Issues we help with

CBT Counselling’s overall focus is to help people manage, and to ultimately overcome, mental health challenges that they’re suffering. Indeed, the issues we help with are wide ranging, but not everyone who seeks out therapy will have a diagnosable mental health condition. For example, many people seek counselling to help them make sense of the behaviours of others, most often to better understand their relationship with them.

Mental health issues we help with

Similarly, sometimes clients just want to weigh up options or declutter their thoughts or to develop strategies to make positive changes in their lives. Sometimes a client just needs to know whether their feelings are out of the ordinary or not; for example, they may be confusing feelings of serendipity with self-diagnosed depression. Such a self-diagnosis is usually quite unhelpful.

Of course, the decision to see a therapist is a very personal one. Indeed, therapy will involve looking closely at yourself, your situation and the people around you. For most people, this can be very daunting at first, but the rewards can be immeasurable. Thus, having a trained professional work with you throughout this process is an invaluable asset.

The most common Issues we help with are set-out below:

Counselling for Anxiety

Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a mental-health disorder.

Anxiety disorders form a category of mental health diagnoses that stem from excessive nervousness, fear, apprehension, and worry. These disorders alter how a person processes emotion and behaves, which can manifest into a broad range of physical symptoms.

Anxiety conditions at a clinical level are often categorised into specific categories in order to be able to determine the anxiety’s onset trigger(s) which will give guidance as to the best therapeutic treatment in response. In most cases, anxiety will fall into the ‘Generalised Anxiety Disorder’ (GAD) category notwithstanding there being varying degrees of intensity. For example, ‘mild anxiety’ might be vague and unsettling, while ‘severe anxiety’ may seriously affect ones’ day-to-day living. Severe anxiety can be expressed as ‘an emotion characterised by feelings of tension, worried thoughts and physical changes like increased blood pressure’.

Symptoms of severe Anxiety include

  • Restlessness and a feeling of being “on-edge”;
  • Constant feelings of being afraid;
  • Uncontrollable feelings of worry & impending disaster;
  • Increased irritability;
  • Concentration difficulties;
  • Sleep difficulties such as problems in falling or staying asleep.

Indeed, the causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present. Severe symptoms of anxiety can sometimes also occur when people experience challenging or traumatic life events, including grief and bereavement.

Possible causes of anxiety include:

  • Environmental stressors such as difficulties at work, relationship problems or family issues;
  • Genetics as people who have family members with an anxiety disorder are more likely to experience one themselves;[1]
  • Medical factors such as the symptoms of a different disease, the effects of a medication or the stress of an intensive surgery or prolonged recovery;
  • Brain chemistry as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain;
  • Withdrawal from an illicit substance the effects of which might intensify the impact of other possible causes;

Often, severe symptoms of anxiety can sometimes occur when people experience challenging or traumatic life events including grief and bereavement.

‘Anticipatory anxiety’ is also a particularly prevalent and specific type of anxiety. Anticipatory anxiety is where a person experiences increased levels of anxiety by intractably thinking about an event or situation in the future. Anticipatory Anxiety can be extremely draining for people as it can last for months prior to an event. The worries people experience specifically focus on what they think might happen, often with catastrophic predictions about an event. The nature of negative predictions about the event will be the difference between an anxiety level that is incapacitating or merely uncomfortable.

‘Social anxiety’ (SAD) is also a particularly prevalent and specific type of anxiety. It is a type of anxiety which is driven by one’s fear of being embarrassed, humiliated, rejected or looked down on in social interactions. In social anxiety disorder, the fear triggered anxiety will usually lead to active avoidance of social occasions thus disrupting one’s daily and life’s routines, including work, school and social interactions which can lead to social isolation. To learn more about social anxiety disorder please click on the following link –social anxiety disorder >>

‘Phobia related anxiety’ is also is also a particularly prevalent and specific type of anxiety. A phobia related disorder is generally triggered by an extreme or irrational fear of or aversion to something, including:

  • Acrophobia – (i.e., fear of heights);
  • Aerophobia – (i.e., fear of flying);
  • Agoraphobia – (i.e., fear of entering open or crowded places, of leaving one’s own home, or of being in places from which escape is difficult);
  • Arachnophobia – (i.e., fear of spiders);
  • Astraphobia – (i.e., fear of thunder and lightning);
  • Autophobia – (i.e., fear of being alone);
  • Claustrophobia – (i.e., fear of confined or crowded spaces);
  • Germaphobia – (i.e., fear of contamination and germs – see also bacteriophobia);
  • Hemophobia – (i.e., fear of blood);
  • Hydrophobia – (i.e., fear of water);
  • Ophidiophobia – (i.e., fear of snakes);
  • Thanatophobia – (i.e., fear of death);
  • Zoophobia – (i.e., fear of animals).

‘Fear of failure’ is also a particularly prevalent and specific type of anxiety. Fear of failure (also called “atychiphobia”) is when we allow that fear to stop us doing the things that can move us forward to achieve our goals. While we all hate to fail, for some people, failing presents such a significant psychological threat their motivation to avoid failure exceeds their motivation to succeed. This fear of failure causes them to unconsciously sabotage their chances of success, in a variety of ways. Some theorise that this acute ‘fear of failure’ can be linked to having critical or unsupportive parents though there are many recorded and anecdotal causes.

‘High-Functioning Anxiety’ – unlike clinical disorders, high-functioning anxiety does not produce intense physical symptoms of anxiety that influence behaviour. Anxiety is experienced, and it may include some physical dimensions (elevated heart rate, sweaty palms, butterflies in the stomach, etc.), but they usually aren’t strong enough to limit activity or be noticed by outside observers.

High-functioning anxiety is sometimes compared to generalized anxiety disorder because of its omnipresent yet somewhat vague nature. But there are overlaps with other anxiety disorders as well, and in contrast to GAD high-functioning anxiety doesn’t create debilitating physical responses, attach as quickly to specific triggers, or cause significant avoidant behaviours. High-functioning anxiety sufferers generally push through their feelings and do what they have to do, even though they frequently feel discomfort before, during, and after their encounters with people or environments that cause them stress.

The emotional and behavioural symptoms of high-functioning anxiety include:

  • Feelings of worry and anxiety that ruin attempts to relax, or that appear even when things seem to be going well;
  • Perfectionism and feelings of constant dissatisfaction with performance;
  • Workaholism, or a need to keep moving or doing even when at home;
  • Overthinking and over-analysing everything, and frequent second-guessing after choices are made;
  • Discomfort with emotional expression, unwillingness to discuss true feelings;
  • Frequent anticipatory anxiety before a wide range of events or encounters;
  • Obsession with fears of failure or of the negative judgments of others;
  • Superstitions (the need to repeat certain behaviours or patterns over and over to stave off disaster);
  • Periodic insomnia, inconsistent sleeping habits;
  • Irritability and quickness to become frustrated or discouraged in the face of setbacks;
  • Difficulty saying no, no matter how time-consuming, inconvenient, or complicated the request;
  • A false sunny disposition: secret pessimism that conflicts with public expressions of optimism;
  • A range of unconscious nervous habits (fingernail biting, hair pulling or twisting, idle scratching, lip chewing, knuckle cracking, etc.);

High-functioning anxiety sufferers often lack self-esteem and self-confidence, and they attempt to compensate for their insecurities by constantly pushing themselves to do better or to please others. Unfortunately, their goals are often unrealistic, and their failure to meet them only reinforces their chronic feelings of tension and inadequacy.

‘Substance-induced Anxiety’: Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants. While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated. Acute exposure to toxic levels of benzene may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.

‘Fear of death Anxiety’: Thanatophobia is commonly referred to as the fear of death. More specifically, it can be a fear of death or a fear of the dying process. It’s natural for someone to worry about their own health as they age. It’s also common for someone to worry about their friends and family after they’re gone. Thoughts of death have the ability to create a sense of powerlessness, loneliness, and meaninglessness, and for some individuals, may seriously undermine their experience of happiness or peace. Although people may develop helpful methods of managing their fears of death, such as building relationships and working towards meaningful goals, they may equally engage in maladaptive coping strategies, such as avoidance. As a result, death anxiety has been argued to be a transdiagnostic construct, contributing to the development and maintenance of numerous mental health conditions.

Left untreated, anxiety disorders can become debilitating. In some extreme cases, anxiety can result in short or prolonged periods of a type paralysing panic (Catatonia[2]) and/or mutism (SM[3] ). Furthermore, suffering an extended period of anxiety is thought to be a major cause of depression and related disorders

Fear versus Anxiety: is there a difference?

The main function of fear and anxiety is to act as a signal of danger, threat, or motivational conflict, and to trigger appropriate adaptive responses. For some authors, fear and anxiety are undistinguishable, whereas others believe that they are distinct phenomena. Fear of failure ought not be confused with a fear of one’s safety.

Although both are alerting signals, they appear to prepare the body for different actions. Anxiety is a generalized response to an unknown threat or internal conflict, whereas fear is focused on known external danger.[4]

Ethologists define fear as a motivational state aroused by specific stimuli that give rise to defensive behaviour or escape.[5] Animals may learn to fear situations in which they have previously been exposed to pain or stress, and subsequently show avoidance behaviour when they reencounter that situation. Young animals may show an innate fear reaction to sudden noise or disturbances in the environment, but rapidly become habituated to them. When they are used to a familiar environment, then a fear of novelty may develop. Ethologists have also made the important observation that fear is often mixed up with other aspects of motivation. Thus, conflict between fear and approach behaviour may results in displacement activities (eg, self-grooming in rats). Such displacement activities may be the behavioural expression of an anxious state, but anxiety is a concept that is apparently not used by ethologists, perhaps because their definition of fear does in fact include all the more biological aspects of anxiety.

