To all our valued clients. We wish you a very Merry Christmas and a wonderful year ahead. We will be closed on the Public Holidays only. Should you require after hours care, please call the surgery 41971567 and follow the directions on the message. (Have a pen handy)

Cognitive behaviour therapy (CBT) is widely reported as being ‘as effective as medication to treat depression and anxiety’ (Better Health Channel 2016). A review by Hofmann et al. (2012) state overall there is strong evidence to support the use of CBT, particularly for ‘anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress.’ What is Cognitive Behaviour Therapy (CBT)? The psychotherapy, CBT, is used to improve dysfunctional thoughts, feelings and behaviours. CBT aims to impart self-help strategies that can improve the client’s quality of life (Better Health Channel 2016). CBT can be used to alter belief or thought trends, such as those that trigger anxiety. Some people have negative automatic thoughts, and CBT can help the client to challenge and overcome these. Cognitive restructuring can then take place, in which the person reframes their negative thoughts into a more positive perspective (Better Health Channel 2016). Cognitive Behaviour Therapy Involves: • Assessment (e.g. surveys) • Education (e.g. increased knowledge about the specific client issues to help them challenge and overcome irrational or ‘unfounded’ feelings and thoughts • Goal setting (e.g. client chooses a goal they wish to focus on between sessions and creates a plan with the therapist to progress towards the goal) • Role-play and skills-practice • Homework or action-plans (e.g. journal entries) • Usually between six and ten sessions • Face-to-face and/or internet sessions/programs (Better Health Channel 2016) (CC) Depicting Basic Tenets of CBT, Urstadt 2015 Another example of a CBT strategy can include asking a person to offer evidence that supports their thoughts, for the purpose of helping the client to understand when they hold a false or irrational belief (Better Health Channel 2016). Evidently, the person can then have an opportunity to challenge or reframe this perception. Uses of Cognitive Behaviour Therapy CBT can be used for various psychological conditions, such as (Better Health Channel 2016): • Anxiety • Depression • Social phobia • Obsessive-compulsive disorder (OCD) • Post-traumatic stress disorder (PTSD) • Poor self-esteem • Anger issues • Hypochondria • Misuse of substances such as alcohol • Gambling • Eating disorders • Insomnia • Marital and relationship issues • Some emotional/behavioural problems in children or teenagers (James et al. (2015) in their review, state that CBT is effective for children and adolescents with anxiety disorders, but there is not enough evidence to conclude whether CBT is more successful than active controls, treatment as usual, or medications at follow-up.) Interestingly, Kew et al.’s (2016) study found that ‘CBT may improve the quality of life, asthma control and anxiety levels compared with usual care’ for adults that have persistent asthma. It was noted that ‘usual care’ and the CBT approach of the studies was diverse, and could call for further research in the future (Kew et al. 2016). Additionally, Kew et al. (2016) reported that there is not any evidence at present for using CBT to treat adolescent asthma. Thereby, this is also an area calling for future investigation. When May CBT Not be the Best Choice? • If the client has a condition (e.g. brain injury) that prevents rational thinking • If the client does not participate actively in treatment (e.g. does not do their homework) • If the client does not like or trust the therapist (it may be better to see a different CBT therapist) • If people are simply looking for ‘quick fixes’ • There may be other reasons as to why CBT may not be appropriate to the individual, and this may need to be discussed by the client with the therapist and/or medical/health professional (e.g. GP) (Better Health Channel 2016) Weston, Hodgekins and Langdon (2016) highlight in their systematic review and meta-analysis that more ‘definitive trials’ are necessary to evaluate whether CBT is a valid treatment for people that have autism spectrum disorders (ASDs) Similarly, the systematic review by Michail, Birchwood and Tait (2017) concludes that there is not enough ‘robust’ evidence to evaluate the effectiveness of CBT for treating social anxiety in people that have psychosis. Harris et al. (2015) found in their systematic review that there was ‘mixed’ evidence to support the use of CBT to manage headaches and migraines in adults. Huguet et al. (2016) convey in their systematic review that there are not enough appropriate CBT or behavioural activation (BA) apps ‘from a clinical and legal point of view’. Thereby, testing, accessibility and development of apps for clients with depression needs to be improved by, for example, implementing high quality ‘scientific, technological and legal knowledge’ (Huguet et al. 2016). Monticone et al.’s (2015) review suggested that clients with sub-acute neck pain had significant pain relief at short-term follow up from CBT. However, Monticone et al. (2015) also express that more research is needed to understand the long-term risks and benefits of CBT. (Please chat with your Doctor if you think CBT may be beneficial). References • Better Health Channel 2016, Cognitive behaviour therapy, Victorian State Government, Melbourne, VIC, viewed 6 October 2017 • Harris, P, Loveman, E, Clegg, A, Easton, S & Berry, N 2015, ‘Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults’, British Journal of Pain, vol. 9, no. 4, pp. 213–24, viewed 6 October 2017 • Hofmann, SG, Asnaani, A, Vonk, IJJ, Sawyer, AT & Fang, A 2012, ‘The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses’, Cognitive Therapy and Research, vol. 36, no. 5, pp. 427–40, viewed 6 October 2017 • Huguet, A, Rao, S, McGrath, PJ, Wozney, L, Wheaton, M, Conrod, J & Rozario, S 2016, ‘A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression’, PLoS One, vol. 11, no. 5, viewed 6 October 2016 • James, AC, James, G, Cowdrey, FA, Soler, A & Choke, A 2013, ‘Cognitive behavioural therapy for anxiety disorders in children and adolescents’, Cochrane Database of Systematic Reviews, no. 6, viewed 6 October 2017 • Kew, KM, Nashed, M, Dulay, V & Yorke, J 2016, ‘Cognitive behavioural therapy (CBT) for adults and adolescents with asthma’, Cochrane Database of Systematic Reviews 2016, iss. 9, viewed 6 October 2017 • Michail, M, Birchwood, M & Tait, L 2017, ‘Systematic Review of Cognitive-Behavioural Therapy for Social Anxiety Disorder in Psychosis’, Brain Sciences, vol. 7, no. 5, viewed 6 October 2017 • Monticone, M, Cedraschi, C, Ambrosini, E, Rocca, B, Fiorentini, R, Restelli, M, Gianola, S, Ferrante, S, Zanoli & G, Moja, L 2015, ‘Cognitive-behavioural treatment for subacute and chronic neck pain’, Cochrane Database of Systematic Reviews, iss. 5, viewed 6 October 2017 • Weston, L, Hodgekins, J & Langdon, PE 2016, ‘Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis’, Clinical Psychology Review, vol. 49, pp. 41-54, viewed 6 October 2017

