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BLOG: 'CBT - the thinking, feeling connection'
Shean Cadby-Lynch • 16 December 2022
Occupational therapist Shean Cadby-Lynch explains why Cognitive Behavioural Therapy (CBT) can help your mental wellbeing
The focus of the blog today is about CBT (Cognitive Behavioural Psychotherapy) and how it might be able to help you.
I qualified as an occupational therapist is 2002 and practised in many different mental health settings over the years. In 2010, I trained to be a cognitive behavioural psychotherapist.
The two professions work rather well together and, as someone who is dual trained, I am able to use all of my skills and knowledge to work with someone in a client centred, holistic way.
Today, I will be trying to explore: What is CBT and how can it help your emotional wellbeing?
It's such a great question because there are so many therapy options out there, from psychoanalytic therapy to counselling to Gestalt Therapy, so how do you know if CBT is for you?
Feelings and behaviours
Well firstly, do you want a therapy that would help you look at the relationship between your thoughts, feelings and behaviours, and how they interact with each other and have an effect on each other? If so, then CBT might be what you are looking for.
CBT is a talking therapy and is based on the concept that there is a relationship between our thoughts, feelings, and behaviours. You and your therapist will look at how your thoughts, beliefs and attitudes affect your feelings and how you behave, and vice versa.
It is based on the belief that how we think about situations can affect how we feel and how we then behave in these situations. For example, if you experience negative thoughts about a situation, you might then experience negative emotions such as low mood, which can then impact on our behaviour (such as withdrawing or isolating ourselves from the situation which has caused the negative thought).
This is what we call in the CBT world, a ‘vicious cycle.’ CBT therapy can support and help you to change these vicious cycles so that you can change and alter the way you think, feel and behave, so that you can overcome your difficulties, feel more positive, and improve your emotional well-being.
Low self-esteem
CBT is evidence-based therapy, which means that there's a lot of research into how effective and helpful it is with depression and anxiety disorders, such as depression, generalised anxiety, panic, health anxiety, phobias, OCD, PTSD
and low self-esteem.
When you first see a CBT therapist
you will have an assessment and this is where you look at the difficulties that you're experiencing, whether that’s symptoms of low mood, anxiety, or both, and how it is affecting your present, day-to-day life.
There is a myth that CBT does not deal with past issues and yes, most CBT sessions do focus on the ‘here and now’, as you are exploring and tackling current difficulties and exploring what is maintaining these difficulties.
But it doesn’t mean that past problems or issues are discounted or not addressed, as past experiences may be an important contributory factor in the development of the problem.
CBT treatment
CBT treatment is goal orientated and can be short-term if a problem is mild. In that case, as little as six sessions could make a big difference. Whereas more complex situations may require up to 20 sessions or more.
Sessions are reviewed on a regular basis to ensure treatment remains goal focused, client centred and collaborative.
One of the things that makes CBT different to other types of therapy is the focus on in session ‘tasks’ and ‘homework’, which are practical tasks that you and your therapist work through together in a session. The you, as the client, would practise these activities or tasks outside of the session. For example, you might keep a mood diary or a thought record.
These ‘tasks’ would be reviewed at the following session, together, and this would enable you to start to build a ‘toolbox’ of strategies for you to use, both during your period of therapy and in the future, remaining valuable long after therapy is completed.
Therapy
You would be an active participant in therapy and would want to allow yourself time to complete the in-between session tasks, to enable you to get the most out of your therapy experience.
The therapeutic relationship between the therapist and the client is really important and for me, this is one of the main contributory factors to successful therapy, as well as active engagement from the client in the treatment process.
Treatment is collaborative whereby you and the therapist work together to explore your thoughts, feelings, behaviours, triggers, and maintenance factors, to enable effective treatment planning and implementation to be carried out that is both goal orientated, client focused and holistic, putting you, the client at the heart of treatment.
I hope my first blog has helped explain CBT just a little?
Maybe you can relate to some of the difficulties I’ve mentioned today? If so, CBT might be a therapy that you want to consider. So, please do give us a call or email kate@wellbeingtherapysolutions.co.uk for a chat.