The fact that anxiety and fear are probably distinct emotional states does not exclude some overlap in underlying brain and behavioural mechanisms. In fact, anxiety may just be a more elaborate form of fear, which provides the individual with an increased capacity to adapt and plan for the future.[6] If this is the case, we can expect that part of the fear-mediating mechanisms elaborated during evolution to protect the individual from an immediate danger have been somehow “recycled” to develop the sophisticated systems required to protect us from more distant or virtual threats.

‘Passive Avoidance’ can drive anxiety related disorders

CBT often engages ‘psychoanalytic’ processes,[7] a form of analysis which delves into one’s past, to help identify ‘passive avoidance’ which has a clear link to anxiety related disorders, including phobias. Indeed, passive avoidant behaviour can sit deep in one’s unconscious so as not to be plainly obvious to the sufferer.

The underlying subject of the avoidance, may lay dormant, simmering beneath the surface, until an emotional response is triggered by a particular stimuli, causing the sufferer to react (objectively) drastically and irrationally. For example, a particular smell or song could trigger a drastic and irrational emotional response to the previous loss of a loved one; similarly, a particular expression on someone’s face, otherwise objectively benign, could trigger a drastic and irrational response if interoperated as a threat (fear response) causing the sufferer to retreat or to lash-out.

There are many possible combinations of stimuli triggers and seemingly irrational behavioural responses, some of which could stem back to a repressed childhood trauma or some other type of repressed anguish. Sometimes this type of behaviour is diagnosed as ‘Neurosis‘, however, neurosis is of a more generalised ‘worrisome tendency’ type of behaviour as opposed to an extreme, drastic and/or irrational reactive behaviour stemming from an unconscious phenomena.

Of course, avoidance is a natural and adaptive response to danger. Animals, including humans, cannot survive without the ability to avoid harm. Nevertheless, avoidance can have detrimental consequences – excessive and/or unnecessary avoidance is a hallmark of anxiety disorders. The idea is that basic emotions such as anger, fear, happiness, sadness, and disgust evolved for particular functions. It is likely, for example, that the basic emotion of fear evolved to enable an organism (including a human) to rapidly detect and respond to danger in its environment. Much research has been conducted on the brain’s fear system in both animals and humans. The fear system involves a range of neural areas, in particular the ‘amygdala’, and this system is especially sensitive to naturally occurring fear-relevant stimuli, such as for example, snakes or angry faces. From this perspective, it should come as no surprise that different emotions may be characterised by quite different patterns of cognitive biases.

By uncovering and examining such reactive cognitions through psychotherapy, it is possible to teach a sufferer different ways to  recognise and manage these the underlying avoidance and cognitions  so as to at least significantly reduce the intensity of the reactive behaviour with the view to eradicating it altogether.

Getting help for your anxiety

While it is never too late to seek out professional help, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you.

Therapy for Anxiety & Depression About CBT

Cognitive behaviour therapy (CBT) is a great option if you’re struggling with Depression or Anxiety

CBT is an effective treatment for a range of mental and emotional health issues, including for anxiety and depression. Research has shown CBT to be particularly effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalised anxiety disorder, major depressive disorder (MDD) among many other conditions.

CBT is the most widely-used therapy for Anxiety & Depression related disorders. To learn more about CBT please click on the following link – about CBT >>

We at CBT Counselling & Psychotherapy look forward to helping you.


[1]  Researchers are learning that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other disorders. Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events- per ‘Anxiety & Depression Association of America’

[2]  Catatonia — depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture.

[3]  Selective mutism (SM) is an anxiety disorder in which a person who is normally capable of speech cannot speak in specific situations or to specific people. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.

[4]  The biology of fear- and anxiety-related behaviors – Thierry Steimer, PhD* – Dialogues Clin Neurosci. 2002 Sep; 4(3): 231–249.

[5]  Craig KJ., Brown KJ., Baum A. Environmental factors in the etiology of anxiety. In: Bloom FE, Kupfer DJ, eds. Psychopharmacology: the Fourth Generation of Progress. New York, NY: Raven Press; 1995:1325–1339.

[6]  Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. Barlow DH Am Psychol. 2000 Nov; 55(11):1247-63.

[7]  ‘Psychoanalysis‘ is defined as a set of psychological theories and therapeutic techniques that have their origin in the work and theories of Sigmund Freud. The core of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories; and that the unconscious mind, includes all of the things that are outside of our conscious awareness, such as early childhood memories, secret desires, and hidden drives. According to Freud, the unconscious contains things that we might consider to be unpleasant or even socially unacceptable. We bury these things in our unconscious because they might bring us pain or conflict. While these thoughts, memories, and urges are outside of our awareness, they still influence how we think and behave. In some cases, the things that are outside of our awareness can influence one’s behaviour in negative ways and lead to psychological distress.

Counselling for Depression

If you feel sad, empty, and hopeless most of the day, nearly every day, if  you have lost interest or pleasure in your hobbies or being with friends and family, if you are having trouble sleeping, eating, and functioning, and you have felt this way for at least 2 weeks, you may have depression, a serious but treatable mood disorder.

Of course, everyone feels sad or low sometimes, but these feelings usually pass with a little time. Depression—also called “clinical depression” or a “depressive disorder”—is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, symptoms must be present most of the day, nearly every day for at least 2 weeks.[1]

Notably, depression is a common mental health disorder and can come about for a great many reasons, including for example as result of a traumatic life event or crisis, such as the death of a spouse or family member, loss of a job, or a major illness. However, when the depression continues to be present even when stressful events are over or there is no apparent cause, it may be classified as clinical or major depression.

There are two major categories of depression: ‘Major Depression Disorder’ (MDD) and ‘Persistent Depressive Disorder’ (PDD). Within those categories, there are a range of depressive related disorders, which manifest in a variety of symptoms and degrees, though, generally speaking, symptoms of depression manifest in persistent or regular recurrent feelings of sadness and/or a loss of interest in activities once enjoyed which lead to a range of emotional and physical problems and can decrease a person’s ability to function at work, school or at home.

Major depression is a serious disorder of enormous sociological and clinical relevance. Fortunately, depression, in most cases, is treatable.

As mentioned, significant and/or traumatic events in one’s life can cause some of those symptoms and behavioural manifestations, so to can chemical changes in one’s brain. Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged work stress – are more likely to cause depression than other life stresses.

Symptoms of clinical depression can include

  • A depressed mood;
  • Reduced interest or pleasure in activities once enjoyed;
  • A loss of sexual desire;
  • Major changes in appetite;
  • Concentration difficulties;
  • Unintentional weight loss or gain;
  • Sleeping too much or too little;
  • Agitation, restlessness, irritability and pacing up and down;
  • Slowed movement and speech;
  • Unexplained fatigue or loss of energy;
  • Feelings of worthlessness or guilt;
  • Difficulty thinking, concentrating or making decisions;
  • Unexplained fatigue or loss of energy;
  • Recurrent thoughts of death or suicide, or an attempt at suicide.

It is important though to realise that sadness is not necessarily the same as depression. We often experience feelings of sadness in our lives as a result of a great many things, but, that sadness usually lessens in its intensity over time, whereas, depression on the other hand is a mood disorder that involves a persistent or regularly recurrent feeling of sadness and loss of interest in  things that were, or ought to be, important to that person, for example the affected person’s family or job.

Does depression look the same in everyone?

Depression affects different people in different ways. For example:

Women have depression more often than men. Biological, lifecycle, and hormonal factors that are unique to women may be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.

Some types of depression are unique to females such as:

  • Peripartum depression (formerly Postpartum depression);[2]
  • Premenstrual dysphoric disorder.[3]

Men with depression are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognise their depression and fail to seek help.

Notably, males with depression are more likely than females to:

  • Drink alcohol to excess, display anger and engage in risk-taking;
  • Avoid families and social situations;
  • Work without a break;
  • Have difficulty keeping up with work and family responsibilities;
  • Display abusive or controlling behaviour in relationships.

Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.

Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.

Older children and teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse.

Possible causes of clinical depression

There are many possible causes which are thought to trigger depressive related symptoms and behaviours. Some possible causes include a combination of biological, psychological and social sources of distress. Increasingly, research suggests that these factors may cause changes in brain function, including altered activity of certain neural circuits in the brain. Some factors that are likely to play a role in the development of a depressive disorder include:

  • Genetic and epigenetic features;
  • Changes in the brain’s neurotransmitter levels;
  • Work without a break;
  • Environmental factors;
  • Psychological and social factors
  • Having a history of extreme or persistent anxiety;
  • Additional conditions such PTSD/PTSI or bipolar disorder;

There is growing evidence that depression is in part an illness with a biological basis. For example, it is more common in individuals with close relatives who have been depressed. Research on the physiology of the nervous system suggests that the level of activity of neurotransmitters, such as norepinephrine and serotonin changes in long standing depression.

Depression is not a homogeneous disorder, but a complex phenomenon, which has many subtypes and probably more than one etiology. It includes a predisposition to episodic and often progressive mood disturbances, differences in symptomatology ranging from mild to severe symptoms with or without psychotic features, and interactions with other psychiatric and somatic disorders.

The psychopathological state involves a triad of symptoms with low or depressed mood, anhedonia, and low energy or fatigue. Other symptoms, such as sleep and psychomotor disturbances, feelings of guilt, low self-esteem, suicidal tendencies, as well as autonomic and gastrointestinal disturbances, are also often present in clinical depression.

Depression is not to be taken lightly, it is a potentially life-threatening disorder which affects hundreds of millions of people all over the world. It can occur at any age from childhood to late-life and is a tremendous cost to society as this disorder causes severe distress and disruption of the sufferer’s life, and if left untreated, can be fatal.

Some common variants of depression are

‘Dysthymic Disorder’ –  is a depressed mood most of the day for more days than not, for at least 2 years, and the presence of two or more of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning:

  • Poor appetite or overeating;
  • Insomnia or sleeping too much;
  • Low energy or fatigue;
  • Low self-esteem;
  • Poor concentration or difficulty making decisions;
  • Feelings of hopelessness.

