Tag Archives: #Anxiety

What is the Menopause and can Cognitive Behaviour Therapy (CBT) help?

This year, World Menopause Day is the 18th October. The aim of the day is to provide support to women who are going through menopause and to raise awareness of the menopause and the support options available.

My experience of the (peri)menopause thus far is that it’s an exhausting, lonely, scary and overwhelming place to be. The menopause and perimenopause remain one of those subjects around which there is a conspiracy of silence – cloaked in a blanket of shame and embarrassment and often discussed in private using hushed voices. Mental health problems are a natural part of life, like having a cold, we should be able to talk about it.

So, let’s talk about the menopause … firstly, what is it? Well, it’s is a point in time 12 months after a woman’s last period – when the ovaries stop producing a hormone called oestrogen and no longer release eggs. The years leading up this point, when a woman’s periods may become less regular as oestrogen levels fall is known as the ‘perimenopause’. Perimenopause often begins between ages 45 and 55 and lasts, on average, about 7 years.

Menopause affects every woman differently. Some women may have no symptoms at all, or they might be brief and short lived. For other women the symptoms are severe and distressing. The hard truth about being menopausal is that it can make everyday life a challenge and not only affects a woman’s life but also impacts the lives of her family and work colleagues as well.

Unfortunately for those women who do experience symptoms, it can be a very difficult and frightening time to navigate through. Often menopausal symptoms can, incorrectly, be (and often are) explained away by many other ‘medical diagnoses’.

What are some of the most common symptoms associated with menopause?

Many of the symptoms associated with menopause tend to be as a result of hormone imbalance and lack of oestrogen. These symptoms can affect how you feel. You may find that you become stressed, anxious and irritable, suffer with low energy levels and experience mood swings. This change in emotions can lead to feelings of low mood and depression. All of which can be made worse if you are fatigued and experiencing symptoms such as disturbed sleep or insomnia due to night sweats.

In addition, you may experience difficulty concentrating, suffer with ‘brain fog’ and poor memory which can negatively affect your confidence. During this period, the body begins to use energy differently, fat cells change, and women may gain weight more easily.

It is likely that you will also experience some of the following physical symptoms: hot flushes, vaginal dryness, digestive problems, itchy skin, breast pain, loss of sex drive, sensitive bladder (an increase in incontinence) and headaches. Bones also become less dense, causing joint aches and pains, making women more vulnerable to fractures.

However, the menopause does not happen in isolation. Women’s lives are complex, particularly at midlife – changes in family dynamics, health problems and significant life events may coincide with menopausal symptoms. Trying to balance work life with domestic responsibilities, where women may be caring for young children, teenagers, grandchildren, ageing parents, and in some cases their partner. Maybe supporting teenagers through exams, and coping with children leaving home only to return at some stage to fill the ‘empty nest’.  Throw bereavement, chronic illness and disease, divorce, financial concerns and other factors into the mix and all this can exacerbate symptoms and add to the burden of uncertainty, anxiety and stress women often feel around the menopause.

Creating a more positive approach with CBT

Fortunately, it’s not all ‘doom and gloom’ (phew!) We have far more influence over our menopause journey than we are led to believe. Taking time for yourself, challenging negative attitudes and expectations about menopause and midlife can be helpful.

In addition to medical treatments, such as hormone therapy, many women prefer non-medical options such as Cognitive Behavioural Therapy (CBT). The National Institute for Health and Care Excellence (NICE) guidelines recognise that mental health issues can be symptoms of the menopause and have recommended CBT as an effective approach.

CBT is a well-researched and effective treatment for menopausal symptoms such as anxiety, depression, and sleep problems. More recently it has also been demonstrated to be effective in reducing the impact of hot flashes and night sweats. It is based on the concept that our thoughts, feelings, and actions are linked. Consequently, how we feel and think affects how we behave. It makes sense, therefore, that our negative thoughts and feelings can trap us in a vicious cycle of thinking and acting in a certain way. For example, if your night sweats and insomnia are keeping you up at night, you might feel irritable and angry the next day, which could negatively impact your performance at work, leading you to feel even more upset and angry by the end of the day which in turn keeps you awake with anxiety. CBT will help you to understand these links and other negative thought processes that lead to low mood or anxiety.

How might CBT help with Menopausal symptoms?