Is life pulling you down? We all have times when we feel desperate and alone. Please do not hesitate to use Lifeline's online chat. Or, come and talk with your doctor. We have Psychology services available as well.

Suicide...some ideas to start the discussion

Today World Mental Health Day – Tuesday 10 October - and Mental Health Australia is calling on the nation to further reduce stigma and promise to see mental health in a positive light. Australia has great well-being, mental health services and resources, but it can be tough finding the ones that suit you best. We’ve made your search easier. Check out www.headtohealth.gov.au

Pics of the well supported R U OK BBQ in Maryborough yesterday - a huge thanks to Kodie & Matt Axelsen who helped highlight the importance of suicide awareness in our community.

Today is R U OK day. Got a niggling feeling that someone you know or care about it isn’t behaving as they normally would? Perhaps they seem out of sorts? More agitated or withdrawn? Or they’re just not themselves. Trust that gut instinct and act on it. By starting a conversation and commenting on the changes you’ve noticed, you could help that family member, friend or workmate open up. If they say they are not ok, you can follow our conversation steps to show them they’re supported and help them find strategies to better manage the load. If they are ok, that person will know you’re someone who cares enough to ask. Some conversations are too big for family and friends to take on alone. If someone’s been really low for more than 2 weeks - or is at risk - please contact a professional as soon as you can.

Do you know the signs of stroke? As smoking is also a risk factor talk to your doctor & ask for help if you are ready to give up.

Wide Bay Health have advised that we are experiencing a high number of flu cases across the Wide Bay and urge people to take action to prevent its spread. Frequent handwashing, staying home when sick and ensuring you cough into your elbow or a tissue are some easy steps you can take to reduce the chances of other people catching it off you!

This is a new site and will be helpful for parents and others who would like further information. Gail Aylmer, Public Health Nurse, Wide Bay Public Health Unit, Wide Bay Hospital and Health Service. Ph: 07 4303 7516