Sunday, April 23, 2017

Cognitive Behaviour Therapy Series #2) Why is CBT a good approach?

There is considerable evidence that  CBT can be helpful  for many common mental health problems.

For me, this is a big deal.

If I have a bad back, I would want to choose a type of treatment that had a good track record for helping with bad backs.

If I was trying to learn a language, I would prefer to choose a method of learning that had helped many students learn in a relatively short-space of time.

If I had problems with worry, low mood, anxiety or stress I would like to know that the tools I would be given  had worked with others with similar issues.

One key advantage of CBT is that it explicitly draws on a good deal of  psychological research about what maintains these common mental health problems.  Researchers have discovered the key processes that keep depression, worry, panic, phobias and other problems going,  This means that if you go to see a CBT therapist  wanting help with, for example, depression they will have in their minds a map of the territory of depression.

This is very helpful. If I was a tourist new to London trying to get from Liverpool Street to Buckingham Palace, I would prefer to have as my guide someone who had a map and who had accompanied people on that journey before. A guide without a map might get us to the Palace eventually, but  then again we might end up in the suburbs and never reach our intended destination.
In the same way, a CBT therapist knows the territory of common mental health problems and so is more likely to be a reliable guide than someone who does not,

Researchers have also designed treatment packages which are most likely to work efficiently, given their understanding of the problem.

Your experienced and reliable guide will have a map of ways to get from Liverpool Street to Buckingham Palace. Like google maps or a good Satnav they will also understand whether tube, bus or taxi or foot or some combination - is most efficient.  A good CBT therapist will understand, for example, that at the beginning of threapy behavioural techniques are more likely to be effective for low mood, whilst a  cognitive intervention will be vital in the early stages of therapy to help someone panic disorder.

Researchers have tested out  treatment packages for each common mental health problem mentioned above. CBT therapists learn in their training which packages are most impactful for which disorder and how to implement these treatments.

CBT is also committed to continuously refining and improving these packages - a bit like getting a software upgrade to your Satnav.

It is these two elements - a map of common mental health problems and associated, tested and effective treatment packages - that in my view make CBT such a good approach if you do have a common mental health problem

Of course there is a lot more that could be said.  We are all different, and the map of your depression  may not exactly fit the most common pattern for depression. A good CBT therapist will be informed by the  map of the territory but will not be constrained by it. They will tailor the treatment to your problem,

Equally, not everyone who could benefit from CBT has a common  mental health problem. But if you do have one of these problems - depression, panic disorder, generalised anxiety disorder (worry), OCD, PTSD, social anxiety, health anxiety, phobias - then CBT is likely to be particularly effective.

My experience as a therapist though suggests that the reverse is more often true. Many people are suffering from a mental health problem but are not aware of it. If you are reading this and suspect you may be suffering from one there is a strong case for seeing an experienced CBT therapist to see if they can help.

In the next article in this series we will look at each of these problems mentioned - what they are and how you find out more about them.

Sunday, March 12, 2017

Cognitive Behaviour Therapy Series #1) What is CBT?

CBT is an evidence-based talking therapy therapy that can help with a wide range of mental health problems including depression, anxiety, low self-esteem, procrastination, stress and anger management 

In many ways going to see a CBT therapist is as much like going to a yoga teacher or language teacher as it is going to see a traditional counsellor. The emphasis is on understanding your issues in a new way and then teaching you skills to help you manage it, given this new understanding.

Does that make sense?  This short video produced by the charity MIND explains CBT particularly well.

CBT is usually short-term. Some anxiety disorders can be treated very quickly -for example panic attacks and phobias can very often be treated in 3 or 4 sessions. Other problems take longer . It's part of the CBT process to regularly review how treatment is going and to reflect on how to make it more effective or suggest alternatives if necessary.

CBT focuses mainly on the here and now. If there was a fire you wouldn't want to spend a long time searching for the match that started it. If you are suffering from depression, anxiety or stress you need to work on  alleviating it. So the focus is usually on what's keeping it going now and on changing that. Sometimes it is important to talk about the past, and in these cases CBT will delve into the past. but only as much as is necessary.

CBT is very practical.  Your therapist will help you find practical ways to alleviate your distress,rather than just providing a listening ear.

CBT also involves exercises to be done between sessions - just like yoga and learning a language would.  This is often called "homework". I prefer to avoid this term as whenever anyone asked me to do homework, I left it to the last minute possible. The point of CBT home practice is to check in and learn something new or try something new every day.

CBT is structured.  Sessions usually follow a set structure - quick check-in, setting agenda for today, review of home practice, 1 or 2 main items for today, then setting home practice for next time and summary of main points from session. Don't worry, it's not your job as client to set this structure. Like a good talk show host, like Jonathan Ross or Graham Norton (or Michael Parkinson, if I dare show my age), your CBT therapist will be in charge of the process, so you can focus on your issues.

CBT involves teamwork. You know about yourself, your goals and your problems. Your CBT therapist knows about your condition and about proven ways to help.

Does all that make sense? Here is David Clark, a leading CBT researcher, with his explanation of what CBT is all about.

This is the first in a series of articles about CBT.

Other articles are planned to cover questions such as
- does how you think affect how you feel?
- does what you do affect how you feel?
- is CBT all about techniques? (the answer is no, it's about understanding your problem then learning and applying techniques)
-  what problems can CBT help with?
- what can't CBT help so much with, and what other treatments are likely to help?
- can CBT help me or someone I care about?

Tuesday, March 07, 2017

6 Big Ideas from the WGS. #6) The need for wise leadership: Can Dubai be the Florence of the 21st Century?

"Until philosophers rule as kings in their cities or those who are nowadays called kings and leading men become genuine and adequate philosophers ... cities will have no rest from evils." Plato The Republic

In the USA, instead of a philosopher king,  we have a president who as Josef Stiglitz  pointed out,  is questioning science  and has  chosen to appoint no economists whatsoever into his cabinet.

