When is a Therapy not a Therapy?

I have been on a lot of training lately- some I have loved, and some I have found less impressive-  the techniques just don’t resonate with me, so I have decided not to adopt them in my therapeutic work. That isn’t to say that the types of therapy do not work, I just don’t see them fitting in to my practice, be it because of a lack of a rigorous scientific background, or I just didn’t like the form of therapy! This got me to thinking- who is to say what works and why? Whilst pondering this (eternal) question, I found a study in the Psychological Bulletin that really intrigued me.

The study is called The Effects of Cognitive Behavioural Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis, so perhaps from this, you can see why my interest was piqued! The study is a meta-analysis, which means that they have taken all the studies (between 1977 and 2014) that are about CBT (Cognitive Behavioural Therapy) (Johnsen and Friborg, 2015) and have analysed them to produce an overall investigation in to the efficacy (how it is working) of CBT. The results are, interesting, to say the least!

The study tracked the fluctuations in the effectiveness of CBT over time, and what the study found was that CBT appears to becoming less effective over time. This is not good news for the NHS, as this is the main type of therapy that they advocate. So, why does it appear to be falling out of grace, and why?

The study shows that over a period of time, 1977 to 2014, CBT has become roughly half as effective in treating depression as it used to be. I have to say, that from my clinical practice, I am finding that clients are becoming more and more resistant to CBT- in my (limited!) opinion, it is because we are becoming more self aware, and the more self aware we become, the less we can justify it to ourselves. But then, I am just one psychologist and that is my opinion!

One theory that is being bandied around is the idea of the placebo effect, which I am sure you have all heard of. The placebo effect is the idea that if you take a pill for your headache, and you believe it is paracetamol, but it is actually just a sugar pill, that the power of your mind is so strong that you will believe that this ‘tablet’ has made you better and your headache disappears, even though there was no ‘active ingredient’ in the pill you took.

Perhaps, like a popular friend in your network of friends, CBT’s reputation precedes it; the fact that CBT was hailed as a miracle cure, could mean that people really thought it worked (the placebo effect) when in actual fact, it didn’t work as well as was expected.

Part of this theory is about our expectations, which kind of ties in with my theory on the efficacy of CBT- in comparison to when CBT came about, when it was developed by Dr Aaron Beck in the 1960’s, our expectations of life have changed greatly. We are more realistic about life, in general. So, perhaps we do not expect a ‘miracle cure’ anymore? Perhaps we accept that we are who we are, and we can only change things if we want to? Who knows? That, my friends, is another study waiting to happen!

Another theory is that, as any therapy develops and becomes more popular (which is inevitable!), that the number of incompetent or inexperienced therapists applying these techniques increases. This means that the efficacy of the therapy decreases- if you are not attending CBT therapy with an experienced practitioner, it is not going to work as well. It’s like taking your Porsche to the Skoda garage- it’s similar, but not quite the same, and a Porsche has a specialist management system, so a Skoda garage wont be able to give you as good service as the Porsche garage will; although your car may be fixed to a certain extent, there is still work left to do.

Whatever the reason, life has changed and therapy changes with it. Who is to say that the placebo effect can’t actually help? I mean, if CBT works for you, who cares if it is the placebo effect at work? As long as it works, right? The problem though, lies in if it doesn’t work for you because you have been to an inexperienced therapist, or perhaps, as in my experience, you are actually self-aware and you know what is happening for you. Either way, if the only therapy available to you is CBT, and it doesn’t work, what do you do?

Well, the current therapy du jour happens to be mindfulness. Now, I have been using mindfulness for a few years, and just attended a course to brush up on my techniques, learn any new theories and to make sure I am not an inexperienced practitioner! But, is mindfulness just the next buzz word- in 40 years time, will the studies be there to show us that, just like CBT, mindfulness has become less effective also?

