Anxiety and Depression Foundation Programme - Session 1

Anxiety and DepressionFoundation Programme - Session 1

11 2 3 4 5 61 2 3 4 5 6Updated 07-06-13

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Foundation Programme OverviewFoundation Programme Overview

• Session 1 – Understanding Stress, Fear and Sadness

• Session 2 – Behaviour, Emotions, Sensations and Thoughts

• Session 3 – Goals & Action Plans

• Session 4 – Panic, Anger, Futility and other Strong Feelings

• Session 5 – Healthy Relationships – Communication & Belonging

• Session 6 – Staying Well, Healthy Living

First, a few housekeeping rules (next slide) ...

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HousekeepingHousekeeping

• In case of fire!

• Taking a break

• Groundrules

• Anything else?

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Why Treat Anxiety & Depression Together?Why Treat Anxiety & Depression Together?

• Because anxiety and depression often occur together

• Because some of the things that help anxiety also help depression

• If we suffer from depression, we are much more likely to feel anxious (and vice versa)

• If we suffer from both anxiety and depression, the symptoms of one can make the other worse

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Getting the Most out of the ProgrammeGetting the Most out of the Programme

• Work at a level that feels right for you – you wont have to say anything personal or revealing that you feel uncomfortable about

• It’s fine to say ‘no thank you’

• If you’re not sure about anything – please ask

• Don’t worry if you can’t remember it all

• Generally, the more you put in, the more you get out

• If you’re not having a good time in the group, don’t suffer in silence - let us know!

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Session 1 ContentsSession 1 Contents

• What is Stress?

• Sadness and Depression

• Fear and Anxiety

• What Helps Most & What Helps Least?

• Stigma and Shame

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StressStress

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What is Stress? (1 of 4)What is Stress? (1 of 4)

• Stress is a normal part of life• Most of us get stressed when we have to:

– Sit an exam– Make a speech– Start a new job– Lose our job– Move house– Have relationship problems

• And we expect our stress to reduce when we things get better ...

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• Some stress helps us perform some tasks better

• Most of us find that our stress levels change from day to day

• Sometimes we cope better than others

• If stress levels increase and start to affect our everyday lives, we may want to seek help

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The Yerkes-Dodson Curve (3 of 4)The Yerkes-Dodson Curve (3 of 4)

• Some stress helps us perform some tasks better ...

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• Stress affects us all – young and old, outgoing and shy, male, female, rich and poor

• Stress, over a long period, can affect our immune systems and make us more vulnerable to health problems

• Other problems may keep our stress going and, in turn, can be made worse by stress - which can become a vicious circle

• Some people, e.g. those with ongoing health problems or those without much support can be more vulnerable to stress

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Recognising StressRecognising Stress

• You might not be able to relax, might feel tense or shaky, not be able to sleep, worry a lot and perhaps feel low

• You might avoid people and places or avoid doing the things you have coped well with before

• Stress affects your self-esteem and self-confidence

• You might become more self-conscious

• You might feel ‘out of control’

• You might have a mixture of ‘hard to explain’ physical symptoms

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The Stress BucketThe Stress Bucket

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Depression and SadnessDepression and Sadness

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Depression and SadnessDepression and Sadness

• Differences Between Sadness & Depression

• When Does Sadness Become Depression?

• Recognizing Depression

• What works well, what doesn’t

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SadnessSadness

• Sadness is a normal reaction to loss• The loss may be personal, a relationship or perhaps a hope or

expectation• Sadness is transient, it doesn’t last long• People prone to depression can find sadness difficult, they may fear

it could signal the return of depression

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Differences Between Sadness & DepressionDifferences Between Sadness & Depression

• We all have periods of sadness from time to time. While sadness is transient, depression is a persistent lowering of mood sometimes accompanied by feelings of distress and despair

• Sometimes there will seem to be a reason for becoming depressed, sometimes not. There is usually more than one reason, which may be different for different people. However, sometimes it isn’t clear why we feel depressed, either to ourselves or to anyone else

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Symptoms of Depression (1 of 2)Symptoms of Depression (1 of 2)

• Crying• Pessimistic thoughts• Brooding about past unpleasantness• Preoccupation with feelings of inadequacy• Feeling resentful, irritable, angry• Physical complaints not caused by physical illness

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Symptoms of Depression (2 of 2)Symptoms of Depression (2 of 2)

• Loss of interest or pleasure in social contact or sex• Feelings of self-blame or guilt• Reduced ability to think or concentrate• Poor appetite or weight loss or increased appetite or weight gain• Sleep difficulty, or sleeping too much• Loss of energy, fatigability or tiredness

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Why Do I feel Like I Do? (1 of 6)Why Do I feel Like I Do? (1 of 6)

• It’s not usually possible to pinpoint any one single cause of our problems

• But we know that physical, social and psychological factors all play their part …