‘Cyclothymic Disorder’ – is a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder.[4]

‘Substance-Induced Mood Disorder’ – is a common depressive illness of clients in substance abuse treatment. It is defined in DSM-IV-TR[5] as “a prominent and persistent disturbance of mood . . . that is judged to be due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or somatic treatment for depression, or toxin exposure)”. The mood can manifest as manic (expansive, grandiose, irritable), depressed, or a mixture of mania and depression. Generally, substance-induced mood disorders will only present either during intoxication from the substance or on withdrawal from the substance and therefore do not have as lengthy a course as other depressive illnesses.

‘Mood Disorder Due to a General Medical Condition’ – is not as common to find depression due to a general medical condition in substance-abuse treatment settings, but it is important to note that depression can be a result of a medical condition, such as hypothyroidism or Parkinson’s disease.[6] The criteria for diagnosis are similar to ‘Major Depressive Episode’ or a manic episode; however, the full criteria for these diagnoses need not be met. It is important in diagnosis to establish that the depressive symptoms are a direct physiological result of the medical condition, not just a psychological response to a medical problem.

‘Adjustment Disorder With Depressed Mood’ – is a psychological reaction to overwhelming emotional or psychological stress, resulting in depression or other symptoms. Some situations in which an adjustment disorder can occur include divorce, imprisonment of self or a significant other, business or employment failures, or a significant family disturbance. The stressor may be a one-time event or a recurring situation. Because of the turmoil that often occurs around a crisis in substance use patterns, clients in substance abuse treatment may be particularly susceptible to adjustment disorders. Some of the common depressive symptoms of an adjustment disorder include tearfulness, depressed mood, and feelings of hopelessness.

The symptoms of an adjustment disorder normally do not reach the proportions of a ‘major depressive disorder’, nor do they last as long as a Dysthymic Disorder. An acute adjustment disorder normally lasts only a few months, while a chronic adjustment disorder may be ongoing after the termination of the stressor.

‘Melancholic Depression’ – was first described by Hippocrates, “melancholia” or melancholic depression was considered a specific condition that commonly struck people out of the blue – and put them into the black. In modern times, it came to be described as “endogenous depression” (coming from within) in contrast to depression stemming in response to external stressors.

Melancholic depression is a form of major depressive disorder (MDD) which presents with melancholic features. Although melancholic depression used to be seen as a distinct disorder, the American Psychiatric Association (APA) no longer recognises it as a separate mental illness. Instead, melancholia is now seen as a specifier for MDD — that is, a subtype of major depressive disorder.

Melancholia has a strong genetic contribution, with sufferers likely to report a family history of “depression”, bipolar disorder or suicide. It’s largely biologically underpinned rather than caused by social factors (stressors) or psychological factors, such as personality style.

‘Psychotic depression’ – is a type of severe depression combined with psychotic episodes, such as hallucinations (seeing or hearing things that others do not) or delusions (having fixed but false beliefs). The episodes may be upsetting or disturbing and often have a theme.

‘Seasonal affective disorder (SAD)’ – is another type of depression that occurs during certain seasons of the year. It typically starts in the late autumn or early winter and lasts until spring or summer. Less commonly, SAD episodes may also begin during the late spring or summer. Symptoms of winter seasonal affective disorder may resemble those of a major depression. They tend to disappear or lessen during spring and summer.

Other mental-health disorders of which depression can be a primary symptom

Sometimes depression is symptomatic of another mental disorder. This is particularly true when the nature of the mental disorder causes excessive distress to the individual. While, in this context, the depression is a symptom, it is still important to recognise its impact on the person and his or her ability to respond to substance abuse treatment.

Some of the psychiatric disorders in which depression can play a major role include:

A. Posttraumatic Stress Disorder (PTSD)

Symptoms include episodes of reexperiencing the traumatic event or reexperiencing the emotions attached to the event; nightmares, exaggerated startle responses; and social, interpersonal, and psychological withdrawal. Chronic symptoms may include anxiety and depression. PTSD is categorised as an anxiety disorder.

B. Anxiety Disorders, including Panic Disorder, Agoraphobia (fear of public places), Social Phobias, and Generalised Anxiety Disorder

Symptoms of anxiety disorders are most often on the anxiety spectrum, but the chronic stress faced by individuals with anxiety disorders can produce depressive symptoms including irritability, hopelessness, despair, emptiness, and chronic fatigue.

C. Schizoaffective Disorder and Schizophrenia

Individuals with schizoaffective disorder have, in addition to many of the symptoms of schizophrenia, a chronic depression with most of the features of Major Depressive Disorder. Because of the difficulty individuals with schizophrenia have in coping with the daily demands of living, depression is often a symptom. With both schizoaffective disorder and schizophrenia, the depression adds an additional dimension to treatment, specifically in helping the person mobilise in the face of their depression to cope with their illness.

D. Personality Disorders

People with personality disorders are particularly susceptible to depression. These individuals are at high risk for substance use disorders. As a result, it is not uncommon to find clients in substance abuse treatment with all three diagnoses. Because personality disorders are categorised in DSM-IV-TR as Axis 2 disorders (see DSM-IV-TR for a description of multiaxial assessment), it is common to find their depression diagnosed separately (from the personality disorder) as an adjustment disorder, dysthymia, or major depressive disorder.

Depression can also be one phase of bipolar disorder (formerly called manic-depression). But a person with bipolar disorder also experiences extreme high—euphoric or irritable —moods called “mania” or a less severe form called “hypomania.”[7]

Getting help for depression

Psychotherapy helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to depression. Therapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse.[8]

CBT is a great option if you’re struggling with Depression or Anxiety

Therapy for Anxiety & Depression About CBT

Cognitive behaviour therapy (CBT) is an effective treatment for a range of mental and emotional health issues, including for anxiety and depression. Research has shown CBT to be particularly effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalised anxiety disorder, major depressive disorder (MDD) among many other conditions.

CBT is the most widely-used therapy for Anxiety & Depression related disorders. To learn more about social anxiety disorder please click on the following link – about CBT >>

While it is never too late to seek out professional help, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you.

We at CBT Counselling & Psychotherapy look forward to helping you.

[1]  per The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders.

[2] ‘Depression During Pregnancy and after Childbirth’ – Peripartum depression refers to depression occurring during pregnancy or after childbirth. The use of the term ‘peripartum’ recognises that depression associated with having a baby often begins during pregnancy. Those who develop postpartum depression are at greater risk of developing major depression later on in life. Symptoms might include insomnia, loss of appetite, intense irritability and difficulty bonding with the baby. Untreated, the condition may last months or longer. Treatment can include counselling, antidepressants or hormone therapy.

[3]  Premenstrual dysphoric disorder (PMDD) is a health problem that is similar to premenstrual syndrome (PMS) but is more serious. PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts. Symptoms usually go away two to three days after your period starts.

[4]  ‘Hypomania’ is usually described as a mood state or energy level that is elevated above normal, but not so extreme as to cause impairment — the most important characteristic distinguishing it from mania. ‘Bipolar disorder’ is a disorder associated with episodes of mood swings ranging from depressive lows to manic highs. The exact cause of bipolar disorder isn’t known, but a combination of genetics, environment and altered brain structure and chemistry may play a role. Manic episodes may include symptoms such as high energy, reduced need for sleep and loss of touch with reality. Depressive episodes may include symptoms such as low energy, low motivation and loss of interest in daily activities. Mood episodes last days to months at a time and may also be associated with suicidal thoughts. Treatment is usually lifelong and often involves a combination of medications and psychotherapy.

[5]  DSM-IV codes are the classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, a manual published by the American Psychiatric Association (APA) that includes almost all currently recognized mental health disorders.

[6]  Hypothyroidism is a health condition characterised by unusually low hormone production. It is when your thyroid gland becomes underactive and cannot produce enough hormones to regulate your metabolism. If your thyroid can’t secrete enough hormones into your bloodstream, your body’s metabolism slows down rapidly. Hypothyroidism’s deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women. Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain. Treatment consists of thyroid hormone replacement. Parkinson’s disease is a progressive, degenerative neurological condition that affects the control of body movements. It causes trembling in the hands, arms, legs, jaw, and face; rigidity or stiffness of the limbs or trunk; slowness of body movements; and unstable posture and difficulty in walking. Nerve cell damage in the brain causes dopamine levels to drop, leading to the symptoms of Parkinson’s. Parkinson’s often starts with a tremor in one hand. Other symptoms are slow movement, stiffness and loss of balance. Medication can help control the symptoms of Parkinson’s.

[7]  Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behaviour that impairs daily functioning, and can be disabling. Schizophrenia is characterised by thoughts or experiences that seem out of touch with reality, disorganised speech or behaviour and decreased participation in daily activities. Difficulty with concentration and memory may also be present. Treatment is usually lifelong and often involves a combination of medications, psychotherapy and coordinated speciality care services. Schizophrenia is usually a condition treated by Psychiatrists and/or other medical suitable qualified professionals.

[8]  See [4] above

[9]  Medications called antidepressants can work well to treat depression. They can take 2 to 4 weeks to work. Antidepressants can have side effects, but many side effects may lessen over time. Talk to your health care provider about any side effects that you have. Do not stop taking your antidepressant without first talking to your health care provider. Please Note: Although antidepressants can be effective for many people, they may present serious risks to some, especially children, teens, and young adults. Antidepressants may cause some people, especially those who become agitated when they first start taking the medication and before it begins to work, to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start taking them. For most people, though, the risks of untreated depression far outweigh those of antidepressant medications when they are used under a medical doctor’s careful supervision.

Mood swings might best be framed as excessive or abrupt changes in one’s frame of mind. For example, one’s mood may suddenly shift from elation and euphoria to extreme sadness or terror and then on to another emotion.

In some cases, mood changes are reactions to one’s environment or circumstances, although the intensity of the mood might seem out of proportion with the significance of the event. In other cases, mood swings may occur for no apparent reason.

