Tag Archives: CBT

CBT & Bipolar Disorder

認知行為療法 (CBT) 如何幫助躁鬱症(雙極症, bipolar disorder)?

躁鬱症的治療過程中,藥物扮演非常重要的角色。而加入認知行為療法(CBT),則可以幫助穩定患者的情緒和保持日常的穩定。

是甚麼導致躁鬱症的高低起伏?根據研究,情緒的起伏,受我們的想法影響。該研究發現極度消極負面的想法或過度積極正面的想法都會影響躁鬱症患者的情緒和行為。而學習和練習CBT就可以緩和這些極端,CBT讓患者學習如何捕捉、挑戰、改變錯誤的或極端的思維,同時識別和改變有問題的行為習慣。

六個針對躁鬱症的CBT技巧

  1. 接受“躁鬱症”這個診斷。首先第一步就是明白和理解這個可以對你的症狀做出解釋的疾病。對很多躁鬱症患者來說,這往往很難接受,所以讓他們學會關於躁鬱症的信號、症狀、起因、病程等是很重要的。這讓患者能去尋求幫助,而且也知道他們其實並不孤單。
  2. 監控情緒。這通常是用工作表或日記來紀錄。目的在於更加能夠覺察情緒的導引和改變。
  3. 進行認知重建。這過程專注于通過學習如何更好的識別想法對情緒扮演的角色、如何識別有問題的想法、和如何改變或糾正它們來改變思維的習慣。(有些時候接受該想法,再與想法產生距離化可能比挑戰和改變想法有幫助-似情況而定)。
  4. 頻密進行問題解決。其中的步驟包括如何識別問題,產生可能的解決方案,選擇適合的方案,嘗試它,和評估其結果。問題解決療法可以應用在生活的任何領域,不管是兩性關係、失業、或卡債等。這所有壓力的根源,如果沒有被好好處理解決,都會帶來復發。
  5. 增強社交技巧。有些躁鬱症的患者缺乏社交技巧,這讓他們覺得自己沒辦法控制生活的其中一些部份。學習自信心訓練等技術能幫助處理與他人的關係。
  6. 穩定日常節奏。給生活建立一個規律的日常活動和節奏,這有助于穩定情緒。

而為了最大化躁鬱症的治療,聽從醫生的指示、完成CBT的家庭作業,和不斷繼續學習關於躁鬱症是很重要的。

想睡得更沉更好? 不妨先让自己醒着吧!

你无法入睡。粗略估计,在美国大约有30%的人长期失眠,一般的标准建议,就是养成良好的睡眠习惯,并尽量早点上床。如果(或者)这方法行不通,也还有几十种帮助睡眠的药物。

然而,根据科学文献 (scientific journal articles),对于长期失眠最好的治疗方法,却是大多数人都没有尝试过,而且听起来有些疯狂:睡得更好的秘诀就是(至少在一段时间里)故意减少睡眠时间。

这就是所谓的睡眠限制疗法 (Sleep Restriction Therapy),它是认知行为疗法专门针对失眠治疗(CBT-I, Cognitive Behavioural Therapy specifically for Insomnia)的其中一部分。这样做是为了减少你花在试图睡着的时间(比起你实际能睡着的时间)。

方法是这样的:用几个星期的时间,记录你真正得到的睡眠是多少个小时 – 比如说每晚可以睡五个半小时。下来,设定肯定必须起身的时间,通常是你最迟必须醒来又来得及去上班的时间 – 比如,早上6:30,所以,在睡眠限制疗法的原则下,你不让自己在凌晨1点之前上床。如果你在这段时间(1点多到6点半)成功地睡着了,你就可以开始渐渐地让自己早点休息,每次大约提早15分钟上床,直到你可以每晚熟睡完整的七八个小时。

当然,任何一个失眠者最不想做的事情就是故意剥夺减少自己的睡眠时间。然而大量的证据表明这个方法有效,而且根据一些研究至少跟药物同等有效(或比一些药物更为有效)。

当然 CBT-I 不仅仅是睡眠限制 – 它着重于改变失眠者有关睡眠的思想和行为,包括典型的建议,如在睡前一小时关掉手机等的电子设备,还有每天在固定的时间上床和起床。虽然这是一个优秀的治疗方法,但是患者一旦发现他们必须做的是特地的剥夺自己的睡眠时间,他们就选择放弃疗程。 这也是为什么这个已经被研究证明有效的方法没有得到充分利用的原因。当然这方法一点也不容易执行,尤其对失眠者来说要抵抗睡意,想睡时不去睡觉是非常困难煎熬的。失眠者往往非常在意他们睡了多少个小时,但是他们可能忽略了,睡了五六个小时不是问题所在,他们最应该驱除的,是躺在床上干看天花板辗转难眠的时间。

 

原文的英文版在这:

To Get Better Sleep, Maybe Try Staying Awake 

之前写过给失眠者的建议:

Insomnia & Poor Sleep

睡好眠清单 (.pdf)

Where to find Hypnosis or Hypnotherapy in Malaysia?

I’ve come across this question three days in a row, of people asking for hynotherapist in Klang Valley or Kuala Lumpur or Malaysia.

All the while I never really mentioned to people that I’ve a diploma in Cognitive Behavioural Hypnotherapy (accredited by the UK College of Hypnosis and Hypnotherapy), especially ever since I came back from the UK. I thought the Malaysians would hold so many misconceptions about hypnosis that if I were to tell people about this qualification of mine, people were going to be worried what I was going to do to them! (Make them give me all their savings?!)

