Peter H Brown Clinical Psychologist

Psychology News & Resources

Exercise DOES Help Improve Mood! And Just 25 Minutes Worth Will Decrease Stress & Increase Energy

Having an Honors degree in Human Movement Studies and working in gyms in a former life while studying for my Clinical Masters degree, I have seen this to be true.  Of course it seems self evident, but these researchers have used great science with an excellent and now research-proven written program and workbook. These, along with their recent meta-analytic research review, show just how effective exercise can be in improving mood.

Credit: PhysOrg.com) — Exercise is a magic drug for many people with depression and anxiety disorders, according to researchers who analyzed numerous studies, and it should be more widely prescribed by mental health care providers.

“Exercise has been shown to have tremendous benefits for mental health,” says Jasper Smits, director of the Anxiety Research and Treatment Program at Southern Methodist University in Dallas. “The more therapists who are trained in exercise therapy, the better off patients will be.”

The traditional treatments of cognitive behavioral therapy and pharmacotherapy don’t reach everyone who needs them, says Smits, an associate professor of psychology.

“Exercise can fill the gap for people who can’t receive traditional therapies because of cost or lack of access, or who don’t want to because of the perceived social stigma associated with these treatments,” he says. “Exercise also can supplement traditional treatments, helping patients become more focused and engaged.”

The Program used in the study is available from bookstores-Click Image to view description

Smits and Michael Otto, psychology professor at Boston University, presented their findings to researchers and mental health care providers March 6 at the Anxiety Disorder Association of America’s annual conference in Baltimore.

Their workshop was based on their therapist guide “Exercise for Mood and Anxiety Disorders,” with accompanying patient workbook (Oxford University Press, September 2009).

The guide draws on dozens of population-based studies, clinical studies and meta-analytic reviews that demonstrate the efficacy of exercise programs, including the authors’ meta-analysis of exercise interventions for mental health and study on reducing anxiety sensitivity with exercise.

“Individuals who exercise report fewer symptoms of anxiety and depression, and lower levels of stress and anger,” Smits says. “Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing.”

After patients have passed a health assessment, Smits says, they should work up to the public health dose, which is 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity activity.

At a time when 40 percent of Americans are sedentary, he says, mental health care providers can serve as their patients’ exercise guides and motivators.

The patient workbook which accompanies the program - Click image to view description

“Rather than emphasize the long-term health benefits of an exercise program — which can be difficult to sustain — we urge providers to focus with their patients on the immediate benefits,” he says. “After just 25 minutes, your mood improves, you are less stressed, you have more energy — and you’ll be motivated to exercise again tomorrow. A bad mood is no longer a barrier to exercise; it is the very reason to exercise.”

Smits says health care providers who prescribe exercise also must give their patients the tools they need to succeed, such as the daily schedules, problem-solving strategies and goal-setting featured in his guide for therapists.

“Therapists can help their patients take specific, achievable steps,” he says. “This isn’t about working out five times a week for the next year. It’s about exercising for 20 or 30 minutes and feeling better today.”

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April 5, 2010 Posted by | anxiety, Books, brain, Cognitive Behavior Therapy, depression, Exercise, Health Psychology, Positive Psychology, research, Resilience, Resources, stress, therapy | , , , , , , , , , , , , , , , , , , | 4 Comments

Martin Seligman: Author Of “Learned Optimism” Speaks About Positive Psychology And Authentic Happiness

Martin Seligman was originally best known for his classic psychology studies and theory of “Learned Helplessness” (1967) and it’s relationship to depression.

These days he is considered to be a founder of positive psychology, a field of study that examines healthy states, such as authentic happiness, strength of character and optimism, and is the author of “Learned Optimism”.

This is a terrific talk on Positive Psychology and what it means to be happy. It’s about 20 mins. long but definitely worth a watch!

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April 1, 2010 Posted by | anxiety, Cognitive Behavior Therapy, depression, Health Psychology, Mindfulness, Resilience, Resources, Technology, therapy, video | , , , , , , , , , , | 2 Comments

Self Help For Anxiety & Depression: A List Of FREE Interactive Self Help Websites

Today I wanted to get around to doing what I have been meaning to do for a while and post a list of free access interactive and/or educational websites which I have come across. These sites are fantastic resources and each one offers a different way to get involved with your recovery. Please note I am not affiliated with any of these sites and they are not affiliate sites. I hope you find one or more useful as I know many of my clients have.

Click Image to Read Reviews

Self Help / Educational Websites

Updated 27th March 2010

There you have it! Check them out and let me know what you think. Know of any others? (No affiliate sites please).

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March 24, 2010 Posted by | Acceptance and Commitment Therapy, anxiety, Cognitive Behavior Therapy, depression, Dialectical Behavior Therapy, Education, Internet, Mindfulness, Positive Psychology, Resilience, Resources, Technology, therapy | , , , , , , , , , | 8 Comments

Borderline Personality Disorder: What’s with the Name & Just What Is It?