Last week I attended training on a course called Havening Techniques®. Yes, yet another new form of therapy. I have not had enough experience with Havening to fully make my mind up about it, which is why I need volunteers to work with. But, this brings in to question, again, the efficacy of a therapy and the placebo effect- who is to say what is right and what is wrong? If a therapy works for you, and a competent therapist is treating you, then does it really matter what the modality of therapy is? Perhaps, in our ever-changing world in which we live in, the changing modality of therapies is actually useful. Perhaps therapy is adjusting to our different lifestyles and expectations in life?

Back when Freud was just at the beginning of his Psychodynamic theory, life was very different. People did not understand how their emotions effected, and affected their lives. The ‘new therapy’ gave us an understanding of what was happening in our lives. But now we understand, we want to solve our problems. And, in true modern fashion, we don’t want to wait; we want to fix them NOW.

Perhaps this is where Havening® could fit in? Dealing with trauma and emotions in a focused way, whilst, at the same time, giving you techniques to practice at home, where you do not have to be an expert? I don’t know, but I do know one thing- I am looking forward to finding out!


 

★ if you have contacted me with regards Havening therapy; I am in the process of writing contracts etc. to begin the therapy. I hope to be in contact with you in the next week or so to book appointments!


Johnsen, T.J. and Friborg, O. (2015) ‘The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis’, Psychological Bulletin, May.

Phew- What a Scorcher!

Hi Everyone!

Hasn’t the weather been glorious this week? I have been sat in training this week, so I have missed most of the sunshine!

I am just writing a brief blog post today, as I wanted to share with you the training that I am working with this week- it is called Havening Techniques and, so far, proves to be working very well!

Havening Techniques can deal with traumatic events in your past, that can cause difficulties in your present. Havening Techniques can also help to deal with strong emotions. It is a relatively new form of Therapy, and, as such, most people have never heard of it!

I will be looking for volunteers to work with over the coming months- in order to gain my Practitioner certificate, I will need to treat and record case studies for 30 clients. In order to be part of my study group, you will need to agree to (anonymously) have your data written up and for some of you, to agree to being filmed whilst undergoing your treatments!

So, if this sounds of any interest to you- do get in touch!


 

* For more information, go to www.havening.org

Being Mindful of Mindfulness!

I was on a Mindfulness course last week- Mindfulness is a really hot topic with Mental Health workers at the moment. I have been working with Mindfulness for around 4 years, so I thought I would scrub up on my techniques and ideas and get back into my Mindful practice for myself!

Did you know that in 2012 there were 40 new papers on mindfulness published every month according to Google Scholar? Guardian journalist Barney Ronay noted that 37 new books had been released that week alone! I think that this demonstrates just how popular mindfulness has become.

Mindfulness, the act of paying attention, in a non-judgmental way, to ones own experiences of the here and now. So, what exactly does that mean? Well, exactly what it says- paying attention to what is happening to you, around you, in the moment that you notice them.

Whenever anyone is going on a mindfulness course, the first thing people who are experienced in mindfulness will say to him or her is “Wait until you do the raisin exercise!” What? What on earth is that? Well, a good way to explain mindfulness is to take a raisin. Don’t eat it- you are jumping the gun there! Hold it in your hand. Have you ever really looked at a raisin? Have you noticed the colours? Have you held it up to the light and looked at the brown and amber hues that are in front of you? Have you ever looked at the creases, the ridges, and the folds? The size of the raisin or the shape of it? Have you felt it between your fingers? Is it squishy? Hard? Smooth? Textured?

No? I am sure you haven’t. Not really. Not closely.

Well, let’s not stop there! Pick up the raisin. Put it to your ear. Do you hear anything? No, of course you don’t, but then roll the raisin between your fingers. Can you hear the squeakiness of the raisin now? The slight grinding as you roll the raisin between your fingers?

Take the raisin and hold it up to your nose. Take a deep breathe in- can you smell it? What does it remind you of? Christmas cake? Cinnamon rolls? Is it a slight smell, or pungent?

Now, put the raisin in your mouth- but don’t chew it or swallow it! Roll it around in your mouth and really feel it. Put it between your teeth, give it a little squeeze. Can you feel the textures and the taste starting to spread? Gently chew the raisin, experience the flavour. Is it sweet? Bitter? Finally, swallow.

