What is depression?
Excerpt from Howell, C. (2009). Keeping the Blues Away The Ten Step Guide to Reducing the Relapse of Depression. Radcliffe Publishing, Oxford.
WHAT IS DEPRESSION?
Everyone experiences feelings of sadness, loss or ‘depressed’ feelings at times. These are part of life, and part of coming to terms with difficult events. But these common feelings are not the same as the as clinical or major depression.
The term ‘depression’ is used when the mood is persistently and severely depressed, and when the low mood and other associated symptoms are debilitating, affecting the ability to cope and function
Sometimes it is hard to pick that the problem is depression. It may seem that the main problem is tiredness or disturbed sleep. Often individuals go to the doctor with a physical problem, rather than recognising that there is an emotional concern. Another complication is that anxiety often accompanies depression, and may seem to dominate initially.
The diagnosis of depression requires the following symptoms to be present:
For at least a two-week period, either consistently low or depressed mood, and/or loss of enjoyment or interest in most activities. At least four other key depressive symptoms will have been present:
- significant weight or appetite changes
- too little or too much sleep
- agitation or slowing down
- significant decrease in energy levels, or excessive tiredness
- feeling very guilty or worthless
- having trouble making decisions, thinking clearly, or concentrating
- thinking frequently about death or suicide.
From: American Psychiatric Association, 2004, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), American Psychiatric Association, Washington.
See the Beyondblue or Blackdog websites (www.beyondblue.org.au or www.blackdoginstitute.com) for a questionnaire about depression. There are useful resources and a listing of mental health practitioners across Australia.
How can depression be managed?
Depression can be managed in different ways, depending on severity of the depression, the client’s age, and any history of previous episodes. Management follows the bio-psycho-social-spiritual model (addressing all these areas as appropriate for the individual) and might include:
- Having a thorough assessment by a doctor and excluding a physical cause through examination, appropriate investigations.
- Providing information about depression to increase understanding.
- Together with the individual, creating management goals and a plan of action.
- Conveying a sense of hope or reassurance that help is available, and that depression can improve over time.
- Having a list of agencies and people to contact if there is a crisis.
- Having information on useful resources (books, websites).
- Lifestyle measures; such as healthy nutrition and exercise, improving sleep, reducing stress, addressing work-life balance, and addressing any drug and alcohol issues.
- Encouragement of pleasant and meaningful activities can be very helpful.
- Psychological therapies include problem-solving, Cognitive Behaviour Therapy (CBT), relaxation techniques, Interpersonal Therapy (IPT), Acceptance and Commitment Therapy (ACT), narrative therapy and hypnotherapy.
- Central to recovery will be understanding and managing the range of emotions being experienced, and rebuilding the sense of self and personal strengths.
- Medication may be suggested, and if prescribed, information on its use must be provided, and its effects must be monitored carefully Doctors or therapists may also meet with family or carers.
- Individuals may want to incorporate complementary therapies; such as fish oil supplements, vitamins and minerals, St John’s Wort (not to be taken with antidepressants) and reiki.
- Ongoing support and follow-up is vital, and a relapse prevention plan should be developed (including identification of early signs of depression, high risk situations, and a plan of action).
What is Bipolar Disorder?
Bipolar disorder is the name used to describe conditions in which there are significant ‘mood swings’, from depressed mood to elevated mood or ‘highs.’ There are several types of bipolar disorder, including:
1) Bipolar disorder I, the more severe disorder in terms of symptoms. Individuals experience symptoms of mania or elevated mood including psychotic symptoms (such as delusions or fixed beliefs e.g. ideas about greatness), and be more likely to be hospitalised. Depressive swings can be very severe.
2) Bipolar disorder II refers to a person experiencing the symptoms of a high but with no psychotic symptoms, and periods of depressed mood. These episodes tend to last a few hours to a few days.
People will experience mood swings of varying severity and duration. There will be periods of elevated mood (hypomania) and depressed mood. When the person is high they may be very gregarious, have lots of energy, do a lot, make decisions quickly, sleep very little and possibly gamble or drink more, have a higher libido or spend too much money. The depressed phases can interfere with ability to relate to people or go to work. Individuals can feel suicidal at times.
It is important to note that everyone has mood swings from time to time, and it is only when these moods become extreme and interfere with our daily lives that bipolar disorder may be present. People with Bipolar Disorder can experience normal mood between the mood swings.
If you care concerned you for yourself or someone else, see www.blackdoginstitute.org.au or you can call:
- Beyondblue information line – 1300224636
- Lifeline 131114
- ACIS (rural and remote) 131465
How do you define stress and anxiety?
Stress is a response to a demand which we are experiencing, such as responding to a hungry child or dealing with a problem at work. However, stress is an individual experience, and has different meanings to different people. Some people might describe stress as tension, others as worry, or feeling overwhelmed or out of control. Anxiety is also a normal and universal emotion, and is related to one of the key human emotions, fear.
We all know the feeling of fear, whether experiencing fear related to a job interview or giving a talk. We can recognise when we are feeling frightened or anxious by what we experience in our mind and body. These responses can help us survive in a dangerous situation, but in many cases anxiety can be distressing and can significantly interfere with a person’s home life, relationships or work.
Some people experience acute or sudden anxiety, while others might experience ongoing anxiety. Anxiety is typically about something that might happen in the future. When a person feels anxious, they might be anticipating a problem or there might actually be some element of danger, such as when driving on a busy freeway.
Excerpt from Howell, C. and Murphy, M. 2011, Release Your Worries: A Guide to Letting Go of Stress and Anxiety, Exisle Publishing, New South Wales.
How can I deal with panic attacks?
Panic episodes involve unexpected and intense fear. When talking with a client about panic, we find out more about the panic attacks and the person’s background, and we do some tests to rule out medical causes of the symptoms. We also check whether the panic attacks are leading to disability, in particular avoidance of doing usual activities. For example, if a person has a panic attack in the car, then they might avoid driving the car. It is also important to find out the underlying fears in panic, as some people worry that the physical symptoms are signs of illness, or that they might pass out, or even die. Some people worry about how other people are going to react when they have a panic attack, and that they might not be supportive.
flight’ response to threat is what underlies the symptoms of panic. These symptoms don’t feel good, but they are actually designed to protect you and will not can be challenged. There are a range of psychological treatments that can be helpful, including working with thoughts that are not helpful, and relaxation and breathing techniques. This is called Cognitive Behaviour Therapy.
