CBT for menopause: How Simona Stokes is using her expertise to change lives

Today, I'm really excited to be talking to Simona Stokes. She's a counselling psychologist who runs a very busy associate practice, but has also set up a specialist clinic called Menopause CBT Clinic, providing much needed one to one services, groups and training for both organisations and professionals around the psychological aspects of the menopause, and how we can all thrive through it.

Full show notes and a transcript of this episode are available at The Business of Psychology

Links for Simona:

Facebook: ThrivingBeyond40

LinkedIn: Simona Stokes

Instagram: @menopausecbtclinic

Website: www.menopausecbtclinic.co.uk

Freebie: What sex hormones have to do with mental health?

The highlights

• I introduce Simona 00:00
• Simona talks about what motivated her to set up her model 02:40
• Simona explains how the EMBERS model came to be 07:08
• Simona tells us how she is using EMBERS outside of therapy 13:31
• Simona talks about the challenges she has faced getting to this point 19:33
• Simona tells us where we can learn more about what she’s doing 32:09
• Simona talks us through the main sex hormones and their impact on mental health 33:56

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SPEAKERS

Rosie Gilderthorp, Simona Stokes

Hello, and welcome to the Business of Psychology podcast. Today, I'm really excited to be talking to Simona Stokes. She's a counselling psychologist who runs a very busy associate practice, but has also set up a specialist clinic called Menopause CBT Clinic, providing much needed one to one services, groups and training for both organisations and professionals around the psychological aspects of the menopause, and how we can all thrive through it. A topic that I think most of us can agree doesn't get enough air time. So welcome, Simona, I'm really pleased to have you here today.

Thank you Rosie for having me on your podcast. I'm delighted to be here, and thank you for giving me this opportunity to speak about the work I'm doing.

Well, I've been very lucky, I think to get to know you a bit over the past couple of years, because Simona is part of the Do More Than Therapy Membership, and we've also been doing some coaching together. And to be honest, the project that you're working on has really inspired me and I think there's such a gap in the market for it that's yeah, I think it's really important that we spread the message as far as we can, about what you're doing. So very, very happy to be here so that you can talk to our psychologist and therapist listeners about what you're doing, and also a little bit about the nuts and bolts of how the business side of it works. Because I'm sure there are people listening who would love to develop something in their specialism that's similar to what you're doing, but might get stuck on those starting blocks. And I've seen you kind of bust through those barriers and really get going with this. So it'd be lovely to talk about the model that you use and the model that you've developed first, and then dive into some of that business stuff a bit later as well, if that's okay with you.

Yes, definitely, I'm really keen to share some of the struggles as there were plenty. You know the story so far, and I'm sure there are going to be many more ahead of me, but one step at a time. And, you know, hopefully, we'll get to a point where women can access evidence based services for supporting them with emotional difficulties through the menopause. And really, my mission is to try to, you know, offer something that's like I said, evidence based rather than some of the advice that sometimes you can find out that that is just made up on a spot, and it's not necessarily the best advice to support women with their mental health during the menopausal transition.

So that brings me really to my first question, which was going to be what gave you the motivation to set this up because you were already very busy. So how did this start in your mind?

Well, it's, you know, as a psychologist, we tend not to speak too much about our personal experience. Nonetheless, as a woman, I, you know, obviously, I am in my 50s, I've been going through the menopause. So by the time I reached my 50s, my fire was about to go out, my energy, my drive, my motivation and zest for life I had throughout my other life has started to fade to a point that I did not recognise myself. I became lethargic, anxious, forgetful, and ultimately despondent to a point where I, I felt like this is not me. So no one really told me that this is how it's going to be when going through the menopause. I knew about hot flushes, about the night sweats, but did not expect to really completely lose my mojo and the essence of who I was when going through this stage of life. What I found most troubling was the loss of sleep and the effect this had on my thoughts, emotions and actions, or shall I say, inaction, as I couldn't function too well on a day to day basis. So that brought me to the point where I thought, gosh, I'm a psychologist, you know, I know a thing or two about mental health, depression, anxiety, low mood, mood swings, so I thought I'd better go into my tool bag and find something to to help myself in a first instance. But probably like many colleagues, like many psychologists, in our training, we had very little kind of input in learning about the hormonal changes and the impact of that on our mental health. So I had to start an intense process of re learning and adapting, you know, the knowledge, that psychological knowledge I had to the menopausal landscape. So that's how I got into finding out a little bit More about menopause and mental health. You know, first instance, doing a little bit of mesearch, applying all of that onto me applying the adaptations, and when I started seeing how it works, I became much more aware of all the women that actually they were struggling with similar issues and sometimes not even knowing that some of their symptoms were the result of the hormonal fluctuations experienced during the perimenopause.

