Cognitive Therapy of Depression

Eating chocolate is one of the world’s most popular passions. The typical Swiss eats more than 21 pounds of this chocolate each year. Even the average Belgian or Brit downs some 16 pounds annually. In the United States, consumption weighs in at roughly 11.5 pounds per year. The earliest record of chocolate was over fifteen hundred years ago in the Central American rain forests, where the tropical mix of high rainfall combined with high year round temperatures and humidity provide the ideal climate for cultivation of the plant from which chocolate is derived, the Cacao Tree.

The Cacao Tree was worshiped by the Mayan civilization of Central America and Southern Mexico, who believed it to be of divine origin, Cacao is actually a Mayan word meaning “God Food”, hence the tree’s modern generic Latin name “Theobrama Cacao” meaning ‘Food of the Gods’. Cacao was corrupted into the more familiar “Cocoa” by the early European explorers. The Maya brewed a spicy, bitter sweet drink by roasting and pounding the seeds of the Cacao tree (cocoa beans) with maize and Capsicum (Chilli) peppers and letting the mixture ferment. This drink was reserved for use in ceremonies as well as for drinking by the wealthy and religious elite, they also ate a Cacao porridge.

Chocolate is full of mood-enhancing chemicals. To start with, it is loaded with sugar, which is a carbohydrate and triggers the release of seratonin. Chocolate also contains fat, which in itself provides a feeling of satisfaction since it answers the urge for calories. Chocolate is also said to have the same mood-enhancing chemical that is found in marijuana, although in much smaller quantities. To test the theory that chocolate enhances mood, a study was conducted at the University of Pennsylvania. Students who felt the urge to eat chocolate were given either milk chocolate, white chocolate (which contains no cocoa, just cocoa butter and flavoring), and pills containing stimulants found in chocolate.

Researchers say the findings were predictable. The pill didn’t do the trick, but both the white and milk chocolates did satisfy the students. The results suggest that it is not some secret chemical ingredient in chocolate that provides the euphoria, but the sensory experience such as the taste, the smoothness and the aroma. While some may be using chocolate as an energy booster, a study published in the British Journal of Psychiatry has found a link between chocolate cravings and personality. Results suggest certain personality types are not only more likely to crave chocolate, but it may also improve their mood.

Researchers from the Black Dog Institute correlated results from an online survey completed by nearly 3,000 people. Of the respondents, 54 percent reported food cravings during bouts with depression, of which 45 percent specifically wanted chocolate, and 61 percent of these said chocolate improved their mood and reduce stress. It’s believed substances in chocolate called endorphin and opioid, may be responsible for the mood enhancing effect. These compounds may make one feel more relaxed, thereby reducing stress and anxiety and improving mood.

Chocolates can also play a major role in a number of disorders, including bulimia, binge eating, and obesity. There’s some hints that chocolate may possess natural analgesic properties. Studies indicate that eating high-fat, chocolate foods can trigger the brain’s production of natural opiates. During the study, it showed that when a physician used a drug to block the brain’s opiate receptors, a binge-eater’s desire for sweet, fatty foods such as chocolate, dropped down. Still, there are questions left unanswered on the experiment, such as: Does the body simply desire anything sweet and fatty, or men naturally feel some special craving for chocolates?

The potential health benefit of chocolate is a popular area of study. Previous research has shown dark chocolate may be good for cardiovascular health and some scientists recommend them for reducing heart disease risk. The down-side is, of course, the calories. Chocolate is full of fat and sugar. While small amounts can be beneficial to your health, larger quantities are not so good. When using chocolate, even as medicine, moderation is the key.

We are often taught to ignore and bury our problems and upsets and to ‘be strong.’ This is a temporary solution for distress that has serious drawbacks. Learning to identify and to release our feelings are much better ways of handling them. Varieties of self-treatment methods enable us to do this, with excellent results, including the release of anxieties about having problems in the first place.
Bandages
I was taught in medical school in the 1960s that psychological wounds, like physical wounds, are often best handled at the time of emotional injuries by bandaging them, ignoring them as best one could, and carrying on with life. This was then, and continues to be now, the prevalent attitude of the majority of people.
Most of us develop habits of doing just that from childhood, both on our own and with the encouragement of family, friends and other authority figures. We cover over our wounds, burying them in our unconscious mind, and do our best to ignore them, or better yet, to totally forget them.
In childhood, this may be truly helpful. When we have only a limited understanding of the world, and limited coping abilities, it far less painful to bury our hurts than to suffer with them.
‘Billie’ started out in life a bright and cheerful girl with lots of curiosity and good energies. She had the misfortune to be born into a family stressed by her father’s limited earning capacity and her mother’s chronic depression, which was self-medicated with whiskey. Billie suffered neglect and the abuse of her parents’ violent arguments. She learned to grit her teeth to remind herself to be silent, lest she draw the angers from between her parents to herself. She also suffered from frequent criticisms from both her parents, never seeming to be able to do anything that would gain her their praises. The best she could manage was to draw the least attention possible to herself.
Baggage
As adults we have far better coping mechanisms for dealing with hurts. However, at that point we already are in the firm habits of burying our hurts and running away from them. These habits are so much a part of ourselves that we don’t even know they’re there.
The problem is, when we bury our hurts, we end up carrying them around with us in our unconscious mind. Through the years, we may accumulate enormous collections of such buried emotional baggage.
A buried hurt is like a festering sore. It sits in an internal trash bucket in our unconscious mind and exudes negative energies. The unconscious mind senses these as warnings about having been hurt in the past and remains alert lest we be hurt again in the present.
The unconscious mind then keeps us away from anything in the present that is similar to the warning signals it is getting from the buried hurts. In milder cases, we may have aversions for occasional foods, people and places with which we had negative experiences – often without conscious awareness we are doing these things for those reasons. In moderate cases, we may generalize from hurts in a specific situation and then we avoid anything similar to the original trauma. People who had an abusive parent my avoid relationships in their present lives with anyone of the same sex as their abusive parent. In severe cases, people may respond to the approaches of a person of the same sex as their abusive parent with stress reactions. This is called a post-traumatic stress disorder (PTSD).
It is often in our most intimate relationships that these buried issues become apparent. A colleague at work, a close friend or a life partner may stir the buried hurts in our inner buckets and be utterly blindsided by our inappropriate responses. The behaviors of people in our lives today trigger us to respond with feelings that have been buried in the past.
It is at this point that many people will seek me out for psychotherapy, as they waken to the fact that they are not behaving rationally but don’t fully comprehend why this is happening. Others come with requests for psychiatric medications, thinking they need stronger bandages.
Billie suffered from frequent, severe tension headaches. She knew they were set off by stresses in her life, but could not figure out how to not get stressed when she was confronted by any criticisms from her boss, her fiends or her boyfriend.
Balms
Varieties of treatments are available to help with these sorts of problems. Each has its benefits and limitations.
Medications are the quickest ‘fix.’ They require the least efforts on the part of family physicians, psychiatrists and people who just want to be free of their symptoms, but have little sense of the emotional baggage that may be contributing to the symptoms. Not only do then not address the underlying problems, they also carry risks of side effects, including fatalities. It is a little publicized fact that over 100,000 people die annually in the US from medications that are properly prescribed and properly used. Pain medications contribute to significant numbers of these deaths.
For those who are willing to take the reins of their lives into their own hands, there are many helpful approaches. The most popular today is Cognitive Behavioral Therapy (CBT). This can include relaxation exercises to reduce tensions; imagery exercises to reprogram the mind to not respond in the present with reactions from the past; and developing more constructive plans of action to handle inappropriate responses. CBT is a methodical approach for developing better habits to deal with buried hurts, but a rather slow one. It can take many weeks and months to make modest progress in changing one’s habits of reacting to stresses that trigger unhealthy responses.
Many varieties of complementary/ alternative therapies are available for addressing problems. Some are symptom-based and some are person-based, and the ‘how’ of the therapist administering the therapy may determine which approach is taken. For instance, acupuncture, homeopathy, Ayurvedic medicine, hypnotherapy, massage and relaxation techniques can all be offered as doorways to transforming one’s life, or as balms for particular symptoms.
Billie explored acupuncture because it has a good reputation for alleviating pain, but her acupuncturist was a physician who had only been on several weekend courses and used the needles much as he used medications – i.e. to alleviate the symptoms. Relaxation exercises provided temporary relief when she had the headaches, but they kept coming back, often at stressful times at work when she was unable to use these methods.
WHEE: Whole Health – Easily and Effectively finally provided permanent relief, with the release of fears, angers and hurts that had been buried since childhood.
Blessings
As we learn to deal with our physical and emotional pains, we often grow wiser in the process. We come to realize that our body is an intimate part of our whole being. When we have symptoms and illnesses, we learn to ask, “What is my body telling me about stresses and disharmonies in some part of my life?”
Many therapies end with the release of symptoms and problems. WHEE teaches how to install positive feelings and awarenesses to replace the negatives that have been released.
As she learned to listen to what her body was telling her, Billie came to understand that when she was clenching her teeth she was unconsciously ‘biting her tongue’ to hold back from sharing her feelings of anger and frustration and telling people off. She learned to use WHEE on her negative feelings and was then able to prevent her headaches and other pains from recurring
As we use self-healing methods, we can also come to understand how to nurture ourselves and to be more considerate of our physical and emotional needs. With continued practice, we even free ourselves of the fears about getting upset.

For those who are familiar with stress, there is a distinct
difference between regular stress and acute stress. While
regular stress is a part of daily life in the hectic world
of today, acute stress is an altogether different animal.

While stress is certainly a problem, considering that it
can cause a weakening of the immune system, problems with
memory, an inability to concentrate, and coronary disease,
acute stress is something else. In fact, acute stress can
actually cause a complete mental and physical breakdown.

Acute stress is caused by the most severe circumstances.
It is often the result of threatened or actual death,
serious injury, or some form of physical violation, such as
rape. The person suffering from acute stress usually feels
some sort of revulsion or horror at the sight of the event,
or from the experience of the event. Then, after acute
stress, the person is at serious risk of developing
post-traumatic stress disorder. Furthermore, the
experience of acute stress can have lasting, even permanent
effects upon the person who suffered the acute stress and
they may not be able to fully adjust to life after the
event.

Acute stress is, at its core, a form of psychological
trauma, not unlike physical trauma. The person is in such
a form of mental distress that the brain is almost
incapable of coping with the stress and shuts down. The
person who suffers from acute stress feels a sense of
numbness and they are unable to connect to the world
outside. They cannot adjust to the reality that surrounds
them and they are, in many ways, stuck in the moment when
they suffered the acute stress.

The problem with acute stress is that it creates a sort of
loop tape in the person’s mind, in which they continually
replay the event over and over again without being able to
stop it. The event is so completely consuming and yet so
terrible that the person who lived through it continues to
think about it until they are almost incapable of moving
beyond it.

Unfortunately, the results of acute stress are not merely
limited to inward issues. If left unchecked, acute stress
can result in anxiety, inability to concentrate,
post-traumatic stress disorder, and even nervous breakdown.
Thus, acute stress is no minor issue. In fact, it must be
dealt with quickly in order to prevent serious
repercussions upon the mind.

If the symptoms of acute stress, such as detachment,
anxiety, or a general desire to avoid anything that may
remind the person of the event that caused the acute
stress, it is generally considered that the acute stress
has transitioned into post-traumatic stress disorder.
Thus, anyone who has suffered acute stress should seek some
sort of treatment so that this does not happen.

The first form of treatment that comes to most peoples’
minds is psychotherapy. The sessions with a psychiatrist
or psychologist are at least familiar to people and they
are very useful for treating acute stress. However, many
people shy away from psychotherapy simply because of the
stigma attached to it.

Another method of therapy for acute stress is cognitive
behavioral therapy (CBT). CBT is designed to help people
deal with their problems or fears through a combination of
treatments all working toward the same goal. The cognitive
portion of CBT treats the mind and helps it think
differently about its memories. Then, the behavioral
portion helps the person by exposing them to things that
will force them to confront their fears or their problems.
The behavioral method is already well known as a treatment
for phobias and the cognitive treatment is familiar from
psychotherapy. However, by combining these methods into
one holistic treatment, CBT can bring about some very good
results.

Another method for combating acute stress and its aftermath
is through medication. Depending on the symptoms, a doctor
might prescribe an antidepressant, an anti-anxiety drug, or
perhaps some other form of medication. However, people
must be very careful with these mood-altering medications,
since they do tend to alter the way they think. Thus,
people taking medications like these must monitor
themselves and see how they react to their effects.

Overall, acute stress is manageable and it is treatable.
And it should be treated, as it can lead to depression,
anxiety, post-traumatic stress disorder, and even a
complete mental breakdown.

Though people may think that they are handling it fine,
acute stress is a form of mental trauma that is essentially
comparable to physical trauma; the more severe the trauma,
the more severe the results on the person. Thus, anyone
who has suffered from some traumatic experience that
doesn’t seem to want to go away should seek treatment as
soon as possible. Though people can’t change what happened
to them, they can do something to prevent the memories of
it from taking over their lives.

Introduction:

Stressful events or adverse ‘life events’ are known to contribute to the aetiology of many psychiatric disorders, including mood disturbance and anxiety disorders.

Generally, the individuals affected have some vulnerability to the mental illness as a result of genetic factors, childhood experiences, or drug or alcohol abuse. The stress may precipitate an episode of illness. Hoses with high vulnerability may become ill in the absence of stressful event, or with a relatively minor stress. In contrast the reactions to stress described here are a direct consequence of the stressful event, and would not arise without it. Three types of disorders will be described:

 It is normal to react to stress in an emotional way. The disorders described here are considered to be abnormal reactions to stress either because the reaction is extreme or prolonged, or because it prevents the individual from functioning at home or work in their usual way. An abnormal reaction to stress may occur because of the nature of the stressor, or the resources of the individual to cope with it, and often a combination of the two  Control over events  

The stressor may be unusually intense, such as a combat situation or a natural disaster. Less intense events may be made more stressful by a long duration, or by a lack of control over events. Individual coping abilities are influenced by personality characteristics and previous experiences of stress and methods of coping with it. Stressful events are generally more difficult to cope with if they arise against a background of social difficulties, lack of social support or even physical illness (remember the bio-psycho-social model, for causation and management).

1. Acute Reaction to Stress:

This disorder is rarely seen by mental health professionals, but may present to primary health care (PHC). It is short-lived, with symptoms settling within hours or at most couple of days (ICD-10). The symptoms are severe, often with an initially dazed state, followed by a variety of reactions from stupor to marked agitation. Panic attacks are common. The stress that precipitates an acute stress reaction is often an overwhelmingly traumatic physical or psychological experience, such as an assault, accident or bereavement. In most cases no treatment is required as the symptoms settle spontaneously (depending on the individual). If medical help is sought, a short course of BDZ or propranolol (a ? blocker) is an appropriate treatment; with support.

2. Post- Traumatic Stress Disorders (PTSD):

PTSD occurs in response to an extremely stressful event, beyond the realms of usual experience that would be distressing to most people. This might include a serious accident or assault in which the life of the individual or their family is threatened, or man-made or natural disaster.

There is often a delay of days or weeks before the symptoms begin, although generally the disorder is established within six months of the stressor and runs a chronic, fluctuating course. The range of symptoms that are found could be arranged under three broad headings:

The anxiety symptoms are prominent, and this may demonstrate itself with irritability, wariness and an exaggerated startle reflex. Insomnia is common, with difficulties in both falling asleep (anxiety) and staying asleep or waking up early (depression). Nightmares are common. Recurrent thoughts about the traumatic event are characteristic of PTSD. Vivid memories come to mind repeatedly despite attempts to block them out, and these are often accompanied by the emotions that were experienced at the time. Very intense and distressing flashbacks can occur, that can feel though the trauma is happening or about to happen again. Any reminders of the trauma are avoided, and this can result in social isolation. Depressive disorder is a common co-morbidity, and substance misuse may be an effort to cope with the symptoms.

The presence of extreme stress is the key aetiological factor in PTSD (remember the vulnerability to mental illness diagram). The greater the stress, the more likely it is that PTSD will develop.

There is some evidence that it is more likely to develop:

Treatment of PTSD include: (Bio-psycho-social)

3.  Adjustment Disorders:

Are abnormal response to significant life changes, such as a bereavement, marital separation, redundancy or starting a new job or college. The abnormal response takes the form of an emotional disturbance, with symptoms of anxiety, depressed mood or feeling unable to cope. The symptoms are not severe enough to merit a diagnosis of depressive disorder or anxiety disorders, but must interfere with the patient’s ability to function normally at home, work or in social situations before a diagnosis can be made

Adjustment disorders usually begin within a month of precipitating event, and in most cases resolve within six month, simple psychological and social treatment, such as providing the patient with support, an opportunity to talk about their feelings and a practical problem-solving approach are often all that is required.

Bereavement:

Loss of a close relative or friend is always an extremely stressful event that will inevitably provoke a marked emotional response. This is, of course, entirely normal, and the majority cope with their grief without any professional help.

The normal grieving process: (e.g. death of a husband)

Needless to say, that the process above is simplified. Some individuals will ‘skip a stage’, others will not follow the above order and some will go back to a previous stage.

Bereavement can closely resemble depressive illness with persistent low mood, insomnia, loss of appetite and thoughts of hopelessness and guilt. The only treatment required, however, is support, an opportunity to talk and reassurance that it is part of a normal process of adjustment that will gradually improve.

Abnormal grief:

Grief is considered to be abnormal if:

An Abnormal grief reaction is more likely to arise if:

Bereavement therapy is a brief form of psychotherapy which focus specifically upon the bereavement, encourage the individual to talk through the events leading up to and following the death in detail, and guiding them through the normal grief process, for example by encouraging ventilation of feeling of anger and guilt

Other psychological treatments include support groups, CBT and IPT (Inter Personal Therapy).

References:

1. Stevens L, Rodin. Psychiatry: An illustrated colour text, Churchill Livingstone 2001

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

As Fibromyalgia (FM) sufferers we are often made to feel like our pain is “all in your head”, but research has consistently proven that Fibromyalgia is not a form of depression or hypochondria. IT IS REAL!  However, there is a connection between FM and other chronic pain conditions to depression and anxiety.  Treatment is important because both can make FM worse and interfere with symptom management.

There is some debate by medical and mental professionals about what causes what.  The “What came first?  The chicken or the egg” debate translates into “What came first?  The chronic pain or the depression?”  TRUE Fibromyalgia experts, researchers and others know that the chronic pain of FM & overlapping conditions leads to depression and anxiety. 

Fibromyalgia is a common condition in which a person suffers from chronic musculoskeletal pain. There are points called tender points, sometimes all over the body, and these tender and painful points are used as part of the diagnosis of FM. Individuals with FM may also be more susceptible to pain in general. Whenever the tender points are simply touched, they can send sharp pain impulses. Many Fibromyalgia sufferers experience pain all over and some experience pain only in specific regions. It can involve the muscles and the joints. Sometimes, there is so much pain that it is hard to pinpoint exactly where the pain originates.  Fibromyalgia is often accompanied by other overlapping conditions such as chronic myofascial pain (CMP), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), restless legs syndrome (RLS), migraine & tension headaches, interstitial cystitis (IC), mitral valve prolapse (MVP), cognitive dysfunction, depression, anxiety and more.  The symptoms of Fibromyalgia, alone, are wide-ranging and debilitating.  Do they really think that depression and anxiety is the CAUSE for ALL of the above?

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It is a constant low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment and if you have Fibromyalgia, you may have to fight it for the rest of your life.

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat.  Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, periods of anxiety may indicate an anxiety disorder. Other indicators of an anxiety disorder are anxiety that occurs without an external threat and anxiety that impairs daily functioning.

What can cause depression & anxiety?  Stressful life events, chronic stress, low self-esteem, imbalances in brain chemicals and hormones, lack of control over circumstances (helplessness and hopelessness), negative thought patterns and beliefs, chronic pain, chronic physical or mental illness, including thyroid disease & headaches can ALL cause both.  Little or no social  and familial support can be a main factor in depression for FM patients. Family history of depression & anxiety can also be a factor.

Lack of quality sleep is also believed to have an influence on depression.  Since FM & Chronic Fatigue Syndrome patients tend to have insomnia and/or other sleep disorders, it stands to reason that poor sleep can lead to depression.

There is a wide variety of medications, vitamins, minerals, herbs and therapies that can help ease the impact of pain, anxiety and depression.  With so many out there, you and your doctor may have to go through the process of trial and error to find what works best for you!

Exercise is not only good for FM, it is also highly beneficial for depression and anxiety.  Recent studies suggest exercise can change your brain chemistry. Exercising can boost your level of serotonin, a brain chemical that is effects mood and pain perception. It can also stimulate the production of endorphins, natural painkillers that can give you an overall feeling of well-being.

Exercise is a great for stress, too. It relieves muscle tension and it gets the heart rate up. The combination makes us more relaxed and alert, which helps us deal with our problems in a calmer and more controlled way.

There are several other methods you can use to combat stress, including: meditation, deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, relaxation to music, biofeedback, counseling – to help you recognize and release stress. 

You can learn more about this topic, medications, supplements, alternative therapies and more at my website AND I will be writing more articles – so check back here!

Behavior-based treatments don’t involve a prescription and ultimately work better than pills. Hello, there, night owl. Here you are, switching on a light to read the newspaper again — even this story — because you just can’t get back to sleep.

Well, don’t feel alone. You have lots of wide-eyed company. Like at least 35 million other Americans, you have a condition called insomnia. It can lead to aches, bad moods and eventually an overall feeling of negative mental or physical health.

But you don’t have to stay sleepless — in Springfield, Strafford or Sparta, not to mention Seattle and points in between. Unless your insomnia is caused by a condition that requires medical treatment, like sleep apnea, more than one road can lead you back to a good night’s sleep.

Sleeping pills can help some chronic insomnia sufferers.

However, other treatments — including biofeedback and positive sleep habits — don’t involve a prescription and may even be more effective than medication.

Negative effects

Insomnia could eventually lead to a lower quality of life, according to Dr. Jennifer Lynch, a CoxHealth neurologist specializing in sleep medicine. “You can imagine how you feel after a horrible night’s sleep. You ache more, you can’t remember very well, you don’t want to do much, you can’t get as much done.

These (symptoms) all mimic pain disorders, depression and mood disorders,” Lynch says, explaining that insomniacs are frequently misdiagnosed as having dementia, depression, fibromyalgia and other medical conditions.

Insomniacs are also more prone to infections, says Dr. John Brabson, a pulmonologist and sleep specialist who directs the St. John’s Sleep Disorders Center, and they’re more likely to have medical issues requiring office visits and tests. Depression, for example, often occurs along with insomnia, although one is not necessarily the cause of the other.

Types and causes

Primary insomnia is a condition on its own and is not caused by any known medical problem. Secondary insomnia is caused by a underlying condition. The National Institutes of Health says to be considered insomnia, the difficulty getting to sleep or staying asleep must have occurred for at least one month.

Insomnia is considered chronic if you’ve been having trouble going to sleep or getting back to sleep three nights a week for three months, according to the American Sleep Disorders Association. Primary insomnia is often triggered by specific circumstances.

“The common story of insomnia is that there is usually some type of precipitating event — let’s say a divorce,” Brabson says. “What happens is the precipitating event can often go away, but the insomnia part stays.” Insomnia continues when bad sleep habits begun during a trying, troubled-sleep time of life aren’t broken, sleep experts agree.

Retrain your brain, body

That’s where cognitive behavioral therapy, or CBT, may come in, Brabson says. CBT, as it relates to insomnia, means practicing stress management as well as good sleep habits or hygiene, says John Essman, a St. John’s clinical psychologist and sleep specialist who advocates CBT for his insomniac patients.

Besides avoiding stimulants, both chemical and technological — coffee, tea and too much TV — those with sleep problems can also try banishing stressful thoughts and activities from their brains and bedrooms before it’s time to go to sleep.

People develop conditioned responses — and the sleep-deprived, unfortunately, have learned to associate bad stuff with bedtime, Essman says. “Whether it’s an argument that we’ve had or past nights that we’ve had trouble getting to sleep or staying asleep, that can contribute to the current night’s problems,” he says.

The obvious solution is to “maintain the sanctity of the bedroom,” Essman says. “People use their bedroom and their bed for a lot of different things sometimes, so it’s suggested that the bed and the bedroom be used primarily for sleep or sex,” he says. “Try to avoid paying bills as well as having distressing pillow talk.”

If you’re a worrywart, sleep experts suggest penciling time for fretting into your schedule instead of saving it for the end of the day. Bedtime is “not a great time to worry about bills or kids or jobs,” Brabson says. Worry often results from a lack of organization during the rest of the day, Lynch says. If it’s causing insomnia, then “make a list and adhere to it. Don’t procrastinate.

“A lot of people worry about things they have no control over,” she adds. “They should make a cognitive decision not to worry about it, or if they’re faithful people, pass it on to God or symbolically let go of these worries they have no control over.” Unfortunately, after too many nights of frustrated sleep, some insomniacs add worry about not getting good rest to their list of concerns.

“As soon as their head hits the pillow, they get anxious wondering, ‘Am I going to sleep tonight?’” Lynch says. “A lot of people get into a bad cycle, and then they can’t break that.”

It’s an attitude called “bed dread,” Essman says, and it only digs the insomnia rut a little deeper.

“It’s getting close to bedtime, that little voice can pop in,” Essman says. “Many people get in kind of a negative frame of mind.”

Types of cognitive behavioral therapy can help pull insomniacs out of this rut, including biofeedback. Biofeedback is the use of instruments to give people information about their bodies.

With the equipment, a person can get real-time data about things such as muscle tension, sweating, blood pressure and heart rate.

The person can use this information to help control his or her body’s reaction to an event.

Biofeedback has been successfully used to treat insomnia. Some biofeedback devices on the market allow people to monitor their own brain waves, Brabson says.

“You can actually teach your brain to go into certain waves, which are called alpha waves, and you can watch the waves on a computer screen,” he says. It’s possible to get biofeedback without using a medical device. Insomniacs may monitor their heart rates while practicing deep breathing or other relaxation therapies, Essman says.

“To see that my heart rate went from 100 to 85, it’s very tangible, very immediate,” he says.

Other ways to calm down before bedtime include yoga, relaxation tapes, guided imagery and visualization, sleep experts say.

Pills do have a place

The American Sleep Disorders Association says sleeping pills can help some chronic insomnia sufferers as well as those with sleep problems caused by acute stress, such as a death in the family or the start of a new job.

Jet lag, shift work changes, predictable stresses and medical disorders are also listed as reasons to use pills. Newer sleep medications like Ambien and Lunesta, which have less of “hangover effect” than older drugs, can help with short-term insomnia, particularly sleeplessness caused by acute stress, local experts agree.

Yet they also agree that CBT works better as a long-term cure. “I think it’s unfortunate that a lot of people are given these (drugs) as the first answer, because most medications are somewhat habit-forming and tend to then become an ongoing need,” Lynch says, adding that medications don’t address the underlying causes of long-term insomnia.

“Studies have shown that working on sleep hygiene and these cognitive therapies are actually more effective for a longer period of time than the medications are.”

We are all encouraged to have goals – to set objectives and have targets. When we think of goals, usually we only consider the big long-term goals, such as buying a home. However it is often our everyday goals and actions which we need to focus on in order to increase our happiness and make life more enjoyable. Our thoughts, emotions and behaviour can either support or undermine us in our pursuit of goals and objectives. Goal directed thinking and behaviour supports us in our aims, objectives and survival. In this newsletter I have included some tips and examples to keep you goal directed and mindful of your everyday goals.Staying goal directed means that we are personally responsible for our thoughts, emotions and behaviour. Therefore we are personally responsible for our outcomes and are in control.It is our thinking and beliefs that cause us to have negative or harmful emotions such as anger, frustration and irritation. These emotions can then have an impact on our behaviour towards situations and other people.For example, I may go to a party – think that I’m unattractive (thoughts) – feel depressed (emotions) – drink two bottles of wine (behaviour) – have a fight with my best friend (outcome). Does this sound familiar? (My details are at the bottom of the page)So, by recognising that our thoughts and behaviour are not supporting us and are self-defeating, we can dispute them and choose realistic thoughts to maintain perspective and stay goal directed. To stay goal directed we could ask ourselves simple questions about our current situation and circumstances.What is my goal here? To have a pleasant journeyTo enjoy my eveningTo have a loving relationshipTo get on with peopleTo effectively communicate with my childrenTo stay healthyTo have a successful careerTo work harmoniously with my colleaguesWhen having negative thoughts and emotions we can stay goal directed by asking ourselves this pragmatic question:How does thinking or behaving this way help me to feel good or achieve my goals?Does being angry with peoples’ noisy ipods and phones help me relax and have a pleasant journey?Does worrying about how I look help me enjoy my evening?Does blaming my partner and staying angry help me have a loving relationship?Does demanding that others have the same beliefs as I do, help me get on with people?Does shouting help me to communicate with my children?Does eating fatty foods help me stay healthy?Does being late help me have a successful career?Does blaming and labelling my colleagues help the team effort?Simple isn’t it? As long as we remain mindful of our goals and objectives in everyday situations we can adapt our thinking and behaviour to obtain those goals. It’s just a case of taking a moment to reflect on our goals, before harmful emotions such as anger take a hold of our actions.Put this into practice today, maybe before you make that phone call, enter that meeting or… go on that date.

You may often hear the phrase “you are what you eat” and clearly there is some truth in that; we are constantly reminded by the media and government to eat healthily. However, what we think is more important and in particular, that inner critical voice which we hear all day long. Our inner voice either supports us and makes us feel good or undermines our self-esteem and self-worth causing us to feel down. With that in mind I have included in this article a common thinking error called labelling, which can make anyone feel lousy. The simple truth is “You are what you think!”These days we are more brand aware than ever before. We may not all wear designer clothes or drive expensive cars or even eat designer food, but we are all aware of brands and labels. We make conscious and unconscious judgements about people, their identity and status based on the items they use. Consequently, we will then make judgements and evaluations about our own identity and self-worth.We may also label others and ourselves by traits, behaviours and actions. Rather than look at the whole person and all their good and bad points, a specific evaluation is accorded to their whole being. For example, “He did a stupid thing, therefore he is stupid”. “She broke a plate, therefore she is clumsy”.  It is more helpful to acknowledge when we and others have done something wrong or made a specific error. For example “that was a silly mistake” “that didn’t go down too well”, then we can distinguish between the actions and the person as a whole. Labelling people makes it more difficult to get on with others and causes hostility if we see them as one-dimensional For example “that guy is a jerk”, “She’s an idiot”. I once worked in a company where one of the IT staff made an error that caused the network to temporarily crash, he soon became known as “TITI” (Titty – The IT Idiot). Needless to say this was very upsetting for the individual concerned – he left a short time afterwards. Labelling is more than name-calling; it is mud that sticks.When directed at ourselves labelling can cause diminished self-esteem, guilt, self-loathing and depression. We will often acquire negative labels in childhood and early relationships; it is important that we challenge and dispel them rather than continue to wear them on the inside.A useful exercise is to monitor your inner critic; that voice that you hear through the day that says things such as “I’m not smart enough”, “I’m boring and uninteresting” “I’m too old” “I’m unattractive”. Write these comments down and then dispute, challenge and replace them with more helpful and rational statements such as “I’ve learned a lot and continue to learn”, “I am as interesting as anyone; I have my unique style”, “Age is an irrelevance”, “I’m as attractive as anyone”. This takes a bit of effort, but “you’re worth it”. You will feel better about yourself, increase your self-esteem and discard unwanted mental baggage.Choose your labels with care!RegardsPhil Pearl DCH, DHP, MCH, GHR Reg

