It is most important to realise that we will feel anxious and frightened when working with a CBT program. By accepting this we can work with it, not against it.

Making allowances

As an example, part of our CBT program may include doing the shopping alone. This can be broken down into easy steps. To begin with, we can go to the shop early in the morning. We will feel more comfortable in letting the anxiety and attack happen if the shop is not too crowded. As we become more confident in letting it happen, we can begin to shop at different times of the day.

If part of our program means going to dinner or the theatre, we can ask to be seated by an aisle or an exit, or both-not so much for a quick getaway, but to help break down the feeling of being trapped. The aisle or exit is there if we do need to leave quickly. If we work with our thinking and let the anxiety and attack happen, we will find we won’t have to leave.

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Values. As you plan for the ideal sleep situation, take into account the specific values you hold, and set expectations that fit your lifestyle. Values are as unique as each family.

We are frequently out evenings, so we value Maureen’s ability to get to sleep smoothly—and on her own.

Because my wife works late and enjoys spending time with the kids when she gets home, we appreciate their late bedtimes.

Goals. Your values will clarify the goals toward which to aim. For example, if you value everyone sleeping together, then your goal is to arrange a family bed where everyone is comfortable and teaching independent sleep will not be an issue. If you value independent sleep, you will not take your child into your bed under normal circumstances.

As you carry on, check to be sure your action supports your goal—watch that “just for tonight” doesn’t slip into an unwanted pattern.

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As a result of her low mood, Mercedes would procrastinate, putting off unpleasant tasks such as housekeeping or paperwork in favour of activities she greatly preferred, such as knitting, crocheting or playing with her birds and her dogs. Naturally introverted, she would withdraw in social situations, where she always felt as though she was holding back.

Mercedes decided to try St John’s Wort because it was natural and she understood it to cause few side-effects, starting with 300 mg three times a day. It took at least five weeks to notice an effect, and even then it was subtle though palpable. She stopped procrastinating as much and was more outgoing in social situations. Her husband noted the change, remarking that her dark moodiness had lifted and that she now seemed ‘lighter’. She experienced no side-effects whatsoever, plans to continue to take the herbal anti-depressant and is interested in recommending it to several of her clients.

The stories of Matthew and Mercedes illustrate how versatile an anti-depressant St John’s Wort is, capable of bringing someone out of the dark depths of despair, as in Matthew’s case, or of alleviating the milder and more subtle dysthymia which affected Mercedes. The dosages needed by these two individuals were quite different, with Matthew responding to 300 mg per day while Mercedes used the more conventional 900 mg per day dosing schedule. Optimal dosages of other types of anti-depressant medications vary widely and there is no reason to suppose that this will prove to be different for St John’s Wort. The size of the patient is not always a good guide to the best dosage, as these two cases illustrate: Matthew is 6-foot tall and weighs 13 stone, yet required only one-third the dosage used by Mercedes, who is a small woman. Another difference between Matthew and Mercedes is the time scale of the effects of the herbal anti-depressant, from the almost immediate beneficial effects experienced by Matthew to the five-week lag before the treatment kicked in for Mercedes. Such observations indicate why it can be useful to experiment with different dosages for different people and why it is important to persevere for several weeks before declaring a trial of St John’s Wort to be a failure.

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