Yes, absolutely. One thing that really has disturbed me, actually, since I started talking to you about this last year, or was it the year before, who knows, time? But when we started talking about this, I became really disturbed by how many women I must have seen who this stuff will be really relevant for and it wasn't part of my formulation. And really makes me quite angry that in my training course, we had a whole module dedicated to the lifespan, and the menopause did not feature. I just think that is utterly shocking and disgraceful. And it's sad that you had to come to this realisation through your own struggles. But, you know, I've got to admire that motivation to once you've got yourself kind of through it, to then want to take that out to other people to prevent them from struggling in the same way.

Yeah, I think that once you see it, you cannot not see it. And you know, it just doesn't feel right, you know, to have that knowledge, to hold it all to myself. So, you know, there is this idea of sisterhood, you know, we want to help all our colleagues, friends, other women, and, you know, as psychologists we are motivated to help others. So, I started actually using my knowledge into formulating, like, you're saying, to help women understand why they are feeling the way they are feeling, then, you know, to look at strategies to help them overcome the difficulties they experience.

Okay, so it started from a place of trying to help yourself and then very quickly turned into trying to prevent other people from going through that suffering that you'd unfortunately had to go through with no support. So how did the EMBERS model come to be? Because I know that that is your kind of trademarked core model that you use in your work.

It's been a journey with EMBERS. Actually, the whole journey started during the pandemic, I started already working with issues around menopause with mental health difficulties generated by the perimenopause and menopause. But I just found that my approach was maybe... how can I say, not necessarily very strategic, and then, you know, just listening to a whole range of podcasts during the pandemic, it came to me that maybe it would be much more beneficial to develop a system, a framework, a roadmap that would guide my thinking on what are the components? What are the parts? What are the areas that would need some input and when addressed, women can feel better. So for me EMBERS, it's a word that carries a lot of meaning. If you are thinking an ember, it's a little piece of wood, or coal that is hot and glowing, and it's what it's less before the fire goes out. For me, EMBERS, it's a metaphor of how I felt when going through this stage of life. And I know it's a metaphor for so many women going through this stage of life. I hear this day in day out in my practice, women feeling like you know, they don't have that spark that they had before, they don't have the energy, they don't have the drive. So EMBERS was a word that I don't know stuck to my mind, and then I was just thinking, is there any way that with this word, I can create an acronym that actually it's going to mean something, it's going to help me provide a better formulation in my clinical work. So now the name EMBERS it's an acronym of six areas that I believe that when addressed, women can regain their emotional well being and enjoy much more fulfilled life. And around this world, I created a CBT for menopause model, which is based on a third wave CBT like ACT, CFT, mindfulness based cognitive therapy and has got six steps attending to the main areas that can become imbalanced during the menopausal transition such as sleep, cognition, emotional regulation, and identity issues.

Wow. So you were busy?

Yeah, it's been quite a busy time. But I can say that the framework, when I hooked into this word, EMBERS, it just came to me within about half an hour, I managed to plot it all out. And since then, you know, I just developed the whole approach around this word and around the six steps of EMBERS.

And I really like that. I think the fact that the word EMBERS has such meaning for you, but also for the ideal client who would benefit from this, I think that makes it really work. Often when I see frameworks or acronyms, the acronym doesn't mean anything on its own and that makes it difficult for the person who we're trying to explain it to, to retain it and hold it and use it. Whereas you sort of worked backwards from a word that was meaningful, and then made your kind of vast theoretical knowledge fit. And I often think that from the clients perspective, that works a lot better. So I like the way that you approach that. And I also think another thing that you've done there is you've taken your clinical practice and something that you were doing organically anyway, and created a process so that somebody could replicate that. And often when psychologists and therapists come to me and they're saying, I want to produce an online course, or I want to write a book, they often feel really stuck about where to start. And that's the best place to start, what you're already doing in the clinic room, because your approach will always be different to everybody else's. And I'm willing to bet that if we analyse what we do in the therapy room, most of us have got a system or a process, a way that we approach things that we could share with other people, especially if we do work in a tight specialist area like you do.

