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Institute Inbrief - 26/07/2016


Welcome to Edition 251 of Institute Inbrief! As with questions of diet, exercise is perhaps uppermost in the minds of those looking to enhance their wellness. In this edition’s featured article we explore four components of an exercise program, and how you can help your clients improve (or establish) their exercise regimen.
Also in this edition:
  • New Counselling Connection Blog
  • Identifying and Replacing Stress-inducing Attitudes in Clients
  • The Efficacy of CBT Treatment for Depression
  • When It’s All About You: Doing Personality Inventories
  • Social Media Updates & Much More!
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Exercise: A Moving Part of Wellness
As with questions of diet, exercise is perhaps uppermost in the minds of those looking to enhance their wellness. The quest for fitness, however – as with diet – is so pervasive in developed cultures that some controversies are inevitable. As with our previous article on diet, we believe the best approach is for you to offer your client basic guidelines to help them (re-)shape their fitness regimens, but let them be the ultimate arbiters of what is right for their bodies, lifestyles, and preferences.
In order to maximise the value of our tips and be instrumental in making your client’s program a long-term one, ask your client to respond to the following questions before you discuss the points in the rest of this article. As your client will read, making an exercise program work is about more than choosing the exercise. The intensity of it, the time of day, the setting, cost factors, and who else is involved all help determine whether the program will be a success or not for your client. Your best role may be to help clients understand the importance of continuity and engage them in dialogue around how to customise the various factors to suit their individual needs.
Stacking the continuity deck in your favour (questions to ask your client)
What are your exercise goals? Some people want to train to run a marathon or do a triathlon. Others merely want to be fit to enjoy a variety of activities in their life. Still others hope that they can keep chasing their toddler grandchildren around the garden. Or perhaps your goal is about losing weight. Gaining clarity on this can help you tailor the component parts of your program to better meet your goals.
What is your current level of fitness? If you have already been working out regularly, you can obviously start at a more intense level than if you haven’t or if you have been recovering from illness or injury. If you have physical limitations, get a doctor’s advice about what restraints you should observe (for example, even younger folk with knee joint replacements may not be able to jog or do jarring aerobic exercises).
What activities do you enjoy doing? Even if you are healthy and fit enough to jog, if you hate running, it is probably not the way you should get your cardio workouts. Maybe you adore dancing or roller blading, or love being out on your kayak. Working out which component(s) – meaning, aerobic, strength training, flexibility, or balance – your preferred activities satisfy can help you plan a total program you will stay with.
What kind of budget do you have? Some very keen fitness enthusiasts happily pay gym fees and then hire personal trainers on top. Others can afford an aerobics or yoga class most nights. If that is not you, don’t despair. You can get just as good a workout from a pair of dumbbells hidden “off duty” in your wardrobe as you can from a full gym membership. Walking and running are usually free, except for the cost of decent shoes. There are many exercises for strength training using the body as a weight which can be done in your own home. When you know what you can spend, you can work out how best to deploy your available funds toward your preferred program.
What kind of setting works for you?  Maybe you adore swimming, but live in a place that’s cold nine months of the year and you have no access to an indoor pool. Perhaps you live in a flat area that would well accommodate fitness trips on your new bicycle. Or perhaps you work near a gym and could arrange to work out at lunch or just after work.
What time of day works for you? Granted, you should not be exercising too close to bedtime, as that is stimulating, but if you’re a night owl, you also may not feel as happy exercising in the morning. Maybe you are constrained by your work schedule or your family duties and do not have total choice in the matter. The point is to try to find the best possible time for your own body/mind, lifestyle, and commitments, and then stick with that scheduled time. Habits become powerful when ingrained.
Are you an introvert or extravert in terms of your exercise? That is, do you prefer to exercise alone, with one person, or in a large crowd? Some people love weight training but hate the noise and crowds of gyms, so investing in their own equipment is a sensible option. Others feel more motivated when working out with others, and some find that – on days when they are struggling with energy or motivation – their workout partner can get them going: a service they gladly provide in return when the partner is having a “low” day. A walking companion is preferred by many hikers and walkers (adapted from, n.d.).
