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Rather like the conundrum of the chicken and the egg, it is difficult to know which comes first in the case of M.E. - depression which develops as a result of having a chronic, debilitating illness, or is it a somatic disorder, masquerading as an organic disease ? When I was diagnosed with M.E. in April 1999, my initial response was a mixture of relief and denial. Relief that, at last, there was an explanation to that confusing jumble of symptoms : Denial because, as a therapist, I saw clients with M.E. and I really didn't want to go down that road ! I had already developed a belief - totally unsubstantiated - of what M.E. was all about.

The sufferers I saw appeared to run the gamut of symptoms : some were obviously worn out/burnt out and displayed an extensive array of problems, often including I.B.S., menstrual disorders , food intolerance's and insomnia. And yet others appeared relatively healthy. They held down stressful jobs and seemed to lead a normal life. Many of them slotted neatly in to the 'Type A' personality profile ( A term coined by two cardiologists, Friedman and Rosenman, in the seventies. Type A people are more prone to heart disease and stress-related illnesses. They usually present as ambitious, impatient individuals, who move and talk quickly and are often restless and inattentive to others.) Resorting to therapy was often a 'last resort', and followed a long line of healers, dieticians, homeopaths and aroma therapists. Few clients had considered psychotherapy, despite being prescribed anti-depressants and/or sleeping tablets. Many seemed, not exactly depressed, but resigned. ALL had suffered some kind of earlier trauma, resulting in feelings of insecurity, loss and frustration and often linked to relationships - but then many of my clients shared that same ! history !

The perception which under pins my approach to therapy is that beliefs affect outcome. Our own personal belief structures - what we should do and say, how we should react, what is right or wrong, how we see the world - are often formed in childhood. They may become distorted by other's beliefs. For instance, if ones primary carer believes that the world is a dangerous place and others are 'out to get you' you, as a child, may respond by either agreeing with that belief or by reacting to it, maybe by becoming hyper-vigilant or reclusive. We constantly translate mood into physical sensation - heartache, burning with desire ( or rage), eaten up with jealousy. We scratch and stutter our way around feelings and fear confronting our emotions. The very nature of M.E., with its physical and emotional peaks and troughs, leads to heightened awareness. Regular fatigue may be subconsciously intensified to a point where we fear a relapse is inevitable. So called 'good days' may result in boredom and frustration, 'bad days' in depression and anxiety. We may feel that we are 'paying the price' when 'normal' behaviour ( a walk in the park, an evening out with friends )results in exhaustion and a reoccurrence of symptoms. We soon become demoralised and loose confidence in our ability to influence our own recovery. It can be a hard-won battle to discover our own limits and to stick to them ! We may have never considered pacing ourselves in order to find acceptable levels of tiredness and attempting to underachieve.

For many years now, the concept of 'no pain - no gain' has been our battle cry. No wonder we feel anger and frustration when pushing ourselves to the limit = fatigue = pain. My own approach to my illness, since used with my own clients, combines the wonderfully effective holistic treatment, based on the work of Dr Jacob Teitelbaum and administered by Prof. John Davies and Dr Naomi Byles. at 10. Harley St., London with my own eclectic therapeutic skills. As a therapist, my work deals mainly with stress related illness. Stress, the scourge of the modern world, is often given as a throwaway diagnosis which disparages the very real implications of too much stress ( stressors ) combined with too few coping strategies. How many people, diagnosed with M.E., can, hand on heart, say they have never suffered the negative effects of stress and resorted to maladaptive strategies - too much coffee, alcohol, junk food, or worse - in order to 'cope'. Lets be clear on this - stress is neither 'good' nor 'bad' BUT our reactions to our perceptions of stress can be devastating. The biology of stress is a complex area. Short-term stress responses, such as the reactions you may get when asked to give an important presentation, are triggered by the sympathetic nervous system. The response to a perceived stressful situation is usually a combination of physical and mental changes, such as a dry mouth, palpitations, perspiration, dilated pupils and mental alertness - the classic 'fight or flight' syndrome. The parasympathetic nervous system kicks in, energy reserves in stored fat is broken down and blood is directed towards the muscles and away from the extremities.