Yes, I do like to create systems and I do like to create processes, my mind works a little bit like that. And throughout my clinical experience I worked many years in NHS, I worked as a clinician, I worked as a manager, senior manager, I could see the value of standardising processes to a point. Now, obviously, when we work with individuals, we need to have a system that's flexible enough. But we need to have a roadmap that allows us to have an idea of how to get a person from A to B to C or D. And for that reason, I think systems are very valuable, and that's really what prompted me to develop also the EMBERS model. And like you're saying anywhere else in my practice, I can see some, some little frameworks that are always in the back of my mind and I want to share this with clients, because when they understand my thinking, they could pick up those kinds of tools in a much organic way, and use them beyond of coming to see me. And sometimes I say my biggest kind of joy in the work I'm doing, it's really when the, the clients are leaving therapy, and they are better and they are able to look after themselves and they know what to do to tweak a few things and manage their emotions and deal with day to day life challenges in a much more balanced way.

I love that. But I also notice that although this has great application inside the therapy room, and that's how it started for you. You've started using the EMBERS model in lots of different ways. Can you talk to us a bit about how you're using EMBERS outside of therapy?

Well I'm trying to use EMBERS in developing more online courses, group work programme, I'm trying to set up a pilot study at the moment just to see the what's the effectiveness of using this model in a group setting rather than one to one basis. So these are some of the uses I've got for this model. And hopefully in the future, I'm going to find different other avenues for launching the baby EMBERS into the world.

I think there's so much scope because certainly it's been a gap in training for so many of us that the scope for training up other professionals who we don't want to be ignorant about this. You know, I'm a perinatal specialist, but I see women in their 40s and I really didn't understand you know, I'm ashamed to admit this, but I will do in the spirit of disclosure. I really didn't understand how early perimenopause starts, the vast impact that could have on somebody and that somebody could actually be going through that very shortly after a traumatic birth, for example, I might be seeing somebody for birth trauma, who then has this to deal with on top of that, and I've been ignorant of that. So I certainly feel like the scope for getting our existing workforce up to speed with this stuff is, is massive, and really, really important.

Yeah, it's talking about this, I started training a few of my colleagues that are associates with me, you know, on to the EMBERS model and the training package I put together to help them understand the intricacies of this framework, I'm going to use to, to launch a professional training programme for CBT for menopause in the latter part of this year. So far, I've run some webinars just giving a brief outline of EMBERS. And it's been quite an interest that it generated among other health professionals, psychologists, counsellors, coaches, even medics, medics that are working within the menopause field or GP practice. So I've been really surprised to see the interest that people have in learning more about the psychological impact of the menopause and wanting to learn a specific evidence based tool to help women overcome the difficulties they can encounter while dealing with hormonal fluctuations.

I'm not surprised at all, actually, that people are really interested in this. I'm really glad I think there's been a bit more kind of media attention on the subject of menopause, women are starting to speak up about it, and people going through that transition are being more open about it. And I think that media attention often doesn't have anywhere to go. There's no logical next step, people - it piques their interest, and then people go, what now? And you're providing the kind of 'what now?' as the logical next step. So I think you've developed this at exactly the right moment, and it's about maybe harnessing that energy that there is around this topic at the moment and making sure that it does become something meaningful, that people do really get trained up in how to implement this, as I see very exciting things in the future for the model.

Well it's an exciting time for all women, because ultimately, we are going to benefit from this. And you know, over the last four or five years, since I have become more interested in this area of expertise, I definitely seen an increase in interest. It's almost like you can't pick up a magazine or a paper without an article on menopause. And I think it's long overdue to reduce the stigma around the menopause and educate women about what it actually means to go through this stage of life and what they can do to help themselves. The old kind of thinking that we must soldier on and life will get better, I don't think that it's valid at this stage of life where we are dealing with many more stresses, there are many more demands on women, on our careers. And we are not really retiring at the time that we hit menopause like maybe our mothers or grandmothers have done in the past. And we still have to keep going. And also we want to keep going and we want to really have a life that it's giving us the enjoyment that we can extract from all the activities, from all the things that we can do.