READ MORE: Explore more of our adult therapy sessions
More employers are recognising the need for workplace based support for employees. Being given space to be heard and understood is so valuable to helping people continue to give their best in the workplace. I have been supporting employees both through group work and individual support. It is always such a privilege to hear people share their burdens and concerns. I work through these together with the person or group to create an outcome that improves the situation. Sometimes employees can feel like they are trying so hard to make things work, yet not seeing a result from all of their efforts. One thing that has struck me during my time of providing workplace support is many employees I have spoken to are in a supporting role. This can give them a sense of not being good enough and that they should be able to cope with what is entrusted to them. Yet the reality is that carrying other people’s worries and concerns is difficult. It takes a lot of emotional energy to support others as well as supporting yourself. When people see you as a kind, empathetic person you are also more likely to get others sharing their worries with you. This can create a caring burden or emotional burnout which is usually a sign of having been too strong for too long, not a sign of weakness. “Sometimes the listeners need a listener too” Everyone needs a space to be heard, especially when dealing with challenging or emotional content. Having regular times for employees in caring roles to offload and share openly is an important part of looking after the overall wellbeing of staff. As Occupational Therapists, we can facilitate this to help your staff to have a listening ear and be able to continue their amazing work.
Have you ever considered gardening to be a form of exercise? This week I was pleasantly surprised to read that 3 hours gardening is the equivalent of 1 hour in the gym! Gardening is indeed a fantastic form of exercise, offering a fabulous blend of both physical and mental health benefits. I often find that as a busy working mum I don't have the hours to spend in the garden, but find that even half an hour doing a bit of weeding or planting is totally rewarding and often helps me to feel rejuvenated and re-centered. It is a go-to stress reliever, promoting relaxation and improving mood, with the added benefit of engaging all the major muscle groups as well as building strength, improving flexibility, balance and range of motion! So, whether you have a few minutes or a few hours, tending to your garden is a fantastic way to stay fit and centered. If you don't have your own garden, there are plenty of community gardening projects and volunteering opportunities around that you could get involved with, highlighted by Rebecca in her recent blog .
I t's Mental Health Awareness week 2024: with the theme of “Movement: Moving more for our mental health” So, how do we define movement? Well, it can be any type of movement that has a positive benefit on your social, emotional, and physical wellbeing. If it is meaningful, rewarding and you enjoy it, then you are more likely to repeat it. Engaging in any type of meaningful activity that gives a sense of pleasure, achievement and purpose will improve your mental health, reduce anxiety, depression, low mood and improve your self-esteem. Participating in activity that we enjoy, such as exercise, whether it be walking in the fresh air, working out at a gym, or going to a yoga class, can have such positive effects on our wellbeing. If exercise isn’t for you, movement doesn’t need to be structured, it can be any type of physical activity, which increases your movement, which could include domestic chores, necessary tasks, playing football with your children, dancing around the house or walking to the shop. However, sometimes this feels tricky if we are experiencing low mood and a loss of motivation. When this happens, we probably start to move less as we start to avoid engaging in some of our daily activities. As you avoid these activities, you then reduce your opportunity for social and personal activities that give you pleasure and achievement. Behavioural activation is a treatment technique used in Cognitive Behavioural Therapy to help you to address avoidance and focus on activities to reestablish daily routines, increase pleasurable activities, and address important necessary tasks, therefore, increasing movement and supporting positive wellbeing. This strategy helps clients to re-engage in activities to improve their level of pleasure and achievement, improving their mood and improving their positive thoughts leading to an increase in motivation. How do we overcome this: - Make a list of activities that you’ve stopped doing (routine, pleasurable and necessary) - Think about new activities that you might like to start - Start small and try to plan and schedule activities into your day starting with the easiest, e.g., go for a daily walk - Be consistent - Regular small activities are better in the early stages to reduce procrastination and to encourage motivation. Therefore… just try a little bit of extra movement and see the positive benefits on your wellbeing. Find out more about Cognitive Behavioural Therapy in Shean's earlier blog Learn more about Shean and her approach to therapy with her clients
