Rearview : Is delivering CBT having an hazardous effect on your behind?
Here at the IPSIG we can never be accused of ignoring the most pressing issues of the day and so it is with the utmost seriousness and grave concern for your general wellbeing that I pose the following question: How many hours a day do you spend delivering CBT whilst sat in a chair? If you are spending more than five hours a day seated and have been for a little while you might want to turn around and check out your butt. If like me, your derriere resembles a bake off bun that’s lost its definition you’ve come to the right place. If however, you have a soggy bottom as well you’re really deep in it and this warning may have arrived a tad too late.
Worryingly, it’s not just your butt at stake. Check out this list of potential health hazards for the desk bound: weight gain, muscle atrophy, back pain, disc compression, anxiety, depression, increased risks of diabetes, some forms of cancer and heart disease., deep vein thrombosis and varicose veins.
A colleague who occupied an office next door to mine cornered me on the day she retired warning me in urgent tones of the hazards of our job. Her back she said was well and truly knackered and all her retirement plans had to be revised. “It’s not too late for you “ she wheezed as I watched her hunched and stiffened gait navigate the stairs down from her office for the last time. Not going to happen to me I thought smugly but here I am one year later and I can’t deny that as a woman of a certain age I am beginning to feel the effects of a sedentary work life. I should say at the outset that sitting still does not come easily to me. I am by nature a fidgety person which can be extremely annoying for my nearest and dearest and you really don’t want to be sitting next to me in a cinema or theatre if repeated and involuntary limb movements irritate you. I’ve really had to work against my own physicality in this job and although it’s way too late for a career change if I could do it all again I would have chosen a career that involved a lot more jumping about. Like a CBEEBIES presenter or a mattress jumper. Yes, that is an actual job.
More recently I have been bringing my trainers into work and then actually putting them on in my break. I find this increases the chances of me doing something athletic and in between patients I’ll either do repeated squats or use an exercise band. You have to be careful with the latter because if you use the high-tension band and insist on texting patients at the same time you can lose your grip and lacerate yourself.
Little changes in day-to-day practice can make a big difference. For example, I tell patients to wait for me in the waiting room so that I can run up and down the stairs to get them. I’ll often write up my session notes standing up and will lie flat on the floor if I need thinking /reflective time. Occasionally when I’ve overdone the squats I’ve had patients ask If I’m OK (bless) and you do need to keep the room well ventilated if you want to create a hygge vibe as opposed to that of an adolescent boys bedroom. In the summer months some of my patients are happy to conduct a session al fresco and I’ve had some memorable moments conducting final sessions walking around the local park reviewing and evaluating work we’ve done together. There’s something egalitarian about getting outside the therapy room that’s freeing for both patient and therapist and I totally recommend it. If motivation is low TED-ed talks seem to galvanise lots of folk so give yourself a kick start with this.
If you’re one of those people who consider themselves to be in tip top physical condition I salute/hate you . Please don’t think that this stuff doesn’t apply to you though. You can be fit and unhappy, depressed even. According to recent studies the emotional fallout of too much sitting makes for sobering reading. For example – A study of more than 3,300 government workers in Australia found that those who spent more than six hours of a typical workday seated were more likely to score in the moderate to high range on a test of psychological distress than those who sat fewer than three hours. This held true, regardless of how much leisure time exercise they got.
Another study of nearly 9,000 women in their fifties found that those who sat for seven hours per day—and were physically inactive—were three times as likely to have symptoms of depression than individuals who sat for fewer than four hours and got the recommended amount of daily physical activity. The relationship between depression and sitting may be a two-way street: Depression saps people’s energy and motivation to move, and sitting a lot may just make the depression worse”.
Delivering CBT does provide plenty of opportunity for creativity particularly for independent practitioners where conducting behavioural experiments outside the therapy room is standard practice and certainly working with patients with anxiety based problems provides a perfect opportunity for the therapist to model the physical effects of activity for health anxiety patients or those with panic disorder. Perhaps that’s the solution, back-to-back interoceptive exposure sessions. I’m exhausted just thinking about it and as a treadmill desk is just way too expensive I’m afraid that whilst the following advice is mundane you and your butt will thank me one day. You’re welcome.
- Get up every hour and sprint up and downstairs or walk briskly up and down the corridor (keeping health and safety in mind, of course).
- Take a brisk 15-minute walk during you lunch break.
- Stretch your arms in the air regularly to relieve any stress in your shoulders.
- Pay attention to your abs, even when you’re sitting down. Pull your belly in to activate the muscles and try to keep them activated all day to improve your pelvic floor and posture.
- Invest in a small mini-exerciser to keep under your desk. You can use this to pedal with your feet or take it up onto the desk to work your arms.
- Make sure you plan something active for after work, such as a brisk walk, jog, swim or sport.