In particular, abdominal or slow breathing is helpful. An example follows:
- Stop what you are doing, sit down if you can and breathe in and out slowly. Take medium breaths (not deep or shallow breaths), breathing down to your abdomen. Breathe in a 6-second cycle, that is, breathe in to the count of three, and then out for the count of three: in, two, three; out, two, three.
Some people find carrying a written card in their purse/wallet useful, with words such as; “I know this is panic and I know what to do, breathe slowly and relax, it will pass and I will be fine.” If you need some assistance, see your GP and they may suggest that you see a psychologist or counsellor. Looking after your general lifestyle (nutrition, exercise, sleep), doing yoga or tai chi, and thinking kindly about yourself can also assist.
There are some helpful resources, including:
- “Release Your Worries, A guide to letting go of stress and anxiety,” by C Howell and M Murphy, published by Exisle in 2011.
- Centre for Clinical Interventions (www.cci.health.wa.gov.au): provides a wide variety of mental health information and resources.
- Clinical Research Unit for Anxiety and Depression (CRUfAD) http://www.crufad.org/index.php/about has a wide range of information and resources.
What is Cognitive Behaviour Therapy?
You will find that Cognitive Behaviour Therapy or CBT is often utilized in the treatment of depression or anxiety. I actually think it is helpful for everyone to understand the principles of CBT, both children and adults. CBT is based on the idea that cognitions (thoughts and beliefs) affect behaviour, and that these can be changed through a range of cognitive and behavioural techniques.
At its essence is the idea that the way we think and what we do affect how we feel. CBT invites you to notice your feelings and your thoughts. We often mix up our feelings and our thoughts, perhaps saying, ‘I feel as though I’ve made a mess of things.’ This is actually a thought, whereas the feeling might be sadness or disappointment. We all have fairly constant streams of thoughts, often automatic in nature, which can impact on our feelings and behaviours.
In other words, what you think affects how you feel and how you feel affects what you think. And, what you do impacts on how you feel and think. Going out for a walk in the sunshine, for example, may lift mood. Focussing on everything that is going wrong will bring your mood down.
Learning how thinking and feeling interact, and how to develop different ways of thinking is the basis of the cognitive part of CBT. The role of behaviour is the basis of the behavioural part of CBT. In CBT, the therapist works collaboratively with the patient to guide them through cognitive strategies such as identifying unhelpful thoughts, challenging them, and developing more helpful ones. Underlying beliefs are identified and tested in a similar way. Behavioural techniques include behavioural activation (engaging in activities), relaxation and assertiveness training. These strategies aim to break the unhelpful think-feel-do cycles.
Can you relate to any of the unhelpful thinking errors below? Most of us can, and CBT teaches us to recognise them, to challenge them and to develop more helpful thoughts. .
|All-or-nothing (“black and white”) thinking||There is no middle ground. Things are seen in black and white; for example, if you make a small error at work, you see yourself as a failure.|
|Jumping to conclusions||You make a negative interpretation of things; for example, you may interpret that someone is thinking negatively about you when there is no evidence of this – “they think I’m a loser” (mind reading); or you may presume that things will turn out badly (fortune-telling)|
|Catastrophising||This is overemphasising the importance of events; a small mistake may be perceived as a disaster.|
|Disqualifying the positives||Discounting any positive experiences and maintaining a negative outlook.|
|Emotional reasoning||You feel bad, and so this is seen as reflecting how things really are.|
|Should statements||This is about motivating yourself with “shoulds” and “musts”. It is about setting high expectations for yourself, and the emotional results may be guilt, frustration or anger.|
|Labelling||This is giving yourself a label and follows on from over-generalisation; for example, making a mistake results in thinking “I’m a loser”.|
To find out more, see ‘Release Your Worries’ (Murphy and Howell, 2011), or ‘Keeping the blues away’ (2009). I can also recommend Sarah Edelman’s book called ‘Change your thinking’.
There are also some very good websites which utilize CBT, such as:
- Centre for Clinical Interventions (CCI): www.cci.health.wa.gov.au
- CRUFAD (Clinical Research Unit for Anxiety Disorders University of NSW): www.unsw.edu.au
- Australian National University’s MoodGym: http://moodgym.anu.edu.au
What is mindfulness?
Mindfulness stems from Buddhist and Hindu practices, and a current definition is paying purposeful attention to the present, nonjudgmentally (Siegel, 2007, p. ). We spend a lot of time doing just the opposite in life, being mindless! How often have you eaten a meal and not actually been aware of what you have eaten? Mindfulness has come under much greater attention in the West in recent years , and has been incorporated into treatment programs for pain, stress, anxiety and depression, and other mental health issues.
And so how does mindfulness help? When we are mindful, our mind is in the now, rather than in the past or future. As a result there is less ruminating, less reactivity and a greater sense of peace and wellbeing. Mindfulness is also relaxing! In the mindful state, the brain demonstrates ‘neuroplasticity’ (nerve cell growth). The brain is capable of change, and we can change how we think, feel and behave. This makes sense intuitively – when we learn to tie up our shoelaces, or to drive a car, we must focus our attention on the task at hand to the exclusion of all else. This is why several newer psychological approaches, such as Acceptance and Commitment Therapy (ACT) and Mindfulness-based Cognitive Behaviour Therapy (MBCT), incorporate mindfulness.
For further information, see: www.actmindully.com.au and www.mbct.com/
Howell, C. and Murphy, M. 2011, Release Your Worries: A Guide to Letting Go of Stress and Anxiety, Exisle Publishing, New South Wales.
Siegel, D.J. 2007, The Mindful Brain: Reflection and attunement in the cultivation of wellbeing, Norton & Company, New York City.
What is Acceptance and Commitment Therapy?
One of the therapies that I utilise is Acceptance and Commitment Therapy or ACT. Its use has gained incredible momentum over the past 20 years, and there is now a lot of evidence that it is effective in managing anxiety, depression, eating disorders and other issues. Again, the principles of ACT are useful for everyone to know.