Yeah, absolutely. I think it's such a powerful mission. And I think we've been talking very positively here about the way that you have, you know, harnessed your vision and your values and created something that's really going to help a lot of people. But I know that it hasn't been smooth sailing getting to this point where there's a model which you can disseminate in this way. So could you kind of talk a little about the challenges that you faced getting to this point?

Well, there were a number of challenges. The main challenge has been juggling the development of the EMBERS model, of putting the time to write, to develop training materials, to start making myself more available for interactions like this and managing the pressure to generate an income. At the end of the day, as you now a lot of us to have a private practice that can be one man band, or everything depends on us operating the business. And when we are not there, not seeing clients, basically, we don't earn a living. And it's a very fine line to juggle in between putting the time needed to write websites, to develop materials, and still having enough headspace to be available for clinical work. So even to this day, I can say hand on heart that sometimes I have to take quite a chunky pay cut the month in order to have the time available to do another piece of work, to write another article or something like this. So you know, that's, in my mind that the cost that I'm prepared to pay, but everyone should be aware of that should they really want to develop a service, a product or a framework, a model, a system. And then you know, the other challenge are the costs involved in all of this. Many people have wonderful ideas, and everything can stop at an idea stage. And in order to bring an idea to reality, there is a need for professional input, there is a need for training, coaching, you mentioned that we have some coaching sessions in the past that have helped me a great deal, but also I needed, like legal advice. As you already mentioned, I have trademark the EMBERS model, and in order to make that a reality, I needed to avail of an IP lawyer services, which is not cheap kind of service. And then developing a website and different other pieces of work that needed to come together amounted to quite a significant cost. But again, it's, in my opinion, it's worthwhile. And last but not least, I would say that there is a challenge when we have an idea and we work with other companies, other organisations, other services, I learned maybe the hard way that I need to be mindful of how I protect my intellectual property, how I protect really the work that I have developed and my copyright. Regrettably, I came across organisation services that expect that if they give you a voice, you know for the work that you're doing, somehow that it's an implied expectation that anything that you do under their umbrella becomes their property, which can become problematic if you put a lot of time and energy to develop something that it's actually your work. So this have been some of the challenges I had in my work.

Yeah. And I think well, there's two things to pick up there. There's firstly, the point you were making around investment. And I think people do need to consider that at the beginning of their journey. You wouldn't expect to be able to set up a hair salon with no investment. We're very lucky, because we're able to set up our private practices in what's called a cockroach model, which basically means that you know, we are the skill, we are the asset, so we don't need to invest very much in the beginning of our practices, and we can get money coming in and sustain that income, with very little expenditure. I know it doesn't always feel like it, because we tend to be quite tight when it comes to money. So people will be like, what, £30 a month for a practice management system? But compare that to what you'd be paying if you were a self employed hairdresser, for example, with all your own tools, let alone the rental for a salon if you went that far, we're very, very fortunate in that way. But when you start trying to do something outside of the therapy room, you are going to have to invest, you're going to have to get advice of professionals. I would never do anything like this without coaching. I always have a coach. You're going to have to invest in software, you're going to have to invest in, you know, probably doing extra training yourself to figure out how all of this stuff works. And then eventually you're going to have to pay something for marketing because you won't have time to do it all organically. And of course there are ways of going about that. You can decide, okay, I don't have any cash, so I'm never gonna sleep. And this is what you know, Silicon Valley blokes in their early 20s do. They don't sleep, they do everything themselves, they work all the way through the night and they take home very little money because they've got no responsibilities and they've got lots of time so they're able to do that. Most people that come to me for coaching are not in that position, have to take a more measured approach. And when we do that, we have to decide on the balance. What am I going to do myself? What time am I going to invest? And what am I going to outsource to other people and see as a financial investment? And just like with any other business, you can fund that financial investment in different ways too. So there might be grant funding that's available for people, there might be startup loans that are available for people. Or it might be that your existing business can give you some of its profit to get this going. And I know that's more what you've done with this project.