The hypothalamus is the 'nerve centre' of the stress response. During a typical physiological response, the hypothalamus triggers the release of both adrenaline and nor adrenaline. If we develop CHRONIC STRESS, our levels of these hormones will be permanently raised. When the body is in a constant state of arousal, the very effects which are designed to get you out of a dangerous situation can become harmful themselves. Blood pressure may increase, we begin to hyperventilate and develop digestive disorders.(Or decrease if our adrenal glands are not functioning correctly - not uncommon in this disorder). We become prone to skin problems and muscular tension. Our immune system becomes less efficient and we are more susceptible to disease. We eventually become exhausted. The work of the hypothalamus does not stop there. Messages are transmitted to the pituitary gland, which releases Adrenocorticotropic Hormone - ACTH. This is then carried to the adrenal glands, where it further stimulates the release of more hormones, the most important of which is cortisol. These hormones can further suppress immune function. It appears that some people are more sensitive to stress. Interestingly, these same people may also be more prone to drug addiction and alcohol abuse.

So how do we control stress ? First of all, the perception of control is vital. Those people who possess an external locus of control ( that is, we feel powerless when confronted by stress) tend to suffer the most. We generally deal with stress in one of three ways : we fight it head-on, we attempt to reduce its impact or we run away from it. Clients suffering from depression often have an exaggerated external locus of control, in addition to other unhelpful ' attributional styles'. Stress Management can teach clients to recognise their own particular stressors and enable them to exert some control over their stress reactions. In the case of M.E., the use of CBT ( Cognitive Behavioural Therapy) may help these clients identify inappropriate coping strategies and break the cycle of fatigue-helplessness-disability by addressing distorted thought processes.

Clients are asked to keep a diary, listing both their perceptions of their physical well-being and their thoughts and beliefs about these perceptions. Therapist and client can then begin to work together to plan graduated activities coupled with relaxation techniques. I use a combination of autogenics, relaxation, hypnosis and, eventually, self hypnosis, to bring about a feeling of mental and physical relaxation. The benefits of hypnosis are immediately apparent, not just on a physical level ( muscular relaxation and good quality sleep) but on a psychological level. The ability to switch off the outside world for a while, allowing the body to repair itself and release endorphins - natures opiates - cannot be underestimated. Many clients had previously dismissed 'relaxation techniques' as too difficult but an individual approach to each client means that the appropriate hypnotic techniques ( of which there are many !) can be used. NLP ( Neuro Linguistic Programming ) can also be of use, being a powerful technique which can change previously learned responses to specific situations and allow the client to practise coping with future stressful situations. Two other therapeutic techniques which deserve a mention are EFT ( Emotional Freedom Technique) and EMDR ( Eye Movement Desensitisation and Reprocessing). EFT, also known as a Meridian Therapy, uses a combination of kinesiology ( muscle testing) and accupressure, concentrating on the twelve acupuncture meridians related to specific emotional states. Clients are taught how to self-administer a series of exercises designed to heal both mind and body, particularly concentrating on negative emotional and physical states. EMDR is a treatment model particularly suited to anxiety disorders and trauma. It is particularly helpful where clients have lowered self esteem and feelings of insecurity and depression. As a final thought, I believe that all things happen for a reason ( typical therapist reaction, I hear you say !).

Confronting a chronic illness helped me to view the world in a different way. My own belief system grew stronger. I decided that I was not going to become my illness and gave myself a year to recover. It is now fourteen months since I was first diagnosed, and seventeen months since I first became ill. The only lasting effects from the illness are a more laid back approach to deadlines. I am aware that what I put into my body can have a profound effect on my physical health. My energy levels are just about back to normal ( as opposed to manic!). My memory and mental ability is perhaps reduced a little, or maybe that's my age ! In April of this year, almost a year to the day that I was diagnosed with M.E., I took part in a self development course.