Using an educational approach, CBT will address problematic symptoms via a number of strategies and techniques. The menopause happens to every woman and it is easy to become lost in the ‘I’m menopausal’ mindset. There is light at the end of the tunnel and it is possible to feel good about yourself. Changing the way in which we think about the menopause is the first step. CBT will help you to:

  • Identify unhelpful underlying thoughts that are self-perpetuating and may negatively impact your quality of life and self-esteem.
  • Reduce ‘catastrophising’ and self-critical thinking.
  • Review and challenge unhelpful behavioural responses to anxiety and stress. For example, are you working longer hours? Are you eating or drinking too much? Are you avoiding certain people or activities? Are these healthy responses? Could you find a more appropriate response?
  • Challenge negative social images and negative attitudes about menopausal women (which can negatively impact our self-esteem) with the goal of becoming more compassionate to ourselves.
  • Address low mood by increasing activity, engaging in pleasurable activities, developing a structure to your day and reducing self-critical thinking.
  • Reduce stress which exacerbates vasomotor symptoms such as hot flushes and night sweats
  • Address sleep disorders, sexual concerns and depression by working through negative thought patterns, establishing positive behavioural changes and reframing the experience.
  • Manage sleep and night sweats by creating good habits to optimise sleep behaviour and environment

Alongside, and in addition to, the above cognitive solutions, CBT offers a number of practical behavioural steps you can take to help with problems associated with menopause. For example,

  • Relaxation and paced breathing – to calm your body’s physical and emotional reactions. Breathing from your stomach will reduce physiological arousal and allow focus to shift to neutral calming thoughts rather than on self-critical or other unhelpful thoughts. This is an important part of the CBT approach for hot flushes.
  • Good sleep hygiene – train your body’s natural rhythms to facilitate sleep. Limit light in the bedroom (including light from mobile phones and laptops). Limit caffeine and alcohol which can impact sleep onset and quality. Develop a good bedtime wind down routine to help you relax before going to bed. Maintain a regular sleep pattern.
  • Hot flushes – keep cool and avoid possible triggers such as spicy foods, caffeine, alcohol, smoking or stress. Dress in layers so you can remove items if you feel too warm.
  • Regular exercise – may help reduce hot flushes, improve sleep and lift your mood.
  • Pelvic floor exercises – squeezing and releasing the muscles that support your bowel, bladder and vagina can help strengthen your pelvic muscles and may improve your bladder control.

While CBT may not be for everyone, the benefits can certainly be worth it. CBT teaches life skills that once learned can be applied in situations long after ‘treatment’ has finished.

Don’t suffer in silence! If you’re struggling with symptoms of the menopause and think you could benefit from CBT, give me a call!

Siobhan Graham Psychotherapy – www.siobhangraham.com – 07863 546421

 

How to look after your mental health when working from home

This week, the government announced that due to coronavirus cases spiking across the UK, anyone who could work from home, should do so. The latest guidelines suggest that these new coronavirus restrictions for England could last for up to six months.

With this in mind, it is important to note that working from home for long periods of time can negatively affect our mental health. Working at home during a pandemic is slightly different to working from home pre-pandemic. I find myself in a situation where both myself and my husband are working from home at the same time. Practically this means that space and quiet is often hard to come by, stress levels increase and heated ‘negotiations’ often take place!

While working from home certainly has its benefits, you may also be experiencing some of the following feelings

  • Feeling isolated, lonely, or disconnected from other people – socially and professionally
  • Feeling stressed and overwhelmed
  • Being unable to ‘switch off from work’
  • Having difficulty staying motivated
  • Having difficulty prioritising your workload
  • Feeling uncertain about your progress, and whether you’re performing ok
  • Insomnia and sleep problems

So, how you can protect your mental health while working from home?

Set up routine and structure for your workday — create boundaries between ‘work time’ and ‘home time’

We are creatures of habit so establishing a routine and sticking to it when you are working from home is a good way to keep your motivation and productivity on track.

Define your work hours – if you find yourself staying up late or waking up early to meet deadlines, professional and personal boundaries will become blurred. Try to get up at the same time during the work week as you would if you were going to an office. Stick to predetermined break times and block out time to get up from your desk to stretch and move about.

Change out of your pyjama’s and into different clothes for working in. When the routine of getting changed into new clothes for working at home is practiced enough, psychologically you become conditioned to associate the changing of clothes with a change of mindset, preparing you for the working day ahead.

Stay consistent and ‘leave work’ when your working hours are over. It’s very tempting to ‘just answer one more email’ when you don’t have to leave to catch a train or avoid the rush hour.

This will help you switch off from work at the end of the day and minimise the possibility of work intruding into your family time.

Set up a specific ‘work’ place in your home (avoid your bedroom)

It is important (where possible) to create a designated work space that (pardon the pun) ‘works’! Try to ensure you have access to a desk, a comfortable chair and plenty of natural light.