The benefits of being in nature are well documented. When it comes to movement, we are more likely to experience exercise as restorative when in green environments and blue spaces, compared to exercising in built outdoor environments (Kajosaari and Pasanen 2021). What if your mental health makes being active outdoors difficult, however? If you feel you need some extra support to move more outdoors, here are some ideas… Green Gyms Offer free, outdoor volunteering sessions across the UK, transforming green spaces. To find a green gym near you, go to: https://www.tcv.org.uk/greengym/find-green-gym/ Mental Health Mates Peer support groups IRL and online, run by people with lived experience of mental health issues, meeting regularly to walk, connect and share without fear or judgement. To find a local walk: https://www.mentalhealthmates.co.uk/find-a-walk/ Wellbeing Walks Many local councils now run “wellbeing walks” – these typically involve shorter distances, with the option to join longer walks if you wish. Check your local council website for further information. The Ramblers Association also facilitate Wellbeing Walk Groups. To find a Wellbeing Walk Group local to you: https://www.ramblers.org.uk/go-walking/wellbeing-walks-groups Community Garden Groups The Royal Horticultural Society (RHS) has information on how to join a local community gardening group. Go to: https://www.rhs.org.uk/get-involved/community-gardening/find-a-group Accessible Green Spaces Accessible Countryside for Everyone (ACE) has details of green spaces accessible by those with restricted mobility, wheelchair, pushchair and mobility scooter users. Go to: http://www.accessiblecountryside.org.uk Wildlife Spending time outdoors with other living creatures can be very beneficial for our mental health. Wildlife events can encourage movement, whilst providing a focus other than exercise. If you don’t have a garden, try visiting a local park or urban green / blue space. The Big Garden Bird Watch takes place in January each year: https://www.rspb.org.uk/whats-happening/big-garden-birdwatch Big Butterfly Count takes place from Friday 12th July until Sunday 4th August 2024: https://bigbutterflycount.butterfly-conservation.org The Wildlife Trusts also offer “citizen science projects” both locally & nationally: h ttps://www.wildlifetrusts.org/citizen-science Some other added benefits of moving more outside… • Decreased stress levels • Improvement in mood • Increased relaxation • Meeting your sensory needs • Increased energy levels • Having a change of scene • Connection to the seasons • Getting to know your local area
“The kitchen is a place of solace, where problems are solved.” Nadiya Hussain (British Chef)
“People can’t just fit in anymore these days. Everyone needs this and that, just for them” Ahh a penny for every time I have heard something similar when I tell people that my job is working with children and young people with mental health issues and neurodivergence. I would certainly be rich but I would not stop doing the job I am currently doing. [Pause here if you are new to the term neurodiversity, please refer to my previous blog first] Understanding is key and I am completely understanding of people’s attitudes to something that they do not understand. So please, allow me to explain… Let me take you back to the early 90s (yes I was there before you think I am writing out of turn) with a huge number of office workers sat all day long looking at a screens on box-standard chairs at box-standard desks slowly but surely working themselves into screen-related eye problems and posture-related back problems. My dad was one of these dutiful workers who ended up with both of these issues, struggling through the day trying to stretch every now and then and drowning the rest out with coffee. Until one day, someone started to realise that these problems could all be prevented with screen breaks, better adaptable seating and that maybe we could start doing workplace assessments to ensure office workers were better supported. What does any of this have to do with neurodiversity ? Well, after realising we all have different body sizes and lumbar support needs, we are now realising that we have many different types of brains that equally need different kinds of support. We are realising that doing something in exactly the same way all the time is maybe not the most productive way to work and we can be just as productive with certain breaks and changes in posture. A neurodivergent brain is wired differently and responds differently. If ever I am in an emergency or crisis situation, please let me be surrounded by neurodiverse people as their quick thinking and innovative ways of looking at problems will most likely produce the best rescue. Neurodivergent people have incredible analytical skills, they can think at a dazzling speed and digest huge amounts of information … if they learn to play to their strengths and are in a positive, neuro-affirming environment where they can be themselves. I know amazing people who can do all those things mentioned above, yet crumble under the pressure of delivering a 10 minute presentation in front of a critical colleague. Young people who are so creative they could earn a living from their creations, yet are being told they are failing their year at school. The key is down to understanding their thinking patterns or executive functions . Neurodivergent people’s brains are much more fine-tuned to the world around them. This can be super helpful when assessing risk in a crisis situation. It can also mean that they live in a world where they are bombarded by sounds, sights, smells. The world can feel exhausting if you are physically unable to turn off the sensations coming at you. Neurodivergent brains are incredible at out-of-the-box thinking. This also means that arbitrary rules that are not based on logic can be hard to follow. That unwritten social codes can be completely confusing, despite their best intentions to be kind, generous and honest. (Honesty and being socially acceptable do not often go together when you really think about it…) That perhaps their mind needs a better reason to follow an instruction than ‘because I said so’. If you want to understand neurodiversity better, start to look up information about executive functions instead of looking up diagnoses. If you want to be able to better support a neurodivergent person, ask them how you can support and allow them to be honest – even if you don’t like to hear the answer. No two neurodiverse people are the same as they are all spectrum conditions, meaning people can be miles apart in their presentation. Most of all, do not presume every odd interaction, word or comment is a deliberate personal attack. A little bit of empathy goes a long way. Just check if they are upset or annoyed or if they just got the tone or words wrong. They will soon tell you and then you can work together and harness the beautiful power their brain holds.