Now. I bet you haven’t experienced a raisin like that before, have you? You could do the same with making a cup of tea or brushing your teeth- any activity that you do during the day, that you can break down and really pay attention too!

So, what on earth has fiddling with a raisin for the last 10 minutes done for you, eh? Well, by exercising all of your five senses, your cortisol level has decreased (stress hormone) and you will feel calmer than you did before you started. By looking at things from a visual, auditory, kinaesthetic, gustatory and olfactory sense (see, hear, touch, taste, smell!) you have brought yourself into the present moment. You are not thinking of that annoying colleague today at work and you are not thinking of all the work you need to do tonight to prepare for tomorrow. You are in the moment, and that moment is peaceful and calm.

So, by practising this every day (for those of you in the know, it is VAKGO. Yep, snazzy, eh?) we can just stop what is happening, take a few minutes out of life to relax and calm down, before we go on to the next busy period of the day.

So, how exactly does being mindful, which can actually be a personality trait anyway, actually be beneficial? A study in 2011 suggests that

Evidence suggests that mindfulness practice is associated with neuroplastic changes in the anterior cingulate cortex, insula, temporo-parietal junction, fronto-limbic network, and default mode network structures” (Hölzel et al., 2011)

Say, what?! Well, what this means is that by practicing mindfulness, area’s of the brain, associated with neuroplastic changes (referring to changes in neural pathways and synapses that occur due to changes in behavior, environment, neural processes, thinking, and emotions – as well as to changes resulting from bodily injury) in areas of the brain that are responsible for attention, focus and regulation. Simply put, by utilizing mindfulness you can actually change the structure of your brain (the area’s that are ‘plastic’) for your benefit; to increase your sense of personal perspective awareness, your attention and focus, your emotional regulation and your body awareness.

Nah, that’s not real. Once your born, your brain doesn’t change. Well, actually it does- as we grow so does our brain. Our neural pathways and synapses develop and change, according to our environment, what we learn, what we don’t learn and genetics. So, if we train our brain to be present in the moment, really present, we can grow the area that we use to focus and pay attention. What magic is this, I hear you ask? Well, it is simply the wonder of the human mind- although science has come along way over the last 100 years, we still do not really know how the brain functions; we are learning more every week.

So, if mindfulness is so magic, why isn’t everyone doing it? Well, I cannot answer that one, I am afraid! What I can say is that mindfulness is NOT a cure all. It is a technique you can use to develop and enhance your day-to-day life. In fact, there are studies available that say certain people should not practice mindfulness; a study in 2012 concluded that there was not enough data available to fully analyse who should or should not partake in mindfulness meditation or therapy, but that people for whom there are deep-seated mental health difficulties or long term psychological affects, mindfulness meditation may not be appropriate (Dobkin, Irving and Amar, 2012).

The reason that mindfulness may not be appropriate for some people is that the act of mindfulness takes us deep in to meditation- by doing so, we are relaxing and allowing ourselves to be in the moment. If you have any traumatic experiences that you perhaps haven’t dealt with, or that still trouble you, the by going in to the mindful state can reduce your inhibitions, and the safety mechanisms, the defence mechanisms you have in place, to protect you from your difficult thoughts, are suddenly lowered, which can leave you in a very troubled place.

So, this blog then becomes a cautionary tale! Mindfulness, to some, seems like it is a waste of time, however, this is not what we are seeing from the studies that are coming out. Mindfulness has been shown to reduce anxiety and depression and to help with many other issues people have. However, it is not a one size fits all therapeutic achievement. In fact, if you are not in the right place in your life, in the right state of mind, mindfulness could in fact be quite dangerous for you- raising traumatic memories that you have repressed, hidden deep down or simply memories that you actually don’t want to, or can’t, deal with. Mindfulness is not the be all and end all that we originally thought it to be, the studies are showing this, but. That said, it could really work for some people.