Moods are thought to result from interplay of chemicals in the brain the cause of mood swings has been the subject of debate for decades, but the general consensus is that extreme changes in moods may be related to imbalances in these chemicals.

Mood swings can certainly occur as a symptom of psychiatric disorders such as bipolar disorder or borderline personality disorder or they may result from a medical condition that directly affects the central nervous system such as dementia, brain tumours, meningitis, and stroke. Mood swings can also result from conditions that deprive the brain of nutrients and oxygen such as lung and cardiovascular diseases. Substance abuse, medication side effects, and hormonal changes are other potential causes of mood swings. Mood swings can also occur with hormonal changes. Indeed, mood swings can be symptoms of serious, even life-threatening, conditions.

Mood swings may accompany other psychological or cognitive symptoms including:

  • Anxiety, irritability or agitation
  • Boredom
  • Changes in mood, personality or behaviour
  • Confusion or forgetfulness
  • Depression
  • Difficulty with concentration or attention
  • Difficulty with memory, thinking, talking, comprehension, writing or reading
  • Excess alcohol consumption
  • Hallucinations or delusions
  • Poor judgment
  • Racing thoughts and rapid speech
  • Reckless or inappropriate behaviours
  • Social withdrawal

Mood swings may also accompany symptoms related to other body systems including:

  • Appetite and weight changes
  • Cough that gets more severe over time
  • Fatigue
  • Incontinence, weakness or sensory changes
  • Missed menstrual cycles
  • Nausea with or without vomiting
  • Seizures and tremors
  • Shortness of breath
  • Sleep disturbances

Mood swings may also be caused by psychiatric conditions including:

  • Bipolar disorder
  • Borderline personality disorder (disorder characterized by unstable relationships)
  • Dementia, including Alzheimer’s disease and Huntington’s disease
  • Intermittent explosive disorder (disorder characterized by extreme anger)
  • Postpartum depression
  • Premenstrual dysphoric disorder
  • Substance abuse

Mood swings can also be triggered by:

  • Head injury
  • Medication side effects
  • Menopause
  • Pregnancy
  • Puberty
  • Sleep disorders
  • Substance abuse

In some cases, mood swings may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Acute delirium (sudden onset of mental status changes due to illness or toxicity)
  • Alcohol poisoning or drug overdose
  • Mania (elevated mood and energy levels that can occur in bipolar disorder)
  • Meningitis (infection or inflammation of the sac around the brain and spinal cord)
  • Stroke
  • Traumatic brain injury

Left untreated, mood swing disorders can manifest in a range of major mental and physical conditions. As one can see, mood swings can be indicative of a major biological or neurological medical condition such as a stroke or brain tumour or stem from a head injury, concussion for example. Once the cause of the mood swing(s) is determined, a suitable therapy can be developed to address the fundamental causative issue information qualification

Stress is your body’s natural reaction to any kind of demand that disrupts life as usual. It can produce physical, mental and emotional symptoms that can affect any part of the body. Stress is often caused by some type of change or pressure in your life.

No one can avoid all stress and a certain amount of stress is actually good for you. It helps you react quickly and can be an effective motivator. For example, stress typically brings on the ‘fight-or-flight’ response which prepares your body for an emergency. As part of this response, your adrenal glands increase secretion of substances, such as cortisol, epinephrine and norepinephrine. This, amongst other things, raises your heart rate and blood pressure constricts the veins of your skin dilates your pupils, the airways of your lungs, and the blood vessels of your heart decreases the activity of your digestive and immune systems increases your alertness and increases the availability of blood glucose which your body can quickly convert to energy.

As described, short-term activation of the ‘fight-or-flight’ response can be very helpful in dealing with brief periods of stress. Once the stress has passed, adrenal secretion of these hormones returns to normal. Excessive or chronic stress, however, can lead to prolonged exposure to the substances released as part of the fight-or-flight response which can in-turn lead to a range of physical and mental health problems.

Indeed, prolonged stress -Chronic stress- can cause psychological and cognitive symptoms, such as anxiety, depression, irritability, mood swings, agitation, upset stomach, high blood pressure poor concentration, forgetfulness and sleep disorders. It can also cause physical symptoms, such as headache, muscle and body aches, digestive problems, weight changes, fatigue, shortness of breath and chest pain.

Chronic stress can occur when a person feels trapped in a grinding routine of never ending troubles. It can arise from situations that create ongoing challenges over a long period of time, such as a dysfunctional relationship, being unhappy at a job or caring for a loved one with a chronic medical condition. When stress becomes chronic, people sometimes don’t know when or whether the challenge will ever end. Over time, chronic stress can wear a person down both mentally and physically, damaging the body and contributing to or aggravating many serious conditions.

Periods of intense stress, even for a short while, may accompany psychological or cognitive symptoms including:

  • Anger or hostility
  • Anxiety (severe), agitation or irritability
  • Change in level of consciousness or alertness
  • Changes in mood, personality or behaviour
  • Concentration or attention difficulties (confusion)
  • Depression
  • Difficulty sleeping
  • Heightened arousal or awareness
  • Mood swings

Other physical symptoms that may occur along with stress include:

  • Abdominal pain or cramping
  • Appetite or weight changes
  • Body aches
  • Change in bowel habits
  • Chest pain or pressure
  • Difficulty breathing
  • Dizziness or light-headedness
  • Fatigue
  • Headache
  • Heavy sweating,
  • Indigestion
  • Nausea with or without vomiting
  • Rapid heart rate (tachycardia)
  • Severe pain
  • Sudden change in vision
  • Weak pulse, seizure

Evidence suggests that a person’s genes and early childhood experiences such as child abuse or neglect can also affect how that person throughout their life handles stressful situations.

Left untreated, stress, particularly chronic stress can cause or otherwise exacerbate a range of mental health disorders and as well a range of physiological medical conditions. It also can ruin relationships cause problems at work and make it difficult to overcome serious illnesses. Cognitive behavioural therapy (CBT) has been found to be effective in treating stress disorders. CBT is a form of therapy focused on the present and problem solving. CBT helps a person to recognize distorted thinking and then change behaviours and thinking information qualification

Anger issues is often referred to as ‘Intermittent explosive disorder’ (IED) which is an impulse-control disorder characterised by sudden episodes of unwarranted anger. The disorder is typified by hostility, impulsivity, and recurrent aggressive outbursts. People with IED essentially ‘explode’ into a rage despite a lack of apparent provocation or reason.

Individuals suffering from intermittent explosive disorder have described feeling as though they lose control of their emotions and become overcome with anger. People with IED may threaten to or actually attack objects, animals and/or other humans. IED is said to typically begin during the early teen years and evidence has suggested that it has the potential of predisposing individuals to depression, anxiety and substance abuse disorders.

Individuals with IED have reported that once they have released the tension that built up as a result of their range, they feel a sense of relief. Once the relief wears off, however, some people report experiencing feelings of remorse or embarrassment. While IED can be extremely disruptive to an individual’s life, as well as to the lives of those around him or her IED can be managed through proper treatment, through education about anger management, and possibly through the use of medication information qualification

There are a variety of symptoms that people who have intermittent explosive disorder will display based upon individual genetic makeup, development of social skills, coping strategies, presence of co-occurring disorders, and use or addiction to drugs or alcohol. The following are some examples of various signs and symptoms that a person suffering from IED may exhibit:

  • Physical aggressiveness
  • Verbal aggressiveness
  • Angry outbursts
  • Physically attacking people and/or objects
  • Damaging property
  • Road rage

Some physical symptoms of IED might manifest in:

  • Headaches
  • Muscle tension
  • Chest tightness
  • Palpitations
  • Tingling
  • Feelings of pressure in the head
  • Tremors

Some cognitive and psychosocial symptoms of IED might be:

  • Low frustration tolerance
  • Feeling a loss of control over one’s thoughts
  • Racing thoughts
  • Feelings of rage
  • Uncontrollable irritability
  • Brief periods of emotional detachment

The cause of intermittent explosive disorder is said to be a combination of multiple components, including genetic factors, physical factors and environmental factors. The following are some examples of these varying factors:


Genetic: It has been hypothesised that the traits that this disorder is composed of are passed down from parents to children (epigenetics) however, there is presently not any specific gene identified as having a prominent impact in the development of IED.

Physical: Research has suggested that intermittent explosive disorder may occur as the result of abnormalities in the areas of the brain that regulate arousal and inhibition. Impulsive aggression may be related to abnormal mechanisms in the part of the brain that inhibits or prohibits muscular activity through the neurotransmitter Serotonin. Serotonin, which works send chemical messages throughout the brain, including as to controlling moods may be composed differently in people with intermittent explosive disorder.

Environmental: The environment in which a person grows up can have a large impact on whether or not he or she develops symptoms of IED. It has been hypothesised that people who grow up in homes in which they were subjected to harsh punishments are more likely to develop IED. The belief is that these children will follow the example set by their parents and will act out aggressively their initial reaction to something negative that they encounter. Another theory is that if children endured harsh physical punishments, they may find a sense of redemption in putting others through the same form of physical pain.

It’s estimated about one-third of IED sufferers also have a major depressive disorder or substance abuse disorder. Experts still don’t have a clear picture of how exactly substance abuse and IED are linked, however, the connection is strong enough that a history of substance abuse is one of the risk factors for intermittent explosive disorder. People with IED also have a higher risk of self-aggression and suicide. Left untreated, anger issues, and more over IED, can lead to the development and progression of significant mental health issues information qualification

When Grief overwhelms you

We understand that experiencing a loss can seem sudden and extremely painful. But when grief is unrelenting and overwhelms you for a prolonged period of time, you might be suffering ‘Persistent Complex Bereavement Disorder’.

Grief is a normal emotion usually associated with the loss or death of a loved one, but that’s not always the case. People can also grieve when adjusting to any sort of new normal; for example, in becoming an empty nester, newly single (relationship breakdown) or even newly retired. However, for the purposes of this article we will concentrate on complex grief coming about as a result of the loss or death of a loved one.