Yes, definitely. And I just had to make a calculated kind of, take a calculated risk that I'm investing in a business, but it's a business that I'm very passionate about. And almost like money is no object now, I'm so far into it, you know, EMBERS has been developed in August 2020, so it's a two year old model now. And, you know, since then, you know, I've been putting a lot of time, energy and money to get it as far as it is now. But I agree with you in that, when we have the skills we have, we can work as a one man or one woman band and just start earning an income straight away. But that it's a business model that is not necessarily sustainable. And from the very beginning, I've been quite interested in how to make a business sustainable and move from this kind of model where everything depends on me where I work in the business, I wanted to move to work on the business. And for me, developing the Menopause CBT clinic and developing EMBERS has been an endeavour to move to the to the stage where the business is becoming more sustainable. And actually, EMBERS is giving me the opportunity to upscale the business. And I can see it already in that I get individuals coming and asking questions about training, wanting to learn about the EMBERS framework. And I know that when I get to the point of developing training materials that are written, you know, those kinds of training materials can be then sold, or, you know, I can generate a different kind of income, we all chasing this kind of unicorn, the passive income unicorn, but it's very difficult to achieve it. I understand that some people are creating online courses, and indeed that can generate some passive income, but it still needs some attention and some updating and regular kind of input. Also, having associates you know, can generate some passive income, but that kind of endeavour has got its advantages and disadvantages. Now, I'm not saying there are not disadvantages to upscale a business in a way that I'm thinking about, but I think that having something that standardised, that can be packaged in a certain way, hopefully, in a long run would allow me the freedom to maybe even step aside of the business now that I'm planning for the foreseeable future.

I love that. I think it's all about freedom. The fact is that once you've, because you've got this framework, you could decide to turn it into an online course, you could decide to turn it into a train the trainer model, you could decide to turn it into, you know, psychology textbooks going forward. There's loads of different avenues that you could take depending on your values and how you want to live your life. And I think ultimately, that's what we need to be looking for in our businesses. Can this give me the kind of lifestyle that I want long term? And what I think is really great about your mindset on this is that yes, you've made a lot of investment upfront, but you've got a plan for how that is going to come back to you. Because I think sometimes in coaching, it might be me being like there does need to be a monetization plan because your passion can drive you very far. But often, we need to be realistic about the sustainability and how is this financially going to pay off in the long run. And I just liked the fact that you've spoken about what a long journey that can be, but it's okay if you can see that endpoint and that it is going to pay, it is going to pay for itself. It's just not going to pay for itself in the first week. And I do wish that message was out there a bit more often.

Yes. Well, ultimately, we need to enjoy the journey as well. It's not just about getting to the destination. Obviously, I would like to record some of the investment I have made, but at the moment, I'm not motivated by money. I'm motivated much more by the mission, I'm motivated much more by the vision of what I want to achieve with this work, with this model. And, yes, I know that hard work, you know, will pay eventually. In my clinical work, I talk sometimes about taking steps, you know, value based actions, many ACT practitioners will know about this, and I talk that value based actions is short term pain for long term gain. And here is the short term pain, you might have to put a lot of time, energy and money. But as long as you enjoy the journey, you know, hopefully there is going to be some benefit further down the line. And I'm confident that even if I don't make a fortune out of this, the benefit would be for all women that hopefully they will find out about the EMBERS model and they will learn certain tools that are based on cognitive behavioural therapy, and I always talk in my work that I want to get women to learn CBT, Cognitive Behavioural Therapy tools to become CBT; confident, brave and thriving again.

I love that! You're so good at acronyms. That's very catchy.

Yes, but I actually you know, all this cognitive brave and thriving, I've seen it day in day out in, in women that I'm working with in my practice. And it's fabulous to see women returning to, you know, to embodying a different frame of mind embodying different kind of passions, having a different outlook on life after they've been through sometimes quite a traumatic stage in their life. So yes, it works, I think.

I feel like there's going to be a lot of people listening to this who really want to get involved and learn more about the EMBERS model. Where's the best place for them to go to learn more about what you're doing?

