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Check out our new services in you local area August 2013 Message from Susie page 1 CBT in the
Uk page 3
Depression 4 Anger 4 step Page 5 Facing your feelings 6 an appointment or enrol in a Group CBT Programs you will need to contact us, online or telephone
0207 467 1508 Established
The journey started in January 2006 in 10 Harley Street when Matt Broadway-Horner was working full time at the Priory hospital in north London. Initially he started part time in his clinic working two evenings weekly for the first year and then gradually growing until now working full time in 4 locations, 3 in London and 1 in St Albans. This has been a dream come true for Matt to work using CBT to help people deal with their problems before it becomes chronic and they are forced to take time off work due to illness. Indeed the driving force behind the formation of the clinic comes from personal experience of Matt watching a relative struggle with mental illness with no alternatives proposed by the NHS until the conditioned worsened needing the enforcement of the Mental Health Act (1983)
Clinic services Our priority is work with you in finding the right therapist and that is convenient to you. There are 2 main ways to contact us Call on 020 7467 1508 Contact@cbtinthecity.com
What is CBT?
Message From Susie @ CBT in the City The clinic now offers clients the ability to control how many sessions they want and when to have them by paying on the website. This facility is easy to use and all you need to do is pay for the number of sessions you wish to use. It accepts all major credit cards and once payment is received then all the rest I take care of and ensure an appointment sent with in 24 hours. Also the clinic specialists offer therapy via, telephone and video online to fit into your busy schedule and child care arrangements, so help can literally be at hand at any time and any where! Remember we are here to help with not just mental health issues but physical health as well, try out our well being clinics which specialise in helping people with Long Term Conditions like diabetes, asthma, heart problems, breathing problems, HIV are just some to
name and others too. Through a recent study (Broadway-Horner et al 2013) carried out by Matt and his research team they have found that 2 out 3 people within a local services have a long term health condition which have implication for mental health services today. Physical care needs to be addressed and not be separated into another service. Physical care teams need to also address that psychologically we need help and not just be treated medically. Our therapists can help with rehab from medical problems as well as the main bread and butter stuff like anxiety and depression, hoarding and obsessional problems. Call Matt or Susie on 02074671508
Cognitive Behaviour Therapy is a tradition that focuses on the way people think and act in order to help them overcome their emotional and behavioural problems. The effectiveness of CBT has been extensively researched more than any other Therapy and has shown that people stay well longer. This positive result is due in part to the educational aspects of CBT which can be applied to help an individual to become their own CBT Therapist
Which one? Within therapy services we offer different approaches with in the CBT tradition, like REBT, Behavioural Activation, ACT, Mindfulness, CT, Imagery and Rescripting therapy, and Functional Analytic Psychotherapy. All have evidence of working and can significantly improve your life
Social media Join Our Facebook Groups: CBT in the City - CBT in the City for Schools Mindfulness and the City • Follow us on Twitter: CBTDaily - SchoolsCBT - MindfulnessCB
their ability to work and have relationships to housing and education opportunities. Here at CBT in the City we hope to ensure a good experience of services to ensure a good quality of life and to bring about an improvement in the life of the condition. Aims of treatment can be:
Cognitive Behavioural Treatment (CBT) is now recognised by the NHS and private sectors as the best treatment for depression and anxiety. CBT helps people learn to think about their problems in a different way and how to cope better
•To aid problem solving in order to achieve • To talk about the condition and explore options •To understand the link that how I think is how I feel and vice versa •To work collaboratively on their problem and thus help the process of taking charge • To feel supported by a health professional who understand the difficulties that you are going through • To aid knowledge To feel more confident in being able to manage the long term conditions
In the UK, currently In England, more than 15 million people have a Long Term Condition - a health problem that canʼt be cured but can be controlled by medication or other therapies. This figure is set to increase over the next 10 years, particularly those people with 3 or more conditions at once. Examples of long term conditions include high blood pressure, depression, dementia, multiple sclerosis, cancer, heart problems, epilepsy, chronic pain, chronic fatigue and arthritis
For more information please contact us
Long term conditions can affect many parts of a personʼs life, from
CBT London and the Home Counties Our head office is based in
Harley Street, London, while we also hold
London CBT Clinics at the
Centre Islington and
in Southgate, North
London. Highbury and
Brixton, Dulwich, Camberwell
CBT Therapists available on
. In the home counties we have
the network in Berkshire, Buckinghamshire,
St Albans in Hertfordshire
, Kent ,
Surrey and Sussex. For more information, book an appointment or enrol in a Group CBT Programs you will need to contact us, online or telephone
0207 467 1508
Feelings aren’t facts In Depression all thoughts and feelings are treated as fact which is problematic as this weighs heavy on the sufferer leading to reduced quality of life. Once you appreciate that not every thought and feeling is worthwhile to act upon will be the moment you start to recover. Remember the thinking error Emotional Reasoning (Ruled by your emotions) this being one of the main types of thinking that creates biased attention. The attention is often negative and always sees the negative in everything leading to you giving into the feeling, reducing activity and increased isolation
What fuels Depression?