I have continued to receive a number of requests by email and on Twitter about Borderline Personality Disorder, its name, its presentation, its treatment and its psycho-genesis. Below is a brief post which I think covers most of these questions in outline form. I am open to suggestions as to which, if any areas readers would like to discuss in more detail. A small collection of books on BPD which I recommend to patients, carers, significant others and counsellors can be found here, most with reader reviews. I would be happy to hear of others.

What’s with the name?51RzQ0P9lvL

The term “borderline” was first used by early psychiatrists to describe people who were thought to be on the “border” between diagnoses. At the time, the system for diagnosing mental illness was far less sophisticated than it is today, and “borderline” referred to individuals who did not fit neatly into the two broad categories of mental disorder: psychosis or neurosis.

Today, far more is known about BPD, and it is no longer thought of as being related to psychotic disorders (and the term “neurosis” is no longer used in our diagnostic system). Instead, BPD is recognized as a disorder characterized by intense emotional experiences and instability in relationships and behavior.

Many experts are now calling for BPD to be renamed, because the term “borderline” is outdated and because, unfortunately, the name has been used in a stigmatizing way in the past. Suggestions for the new name have included: “Emotion Dysregulation Disorder,” Unstable Personality Disorder,” and “Complex Posttraumatic Stress Disorder.”

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual’s sense of self-identity. Originally thought to be at the “borderline” of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.1 There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases.2,3 Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.4 Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day.5 These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

41yVtFwvk2LPeople with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Treatment

Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies.6 Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.7

Recent Research Findings

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children.8 Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver.9 Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.

NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.10 The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.11

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain’s major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.7

Future Progress

Studies that translate basic findings about the neural basis of temperament, mood regulation, and cognition into clinically relevant insights which bear directly on BPD represent a growing area of NIMH-supported research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. The Institute is also collaborating with a private foundation to help attract new researchers to develop a better understanding and better treatment for BPD.

References

1Swartz M, Blazer D, George L, Winfield I. Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 1990; 4(3): 257-72.

2Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 1994; 8(4): 257-67.

3Gardner DL, Cowdry RW. Suicidal and parasuicidal behavior in borderline personality disorder. Psychiatric Clinics of North America, 1985; 8(2): 389-403.

4Zanarini MC, Frankenburg FR. Treatment histories of borderline inpatients. Comprehensive Psychiatry, in press.

5Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG. The pain of being borderline: dysphoric states specific to borderline personality disorder. Harvard Review of Psychiatry, 1998; 6(4): 201-7.

6Koerner K, Linehan MM. Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 151-67.

7Siever LJ, Koenigsberg HW. The frustrating no-mans-land of borderline personality disorder. Cerebrum, The Dana Forum on Brain Science, 2000; 2(4).

8Zanarini MC, Frankenburg. Pathways to the development of borderline personality disorder. Journal of Personality Disorders, 1997; 11(1): 93-104.

9Zanarini MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 89-101.

10Davidson RJ, Jackson DC, Kalin NH. Emotion, plasticity, context and regulation: perspectives from affective neuroscience. Psychological Bulletin, 2000; 126(6): 873-89.

11Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation – a possible prelude to violence. Science, 2000; 289(5479): 591-4.

Bernstein, PhD, David P., Iscan, MD, Cuneyt, Maser, PhD, Jack, Board of Directors, Association for Research in Personality Disorder, & Board of Directors, International Society for the Study of Personality Disorders. “Opinions of personality disorder experts regarding the DSM-IV Personality Disorders classification system.” Journal of Personality Disorders, 21: 536-551, October 2007.
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Sources: about.com and nimh.gov.org

March 15, 2010 Posted by | Cognitive Behavior Therapy, diagnosis, Dialectical Behavior Therapy, Education, Personality Disorder, Resources, self harm, therapy | , , , , , | 1 Comment

Happiness: Why It’s Harder to Find in Depression’s “Shrinking World”

http://www.PsychologicalScience.org via http://www.psychcentral.com

A new research study investigated whether happy and unhappy people differ in the types of conversations they tend to engage in.

For a four-day period, psychological scientists from the University of Arizona and Washington University in St. Louis had volunteers equipped with an unobtrusive recording device called the Electronically Activated Recorder (EAR).

This device periodically records snippets of sounds as participants go about their lives. For this experiment, the EAR sampled 30 seconds of sounds every 12.5 minutes yielding a total of more than 20,000 recordings.

Researchers then listened to the recordings and identified the conversations as trivial small talk or substantive discussions. In addition, the volunteers completed personality and well-being assessments.

An analysis of the recordings revealed some very interesting findings.

Greater well-being was related to spending less time alone and more time talking to others: The happiest participants spent 25 percent less time alone and 70 percent more time talking than the unhappiest participants.