Well, the best place it's the Menopause CBT Clinic. It's the website for the service that I'm providing for women going through the perimenopause and menopause. There are, there is a page there for training, and at the moment I've got a webinar that is running at beginning of September. Lasts one hour, one hour and a half webinar in EMBERS again, just like a top level introduction to what the framework is about and I'm planning by the end of this month to put more details and information on our website about the professional training programme in EMBERS, which I'm planning to run at the end of November, beginning of December latest, I'm still waiting for a few pieces to fall into place just to have some certainty around dates and fees. But the training programme is going to be a four day training programme. And it's going to be from a Thursday to Sunday. It's going to be online because I've got already quite a few inquiries from Ireland, from Scotland, from different parts of the country, and in this day and age when we got so much more familiarised with using online platforms, I think it would make it easier to run the first training online.

Fantastic. So by the time this goes live, you should be able to go to Simona's website and book yourself on some training to really get under the skin of the EMBERS model and start using it in your own practice. Before we finish Simona, I feel a bit cheeky asking this but I in one of our first meetings you explained to me about the impact of hormones on mental health. And it really struck me how important that is and how little I knew about it before. So would you mind just quickly talking us through the main ones that we need to be aware of so that we can all go away and be better mental health professionals tomorrow.

Okay, so probably all of us will be familiar with the main sex hormones, you know, and these sex hormones are for women and men alike, but we have them in different proportions. So the main sex hormones oestrogen, progestorone and testosterone govern not only our reproductive cycle and dictate a number of our physical and emotional characteristics, but also play a vital role in our physical and emotional health. So oestrogen for example, it's called the master hormone and is responsible for females brain health and regulating many functions in the body. Usually it's associated with sexuality and reproduction, but oestrogen also plays a key role in energy production, protection of the brain cells from damage and supporting the development of new connections between neurons. So oestrogen, it's often referred to as the nature's Prozac, as it supports the creation of serotonin and production of GABA, GABA which is a neurotransmitter that has protective and soothing functions in the brain. This often means that when oestrogen levels drop during the menopause, the serotonin and GABA levels go down too, which has been linked to sleep difficulties, low mood, increased anxiety, brain fog, concentration and memory problems. Then we have the progesterone. Progesterone is responsible for a calming effect on the brain and has been linked to improve cognitive functioning, aiding sleep and calmer emotional states. So when progesterone starts to drop during the menopause, it can lead to sleep difficulties, irritability, anxiety, memory issues, brain fog, which can have a huge impact on women's overall well being and ability to function. And not forget about testosterone. Actually, women's bodies produce testosterone too, all be it in lower quantities than men. But testosterone plays a key role in female's health being responsible among many functions for increased concentration, physical strength, energy levels, and sexual drive. So as with all the other sex hormones during the perimenopause and menopause, testosterone production starts to deplete, and this can trigger a loss of concentration, low mood, low libido, low energy levels, and weight gain. So just that quick, kind of tour of the main hormones and just to understand that the sex hormones, they are not just affecting our reproductive function, but they have such a huge impact on our general health and mental health. And actually, every single cell of women's body has got receptors for oestrogen. So by the time we hit menopause, basically, our hormones level can be depleted to 90%. So no surprise, then that some women struggle a great deal.

Absolutely. I mean, we don't stand a chance, do we? And so thank you for sharing that. I feel like we're all gonna go away and factor that into our formulations going forward, that's really helpful. And for anybody who was like furiously trying to take notes then or who might be unable to take notes, because you're in the shower or walking or doing something else, while you're listening to this. I know Simona has a cheat sheet where all of that is documented for you, and a bit more. So where can they find that Simona?

It's again, on my website, if they go to the training pages at the bottom of the training page, there it's a freebie that can be downloaded, that's a sex hormone cheat sheet for any practitioner that would like to at least have some information in front of them about the impact of the sex hormones on women's mental health.

Fantastic. That's so useful. And I'll make sure that all of those links are in the show notes for you, so you can just hop straight over there. Well, thank you so much for joining us today Simona, it's been a real pleasure. And good luck with spreading the word.

Thank you so much Rosie. Thank you for having me. And thank you for all the support along the way to develop this. It's been invaluable.

My pleasure.