Components of your exercise program
Your client may already be doing some exercise, but what types of exercise should the person engage in order to say that he or she has a “total” fitness plan? We look at the “standard” three: strength/resistance training, aerobic/cardio, and flexibility, and also include a word on balance, a component which seems unnecessary when we are younger, but comes to be more important as people get older.
Strength/resistance training
This aspect of physical training helps us improve our ratio of lean muscle mass to fat, builds muscle, tones muscles, and protects against bone loss. Any time our muscles have to work a bit harder than what they are used to – that is, they encounter increased resistance – they begin to get stronger from having to adapt to this. We can use the increased strength both for actual strength training exercises (say, when we can increase the weights we are lifting) and also as functional strength to help us do things in everyday life (such as lift a heavy grocery sack or a growing child, or climb more/steeper stairs than usual). Current guidelines say that we should be working each of our major muscle groups (shoulders, chest, arms, abdomen, back, hips, and legs) once or twice a week. One “set” (probably 8 to 12 repetitions) is okay, although 2-3 sets would be better. Bodies need to recover for 48 hours after strength training, so we can either fill in with other components of exercise on the “off” days, or else train, say, upper body on Monday and lower body on Tuesday, then upper body again on Wednesday and so forth, alternating the muscle groups.
What can we do?
Machine weights, free weights (either barbells or dumbbells), and resistance bands and tubes are all good tools for strength training. Many exercises, however, can use just our body weight. These include push-ups, lunges, squats, crunches, and planks.
Tips to help the client make the most of it:
  • Warm up and cool down. Get the muscles ready to be tightened by, say, walking. Stretching works well as a cool-down.
  • Go for a steady tempo. The client can stay in control and make better strength gains when s/he actually lifts the weight, as opposed to using momentum to help lift it.
  • Focus on form, not on how much weight is being lifted. The client will be able to lift more weight sooner and keep with the program if he or she does not sustain injuries through bad form. Slow, smooth lifts and controlled descents work best; ensure that the client actually isolates the muscle being worked.
  • Challenge the muscles to lift increasing weight; remember it is resistance training. Breathe while doing it.
  • Regular practice and respecting the 48-hour recovery period cement the gains (, n.d.; Mayo Clinic, 2016; Robertson, 2009; 24 Hour Fitness, 2016).
Aerobic/cardio exercise
Many exercise experts consider aerobic exercise the lynchpin of an exercise program, the central component around which other types of exercise must revolve. Cardio or endurance activities, as they are also called, burn calories, work off unwanted fat, and are the type of exercise most often named in studies which assert the capacity of exercise to avoid, or even reverse, disease, lengthening the lifespan. Aerobic exercise typically involves the large muscles which contract and relax repeatedly, boosting heart rate and breathing, oxygenating the muscles, and accelerating cardiovascular endurance. Ask your client how much aerobic activity feels right. Experts say we should aim to do 2.5 hours weekly of moderate aerobic activity (such as walking) or 1.5 hours weekly of vigorous activity, working up to totals of 5 hours moderate or 2.5 hours vigorous endurance activity. To make it harder, exercisers can go faster on the treadmill, they can skate or bicycle against the wind, or they can add distance or incline (a hill) to a walk/jog.
What can we do?
When you think “cardio”, think of walking or jogging (indoors on a treadmill or outdoors), swimming, biking, skating, and skiing.
Tips to help the client make the most of it:
  • Safety is paramount. Physical safety involves not going through unsafe neighbourhoods – or perhaps after dark – and choosing routes on quiet streets that have footpaths or trails clearly marked. Reflective vests may help the client get noticed if in traffic.