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• Brain chemistry – Many people believe that problems are caused by an incorrect balance of chemicals ( ‘neurotransmitters’) in the brain

• By providing medication, or other forms of medical treatment, the balance can be restored

• Medication rarely works immediately, often taking up to six weeks before improvements are felt

• Treatment is often continued for 6 - 18 months after recovery, which helps prevent relapse

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• Illness – Problems can strike when we’re physically ill. This can be true for life-threatening illnesses such as cancer and heart disease, but also for illnesses that are long and distressing or painful, like arthritis or chronic breathing difficulties - viral infections like ‘flu’ or glandular fever can also cause problems

• Alcohol and other addictive substances can lead to problems

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• Life events – The early loss of a parent or a difficult childhood can make us more vulnerable. Distressing events such as bereavement, divorce or the loss of a job can make us feel depressed, stressed or anxious

• Social factors – If we’re alone, or have few friends, we’re more vulnerable

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• Women may get depressed or anxious more often than men (or men are less likely to talk about their feelings). Men and women’s lives are very different. There are genetic and hormonal differences, childbirth and childcare, economic and social inequality, prejudice and discrimination, relationship difficulties and domestic abuse to be taken into account

• Long-term conflicts with others can take their toll on our well-being, as can other stressors such as financial difficulties, retirement, unemployment, overwork, childbirth, loneliness or the loss of someone or something important

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• Personality - When we’re depressed we often have a negative view of ourselves and the world, when we’re anxious, the world can seem a very scary place

• Negative thinking styles can be an important influence on the course of depression - some people have a tendency to view things this way, even when they’re not depressed

• Problems can run in families – Studies have looked at identical twins (they have exactly the same set of genes) and have found that if one twin has depression, there is a 70% chance that the other twin will develop depression

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What Helps Depression LeastWhat Helps Depression Least

• What Helps Least

– Taking to our beds

– Not going out

– Not talking to people

– Avoiding work

– Avoiding exercise

– Coming off medication too early

– Abusing alcohol, drugs becoming addicted to something

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What Helps Depression MostWhat Helps Depression Most

• What Helps Most

– Mindfulness

– Exercise

– Work

– Helpful Relationships

– Talking

– ‘Sticking with it’

– Optimism and hopefulness

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AnxietyAnxiety

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Fear and AnxietyFear and Anxiety

• Differences Between Fear and Anxiety

• When does Fear become Anxiety?

• Recognizing Anxiety

– GAD, Panic, OCD, Health Anxiety, PTSD, Social Anxiety, Specific Phobias

• Treatments for Anxiety

• Getting Help

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Fear and AnxietyFear and Anxiety

• Fear is a natural reaction to something which threatens our safety. It is a combination of a physical response, some rapid, focused thoughts and often results in rapid action

• Anxiety is a response to a perceived threat, which, in actual fact, represents no threat to our safety – however, many of our physical reactions to anxiety are the same as when we’re afraid

• Anxiety is very common – figures range from one out of three to recent estimates of five out of every six people will develop either anxiety or depression at some time during their lives

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How is anxiety different from fear?How is anxiety different from fear?

• Anxiety is a disproportionate response – our reaction is too strong for the level of threat we perceive

• Anxiety can:– Prevent us from enjoying life– Getting on with our work– Affect our relationships with others– Stop us sleeping and make us worry all the time

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Different Types of AnxietyDifferent Types of Anxiety

• Some types of anxiety:

– Occur after an accident or trauma (PTSD)– Make us worry all the time and lose sleep (GAD)– Make us perform rituals and make our thoughts go round and

round (OCD)– Prevent us from going out and make us avoid things (Phobias)– Make us very self-conscious, ashamed and reclusive (Social

Phobia)– Make us think we’re ill (Health Anxiety)– Make us panic (Panic disorder)

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Symptoms of AnxietySymptoms of Anxiety

• Palpitations• Shortness of breath• Churning stomach• Sweating• Wanting to go to the toilet• Thoughts racing • Feeling ‘out of control’• Panic attacks• Avoiding things• Feeling ‘on edge’ being easily startled• Feeling irritable• More …

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What Helps Anxiety Least What Helps Anxiety Least

• What Helps Least

– Avoiding problems

– Withdrawing from life

– Avoiding difficult situations

– Alcohol, tobacco, caffeine

– Constantly seeking solutions – asking ‘why?’

– Living in fear of panic

– Believing we’re seriously ill

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What Helps Anxiety MostWhat Helps Anxiety Most

• What Helps Most

– Facing up to our fears

– Solving our problems

– Maintaining a normal lifestyle, including work, relationships and socialising

– Learning to relax

– Finding an encouraging support network

– Not being afraid of panic (it’s just a sensation – not fatal!)