As Human Beings, we have neurologically and culturally evolved to expect the inevitable loss of a parent in the usual life cycle completed upon passing. One might say that such an expectation is normal – how often do we hear someone saying “well he had a good innings”. Accordingly, grief is an inevitable, inescapable part of life.

Thus, it is inevitable that we will all experience grief during our life-time, countered with that inevitability being understood. It sought of makes sense to us. The circle of life if you will. While extremely painful most of us will, after a few weeks, get through the immediate intensity of the grief and assume our normal lives; all-the-while remembering those lost to us.

However, where, for example, we lose a loved one, or loved ones, in unforeseen circumstances, such as in a tragic accident or by sudden illness, this will likely have a powerful effect on our brain which we are never really prepare for, and consequently find our loss difficult to accept. Nevertheless, most of us will eventually get through such a horror to resume our normal lives, though, no doubt, most will carry lingering feelings of grief and despair for an extended period; sometimes throughout one’s entire life-time. While lingering, that intensity of one’s grief will usually dissipate to a manageable level over-time, however, on some occasions, such as on birthdays, the lingering grief might return with intensify for a relatively short period. This is normal.

But, for quite a number of people who experience loss of a loved one in tragic or otherwise unexpected and rapid onset circumstances, their grief is so intense that it doesn’t organically dissipate over-time to the stage of ‘acceptance’ which is widely regarded as the final stage of the grief adjustment process. Indeed, in some circumstances the bereaving person’s grief may in fact intensify over time. This might be diagnosed as ‘Complicated Grief’ or ‘Persistent Complex Bereavement Disorder’. For the purposes of this article we will largely use the term ‘Persistent Complex Bereavement Disorder’.*

Generally speaking, there are five stages of grief:

  • Denial;
  • Anger;
  • Bargaining;
  • Depression;
  • Acceptance.

The term ‘bereavement’ is the period of mourning after the death of a loved one. Essentially, bereavement is the period of time spent adjusting to the loss. During this time, bereaved persons will generally experience varying levels of grief that can manifest in feelings of shock, numbness, sadness and/or yearning for the person who has passed. It’s typical during the period of bereavement to experience a mix of emotions, as well as fatigue, disturbed dreams, distress, agitation and even guilt – before acceptance of the loss sets in.

For people suffering from persistent complex bereavement disorder, this final stage of adjustment – ‘acceptance’ – could take much longer to reach (if ever at all). As the term denotes, persistent complex bereavement disorder is characterised by persistent and unshakeable grief that does not follow the general pattern of the stages of improvement over time; instead, the bereaved person continues to experience persistent and intense emotions or moods and unusual, severe symptoms that impair major areas of their normal life functioning, and which often cause extreme distress for them.

In many cases, persons with persistent complex bereavement disorder are incapacitated by their grief and focus on the loss to the exclusion of all other interests, personal enjoyment and concerns – even their family. Moreover, there is rumination about the death and longing for reunion with the deceased, identity confusion, inability to accept the loss, anhedonia*, bitterness, difficulty trusting others and a feeling of being ‘stuck’ in the grieving process.

Persons suffering this persistent high-level of grief report loss of self-worth and sense of self, feel emotionally disconnected from others and do not wish to move on from bereavement, sometimes feeling that to do so would represent a betrayal of the deceased. Indeed, it is not uncommon for the sufferer, for no apparent reason, to blame themself for the loss. Furthermore, many sufferers of such intense prolonged grief relate that they feel that there is no closure because they didn’t get to say goodbye, as they may have had if the loss had been expected.

Some symptoms of Persistent Complex Bereavement Disorder

Somebody suffering from persistent complex bereavement disorder will display symptoms that may include the following:

  • Indefinitely yearning/longing for the deceased;
  • Preoccupation with the circumstances of the deceased’s death;
  • Intense sorrow and/or distress that does not improve over time;
  • Difficulty trusting others;
  • Depression;
  • Detachment and/or isolation;
  • Difficulty pursuing interests or activities;
  • A desire to join the deceased;
  • Persistent feelings of loneliness or emptiness;
  • Impairment in social, occupational or other areas of life.*

While these symptoms are all characteristic of grief more generally, for a diagnosis of persistent complex bereavement disorder to be made, the bereaved person will usually have suffered symptoms over a prolonged period; usually for period exceeding 6 months.

Post-Traumatic Stress Disorder -and- Grief

Sometimes these persistent symptoms of complex grief are related to Post Traumatic Stress Disorder*. (“PTSD”) In some cases the sufferer may have witnessed, or indeed survived, the tragic event, or seen the aftermath of it. Such significant and traumatic events in our lives are indelibly marked in our brain so that when certain circumstances arise which are relatable to the trauma – consciously and/or subliminally, anxiety, indeed intense anxiety might be triggered. We’ve all heard about some Vietnam veterans automatically reacting with painful agitation to the sound of military helicopters flying overhead – even 40+ years on. This example is a mere, but relatable one as to what might trigger a latent PTSD condition to manifest in the form of anxiety, even extreme anxiety.

It is thus important to ensure that a condition of PTSD is not masked by a generalised diagnosis of grieving or bereavement. This is because the affected person may be struggling to get an image out of their head or experiencing flashbacks, for example, to the moment they learned of their loved one’s death, from which drives the trauma, and which thus can keep them from working through their grief to the end stage of acceptance. Thus, a key factor to successfully helping a person suffering persistent complex bereavement disorder may well lay in treating PTSD and other related trauma driven emotions.

The Brain and Grief

There are several regions of the brain which play a role in emotion, including areas within the ‘limbic system’ and ‘pre-frontal cortex’. These involve emotional regulation, memory, multi-tasking, organization and learning. When you’re grieving, a flood of neurochemicals and hormones dance around in your head. There can be a disruption in hormones that results in specific symptoms, such as disturbed sleep, loss of appetite, fatigue and anxiety. When these symptoms converge, your brain function takes a hit. After all, if you’re overwhelmed with grief, it stands to reason that you won’t absorb your environment the same way you would when you are content.

Consider these areas of the brain and how scientists believe grief symptoms affect them:

The parasympathetic nervous system: This section of your autonomic nervous system is in the brain stem and lower part of your spinal cord. In this system, which handles rest, breathing, and digestion, you may find that your breath becomes short or shallow, appetite disappears or increases dramatically, and sleep disturbance or insomnia become an issue.

The prefrontal cortex/frontal lobe: The functions of this area include the ability to find meaning, planning, self control, and self expression. Scientific brain scans show that loss, grief, and traumas can significantly impact your emotion and physical processes. Articulation and appropriate expression of feelings or desires may become difficult or exhausting.

The limbic system: This emotion-related brain region, particularly the hippocampus portion, is in charge of personal recall, emotion and memory integration, attention, and your ability to take interest in others. During grief, it creates a sensory oriented, protective response to your loss. Perceiving loss and grief as a threat, the amygdala portions of this system instructs your body to resist grief. You may experience strong instinctual or physical responses to triggers that remind you of your losses.

As we can see, complicated grief in the form of persistent complex bereavement disorder cannot be confined to just one syndrome or disorder. In other words, there is not just a single form of complicated grief, but rather many forms of it. Indeed, the diagnostic term for complications that arise in the course of grieving has been variously defined over the past 30 or so years, with a multitude of adjectives used to describe variations from normal grief. These terms include absent, abnormal, complicated, distorted, morbid, maladaptive, atypical, intensified and prolonged, unresolved, neurotic, dysfunctional, chronic, delayed, and inhibited.

Grief Counselling – Complicated Grief Therapy

The main goal of grief counselling is to help our client integrate the reality of their loss into their life going forward, and helping them to maintain a healthy bond to the loved one they lost. In complex situations such as persistent complex bereavement disorder, we call this ‘Complicated Grief Therapy’ (CGT), which is a relatively new, and evolving, psychotherapy model designed to address symptoms of complicated grief.

Drawn from attachment theory CGT has its roots in both Interpersonal Therapy (IPT) and Cognitive-Behavioural Therapy, (CBT). Many of the CBT strategies that are used in the treatment of anxiety disorders and depression, such as graded exposure to avoided or feared situations, increasing pleasant events and challenging unhelpful thoughts, can be modified for working with people suffering persistent complex bereavement disorder. Indeed, strategies which focus on increasing the sense of control and wellbeing can help facilitate a grieving person’s adjustment to acceptance.

Of course, no two people will experience the death of a loved one in the same way. How individuals express their pain depends upon a number of factors including their personality, the circumstances surrounding the death, and the way they view the world. Indeed, how someone thinks about life and death has a significant impact on how he or she will grieve. Thus, a major part of grief counselling is for the therapist is to educate the bereaved person about what they might experience following the death of a loved one in an attempt to increase their sense of control and facilitate their adaptation in coping with their grief.

While it is never too late to seek out therapy to help you cope with grief, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you. If your symptoms are so severe that you have trouble coping with day-to-day activities, you should contact a therapist as soon as practicably possible. CBD Counselling & Psychotherapy can assist you to manage your grief so that you can lead a normal life once again.

Tips for Coping with Grief

1.  Do not grieve alone
It’s vital that you stay connected with others during this time. Your support system may include your family, friends, leaders in your faith, a bereavement support group, and/or a licensed mental health professional to help you cope.

Your support system can help you:

  • Make the funeral arrangements or help you with new responsibilities;;
  • Find peace and comfort through your faith’s mourning rituals;
  • Share your grief with others who can relate;
  • Work through your difficult emotions in a safe setting.

2.  Take good care of yourself
It can be easy to forget about our own needs when we are reeling from loss, but neglecting yourself won’t help you effectively deal with your grief.

Remember to:

  • Do something creative to express your feelings (e.g., write something, paint, put together a scrapbook, or play a musical instrument);
  • Eat, sleep, and exercise to avoid adding physical fatigue to your emotional fatigues;
  • Be patient with yourself and allow yourself to feel whatever you feel;
  • Understand what triggers your grief and prepare for those triggers (e.g., plan to take a day or two off of work, let your friends and family know you’ll need extra support, etc).