Sheikh Mohammed bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai, who brought all these thought leaders to Dubai for the WGS and in 2016 appointed the World’s first Minister of Happiness, provides a contrasting positive role model of leadership.  

Yet he  makes no claim to be a philosopher king. In his book,  Flashes of Thought, he says

“I would like to point out that I am no scientist. Nor do I claim to be a wise philosopher. This is simply a collection of concise messages, experiences, ideas and thoughts, whose sole aim is to serve our nation and to bring some happiness to our fellow citizens.”

Nevertheless in a 2015 article journalist Faisal J. Abbas in 2015 compares Dubai to Renaissance Florence. “Both cities”, wrote Abbas,  “managed to overcome their limitations, exceed their natural boundaries and achieve a ‘global status;’ mostly owing to the visionary ruling families, namely the Medicis of Florence and the al-Maktoums of Dubai”

The World Government Summit, Global Dialogues on Happiness,  Museum of the Future and the Emirates  Mars Mission are all examples of Dubai’s role in trying to build a better world future.  

 I do not know exactly what form future World Government Summits or Global Dialogues on Happiness will take, but I hope that what we saw in Dubai this month is just the beginning. 

The world may be at an inflexion point. We face either unprecedented wealth, happiness and technological advance – or a return to the dark times of the 1930s or worse -  technological Eden or Destruction. 

In these most interesting of times, the world urgently needs wise leadership.

Monday, March 06, 2017

6 Big Ideas from the WGS - #5) The need for scientific knowledge - and wisdom

“Knowledge without action is wastefulness. Action without knowledge is foolishness”
(Al Ghazali , quoted by Sheikh Mohammed at the WGS)

Imagine that your town is likely to be hit by a hurricane next week. 
You have four options
1 Business as usual, hope for the best
2 Take a vote on what to do. Let democracy rule
3 Hope that  the free market will sort it out
4 Gather together those with the most knowledge and understanding about hurricanes and act on their recommendations

Which option should you choose?

The challenges we as a world face are potentially even more serious than even a hurricane.  
The expertise on show at WGS was truly dazzling. 

Engineers like Musk and  Kalanick informed us of advances in technology. 

Psychologists like Seligman, Diener and Csiksentmihalyi told us about important developments in the psychology of human flourishing, Positive Psychology.

Economists  Stiglitz and Schwab shared their understanding of  the  economic impact of globalisation and technological change. 

Psychologist Arie Kruglanski   even shed light on such important matters as how to be smart at  fighting terrorism

There is an enormous and growing amount of scientific understanding and  knowledge available to the world now – we need use it, wisely,

6 Big Ideas from the WGS #4) The Fourth Industrial Revolution will have losers – we need to take care of them

                     Would Hillary have won if she’d engaged as much as Trump with people who felt so disempowered and disenchanted? 

                    Quite  possibly.

                     If there is one clear lesson from Trump and Brexit, it’s that governments need to show more wisdom and compassion to those threatened by changes.

                     A Universal Basic Income has been proposed whereby everyone is paid by the state a sufficient amount to cover basic needs. In an age where robots take over jobs, this might sound sensible, but as Elon Musk recognised, it  is not  sufficient.

                “I think universal basic income will be necessary” said Musk  “but the much harder challenge is: How will people then have meaning? A lot of people derive meaning from their employment. If you’re not needed, what is the meaning? Do you feel useless? That is a much harder problem to deal with. How do we ensure the future is a future that we want, that we still like?”

              Suppose that  there are no more truck drivers, for example, in 5 years time.  
              How will truck drivers gain any meaning from their life? 
              Bread and circuses?

              We need better routes to meaning and we need to be thinking about this now. 
              An important development is increased psychological research on meaning in life.

              Books like  Emily Esfahani Smith’s The Power of Meaning  will help this cause, as will the First International Meaning Conference to be held at Roehampton, UK in June 2017.  

                     If the first wave of  Positive Psychology focussed on happiness, the second wave needs  to focus on meaning, virtue  and flourishing– how to live a good life. 

                    Psychologists need to help us understand  conditions that are correlated with meaning, virtue and flourishing as well as happiness, and then politicians – at least the ones who choose to listen to experts- can then propose appropriate compassionate  policies.

Sunday, March 05, 2017

6 big ideas from the WGS = #3) Improve Mental Health - Create programmes like IAPT which give free access to evidence based psychological therapies

Improving mental health should be at least as high a priority as improving physical health.  

Mental illness is extremely common and can have a vert serious impact on  individuals, families and society as a whole. 

Significant progress has been made in the last 50 years in our ability to effectively treat common mental illnesses such as depression and anxiety. 

Yet not enough is being done to make these treatments widely and cheaply available.

In the UK Lord Layard, who spoke at the WGS, led a team that wrote  the Depression Report  which was instrumental in persuading the government to create IAPT (Improving Access to Psychological Therapies). 

The Depression Report

The  IAPT programme pays for itself, since the economic cost of mental illness is more than the cost of training therapists and providing therapy. In  England and Wales, at least, there is much better access than ever before to evidence-based and effective therapies such as CBT to treat those suffering from common mental illnesses. 

Whilst  countries without a National Health Service may not be able to adopt identical schemes  to IAPT more can still be done throughout the world. For example, they could subsidise the training and provision of therapists of evidence-based therapies.  Educational programmes about mental health should also be encouraged, including taking steps to reduce the stigma associated with mental health problems.

But don't take my word for it. 

I asked Lord Layard two key questions.

1) "Have other countries adopted an IAPT-like approach?"

 2) "Should they? "

Lord Layard's answer?