Therapy Guide

Aromatherapy

Aromatherapy is the use of essential oils (which have been extracted from various organic material) for therapeutic purposes.

In order for aromatherapy to work, the essential oils need to enter the body. They can do this by two methods: inhalation and absorption.

The smell of the essential oil stimulates the olfactory nerves, which are located at the back of the nose. (Olfactory is the posh way of saying “something involved with the sense of smelling.”) From the olfactory nerves, messages are transmitted to the olfactory bulb which is located in the limbic system of the brain. The limbic system is very important in many body activities, especially the expression of mood and activities within the endocrine (hormone) and motor systems.

In the limbic system, the oils may affect the pituitary gland (which regulates hormone production and gland activity.) They may also affect the hypothalamus (which affects both the appetite and the autonomic nervous system; the part of the nervous system involved in involuntary activity, e.g. heart beating, breathing etc.) Basically, inhaling essential oils can have many different affects on the body.

Also, as well as travelling to the olfactory bulb in the limbic system, the inhaled oils also travel the lungs where they are absorbed into the bloodstream. (They can then affect the body via “absorption means” which are described below.)

When essential oils are applied to the skin, they are absorbed into the bloodstream. Once in the bloodstream, they either increase the levels of vitamins, nutrients etc that are naturally produced in the body (different oils affect different nutrients) or they increase the activity of the immune system.

    •    Bath
Run hot bath. Once the bath is run, add approximately 6 drops of essential oils to the bath and swish water around. Soak in bath for at least ten minutes.
n.b. It is advisable to dilute the oils in a carrier oil base as this makes for easier mixing with the water. Otherwise, you are likely to end up with a layer of the oil on the top of the water (as oil & water do not mix well.) You are then likely to get into the bath and sit directly in non-diluted oils which will hurt a lot. (take it from someone who spent 2 days with very sore thighs and other bits!)
You can use a “normal” carrier base, or you can get special bath carrier which will give you bubbles! n.b. Do not use bubble bath etc at the same time as the chemicals may interact with the oils.

    •    Burner (Room Burner / Oil Burner / Vaporiser / Diffuser)
Fill the top of the oil burner with cold water and then add a few (between 3 and 5) drops of the oil to the water. Light a candle in the base of the burner. The candle will slowly heat the water and as it evaporates, it will carry molecules of the oil throughout the room.

    •    Compress
Fill a basin with hot or cold water and add approximately five drops of the essential oil to the water. Swish it about to mix it up. Put flannel into water, squeeze out excess water and apply flannel to affected part of the body. Compresses are often used for headaches and muscular aches    

    •    Cream (Lotions)
Add 1-2 drops of essential oil to every 5 ml of carrier lotion. You can then gently rub the lotion into the skin.
n.b. It is a good idea to store extra lotion in a dark glass bottle to prevent the sun from reacting with the oils in the lotion.

    •    Footbath
Add a few drops of oil to a bowl of warm water and soak feet for at least 20 minutes.

    •    Inhaling
Inhaling can be done in various ways. Add a couple of drops to a tissue and sniff as & when. Place a few drops on your pillow prior to bedtime and you can inhale throughout the night. Add a few drops of oil into a bowl of steaming water and inhale the fumes (max of 10 minutes).

    •    Massage
Mix essential oils into carrier oil (approximately one drop of oil to 2ml of carrier oil)

    •    Neat
Apply a few drops of undiluted oils, using fingertips or cotton bud. (Only Lavender, Chamomile, Tea Tree and Lemon are safe to use neat.)

 

    •    Before you start using any essential oils, talk to a qualified aromatherapist.

    •    If you are taking any prescription medication or over-the-counter medication, discuss possible essential oil interactions with your chemist, doctor or a qualified aromatherapist.

    •    If you have high blood pressure, do not use cinnamon, clove, hyssop, rosemary, sage or thyme.

    •    If you are pregnant, best to consult with an aromatherapist before you use any essential oils. But definitely avoid aniseed, basil, camphor, cedarwood, chamomile, cinnamon, citronella, clary sage, clove, cypress, fennel, hyssop, juniper, marjoram, myrrh, nutmeg, oregano, parsley, peppermint, rosemary, sage and thyme.

    •    If you are epileptic, do not use basil, clary sage, eucalyptus, fennel, hyssop, rosemary or sage.

    •    If you are diabetic, avoid angelica, eucalyptus, geranium and lemon.

    •    The following oils are phototoxic (i.e. interact with sunlight and you are likely to end up with a fantastically painful sunburn) bergamot, lemon, grapefruit, lime, orange & other citrus oils.

    •    Many oils should NOT be combined with alcohol as they may induce hallucinogenic effects.    

    •    If you have sensitive skin, it is best to test an aromatherapy blend on a small area of skin before using it on a larger area. The following oils may irritate sensitive skin: basil, bergamot, citronella, fennel, ginger, grapefruit, lemon, lemongrass, orange, peppermint, scots pine, tea tree and ylang ylang.

    •    NEVER USE ESSENTIAL OILS INTERNALLY.