So, if you are having difficulty sleeping, or are feeling stressed from your busy life, why not take 10 minutes out of your busy day to practice some mindfulness meditation (as long as you are not in the group of people discussed above, for whom mindfulness is contradictive!)? It doesn’t have to be the raisin, although, why not? Perhaps you are just going to use the VAKGO to notice what is going on around you, or you are just going to close your eyes and concentrate on your breath. In and out, slowly, clearly, purposefully. You never know. After 10 minutes of it, you may feel like a whole new person!


 

Dobkin, P.L., Irving, J.A. and Amar, S. (2012) ‘For Whom May Participation in a Mindfulness-Based Stress Reduction Program be Contraindicated?’, Mindfulness, vol. 3, no. 1, March, pp. 44-50.

Hölzel, B.K., Lazar, S.W., Gard, T., Zev, S.O., Vago, D.R. and Ott, U. (2011) ‘How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective’, Perspectives on Psychological Science, vol. 6, no. 6, November, pp. 537-559.

 

 

Death To All, But Metal \m/

Sometimes, you read a piece of research that really makes you sad, but sometimes, you read a piece of research that makes you smile and laugh- this is one of the blogs!

This week, a piece of research came out that really spoke to my soul (and, in particular, the teenager in me!)- the study comes from America, but is equally valid in the UK. As a teenager, and even now, I was heavily in to the ‘Alternative scene’. I didn’t listen to pop music, I listened to Grunge, Metal and Goth music, and the music seemed to offer a sort of peace of mind- I wasn’t the only person who thought this way. In fact, despite outward appearances and behaviours, I was actually really quite normal (if there can be such a thing as normal!).

So, the team in the USA wanted to find out- did the Heavy Metal kids from the 1980’s go on to lead a happy life? The back story to this study started, I guess, in the 1970’s with the birth of Heavy Metal music- bands like Black Sabbath, Deep Purple and Kiss had come to the forefront and exploded out of our stereo’s. Common myths were expounded at the time- if you played Sabbath’s records backwards, you would get a message from the devil! Now, we know that this is not the case, but back in the 1970’s and 1980’s, people genuinely feared for the sanity and the health of ‘Heavy Metallers’. They were seen as Satanists, or Occultists, and that no good would ever come of them and all they were trying to do was to get one over on ‘Big Brother’.

However, in reality, if you were in to this scene, you would know that this wasn’t true- the music was an escape for a lot of people, for the bad things that were going on in their lives. It gave people, who, like me, were ‘different’, somewhere to come together with likeminded people, talk, party, socialise and have something in common. To us, we were the normal ones, and the ‘norms’ were all weird!

So, back to the study- what did happen to those 80’s Metallers, and are they still living their Satanically demonic, drug-fuelled lifestyles? Well, the answer seems to be quite clear- the study from Humbolt State University utilised Social Media, to get together a group of 99 fans of Metal music, 20 musicians and around 20 ‘groupies’ (usually women, but sometimes men, who followed the groups around) and used a control group of a similar age, who were in to pop music, how their lives had turned out (Howe et al., 2015).

The heavy metal fans and groupies, but not musicians, reported that during their childhood they experienced more adverse childhood experiences than the control group did, with the groupies being particularly prone to suicidal tendencies. So, what does this tell us? Well, it tells us that the fans of metal music could have been drawn to the music because of the underlying themes of the music and the tone of the music, which seemed to tie in with their real-life experiences- life being dark, serious, moody and challenging; quite unlike the airy-fairiness of pop music.

The cohort of the study were examined against controls of attachment In their adult years (how well they form and keep personal relationships), the Big Five personality traits (openness, conscientiousness, extraversion, agreeableness, and neuroticism) and how this interacts with their personalities and how they function with them. Comparing the control group with the test group found that there was really not much difference between the two groups, psychologically- despite the Metal groups early childhood difficulties.

So, what about now? How are they dealing with life now? Well, believe it or not, the Metallers actually feel as content in their lives as the ‘norm’ group, but, crucially enough, the Metallers actually recalled being significantly happier in their youths and only one third of the metal group expressed any regrets in their lives, whereas in the control ‘norm’ group, at least half of them actually expressed regrets over their lives, and this group actually had a higher occurrence of commencing counselling for emotional problems.

