Eye Movement Desensitisation and Reprocessing (EMDR) is a treatment strategy that has been shown in countless controlled studies world wide to significantly improve many symptoms of PTSD, particularly flashbacks and the associated anxiety/stress/shame responses that come with them.
Francine Shapiro, a psychologist in the US, is credited as first discovering randomly when out walking that when she moved her eyes rapidly back and forth while focused on some disturbing thoughts her anxiety lifted. Intrigued she tried it out on some of her clients who also reported improvement.
EMDR has come a long way and now considered by many as one of the gold standard treatments for single event traumas but also now is used to help clients who experience phobias, anxiety, depression and in some cases complex trauma.
While we dont know exactly how EMDR works it thought to somehow possibly replicate the process of REM (rapid eye movement) sleep stage when memories are thought to be laid down.
However, EMDR is not for everyone. The process requires that the client is able to hold the trauma memory in their mind for a significant period of time while also tracking the therapists finger as it occilates from side to side.
Many people will not be able to hold a trauma event in their mind without becoming extremely distressed. In this case a slower more gentler approach to trauma treatment should be considered with the possibility of even working up to be able to manage distress levels to do EMDR at a later date.
The most important thing with EMDR is that the 'work up' is as important as the proceedure. Many clients have been unnecessarily retraumatised because the proceedure was rushed or seen as a cure all. It is not on any level a 'cure all' and no replacement for long term trauma therapy but rather a valuable strategy to aid in some of the distressing symptoms of trauma.
Clients who experience DID or other significant dissociative symptoms are not generally considered to not be suitable candidates for EMDR.
How do you get motivated to do anything when you can barely get yourself out of bed?
One of the most disabling and difficult symptoms of depression is low motivation. Getting motivated to do anything when you are suffering from depression can feel overwhelming and to make matters worse most people will end up beating themselves up about it. Why cant I do this? Whats the matter with me? Ime wasting my life.
Unfortunately there is no easy way to deal with low motivation. For some people this is where medication can help take the edge off depression and while not the whole solution might give you enough energy and motivation to help you start to make other changes that will help in recovery. But medication doesn’t suit everyone and others prefer not to take it.
You can help move the process along by setting small achievable goals for yourself. Small steps mean a lot and some days you will find it a lot harder than others to achieve these. That' s ok. You’re not competing with anyone. Not even yourself. You just want to get better. Self care and nurturing is of the essence. It might sound trite but looking after yourself is the main goal here.
What to do when you feel unable to do anything.
* Stop beating yourself up. It’s a waste of time and it doesn’t help. If anything its going to make you feel worse and you already feel bad enough. Don’t do it to yourself. When the negative voice starts yapping in your ear, tell it where to go. Really, think of it like a vampire, it can only come in to your head if you let it.
* Get up every morning at a reasonable hour. Put the alarm on if you have to. Get up straight away. This is important. Do NOT lie there thinking about getting up. If you spend time thinking about it, you wont do it. Depression loves procrastination. You will be able to come up with a hundred reasons why you shouldnt do something. Likewise if you need to get something done, do it earlier in the day and dont think too much about doing it. Just do it.
* Shower and get dressed as if you have something to do. You do. Your working towards getting better. That’s your job for the moment and it takes effort and energy. You will be surprised at the difference just getting up, showered and dressed at a reasonable hour will make even if its just for a short while.
* Eat good food. Your brain needs nutrients to heal and recover. Dont feed it rubbish and definately dont starve it. If you are not hungry then graze frequently.
* Plan to do one new thing every day if possible. This helps move the brain out of depression mode. Take a short walk outside, walk the dog, ring someone. Make sure that it is something that normally you would get some enjoyment or satisfaction from. Even washing up a sink full of dishes will make you feel better when its done.
* Be your own best cheerleader. We all need encouragement. If you have managed to achieve a goal, however small, acknowledge it and allow yourself to be pleased. And if you didnt achieve what you hoped for, give yourself credit for at least trying.
For help with depression, Contact Cate:
Depression is one of the most common issues that people seek help from therapists for.