 

 

This form of treatment was devised by Marsha Linehan (1993) and is a systematic cognitive-behavioural approach to working with individuals who meet criteria for borderline personality disorder with the aim of reducing suicidal or other severe dysfunctional behaviours. The emphasis is on "dialectics" - the reconciliation of opposites in a continual process of making the individual whole. It addresses self harming behaviour, encourages acceptance and validation strategies with training in the acquisition of new skills. DBT tries to get the person to reflect on their own thoughts and feelings without the need to act upon them, and is delivered by trained therapists either one-to-one or in a group. People receiving DBT may also receive telephone support from the therapist. This is usually given for 1 to 4 hours per week and lasts for at least one year. The participants are expected to maintain a diary between sessions.

According to Linehan DBT consists of a combination of:

"concomitant weekly individual behavioural psychotherapy sessions and psycho-educational skills training groups in its treatment plan. Individual therapy focuses primarily on motivational issues, including the motivation to stay alive, and the specific session agenda is determined by the patient's behaviour since the last session. Behaviours highest on the dialectical behaviour therapy target list that are still problematic receive the most attention. Group therapy teaches self-regulation and changes skills (interpersonal, emotional-regulation skills) and self and other acceptance skills (distress tolerance, mindfulness skills). As whole, dialectical behaviour therapy blends validation and acceptance treatment strategies (similar to client-centred, Eastern and Zen psychologies, and psychodynamic approaches) with comprehensive cognitive behaviour therapy (including problem solving, contingency management, cognitive modification, exposure-based procedures and skills training)" (Linehan, M.M et al, 1994)

Ref: LINEHAN MM, TUTEK DA, HEARD HL, ARMSTRONG HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. Am J Psychiatry, 151:1771-6, 1994.

"Pilot study of the efficacy of a psychosocial intervention for frequent parasuicide attempters with personality disturbance" (Prof Peter Tyrer at Imperial College, Academic Unit of Psychiatry, London. December 1998)

The goal of this study was to evaluate a new (at the time) form of psychological therapy, which was based on Dialectical Behaviour Therapy (DBT) which had been developed in the U.S. This therapy was referred to as "manual-assisted cognitive therapy" (MACT) and was delivered by one therapist for up to six sessions. This study compared MACT with treatment as usual (TAU.)

34 patients (criteria: at risk of self harm, at least 2 previous self harm episodes in the last year and diagnosed with "personality disturbance in the flamboyant cluster") were chosen and assigned to either MACT or TAU groups. These patients and their progress were reviewed after six months.

The results were as follows:

    •    Rate of suicidal acts per month was lower with the MACT group

    •    Depressive symptoms (self rated) were significantly improved within the MACT group

    •    MACT cost of care was 46% less expensive than TAU

 

Following this study, it was decided that MACT was indeed a possible NHS treatment, but that research with a larger sample had to be carried out. Funding was obtained via the MRC (Medical Research Council) to perform studies at seven centres throughout the U.K.

EMDR is a relatively new form of therapy. It is used to 'dissipate' traumatic memories so that they can be worked through in therapy. It has been suggested that a few sessions of EMDR can be equivalent to many months of other talking treatments.

Many mental health problems (including BPD) have arisen from some form of early trauma. The traumatic event becomes frozen in the individual’s mind and may be recalled long after the original event. These memories are usually vivid, detailed and evoke strong emotions. Often, the 'flashbacks' of trauma can be just as frightening as the original situation. Because such strong emotions are evoked by the traumatic event and its memories, the body reacts by moving into the 'fight or flight' response. With individuals that have been exposed to long-term or severe trauma, their bodies are often in a chronic 'fight or flight' state of arousal. This affects perception of self and the surrounding world and consequently affects self-esteem, relationships etc. (often resulting in mental health issues.)

The basis of EMDR suggests that moving the eyes in a particular fashion whilst thinking of unpleasant or traumatic memories (i.e. when the body would be in the 'fight or flight response') decreases the intensity of painful emotions that accompany these memories. This, in turn, allows the individual to move into a situation where they feel able to discuss these memories without being overwhelmed by painful and difficult emotions.

The scientific basis of EMDR is not yet understood. One theory suggests that the specific movement of the eyes during EMDR mimics that found during REM sleep. A related theory suggests that EMDR produces a calming effect on the body and promotes physiological relaxation – thereby lessening emotion intensity.

Yet another theory suggests that EMDR activates areas of the brain, which are separate from the traumatic emotional memories. By 'training' the brain to do this when traumatic memories emerge, it can bring about considerable changes in the way the individual deals with his or her memories.

Studies have shown that EMDR is effective in treating individuals with a history of trauma. Most of these studies have been carried out in relation to PTSD. However, it has been suggested that EMDR is effective for BPD (perhaps because BPD often has a component of PTSD.)

Music Therapy:

Music therapy provides a setting in which individuals can express themselves non-verbally and become more aware of their feelings. Difficult feelings can therefore be accessed in a 'safe' fashion.

Music therapy is usually done as group therapy (between six and eight people), although individual sessions can be arranged. The group meets weekly for approximately 90 minutes and is co-ordinated by a music therapist, and sometimes another mental health professional. The group members do not need to have any musical abilities or previous experience; and might play instruments or listen to music.

The co-ordinator may choose a theme for the session, or individuals may simply express their current thoughts and emotions. The music therapist might join the individual in playing music or may ask them to discuss the sounds and mood of the music they have just played.

The crux of music therapy is that it enables the client to express emotion that may not be able to be expressed verbally.