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Better Days CBT News

What you will find in my blog

I will be writing about life transitions, how they can affect us. I will be talking about Cognitive Behaviour Therapy, and offering tips on how you can help yourself.

11 Tips to Promote a Good Night Sleep

Are sleep problems common?


Sleep problems are quite common, affecting up to 30% of the popultion, it is even more common in people over the age of 65.Having difficullties with sleep, at some time in our lives is normal.


How much sleep do we actually need? 


We are probably all familiar with the idea that we should get 7-8 hours of sleep a night. But how much sleep we need varies amongt people, some people function happily off 6 hours sleep a night, others say they need 10. The amount of sleepwe get varies over our life time, when we are babies we sleep a great deal, whilst when we are older we may sleep less.


Stages of Sleep


Sleep goes through stages in the night, cycling between Rapid Eye Movement sleep, when we dream, and non-Rapid Eye Movement sleep. Each time we go back into non_Rapid Eye Movement Sleep our sleep gets deeper. We also wake up in the night, but we don't remember.


How Does Lack of Sleep Affect us?


Not getting enough sleep can make us clumsy and unco-ordianted and affect our abiity to concentrate and pay attention. It can also make us bad temprered.


What cab cause sleep problems?


There are several possible resons why we may be having difficulty sleeping.

  • Age
  • Being less active
  • Needing to go to the toilet more often at night
  • Pregnancy
  • Pain
  • Hot flushes (menopause)
  • Diabetes, high blood pressure and breathing difficulties
  • Depression
  • Stress, worry and anxiety
  • Bereavment
  • Noise, heat/cold

Of course, you may have a combination of the above factors affecting your sleep.


Seeing Your GP


If you are not sleeping due to pain, or your going to the toilet more frequently , or having breathing difficulties, you should consult your Doctor.You are also advised to see your GP if you have been having problems with sleep for months,you have tried changing your sleep habits (see tips below), or you inability to sleep is affecting your everyday life and making it hard for you to cope. These days, sleeping pills are rarely prescribed. You may be referred for Cognitive Behaviour Therapy.


11 tips to promote the chances of having a good night sleep

  1. Go to bed and get up at roughly the same time everyday.
  2. Only go to bed when you are sleepy.
  3. Use bed for sex and sleep
  4. Don't read, or watch TV in bed
  5. If you have been in bed for 20 minutes, get up and do a calming, or boring activity and then go back and try again. Repeat if necessary.(If you require assisstance getting in to and out of bed, or your are are at risk of falling, ignore this tip)
  6. Avod caffeine for 6-6 hours before bed
  7. Have a bath a couple of hourse before bed
  8. Take some exercise during the day
  9. Don't nap during the day
  10. Don't watch the clock in bed
  11. Ensure the room is not too hot, or cold, is quiet and ventilated

References 

Sleeping problems: an NHS Guide, Northumberland Tyne and
Wear NHS Foundation Trust. 

https://web.ntw.nhs.uk/selfhelp/leaflets/Sleeping%20Problems.pdf
(accessed August 2020) 

Centre for Clinical Interventions-Sleep 

https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Sleep/Sleep---Information-Sheets/Sleep-Information-Sheet---04---Sleep-Hygiene.pdf 

NHS INSOMNIA https://www.nhs.uk/conditions/insomnia/ (accessed August 2020) 

CBT for Sleep

Problems sleeping can arise from underlying medical reasons and you should see your GP if you are experiencing problems with your sleep. Sleep disturbance can also arise for psychological and emotional reasons. Depression, worry, anxiety and bereavement, can all lead to difficulties sleeping. If you see a Cognitive Behaviour Therapist they will assess all of the difficulties you are experiencing. Cognitive Behaviour Therapy is an effective treatment for Depression, worry, anxiety and bereavement. It could be that working on one, or more, of these problems results in sleep returning to normal. Cogntivie Behaviour Therapy can be used to treat sleep problems, in their own right.


if you, and your therapist, agree to work directly on sleep, you will learn to monitor you current sleep pattern. You will identify any behaviours you, or others, are doing that are affecting your ability to sleep. You will learn the importance of good sleep habits. You will work together to identify, and tackle, thoughts that are making you worried, or anxious. Finally, you will re-establish a sleep pattern that is adequate and allows you to function well in life.

CBT for Loneliness

The feeling of being lonely is subjective, some people can live with little social contact, and others need a lot.


Loneliness has been deifined as "The feeling of discomfort, or distress that results when one perceives a gap betwee ones desires for social connection and your actual experience of connection".