In addition to the difference in the amount of social interactions happy and unhappy people had, there was also a difference in the types of conversations they took part in: The happiest participants had twice as many substantive conversations and one third as much small talk as the unhappiest participants.

These findings suggest that the happy life is social and conversationally deep rather than solitary and superficial.

The researchers surmise that — though the current findings cannot identify the causal direction — deep conversations may have the potential to make people happier.

They note, “Just as self-disclosure can instill a sense of intimacy in a relationship, deep conversations may instill a sense of meaning in the interaction partners.”

The findings are reported in the latest issue of Psychological Science, http://www.psychologicalscience.org

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March 8, 2010 Posted by | Cognitive Behavior Therapy, depression, Health Psychology, Intimate Relationshps, Positive Psychology, stress | , , , , , , , | 1 Comment

“I Just Want to be Happy!” The Struggle for Happiness PART 1: The Complete First Chapter of “The Happiness Trap”

If you’ve read some previous posts, you’ll be aware that I’m a huge fan of Australian MD Dr Russell Harris’ book “The Happiness Trap”. “The Happiness Trap” is a book which outlines the key principles of Acceptance and Commitment Therapy (ACT). I have said previously that I would come back to this topic so here goes!

51j3AEpsNpLACT is a relatively new (mid to late 1990’s)  approach to cognitive therapy, based around the principles of “mindfulness” and acceptance of the difference between the realities of what is going on around you as opposed to your evaluation or judgment of what is going on around you. These evaluations and judgments are often dependent on how your thoughts and assumptions are attached to or “fused” to your emotions and perceptions of yourself and others. It is a well researched model which is widely becoming more and more accepted as an effective intervention for anxiety,depression and other mental health and wellness issues.

Sound complicated and confusing? Well actually it’s not. And to prove it I am providing a link here to The full first Chapter of Dr Harris’ book in PDF format. You will need acrobat reader (free) or another free PDF reader to access this chapter which you can find by clicking on the link below.

I will be coming back to the principle of ACT and mindulness hopefully once or twice a week, and my aim is to walk you through the rationale of this approach and show you some tools,worksheets and strategies to help you to explore and implement some of basics of ACT, so subscribe to my RSS or come back regularly to keep up!

Here’s the link!

Chapter 1 of “The Happiness Trap” – Dr Russell Harris (No catches or tricks..it’s free!)

You will probably find a copy of The Happiness Trap and other ACT Books in your local library. You can also purchase a copy Here, and if you are in Australasia, Here. You can read more about it at Dr Harris’ website and there are customer reviews in My Highly Recommended Books.

Enjoy

Part Two coming soon!

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July 26, 2009 Posted by | Acceptance and Commitment Therapy, anxiety, Cognitive Behavior Therapy, depression, Resilience, therapy | , , , , , , , , , , | 4 Comments

Do We Need A Simpler Definition For Major Depressive Disorder?

I’ve just come across this press release. Thought provoking..will have to chew it over.

Researchers from Rhode Island Hospital’s department of psychiatry propose that the definition for major depressive disorder (MDD) should be shortened to include only the mood and cognitive symptoms that have been part of the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for the past 35 years. Their recommendation would exclude those symptoms that are currently part of the definition that may be associated with medical illness rather than depression. The proposal is based on a study that appears in the July 23 online first edition of the journal Psychological Medicine.

The current definition of major depressive disorder in the fourth edition of the DSM (DSM-IV) includes nine 51MeMte0MBLsymptoms — a definition that has remained essentially unchanged since the 1970s. With preparations for the fifth edition of the DSM underway, the researchers propose that there are two practical problems with the symptom criteria: the length of the definition and the difficulty in applying some of the criteria to patients with co-morbid medical illnesses. The researchers’ proposal recommends a shortened list of symptom criteria that includes only low mood, loss of interest or pleasure, guilt/worthlessness, impaired concentration/indecision and suicidal thoughts. It would exclude the somatic criteria of fatigue, appetite disturbance and sleep disturbance (increased sleep or insomnia) as these may be associated with medical illnesses other than depression. Their proposal is called the “simpler definition of MDD.”

Lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, says, “While the principles guiding criteria revision have not been clearly explained, we believe that existing diagnostic criteria should be revised when a conceptual problem is identified, or a more valid or simpler method of defining a disorder is developed. The reason for even considering a change to the symptom criteria for major depressive disorder after all these years is two-fold.”

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, continues, “First, studies have indicated that there are significant gaps in the knowledge or application of the MDD criteria among practitioners. Second, somatic criteria that are currently part of the DSM-IV definition such as fatigue or sleep or appetite disturbances are also symptoms of other medical illnesses and may not be indicative of a major depressive episode.”