One of the many goals I set during that programme was to be healthy and to increase my energy levels by 100 %. Approximately half way through the course I visited Professor Davies for the third of a series of four Myers Cocktail infusions - a cocktail of vitamins and lignocaine,including B12 and magnesium, Not only were we both impressed by my energy and obvious feelings of well being, my body appeared to 'reject' the treatment - the canula couldn't be inserted into my vein and we concluded that my body was ( maybe) saying ' no thanks, don't need it now !' Carole Wan 7/01

Fear of dentistry can develop either directly (painful dental experience, earlier traumatic memory) or indirectly (negative messages received from the media/friends and family).

Although dentistry today is far removed from the unpleasant experiences of our predecessors there are still aspects which 'feed' a phobic response ? the inability to speak, difficulty in breathing, unaccustomed position of the body. Add to that the perceived loss of control, fear of the unknown and preponderance of sharp, shiny instruments and it is hardly surprising that severe dental phobias can develop!

Up to 75% of the population are anxious about undergoing dental treatment. Approximately 10% of these people will avoid visiting the dentist altogether ! No wonder dentists suffer from a high level of stress and stress?related illnesses!

How can hypnosis help in making a visit to the dentist a pleasant experience?

Although sedation can, of course, be accomplished chemically it may also be desirable to re?educate a patient, enabling them to respond to the prospect of dental treatment in a positive and relaxed manner. If a patient learns self?hypnosis it effectively puts him back in control. Apart from dealing with dental phobia, hypnosis can also be employed for anaesthesia ? useful in ROUTINE dental procedures where fear induces an over?sensitivity to pain, or even (in 'deep trance' hypnotic subjects)as a substitute for chemoanaesthesia where this is contraindicated. Children, in particular, respond well to hypnosis. Even quite young children can be put into trance and most will actively participate in and enjoy the process.

An abnormal gag response can also be controlled, useful in the field of orthodontics. Although less common, hypnosis has also been used successfully to conquer bruxism, TMJ and thumb sucking.

Where hypnosis is used for surgical procedures suggestions can also be given in order to enhance post?operative healing. Although hypnosis is no substitute for good dentistry it CAN reduce fears and therefore enable the. dentist to carry out his/her work more quickly, easily and more comfortably ? surely an advantage for both dentist and patient alike! 

 IBS
I.B.S. is a common digestive disorder thought to affect h of the population of the U.K. occasionally and 10% severely. Although it most commonly starts between the ages of 15 and 40 it can in fact occur at any age. It can affect both men and women and women may find it increases in severity pre?menstrually. It also seems to be linked to endometriosis.Many problems within the digestive tract are linked to stress. Nerves receive messages from the brain in the form of hormones which expand or contract the intestinal muscles. Stress can affect this delicate hormonal balance.

The resulting pain can be like an internal fist clenching. Other symptoms include bloating, diarrhoea and constipation. Chronic, long?term stress can shut down the digestive system altogether. Irritable Bowel Syndrome is often treated initially by a high fibre diet. The average annual drug bill for a patient suffering from I.B.S. is £550 ? this figure EXCLUDES hospital visits, tests and G.P. time. Although, as mentioned previously, anyone can suffer from this problem, symptoms may develop after a significant trauma such as bereavement or divorce. Rather like a typical migraine personality' many patients are perfectionists and may find it difficult to express anger.

Research carried out at Withington hospital in Manchester concluded that the use of hypnotherapy in patients diagnosed as suffering from severs I.B.S. resulted in a dramatic improvement in the incidence and severity of pain, bloating and bowel disturbance and also enhanced the overall feeling of well?being of the patient. Hypnosis was also found to help alleviate the symptoms of Inflammatory Bowel Disorder and Crohns Disease.

The most important aspect seemed to be the reduction of stress. Another important feature was that patients enjoyed the treatment as, by learning self?hypnosis, they finally felt in control of the disease.
Tests taken at the hospital showed that both excitement and anger affected I.B.S. by increasing the colonic pressure. This pressure was reduced when the subject felt relaxed or happy. After a full history of the patient was taken, hypnosis was used to induce feelings of calm and relaxation, together with direct suggestions of pain relief. Many clinicians believe that I.B.S. is purely psychosomatic and whilst other medical experts may accept that other factors are just as important most would agree that relaxation techniques are extremely beneficial.