It can be one of the loneliest and difficult experiences of a person's life to go through an episode of depression. Despite it being spoken of in the media more than ever, many people still experience feelings of shame around not being able to cope or just snap out of it. Just about everyone will experience a period of feeling overwhelmed and not able to cope at some point in in their lifetime and nearly fifty percent of the population will experience a diagnosable episode of depression.
Depression presents in many different ways. Neuroscientists are still grappling with what really happens in our brain when we become depressed. Some of the symptoms that people may experience when they are depressed include low mood, crying frequently, difficulty sleeping or sleeping too much, anger or irritability, poor concentration, low motivation and lack of joy out of activities that you previously liked doing, low sex drive and substance abuse.
There is always a reason for experiencing depression even if you are not aware of what it is. Life events either in the past such as childhood issues or ongoing stresses such as relationship difficulties, unemployment, poor job satisfaction or harrassment, physical illness, lack of life fulfilment or loneliness can all contribute to depression. A family history of depression may also be a factor. Antidepressants maybe helpful for some people. Only a GP or Psychiatrist are able to prescribe antidepressants.
Therapy can help in a number of ways. First and foremost being able to talk through some of the things that may be contributing to your depression and being heard and validated can really help. Knowing that depression is not just something that you can just 'snap out of' can help you to stop beating yourself up and making it worse. Secondly working through with your therapist strategies and things that you can do that will put you in the right direction for recovery. Some of these we know are good for just about everybody but some things will be specific to you.
Some people may also experience suicidal thoughts which can be especially distressing. If you are experiencing suicidal thoughts you should see your GP as soon as possible or if you feel that you might act on these thoughts then attend your closest Emergency Dept or call the Mental Health Emergency Response Line: ph 1300 555 788
For help with depression call Cate to make an appointment:
Phone: 0408 831 421
Wake up and smell the coffee
It seems that everyone is talking about Mindfulness. There have now been countless research studies on the efficacy of mindfulness in improving mental health and wellbeing. The great news is, it’s not hard to learn and with a commitment to practice regularly everyone can experience its benefits.
Mindfulness has its origins in meditation traditions of eastern religions and has been around for over 2500 years. There are many types of meditation, mindfulness is just one of them. Mindfulness practice as used as a tool in counselling and psychotherapy has been adapted to remove any religious reference or connotation so that it may be used by anyone no matter what their spiritual beliefs may or may not be.
What is mindfulness?
Mindfulness at its most basic refers to focusing your awareness on the present moment , what you are seeing, hearing, smelling and what you are feeling both emotionally and physically right now. Observing and noticing without judgement what you are experiencing in this moment. Noticing is key.
How can mindfulness help our mental health and wellbeing?
When we learn mindfulness we become more aware and more attuned to what we are thinking about, what we are doing and what we are feeling. Not being aware of what is going on for us can be particularly problematic if we suffer from mental health issues (and everyone does from time to time). Not recognising whether we are feeling sad or anxious for instance, because we are on ‘auto pilot’, gives us little opportunity to make changes so that we feel better. Likewise, it is easy to get caught up thinking unhelpful thoughts about past events –regret about what we could have done or said- or anxiety and worry about something in the future that might or might not happen. Ruminating in this way about things that we have no control over only makes us feel worse and is a big part of depression and anxiety.
Being present centred means that we are not thinking about the past, where a lot of our depression may be focused and not anticipating the future, which may cause worry and anxiety. Over time regular mindfulness practice can help us to become aware more quickly when we move into unhelpful thinking and to bring our attention back to the present. At its essence it is mind training.
The benefits of Mindfulness
According to the American Psychological Association (APA) learning and practicing mindfulness regularly has been shown to :
*Help manage difficult emotions such as anger and low mood
*Improve concentration , attention and memory
*Reduce overall anxiety and stress
*Increase awareness and life satisfaction
How can I become Mindful?
Learning to become mindful is not hard but as with all new skills requires practice and commitment Learning a ‘mindfulness practice’ is a good place to start.