Under Zimmerman’s direction, researchers from Rhode Island Hospital and The Warren Alpert Medical School of Brown University previously developed the simpler definition of MDD for a project known as the Rhode Island Methods to Improve Diagnostic Assessment and Services (RI MIDAS) project, an integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center.

Zimmerman says, “In our previous report from the RI MIDAS project, we developed a briefer list of the symptom criteria of MDD that was composed entirely of the DSM-IV mood and cognitive symptoms. That simplified definition did not include the somatic symptoms.” He continues, “Our initial research found high levels of agreement in diagnosing MDD between the simplified and DSM-IV definitions of MDD. Our goal in this study was to replicate these findings in a large sample of psychiatric outpatients, and to extend the findings to other patient populations, including those presenting for treatment of pathological gambling and candidates for bariatric surgery.”

Zimmerman says, “After eliminating the four somatic criteria from the DSM-IV definition of MDD, leaving the five mood and cognitive features, a high level of concordance was found between this simpler definition of MDD with the original classification in all three patient samples studied.” He adds, “This new definition offers two advantages over the DSM-IV definition – it is briefer and therefore more likely to be recalled and correctly applied in clinical practice, and it is free of somatic symptoms, thereby making it easier to apply with medically ill patients.”

Using the Structured Clinical Interview for DSM-IV (SCID), the researchers conducted a study of more than 2,500 patients. The patient population consisted of 1,100 psychiatric outpatients, 210 pathological gamblers who presented for treatment and 1,200 candidates for bariatric surgery. Across all patients, the level of agreement between the simplified definition and the DSM-IV definition was more than 95 percent.

The researchers note that there are implications to changing the criteria for MDD. Because their findings indicate that the simpler definition is highly concordant with the current version, there would be no meaningful impact on prevalence rates. Reducing the number of criteria, however, would reduce the time needed to fully assess criteria in patients and diagnostic interviews could be shortened.

Zimmerman and the researchers conclude, “In deciding how to proceed in the next version of the DSM, the conceptual and practical advantages of a briefer set of criteria that is easy to apply to all patients, particularly medically ill patients, needs to be weighted against the disadvantages of deviation from tradition.”

Along with Zimmerman, other researchers involved in the study include Janine Galione, PhD; Iwona Chelminski, PhD; Joseph McGlinchey, PhD; Diane Young, PhD; Kristy Dalrymple, PhD; Camile Ruggero, PhD; and Caren Francione Witt, PhD; all of Rhode Island Hospital and Brown University.

Source: Nancy Jean  Lifespan
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What do you think? Leave a comment and we’ll see if we can get some discussion happening!

July 25, 2009 Posted by | Acceptance and Commitment Therapy, Cognitive Behavior Therapy, depression, Dialectical Behavior Therapy | , , , , , , | Leave a comment

Cognitive Distortions:Some Questions to Ask Yourself to Unbend that “Stinking Thinking”

The theory of cognitive distortions was first proposed by David Burns, MD. Eliminating these distortions and negative thoughts is one of the goals of many research proven Cognitive Behavioral Therapy(CBT) approaches to conquering mood disorders  such as depression and  chronic anxiety. The process of learning to refute these distortions is called cognitive restructuring. David Burns originally came up with 10 types of cognitive distortions, and a few others have been suggested subsequently by other researchers.

A number of years ago, myself and psychologist Jillian Hooper adapted these types of distortions into questions which clients and patients could use to challenge their dodgy thoughts. I thought it might be useful to post them here in the hope that they may be of use to readers. So here they are:

Questions to help you challenge negative thinking

What real evidence is there?

Am I turning a thought into a “fact”?

Am I jumping to conclusions?

What alternatives could there be?

What is the effect of thinking the way I do?

Is thinking this way helpful?

What are the pros and cons of thinking this way?

What thinking errors am I making?

Am I asking questions that don’t have answers?

Am I thinking “all or nothing” thoughts?

Am I “always” exaggerating “everything?”

Am I questioning my worth as a person because of one thing that has happened?

Am I focussing on my weaknesses and forgetting my strengths

Am I blaming myself for things that aren’t really my fault?

Am I taking things personally?

Am I expecting more of myself than I would of others?

Am I only noticing the negative side of things?

Am I making a mountain out of a molehill?

Am I expecting a catastrophe?

Am I worrying about things that I can do something about?

Am I assuming that things can’t change?

Am I trying to predict the future?

Brown, P H & Hooper, J (1998) Accessible Interventions for Depression in Rural and Remote Areas. Royal Queensland Bush Children’s Health Scheme.

David Burns Brilliant Book Feeling Good: The New Mood Therapy has been revised and updated over many years and remains one of the best self help tools for people suffering from depression and anxiety. It is also listed in my Highly Recommended Reads accessible via the link in the right column.

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July 14, 2009 Posted by | Cognitive Behavior Therapy | , , , , | 76 Comments