One of he aims with overcoming Depression is to reduce the amount of time you brood and Worry about negative events, emotions and behaviours. Psychologist refer to brooding as a thinking behaviour about the past and the coulda-woulda-shoulda demanding thinking that often is part of it. Worry is a thinking behaviour about the future and often has the ‘what if,’ thinking cycle looking at the minutia of detail and the impact of that detail upon the course of possible action. Tip-try treating the feeling with skepticism and act upon the goal behaviour-Just do it! Try rating your daily amount of brooding 1----2----3----4----5----6----7----8 hours and the same for worry 1----2----3----4----5----6----7----8 hours This can be a simple way to rate your daily journey as you begin to overcome Depression as the aim here is to have zero rating for brooding and worry.
Four steps for dealing with anger Anger is a particularly strong emotion and if expressed inappropriately can be highly damaging. One method that can help is called the anger 4-step approach, which taps into the idea of hindsight being golden, as in ‘I wish I’d acted differently because then I’d have acted like this’: 1. Walk away. Decide to come back to the situation in one hour and then make an excuse to walk away, such as you need to make call or that you’re late for an appointment and must dash. 2. Get calm. Go for a slow walk or another activity that calms you down. 3. Rethink. How do you want others to think about you? How do you want to think of yourself? Are you fostering or nurturing that desired relationship with yourself and the other person/people involved? 4. Come back with a response. This response can be to yourself (‘I’m annoyed about this but now it’s okay and life goes on’) or a response to the other person (‘Let’s agree to disagree’ or ‘I’m sorry’). The four steps help to create a pause button while you collect your thoughts and decide a course of action. Although pausing and rewinding can cause you to feel hot with anger, pausing and fast forwarding helps you see the potential consequences before they occur and salvage the situation before it becomes a problem.
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Facing Your Feelings to Tackle Depression by Matt Broadway-Horner
Discerning helpful negative emotions Helpful negative emotions are less trouble than unhelpful ones and part of the human experience. Feeling sad, disappointed, embarrassed, annoyed, remorseful, jealous, and so on is part of life. These emotions are useful in helping you discover how to deal with experiences and how you fit in with other people. Example I’m 30 minutes late meeting my brother, and he’s disappointed. He believes, however, that I wasn’t intentionally late and is flexible enough to understand that life happens. The fact that I was late doesn’t mean that I don’t care about him but instead that I was simply stuck in traffic. Here, disappointment is a helpful negative emotion that brings about a discussion and develops an understanding, which helps people to trust each other better. This understanding leads in turn to feeling accepted and supported. Even a negative emotion such as anger can be helpful, too. To understand this, you need to accept that you can experience such a thing as justified anger, which can help you to recognise injustice, abuse, mistreatment, and so on, and motivate you to take action to prevent or stop it happening. So, in these circumstances, anger would be helpful.