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VulnerabilityVulnerability

• We all have some vulnerability to mental health problems – the most vulnerable people are:

• People with money problems

• People out of work

• People who are bullied or stressed

• People who live alone, are divorced or without friends

• People whose early lives were unpredictable or contained violence, confusion or neglect

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StigmaStigma

• When people see others as ‘different’, they may distance themselves from them, not want to be associated with them, even avoid them

• This can set up a vicious circle where it becomes easier to ‘label’ people as ‘weak’ or ‘bad’ than listen or try to understand

• People can be seen as ‘outsiders’ by others, and become misunderstood, made fun of or called names

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ShameShame

• People who are stigmatised in such a way can feel low self-esteem and shame – they can begin to feel sensitive to people judging them. Feelings of shame are different to feelings of guilt - we might feel guilty about something we have done

• Shame is more about who we are, we can ‘take inside’ the judgments other people make of us (or imagine they make of us) and come to feel bad, unworthy, or ashamed of who we are

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Am I Normal?Am I Normal?

• There will sometimes be an obvious reason for feeling unwell, sometimes not. There is usually more than one reason, which may be different for different people. The reason may seem obvious - disappointment, frustration, losing something or someone important. However, sometimes it isn’t clear why we feel depressed, stressed or anxious - either to ourselves or to anyone else

• We don’t know for sure how many people suffer from anxiety and depression – many people ‘suffer in silence’

• Some studies suggest the majority of people have anxiety or depression at some point in their lives

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Getting HelpGetting Help

• Your GP (maybe a counsellor or specialist)• Your CMHT• Local voluntary or self-help group• National and local resources on the Internet• Telephone resources (helplines)• Talking to friends and family• Reading

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Session 1 SummarySession 1 Summary

• Stress



• What Helps Most & What Helps Least


• Getting Help

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During Session Two We Will...During Session Two We Will...

• Examine the link between what we think, how we feel and what we do

• Learn to recognise unhelpful thoughts

• Learn how to challenge unhelpful thoughts

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Take-Home MessageTake-Home Message

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Stress, sadness and despair are

common experiences for many of

us – the uncomfortable truth is that

we are all responsible for learning

to manage our thoughts, feelings

and emotions

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End of Session 1End of Session 1

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FoundationProgramme Session 2

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Programme OverviewProgramme Overview







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ContentsContents

• Recap from Session 1 • The ‘four buttons’• The thought /emotions connection• The thoughts / physical feelings connection• The thought / behaviour exercise• Challenging negative thoughts• Challenging negative thoughts• What is a thought and what is a belief?• Unhelpful beliefs• Conclusion

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Recap - What We Did Last SessionRecap - What We Did Last Session

• Stress



• What Helps Most & What Helps Least


• Getting Help

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OverviewOverview

• Our thoughts, emotions, physical sensations and our behaviour all

affect one another

• We will look at how changing one of these areas can help bring

about change in all of them

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The ‘Four Buttons’The ‘Four Buttons’

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• What we do (‘behaviour’), what we think (‘cognitions’), what we

feel (emotions) and the physical feelings we have in our bodies

(sensations) all interconnect and influence one another…

• For example, what we think about affects our emotions, the

feelings in our bodies, and can alter how we behave

• The good thing is, when we change one thing, we begin to change

them all!

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The ‘Four Buttons’The ‘Four Buttons’

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Physical Signs of DepressionPhysical Signs of Depression

Physical or body symptoms

• Tiredness

• Restlessness or agitation

• Sleep problems

• Feeling worse at a particular time of day (often the morning)

• Changes in weight, appetite and eating habits

• Lack of energy (motivation to do things)

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EmotionsEmotions

Emotions

• Feeling sad, irritable, guilty, numb, despairing

• Losing interest or enjoyment in things (‘anhedonia’)

• Crying a lot, or being unable to cry when a sad event occurs

• Feeling alone even when you’re in company

• Feeling angry about the slightest thing

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ThinkingThinking

Thoughts

• Losing confidence in yourself

• Expecting the worst and having negative or gloomy thoughts

• Thinking that everything seems hopeless

• Thinking you hate yourself

• Poor memory and concentration

• Believing that, if bad things happen, it is because of ourselves

• Believing that, if good things happen, it’s down to luck

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What We Do…What We Do…

Behaviour

• Having difficulty making decisions

• Can’t be bothered to do everyday things

• Putting things off

• Not doing the things you used to enjoy

• Moping

Are there any other emotions, physical / bodily signs, thoughts or behaviours you experience?