3.  Seek professional grief counselling
Not everyone will need the services of a counsellor or therapist during their grieving period, but it can be very helpful for those who are really struggling. A qualified professional can help you understand the grief process and give you the tools you need to cope with your emotions.

4.  Be Patient. Healing Takes Time.
Ultimately, take it easy on yourself. Healing from loss takes time, and that’s all you can do: wait and treat yourself kindly. Remember that those around you should also understand that this grieving process takes time; that way, you don’t feel needy or rushed in the stages, which can lead to unearned guilt. Allow yourself to move through all of this organically.

Never feel selfish for grieving. As mentioned, grief is your body and brain’s natural approach to healing from something incredibly painful; let them do their job for you. Then, do your job in aiding your body and brain to heal by loving yourself, getting the sleep you need, eating as well as you can, and seeking support from others around you to combat any feelings of loneliness or ruminating thoughts.

In the end, you are not alone. Everyone in the world experiences grief at some point; let us all support each other through it and let ourselves grow from it.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) – DSM 5, published in 2013, includes a condition of Persistent Complex Bereavement Disorder (PCBD) codable as a “severe and persistent grief and mourning reaction” in “Other Specified Trauma- and Stressor-Related Disorder” 309.89 (F43. 8). You can find this on page 289.

Anhedonia is the inability to feel pleasure. It’s a common symptom of depression as well as other mental health disorders.

Post traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

Hypomania’ and ‘Mania’ are periods of over-active and excited behaviour that can have a significant impact on your day-to-day life.

  • Hypomania‘ is a milder version of mania that lasts for a short period (usually a few days)
  • Mania‘ is a more severe form that lasts for a longer period (a week or more)

You might have Hypomania and/or mania on their own or as part of some mental health problems – including ‘bipolar disorder’, ‘seasonal affective disorder’, ‘postpartum psychosis’ or ‘schizoaffective disorder’.

Some people find Hypomania and mania enjoyable. Or you might find them very uncomfortable, distressing or unpleasant.


Hypomania lasts for a few days, and can feel more manageable than mania. It can still have a disruptive effect on your life and people may notice a change in your mood and behaviour. But you will usually be able to continue with your daily activities without these being too badly affected.

Symptoms of Hypomania can include-

You may feel:

  • happy, euphoric or a sense of wellbeing
  • very excited, like you can’t get your words out fast enough
  • irritable and agitated
  • increased sexual energy
  • easily distracted, like your thoughts are racing, or you can’t concentrate.

Your behaviour may include:

  • being more active than usual
  • talking a lot or speaking very quickly
  • being very friendly
  • sleeping very little
  • spending money excessively
  • losing social inhibitions or taking risks.

Everything is extremely bright and loud and everything inside my head is moving extremely fast. I’m irritated with everyone because no-one talks or does things as fast as I do. It’s amazing but horrible at the same time… it’s like I’m in my own amazing colourful world but everyone else is still stuck in the normal dull grey one.


Mania lasts for a week or more and has a severe negative impact on your ability to do your usual day-to-day activities – often disrupting or stopping these completely. Severe mania is very serious, and often needs to be treated in hospital.

Symptoms of Mania can include any of the symptoms of Mania listed above, and can also include-

You may feel:

  • happy, euphoric or a sense of wellbeing
  • uncontrollably excited, like you can’t get your words out fast enough
    irritable and agitated
  • increased sexual energy
  • easily distracted, like your thoughts are racing, or you can’t concentrate
  • very confident or adventurous
  • like you are untouchable or can’t be harmed
  • like you can perform physical and mental tasks better than normal
  • like you understand, see or hear things that other people can’t.

Your behaviour may include:

  • being more active than usual
  • talking a lot, speaking very quickly, or not making sense to other people
  • being very friendly
  • sleeping very little or not at all
  • being rude or aggressive
  • misusing drugs or alcohol
  • spending money excessively or in a way that is unusual for you
  • losing social inhibitions
  • taking serious risks with your safety.

My speech started getting really fast… I became aggressive and thought that I could solve the world’s problems by myself. I didn’t sleep, hardly ate or drank and had so much energy that I would pace around the room.

After an episode-

After a hypomanic or manic episode, you might:

  • feel very unhappy or ashamed about how you behaved
  • have made commitments or taken on responsibilities that now feel unmanageable
  • have only a few clear memories of what happened while you were hypomanic or manic, or none at all
  • feel very tired and need a lot of sleep and rest
  • if you experience Hypomania or Mania as part of another mental health problem, such as ‘bipolar disorder’ or ‘schizoaffective disorder’, you may find that the episode is followed by a period of depression.

Left untreated, the disorders of Mania and Hypomania can become debilitating.

Note: The above information is of a general nature only. For further information please refer to our ‘Information Qualification‘ near the bottom of this page.

Low Self-Esteem can lead to a number of mental health problems not least the inflictions of anxiety and depression. Someone with low self-esteem will usually have negative feelings about themselves believing that they are not worthy of love, happiness or success. With research linking low self-esteem to mental health issues and poor quality of life this is a potentially dangerous way to live.

When a person has low self-esteem they typically have low motivation, feelings of hopelessness and worthlessness and can be prone to temperamental outbursts which might stem from some deep-rooted and unresolved psychological trauma in their life.

Indeed, there are clear links between the way we feel about ourselves and our overall mental and emotional well being. For example, low self-esteem is a vulnerability factor for numerous psychiatric problems including:

  • Eating disorders
  • Being extremely critical of oneself
  • Downplays or ignores one’s positive qualities
  • Judges themselves to be inferior to their peers
  • Uses negative words to describe themselves such as stupid, fat, ugly or unlovable
  • Has discussions with themselves (this is called ‘self talk’) that are always negative, critical and self-blaming
  • Assumes that luck plays a large role in all their achievements and doesn’t take the credit for them
  • Blames themselves when things go wrong instead of taking into account other factors over which they have no control such as the actions of other people or economic forces
  • Doesn’t believe a person who compliments them
  • Being particularly sensitivity to criticism
  • Inability to handle stress
  • Anger and aggression while under stress
  • Social withdrawal
  • Hostility and ‘snappiness’
  • Excessive preoccupation with personal problems
  • Physical symptoms such as chronic fatigue, insomnia and headaches
  • Unexplained lack of concern for family and friends

These symptoms not only make one’s life miserable they also can lead to loss of relationships, jobs and a sense of meaning in life.

In some cases, low self-esteem might be the result of simply being low or resistant in the brain chemical or neurotransmitter dopamine which can cause such symptoms. From a neurological point of view there are hormones in our brain associated with positive emotions. Dopamine for example is a hormone associated with happiness and another chemical Serotonin regulates our mood.

Dopamine has also been implicated in schizophrenia and ADHD, the brain systems underlying these conditions (as well as substance abuse disorder) are complex. The activity of the dopamine system depends on the state of one’s dopamine receptors and in people with these conditions the chemical interacts with other factors in ways which can have major impacts on one’s mental health.

Untreated, low self-esteem may even lead to tragic results information qualification

When can an Obsession become an Obsessive Compulsive Disorder – “OCD”?

There is a fine, but distinctive, difference between having an obsession and that of having an obsession disorder in the nature of ‘Obsessive-Compulsive Disorder’ commonly referred to as OCD. Indeed, OCD is an easily misunderstood condition, and can be highly distressing for both the person affected as well as their family and friends. In essence, OCD is an anxiety disorder.

People living with OCD are troubled by recurring unwanted thoughts, images, or impulses, as well as obsessions and repetitive rituals. People with OCD are often aware that their symptoms are irrational and excessive, but they find the obsessions uncontrollable and the compulsions impossible to resist.

Indeed, ordinary obsessions can take many forms, for example, a stamp collector who spends many hours deriving joy and satisfaction from collecting and cataloguing his/her stamps, may to an ordinary and dispassionate observer, appear to be a form of obsession; and that may be a fair view. Similarly, a motor sport’s enthusiast or avid football fan might also  seem obsessed to an ordinary and dispassionate observer. But here is the significant difference between an ordinary obsession and that of OCD.

OCD usually features a pattern of unwanted thoughts and fears (obsessions) that lead one to repetitive behaviours (compulsions) which detrimentally interfere with the affected person’s daily activities and moreover cause major distress and impair their work, social or other important life functions. There is no joy or satisfaction derived by such obsessive compulsions. OCD, left untreated, can cause the sufferer extreme distress and leads to social isolation and ultimately social debilitation.

Returning to the example of the stamp collector, if that person regularly went without food for a significant periods because they could not bring themselves to leave their collection, so that their psychical and mental health deteriorated, and/or they became irritated and/or distressed when not with their collection, and/or their sleep was majorly interrupted because the collection dominated all other thoughts, then these symptoms could indicate the obsession-compulsion matrix to found a diagnosis of OCD.

If you suspect that you, or a loved one, might have an obsessive-compulsive disorder, the good news is that with treatment you can learn to manage, and hopefully ultimately overcome the behaviours that are putting your life, and the lives of your loved ones on hold.

If you are experiencing any of the following symptoms over a period of a few weeks, or  otherwise for shorter periods in a reoccurring and regular pattern, it might be time to seek out professional help. While it is never too late to seek out professional help, the sooner you do the better the possibility of assisting you alleviate your suffering.

Obsessions often have themes to them, such as

  • Fear of contamination or dirt;
  • Doubting and having difficulty tolerating uncertainty;
  • Needing things orderly and symmetrical:;
  • Needing things orderly and symmetrical;
  • Unwanted thoughts, including aggression, or sexual or religious subjects.