Using the breath as an ‘anchor ‘ to focus your attention is the most common way of learning a mindfulness practice. This means that we focus on our breath, one breath at a time going in and out, with out doing anything to it. Just observing . Just watching. You may focus on the air as it goes through your nostrils or of the rise and fall of your chest or abdomen . When I focus on the breath I have a mental image of my lungs as if they were a set of wings going up and down with each breath. Even after just a few focused breaths you might find that your mind will drift off to something else. It maybe a sound outside, discomfort in part of your body , something that has been worrying you or even what you are going to have for dinner tonight. When you notice that you are no longer focused on your breath bring your attention back to the breath. In this way the breath becomes a place that you can always return to.
You can expect that when you first start a mindfulness practice you will drift away from the breath many, many times. This is normal and how our minds’ work. It is not the goal of mindfulness to stop thoughts but rather to not ‘follow’ or attach to them. After doing a regular mindfulness practice your mind will become more disciplined and not wander off quite so quickly and when it does you will notice sooner to bring it back to the breath again.
Many teachers of mindfulness practice suggest that you should practice for twenty to thirty minutes a day. This is really quite a long period of time for many people and research has shown that just ten minutes a day will bring results after just a few months. Ten minutes is a good place to start and certainly achievable for most people. Put your phone on timer so that you are not continually thinking about whether “ it is time yet’. Sit comfortably with as straight a back as you can manage but you don’t have to sit cross legged. In a chair with your feet resting on the ground is fine. Sometimes people fall asleep especially when they are first starting. If you do its ok, but it is better to stay awake. The goal of a mindfulness practice is to remain awake and alert but in a deeply relaxed state.
As well as a formalised mindfulness practice that you put time aside to do every day, getting into the habit of regularly 'Checking in' with yourself throughout the day is a great way to bring mindfuless into the rest of your life. Bringing yourself back to ‘now’ and what is going on for you in this moment. Getting into the habit of asking yourself ‘How do I feel?’ ‘Am I ok?’ ‘What do I need to do to look after myself right now?’ rather than waiting until you are in the grips of being overwhelmed, over tired or even just hungry (or hangry!).
To find out more about mindfulness and how it can help improve your mental health and wellbeing contact Cate
Like many people I've had my own mental health issues and over many years have been to a few 'first sessions' with new therapists.
Most have been good, some not so much. It is entirely normal and understandable to have some anxiety about going to see a counsellor ( or a new Counsellor) for the first time. Telling a complete stranger, even if they are a professional, about some of the most painful and distressing aspects of your life can be daunting. You may also be afraid of your own emotions and worry about whether you can keep it together and if you dont, what they will think of you. You hope and expect that they will treat you with respect and compassion and understand what a big deal it is to disclose things that you might not have told anyone else.
Sometimes having some idea of what to expect can help to ease some of the first session jitters. In your 'first session' with me, I will be wanting to find out about why you have come to counselling and what you are hoping to get from it. How I get that information will depend on you. Many people have no problem in saying what is happening for them and what they are wanting from me and the counselling process. Others might find it a little more difficult. They dont know where to start or are highly anxious and they may prefer that I ask them questions and we go from there. There is no right or wrong way and I try to keep things pretty relaxed but I am always led by you. I want you to feel safe and comfortable to say the things that you need to say but also I do not want you to feel pressured to talk about things that you are not ready to. I often take notes in the first session but usually not in future sessions. It is totally Ok to cry and many people do, particularly if they have a lot of things that they have not had an opportunity to talk about with anybody else or have been struggling with alot of emotional pain. Crying can be very cathartic for alot of people.
Our first session will also be a 'getting to know you meeting' . You will be working out whether I am someone that you would like to work with. Choosing the right therapist is important. You have to feel comfortable and safe. You have to 'click' . Sometimes it may take several sessions to find that out but usually you know after the first whether this is the therapist for you.
First sessions are about assessment and connecting.
Its a really important part of the therapy process. Sometimes, I will will only see someone for one session. They want to check out something, get some strategies or just talk about something that is worrying them and feel that they will be ok on their own after that without any further sessions. Most people come for more than one session and depending on what has brought you to therapy will depend on how many sessions you attend and how often. We can also discuss this when we first meet. At the end of the day you are in charge and you decide what is right for you.