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Events

Physical Feelings

Emotions

Thoughts

Behaviour

Influences

Leads to

Leads to

Results in

Influences

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Relationshipbreak-up

Tiredness, lethargyTension, aches & pains

DepressionAnger

I must be worthlessI’ll never find anotherI’ll be lonely for therest of my life

Moping, slowed downAvoidance, tearful

Influences

Leads to

Leads to

Results in

Influences

Depressive response

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Relationshipbreak-up

More relaxed

Sadness, normal griefacceptance

I feel sad but I can copeWe were just differentI am not without value

Socialising,Optimistic behaviour

Forward planning

Influences

Leads to

Leads to

Results in

Influences

Neutral response

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BeliefsBeliefs

• Thoughts pass fairly quickly through our minds. A belief is a thought we hold to be true for a longer period. We rarely question our beliefs, as we come to believe our identity is linked up to them. Some beliefs are central to our sense of self and are called ‘core beliefs’

• We have core beliefs about ourselves, other people and life itself

• Our core beliefs influence our thoughts, which in turn influence our emotions, our physical feelings and the way we behave

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How to Identify an Unhelpful BeliefHow to Identify an Unhelpful Belief

• Unhelpful beliefs are often full of words like: ‘MUST’, ‘SHOULD’,

‘OUGHT’, ‘CAN’T’

• Can you think of any unhelpful beliefs you might have?

• Are there any more helpful beliefs you could update them with?

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Examples of Unhelpful Beliefs (1 of 2)Examples of Unhelpful Beliefs (1 of 2)

Some beliefs are unhelpful, because they make us feel bad, or hold us back in some way. Think about the following – do you have any similar beliefs?

1. Everyone should always love and approve of me

2. I should always be able, competent and successful

3. It’s terrible and very disturbing when things don’t go my way

4. Bad luck (or other factors outside my control) cause my unhappiness

5. I should worry all the time when things don’t go well

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Examples of Unhelpful Beliefs (2 of 2)Examples of Unhelpful Beliefs (2 of 2)

6. It is easier to avoid difficult situations than it is to face up to them

7. I need someone to be with and to lean on

8. I can’t do anything about my problems as I’ve had them a long time

9. When friends have problems it’s only right that I get upset too

10. I don't like the way I feel but I can't help it. I just have to accept it

11. I know every problem has a solution and I should be able to find it

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Challenging Our Thoughts, Feelings, Emotions Challenging Our Thoughts, Feelings, Emotions and Behavioursand Behaviours

• We all have ‘negative thoughts’ from time to time. Negative thoughts are stronger and last longer when we’re low, anxious or stressed

• We can challenge negative thinking by thinking carefully about our thinking, noticing changes within ourselves or perhaps checking our thinking with someone else

• It’s a good idea to find a way to distract ourselves from unhelpful thoughts and feelings of anxiety

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How to Change Our Minds!How to Change Our Minds!

• Distraction – find something more interesting to think about! Thoughts have ‘charm’ – some capture our attention more readily than others!

• Thought stopping – Shout to oneself – STOP!• Mindful Noticing – attend to our experience without judging –

accept and let go, which is a skill and can be a lot harder to do than it might sound

• Talking – letting someone else know what we’re thinking• Checking our thoughts with others – am I right to think this way?

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• Our thoughts, emotions, physical sensations and our behaviour all

affect one another

• We saw how changing one of these areas can help bring about

change in all of them

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During Session Three We Will...During Session Three We Will...

• Learn about change

• Examine the importance of having clear goals

• Think about having a personal action plan

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It’s not events that directly cause

our emotions, but our thoughts

about the event and the beliefs

that we have about it that shape

our feelings, our emotions and our

behaviour

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69


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• The ‘four buttons’• The thought /emotions connection• The thoughts / physical feelings connection• The thought / behaviour exercise• Challenging negative thoughts• Challenging negative thoughts• Thoughts and beliefs• Unhelpful beliefs

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During Session Three We Will...During Session Three We Will...

• Learn about change

• Examine the importance of having clear goals

• Think about having a personal action plan

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Making ChangesMaking Changes

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Thinking About ItThinking About It

Stage 1 (Precontemplation)• People at stage one have not yet thought about the possibility of

change. They may not believe there to be a problem at all. They may be relatively comfortable with how things are

Stage 2 (Contemplation)• People at stage two are thinking about change, but are not convinced

that they may need help. Perhaps they are unsure or even frightened to change. People at stage two often feel more uncomfortable than those at stage one (who may be in denial)

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Thinking About ItThinking About It

Stage 2 (continued)• They may realise a problem exists but perhaps believe things can’t be

changed• They may have convinced themselves that their problem isn’t worth

dealing with, or that there’s nothing they can do about it themselves• They may also be weighing up the costs and the benefits of change. We

use the term ‘decisional balance’ to describe the way people work out how changing something might benefit them and how much work and upheaval it might cause. Our motivation and our commitment to change are influenced by our decisional balance

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Preparing For ItPreparing For It

• Stage 3 (Preparation)• People at stage three are firming up their decision to change. They may

have made specific plans to do something. Maybe they have made an appointment to speak with a therapist, or have set a start date from which they will begin making changes

• They have made a resolution to start. When we’re at this stage we often feel a little better because we have a plan and have taken some positive steps towards recovery

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Doing ItDoing It

Stage 4 (Action)• We start to take some direct steps towards changing• We sometimes use the term ‘self-efficacy’ to describe a person’s

confidence and belief in their ability to recover• Self-efficacy is a strong predictor of success in stages four and five

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Maintaining ItMaintaining It

Stage 5 (Maintenance)• Changes become easier and our commitment grows with each success.