ACT is a behavioural therapy and it incorporates ideas from Eastern philosophies, as well as elements of a number of Western therapies such as CBT, Narrative Therapy, NLP and Hypnotherapy. ACT receives its name from one of its central principles, namely taking action. This relates to accepting what is out of our control, and taking action that helps create a rich and meaningful life (Harris, 2009, p 2).
“It is important to recognise that thinking and feeling ‘well’ does not necessarily mean that you will live a rich and meaningful life, and thinking and feeling ‘poorly’ does not mean you can’t live a rich and meaningful life)” (Howell & Murphy, 2011, p 162). ACT proposes that the problem is struggling with anxiety-provoking thoughts and feelings, and the solution is for people to learn how to develop comfort in their own bodies and minds while still having these anxious thoughts and feelings (Forsyth & Eifert, p 16). That is, ACT advises us to stop the struggle to think and feel better!
It suggests that instead you focus on what you can control or what you can do to live a meaningful life. The idea is to become less caught up in the pain in our bodies and heads, and get more involved in doing what we care about and value. This involves changing your relationship with stress and anxiety/ ACT encourages the acceptance of distressing emotions or events, or a willingness to experience them, without trying to change them. It utilises techniques such as cognitive defusion (including observing thoughts or thanking the mind for a thought, or singing the thought) to assist acceptance. It encourages us to connect with the present moment (mindfulness) and to clarify and connect with our values.
The ACT model incorporates six central processes that are part of a whole:
- contact with the present moment or mindfulness
- defusion of feelings and thoughts
- acceptance – of uncomfortable feelings and thoughts and the difficult things life throws at us
- self-as-context (the part of the mind that notices thoughts and feelings that is calm and non-judgemental
- values or living a life consistent with what is important to us
- committed action – effort and action are central to change.
And ACT encompasses different areas or domains in life, namely:
• family and friends
• romance or intimate relationships
• health and your body
• education and personal development
• work and finance
• citizenship or community life
• environment or nature
• spirituality (Harris, 2007; p 296).
If you wish to find out more, there is a chapter in ‘Release Your Worries’ on ACT (Chapter 6), and the books by Russ Harris and his website on ACT are very helpful.
Forsyth, J. and Eifert, G. 2007, The Mindfulness and Acceptance Workbook for Anxiety, New Harbinger Publications, Oakland, USA.
Harris, R. 2007, The Happiness Trap: Stop struggling, start living, Exisle Publishing, Wollombi, NSW.
Harris, R. 2009, ACT Made Simple: An easy-to-read primer on Acceptance and Commitment Therapy, New Harbinger Publications, Oakland, USA.
Howell, C., Murphy, M. (2011). Release Your Worries A guide to letting go of stress and anxiety.
Suggested website: www.actmindfully.com.au
What is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy (DBT) was developed by psychologist Dr Marsha Linehan, and considered best practice in helping people who struggle to manage intense and extreme emotions. It was designed for adults diagnosed with Borderline Personality Disorder but is now being utilised with a much broader group of individuals.
It is a model that incorporates theory and strategies from a range of therapies and approaches, and it focuses on teaching the person practical and effective coping skills. It encourages acceptance of the person as they are plus an expectation that current behaviours need to change. The tension between these two factors is known as ‘dialectical tension.’
The aims of DBT are to reduce destructive or unhelpful behaviours that interfere with functioning and therapy, such as interpersonal problems or substance abuse, whilst teaching life skills and psychological strategies. DBT requires a strong commitment to therapy from the client and therapist. The following skills are taught:
- Mindfulness skills
- Interpersonal effectiveness skills (e.g. assertiveness training)
- Emotion regulating skills (e.g. labelling emotions, learning triggers to uncomfortable emotions, increasing positive emotional events)
- Distress tolerance skills (tolerating distress)
For more information, see ‘The Dialectical Behaviour Therapy Skills Workbook’ by Matthew McKay.
What is Interpersonal Therapy?
Interpersonal Therapy (IPT) was developed in the USA in the 1970s by Klerman and Weissman. It focuses on interpersonal issues, which are understood to be connected with psychological symptoms. It recognises the importance of the person’s current interpersonal world in relation to their mood and symptoms, and IPT interventions aim to reduce symptoms and improve social functioning. IPT is an effective brief treatment for a number of mental health issues, including depression and eating disorders. It has been adapted for use in a number of population groups, including the elderly and adolescents.
IPT links the mental health issues to relationship difficulties and categorises them into four types:
- Grief due to loss
- Interpersonal disputes (conflict)
- Role transitions (moving from one role to another e.g changing jobs, moving from adolescence into young adulthood, retirement, divorce…)
- Interpersonal sensitivities (difficulties with social skills or forming connections with others).
- Review of symptoms, identifying problems, psycho-education, review the need for medication.
- Relating the issue to the interpersonal context by reviewing current and past relationships as they relate to the symptoms.
- Identifying major problem areas and setting treatment goals.
- Psycho-education or the provision of information regarding IPT.
- Grief: identify loss and grief and facilitate grieving process.
- Interpersonal disputes: work on relationship expectations and communication issues.
- Role transitions: facilitate grieving process and acceptance of loss of old role, assist the person to consider new roles more positively, explore related feelings, enhance self-esteem.
- Interpersonal sensitivities: aiming to reduce social isolation and encourage the formation of new relationships.
- Reviewing and completing the therapy.
- Organising follow-up and plans for preventing relapse.
Further information on IPT can be found at http://interpresonalpsychotherapy.org, or
Weissman, M., Markowitz, J., and Klerman, G. (2007). Clinician’s Quick Guide to Interpersonal Psychotherapy. Oxford University Press, Oxford.
What you might ask about relaxation strategies
From Cate Howell & Michele Murphy’s (2011) ‘Release Your Worries: A Guide To Letting Go Of Stress and Anxiety’
Some common questions about relaxation are answered below, with the aim of reducing road blocks or barriers to you trying out the techniques on a regular basis.
WHAT DO I DO WHEN I ’M TOO TENSE TO RELAX?
Sometimes when people have been stressed for a long time they forget what it feels like to relax. There may be many different thoughts and feelings that make it difficult for the person to ‘let go’ of the tension they are holding. For example, some people associate the word relaxation with laziness and fear they will become a non-achiever if they stop striving constantly. For some people who are pushed around by these ideas it is easier to start with some form of active or physical relaxation; for example, a jog or a bike ride. The feeling of exhaustion at the end of a particularly strenuous workout is very much like the relaxation response.