  • Comfort is a close second. While safety is Number 1, stress to the client how important it is to get comfort right so that he or she will be able to continue the program. Thickly-cushioned walking shoes or trainers with flexible soles are a must, while “breathable” materials such as nylon mesh help the sweat factor. Lighter clothes or fewer layers are needed than if just standing in the same environment, so layering the levels and being able to pull off some as the warm-up proceeds is helpful.
  • Brisk but not breathless works best. If clients are too breathless to keep conversation going, they should slow down. Good posture helps a person’s health in so many ways, including making the exercise easier in the long run, so encourage the client to pay attention to having the back straight with head up and chest and shoulders lifted (for walkers, joggers, or skaters). When going uphill, lean forward slightly.
  • The warm-up and cool-down are important. Starting at a slower pace makes for a better warm up; stretching is a good way to cool down.
  • Slow and steady wins the race. Going too fast or doing too much in the beginning increases the potential for injury, to say nothing of destroying a person’s motivation to continue. Encourage clients to start moderately and increase intensity and/or duration as they get more fit (, n.d.; Mayo Clinic, 2016; Robertson, 2009; 24 Hour Fitness, 2016).
Flexibility exercises
Muscles get shorter and tighter when we don’t use them and as we age, making us vulnerable to injuries and contributing to neck/shoulder, back, and balance issues. Stretching and flexibility work helps to reverse that trend through repetitive performance of exercises which isolate and stretch elastic fibres surrounding muscles and tendons. We can improve our performance of various sports and activities when our muscles are flexible, as we can attain the full range of motion. Reaching, bending, stooping, serving a tennis ball, teeing off for that golf game, or even swaying properly on the dance floor are all more possible with a well-stretched body. The more we do, the more limber we get.
What can we do?
This component includes disciplines such as yoga, Tai chi, Pilates, and most stretching exercises which occur after aerobics classes or strength training workouts. These are often combined with relaxation activities (such as meditation or mindfulness work) for maximum impact. A balanced exercise program should have a minimum of several stretching sessions a week, but every day would be even better. Idea: flexibility exercises can be done on the same days of the week as aerobic or strength training; they can form the cooldown part of the workout. Each muscle group should be stretched.
Tips to help the client make the most of it:
  • Check with the doctor. Especially for those who have osteoarthritis or other joint issues and those who have had joint replacements, consultation with one’s medical advisor is an important prerequisite.
  • Don’t warm up for stretching with stretching. This used to be advised, but now guidelines are to walk, take a warm shower, or otherwise get the muscles warmed up before starting to stretch in earnest. Warmed-up muscles are much more flexible.
  • Go for “sweet pain”. Some proponents of yoga observe the difference between “sweet pain” – that is, mild tension, which accompanies a good stretch - and injury-causing pain, when a muscle is stretched too far.
  • Don’t bounce; it tightens the muscle.
  • Breathe through the stretch. Remind clients to hold a stretch for 10-30 seconds and repeat several times, breathing through the nose (some disciplines, such as yoga, have different holding and breathing requirements) (, n.d.; Mayo Clinic, 2016; Robertson, 2009; 24 Hour Fitness, 2016).
Balance exercises
An addition in recent years to the ruling triumvirate of strength, aerobic, and flexibility exercises, activities to enhance and maintain balance now rank high in the minds of many fitness experts, especially for those who: (1) have conditions such as neuropathy (a complication of diabetes), (2) are on certain medications, (3) have vision problems, or (4) are part of the rapidly expanding demographic of seniors. Because our balance tends to get worse as we get older, it is wise to begin working on this aspect of fitness well before the tendency to fall sets in during the later years. Falls can cause head injuries and disabilities (sometimes permanent) to the bones and nervous system, jeopardising independence. Clues to the importance of this in the minds of fitness experts can be seen in the recommendation to do 30 minutes of balance exercises, three times weekly.
What can we do?
Fortunately, many of the exercises which help flexibility – yoga, Tai Chi, Pilates – as well as some forms of dance greatly assist with the maintenance and promotion of balance.