Identifying unhelpful negative emotions Unhelpful negative emotions play a big part in depression. They can feel overwhelming and are certainly more problematic than helpful negative emotions. Using the same scenario as in the preceding section, the following example illustrates the unhelpful emotion of hurt. Example I’m 30 minutes late to meet my brother, and he’s hurt because he thinks I intended to be late. He attributes this belief to past hurts and begins to dwell on them. This unhelpful negative emotion spirals out of
control and causes him to sulk – a self-defeating behaviour leading to isolation and withdrawal. No discussion takes place of the event, and the result is a troubling distance in our relationship. To look at another emotion used in the preceding section in another light, anger can be an unhelpful negative emotion, too. Unhelpful anger is usually unjustified, occurring when you find yourself feeling anger that is out of proportion to the circumstances. Unhelpful anger is usually based on unhealthy sensitivities based on previous experiences. For example if, you experienced ridicule or bullying at school you may develop a sensitivity to this and scan for signs that people are about to ridicule you. You may engage in mind reading or misinterpret innocent banter as bullying, and get inappropriately angry.
Seeing the value in some negative emotions Recognising that some negative emotions can be helpful and contain positive benefits is important, because when you’re depressed you tend to see all negative emotions as unhelpful. As you come to see that helpful negative emotions are normal and natural, you can accept and tolerate them better and use them productively. For example, feeling guilty can be really useful if you employ it to motivate yourself to respond differently the next time you find yourself in a similar situation.
Appreciating the Thought/Feeling and Feeling/Behaviour Connections You may not be able to turn frogs into princes or everyday metals into gold, but you do something equally amazing: You can turn mere feelings into actual behaviours at the drop of a hat, usually without even knowing it. Thoughts and feelings are intimately linked, and the same applies to feelings and behaviour. Understanding these connections is vitally important when combating depression. You don’t have to be at their mercy, and following the suggestions that I provide in this section (such as altering your attitude) allows you to find a way out of what can seem like (but certainly doesn’t have to be) a vicious circle. Remember You don’t feel anything without thinking something to make you feel that way (the thought/feeling connection). This truth helps you to recognise and name
your feelings, often in one word such as hurt, angry, happy, sad, and so on. People often misunderstand negative emotions and say they feel irritable when they’re really anxious or feel angry when they’re actually really hurt, so correctly naming your emotions is a great start in discovering how to respond to them appropriately. As soon as you become aware of a negative feeling, asking yourself what was going through your mind that explains why you’re feeling negative (in other words, you’re looking for the thought/feeling connection) can help you recognise what you’re really thinking. The meaning that you attach to events is what causes your emotional response to that event: *You can place a positive meaning on the event, which leads to happiness and contentment. *You can attach a negative meaning to an event, which leads to unhelpful negative emotions and selfdefeating behaviour. In turn, many emotions carry with them an urge to respond by acting in a certain way (the feeling/ behaviour connection). For example: *You feel scared, you run away. *You feel hungry, you eat. *You feel upset, you cry. *You feel tired, you sleep. In depression, relevant examples may be: *You feel hopeless, you give up trying. *You feel stuck, you do nothing. * You feel fatigued, you lie around. *You feel unwanted and/or unappreciated, you withdraw and avoid people. Remember Unfortunately, following these behavioural urges when you’re depressed only makes things worse because the feeling/behaviour connection becomes a trap that keeps you depressed and maintains your negative feelings.