WHAT DO I DO WHEN I DON’T LIKE THE FEELINGS OF RELAXATION?
People tend to be creatures of habit and we are often uncomfortable with change and new sensations. However, there are many things that we have to do even when we don’t feel like it. For example, many people don’t particularly feel like going to the dentist, but they do because they know it is important for their health. Just like any new skill or sensation, relaxation will take a bit of time to get used to before you will begin to appreciate both the short-term and long-term benefits.
Perseverance is important at the start of learning any new skill. It is okay to set yourself a reasonable time limit or date to review your progress. You may choose to practise one relaxation technique daily for one month, and then review whether that particular technique is working for you. You will find a range of different types of relaxation methods to choose from throughout this chapter.
WHAT IF I CAN’T FIND THE TIME TO RELAX?
Most people have picked up this book so they can feel less stressed and may be quite horrified to find that we are asking them to squeeze more tasks into their already overburdened day. It may be useful to view relaxation training as a good investment in time, both in the immediate and long-term future. Have you ever had so many things to do that you go from one job to another without being able to focus enough to adequately finish a single task? This is probably because your attention is scattered and split into too many different directions at the same time. Relaxation can help people focus that attention in one particular direction.
A useful analogy is how a magnifying glass can be used to focus the sun’s rays in order to burn a leaf. Without the magnifying glass the power of the sun’s rays is diluted — on their own, the rays do not have the power to burn the leaf. Theoretically, if you invest 20 minutes per day in relaxation training, you may find that your increased ability to focus your attention makes you so effective and efficient in completing your daily tasks that you may actually end up gaining more free time to do the things you really value.
I AM WORRIED THAT IT WON’T WORK IF I DON’T HAVE 30 MINUTES OF RELAXATION EACH DAY.
It can be useful to initially set aside 20 or 30 minutes when you are trying to learn a relaxation technique. As you become more familiar with the techniques you tend to relax more readily and less time is needed. However, don’t let time be an excuse — even 5 minutes of relaxation is useful. In fact, ‘spot relaxations’ are designed for very busy people who need to relax ‘on the spot’, which may be their desk at work, on the bus or at the kitchen sink at home!
WHY DO I KEEP FALLING ASLEEP WHEN I RELAX?
Some people like to practise their relaxation at the end of the day lying in bed before they go to sleep. Naturally, there is going to be a strong likelihood that you will fall asleep when relaxing in this way. There is no problem with falling asleep when you relax, unless you are relaxing in a place where sleep is not appropriate, such as your desk at work. If you do not want to fall asleep it may be useful to practise your relaxation in the sitting position and at a time of day when you tend to be more alert.
I FEEL TOO GUILTY TO RELAX DURING THE DAY WHEN MY CHILDREN ARE HOME, AND AT NIGHT I AM TOO TIRED. WHAT SHOULD I DO?
Ask yourself the following question: If I had to go to hospital today (for any reason) who would look after my children? Would these people do as good a job as you? Probably not. People often get strong messages about what is expected of them from a very young age. Many women are trained into being ‘people pleasers’. That is, they are given not-so-subtle messages that a nice person puts other people’s needs first, otherwise she may be labelled as selfish. This can become problematic as the woman has children and slowly gains more and more people that she is responsible for taking care of. As her list of responsibilities gets longer she often comes at the bottom of the list of priorities with little or no time to spend on her own self-care. It can often take some kind of crisis before the person realises that they cannot keep taking care of others unless they prioritise their own selfcare. Consequently, it makes sense to put yourself at the top of your priorities list and invest in your own relaxation practice, as it is not only the best thing for you but it will also ensure that you are in a fit state to care for those you love.
I HAVE LIVED THIS LONG WITHOUT RELAXING, WHY SHOULD I START NOW?
Stress and anxiety may have a cumulative effect over many years. Often when people come to see us they are trying to understand why they are experiencing stress or anxiety at this particular point in time. When a farmer grows a crop for many years on the one field, the crop will decline in quality each year. The farmer must rest the field and replenish the soil periodically. Similarly, relaxation is a way of nurturing and replenishing our minds and bodies so that we can continue to grow and flourish. We have also emphasised, in this chapter, the importance of relaxation as a preventative measure in keeping our stress at a manageable level.
HOW DO I KNOW I AM BENEFITTING FROM RELAXATION?
Anyone can learn to relax and experience some benefits. Relaxation techniques can provide quick and simple ways to gain a sense of control and mastery when we are feeling overwhelmed by stress. In this way they can also make us feel a bit better and not judge ourselves so harshly. There are many mental and physical benefits from relaxing, including decreased blood pressure, breathing rate, muscle tension, sweating, adrenaline flow and lowered mental arousal.
I CAN’T STOP MYSELF THINKING?
For people who have very busy minds it may be useful to have a relaxation CD incorporating guided imagery. Preferably, the guided imagery used should encompass your five senses and be complex enough to keep your busy mind totally engaged in the experience. However, if you feel your mind wandering don’t be concerned. This is completely normal and happens to most people. When you become aware that you have been distracted, the key is to let your thoughts drift by and return to listening to the voice on the CD. It can be counterproductive to try too hard to concentrate on the CD because this type of earnestness will probably cause muscle tension and negative thinking. So we suggest accepting that your mind will wander at times, and that you can simply refocus your attention on the relaxation when it does.
For more information on relaxation see the blog on 17th March, 2014. Also see the CDs available in the shop which can assist you in learning relaxation strategies, plus ‘Release Your Worries’ by Dr Cate Howell and Dr Michele Murphy (Exisle, 2011) available from the shop too.
Common questions about hypnosis part 1.
Hypnosis is an extremely useful therapeutic tool. I have been using hypnotherapy since 1992, and a number of questions are commonly raised by individuals when considering its use. Here are my answers!
What is hypnosis?
Hypnosis is an altered state of consciousness or a trance state, different from sleep and different from being awake. It is similar to relaxation or meditation. The brain wave pattern changes in hypnosis, fluctuating between alpha and delta waves. The mind regularly goes into a brief hypnotic state to relax and refresh brain function. In hypnosis, the mind is more open to suggestion, and this is the basis of its use as a therapy. The hypnotherapist can assist the individual in managing thoughts, emotions or behaviours through suggestion.