Creating a specific work place will help you follow a disciplined work schedule when you’re at home – when you sit or stand there, you’re working and when you leave that place, you’ve left work. Because of this, it is suggested that you have “your own” work area at home (and in an ideal world in a separate room.) This may prove a little challenging if you have limited space, more than one person home working and/or a big family.

If you don’t have a specific room to work from set up a separate space (for example, in your living room), somewhere that is quiet, with good light, that allows you to focus, where you can have a comfortable table and chair to work from.

It has been well documented that working from home can interfere with sleep, especially for those who find it difficult to switch off from work. Avoid working from your bedroom if possible so that it does not become associated with being alert, awake and switched on.

Get a good night’s sleep

It may be tempting to do ditch your sleep routine while you’re working from home. Maybe you fancy grabbing a lie-in instead of your morning commute, or maybe you don’t see the need to go to bed as early. This is counterproductive if you want to continue getting consistent, high-quality sleep. Disruption to routine can cause the circadian rhythm (the sleep-wake cycle) to overcompensate, which can lead to you to being sleepy during the day, and alert when you go to bed. Try and keep the same sleeping and waking hours you did before the pandemic. It may not feel like it first thing in the morning, but it will definitely be worth it in the long run.

Maybe you’re finding it difficult to sleep due to increased feelings of worry? We’re living through anxiety provoking times where it is often difficult to detach from the very real fear we are faced with – even when you’re trying to relax. While worry can be a very natural response, it is also an unhelpful one. Try to be proactive about addressing your anxieties. For example, set aside a time before bedtime (preferably not too late in the evening) where you write down the things that are worrying you so that they’re out of your head for the night and allow you get a good night’s sleep.

Set boundaries

Treat your ‘at home office’ as you would if you were in an ‘office office’. During working hours, be clear that you are unavailable for anything outside of your job duties. If you live with other people, let them know that although you might be ‘physically at home’, you are not mentally there – you are working and not available to do chores or have random conversations at any time, (and if you live in my house, not answering the front door to take in a parcel when the postman is pressed up against the window looking at you – this really irritates my husband when he’s ordered something for delivery and I don’t answer the door!)

Think about creating an action plan to deal with distractions and help you stay organised when working from home. Consider establishing cues for other family members. Maybe a closed door means ‘do not disturb’ or if you’re wearing your headphones or sitting at your desk, it means that you’re not available to speak or answer any question, unless it is an emergency (the same type of emergency for which they would call for when you’re at the office). Whatever your plan is, communicate it to others to minimise distractions. Lastly, don’t panic if the dog barks or a child wanders into view when you are on a call – these are strange times and most people will understand the juggle act that takes place when working from home!

Stay connected

For many of us, most of our daily routine, our forms of self-care, and our general sense of safety and stability have been impacted by the pandemic.

Make a conscious effort not to become distanced from your work colleagues while working from home. Not being in the office means that spontaneous meet ups and conversations with colleagues don’t happen. Be proactive in organising meetings and social networking. Maintaining emotional connections, having clear work-life boundaries, and increasing self-care strategies are key to helping reduce stress levels, reducing feelings of isolation and staying productive.

Reduce screen time

While technology makes it easier to stay connected 24/7, the downside is that it can make it difficult to switch off, and separate work and home life. In addition, with so many people using video conferencing apps, many of us are feeling drained while working from home. So much so, the term ‘Zoom fatigue’ is being used to describe this particular feeling of exhaustion. Try to avoid back to back video calls and take regular breaks to reduce the time you spend in front of a screen. Switch off notifications for work emails at the end of your working day and give your brain a rest from ‘work time’.

Try a digital detox to help you switch off from work, and spend quality time with your family, or engage in activities that give you a sense of pleasure and/or achievement.

Take regular exercise

Engaging in regular exercise can help curb feelings of anxiety and depression. When you exercise your brain releases serotonin, which positively impacts your mood and helps you to feel better. It can also help to improve your appetite and sleep cycle. Set aside time to stay active during ‘work hours’ and break up your day with regular screen breaks. If you’re not self-isolating, try to get outside at least once a day. Go for a walk and get some fresh air. If you are self-isolating, walk around your garden, up and down your driveway or onto your balcony and embrace fresh air.

Focus on the ‘positives’

Working from home can have many benefits. It can improve productivity, reduce distractions, reduce stress, improve work satisfaction, lower the time (and cost) you spend commuting, give you greater sense of control over your workday, and can even help to avoid challenging colleagues!

In addition to the tips listed above, don’t forget to maintain positive mental health through

  • Exercising, getting a good night’s sleep and eating well
  • Engaging in activities that give you a sense of pleasure and/or achievement
  • Staying connected and seeking out support
  • Managing stress through problem solving, relaxation and/or meditation
  • Reframe your thinking to look for the positives in a situation