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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


Finding a Cognitive Behavioural Therapist and the importance of Accreditation

Over the last few years there has been an increasing demand for Cognitive Behaviour Therapy (CBT). At the time of writing, the psychotherapy profession is unregulated. What this means, is that anyone can call him or herself a Cognitive Behavioural therapist and anyone can say that they provide CBT (whether they have had appropriate training or not!) Incredibly the title ‘cognitive behavioural psychotherapist’ remains unprotected.

Furthermore, not only can anyone can give themselves the title of ‘Cognitive Behavioural Therapist’, they can also set themselves up in private practice. I find this truly horrifying. For the unsuspecting client who is often distressed and at their most vulnerable when seeking therapy, this has the potential to be incredibly damaging. Therefore, we as therapist’s have a duty of care to be clear about our skills and the services we offer.

To become an accredited Cognitive Behavioural Psychotherapist, I trained for four years to gain my Masters qualification and invested a vast amount of energy, time and money into my training – holding down a full time (high pressured) job while travelling up and down the M1 to University, completing assignments and gaining client experience while working in a Primary Care Team (PCT) and in a Community Mental Health Team (CMHT). I love my job and am extremely passionate about what I do. So, I find it incredibly frustrating to hear from clients and ‘Joe Public’ who have supposedly experienced CBT only for them to say ‘it was rubbish’ or ‘it didn’t work’ amongst other damning statements. In my experience, when questioned these clients have not experienced CBT nor have they been treated by an accredited CBT therapist. While I feel very privileged that I am able to work as a CBT therapist. The flip side is that I am tired, frustrated and incredibly sad at having to continually defend my profession largely due to the poor practice and misrepresentation of others. Unless you are part of a professional organisation that regulates your practice, it is very unfair and unethical to ‘sell’ your services as something they are not.

So, what do I mean by an accredited CBT therapist?

An accredited cognitive behavioural psychotherapist is someone who holds accreditation with the British Association of Behavioural and Cognitive Psychotherapies (BABCP) – the lead organisation for CBT in the UK and Ireland – or the Association for Rational Emotive Behaviour Therapy (AREBT). Both these organisations ensure that therapists are providing quality Cognitive Behavioural Therapy to the public having undertaken approved training and regular supervision. It also means that in order to maintain accreditation therapists are continually assessed to ensure that they meet the high standards set by the BABCP and that they adhere to ethical practice.

All officially accredited CBT therapists can be found on the CBT Register [http://www.cbtregisteruk.com/Default.aspx]. Please note that an online Accreditation Check on the CBT Register is now the only recommended means of verifying CBT Practitioner Accreditation. You can search the CBT Register to check if an individual is accredited by using the surname search. You can also search for an accredited therapist’s contact details by name, location, or language.

To further complicate the issue, being a member of the BABCP is not the same as being accredited with the BABCP; anybody with an interest in CBT can become a member of the association.

This is where it gets complicated … there is a difference between an accredited CBT therapist and an accredited therapist who offers CBT.

There are a significant number of mental health practitioners – psychotherapists, counsellors, nurses, psychologists – offering CBT who are accredited but do not hold BABCP accreditation. They may hold accreditations from organisations such as the British Association for Counselling and Psychotherapy (BACP) or the United Kingdom Council for Psychotherapy (UKCP). These organisations do not offer a lesser accreditation but they are not ‘expert’ with regards to CBT.

So, what does this mean? It is possible that mental health practitioners who work primarily with other therapeutic modalities (for example, Person-Centred counselling, Psychodynamic counselling, Gestalt counselling etc) and who have undertaken little or no training in CBT, become accredited by organisations such as the BACP or UKCP and then once accreditation is obtained start to offer ‘CBT’.

To add another level of complexity, this is where terminology can become confusing. They become accredited as counsellors or psychotherapists rather than ‘CBT therapists’. In simple terms, they may have undertaken CBT training that hasn’t been approved or accredited by the BABCP or AREBT. While they may be a fabulous counsellor or therapist, it may also be the case that their level of training specifically in CBT is lower than the training required for accreditation by the BABCP or AREBT.

As a therapist who has worked in private practice for over 12 years I still find therapist job titles and accreditation issues confusing. If it’s confusing for me then it’s likely to be confusing (and potentially misleading) for clients looking for an appropriately qualified CBT therapist!

To this end, if you are a therapist or counsellor, please ensure that you are advertising your services accurately and ethically. If you are specifically looking for an accredited CBT therapist, please look on the CBT Register to ensure the therapist has the appropriate level of training!

I welcome any comments you may have about this blog/topic.

Siobhan Graham – Accredited Cognitive Behavioural Psychotherapist – www.siobhangraham.com