Tips to help the client make the most of it:
  • Balance exercises work in well with both stretching and cool-downs from aerobic and strength-training sessions. It’s never too early to begin.
Some general tips
Exercise is not something we do today because we are trying to lose weight, or throughout the next month because we are entering some sports competition. It is to be thought of as a lifelong endeavour, something that is central to a life well-lived. To help attain the regularity and continuity that we need from our fitness efforts, here are a few additional strategies which you may wish to share with clients; they address the client.
Keep a record of milestones (i.e., the first two-hour walk, the diary of weight increases on bench press, the first time kayaking all the way around the island near home, etc.). In fact, it’s a great idea to put goals onto paper in the first place as a reminder of what you are going for, and later, how far you have come.
Supplement your efforts with music you like. Not all situations can support this, but with devices attached to fitness belts and earphones, music can go many places with us.
Variety is the spice of life; don’t be afraid to vary routines and activities, trying to keep all your components going.
Get a team of supportive people together, who can champion your improvements and efforts and help you stay on course when motivation and energy might flag. And don’t forget to develop a network of like-minded people: the ones you get together with time and again to do your preferred fitness activities.
Be flexible. Life happens. You might plan for a yoga class one day and end up taking a walk with your partner instead. The point is that you are still moving. Also have compassion for yourself. If you miss a day, consider it “no drama”; it is nothing compared to the whole life of movement you are committing to. And for extra motivation, don’t forget to reward yourself for achieving your fitness goals.
Use technology. The pedometers and “Fitbit” devices coming out can help you measure just how many steps you have taken. And if you have budget issues, don’t forget about local recreation centres, which sometimes offer instruction in certain sports or activities far more cheaply than private gyms can. Also, if you have gone for a set of dumbbells, a few stretch bands, and a stability ball, the internet (e.g. YouTube) has many instructional videos to help you know what to do with the equipment while you work out at home.
Note: Information in this article adapted from, n.d.; Mayo Clinic, 2016; Robertson, 2009; 24 Hour Fitness, 2016)
References: (n.d.). What’s the best exercise plan for me? Retrieved on 20 January, 2016, from: hyperlink.
Mayo Clinic. (2016). Fitness: Tips for staying motivated. Retrieved on 20 January, 2016, from: hyperlink.    
Robertson, A. (2009). Find the best workout for you. WebMD, LLC. Retrieved on 20 January, 2016, from: hyperlink.
24 Hour Fitness USA. (2016). 10 Tips for exercise success. Retrieved on 20 January, 2016, from: hyperlink.
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Identifying and Replacing Stress-inducing Attitudes in Clients
As a therapist, you can initiate the discussion by asking clients about negative, unhelpful attitudes. Which attitudes or beliefs do clients identify for themselves as problematic? Provide them with a copy of the list below and invite them to go through by describing how often they engage these attitudes/beliefs. How does the client currently deal with these distortions? How stressed does the person make him/herself as a result of them?
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The Efficacy of CBT Treatment for Depression
The plethora of studies evaluating the efficacy and effectiveness of CBT (Cognitive Behaviour Therapy) over the last few decades has shown generally solid results for CBT as a treatment for depression (and many other disorders) with different groups, in different modes of delivery, and in manifold settings. There is no controversy on one fundamental finding: there is a vast amount of evidence showing that CBT is effective for depression. In this article we examine the different findings with respect to aspects such as client preference, mode of delivery of treatment, and comparisons between CBT and other treatment modalities, including antidepressant medication.
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When It’s All About You: Doing Personality Inventories
Perhaps the cooler months of winter encourage us to look inward. Maybe the sluggish economy is generating job uncertainty and anxiety. Or maybe we are collectively raising our self-awareness. I’m not sure, but I am seeing an explosion of interest in self-assessment measures, so it might be helpful to revisit personality inventories, seeing how to add that flash of insight to what you already know about yourself. What can personality inventories tell us about ourselves, and why should we do them? What types are out there?
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