Can I be hypnotised?
Almost all people can go into hypnosis. In fact, it is something that you do every day of your life – you just don’t think about it as hypnosis. When you get absorbed in music or a book, or daydream – that is hypnosis. In the same way as some individuals are very musical or sporty, some people are very good hypnotic subjects. However, most people can go into a hypnotic state and gain excellent benefits from it.
How will I be hypnotised?
The hypnotherapist will ask the person to make themselves comfortable, and will use a range of techniques that focus concentration. They also guide the individual through some relaxation and deepening techniques, before focussing on the problem to be addressed.
What about stage hypnosis?
Well, the use of hypnosis for entertainment is not advisable. Stage hypnosis tends to humiliate the person in front of others, and there have been adverse effects from stage hypnosis, such as individuals being very anxious afterwards. Hypnosis is much more appropriately used by qualified therapists to assist individuals manage their problems.
What can hypnotherapy be used for?
Hypnosis is commonly used for relaxation and stress management, to change behaviours (such as smoking, bedwetting or nail biting), to improve sleep or to relieve pain. It is also helpful in working through emotional issues, such as anxiety, grief, anger or guilt. A number of other therapeutic approaches can be combined with hypnosis, such as cognitive-behavioural therapy. Also, the individual will usually be taught self-hypnosis as part of therapy.
How does it actually work?
The relaxation provides a number of benefits, both physically and mentally. The therapist will also utilise ‘direct’ or ‘indirect’ suggestions. Direct suggestions are statements such as ‘you are now a non-smoker’. Examples of indirect suggestions are stories or metaphors. For example, in working with a child who struggles with bed-wetting, the therapist might guide the child through a story of going on a camping trip. On the trip the child wakes up in a warm and dry sleeping bag, thereby indirectly suggesting that the child has not wet the bed.
How hypnosis might help with changing behaviours
Hypnosis can assist with changing behaviours such as smoking, nail-biting or bed-wetting. Often only a few sessions are needed to change behaviours, and this is very rewarding to the person and the therapist.
In helping the person change these behaviours, the therapist would firstly take a history about the behaviour, such as when the individual first started smoking and how much they smoke. They would want to know the reasons for wanting to quit (such as health or saving money) and also what triggers are associated the smoking behaviour, such as drinking alcohol or taking a break from work. They would also ask about the person generally, about their social situation and health history.
It is important that hypnosis is explained to the person before, and I like to address the sorts of questions outlined in my last article, such as “what is hypnosis, and how does it work?” The therapist uses a hypnotic induction technique which involves focussing the concentration, and then uses relaxation techniques to deepen the level of relaxation. Suggestions about the person becoming a non-smoker can then be given. These might be quite direct suggestions, such as “you are now a non-smoker”, or more indirect suggestions, such as “imagine yourself out for a walk, feeling fit, breathing fresh air and enjoying the walk because you are a non-smoker”.
Before giving these suggestions, I have found it helpful to ask the individual’s unconscious mind some questions about readiness to quit smoking. On most occasions the person is ready to quit, but sometimes the unconscious mind indicates that the person is not ready to quit. Reasons can then be explored, and these are commonly related to the mind viewing the smoking as being helpful in some way, such as managing stress. The therapist can then ask the unconscious; “if other ways of managing the stress are explored, would the mind be able to assist in quitting?” The response is usually then positive.
See more answers to common questions about hypnosis in part 2.
Common questions about hypnosis part 2.
How might hypnosis might help with stress or anxiety?
Hypnosis is an altered state of consciousness or a trance state, and is similar to relaxation or meditation. The relaxation techniques used are helpful when stress or anxiety are present. In addition, the individual can be taught self-hypnosis to use on a regular basis. Sometimes anxiety is related to specific issues, such as being in social situations, public speaking or phobias.
Hypnosis can incorporate behavioural strategies, such as using the imagination to practice a talk whilst in the relaxed state and being given suggestions about managing well and growing confidence. Other suggestions about focussing on the ideas to be expressed in the talk and letting go of thoughts about what others might be thinking or taking the focus off the audience can assist. We might also use a post-hypnotic suggestion (or “anchor”) to suggest relaxation and success, such as gently squeezing together the thumb and index finger of the right hand to bring a wave of calmness and confidence.
Can hypnotherapy be combined with other treatment approaches?
The answer is yes, and this article will discuss the use of hypnosis alongside psychological or spiritual approaches.
The psychological approaches used will vary depending on the hypnotherapist’s training. For example, principles of Cognitive Behavioural Therapy (CBT) might be utilised. CBT focuses on the inter-relationship between our thoughts, feelings and actions, and guides the individual strategies to develop more helpful thoughts, to modify their actions to so change how they feel. Hypnosis can reinforce these strategies in a safe and supported way. Other approaches which might potentially be used alongside hypnosis include analytic techniques, such as exploring feelings related to past experiences, or Neuro-linguistic Programming (NLP) which incorporates visualisations and thinking strategies. Some of the strategies from the more recent Acceptance and Commitment Therapy (ACT) have similarities to hypnotic techniques, and the two approaches can work well together.
I believe that treatment should be holistic, and one thing that attracted me to hypnotherapy was the potential to incorporate spiritual approaches if meaningful to the individual. An example of a spiritual approach is mindfulness, or paying attention to the present moment, which stems from Buddhist origins. Mindfulness techniques are very similar to deepening techniques used in hypnosis and can assist the individual to relax or manage anxiety. Also, there is growing evidence that such techniques can assist the individual in learning new ways of being.
In hypnosis, more direct spiritual suggestions or imagery can also be utilised if appropriate. The therapist should ask the individual about their particular beliefs, and about what suggestions or images would fit with their belief systems. For example, a person facing difficulties may find peace and strength from images such as being surrounded by a beautiful white light from a Higher Source, or resting in the palms of God’s hands. Also, as hypnosis involves theta brain wave patterns, I think there is the potential to explore the use of hypnosis alongside theta healing.
Hypnotherapy offers a great deal. It has always struck me as being a healing approach, whether through words, visualisations, suggestions or tapping into the individual’s own resources.
Where can I find a hypnotherapist?