There is currently no 'cure' for I.B.S. Experience with my own clients conclude, that until such a cure is found the use of hypnosis may well be the most effective way of controlling this unpleasant disease.

Phobias
Do you suffer from ailurophobia ? Or how about cynophobia ? The likelihood is that most of you will not have the above phobias
fear of cats ? fear of dogs ) but many will have arachnophobia fear of spiders). What are phobias and why do they affect us ?
A phobia is an irrational fear rooted in the subconscious mind. Although your conscious, rational mind believes that it is silly to be frightened of a tiny, harmless spider the subconscious mind constantly reminds us that logic can sometimes take a back seat.
Many phobias are what are termed 'simple phobias' - one isolated fear often caused by a single event or irrational belief. Sufferers may organise their lives around avoiding their phobia and eventually will become frightened of the fear itself. Although it is more usual to treat phobias over several sessions of therapy it may be possible to conquer a simple phobia in one single session.
Some phobias are more complex and may be either multi-layered e.g. fear of going out, public transport, eating in public, being sick or what may be termed a process phobia ? fear of a situation and all its facets (e.g. booking a holiday, driving to the airport, waiting for the plane, take off, flying, landing ). These more complex problems may actually have been triggered by a single event but are often linked to other, unresolved issues such as low self esteem or relationship problems.

The more unusual or resistant phobias may not be the source of the problem. For instance, imagine that a young child hears about the death of her grandmother whilst sitting in a room with a chiming clock. She may be too young or too traumatised to deal with this in a rational manner and may later become phobic about chimes or clocks or, indeed, anything that was in the room at that time. She may develop a phobia almost immediately or perhaps only much later in life, when dealing with other issues of grief or fear or even denial. The fear is merely a symbol for the emotion.

As a therapist I deal with phobias in a number of ways. I may use hypnotic regression to uncover the activating event that caused the phobia. Hypnosis can also be used to desensitize the client by confronting their fear. NLP (neuro linguistic programming) can be useful when dealing with a vivid memory or traumatic experience that triggered a phobia. The memory is 'neutralised' by using visualisation techniques and dealing with past negative beliefs.

EMDR (eye movement desensitisation and reprocessing) can be very effective where there are specific, current beliefs and/or physical sensations connected with the fear such as 'I'm not in control' linked to feelings of nausea.
As in all types of therapy it is important to be aware of the concept of 'secondary gain' - just as a smoker may justify the habit as he feels that smoking reduces his stress so the client with flying phobia may be avoiding the holiday - or the holiday companion !

Just as no two people are alike, no phobias are exactly the same and therefore the techniques used may be a combination of all the above or only one method may be used. With time and determination however it IS possible to eliminate most phobias, so freeing clients from a fear which may have previously ruled their lives.
 
Addendum
Where there has been previous trauma, resulting in single?incident
phobia, the use of EMDR (eye movement desensitisation and
reprocessing) may also be employed in order to quickly and
effectively treat the phobia/trauma - see attached information
sheet.

Stressed Out (This article first appeared in the Legal Abacus (1998))
Do you  remember the predictions of the mid eighties? The  worker In the nineties was going to be someone who  worked shorter hours' with plenty of leisure time. Instead we are working harder than ever before and workplace ressure is a reality which seems likely to follow us into the millennium.

The current cost of stress is a high one. The cost of workplace stress alone in the USA for example has been estimated at approximately $150 billion per annum. (Karasek & Theorell, 1990).

The key areas of workplace stress are enforced change, resulting in feelings of lack of control, and job insecurity. In addition. the rapid advances in technology load to increased pressure as we struggle to keep up and adapt to new ways of working.
The mental health charity, MIND, estimates that 30% to 40% of all absence Is due to mental and emotional disturbance, resulting in 40 million lost working days. Heart disease, often stress-related, accounts for another 70 million lost working days. Immense social problems resulting in divorce, alcoholism and suicide add to the overall cost. Alcohol related problems are a growing concern. The cost to industry alone is £1 billion per year. The group 'Alcohol Concern' estimates that one in four men in the U.K. drink over the recommended units per week. Workers in their 409 are the most likely group to abuse alcohol, with women increasingly using what was a male behaviour pattern of dealing with pressure.