Maybe it’s the new buzz word of today or maybe people just like to label old things in new ways. You really can’t get away from this neurodiversity word anymore with people coming forward left, right and centre claiming they, too, are ‘that’. As a neurodiversity expert I would love to demystify some of what is happening and make you feel a bit more comfortable with all this neurodiversity (or ND) talk. As there’s a bit of talking to do, this blog is part 1 with part 2 coming shortly. It may not surprise you that the term neurodiversity has actually been around since 1990s. It has gained a lot more momentum and use since around the Covid-19 pandemic in 2020. In itself, neurodiversity simply means: neuro = brain and diversity = different or varied The reason for this term being used is that brain scans have shown physical differences in the brains of many neurodiverse people compared to non-neurodiverse (usually referred to as neurotypical). Most people who are neurodiverse demonstrate differences in their thinking, which can also lead to differences in communication and behaviour. These have and are still often interpreted as personal character flaws and wilful resistance to commonly accepted societal standards. In the next blog I will spend more time on the information processing differences people with neurodiversity often experience. Neurodiversity is an umbrella term for a whole range of different differences. You may be more familiar with them under these terms: autism , ADHD/ ADD , dyslexia , dyspraxia , Tourette’s , tic disorder, dysgraphia , dyscalculia (this is not an exhaustive list). These terms are diagnoses that have to be made by an appropriately trained health professional and are often framed in the light of being a ‘disorder’. The neurodiversity movement is pushing back from the word ‘disorder’ and would prefer for their differences to be seen as just that: different. People who are neurodiverse can have ordinary jobs, ordinary lives and ordinary education. What sets them apart is their extra-ordinary abilities and, sometimes, their extra-ordinary sensitivities. Working with many neurodiverse children, young people and adults I always use a strengths based approach. We analyse their strengths, which are very individual and not necessarily pinpointed to a particular label or diagnosis. We then work with these to overcome the sensitivities which can make everyday life a challenge or cause confusion as to why they can’t just do things the same as everyone else. In reality, it is the neurodiverse people who try their very hardest to blend in, to not be noticed and to mask their true thoughts and behaviours so that they do not get judged or rejected by society. I always highlight to my neurodiverse clients that they can’t do things like everyone else, because their brain differences mean they are not like everyone else. Attempting to mask all day long and worrying about everything they do or say all the time results in huge levels of anxiety and/ or depression. However, once they understand their way of working and can play to their strengths, they can get the same end results as everyone else if they go about it in their own, unique way and valuing their own unique brain. For more insights on this unique brain, please refer to part 2 of this blog .... coming out shortly. Contact us to find out more about ways we can help Neurodiverse young people and adults
Every year at WTS we get behind World Mental Health Day as; you guessed it, we think mental health is so important. We are passionate about encouraging everyone to look after their mental health. This year, we decided to hand ‘the pen’ (well it was a keyboard…) to our associate Marjolein who is our resident children’s and young people’s OT with a specialist interest in neurodiversity. “If looking after our mental health was easy, I would be out of a job” says Marjolein. “As a team of Occupational Therapists we often discuss meaning with people. Meaning is what motivates someone, what they think is the most important in life, what ‘makes them tick’. Finding the answer to this can be a way of unlocking a whole host of other things that suddenly all start to make sense. Why can can’t move on from this situation or why we prioritise certain things over others. Why we make the choices we make or why we feel whether we can make any choices at all. As humans we have an intrinsic need to connect to others. We are relational beings and often our meaning can be found in relation to others or in doing something for others. When we can feel that things are difficult, we can feel discouraged and disconnected from those we are usually close to. Life can feel like an endless series of demands to keep all the plates spinning and keep everyone happy. However, the only person in our connected and sociable world we are forgetting is ourselves. So, I would like to invite you to act on one simple idea. This year for World Mental Health Day I want to invite you to connect. Connect to another person. Someone who can help give you some meaning to the things you are facing right now. Someone who will make you feel like a human being, like you are seen and like you matter. Someone who will stop long enough to really listen or someone who will spend time with you and make you laugh. Give yourself permission to do less ‘doing’ and a little more ‘being’. Spend time with family or friends and just waste time together. Because time spent with people creates the meaning we need and the connection that helps us carry all the other things we do. Mental health is a human right, now it’s time to make it YOUR human right.”