Examples of obsession signs and symptoms include

  • Fear of being contaminated by touching objects others have touched (outside of the current Covid-19 environment);
  • Constant doubts that you’ve locked the door or turned off the stove;
  • Intense stress when objects aren’t orderly or facing a certain way;
  • Regular thoughts and images of driving your car into a crowd of people;
  • Regular thoughts about shouting obscenities or acting inappropriately in public;
  • Continual unpleasant sexual images, a constant need for pornography;
  • Avoidance of situations that can trigger obsessions, such as shaking hands (outside of the current Covid-19 environment).

Compulsion symptoms

OCD compulsions are repetitive behaviours that you feel driven to perform. These repetitive behaviours or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you’re having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they’re intended to fix.

As with obsessions, compulsions typically have themes, such as:

  • Washing and cleaning;
  • Checking;
  • Counting;
  • Orderliness;
  • Following a strict (non-divergent) routine;
  • Demanding reassurance, even for the simplest of things.

Examples of compulsion signs and symptoms might include:

  • Hand-washing until your skin becomes raw;
  • Checking doors repeatedly to make sure they’re locked;
  • Checking the stove repeatedly to make sure it’s off;
  • Counting in certain patterns;
  • Silently repeating a prayer, word or phrase;
  • Arranging your canned goods to face the same way.


The cause of obsessive-compulsive disorder isn’t fully understood. Main theories include:

  • Biology. OCD may be a result of changes in your body’s own natural chemistry or brain functions.
  • Genetics. OCD may have a genetic component, but specific genes have yet to be identified.
  • Learning. Obsessive fears and compulsive behaviours can be learned from watching family members or gradually learned over time.

OCD may have a genetic component. It sometimes runs in families, but no one knows for sure why some family members have it while others don’t. OCD usually begins in adolescence or young adulthood, and tends to appear at a younger age in boys than in girls. Researchers have found that several parts of the brain, as well as biological processes, play a key role in obsessive thoughts and compulsive behaviour, as well as the fear and anxiety related to them. Researchers also know that people who have suffered physical or sexual trauma are at an increased risk for OCD.


Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don’t rule your daily life. Depending on the severity of OCD, some people may need long-term, ongoing or more intensive treatment. In some extreme cases, referral to a Psychiatrist may be necessary including as for the prescription of medication.


Cognitive behavioural therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a component of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn ways to resist the urge to do your compulsive rituals. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions. Learn more about CBT >>

Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviours and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight. Eating disorders clearly illustrate the close links between emotional and physical health.

For example, people with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight sometimes even despite life threatening semi starvation or (malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, patients often deny that they have a problem.

In many cases, eating disorders occur together with other psychological disorders like anxiety, panic, obsessive compulsive disorder and alcohol and drug abuse problems. Some studies suggest that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history.

Some common eating disorders are:

Binge Eating Disorder People with binge eating disorder have episodes of binge eating in which they consume very large quantities of food in a brief period and feel out of control during the binge. Unlike people with bulimia nervosa, they do not try to get rid of the food by inducing vomiting or by using other unsafe practices such as laxative abuse. Binge eating disorder involves frequent overeating during a discreet period of time (at least once a week for three months), combined with lack of control and associated with three or more of the following:

  • Eating more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of feeling embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed or very guilty afterward
  • Binge Eating Disorder also causes significant distress

Where binge eating is chronic it can lead to serious health complications, particularly obesity, morbid obesity, diabetes, hypertension and cardiovascular diseases.

Interestingly, obesity has been defined as having a body mass index (BMI) greater than 30 kg/m2 with extreme obesity defined as a BMI greater than 40 kg/m2.

Anorexia Nervosa: Anorexia nervosa is generally diagnosed when patients weigh at least 15 percent less than the normal healthy weight expected for their height. Hallmarks of anorexia include:

  • Limited food intake
  • Fear of being “fat”
  • Problems with body image or denial of low body weight

People with anorexia nervosa don’t maintain a normal weight because they refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight. Over time, the following symptoms may develop as the body goes into starvation:

  • Menstrual periods cease
  • Osteopenia or osteoporosis (thinning of the bones) through loss of calcium
  • Hair/nails become brittle
  • Skin dries and can take on a yellowish cast
  • Mild anemia and muscles including the heart muscle, waste away
  • Severe constipation
  • Drop in blood pressure, slowed breathing and pulse rates
  • Internal body temperature falls causing person to feel cold all the time
  • Depression and lethargy

Bulimia Nervosa: Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese. But they are not as underweight as people with anorexia nervosa.

A person with bulimia nervosa binge might eat frequently, and during these times they may eat an astounding amount of food in a short time, often consuming thousands of calories that are high in sugars, carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it.

Their binges often end only when they are interrupted by another person, or they fall asleep or their stomach hurts from being stretched beyond normal capacity. During an eating binge a sufferer may feel out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative. This cycle is usually repeated at least several times a week or in serious cases, several times a day.

Many people don’t know when a family member or friend has bulimia nervosa because people almost always hide their binges. Since they don’t become drastically thin, their behaviours may go unnoticed by those closest to them. But bulimia nervosa does have symptoms that should raise red flags such as:

  • Chronically inflamed and sore throat
  • Salivary glands in the neck and below the jaw become swollen cheeks and face often become puffy, causing sufferers to develop a “chipmunk” looking face
  • Tooth enamel wears off teeth begin to decay from exposure to stomach acids
  • Constant vomiting causes gastroesophageal reflux disorder
  • Laxative abuse causes irritation, leading to intestinal problems
  • Diuretics (water pills) cause kidney problems
  • Severe dehydration from purging of fluids

Bulimia can lead to rare but potentially fatal complications including esophageal tears, gastric rupture and cardiac arrhythmias.

Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems and other potentially fatal conditions can result. However with proper care, those with eating disorders will likely be able to resume suitable eating habits and return to better emotional and psychological health information qualification

The affects of substance abuse can manifest in one’s mental well being in many ways not least in the form of relationship Breakdown and/or financial annihilation. The most common addictions impacting a person’s mental health stem directly from drug and alcohol abuse commonly referred to as ‘substance abuse’ or ‘substance abuse disorder’.

Indeed, drugs and alcohol (even in limited amounts) change the way your brain and body work. They change the balance of chemicals that help your brain to think, feel, create and make decisions, thus directly affecting major personality traits such as extraversion (also often spelled extroversion), agreeableness, openness, conscientiousness and neuroticism.

More over, alcohol and drug abuse can increase the underlying risk for mental disorders. Substance dependence can sharply increase symptoms of mental illness or even trigger new symptoms. Abuse of alcohol or drugs can also interact with medications such as antidepressants, anti-anxiety pills and mood stabilizers making them less effective at managing symptoms.

Alcohol for example has a profound effect on the complex structures of the brain. It blocks chemical signals between brain cells (called neurons), leading to the common immediate symptoms of intoxication including impulsive behaviour, slurred speech, poor memory and slowed reflexes.

These short-term effects of alcohol, though potentially dangerous on their own mask the long-term damage alcohol can cause. Damage to the hippocampus region of the brain (responsible for memory creation) is severely affected by drinking and “blackouts,” which can lead to short-term memory loss and brain cell death. Of course, long term alcohol use can also damage organs, particularly the liver.

Drugs come in many different forms and chemical components which effect the brain in a variety of ways, for example one drug might tend to mellow a person’s mental state where as another might alter a person mental state to one to a state of euphoria.

Marijuana for example, in any form effects the cannabinoid receptors in your brain cells which respond to its active ingredient, THC (Delta-9-tetrahydrocannabinol) creating sensations of pleasure and relaxation because most of these receptors are located in the areas of the brain that affect memory, cognition, perception and motor coordination all of these mental functions can be affected by marijuana use not only right after you use the drug but for up to seven days afterwards, according to the ‘Archives of General Psychiatry’.

Clinical research has not yet confirmed that marijuana use can have permanent effects on brain function. So far, the effects of the drug have been linked primarily to long-term use and appear to be reversible. If you stop abusing marijuana, its effects on your memory, learning and coordination may disappear. On the other hand, there’s not enough evidence to prove that using marijuana over the long term won’t affect your memory or your ability to think clearly.

Opiates on the hand, work by binding to specific receptors in the brain, thus mimicking the effects of pain-relieving chemicals that are produced naturally. These drugs bind to opiate receptors in the brain, spinal cord and other locations in the body including the gut in addition to relieving pain, opiates can lead to feelings of euphoria.

Brain abnormalities resulting from chronic use of heroin, oxycodone and other morphine-derived drugs are underlying causes of opioid dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and substance dependence (intense drug craving and compulsive use). The abnormalities that produce dependence, well understood by science, appear to resolve after detoxification within days or weeks after opioid use stops. The abnormalities that produce dependence, however, are more wide-ranging, complex and long-lasting and can produce mental health disorders such as depression and anxiety (which are closely linked). Prolonged substance abuse of this kind can also result in psychotic reactions.

Synthetic drugs (also known as Designer or Party drugs) differ from organic ones in that they are produced via chemical synthesis. Synthetic drugs are designed to mimic organic botanical compounds but they often contain highly processed chemicals which can affect different parts of the brain.

Synthetic drug abuse is a growing epidemic worldwide. Many of these drugs are addictive stimulants and their repeated use can cause long term or irreversible damage to dopaminergic, adrenergic and serotonergic pathways in the brain.

Some of the most commonly abused synthetic drugs include:

  • Ecstasy – (Also E, XTC, RAdam, Euphoria, “X”, MDMA, Molly, Love Doves)
  • Rohypnol – (Rophies, Ruffies, Roofies)
  • Ketamine – (Special K, Baby Food)
  • Magic Mushrooms – (Psylocynbin, Shrooms, Shroomies)
  • LSD – (Acid, Blotter, CID, Microdot, Windowpane)
  • Methamphetamine (Desoxyn, Crystal Meth, Crystal, Speed, Crank, Bennies, Ice MDMA is a derivative of methamphetamine)
  • Anabolic Steroids – (Roids)
  • Synthetic Marijuana – (Spice, K2)
  • Bath Salts – (Meph, Drone, MCAT)

List of designer drugs

Many of these drugs share the same chemical properties and physiologic responses with the drugs they mimic and may exaggerate the pathologic response in the brain leading to dependence.