Changing your attitude The good news is that when you become aware of the thought/feeling and feeling/behaviour connections, you can use this knowledge to change your attitude and response to negative emotions. In this way you begin to tackle your depression and start to lift your mood. This awareness and ability to take conscious decisions about your response to negative emotions is called emotional intelligence. I describe emotional intelligence in more detail in the later section ‘Managing Your Emotions,’ but as an illustration, take a look at the following example of Joe’s journey of self-
discovery, from unhelpful anger, via helpful annoyance, toward some contentment. Example Joe is queuing up at a bank cash machine, and someone pushes in front of him in the queue. Joe thinks that the other man has deliberately been rude and dismissive toward him. He believes that if he’s walked over, he’s an idiot. He’s not going to allow other people to see him being treated like an idiot or else they’ll think that he’s weak and useless (not a real man). These thoughts cause Joe to feel angry and threatened (the thought/feeling connection) and he experiences an urge to react. This feeling/behaviour connection leads to an urge to attack. If Joe acts on his feelings, he may get into an argument or even a fight with the man, causing him further problems and perhaps negative emotions such as guilt or regret. If he doesn’t act on these urges, however, because he’s depressed he’s likely to interpret his non-action negatively, feeling he’s a failure and telling himself that he’s a wimp who lets people walk all over him. Mythbuster This ‘dammed if I do dammed if I don’t’ scenario is called a double-bind situation and is very common in depression. It can cause a sense of hopelessness and thoughts of ‘I can’t win.’ But you don’t need to think that way and you can find a way out of this apparent impasse. Being aware of the problem gives you the choice of changing your attitude about it, as the following revised scenario of Joe’s problem illustrates. Example Joe is queuing up at the cash machine, and again someone pushes in front. Joe reminds the individual that he has jumped the queue, hoping that the man listens and moves to his correct position. But he doesn’t. Joe thinks to himself, ‘This is a misguided individual, but the fact that he chooses not to listen to me doesn’t mean I’m a doormat and the event has no relevance to my self-esteem.’ This change of attitude and use of emotional intelligence leads to a change in emotions and an altered behavioural urge. Extract taken from book: Managing Depression using CBT for Dummies by Thomson & BroadwayHorner 2013 Wiley publishers London UK
a day in the life of a therapist.. What can CBT in the the human condition
City you? I was offer on the plane recently sat next to the middle exit door on the right side, I choose
this location for the extra leg room. Just waiting for take off was on my mind when then my attention was caught up with the emergency lever and then “What if I pulled it” which made me laugh a little to myself but then when the stewards did all the safety checks ready for the flight my brain went into red alert. The plane had just took off and the stewards were going through the health and safety procedure for passengers when my mind said “go on pull it” “the whole plane will dive” and the urge was so great to pull it that I had the tendency to act to neutralise my anxiety by sitting on my hands but I chose not to and instead played with the notion by pretending to yawn and stretch arms out near to lever. Guess what nothing happened and passengers arrived safely at destination, but it occurred to me that all my work with OCD is beginning to rub off on me and that I ought to reduce my work load. That is one option but the other which sits more comfortably with me is to just understand that the mind has a 101 thoughts which are a mixture of good, mad, bad and dangerous but its passing traffic. Not every thought is fact, and indeed in one day the creative mind can pick up many advertisements, colours, themes, ideas, words and emotions to name a few in any given moment. Think of the mind as a little black box which are found on air craft, the box is used to collect data about the build up to a crash. If the mind collects data but then attach the criterion to it that would create and maintain OCD then life as you know it will start to reduce. But if another criterion is placed on it then maybe life will improve and the quality of it better. The mind is not always useful and so my reaction after my experiment was to laugh at myself for being so fearful in the beginning “there it is again my bloody mind.....thanks for that mind I really needed it.......NOT!
Testimonial When I first considered doing CBT I was going through a very tough time characterised by excessive worrying and states of extreme anxiety. This was severely impacting on the quality of my life to the point that even simple, ordinary tasks felt like a big burden which in turn led to inaction. When I started the CBT it was important for my motivation to set clear and specific objectives and attach a timeline to them. Through a number of reallife experiments together with the therapist I started to reeducate my mind. The practical element was paramount as it showed me the lack of real substance of most of those beliefs that were responsible for causing states of anxiety. I soon realised that it was mainly down to me what I wanted to achieve and got rid of the erroneous conviction that the success of the therapy mainly depended on the therapist. A combination of raisingawareness discussions and real-life experiments gradually softened my mind and my approach to problems. Progressively I was taking ownership of my life whiles at the same time excessive worrying and anxiety were fading in the background. By the time I finished my 14/15 sessions over a period of 4 months I felt much better, however the full benefit of the therapy only emerged further down the line when I realised that I had gained a new, more flexible approach to my life on a permanent basis and not simply a quick win on the wave of the therapy." Francesco
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It takes both students and teachers to create a reflective classroom. CBT in the City directly affects Student Learning, Attitudes and Behaviors by imparting knowledge of how they can change their current situation by teaching them about how thoughts can create Self Defeating Behaviours and produce low confidence and low self esteem Through the Reflective Classroom as viewed through the lens of CBT in the City teachers can more easily manage the Social and Academic Environment in which they spend the better part of their waking hours. By making Mindful decisions and employing the same skills they teach children, educational professionals become more collaborative colleagues and better listeners and communicators. Ultimately, greater job satisfaction results A CBT in the City Reflective Classroom is characterised by:• Enquiring young minds ready to learn in an environment that promotes academic , personal and private
success• Growth of respect and personal regard as children learn to acknowledge the unique qualities of others, attentively listen to their concerns, and avoid arbitrary or negative reactions• A rise in positive social exchanges among students and adult colleagues• Reduced bullying• Renewed partnerships with parents and families to promote children’s learning and growth• Reduced teacher stress and vulnerability naturally associated with the challenges of the teaching profession Renew the love that teacher has for his/her own profession and have a fresh impact on the students
The attitude that one undertakes in this practice is crucial and will go against the grain. Our normal development is mainly about achieving and doing things with purpose. In Mindfulness practice it is about developing a curious mind and seeing what happens and this may mean not taking control and learning in a different way by noticing. Mindfulness based CBT for Depression
Testimonial I have multiple sclerosis (MS) and I was very stressed and overwhelmed with normal life stuff really and my doctor told me that if I don’t learn to manage my stress effectively then the MS symptoms will develop more quickly. He persuaded me to seek help and so I contacted CBT in the City and I received help for stress. My therapist was great in helping me understand MS and how I could slow down the depreciation of my spinal column. Now I am more in control, feel less stressed, use positive stress to my benefit as I can sweat the small and larger stuff. Therapy helped me to see that a new approach was needed and I have to say I have received excellent care and therapy from my therapist. My therapy has stopped and my doctor now thinks that the speed of the MS has slowed down. My decline will happen but I want to enjoy the life I have
and not lose time due to unnecessary negative stress and worry. All the best Dileep
Services available from Matt BroadwayHorner
Contract development and security
Masters level marking
Medico legal reports
Who is Matt? Matt is the visiting lecturer & module leader for the module complex mental health problems in the PgDip / MSc CBT program at University of Hertfordshire. Currently Matt is the project leader for the department of health project bid merging Long Term Conditions like Diabetes, Multiple Sclerosis, heart problems etc with IAPT services delivering CBT packages to patients and restructuring it to incorporate health psychology. Another project Matt is involved in is the CBT in Schools which has been running for 3 years and is proving successful in reducing many problems within schools and also empowering teachers to be best they have ever been!
Matt used to work on a research study as a Consultant on delivering Cognitive Behaviour Therapy to people with Learning Disabilities within Camden and Islington
10 HARLEY STREET LONDON W1G 9PF
populations. He is also currently a consultant lead on the CBT in the City Schools Project with the primary objective of delivering CBT to Students in London Schools. The research is supported by Camden and Islington NHS Mental Health Trust, Mental Health Research Network and The National Institute for Health Research Matt also used to work as a Consultant Psychotherapist for the Priory Hospital in North London, working with clients both in group and individual therapy using Cognitive Behaviour Therapy. He also supervises other Therapists, multi-disciplinary team members and trainees. He previously worked as a specialist in the NHS at St George's Mental Health Trust in the Addictions department and acute Adult Psychiatry. He is available for Individual CBT and/or Group CBT Therapy for cash payers and for those wanting to use their private medical insurance