“T hings I wish people knew…” Supportive Practice: Conversations with members of the childless community identified the following examples of supportive steps that a workplace can take: If someone is TTC (trying to conceive), are policies supportive? Staff undergoing fertility treatment may be required to take sick leave or annual leave for appointments & recovery time. This can result in work/life balance being even more difficult to achieve during an emotionally & physically demanding time. Also consider what an employee might need if treatment is unsuccessful. More awareness (especially in all female teams) of how making children / motherhood the focus of team “chat” can result in childless staff members feeling side-lined. If a team member is visiting to introduce their new baby, consider facilitating this away from the main / open plan office. This enables existing staff to have choice regarding their involvement. If this isn’t possible, arranging a specific time can again facilitate choice. On a similar note, recognition that not all team members will feel able to / want to attend “baby showers” or similar such events. Ensure that policies & practices are inclusive of staff members with caring responsibilities not involving parenthood. It is not uncommon, for example, for a care package to be cancelled or changed with little notice. How might this impact a member of your team? Everyone’s lives, inside & outside of work, matter. Further information World Childless Week - Further information about childlessness in the workplace and creating positive change can be found on the website University of Bath - Childlessness in the workplace – opening a conversation (awareness raising event) University of Bath – Supporting employees who are childless not by choice (information & resources) BBC - Do Companies lean harder on non-parents? (article)
September 11th – 17th is World Childless Week "Do you have children?" This may seem like a harmless conversation opener, but for some it can touch on some very painful experiences. A few facts ... • One fifth of British people AFAB (assigned female at birth) will not have had a child by their early 40’s. • One quarter of British people AMAB (assigned male at birth) over 42 will not have had a child. Terminology: “Childfree” Usually refers to someone who has actively chosen not to have children “Childless” Someone who wants or wished to have a child but can’t / couldn’t Sometimes referred to as “childless not by choice” Some find the term “childless” offensive as it implies you are “less” because you haven’t had a child Another term used within the childless community is NOMO – not a mother “Social infertility” or “circumstantial infertility” This refers to people who, through no medical reason, have not had children e.g. they haven’t met a partner A few reasons why some people may be childless: Fertility treatment didn’t succeed Miscarriage or stillbirth Partner didn’t want to have children Partner already has children (& didn’t want to have another child) Physical health (self / partner) Mental health (self / partner) Cancer treatment Early menopause Abusive relationship No obvious reason found (described as “unexplained infertility’) Things to avoid saying: “I know it will work out for you” (this might seem well intentioned, but none of us know the future, & we risk not hearing someone’s experience) “At least you get to have regular lie-ins / cheaper holidays / lots of free time” (consolation prizes don’t exist) “You don’t truly know love until you’ve had a child” (love is love & takes many forms) “You could always adopt” (adoption for many is emotionally complex & the need to be biologically linked to a child can be very strong) Things to consider: Pets or “fur babies” can be hugely important to someone who is childless & can be life enhancing. Someone who is childless may still have significant caring responsibilities (& within some families, it can be assumed that a childless family member is free to step up). “Parent” can also be a verb - to care about & nurture the welfare of another human being or animal is something many people value doing & can be a fundamental part of who they are. The childless community is diverse with needs that can differ. Further information: Communities The Childless Collective A community for childless people, including the opportunity to cultivate new friendships Gateway Women A support and advocacy network for childless women founded by British author & psychotherapist, Jody Day Ageing without Children Campaigning, information & support for people ageing without children Articles “I just assumed it would happen – the unspoken grief of childless men” (The Guardian, August 2023) “Not being able to have a baby was devastating – then I found people who embraced a childfree life” (The Guardian, April 2023)