I would recommend finding a therapist who has completed a well-recognised course. Also ask what areas they have expertise in, as different therapists focus on different areas of practice, e.g. obstetric hypnosis, hypnosis for stress and anxiety etc.
See http://www.hypnosisaustralia.org.au/ for more information.
What are some useful books in the mental health area?
Here are some ideas!
Aisbett, B. (2008), Book of It: 10 steps to conquering anxiety, Harper Collins Publishers, Sydney.
Aisbett, B. (2000). Taming the black dog: a guide to overcoming depression. Harper Collins.
- These are short books using cartoons and comments to encourage understanding and illustrated treatment.
Andrews, G., Lampe, L., et al. (2003). The Treatment of Anxiety Disorders: Clinician guides and patient manuals, Cambridge University Press, Melbourne.
- For clinicians, provides a valuable guide to treatment of anxiety disorders; includes resources for consumers.
Edelman, S. (2002). Change your thinking, ABC Books, Sydney, NSW.
- Excellent CBT book for professionals and consumers.
Eifert, G. H., et al. 2005, Acceptance and Commitment Therapy for Anxiety Disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change strategies, New Harbinger Publications, Oakland, CA, USA.
- About ACT for clinicians, theoretical.
Fox, B. (1996). Power over panic: freedom from panic/anxiety related disorders. Longman.
- About panic, for consumers/carers.
Greenberger, D., & Padesky, C. (1995). Mind over mood: change how you feel by changing the way you think. Guilford Press.
- A CBT workbook, easy to follow, full of exercises.
Harris, R. (2007). The Happiness Trap: Stop struggling, start living, Exisle Publishing, Wollombi, NSW.
- Book on ACT for consumers.
Harris, R., Aisbett, B. (2013). The Happiness Trap Pocketbook. Exisle, NSW.
- Easy to follow pocket book on ACT, with cartoons.
Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and commitment therapy, New Harbinger Publications, United States of America.
- For clinicians or consumers about ACT, easy to read, has exercises.
Hayes, S.C., Strosahl, K. D. and Wilson, K.G. (2003). Acceptance and Commitment Therapy: An experiential approach to behaviour change, Guilford Press, New York.
- ACT, for clinicians, theoretical.
Howell,C. (2009). Keeping the Blues Away: The ten-step guide to reducing the relapse of depression, Radcliffe Publishing, Oxford.
- Easy to understand, holistic approach to managing depression, has exercises to complete, for clinicians of consumers.
Howell, C., & Murphy, M. (2011). Release your worries: a guide to letting go of stress and anxiety. Exisle, Wollombii, NSW.
- Easy to understand, holistic approach to managing depression, has exercises to complete, for clinicians of consumers.
Lampe, L. (2008), Take Control of Your Worry. Australia: Dr Lisa Lampe.
- For consumers, about anxiety.
McKenzie, S., Hassed, C. (2012). Mindfulness for life. Exisle, Wollombi, NSW.
- Good book all about mindfulness, authors have also done mindfulness CDs.
Padesky, C., & Greenberger, D. (1995). Clinician’s guide to ‘Mind Over Mood’. Guilford Press.
- Guide for clinicians to the Mind Over Mood program.
Segal, Z.V., Williams, J.G. and Teasdale, J.D. (2003). Mindfulness-based Cognitive Therapy for Depression: A new approach to preventing relapse, The Guilford Press, New York.
Siegel, D.J., (2010). The Mindful Therapist: A clinician’s guide to mindsight and neural integration, Norton & Company, New York City.
- For clinicians about being a mindful therapist, fascinating.
Tanner, S., & Ball, J. (1991). Beating the blues: a self-help approach to overcoming depression. Doubleday.
- Good book on CBT for consumers.
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: A practice manual and conceptual guide, John Wiley and Sons, New York.
- For clinicians about CBT, theoretical, comprehensive.
What are some useful online resources in the mental health area?
I would suggest:
- beyondblue (www.beyondblue.org.au): this comprehensive Australian website provides information for consumers, carers, and healthcare professionals on depression and anxiety-related disorders.
- Blackdog Institute (www.blackdoginstitute.org.au): another Australian site with comprehensive information on mood disorders, including resources for young people.
- Blue pages (www.bluepages.anu.edu.au): Australian National University online CBT program.
- Centre for Clinical Interventions (www.cci.health.wa.gov.au): provides a wide variety of mental health and disorder-related information, resources, handouts, and worksheets suitable for use by GPs, allied mental health professionals, consumers, and carers.
- Consumers’ Health Forum of Australia (www.chf.org.au): the Consumers’ Health Forum of Australia Inc is an independent NGO that by represents and involves consumers in health policy and program development. The website contains fact sheets and information on projects and the consumer representative program.
- CRUfAD: The Clinical Research Unit for Anxiety and Depression (www.crufad.com) at St Vincent’s Hospital / University of NSW. The site has information for consumers and clinicians, and online treatment programs.
- Department of Veterans’ Affairs: mental health (http://www.dva.gov.au/health/menshealth/mental.htm): contains information on anxiety and depressive disorders in the veteran community, and links on where to get help or more information.
- Grieflink (www.grieflink.asn.au): assisting people who are experiencing grief.
- Headspace (http://www.headspace.org.au): Headspace was established to better meet the needs of young people with emerging mental health and drug and alcohol issues.
- MoodGym (http://moodgym.anu.edu.au): Australian National University online CBT program.
- Reachout: (www.reachout.com.au): a website for young people about mental health and life issues. Excellent resources.
- Sane Australia (www.sane.org): national charity working for a better life for people affected by mental illness – through campaigning, education and research.
- World Health Organisation (www.whoguidemhpcuk.org): has useful mental health information.
What mobile phone apps are available in the mental health and wellbeing area?
There are a large number of phone apps available in relation to mental health and wellbeing, and there is evidence that they are effective in reducing mental health issues, such as anxiety and depression. They can also aid wellbeing by assisting with sleep, relaxation, mindfulness, optimistic thinking and gratitude.
Called mHealth, the Black Dog Institute has been researching their effectiveness, and Konker &Petrie (2013) have written an article on the research. The advantages of mHealth are that the person can monitor their progress, get personalised feedback and support, and use the mHealth resources any time and anywhere.
