in not burdening others with your problems. And for both cultural and religious reasons people with mental health problems like depression were likely to suffer stigmatization, in addition, to the burden of their psychological problem.

Traditionally the major pharmaceutical companies had bypassed Japan when marketing anti depressants because there was not a disorder of depression recognized in Japan to treat and therefore no market for antidepressants. Until that is a new phrase was coined that linked the traditional Japanese notion of Ki and low mood. Kokoro no kaze (your soul has a cold)

Clinical depression treatments: Your soul has a cold

The effect of this clever combination of traditional word and understanding coupled with the new way to talking about something that was an unspoken problem for Japanese society started slowly but with gathering pace to change the status of depression. Depression became defined as a ‘real’ problem. And real problems have real solutions!

clinical-depression-treatments-soul-has-cold
Clinical depression treatments: Antidepressant meds

So far so good. The problem I have with this story is not that depression in Japan was under reported and under treated, I think that is self evident.  And clearly the changing force needed to bring this problem into awareness against a strong and established cultural norm was very substantial. All of that I believe was to the common good. No, the problem I have with this overall approach is that in Japan depression has been characterized as an entirely biological problem that is therefore can only be solved by the use of antidepressant drugs.

Clinical depression treatments:  How the Japanese viewed low mood

To put the problem into an historical context the traditional way of thinking about suffering in Japan may shed some light on why depression was never considered a disease. ‘Melancholia, sensitivity, fragility were not considered to be negative experiences for Japanese hence they were not considered to be problems in need to a solution. They were not considered bad in and of themselves.

Clinical depression treatments: The medical model of depression

In contrast the medical model of depression categorizes suffering as pathological and a problem that requires an intervention. Normally this is a pill. It is the case that the treatment of diseases in more easily understood and funded by health insurance companies and national health agencies and of course the classification of something as a disease helps remove some of the potential for stigmatization. But it also creates a market for the solution where previously none existed. Some critics of this approach have argued that it leads to the pathologisation of normal emotion; the tipping point where moods become medical problems and as such it turns normal human experiences into commodities to be managed.

clinical-depression-treatments-antidepressant-meds
Clinical depression treatments: A Little history

Eli Lilly had decided in the late 1980s against selling Prozac into Japan as there was virtually no demand for antidepressant meds. Even though throughout the western world Prozac and other selective serotonin reuptake inhibitors, or SSRI’s were becoming a virtual cultural phenomena – the antidepressant era!

In 1999, Meiji Seika Kaisha a Japanese company began selling the SSR Depromel. Meiji was among the first users of the phrase kokoro no kaze.

The following year, GlaxoSmithKline (GSK) the maker of the antidepressant Paxil joined Meiji by entering the Japanese market.  At this point people did not realize they were suffering from a disease and so GSK put substantial effort into the re-education of the normal Japanese doctor. GSK created a simply message: ”Depression is a disease that anyone can get. It can be cured by medicine. Early detection is important.”

In the early 2000s GSK sent 1,350 Paxil-promoting representatives to visit doctors on average of twice a week. With additional campaigns to teach GPs and their patients about the symptoms of depression: ”head feels heavy, cannot sleep, stiff shoulders, backache, tired and lazy, no appetite, not intrigued, feel depressed.”

Clinical depression treatments: Recognition of depression is useful

I have to acknowledge that recognition of depression is better than not recognising it. Depression is a problem that causes untold misery. Even today in Japan data suggest that 6.6% of Japanese have depression.

clinical-depression-treatments-low-mood
Clinical depression treatments: Depression is a psychological problem

To promote depression as a solely biological problem is to tell an incomplete story. As a psychologist I am not a dispassionate observer of the capture of  depression by the medical establishment. I treat depression every working day and most of the time my clients never use antidepressant meds. Therefore my experience of clinical depression treatments shows me that depression is more than adequately treated by psychological therapy and probably best by CBT Therapy.  Nevertheless most psychological therapies are likely to have value as depression treatments.

I cannot blame the pharmaceutical companies for doing what they do which is to sell pharmaceuticals. And I know it is a common meme to bash the multi national drug companies. I can see they do a lot of good in many areas. If you have malaria you should take an anti malarial medication. But if you have a psychological problem that is better treated by a psychological therapy than a drug treatment then I have an issue with the bias in the message. That’s all.

The moral question is this: are we only consumers or human beings who can also consume? To assert and promote that depression is only a biological problem without also stating that it is a psychological problem is obviously good business for pharmaceutical companies but it is ultimately misleading and I think in the end immoral. If there are better depression treatments even though they cannot be packaged and sold by pharmaceutical companies they have an obligation to inform the public because that is a morally good act. I don’t observe this happening right now. How have we sleep walked to this place in the world where the pursuit of commercial advantage and money takes precedence over honesty, integrity and the common good?

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Botox as a depression treatment

When looking for a depression treatment you most likely don’t even consider Botox; that’s for lines and wrinkles, isn’t it? Well, Dermatologist Dr Eric Finzi has published a book arguing that how your face looks plays a role in how you feel.

The connection between facial expression and emotion is not a new idea. Indeed there is quite a bit of research on what is called the ‘facial feedback hypothesis.’

Singer, Dannii Minogue spoke publicly about her use of botox following the death of her best friend and while her sister had breast cancer. She said she felt sad and depressed and didn’t want to look at her face.

Botox as a depression treatment

Why botox is used as a depression treatment

A substantial quantity of research has suggested that the expression of emotion can be changed through a process of feedback from facial muscles. In fact going deeper into the field of body feedback shows it is not only your facial expressions but also your whole body posture that affect how you feel.

