What is CBT?

CBT is a specific form of talking therapy which is used to help treat a wide range of emotional and physical health conditions, and has been subject to extensive clinical trials.  CBT looks at how we think about a situation and how this affects the way we act. In turn our actions can affect how we think and feel. The therapist and client work together in changing the client’s behaviours, or their thinking patterns, or their emotional responses or all of these.

CBT is considered a brief psychological therapy, generally over weeks and months rather than years. The number of CBT sessions you need can vary, depending upon the kind of difficulty you need help with, the severity and duration of the problem and on other factors in your life that may be contributing to the problem. Generally treatment is between 5 and 20 weekly sessions lasting 60 minutes each.

The aim of treatment is not only to help you to overcome your problem but to enable you to maintain your well-being in the future by ‘becoming your own therapist’. In other words, to have developed a good understanding of the causes of your original problem, what kept it going, as well as being clear about the things that can help and hinder your recovery and your future well-being.

CBT is used extensively within primary care service provision for anxiety and depression. It is therefore worth checking with your GP whether you can access CBT treatment for free through the NHS, before seeking private treatment.

EMDR  – Eye Movement Desensitisation and Reprocessing

EMDR is a psychological treatment method developed by an American clinical psychologist, Dr Francine Shapiro, in the 1980s. The first research data to support the benefits of the therapy was published in 1989. Since then a wealth of research has been conducted demonstrating its benefits in treating psychological trauma arising from experiences as diverse as war related experiences, childhood sexual and/or physical abuse or neglect, natural disaster, assault, surgical trauma, road traffic accidents and workplace accidents. Since its original development, EMDR is also increasingly used to help individuals with other issues such as low self esteem, social anxiety and phobias.

When a person is involved in a distressing or traumatic event, they may feel overwhelmed and their brain may be unable to process the information like a normal memory. The distressing memory seems to become frozen on a neurological level. When a person recalls the distressing memory, the person can re-experience what they saw, heard, smelt, tasted or felt, and this can be quite intense. Often the person tries to avoid thinking about the traumatic event, to avoid re-experiencing the distressing feelings. Some find that the distressing memories are clearly triggered by something in the environment, for others they seem to just pop into mind without any warning or clear trigger. For example, if someone has experienced a violent assault by a stranger they can find that they become startled and panic stricken if friend or family member goes to hug them, as something in a simple and innocent gesture can act as an unconscious reminder of the distressing event.

How EMDR Works -The alternating left-right stimulation of the brain with eye movements, sounds or taps during EMDR seems to stimulate the frozen or blocked information processing system.  Through EMDR the distressing memories seem to lose their intensity, so that the memories are less distressing and seem more like ‘ordinary’ memories. The effect is believed to be similar to that which occurs naturally during REM sleep (Rapid Eye Movement) when your eyes rapidly move from side to side. EMDR helps reduce the distress of all the different kinds of memories, whether it was what you saw, heard, smelt, tasted, felt or thought.

Assessment and Treatment -In order to establish whether EMDR is likely to be an effective treatment for you your therapist will initially conduct a thorough assessment. This will involve getting to know your history, including the kind of distress you are currently experiencing and the kind of difficulties you may have experienced in the past.  You will also be asked about any physical health problems and any medications you are currently taking, and about any previous treatments you may have had. An assessment will also include developing an understanding of your personal strengths and current coping mechanisms.

If this assessment indicates that EMDR is suited to your difficulty, you are given a more detailed understanding about how EMDR works. We will then spend some time working on relaxation and grounding exercises, which could include ‘safe or pleasant place’ exercises, guided visualisation, deep muscle relaxation, breathing retraining etc.

Once you are sufficiently prepared, your therapist can then help you to target a distressing memory with the use of eye movements or other forms of left-right alternating stimulation, such as sound or taps.  Your therapist will ask you to identify an image that best represents this event, and to identify negative and positive thoughts, your feelings, the amount of distress you feel and where you feel it in your body. You will then begin the eye movements while you hold the image in mind. After each set of eye movements you will be asked what came to mind or what you noticed during the eye movements. During the eye movements you may experience the distressing event quite intensely to start with, but this distress generally reduces as the memory is processed with EMDR. Your therapist is trained to help you manage distressing feelings with techniques previously learned.

Before the end of the session, your therapist will give you time to feel calm again, using the safe-pleasant place exercise or relaxation techniques.