So, you can see from this definition, that we feel lonely when we don't feel we are recieving the amount of social connection we want/need. That's why the amount of social connection required varies so much between people. it isn't just about the number of people we meet, or live with. We can feel lonely in a crowd, and we can feel lonely whilst living with partners/husbands and children.


In 2018, The Guardian newspaper ran a story with the title "Loneliness in over-50's is looming public health crisis" and the Campaign for ending loneliness have estimated that 2 million people, in the UK, witll be experiencing loneliness by the year 2025-26.


Loneliness isn't a mental health problem, but mental health problems can lead to loneliness, and loneliness can lead to mental health problems. Depression and anxiety can lead us to withdraw and isolate, as can low self-esteem. Being isolated can lead to depression, anxiety and low -self-esteem. Some peopl have had mental health problems all of their lives and have become isolated and lonely. Others developed mental health problems later in life and then become lonely. Some people have been married and had children, whilst experiencing mental health problems, and only become lonely when thier relationships brokedown, children left home, or their was a bereavement. Some people develop depression, anxiety and low -Self-esteem as a result of those things happening in their lives.


Whatever the cause of your loneliness, depression,anxiet, or low self-esteem, cognitve behavour therapy can help.


When you see a cogntive behaviour therapist because you are lonely, and/ or have depression, anxiety, or low self-esteem you will learn how your thoughts, feelings and behaviours are linked. You will learn to evaluate and challenge the thoughts you have. You will learn how behaviours your doing are keeping you stuck where you are, and you'll learn how to make changes that will help you move to a new future.

How CBT can combat Loneliness

When things happen to us in life, like divorce or separtation, illness, or job loss, it can change the way we think, feel and behave.



We may start to have negative thoughts about ourselves like "i'm useless", "I'm old and ugly". We may also have thoughts about others such as, "They don't care". "They will think i'm boring", and thoughts about the future "This is how it's always going to be", "Nothing will change".


These negative thoughts trigger matching feelings, shame, embarassement, sadness etc. 


When we have negatvie thoughts and feel bad, it changes the way we behave. We may stop going out, stop looking after ourselves, stop calling firends. These changes lead to further negatie thought, feelings and behaviours, it's a downward spiral.


CBT helps you evaluate your thoughts and check how accurate they are, often we believe everything we think is true, but that is not the case.


When you have CBT you see the links between your thoughts, feeling and behaviours.


Once you have developed more balanced, more positive, thoughts, your feelings will begin to change. You will feel more hopeful and optimistice. You will see that things can change and the future can be worth living for. 


When you feell more hopeful and optimistic, and have a belief in your self and your ability to take control of what happens next, you will be motivated to acheive new things, or re-connect with people and activities you used to enjoy.

Bereavement and Grief

Mind, the mental health charity, say that bereavement occurs when we lose someone important to us, or a loved pet.


We can lose someone due o their death, but also due to separation or divorce. The emotion we feel when we suffer a loss is known as grief. Grief, after a loss, is normal and natural. 


Mind explain that there are different types of grief, the type we get after someone has been lost and:

  • Anticipatory grief where we know someone is going to die, and we begin to grieve before they die.
  • Secondary loss, after the actual loss, their are times when we think about things that won't happen now the person isn't around, like an anniversary, or special event.

There is no set length of time for grief to take place and end. It varies from person to person. 

Whilst grieving we may experience:

  • Sadness, or depression
  • Anger
  • Shock, denial, disbelief
  • Numbness
  • Panic
  • overwhelmed
  • Relief

Some people have all, or some of these feelings, others have none of them. The bereaved person may also:

  • Have dufficulty sleeping
  • Loss of appetite
  • Physical health problems
  • withdrawal and isolation

Many researchers and professionals beleive that grief follows stages:

  • Denial and disbelief
  • Depressed, tired, hopless
  • Anger
  • Bargaining
  • Acceptance

The stages don't always follow this order, and a person can move back and forth bwteen stages until acceptance.

Normal grief, sometimes referred to as simple grief, is not a mental health problem, it is a natural response that usuall reduces over time, and the person returns to coping and functioning adequaley in life.


Some people don't, their grief remains strong and debilitating. There is debate as to how long such emotion and problems in coiping should be seen as normal and when they become a sign of complex grief, that requires professional help to address. Between 6 and 12 months is the lenght of time tthat should elapse before considering that your grief is not resolving as it should and may be complex grief, requiring psychological treatment.


You should seek help at any time, following a loss, if you feel you can't cope.