The following article looks at “demanding” and “preferring”. Understanding the difference between these types of irrational and rational thinking is key to Mental Toughness. Demands are rigid thinking patterns and rules, where we insist that others, the world and ourselves must be a certain way, in order for us to be happy. Albert Ellis, who pioneered Rational Emotive Behaviour Therapy (REBT), called this rigid thinking “demandingness”.Demands are rigid and inflexible rules about how other people, ourselves and life must or must not be, in order for us to be happy. Having rigid beliefs and rules can make us anxious, frustrated and depressed. Demands will often contain the words “must” and “should”, such as:”Everyone must like and approve of me”.”I must be absolutely competent in everything I do”.”The world should always be a fair place”.Preferences are flexible ideas regarding how we would like things to be, without demanding and insisting that they must always be that way, such as:”It would be nice if everyone liked and approved of me, but they don’t have to”.”I want to be competent in everything I do, but I don’t have to be.”"I would like the world to be a fair place, but unfortunately it doesn’t have to be the way, that I want it to be”.Having preferences rather than demands does not mean that we shouldn’t have high values or standards; the point is whether our demands are pragmatic and helping us in our aims and objectives, or are rigid, unrealistic and impractical. The key is to be flexible and accept that people and things will not always go our way and that having rigid and fixed rules is unhelpful and irrational. Here’s an example regarding perfectionism. Let’s suppose that I have a demanding rule that “I must give an absolutely, perfect presentation or I will look hopeless and inept”. If I hold on to this irrational belief, the consequences are likely to be that I will be unnecessarily anxious, and my worry will cause me to lose sleep. I will over-prepare and have too many notes, which will cause further worry as to how I will cram all the material into a set presentation time. I will be over-nervous and worry that I will freeze and my mind will go blank. I may predict catastrophe, attach too much importance to the presentation and imagine I will lose my job. Alternatively, I can hold a preference such as “I would like to do a perfect presentation, but it does not have to be 100 per-cent perfect”. In this case I am more likely to focus on covering the essential points rather than worrying about trying to be perfect, and further realise that there is no such thing as a “perfect” presentation. And besides, it is unrealistic to expect that all of the audience will be paying attention, all of the time. If the audience are students, it is likely that they will have hangovers or be tired.Here’s another example for anyone visiting or living in London and using the Tube trains; where we are expected to let passengers off of the train before boarding. If I have the demand that “people must always let me off the train first, before they start getting on” then I am going to be upset and annoyed on a regular basis, as often people will start getting on in order to get a seat. Of course, a lot of the time people will wait for me to get off, before they get on, but because I have such a rigid and demanding rule, I will still feel tense in the anticipation that my rule will be broken at any second.Alternatively, rather than have such a rigid and demanding rule, I can hold a preference such as “I would prefer it if people let me off first, but in reality this will not always be so”. By holding a preference rather than a demand, I am being realistic and can accept that others do not have the same rules. By holding a flexible preference I am less likely to become angry or upset.Often we seek to change other people and become frustrated in our attempts, however we can change ourselves and how we react to other people and events; we can remain in control and fully responsible for our actions, thoughts and emotions.Being flexible and able to adapt is key to Mental Toughness. Regards

Phil Pearl

Often, we think of medical issues as being “the other guy’s concern.” Why, for instance, would we bother spending our time thinking about arthritis if we feel comfortable and limber? Why would we stew over tuberculosis when we are able to breathe freely and clearly?

The logic behind this line of thinking is understandable. If it doesn’t affect us, there doesn’t seem to be a compelling reason to care a great deal about the problem. Sure, we want to have some knowledge about preventing the onset of some diseases and disorders, but we are not apt to spend a great deal of time considering or researching maladies for which we lack a diagnosis.

There are exceptions to this rule, however, and one of the most notable is the matter of depression. Depression is an illness about which we all should care and to which we should all pay close attention.

What makes depression unique among all of the other illnesses and diseases? There are at least three very good reasons for even the most mentally healthy among us to keep up to date about depression.

The significance of the three reasons outlined in this article is amplified by one fact: there is a depression epidemic underway. The United Nations World Health Organization (WHO) has projected that by the year 2020, depression will be the world’s second most dangerous and devastating disease, second only to heart disease.

The rate of increase in depression diagnoses among children is increasing at a frightening clip—every year sees at least an additional twenty percent increase in the incidence of depression among young people.

Some estimates assert that nearly a quarter of all people will some day suffer from depression. To make matters even worse, none of these trends are abating. Depression continues to grow at an alarming rate with no end in sight to the problem.

The sheer magnitude of the depression problem may be impressive in and of itself, but it also amplifies the need for all of us to track and understand the disease. This is true for three primary reasons.

The first justification for concern is the near certainty that depression will touch each of our lives in a very direct way. The statistics recounted above make it almost impossible to avoid having a loved one, friend or close associate who suffers from depression. Depression is an illness that will enter all of our lives indirectly, at the very least. Whether it is a spouse, parent or best friend, you will someday encounter the devastating impact of depression upon someone you know well.

Secondly, the increasing prevalence of depression increases the likelihood that you may eventually experience the problem. Although depression is more likely among those with a family history of the problem, it does strike others unexpectedly, too. And, contrary to widely held beliefs, it does not require a certain trigger or dramatic event to develop.

Depression is unbiased and indiscriminate. It impacts people of all socioeconomic backgrounds, races and gender. Working with the assumption that depression does impact twenty-five percent of the population, ask yourself a simple question: “Is there any other disease you would ignore if you knew you had a one in four chance of contracting it?” The answer is obvious. We even make sure to immunize ourselves against far less likely maladies.

Finally, even if one was somehow able to escape dealing with a depressed acquaintance and was able to avoid contracting the disorder themselves, they are still sure to feel its impact. Depression is a huge drain on the economy, costing literally tens of billions of dollars annually due to medical treatment costs, work absenteeism and an overall drop in productivity. From the viewpoint of civics alone, one should have an interest in the disease and its treatment.

It’s easy to ignore many medical conditions—especially if one is healthy. Depression, however, should never be ignored. This growing epidemic affects all of us and warrants a high level of attention.