Our sense of mastery and pleasure increases. Our sense of hope increases, and we may begin to feel more optimistic

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Lapse and RelapseLapse and Relapse

Stage 6 (Lapse)• It’s to be expected that from time-to-time we may feel worse and that

the symptoms you thought had gone for good may return • Don’t despair! It’s accepted and understood that recovery doesn’t

guarantee that each day you’ll feel better than the last• Overall, recovery means we feel better as time passes, but for small

periods our recoveries are made up of disappointments and setbacks, as well as celebrations and successes. This is an absolutely normal part of recovery!

• Each return to our symptoms gives us the opportunity to learn more and to deal with our challenges again in healthy ways

• Over time our symptoms tend to reduce in intensity and return less frequently

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Success!Success!

Stage 7 (Success)• Success! After a good deal of work, and maybe some heartache as well

as triumph, you find ways of managing your symptoms. You become able to stay free from anxiety and depression, even when the going gets tough – you become increasingly ‘stable under stress’

• Of course, this isn’t all as straightforward as it might seem. One day you may feel as though you are at stage one and the next day something happens which makes you feel more determined, and you feel as though you’re at stage three

• It’s quite normal to feel uncertain about change; the process can involve switching between ‘good days’ and ‘bad days’ and back again many times before you completely overcome your symptoms

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Motivational Balance (1 of 2)Motivational Balance (1 of 2)

• First decide what you would like to change e.g. ‘I would like to start meeting up with my friends again’

• Then think about:

– What am I likely to gain by making this change?

– What might making the change ‘cost’ (in the broadest sense)?

Example:

a) Gain by making the change b) ‘Cost’ of the change

Meeting old friends Facing up to the fear of public places, possibly having a panic attack, outside ‘comfort zone’

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Motivational Balance (2 of 2)Motivational Balance (2 of 2)

• Think about what you’d like to change

• Then think about what you’d have to do to bring about this change

• If change was simple and easy, we would do it automatically

• Change brings around disruption and can be stressful and time consuming

• If making the change would cost you too much, you may not have enough motivation to change

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Time for a Break Before We Talk About GoalsTime for a Break Before We Talk About Goals

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Why Are Goals Important?Why Are Goals Important?

• Because when we start to think about goals, we form a picture in

our minds of how we would like things to be

• This picture gives us something to aim for, and distracts us from

more pessimistic thoughts

• Our goals should be SMART - that is, Specific, Measurable,

Achievable, Realistic and Timely

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Setting ‘SMART’ Goals (1 of 4)Setting ‘SMART’ Goals (1 of 4)

Specific • Making your goal specific makes it easier to achieve. For instance, ‘I

want to have more ‘me’ time’ is too general to achieve easily. A more specific goal e.g. ‘I want to have half an hour to myself every day’ should make it easier to plan and to get support

Measurable • It’s useful to make a goal measurable so we can assess at different

points how close we are to achieving it. For instance, instead of saying ‘I want to lose weight’ we could say ‘I want to lose half a stone within three months’. Much more measurable!

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Achievable • To be achievable, your goals should be within your capabilities or

resources. It’s important to keep your goals achievable so you don’t inadvertently set yourself up for failure. For instance, the goal of getting a new house may not be within your budget, but a more realistic goal may be to improve on your current house by doing some work yourself, asking friends to help or asking the bank for a realistic loan to carry out some work

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Realistic• Again, it’s important for your goal to be realistic so you don’t set

yourself up for failure. However, the goal should ‘stretch’ you in some way, so you have a sense of achievement once it has been reached. For example, being a professional footballer may be a bit beyond your reach if you’re 40 years old and have a young family. However, it may be realistic to aim to become a player for one of the teams in your local league

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Timely• Setting a timeframe within which the goal is to be achieved spurs

you on to start acting NOW and helps you to set review points along the way. For instance, if you have given yourself a year to achieve your goal, you could review it at monthly intervals to make sure you stay on track

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Goal Setting ExerciseGoal Setting Exercise

• Think about a SMART goal that’s meaningful for you

• The facilitators will be on hand to help if needed

• Write it down if you want to, this could be the first step in identifying your recovery plan!

• Talk with your facilitators if you want to discuss your goals, or bring them along to your post-group interview if you would like to take this work further…

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• We looked at importance of having clear goals

• And the importance of having a personal action plan

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During Session Four We Will...During Session Four We Will...