These drugs have detrimental (and often irreversible) effects on the brain and primarily affect the central nervous system by two mechanisms:

  1. Neural hyper stimulation via increasing activation of certain neurotransmitters (Norepinephrine, Dopamine and Serotonin)
  2. Cause significant reduction in CNS neural connectivity affecting various brain regions such as the basal ganglia, hippocampus, cerebellum, parietal lobe and globus pallidus.

While the short-term effect of these drugs might be intended to give the user a feeling of euphoria, the effects nevertheless, particularly as result of long-term use can result in:

  • Anxiety
  • Aggressive behaviour
  • Rapid increase in body temperature
  • Seizures
  • Violent reactions
  • Paranoia
  • Delusions
  • Depression
  • Racing heartbeat
  • Hallucinations
  • Nausea and vomiting
  • Violent behaviour
  • Suicidal ideation
  • Nightmares
  • Stomach problems
  • Headaches and Dizziness
  • Loss of consciousness
  • Vomiting and even coma or death

Cocaine is highly addictive and its use is particularly prevalent amongst the affluent. In essence, Cocaine speeds up the brain, which helps one to stay alert and awake and sometimes provides an energy burst. It is also a pain reliever and also a party drug.

Cocaine is made from the leaves of the South American coca bush, thus in its purest form Cocaine is organic. However, by the time it gets to the user it has often been mixed (cut) with other drugs (usually of a synthetic nature) and/or with other compounds which can in a pure form be fatal to humans. It is typically snorted through the nose, but it can be injected, rubbed into the gums or added to food and drinks or smoked.

Cocaine is a stimulant drug that causes euphoria and increases in energy. The immediate way that the drug affects the brain is that it stimulates high levels of dopamine, a brain chemical that is associated with pleasure. Over the long-term ongoing use of cocaine can cause changes to genetics in brain cells, proteins and nerve cells and it may even lead to changes that persist and make addiction very difficult to manage.

Cocaine affects all areas of the brain that have dopamine, but the limbic system is most impacted. The limbic system is involved in emotions and memories and the strong effect of cocaine here helps to explain why the drug causes people to experience pleasure and lose control over using the drug. The association of cocaine-created pleasure with memories helps stimulate addiction. The user is reminded of where the pleasure came from cocaine and is led to use again to re-experience the euphoria. Thus, Cocaine is highly addictive, and users crave the same experience over and over again.

While users might feel happy, bright and alert after taking cocaine there are downsides. Users can for example feel paranoid and agitated, have hallucinations take risks ignore pain and display unpredictable or violent behaviour. Indeed, long term users often feel depression, exhausted and can’t sleep. They can become psychotic with delusions and hallucinations (auditory and visually) and can act in strange, aggressive or violent ways.

More particularly because the drug directly interferes with dopamine being reabsorbed by neurons, one of the symptoms of a cocaine comedown is serious depression. If the brain does not reach its original equilibrium then a person who has struggled with cocaine abuse for a long time may develop permanent depression and require ongoing mental health treatment.

Other symptoms of long-term Cocaine use can be:

  • Persistently feeling run down
  • Lower sex drive
  • Hallucinations (auditory and visually)
  • Difficulties with sleep
  • Sensitivity to sound and light
  • Damage to the ‘nasal septum’ (nose) from snorting
  • Tremors and muscle twitches
  • Nausea like having the flu constantly
  • A fast but weak heartbeat, changes in the heart rhythm and heart attack

Higher doses of Cocaine can also cause:

  • High body temperature possibly leading to death
  • A fast but weak heartbeat changes in the heart rhythm and heart attack
  • Seizures possibly leading to coma
  • Stroke possibly leading to coma and death

While considerable debate has surrounded the potential dangerousness of cocaine since many people continue to use the drug on a recreational basis without reporting problems, it is clear that the health risks of cocaine use include a number of medical complications, such as cardiovascular or respiratory disorders that in some cases can lead to death.

Denial is common in substance abuse. It’s often hard to admit how dependent one may be on alcohol or drugs or how much they affect one’s life. Denial frequently occurs in mental disorders as well. The symptoms of depression or anxiety can be frightening, so you may ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit you have a problem. But substance abuse and mental health issues can happen to any of us, and admitting you have a problem and seeking help is the first step on the road to recovery information qualification

Trauma and PTSD/PTSI: A traumatic event is an incident that causes physical, emotional, spiritual, or psychological harm. Some examples of a traumatic event include:

  • Death of family member, lover, friend, teacher or pet
  • Divorce
  • Domestic abuse
  • Moving to a new location
  • Natural disasters
  • Parental abandonment
  • Physical pain or injury (e.g. severe car accident)
  • Prison stay
  • Serious illness
  • Rape
  • Terrorism
  • War
  • Witnessing a death

The person experiencing the traumatic event may feel threatened, anxious, or frightened as a result. Indeed, people respond to traumatic events in different ways. Often there are no visible signs, but people may have serious emotional reactions. Shock and denial shortly after the event is a normal reaction used to protect oneself from the emotional impact of a traumatic event. One may feel numb or detached or not feel the event’s full intensity right away.

Common responses to traumatic events include:

  • Irritability
  • Sudden dramatic mood changes
  • Anxiety and nervousness
  • Anger
  • Denial
  • Depression
  • Flashbacks or repeated memories of the event
  • Difficulty concentrating
  • Altered sleeping or insomnia
  • Changes in appetite
  • Intense fear that the traumatic event will recur, particularly around anniversaries of the event (or when going back to the scene of the original event)
  • Withdrawal and isolation from day-to-day activities
  • Physical symptoms of stress such as headaches and nausea
  • Worsening of an existing medical condition

Once a person has moved past the initial shock, responses to a traumatic event may vary.In some cases, they may not know how to respond, or may be in denial about the effect such an event has had. In all likelihood the person will need support and time to recover from the traumatic event and regain emotional and mental stability.

Where a trauma lingers, a condition known as ‘post-traumatic stress disorder’ (PTSD) can sometimes occur after you experience a life-changing or life-threatening event or witness a death. PTSD (see also PTSI below) is a type of anxiety disorder that affects stress hormones and changes the body’s response to stress. People with this disorder require strong social support and ongoing therapy.

Many veterans returning from war suffer from PTSD. For example, until recently, feelings of deep shame and guilt (‘moral injury’) stemming from doing things you believe are “wrong” and which are often a feature of trauma exposure, had not been studied to any great extent. British veterans with moral injury described experiencing profound psychological distress, including intense feelings of shame, guilt, self-loathing or worthlessness.

Moral injury is defined as the psychological distress which results from actions, or the lack of them, which violate your moral or ethical code. For example due to a lack of resources, a humanitarian aid worker may be unable to provide adequate healthcare to all of their patients.

Unlike PTSD, moral injury is not (yet) considered a mental illness. But such experiences can lead to negative thoughts about oneself or others (for example, “I am a terrible person” or “My colleagues don’t care about me”) as well as deep feelings of shame, guilt or disgust. These, in turn, can contribute to the development of mental health problems, including anxiety, depression, PTSD and substance abuse. Studies have shown that moral injury is not unique to any particular profession.

PTSD can cause an intense physical and emotional response to any thought or memory of the event. It can last for months or years following trauma. Experts do not know why some people experience PTSD after a traumatic event while others do not. A history of trauma, along with other physical, genetic, psychological and social factors may play a role in developing PTSD.

PTSI – ‘Post-Traumatic Stress Injury’: In essence, PTSI refers to the same set of symptoms as PTSD. The main difference is the conceptualisation of what has caused these symptoms. While PTSD refers to a psychiatric disorder, the PTSI definition provided by the ‘Global PTSI Foundation’ refers to a biological injury. This organisation has stated that PTSI is a biological trauma citing the physical changes which occur in the nervous system in people with this condition. While mental health experts have long acknowledged and understood the physical changes associated with PTSD some argue that changing the name would change peoples’ perception of the condition.

Left untreated, trauma related disorders, and more particularly the conditions of PTSD/PTSI can lead to tragic out comes including that of suicide. In such cases where there is a sever level of infliction treatment by a psychiatrist is more likely necessary. For example, a psychiatrist can prescribe medications which can help a sufferer of PTSD/PTSI regain a sense of normality so that a behavioural therapy might then be more productive information qualification

CBT Counselling & Psychotherapy – Sydney CBD

Supporting a healthy approach to life’s challenges through counselling.

Should you require any further information about our counselling and psychotherapeutic services, you can phone or email our clinic via the ‘Contact Us‘ / ‘Phone‘ buttons displayed on your screen.

Important Information

If you’ve decided it’s time to seek out a counselling, then you’ve already done the hardest part by recognising that you could use support with your mental health or an emotional issue.

To help you decide if you are ready to begin therapy, we offer a free 10-minute phone consultation in which we can discuss the problems you are experiencing and how counselling and psychotherapy might benefit you.

Of course, you will have the opportunity to ask any questions you may have, and together we can decide whether ours is the best counselling and therapy service for you.

To book your free phone consultation, please click on the button below:


The information provided on this website ( is offered as general educational content only. The information herein should not be considered as advice, nor should it be used to treat, assess or diagnose a psychological condition, nor should it be used as an alternative to obtaining professional advice, diagnosis or assessment from a mental health professional.

In severe cases of a mental health disorder, including severe cases of any those disorders described herein, or any others such as bipolar disorder, psychosis or schizophrenia, medication may need to be prescribed to the sufferer. Only a Psychiatrist can legally prescribe medications to address such disorders, for example antipsychotic drugs and antidepressants.

If at any time you are concerned about your personal safety or the safety of another person, please contact your local hospital emergency department, or otherwise contact emergency services on 000 for immediate assistance. Where there is not an immediate emergency ‘Lifeline’ may also be able to provide assistance on 13 11 14.

Please also refer to the following disclosure information: