Your individual treatment

What is CBT?

Cognitive Behavioural Therapy (CBT) Is a type of talking therapy which is based on the idea that thoughts, feelings, what we do and how our bodies feel, are all connected. If we change one of these, then we can alter the others.

When we are low, worried, upset, or angry, we can fall into patterns of thinking and responding which can worsen how we feel. CBT can help us to notice and change unhelpful thinking styles or behaviour patterns so we can feel better.

What will happen in the sessions?

In CBT we focus on the here and now and look for practical ways to support people improve their lives on a day-to-day basis. At the beginning of each session, you and the therapist will set an agenda so that you can make sure you cover the most important things in the time you have available.

In the first session you will identify goals for the treatment which you will work towards across the sessions. It is a collaborative therapy, which means that you and the therapist will work together to support you to overcome your difficulties.

It is an active type of therapy where you will complete tasks and challenges both in the session and between sessions. These are a crucial part of the treatment and we know that being able to put time aside to undertake these in between the sessions is essential to making progress. Each time you meet your therapist, you will review how these tasks went and set new ones together.

In your final sessions, you and your therapist will work together to develop a plan that will support you to continue with the progress you have made once the sessions have finished.

How will we know if I am making progress?

There are several different ways that we measure progress in CBT. One is by checking with you at the beginning of each session how your week has been. To support this conversation, each week just before your session, you will receive a message with a link to some questionnaires to complete. These ask questions about a range of common symptoms associated with depression and anxiety and you will rate how much these have affected you over the previous two weeks. We can use your responses to track how your symptoms are changing over time. Many people we have worked with have fed back how useful it is to complete these each week to help them to think about how they are feeling and whether things are improving or not.

In addition, you and your therapist will have a review session every 4-6 sessions when you will discuss how the therapy is going and how useful it is. You will check back in with the goals you identified you wanted to work towards at the beginning of therapy and reflect on how close you are to meeting these. 

What can CBT help with?

CBT is an effective treatment for lots of different problems. It is widely recommended by national treatment guidelines across the UK, Europe and North America for a range of different problems including depression and anxiety disorders.

The National Institute for Health and Clinical Excellence (NICE) provides independent, evidence-based guidance for the NHS on the most effective, proven treatments. CBT is recommended in NICE guidelines for many different problems that we help with in the service, including:

• Post-traumatic stress disorder (PTSD)
• Depression
• Obsessive compulsive disorder (OCD)
• Panic attacks
• Phobias including social phobia
• Eating disorders
• Body dysmorphic disorder
• Generalised anxiety disorder

How is CBT delivered?

We deliver CBT in a variety of different formats to support as many people as possible to be able to access therapy in a way that is convenient for them and their lives. This includes online, via telephone or face to face, via instant messaging with our partner ieso (to find out more about this please click here ) and in group or individual sessions.

Guided CBT or Guided Self Help (GSH) is a treatment that uses Cognitive Behavioural Therapy (CBT) to help people to address their difficulties with the support of one of our clinicians. CBT is a type of therapy which is based on the idea that thoughts, feelings, what we do and how our bodies feel, are all connected. If we change one of these, then we can alter the others. When we are low, worried, upset, or angry, we can fall into patterns of thinking and responding which can worsen how we feel. CBT can help us to notice and change unhelpful thinking styles or behaviour patterns so we can feel better.

GSH sessions will support you to identify the vicious cycles in your life and help you to implement changes with the aim of improving how you feel. You will learn various coping strategies and techniques to allow you to become your own therapist and prevent future setbacks. This will be tailored to your individual needs and directed towards your own personal goals.

Your practitioner will work with you to look at how your difficulties affect you in the ‘here and now’ and what may be keeping them going in weekly sessions that generally last up to 30 minutes. You will have 4-8 sessions in total.

The GSH sessions can be offered face- to-face, via video-call and/or telephone.

The sessions will be focused and structured for you to get the most out of your treatment. GSH is a collaborative treatment, so together in each session, you and a Psychological Wellbeing Practitioner will aim to:

• Set an agenda for the session
• Identify your priorities and goals for the session
• Work through a range of guided self-help booklets
• Guide you in how to use the guided self-help CBT techniques and apply them to your daily life
• Set in-between session tasks (homework) to help you practice the techniques
• Review how you get on with in-between session tasks

GSH is an effective way of helping people with mild to moderate depression and/or anxiety and is recommended by the National Institute for Health and Care Excellence (NICE). Being able to practise and apply the techniques in your daily life in between the sessions is a crucial part of the treatment and we know that being able to put time aside to undertake these in between the sessions is essential to making progress.

SilverCloud (Online/Computerised CBT)

SilverCloud is a form of computerised Cognitive Behavioural Therapy (cCBT) designed to help manage and improve the symptoms of common mental health difficulties, such as depression and anxiety. This therapy option can be accessed through your smartphone, tablet, or computer, and provides a user-friendly and self-directed experience of CBT.

CBT is a type of therapy which is based on the idea that thoughts, feelings, what we do and how our bodies feel, are all connected. If we change one of these, then we can alter the others. When we are low, worried, upset, or angry, we can fall into patterns of thinking and responding which can worsen how we feel. CBT can help us to notice and change unhelpful thinking styles or behaviour patterns so we can feel better.

Whilst accessing this treatment, you will be assigned to and supported by one of our Psychological Wellbeing Practitioners who will set you up on a treatment programme tailored to your needs. The clinician will provide brief weekly online reviews of your progress over a course of 6 weeks, with the first and last consultation over the telephone. They will be able to view your entries on the programme and will be able to guide you with helpful recommendations along the way.

The therapy programmes available offer a range of informative and interactive ‘space from’ modules comprised of many therapy tools to help you on your journey towards recovery. These include: journalling methods, mood diaries, thought and activity diaries, relapse prevention toolkits, plus a range of evidence-based CBT specific techniques. Each programme includes a useful ‘Welcome to SilverCloud’ module to help you make the most of digital therapy.

The supported treatment will last for six weeks. However, you will have access to SilverCloud for up to a year afterwards. This will allow you to continue working on building and maintaining the CBT skills you have learned and continue to gain ‘space from’ the symptoms that have been troubling you.

SilverCloud allows for a flexible and personalised experience of self-help therapy. It not only provides a platform to help make sense of what influences mental health, but also gives you the power to choose when and where you access strategies that will move you towards healthy mental wellbeing. This approach fits in well with people who have busy lives or who find it difficult to attend regular face-to-face or telephone therapy sessions. It means that you can work on your difficulties in your own time and at your own pace.

Being able to practise and apply the techniques in your daily life is a crucial part of the treatment and we know that being able to put time aside to undertake these in between the sessions is essential to making progress.

What is IPT?

IPT is a time-limited and structured talking therapy that is typically offered over 12-16 sessions on a weekly basis. A central idea is that psychological symptoms, such as depressed mood, can be understood as a response to current difficulties in relationships. In turn, the depressed mood can also affect the quality of our relationships. The focus of IPT is on relationship problems and helping the person to identify how they are feeling and behaving in their relationships. When a person can deal with a relationship problem more effectively, their psychological symptoms often improve.

IPT typically focuses on the following kind of relationship difficulties:

• Conflict with another person: Sometimes a significant relationship can become very stuck in disagreements or arguments and is a source of tension and distress.

• Life changes that affect how you feel about yourself and others: Life changes all the time and this can throw up new challenges, such as when we have a child or lose a job. We can be left feeling unable to cope with the demands of the new situation and what is expected.

• Bereavement, grief and loss: It is natural to feel sad following the loss of a significant person. Sometimes, it can be very difficult to adjust to life without that person and we may then put our life on hold, unable to carry on with our normal activities and with our relationships.

• Difficulty in starting or keeping relationships going: Sometimes relationships are difficult because of what is missing, for example not having enough people around us or not feeling as close to others as we would like.

What does IPT involve?

Initially your therapist will want to understand what you are finding difficult in your life and how this is affecting you and people close to you. The therapist will ask you both about your symptoms and also about current and past relationships in your life. You will work to identify those relationships and the main areas that it would be most useful to focus on in therapy.

At the start of therapy and at every therapy session, your therapist will also ask you to complete some questionnaires. These will give them a better idea of the sorts of problems you have, as well as how badly these affect you, and will help you and the therapist see what progress you are making.

You can expect your therapist to be active: they will ask you questions, especially about your symptoms, what is happening in your relationships week-by-week, and how you feel. Because this is a time-limited therapy, your therapist will help you to keep focused on the relationship problem(s) you agreed to work on. This will include helping you to monitor how your symptoms are affected by what is happening in your relationships, and how your symptoms affect your relationships. 

The therapist will also help you to think about the people in your life who may be able to provide support to help you overcome your current difficulties. You will be encouraged to draw people in to support you in your recovery from depression and in resolving interpersonal problems. Where appropriate your therapist will help you to develop new relationships that can provide the support you need. 

Medication and IPT

It is quite common to use IPT alongside medications such as anti-depressants, and for some people this may be more helpful than receiving either treatment alone. Your therapist will discuss this with you where appropriate.

What is EMDR?

EMDR is an evidence-based therapy that helps people recover from problems triggered by traumatic events in their lives. It is recommended by the National Institute for Health and Clinical Excellence (NICE) as one of the treatments for Post-Traumatic Stress Disorder (PTSD) as it has been shown in research trials to be an effective treatment for this problem.

EMDR prevents difficult memories from causing distress by helping the brain to process them properly, working with memory to heal trauma from the past.

What you will do in EMDR therapy

Initially your therapist will talk with you to understand the things that are troubling you currently, including experiences from the past which may be contributing to your current difficulties. You will then spend one or more sessions preparing for processing by learning techniques to manage any distress that arises during the processing of the traumatic memories, such as developing a safe and relaxing space in your mind.

You will then spend several sessions focusing on processing the traumatic memories. In these sessions, you will think about the experience that is troubling you whilst following the therapist’s fingers from left to right with your eyes. These movements are called “bilateral stimulation” and support your brain to process and store the memory properly so that it loses its intensity and causes you less distress. At the end of each of these sessions you will spend time in the safe relaxing space in your mind so that you leave the session feeling calm.

Please do note that EMDR is not hypnosis. Even though you are moving your eyes during EMDR processing, you will always remain conscious AND in control.

What will I feel like after the session?

EMDR treatment will support your brain to start processing and storing difficult memories and this will continue in between the sessions. Some patients report that at the beginning of treatment they notice more memories coming into their mind and this can feel upsetting. The therapist will recommend that you use the techniques learnt at the beginning of the treatment to help you to soothe yourself if this happens. At the end of treatment, many people say they are no longer disturbed by their memories and feel able to return to doing things that they have been avoiding because of their difficult experiences.

What is DIT?

Dynamic interpersonal therapy (DIT) is a therapy that can help people with emotional and relationship problems who are experiencing depression. When a person can deal with relationship problems more effectively, their depression symptoms often improve.

DIT is a time-limited psychodynamic therapy and usually lasts for 16 sessions. The therapy sessions are 50 minutes long and take place weekly. It is recommended by National Institute for Health and Clinical Excellence (NICE) as one of the evidence-based treatments for depression.

One of the main ideas in psychodynamic therapy is that when something is very painful, we can try to ignore it. It’s a bit like the saying ‘out of sight, out of mind’. Most of the time we know when we’re doing this, but sometimes we bury something so successfully that we lose sight of it completely. This is why difficult experiences in the past can continue to affect the way we feel and behave in the present. 

DIT provides a safe place to talk openly about how you feel and to understand what might be causing your difficulties. 

Initial phase

During the initial phase your therapist builds a picture of what you find difficult in your life and how this affects you and people close to you. A questionnaire is used to help with this. They will ask some questions, but you only need to give as much information as you feel comfortable with. Many people find that as therapy gets going, they can talk more openly.

When your therapist has enough information, they will begin to think with you about what it would be most helpful for you to focus on over the 16 sessions. 

Therapy sessions

You may find that your therapist is more ‘silent’ than you are used to. At the start of each session your therapist greets you, but beyond this may not ask questions. Instead, they wait to hear from you about what is on your mind. This isn’t because they’re unfriendly, but because they want you to have space to work out what is on your mind. This can take a while to get used to, but your therapist knows how hard it can be and helps if you find this difficult. 

DIT uses what happens in the relationship between you and your therapist to help think about the problems in your life. This means that your therapist often draws your attention to what you feel in the session. The idea is that by exploring the relationship between you and your therapist, you get a better understanding of what is troubling you. 

You may find that your therapist doesn’t always answer your questions directly. Sometimes they may be interested in what lies behind your questions. For example, someone who is very worried about therapy may not feel able to say this. Instead, they may ask lots of questions about what therapy involves. Rather than answering them directly, the therapist may notice that behind the questions is a worry about beginning therapy. Helping the patient talk about this, rather than answering all the questions, is a more helpful way forward. 

Challenges in DIT

Talking and thinking about emotional problems can be difficult. For this reason, some people can feel worse before they feel better in therapy. Your therapist will work with you to manage strong emotions as they come up.

Behavioural Couple Therapy (BCT) for depression is a brief (typically about 12 sessions) treatment for people in committed relationships where there is both relationship distress, and depression in one or both partners. BCT is recommended by National Institute for Health and Clinical Excellence (NICE) as one of the evidence-based treatments for depression. There is also some evidence that this form of therapy can be helpful where one or both partners are experiencing anxiety.

BCT for depression focuses on the aspects of depression that concern others around you and on factors that reduce stress and increase support within the couple. BCT usually works best when both partners are interested and willing to work on improving their relationship and supporting one another. Both partners need to be able to attend the sessions.

Partners of depressed individuals often want to help, but don’t know how. This treatment helps both members of the couple better understand depression and how to support one another in this process.

This could include goals such as improving communication, managing feelings, changing behaviour, enhancing problem-solving skills and promoting acceptance within the couple. It is quite an ‘active’ form of therapy, and couples are often asked to do ‘homework’ between sessions.

This treatment teaches a variety of techniques to help couples combat depression as a team.   Some of the techniques are similar to those used in individual therapy, but in this treatment, partners learn how to help their partner, and maybe each other, overcome depression.

Research suggests that this treatment works as well as, and sometimes better than, individual treatment for depression.  Additionally, this treatment can enhance and strengthen relationships.

What is counselling?

Counselling aims to help you to deal with and overcome issues that are causing emotional pain or making you feel uncomfortable.  It can provide a safe and regular space for you to talk and explore difficult feelings. The therapist is there to support you and respect your views. They won't usually give advice but will help you find your own insights into, and understanding of, your problems. A therapist is trained to listen with empathy (by putting themselves in your shoes) and to help you deal with any negative thoughts and feelings you have.

Counselling can help you:

• cope with a bereavement or relationship breakdown
• cope with redundancy or work-related stress
• deal with feelings of depression or sadness, and have a more positive outlook on life
• deal with feelings of anxiety, helping you worry less about things
• understand yourself and your problems better
• feel more confident
• develop a better understanding of other people's points of view

You will initially be offered a block of four weekly sessions with your therapist. Each session lasts for up to 50 minutes. Further sessions may then be provided if you and your therapist agree that the therapy is proving beneficial to you. Each course of therapy can be up to 8-12 sessions. It can take a few sessions before the counselling starts to make a difference, and a regular commitment is required to make the best use of the therapy.

What can you expect of your therapist?

Your therapist is responsible for ensuring that your meetings take place at a regular time. Wherever possible they should let you know if they expect to be away or need to change the time of your therapy. Sometimes people find breaks from the therapy hard to manage. When this happens your therapist should discuss this with you and help you to understand why this may feel particularly difficult.

All therapists should be able to help you feel respected and comfortable. Many people find it difficult to talk about their problems with someone they do not know, and it is important that your therapist can make you feel that they are to be trusted and can help you manage if you talk about things which upset you or about which you feel embarrassed.

During your counselling sessions, you'll be encouraged to express your feelings and emotions. By discussing your concerns with you, the therapist can help you gain a better understanding of your feelings and thought processes, as well as identifying ways of finding your own solutions to problems.

Ending the therapy

Many patients find that ending the therapy is difficult. This is because the relationship that develops between you and your therapist can become quite important. Ending therapy can feel like a big loss and you are likely to experience a range of feelings about it. Your therapist will know and understand this, and you should expect them to help you to explore your feelings, including any worries you might have about how you will cope in the future. They should help you think about how you would manage if things became difficult again.