There are are a number organisations that offer help and support after the death of a loved one, such as Cruse Bereavement Care. I have included a link to a pdf document produced by Mind that gives a full list of organisations who offer support, and Mind themselves offer advice and support.



NHS UK say that you should see your GP if :

  • You are struggling with stress, anxiety, or loww mood
  • This has been going on for more than two weeks
  • What you tried yourself hasn't worked
  • You want them to referr you for help.

I have included a link to NHS UK where you can see their full advice and instructions on what to do in an emergency.


You can refer yourself to your local psychological service for assessment and support. 


If, for any reason, you decide to seek help privately , for your grief and related problems, Cognitive Behaviour Therapy has been shown to be effective in helping with grief.


When you see a cognitive behaviour therapist, they wiill take a full list of your issues, such as difficulty sleeping, loss of appetite, worry and stress. They will complelte some assessments with you. You will devleop an understanding of what's happening and why you haven't improved. You will be given information about grief, you will examine your thoughts, feelings and behaviours and learn skills that will help you reduce your distress and function better in life.


Links 


Mind-About bereavement (link to pdf) 

https://www.mind.org.uk/media-a/3361/bereavement-2019-for-pdf-download.pdf 


NHS UK Grief after bereavement, or loss. https://www.nhs.uk/conditions/stress-anxiety-depression/coping-with-bereavement/ 

Is Life Making You Sick?

Negative Life Events can afect your physcial and mental well being, the good news is Cognitive Behaviour Therapy Can Help.


Negative life events are things that happen to us that interfere with our normal everyday life, we have to adapt and adjust to them (Cleland et.al 2016). 


A great deal of research has taken place, over decades, that has suggested that there is a link between negative life events and physical and mental ill health.


Cleleand (2016) and colleagues looked at this relationship too. they said that negative life events, like death, job loss, or illness, can lead to us developing other problems. They also say that, when faced with such circumstances, we can develop, or increase, the use of coping mechanisms (like smoking more, drinking alcohol more, or gaining weight) which can lead to the development of further problems in life.


They carried out a survey, and asked those who took part if, in the last three years, they had experienced one, or more, of a range of negative life events. These life events included illness and disability, job loss, divorce/separation, house move, and more.


The results showed that those who said they they had experienced such life events were more likely to have physical, and or mental health issues. The greater the number of negative life events the person had encountered, the more likely they were to experiences such problems.


In an earlier study,by Kraaij (2007) looked at this issue in relation to depression in older adults and found that there was a correlation between negative life events and depression in older adults.


How can life events make us vulnerable to physcal and mental health issues?



Some think that negative life events lead to stress and that prolonged stress is what makes us more prone to devleoping physical and mental health issues.


Steohen Palmer(2007)defined stress "Stress occurs when pressure exceeds our perceived ability to cope". 


When something happens to us, or someone close to us, we wonder what it means for us, or them. We may wonder if we have the time to cope with what has happened, we may ask ourselves if we have the skills, or the knowledge, to cope with it. We live in uncertainty, We worry. Often, we underestimate ourselves and our abilities to cope, and our fears are magnified.


Cognitive behaviour helps us identify any errors in our thinking and devleop helpful thought patterns. For some, learning about problem solving skills can help them manage their stress. For others, learning how to control and manage worry helps them cope well. Relaxation skills can help to reduce and control unpleasant physical sensations that occur when we are stressed, like pounding heart, sweating and over breathing. Learning to adopt helpful behaviours, like problem solving, or assertiveness, can further enhance the ability to control and manage stress.


If you feel you aren't coping you can always see your GP.


If you are stressed, if you have experienced negative life events, and your stress is not improving, or is even getting worse, you may be vulnerable to developing further problems. You should see your GP for advice.

Cognitive behaviour therapy (CBT) can help you reduce, control and manage your stress, making you more resilient and reducing your risk of further problems.


References

Vivian Kraaij, Ella Arensman, and Philip Spinhoven (2002) Negative Life Events and Depression in Elderly

Persons: A Meta-Analysis,Journal of Gerontology:

PSYCHOLOGICAL SCIENCES Copyright 2002 by The Gerontological Society of America

2002, Vol. 57B, No. 1, P87–P94




Cleland, C., Kearns, A., Tannahill, C., & Ellaway, A. (2016). The impact of life events on adult physical and

mental health and well-being: Longitudinal analysis using the GoWell health and well-being survey. BMC

Research Notes, 9, [470]. https://doi.org/10.1186/s13104-016-2278-x


Palmer,S.(2007) The Sunday Times, Creating Success, How to Deal with Stress