Here are some apps that you might like to look into:
- Breathing meditations (5-60 minutes) http://www.breathing-zone.com/
- Monitoring mood and progress between consultations (help identify triggers, give feedback, includes wellness plan): see http://www.findingoptimism.com/
- Find a good website on meditation, and many apps, at http://meditationoasis.com/iphone-application-support
- Take a Break and iSleepEasy apps available at https://play.google.com/store/apps
- Smiling Mind has meditations for young people as apps: see www.smilingmind.com.au
- Breathe2Relax for stress management. You can record stress level, and utilize a range of technologies to reduce stress, anxiety. Note there is an app that the US Military has developed to treat PTSD: see http://www.t2.health.mil/apps/breathe2relax
- For Post Traumatic Stress Disorder (developed by Australian Centre for Posttraumatic Mental Health): see http://at-ease.dva.gov.au/veterans/resources/mobile-apps/ptsd-coach/
- You can learn Cognitive Behaviour Therapy online at moodgym but also as an app at ithinksmarter.co.uk
- See www.beyondblue.org.au and go to the online supports and treatments for information about online therapies plus apps. Plus see http://www.blackdoginstitute.org.au/public/research/ehealth.cfm for info on their online programs and apps e.g. myCompass (www.mycompass.org.au).
- MoodKit includes mood-enhancing activities, tools to identify and change unhealthy thinking, to chart mood across time, and create journal entries all designed to promote well-being: see wwwthriveport.com
- See also www.reachout.com for apps for young people
- Gratitude journal at www.happyrambles.com
- US site ‘World of Psychology’ had information on apps: see http://psychcentral.com/blog/archives/2013/01/16/top-10-mental-health-apps/
- For more information on apps see www.getselfhelp.co.uk.apps
Reference: Donker, T., Petrie, K., Proudfoot, J. et al. Smartphones for smarter delivery of mental health programs: A systematic review, Journal of Medical Internet Research, 2013l 15(11):e247.
Common Questions about Emotional Eating
What is Emotional Eating?
Emotional eating refers to seeking comfort and soothing emotions, such as stress, anxiety, sadness, anger, boredom or loneliness, through food. It may be that you are facing a difficult problem or dealing with stressors such as relationship, work or financial issues, and food becomes a way of dealing with the issues or stress. Food may be viewed as a reward, and low mood or anxiety can also trigger overeating. A number of triggers can in fact develop, and these include physical, emotional, social and cognitive (or thinking) triggers.
Emotional eating often leads to thinking about food a lot of the time, eating when stressed or anxious, sad, angry, lonely or tired, rewarding yourself with food, not knowing why you are eating, eating until feeling stuffed, feeling guilty about overeating, or having a ‘love-hate’ relationship with food.
How do we learn to eat emotionally?
As infants, when we are upset, we are soothed with food or drink, so we learn about eating for comfort from a young age. It may also be that a parent shows love through preparing food, or there are strong messages given or modelling around food being comforting. Unfortunately individuals may experience trauma as they develop, such as neglect or abuse in some form, and food can be turned to as a comfort. In addition, in our society, we learn to get rid of uncomfortable feelings as quickly as possible, whereas sometimes we actually need to sit with these feelings until they pass.
Is habit part of emotional eating?
Eating is a behavior and we naturally fall into habits with respect to food. For example, if we are used to eating cereals and milk each morning, we associate the morning with having cereals, and having them becomes a habit. If we associate going to the petrol station with buying not only petrol but lollies, soft drink or chocolate, then a new habit can be established. If we associate being sad with eating sweet foods, habit can be part of the problem. We quickly learn habits, but the good news is that we can change them quite readily too.
Does emotional eating happen consciously or unconsciously?
Emotional eating may happen consciously or unconsciously. Let’s just explain what this means. If you think of the mind as like an iceberg, the conscious mind is that part of the iceberg above the water; it involves our conscious awareness of what is around us and our conscious thoughts and decisions. The unconscious mind is like the greater mass of ice below the water. It houses our memories of past experiences and it contains a range of unconscious beliefs that we build up during our lifetime about ourselves and the world.
We may consciously choose to comfort ourselves with food or drink, or we may unconsciously look for food for comfort and we may not even be aware we are doing this. In fact, sometimes individuals can feel quite dissociated when they comfort eat. My understanding is that the unconscious mind just wants us to be content, and so it may lead us to eat for comfort, even though the result may ultimately be distress or gaining weight.
Why do we turn to carbohydrates or fats?
Many people who eat for comfort turn to carbohydrates or fats, and in particular chocolate, chips or foods high in sugar. Stress in the body leads to the release of hormones which can increase our appetite and lead to storage of fat in the body. Sweet foods give us an immediate burst of energy, and can stimulate activity in the brain which lifts our mood. The brain chemical, serotonin, which improves our mood, is released when we eat carbohydrates. The down-side is the effects of such foods are short-lasting and associated with weight gain. And there is increasing evidence that sugar is highly addictive.
Most people experience intuition, but how do you define it?
It should be straightforward to define intuition as it is something that most people have experienced. But what is it exactly?
- Many people refer to intuition as a gut feeling, their inner voice or sixth sense.
- The word ‘intuition’ is defined in The Oxford Dictionary as coming from the Latin word intueri, which means ‘to look inside (or) to contemplate’.
- The CollinsAustralian Dictionary describes intuition as ‘an instinctive knowledge or insight without conscious reasoning’.
- These descriptions suggest that intuition involves looking inside yourself and reflecting, that it is instinctive (unconscious) or protective by nature and different from reasoning with our conscious minds.
- In psychology literature, it is described as the apparent ability to acquire knowledge without the use of reason.1
- That is, intuition refers to the capacity of knowing through direct insight, without rational analysis or deductive thinking.2
These definitions are interesting, but I think the best description is still ‘knowing without knowing how we know!’ What do you think?
Based on my book, ‘Intuition Unlock the Power’, published by Exisle.
1. Bowker, K., et al., 1990, ‘Intuition in the Context of Discovery’, Cognitive Psychology, vol. 22, pp.
2. New World Encyclopedia, 2008, ‘Intuition’, retrieved May 2011: http://www.newworldencyclopedia.org/entry/Intuition.
Can we develop our intuition further?