Working Hours
Britain has the longest working hours in the E.U. and the highest divorce rate. Interestingly the highest producitivity figures come from Germany which has the shortest working week! The working hours of white-collar workers in particular have increased gradually over the last ten years. Individuals who work more than 48 hours per week are at twice the risk of dying from heart disease than those who work a maximum of 40 hours per week. Long and late working hours are now considered the norm in many careers and are viewed as a sign of commitment. Working women are especially vulnerable. Women believe, probably with a certain amount of accuracy, that they have to be seen to be better at their jobs than their male colleagues. The 'new man' is still, unfortunately, a product of the copywriters mind. In most cases women still carry out the majority of domestic chores and have primary responsibility for child care. This pressure has resulted in an increase in both smoking and alcohol abuse among women.

Medical consequences
The average GPs surgery Is full of people with stress related Illnesses. These may include high blood pressure, irritable bowel syndrome, insomnia, panic attacks, menstrual problems, diabetes, depression, heart disease and skin diseases. Stress can depress the Immune system, thus making us more vulnerable to bouts of colds, flu and other infections.
Life In the nineties means that time becomes a precious commodity. We are rarely able to arrange our working life to suit our own personal energy highs and lows. Poor time management can result in for example, an Increase In car accidents and 'road rage'. Relaxation time suffers and relationships are put under pressure. However hard we try we cannot find more than 24 hours in any one day. Although working under a certain amount of pressure can be productive, constant lack of control causes stress. Poor time management can be your worst
enemy in combating workplace stress. Unplanned interruptions, lengthy telephone calls, ineffective delegation and procrastination will all result in wasted time. Travelling by train can provide an opportunity to catch up on work. Symbols of t tie nineties worker, the mobile phone. filofax and laptop computer are all useful if used correctly.

Stress  Management
Stress Management does not just cover workplace stress but encompasses a whole range of techniques to deal with stress. Explained simply, too must stress evolves from PERCEIVED problems (STRESSORS) and our reaction to these events (COPING MECHANISMS). We all have a ,comfort zone' in which we feel able to cope. Any stressor will put strain on that stability although we all differ as to the amount of stress with which we can cope. The stress response - the fight or flight reaction, Is the result of our evolution. Survival of the human race depended on our ability to react quickly to danger. Although life today does not often require this instant response our bodies react to both physical AND psychological 'danger' as if we were under immediate threat. Stress chemicals are released by our body. The resulting physiological changes enable us to Improve performance. Blood supply to the brain increases, lung function increases, and the heart rate speeds up. Glucose is released into the blood stream and blood is diverted away from the stomach and skin. If we are not in a situation where we are required to run or fight. the effects on our bodies can be disastrous
We may develop headaches and a dry mouth. Our heart races and we may experience chest pain. Our digestion is poor and we experience heartburn and indigestion.

Long term stress can result in skin problems, constant feelings of anxiety and impotence. Relying on coffee, alcohol, cigarettes and junk food to help us cope will only exacerbate matters. Excessive caffeine may cause insomnia and increase the output of stress hormones. Eating large amounts of processed, sugary food may lead to hypoglycaemia, another cause of tiredness and irritability. Salty food_ as is most 'fast food' - will increase tension and blood pressure as well as fluid retention. Nicotine increases the stress response further and alcohol causes depression.

Lifestyle
Stress Management therefore looks at LIFESTYLE - what we eat, our leisure activities, our personal life. We assess your coping strategies both good and bad. Time management skills are evaluated as well as environmental stressors noise, overcrowding, and loneliness.
As well as 'quick fixes' to relieve stress we look at long term Issues One of the most effective ways of reducing stress is learning self hypnosis which produces both physical and mental changes. Chronic insomnia can be overcome using both relaxation techniques and light/sound therapy. Stress Management seminars and employee assistance programmes ensure that we capitalise on the positive aspects of stress allowing you to live a life which Is enjoyable and fulfilling.