Session 3. Recognising unhelpful thinking & sleep management. A new Graduated, Rehabilitative Integrated Programme for CFS/ME patients

Transcription

1 A new Graduated, Rehabilitative Integrated Programme for CFS/ME patients Session 3 Recognising unhelpful thinking & sleep management Tees CFS/ME Specialist Service The James Cook University Hospital, Middlesbrough MICB3624c

2 Role of psychology What does a psychologist do? Why is it needed for CFS/ME? Who would normally access psychology? 1 Cognitive Behavioural Therapy (CBT) Explores thoughts, feelings, symptoms and behaviour. Goal = Change unhelpful patterns to improve emotional well-being. Helpful treatment for: depression, anxiety, phobias cancer, pain CFS/ME CBT formulation Predisposing Factors (Early events that increase vulnerability) Precipitating Factors (Events that trigger the problem) Presenting Problem Perpetuating (Things that keep the problem going) Thoughts Behaviour Feelings Physiology Protective (Things that stop the problem getting worse)

3 CBT example Bullied at school Mugged Panic when leaving the house Something bad will happen Looking for evidence of danger Avoid going out Terrified Have to go to work Can t breathe Predisposing Factors - Early Life Experiences that may make someone vulnerable to CFS/ME: 1. Achievement/Performance I must do things perfectly If I can t do something properly I am no good 2. Self-Sacrifice If I don t do what others want I m not a good person 3. Emotional Avoidance If I cannot control my emotions I am weak I must never admit to difficulties 2

4 The problem Thoughts I m making myself ill I must rest to get better Suraway et al., 1995; Burgess & Chalder, 05 I should do more I should try harder Behaviour Avoid activity Burst of activity Consequences Reduction in symptoms BUT failure to live up to standards Some achievement BUT increased symptoms & poor performance Perpetuating factors Resting too much Disturbed Sleep Focusing on Symptoms Belief that symptoms indicate harm/ worsening of disease Life Stress Example of CBT formulation for CFS/ME Predisposing Factors (Achievement, Emotional control, Self-sacrifice) Precipitating Factors (Physical (viral) illness, Stressful events) Perpetuating Too much rest Poor sleep Other stress Presenting Problem Thoughts: I should do more people will think I am lazy Behaviour: boom & bust Emotions: low mood, anxiety Physical: tired, muscle aches Protective Family Services Insight Hobbies 3

5 Overcoming unhelpful thinking patterns Step 1: Developing Insight Group task 4 Others Unhelpful thinking Yourself I can t do it Make you feel worse Hold you back Others people will think I m useless The future things won t get better Distorted How to challenge unhelpful thinking Ask yourself the following key questions a) What evidence is there against this thought? b) Is there another way of looking at this situation? c) Why is it not helpful to think like this? d) What would you say to someone who had this thought? The next step is to think of a more balanced, or positive thought. Thought Challenge Thought Challenge I ll never be able to finish this a) I was just as tired last week as I am now,and I still managed to get through it b) Maybe I am trying to get through too much too soon, if I have a break I will feel less tired (pacing) c) Telling myself I feel tired and I can t do something just makes me feel more anxious and tired, which is slowing me down d) I would tell a friend that they are being too hard on themselves I m so tired I ll never be able to finish all this I get through this amount of work each day with time to spare - there is no reason I will not today If I have a break and talk to a friend I will feel better able to cope

6 Overcoming unhelpful thinking patterns Step 2: Using Techniques Group task 5 Developing good sleep behaviour - Essential for rehabilitation Sleep disturbance Common in CFS/ME Sleeping too much Not sleeping well Amount of sleep needed varies: Between everyone Between each person over time Practical steps to help you with your sleep pattern Sleeping too much The consequences of sleeping too much are: Increased need for more sleep The body getting used to excessive sleep and late waking Inability to concentrate properly Loss of motivation and energy whilst awake Reduced enjoyment and satisfaction in life Managing sleep First goal Developing a sensible sleep routine Regular bedtime and rising time This is the anchor for successful rehabilitation Need for sleep will vary for each person Patience and persistent with yourself Good sleep routine takes time to establish Gradual return to normal awake/asleep cycle Before bed Do... Regular routine before bed eg warm bath before bed Go to bed at the same time each night Set an alarm for same time in morning Don t... Eat and drink before bed - avoid caffeine and alcohol Watch TV in bedroom Have bright lights Have long sleeps during the day Once in bed Stop thinking about today or tomorrow Think pleasant, relaxing thoughts Do relaxation exercises if necessary Bedroom should be dark, quiet and comfortable temperature Turn clock face away from you Get up at the usual time even if you feel that you haven t slept well Further patient information: The Northumberland, Tyne & Wear NHS Foundation Trust have produced practical patient information leaflets on many health issues. You can search their database at: / pic