But these people that I spoke to kind of change what I thought, although some of their beliefs of what hypnosis can do are still not quite true or slightly exaggerated (based on my training background of evidence-based cognitive behavioural hypnotherapy & clinical psychology).

Here I’d like to introduce a few basic introductory (text) books to self-hypnosis, mainly cognitive behavioural based and empirically supported, you can learn more about them and perhaps try to practise them at home, do let me know if you have come up with any problems or obstacles. Not that I’ll definitely be able to answer all your questions BUT I do know a number of therapists in the UK who use hypnosis to help people in their own private clinics.

Books: 

Alladin, A. (2008). Cognitive Hypnotherapy: An Integrated Approach to the Treatment of Emotional Disorders.

Heap, M. & Aravind, K. (2002). Hartland’s Medical & Dental Hypnosis (4th ed.)

Lynn, S. J. & Kirsch, I. (2005). Essentials of Clinical Hypnosis: An Evidence-based Approach (Dissociation, Trauma, Memory, and Hypnosis Book Series)

Robertson, D. (2012). The Practice of Cognitive Behavioural Hypnotherapy: A Manual of Evidence based Clinical Hypnosis.

Straus, R. A. (1982). Strategic Self-Hypnosis.

(The Alladin’s and Lynn & Kirsch’s text books are easy to understand, especially when you have some backgrounds in psychology or practicing self-help; The Robertson’s book is the most extensive resources on CBH you can ever find!)

Websites:

A wide range of resources about what hypnotherapy can do, a private clinic in South Manchester: Manchester Hypnotherapy & Counselling

N.B. If you do come across any hypnotherapist in Malaysia please do share it here!

Mindfulness and Acceptance tasks

Following my previous post Thought Challenging or Thought Accepting, here is a few tasks that may help to explore on how to “accept” your thought without causing too much emotional distress.

Task 1

Pick a word that may cause slight distress in you (e.g. “cockroach”, “snake”, “work”, “boss”, “kids”, “boyfriend”, “presentation” etc). Now repeat this particular word as quick as you can (while still making sure that the word is pronounced clearly) for 30 seconds.

This tasks doesn’t make you feel better about “presentation” itself, but after repeating the word for so many times, you probably can no longer take the word so literally – it loses its meaning. Same goes to negative thought (e.g. “I’m a failure”, “everyone hates me”). If those thoughts pop up in your mind, try to see them only as some words, accept them as they are, but not to relate yourself to them, as if it’s just some unrelated persons saying it to you.

Task 2

Sit down in an undisturbed place, close your eyes and imagine a tiger (or a dog if you find it difficult to picture a tiger in your mind). Let the tiger does whatever it wants to do there in your mind, not to control what it does or doesn’t. If the tiger stays quietly, let it be; if it moves around, let it be, too. Do this for about 5 minutes.

Next, for 5 minutes, try NOT to think about tiger at all. Do not think about tiger. Whenever it pops up in your mind, suppress it, avoid it.

What do you realize? Which part of task 2 is harder? To accept the tiger being there and does whatever it likes, or to suppress the tiger, avoid the tiger?

Task 3

Take a few minutes to practise to complete the following sentence, “Right now I’m aware of …”, and putting different descriptions at the ending each time. For example, “Right now, I’m aware of the brightness of the screen”; “Right now, I’m aware of the sound of the air-conditioner”; “Right now, I’m aware of some numbness on my left foot”; “Right now I’m aware of my thoughts on completing the homework”. Name and describe, avoid making judgement. By using language to describe things, you get to control your attention and get to connect to your field of consciousness, rather than its content, so you’re becoming like an observer to your experience. This task requires more practice!

________________________________________________________________________

Now imagine this: A and B fell over badly in public.

A thinks, “this is so embarrassing, ah, but it’s so funny at the same time”, so he laughs at his own carelessness and let go of it.

B thinks, “this is so embarrassing! Everyone is going to laugh at me and watch me like a clown”, he gets so angry and ashamed.

Most of the time, it’s how we relate ourselves to those incidents, thoughts, feelings etc, it’s really not what that happens. If we choose to calm ourselves down and accept whatever that happens, that come to our minds, and allow ourselves to feel the waves of our emotions, the discomfort will soon no longer be “discomforting”.

Thought Challenging or Thought Accepting?

Which do you think is better or more workable? To challenge your thought or to accept it?

Traditionally, the psychologists of Cognitive Behavioural approaches emphasize that our thinking style is what causes us to respond emotionally to events, so it’s our thinking style that determines our feelings, our ability to overcome and steer through when adversity strikes (Reivich, Shatte, 2002).

However, the Mindfulness and Acceptance-based approaches suggest that it’s not so much of the content of our thoughts and attitudes that matters, it’s our relationship with them, i.e. how we respond to them.

So the former approach traditionally teaches people to gather evidence and dispute the logic of unhelpful thoughts, whereas the latter approach says we can simply acknowledge the thoughts and distance ourselves from them, without getting into an internal struggle.

Have you ever tried to control or avoid unpleasant experiences and later coming to realize that it’s affecting you even more and causing more discomfort? (e.g. some noise while you’re trying to sleep; your worries; some palpitation and fears)

Psychological suffering (feeling sad, anxious, guilty etc) is very common and so realistically cannot be avoided. Our attempts to avoid or control painful internal experiences can compound and prolong our emotional suffering, at the same time damaging the quality of our lives.

I’ll subsequently write more posts on how to practise and achieve that. But from now on, start to notice those unpleasant experience, acknowledge them and accept them, instead of trying to control or avoid them.

10/9/14: Check here for some tasks  to explore Mindfulness and Acceptance.