So, what this seems to suggest to us is that by listening to Metal music, the test group actually managed to get through their tumultuous teenage years, fairing better than their ‘norm’ counterparts. Perhaps this does lend weight to the belief that the music allows its listeners a sense of freedom, a sense of being understood and a sense of catharsis about their lives, allowing for the free expression of their emotions and creating an outlet for the frustrations of adolescence.

One of the most interesting parts of the study was that the Metal musicians actually did better in this study than their counterparts- that actually implies the idea that the musician group of the cohort were actually highly functioning. This means that the musicians decided what they wanted in life and pursued their goals until they successfully completed their ambitions, thus making a career out of a ‘hobby’ that they were incredibly passionate about. Which, just goes to show that, if you have a past time that you truly love and are completely passionate about, if you follow your dreams, you probably will be a lot happier than your peers and counterparts.

One word of warning though- a third of the musicians went on to contract an STD during their lives, which, when accepting that they averaged over 300 sexual partners each, doesn’t seem to be much of a surprise! Remember kids- always practice safe sex!

I guess that the lesson here is, just because you don’t like it, don’t understand it, or don’t agree with it, doesn’t make it wrong. We are all different, and different things make us happy, elated, confident and strive to make the most out of our lives. Even if it does mean we suffer neck ache when we are dancing!

n.b I am away training next week, so I am thinking of changing the blog posting day- Don’t be surprised to see a post earlier in the week!


Howe, T., Aberson, C., Friedman, H., Murphy, S., Alcazar, E., Vazquez, E. and Becker, R. (2015) ‘Three Decades Later: The Life Experiences and Mid-Life Functioning of 1980s Heavy Metal Groupies, Musicians, and Fans’, Self and Identity, vol. 1, no. 25, May.

A Blog so Taboo, you probably won’t think it’s about you!

Menopause. We don’t want to say the word, never mind discuss the connotations we have with it- but why? What is so taboo about such a natural process and why do we find it so difficult to talk about?

When I attended my training day, I realised that even at the age of 38 (I know, I know, I don’t look it!), I hadn’t discussed the menopause with any of my peers- there is a perception that it is something that is going to happen to us, in the distant future!

But, what if it doesn’t? What if it happens when I am 39, and I haven’t had time to talk about it with anyone? Early onset menopause can happen at any age- yes, it is unusual, but it is defined as happening before the age of 45. 45. That seems really young to me right now, but I am sure that to my peers in their late 20’s/early 30’s, it seems a long way off!

So, why do we need to talk about the menopause? As men, why do you need to talk about the menopause, or even know anything about it? Well, if you’re in a committed relationship when your female partner (generally) reaches the age of 48-55, you will generally be facing the menopause together. Generally speaking!

I wonder what your experience of menopause is? Was it talked about as a child/teenager growing up? Did you/do you recognise your mums menopause? Was it a positive experience or a negative one? For me, it was an interesting time, to say the least! What about you?

Menopause can be life changing, for both of you. For the women, there can be a whole range of symptoms- hot flushes, being the one we hear most about. But, what about the others? Well, firstly there is the peri-menopause. Who has heard of that? Come on, hands up! Just as I thought, not many of you. The peri-menopause can last for up to 10 years before you have your final period. That’s a long, long time. In this time, your hormone levels begin to change and drop. Remember your teenage years, when your hormones were gearing up? Remember the emotions and the feelings you went through. Yeah, so it could be like that. It might not be, but it’s certainly something to think about.

Then, there comes the menopause itself. Again, the symptoms can last for years- it is a unique experience for each of us! Menstruation ceases, hot flushes, headaches, hair thinning, mood swings, weight gain, memory loss, depression, anxiety attacks, loss of sexual desire (libido) and a general dissatisfaction in life itself. That is a hell of a lot to be dealing with, particularly if you are bringing up teens, working and trying to maintain your relationship with your significant other.

