Living with a long-term condition like MS does not only mean facing physical challenges, it can mean overcoming mental challenges too.
So at a time of year when the post-Christmas blues have well and truly kicked in, we’re focusing on the talking therapies that are available to help improve low mood.
Here we look at counselling and cognitive behavioural therapy.
Counselling provides a safe space for you to open up and talk about any worries, anxieties or difficulties you’re facing in your life. Your counsellor will listen to how you’re feeling and help you find ways to understand those feelings and develop strategies you can use to deal with them going forward. Counsellors are trained to help people who are going through a wide range of difficulties in their life; they can help people learn to cope with depression and anxiety, and long-term conditions like MS.
Depending on the service available in your area, counselling sessions can take place face-to-face, over the phone, in a group or online through email or live chat services. NICE guidelines recommend that people with mild to moderate depression should have between six to 10 sessions over a period of two to three months.
MS is an unpredictable condition and the uncertainty this brings can lead to feelings of anxiety and low mood. Similarly the challenges that some symptoms can cause may also bring about lower self-esteem and negative thoughts. These are both areas that can be discussed with a counsellor.
Your counsellor won’t tell you what to do, but they can help you to develop coping techniques and adapt to changing symptoms. You might find the first sessions quite difficult emotionally as you begin to talk about upsetting and painful issues in your life. This is completely normal. It may take a few sessions before you start to feel the benefits of counselling. So be patient and try not to feel disheartened if you don’t start to feel better straightaway.
CBT is mainly used to treat anxiety and depression. It’s all about recognising your thoughts and understanding how they impact on your emotions and actions. When you see a therapist, they will want to understand your thought processes, feelings and behaviours and work out whether any of these are unhelpful or unrealistic. They will then suggest ways of changing how you think, feel and behave which you can practise in your daily life and which may break the cycle of low mood and depression.
Sessions can be face-to-face with a therapist or delivered over the phone. There are also computerised CBT programmes which you can go through yourself and a therapist will review your progress as you go along. Group-based CBT is another option. Sessions are usually delivered in groups of approximately eight to ten people. For people with mild to moderate depression, NICE recommends a guided self-help programme which is based on CBT. This involves seeing a therapist between six to eight times over a period of 9–12 weeks and working through a range of self-help materials in between sessions.
There are a number of CBT-based self-help guides available online. The NHS has a CBT-based audio guide for tackling low mood.
Being more aware of your thoughts can make it easier to notice how they’re impacting on your mood and other areas of your life. When living with a condition like MS, it can be easy to get frustrated and blame yourself for things that aren’t necessarily your fault and you have little or no control over.
For instance, if leg spasms suddenly come on and all the house cleaning you had planned for the day doesn’t get done, you may start thinking negatively about yourself because you didn’t achieve what you’d hoped to that day. These negative thoughts may affect your emotions – you might start feeling down, angry or upset. By the time the spasms have stopped, all these emotions may have left you feeling exhausted so you no longer fancy going out with your friends that evening and you decide to cancel. See how thoughts, emotions and actions are all interlinked? Maybe this chain could have been broken by changing those negative thoughts at the beginning and being a bit kinder to yourself.
This is what CBT aims to do; it can help you break the cycle by teaching you to be more aware of your thoughts, allowing you to make those positive changes so unhelpful thoughts don’t have a negative impact on your life.
Talking therapies are available on the NHS although we understand that waiting lists can be very long. Your GP can refer you to services in your area. If you're based in England, in some areas you can refer yourself by searching for your local NHS psychological therapies service and contacting them directly. If you find you’re having to wait a long time to access these services on the NHS, there are some other organisations you can turn to for support.
If you choose to look for services privately, the websites of the British Association for Counselling and Psychotherapy (BACP) and the UK Council for Psychotherapy (UKCP), allow you to search for private counsellors and psychotherapists near you.