My research and life experience indicates that we can, and that is what ‘Inuition Unlock the Power’ is all about – how to understand and develop your intuition. We are learning and our brain is changing throughout our lives. I believe we can enhance our intuition through practice and developing skills in the same way as we can other abilities. After all, intuition is an innate ability and the mind is capable of ongoing change and development throughout our lifetimes.
The middle section of the book is therefore all about:
- assisting you to understand and develop the different levels of your intuition, from protective gut feeling, to sensory experiences, intuitive thoughts, or inspirational experiences.
- developing your relationship with self and your inner knowing, and with others as this is key to enhancing your intuition.
Reviewing the available information on intuition highlighted a number of themes that can be applied to developing your intuition. These are:
- Different levels of intuition have been proposed relating to the conscious and unconscious levels of the mind, and potentially a ‘Higher Self’ or inner wisdom.
- Intuition can act like a compass to guide us in life.
- Mindfulness involves paying purposeful attention to the present and it activates nerve cell growth.
- We are likely to use our intuition when we are in a positive mood and rested. In sleep we tap into creative and intuitive functions of our brain.
- Empathy, creativity and intuition are housed in the same area of the brain.
- We can be taught intuition, through journalling, mapping decision-making, getting feedback on intuitive decisions and using relaxation.
- We often move backwards and forwards between rational thinking and intuition in decision-making.
- Symbols and dream can be keys to our unconscious emotional life.
It was from these themes and from my experience that I created seven steps to assist you in developing your intuition. In ‘Intuition Unlock the Power’, you are guided through the seven steps to enhance your intuition. They are as follows:
- ke space for intuition.
- Connect with yourself and others.
- Practise meditation and mindfulness.
- Enhance your creativity.
- Access you unconscious mind.
- Tap into positivity.
- Apply intuition in your everyday and working life.
Importantly, at the centre of these steps is trusting your heart-felt knowledge. See ‘Intuition Unlock the Power’ for more information on the how of developing your intuition!
What are some useful resources around Eating Disorders?
Here are some helpful resources (books and online) related to EDs
- Cash, T. (2008). The Body Image Work Book. New Harbinger Pubs, USA.
- Ciacchori, J., Bailey, A, Harris, R. (2014). The Weight Escape. Exisle, NSW.
- Edelman, S. (2002). Change your thinking, ABC Books, Sydney, NSW.
- Harris, R. (2007). The Happiness Trap: Stop struggling, start living, Exisle Publishing, Wollombi, NSW.
- Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and commitment therapy, New Harbinger Publications, United States of America.
- Heffner, M., Eifert, G. (2004). The Anorexia Workbook How to Accept Yourself, Health Your Suffering, and Reclaim Your Life. New Harbinger Pubs, USA.
- Hirschmann, J., Munter, C. (2008). Overcoming Overeating How to Break the Diet/Binge Cycle and Live a Healthier More Satisfying Life. OO life.
- Howell, C., & Murphy, M. (2011). Release your worries: a guide to letting go of stress and anxiety. Exisle, Wollombii, NSW.
- May, M. Eat What You Love, Love What You Eat. Available from www.amihungry?
- McKay, M. (2010). The Dialectical Behaviour Therapy Skills Workbook. New Harbinger, US.
- McKay, M., Sutker, C. (2007). Leave your mind behind The everyday practice of finding stillness and rushing thoughts. New Harbinger Publications. US.
- McKenzie, S., Hassed, C. (2012). Mindfulness for life. Exisle, Wollombi, NSW.
- Mitchell, J., Devlin, M. et al. (2008). Binge-Eating Disorder Clinical Foundations and Treatment. The Guilford Press, New York.
- Trimbole, E., & Resch, E. (2003). Intuitive Eating A Revolutionary Program That Works. St Martin’s Griffin, New York.
Acceptance and Commitment Therapy: http://www.actmindfully.com.au/
Advanced Psychology Services http://www.advancedpsychology.com.au/
o Private clinical psychologists specialising in assessing and managing eating disorders.
Beyondblue website for young people: www.ybblue.com.au
Blue pages: www.bluepages.anu.edu.au
o All about depression, developed by the Australian National University.
Centre for Adolescent Health: www.rch.org.au/cah
Centre for Clinical Interventions (CCI): www.cci.health.wa.gov.au
o Excellent website for clinicians or consumers – with workbooks on range of mental health topics e.g. panic, assertiveness, mindfulness, EDs.
CRUFAD (Clinical Research Unit for Anxiety Disorders University of NSW): www.unsw.edu.au
o All about treatment of anxiety disorders, including practical tools. Also have online treatment program.
Eating Disorders Association of SA www.edasa.org.au/
o For young people.
Maudsley Family Therapy www.maudsleyparents.org/
o Information on the Maudsley model and support for parents.
Mood Disorders Unit, University of New South Wales: www.mdu.unsw.edu.au
o Online treatment program for depression (CBT).
NEDC National Eating Disorders Collaboration www.nedc.com.au
o A collaboration of people and organisations with an expertise and/or interest in eating disorders, with the purpose of creating a nationally consistent, evidence-based approach to the prevention and management of eating disorders in Australia.
o Centacare’s Programs for Panic, Anxiety and Eating Disorders.
Positive Psychology website by founder Martin Seligman: www.authentichappiness.sas.upenn.edu
o Information about positive psychology, numerous resources and questionnaires.
o For young people.
SANE Australia: www.sane.org/
o Information about mental health issues, started by a parent.
Statewide Eating Disorders Service (SEDS) http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/eating+disorder+service/about+statewide+eating+disorder+service
o Located at Brighton, SEDS is a specialised mental health service providing assessment, care and information for people living with an ED, or where an ED may be developing, their families and carers. Education and support is available for those needing further information and assistance.
o Referral form on website.
The Australian and New Zealand Academy of Eating Disorders (ANZAED)
o Peak body representing and supporting the activities of all professionals working in the field of eating disorders and related issues in prevention, treatment and research.
The Butterfly Foundation: http://thebutterflyfoundation.org.au/
o Excellent website about eating disorders.
The Eating Disorders Association of South Australia (EDASA) http://www.edasa.org.au/
o The Eating Disorders Association of South Australia, also known as EDASA, is a non-government, not-for-profit, incorporated association based in Adelaide, South Australia. We provide practical advice, empathic support and guidance for those affected by eating disorders in our community.