• Examine Panic, Anger, Futility and other Strong Feelings

• Learn how to deal better with strong feelings

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93

Goals help keep us focused on

what we want to achieve

Action plans provide a road map to

our destination

Without goals or a plan we can

feel ‘out of control’ or aimless

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ContentsContents

• To recap on session 3

• To understand the nature of strong feelings

• To learn ways of dealing with strong feelings

• To learn about grounding

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Strong Feelings?Strong Feelings?

• What are strong feelings?

• An experience made up of thoughts, emotions and physical sensations with an associated pattern of behaviour, in which we feel overwhelmed or extremely uncomfortable, and which we may feel powerless to change

• These feelings may be of anger, sadness, fear, panic, shame, jealousy or outrage

• What other strong feelings may we have?

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What Helps Us Deal With Strong Feelings?What Helps Us Deal With Strong Feelings?

• Noticing them, not denying them

• Accepting they can be a normal and natural part of life

• Learning to express them safely

• Understanding them (what they mean for us)

• ‘Counting to ten’

• Mindfulness, relaxation and meditation

• Noticing the times we feel differently

• Learning to talk about our feelings

• Exercise

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What Doesn’t Help?What Doesn’t Help?

• Denying our feelings

• Telling ourselves it’s ‘wrong’ or ‘abnormal’ to feel the way we do

• Acting on our feelings without thinking

• Blaming others for the way we feel

• Trying to suppress our emotions

• Isolating ourselves

• Using drugs or alcohol to cope with our feelings

• Withdrawal from sources of support, avoiding situations

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Dealing with PanicDealing with Panic

• Two ways– learning to manage our feelings

– Learning to manage panic attacks

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Learning to Manage our FeelingsLearning to Manage our Feelings

• Learning to manage our feelings by …

• Accepting them, even welcoming them (we intensify feelings we resist)

• Practicing diaphragmatic breathing

• Practicing physical relaxation

• Staying in the ‘here and now’

• Watching what we think (not predicting catastrophes, noticing and remembering our successes)

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Learning to Manage Panic AttacksLearning to Manage Panic Attacks

• Learning that we are in control of, and can deal with panic attacks – REALLY learning this in our hearts! So that we are not afraid of fear itself

• Learning to think and breathe slowly through panic

• Putting ourselves in situations where we might panic, and making use of support to help us through

• Watching what we think (knowing and remembering that we can cope!)

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Dealing with Sadness and Despair (1 of 2)Dealing with Sadness and Despair (1 of 2)

• Knowing – REALLY knowing – that sadness is different from depression

• Learning to stay with our feelings in a safe way

• Knowing when despair can put us at risk and getting support when we need it

• Being with someone who knows us well, so they can arrange help if we can’t / don’t realise we need help – making a ‘contract’ with someone who can help us

• The importance of ‘doing things’ – exercise and ‘sorting things out’ around the house and in work

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Dealing with Sadness and Despair (2 of 2)Dealing with Sadness and Despair (2 of 2)

• The time we feel least like getting up and doing something is the time we’re most likely to need to!

• Knowing what sadness and despair mean for you – what is it you need?

• Developing an answer to the question ‘what’s the point?’ – pretty much the only time we ask ourselves is when we’re feeling low, when we’re least likely to be able to come up with an answer

• Having a plan in place about what to do when we’re low – more about this in a later section

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Dealing with Angry FeelingsDealing with Angry Feelings

• Counting to 10 – anger rises quickly and fades quickly

• Anger that sticks around is more likely resentment – ask yourself – what is it I need to let go of my resentment?

• Anger means you want something to change – what is it you want to change? What are you going to do to bring about that change?

• Physical exercise as an outlet

• Avoid dwelling on fantasies of violence or revenge

• Violence is a sign of weakness – it takes real strength to feel great anger, to let it go and to move on

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Dealing with Futility and HopelessnessDealing with Futility and Hopelessness

• Futility and hopelessness can arise when we feel unable to make a difference to our suffering (or that of others)

• Small differences are important – make one small difference to someone today!

• Consider it your mission to answer the ‘what’s the point’ question for yourself

• Don’t become isolated, have at least one optimistic conversation each day

• Are you at risk from futility and hopelessness? Make a plan to rediscover your hopefulness and do something positive TODAY!

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Dealing with Guilt and ShameDealing with Guilt and Shame

• Guilt may be about something we’ve done (or not done) while shame is more about who we believe ourselves to be

• We may need to make reparations and seek forgiveness (from others – and ultimately from ourselves)

• Or guilt maybe a habit we’ve gotten into …

• What we need to do depends on whether our guilt is a ‘thinking habit’ or about something for which we genuinely need to make amends

• Shame is maintained by secrets – to feel less ashamed we need to let others know about ourselves

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Grounding (1 of 4)Grounding (1 of 4)

• And now a grounding exercise …

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Grounding - Stage 1 - The World Around YouGrounding - Stage 1 - The World Around You

• Grounding has 3 simple stages …

• Notice what you can see, hear, feel (touch), smell and taste

• Simply allow yourself to notice things around you, first through your eyes, then your ears, then through your skin, and finally through your senses of smell and taste

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Stage 2 - The World Within YouStage 2 - The World Within You

• Repeat the process, but simply notice experiences within yourself. Start by imagining yourself looking inside your body – what can you see? Lights, colours, images?