But what if you are in your 20’s or 30’s and you have early onset menopause? What then? Where is the support? How do you deal with it? Like I’ve already said, it is a taboo in our society, so who are you going to talk to? It’s not Ghostbusters, that’s for sure.

Women who go through an early menopause can go through an even greater range of mixed emotions; after all, what was the cause of their menopause? Was it surgical, natural or chemical? Perhaps they didn’t have a choice, and are left with feelings of loss- their child-bearing years have been stolen away from them; feelings of being ‘old’ before your time; feeling that it is unfair- why did it have to happen to me? And of course, the emotions that come along when you are actually in the menopause- was it because you had to have a hysterectomy for a medical reason? Was it natural- before you even expected it to happen? Or was it due to chemical experience- chemotherapy for cancer, for example.

In the UK, 8 out of 10 women experience symptoms leading up to the menopausal phase- 45% of these women find the symptoms difficult to manage (Brayne, 2011). 1/3 of women lose interest in sex during the peri-menopause and 40% lose interest in sex during the menopause.

Now I’ve got your attention. Sex. Lack of. That’s going to affect everyone in the relationship.

No matter what age you start your menopause, as you can see from the list of symptoms; there is a lot going on. It doesn’t mean that you will experience these symptoms- all of them or any of them- but there is a fair chance you might.

And in amongst this, life goes on. You have to sit in the meeting at work, suffering from your hot flushes. You have to pick up your teenagers, even though you are feeling so tired from a lack of sleep. Your partner, be they male or female, doesn’t understand what has happened. You have changed over night- what did they do wrong?

Alexandra Pope, an author and workshop facilitator has found that if you have had traumatic life issues, prior to going through the menopause, if these have not been resolved, then it can lead to a harder time during the menopause. Perhaps the message here is self-care; we need to make sure that we are emotionally coherent, even if we are not about to go through the menopause!

What is important, despite the taboos, despite how uncomfortable it is, is that you talk about what is going on for you. Why have you suddenly started sleeping far away from your partner- explain that it is because you get hot at night and laying next to your partner makes you hotter. Why are your moods fluctuating, when they didn’t before? How is this affecting your relationship?

Many women describe a feeling of ‘powerlessness’ over their bodies- this is happening TO them, and they have no control over what is going on. How frustrating- to be in the middle of a mood swing and totally aware that you don’t want to be! Perhaps this is putting pressure on your relationship- your family doesn’t understand what is going on for you, and why should they? We don’t talk about menopause- it is something we dread and avoid from a young age. It isn’t something that we can control, and most people do not like feeling out of control.

So, what can we do about it? Well, some women choose HRT therapy, but that can have consequences of it’s own. If HRT is the way forward for you- talk to your doctor, talk to your friends. What is their experience of it? Ok, it might not be your experience, but it will give you a good idea of what may happen. Perhaps you want to follow a natural path- if so, what support can you get? Are there relaxation techniques you can learn? A book you can read, a support group you can join?

It’s time we didn’t look at the menopause as a taboo subject- it’s going to happen to every woman, at some time, but it’s how we choose to deal with it that makes the difference.

For me, I am feeling more prepared about my ‘change’ when it happens to me. At least I know what is going to happen and why, and I can understand that I may need some support to get through this, and that’s ok. Things are going to change, but they don’t have to change for the worse! How about you? Are you prepared for the change in your life? Do you want to be?


Brayne, S. (2011) Sex, Meaning and the Menopause, 1st edition, London: Continuum.

www.relate.org.uk (relationship therapy)

www.simplyhormones.com

www.nhlbi.nih.gov/ (Put HRT into the search box)

www.theonlineclinic.co.uk (Female Viagra information; flibanserin)

www.wildgenie.com (Alexandra Pope’s website)

www.daisynetwork.org.uk (network for early menopause)

www.earlymenopause.co.uk

www.thebms.org.uk/ (early onset menopause support)

www.fabafterfifty.co.uk (for older women)