My absolute ultimate goal for you in our first session is that you leave feeling better than when you walked in. This doesnt mean that you walk out feeling 'cured' (unlikely) but that you feel heard, respected and validated and that you may now have a little more hope moving into the future.
Emerging from the Fog
Finding your way out of the seemingly endless fog of being mentally unwell can feel overwhelming. Small steps mean a lot. They are runs on the board. No matter what is going on for you, If you can manage to do just one of these things that I am suggesting below , you are moving forward.
First and foremost, stop beating yourself up. Would you beat yourself up if you had a broken leg or diabetes? Mental illness is a very real. You cant just snap out of it. If you could you would. No one likes feeling miserable. It's awful. So when you start noticing (that means paying attention!) that you are having thoughts of being down on yourself for not being able to get on and do all the things that you think you should be doing or for feeling low , Dont ! You dont need to do that to yourself. You already feel bad enough. This means accepting that this is where you are right now ( 'Radical acceptance ' as Marsha Linehan termed it). However, this does not mean accepting that you have to stay here for ever. It just means that you are going to cut yourself some slack for being unwell at the moment.
Secondly, try not to hang out in bed or on the couch all day. You may feel you dont have the energy or the inclination to do anything else and that you want to hide away from the world, but I promise you it will only make you feel worse. The nature of depression is that we become very inwardly focussed so plan to get up at a reasonable hour , have a shower and eat breakfast. I cannot stress enough how much this will help. What we are looking for here are small moments when you are able to think "Ime glad I did that. I feel a little better ". I will be truthful, these moments may not last and you may feel awful again before you know it, but isnt a little reprieve better than nothing? Have enough of these small moments and you will start to feel encouraged that there maybe a way out of this and light at the end of the tunnel.
OK this next one is a hard (I know, they all are when you feeling low).
Get moving Get up now! The evidence is that exersise improves mood. Some studies have even shown that it is comparable to antidepressants in lifting mood. The good thing is that you dont have to join a gym or run a marathon. Just going for a daily walk will help. If you are not use to exersising start off slow and build up to a good half hour of brisk walking. Getting outside is great because getting out of the house is great. Remember how I said depression keeps you inwardly focused ? So doing things that are going to put you out in the world (even when it is the last thing you feel like doing) and focusing outside of your self, looking at the trees etc will help. If you have any bush or beach around you get double the benefit because other studies have shown that being in nature also improves our mood.
Develop your own personal 'Survival tool box' of self soothing and distracting strategies. When you are at your lowest you may not have the capacity to do anything but get to the next moment, and the moment after that. Having a personal ' tool box ' of strategies that you can use will help get you through these times. So when your feeling Ok, make a list of things that usually comfort and soothe you. Put your list somewhere that you can easily access when you need it. What we are looking at here are simple things that will not require a lot of effort. Its important to have a few of them up your sleeve because sometimes when you are feeling low , things that usually make you feel better may not work or only for a short time. Being warm, having a shower, drinking hot chocolate, listening to calming or soothing music, patting the dog or cat, watching a video, listening to calming sounds like rain falling or waves crashing on an app. You get the idea.
Dont believe everything you think. Just because you thought it, doesnt make it true. We can choose to believe what ever we want. Our brains have this amazing capacity to be creative and generate thoughts that may have no real basis in reality. Imagination is great if used for the creative process, not so good if used to destroy any positive sense of self worth. So how do you know what to believe? Be a critic and not about yourself but about your thoughts. Are they really true? What evidence do I have and is that evidence reliable or not.
Connect. Talk with somebody. It can be hard to reach out but you might be surprised to find out just how many other people maybe experiencing, or have in the past, times when they have really struggled with life. If you dont have anyone you feel safe in talking with, think about joining a support group which has been set up for people struggling with similar things as youself. The 'Meetups Perth' website have many different groups for people who feel isolated or struggling with depression and / or anxiety.