• Simply notice these things, don’t dwell on them or analyze them, just notice them. When you have done this, listen to the inside of your body – what can you hear? Transfer your attention to your sense of touch. What is your body touching? What is touching you? Become aware of physical sensations both inside your body and of anything pressing against your skin, then become aware of any smells or tastes you notice from inside of yourself

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Stage 3 – Inside and OutsideStage 3 – Inside and Outside

• The final stage of the meditation is to notice experiences and events outside of yourself and sensations and experiences within you, at the same time - this can feel a little strange at first but it becomes easier with practise

• When we become fully aware of both things within, and things outside of ourselves, we are in the ‘here and now.’ From this place of internal and external awareness, depression has no place to take hold

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113

Feelings come – and go – like

waves. The trick is to keep

thinking while having strong

feelings, to stay in the ‘here and

now’ & to understand that even the

strongest feelings pass with time

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ContentsContents

• Healthy Relationships• Communication• Ineffective Communication/ Effective Communication• Relationships and belonging

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• Understanding the nature of strong feelings• Learnt ways of dealing with strong feelings• Learnt about grounding

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Relationships (1 of 2)Relationships (1 of 2)

• Every day we interact with a variety of people. Our behaviour changes slightly when we interact with others depending on the relationship with that other person

• How we act is influenced by what is expected of us in each and every relationship we have. Our family may expect us to act in one way; friends may expect us to act in another

• Relationships vary between different people and different groups of people

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Relationships (2 of 2)Relationships (2 of 2)

• Relationships are important because they provide us with a sense of belonging. Being in a relationship is a journey of discovery

• Our relationships are always changing. Relating to another person means we have the opportunity to explore and discover who we truly are

• Previous experiences, our own values and beliefs and our upbringing may influence our relationships with others

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CommunicationCommunication (1 of 2)(1 of 2)

• You can’t have a relationship with someone without communicating with them

• Communication involves almost every aspect of our interactions with others; for this reason, communication and relationships are inseparably connected

• Communication involves how we express our thoughts, ideas and feelings to others, including what we say and how we say it

• Emotions can be difficult to communicate. Our language frequently fails us especially when our emotions are strong. When we’re feeling emotional it can be quite difficult to communicate with others

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Communication (2 of 2)Communication (2 of 2)

• Everything we do in the company of others communicates something

• When we communicate with others, we also communicate attitudes, values, priorities and beliefs. It can be spoken or non-spoken

• No matter what we actually say in words, we also send messages with non-verbal communication – gestures, tone of voice, our facial expressions and our attitude

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Ineffective CommunicationIneffective Communication

• Indirect – doesn’t get to the point, doesn’t state purpose or intention

• Passive – timid and reserved• Antagonistic – angry, hostile• One way – over-talking not listening• Unresponsive – shows little interest or the needs of others• Hidden – true agenda is never stated

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Effective CommunicationEffective Communication

• Direct – to the point, leaving no doubt as to the meaning• Assertive – not afraid to state what is wanted or why• Open – No hidden messages or meaning• Verbal – words are used to clearly express ideas• Two way – equal amounts of talking and listening• Responsive – attention paid to the needs and perspective of others• Honest – true feelings, thoughts, and needs are stated

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BelongingBelonging

• We all need to belong to something – we already belong to many groups, but we forget and can feel isolated

• We all need a spiritual connection, a ‘higher purpose’ from which a sense of belonging comes – do you have one?

• How many people do you feel close to? How many do you want to feel close to?

• When we want to feel close to and understood by others, we must start by working to understand other people, we need to work to ‘belong’ to others. Work to improve your relationships with a small number of people. Who will that be?

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SummarySummary

• What we say and do, and how we say and do it, directly shapes how people see us

• The opinions people form about us are based on the way we interact with each other

• Communication is a two way street• Our emotions can affect the way we interact with each other

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ContentsContents

• What does it mean to be ‘well’• The lethargy spiral• Exercise and inactivity• Eating well• Sleeping well• Relapse• Balancing energy

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WellnessWellness

• To ‘live well’ does not mean being happy all of the time. It does mean that we can think about, feel and react to events around us as they happen, without being overtaken by our reactions to memories of things that happened in the past, or by ‘black moods’ that change the way we see things

• To a large extent, being well involves living in the ‘here and now’

• The ‘Grounding Meditation’ helps us live in the ‘here and now’ and deal with strong or unpleasant feelings

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The Lethargy Spiral (1 of 2)The Lethargy Spiral (1 of 2)

• Our thoughts and our mood influence what we do. What we do also, in turn, influences our mood and our thinking

• When this influence is positive, we achieve more and feel better, when negative, we can enter a downward spiral

• The good news is we can break the spiral by:

– Changing what we do

– Changing what we think

– Changing our outlook

– Some of these are harder to do than others!