The original idea that physical feedback affected emotion was originally proposed by Charles Darwin. But now there is experimental evidence for the validity of this view and of course we have all heard that smiling when you are down is beneficial.

Change your expression; change your mood

botox-as-a-depression-treatmentThe academic research on the facial feedback hypothesis does support the common sense view that changing your facial muscle positions affects your emotions. If you feel down this will be reflected on the canvas of your face. The effect of expressing your emotions on your face seems to be to increase the intensity of the emotion. So if you feel down and you also look down your total experience is of an increased or more intense experience of emotion. Conversely if you feel happy and you also reflect this good mood on your face this will increase the overall experience of happiness.

How Botox works as a depression treatment

The important point that Dr Finzi wants to emphasise is that if you inhibit the facial expression of low mood or depression then it can often reduce the overall intensity of the emotion. Dr Finzi’s proposed solution is to freeze the face with botox to prevent the muscles that create the furrowed eyebrows and frown from functioning. No frown equals lessened experience of low mood.

A different viewpoint

I take no issues with the science used as evidence in Dr Finzi’s book nor do I argue with the facial feedback hypothesis research, but I do take a different viewpoint altogether:

In my view depression is a consequence of something else. It is an outcome not a first cause. Therefore if you treat the outcome with some form of medical intervention then you do not change the cause of the problem.

This is the same argument I have with the seemingly overuse of antidepressant meds. The United States Center for Disease Control andThe Powerful Placebo Effect Prevention has stated that the use of antidepressant drugs has soared nearly 400% since 1988, making the medication the most frequently used by people ages 18-44.

My view is that antidepressants purport to treat depression and anxiety but they only treat the outcome they do not touch the cause of low mood or depression which is why there is a high relapse rate following cessation of these drugs.

In fairness the pharmaceutical industry would state that they believe that depression is a biological problem that results from hypothesised chemical imbalances in the brain. But this remains a hypothesis without conclusive proof of its validity.

Treat the cause

Therefore Dr Finzi;s work and the work of others that it is build follows in the tradition of treating a problem that is caused by something else. Why not treat the actual problem instead?

The most effective depression treatment

botox-as-a-depression-treatment-happy-girlCBT therapy provides the most clinically effective depression treatment.

There are no side effects from CBT therapy and because you learn about the causes of depression and how to treat it you gain something valuable you can keep.

Knowledge and wisdom, these twins will keep you safe and help you steer clear of low mood and depression in the future.

It’s better to stamp on depression by learning what causes it and how to defeat it.

Make it irrelevant to your life journey. Then you won’t have to freeze your face for the whole of your life and you will still be able to smile when you want to.

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No one is immune from depression

A long line of objectively successful people have succumbed to low mood. The latest is actress Shobna Gulati who yesterday revealed she quit Coronation Street because of her battle with depression.

She’s not alone. There have been many articles in the press over the last year featuring celebrities such as Frankie Sandford and Helen Flanagan  talking about their experiences with depression and anxiety problems.

  • At Christmas, actress, Helen Flanagan told a national newspaper that she had considered killing herself in a car crash on the way to the Coronation Street studios.
  • And just last year, Singer, Frankie Sandford spoke to Glamour magazine about her battle with negative thoughts and panic attacks, which escalated, leading to her being hospitalised.

Depression destroys lives and no one is immune.

There are approximately 121,000,000 people suffering from depression throughout the world.

What causes depression?

Depression is often caused by a nagging fear that failure is only around the corner. No matter how much success is achieved the person cannot shake off this fear.

At its heart low self esteem is based on the false belief that you are not good enough. Not simply not good enough in what you do, that would be a lot more manageable. No, the belief that you are not good enough as a person. You are unworthy and maybe even unlovable.

If you achieve success it is only through luck and you expect to be found out and exposed for what you believe you really are at any moment. A part of you cannot believe you have not been seen as the fraud you feel you are.

Battling depression in the public eye

If you are at all in the public eye and anyone makes a derogatory comment about you it can be crushing. While in reality it is just a throw away comment by a viewer or follower it can seem like they have somehow seen into your soul and discerned the truth. If they can see it then surely everyone else can also see it. And yet they seem not to.

The tension of waiting to be exposed and your inner feelings seen by all is very tiring. This can cause a stress that swings you from hoping you may actually be okay as you are to truly believing the most horrible and negative things you can imagine about yourself.

Often in the end it seems easier and a lot less trouble to just walk away. That way you have the relief of knowing that the imminent danger of exposure is further back and therefore more manageable. But it can make it harder to re-engage again because staying at home with the curtains shut feels a lot safer. As we age it feels like taking the ‘chance’ of exposure again has too high a price tag.

Anxiety and Depression Treatment

Sometimes counselling is not enough. What is needed is a CBT Therapy that challenges and changes the distorted and inaccurate negative beliefs we all hold but which sometimes seem to ruin our experiences.

Cognitive Behavioural  Therapy (CBT therapy) is put forward by the National Institute for Health and Clinical Excellence (NICE) as the psychological treatment of choice for mental disorders such as anxiety and depression.

Recovery rates from CBT therapy are impressive with up to 70% of sufferers achieving significant clinical gains over the course of a treatment program for both depression and anxiety.

Mood Control CBT System

When you have anxiety problems or depression you may want anxiety therapy or depression treatment immediately, in your own home.

This is why I created, the Mood Control CBT System which is an affordable membership program which delivers the full  personalised CBT therapy experience straight to you in your home via the internet on your personal Mood Control dashboard. Learn more.

 

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