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BehaviourBecome less active

Avoid situationsAvoid people

MoodFeel discouragedFeel inadequateFeel worthless

Feel guilty

ThoughtsThere’s no point trying

What’s the pointI can’t be bothered

The Lethargy Spiral (2 of 2)The Lethargy Spiral (2 of 2)

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Feeling Low Can Cause a Vicious SpiralFeeling Low Can Cause a Vicious Spiral

• Choose a partner and talk about / or think about how negative thoughts affect your mood

• …About how this causes your body to feel?• …About how this affects your activity levels?• Do you then carry on doing the things you used to?• If you stop doing the things you used to do, how does this change the

enjoyment or satisfaction you get from life?• What effect does this have on your confidence, your mood and your

thoughts?

Example on next slide…

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The Depression / Inactivity Vicious SpiralThe Depression / Inactivity Vicious Spiral

• Negative thoughts can make us feel miserable and discouraged• Which can make us feel slowed down and tired• So we may be less inclined to be active• So we may do fewer things and start avoiding situations• Which reduces our chances of having good experiences that could

have led to positive thoughts• So our confidence sinks lower, which may lead to more negative

thoughts and low mood• And we do even fewer things and become less active• And so the cycle goes on...

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ExerciseExercise

• Staying well requires both physical and psychological well-being - our minds and our bodies are closely linked, to be truly well we must be physically healthy as well as healthy in our minds

• We recommend you begin a programme of gentle exercise, if you haven’t already done so - exercise helps us feel better about ourselves, and helps our brains work better

• Only begin a programme of exercise after speaking with your doctor, especially if you haven’t exercised for a while, or if you have any physical problems

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Tips for ExercisingTips for Exercising

• Choose an exercise that’s fun

• Start small – increase in gradual steps – don’t overdo it!

• Some people prefer to exercise alone, others prefer the support of a group and find other people help them stay motivated

• Make exercise a healthy habit – exercise regularly, three times a week for 10 - 20 minutes each time to begin with. If we do this for a month, we’ll get used to feeling better. Then we can increase this to exercising a little more each day. People who exercise regularly for a month feel better and are more likely to continue exercising than those who only exercise from time-to-time

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Tips for Eating WellTips for Eating Well

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Eating a healthy diet is very important

See the next slide for some suggestions

about healthy diet …

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Tips for Sleeping Well (1 of 2)Tips for Sleeping Well (1 of 2)

• Adopt a bedtime routine - relax, take a bath, read, build in a quiet period before bedtime, a milky drink at night time can help us get off to sleep - get up at about the same time each day

• Avoid ‘catnapping’ during the day

• Avoid eating heavily before bedtime

• Avoid tea, alcohol, coffee, and any soft drinks containing caffeine

• If you can’t sleep, get up and do a few simple jobs, then return to bed when you’re sleepy, don’t worry about not sleeping

• Lavender, hops, camomile and peppermint can all help promote sleep

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Tips for Sleeping Well (2 of 2)Tips for Sleeping Well (2 of 2)

• Make sure your bedroom is as peaceful and restful as possible, avoid using your bedroom for anything other than sleep and lovemaking

• Regular moderate exercise and exposure to natural daylight helps us sleep too, so out-of-doors exercise is a good thing

• Stop smoking - smokers find it more difficult to sleep and wake up more often in the night

• Take more exercise - regular, moderate exercise such as swimming or walking can help relieve the day's stresses and strains - but not too close to bedtime or it may keep you awake

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Suggestions for Exercising …Suggestions for Exercising …

• A brisk walk

• Aerobic exercise

• Cycling

• Gardening

• Swimming

• Walking to the shops

• Walking up and down stairs

• Yoga

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RelapseRelapse

• Relapse means feeling worse temporarily, relapse is a normal part of recovery - Relapse does not mean we’re back to square one again

• The things we’ve learnt and the skills we’ve gained in dealing with our thoughts and our feelings mean we can recover from relapse more quickly than we once would have done, and that the intensity of each relapse may well be less than the one before it

• We must remember to be gentle with ourselves – should our symptoms return we should just accept them as a normal part of our recovery process, without judging ourselves to be weak or despairing about our progress

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Early Warning Signs (1 of 2)Early Warning Signs (1 of 2)

• Feelings of physical pain

• Feeling slowed down

• Increasing worry

• Increased conflict and arguments with friends and family

• Feeling ‘got at’

• Difficulty in falling asleep or staying asleep, waking up early

• Difficulty in concentrating

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Early Warning Signs (2 of 2)Early Warning Signs (2 of 2)

• An increase in drinking alcohol and smoking

• Losing weight

• Frequent tension headaches

• Feeling bad in the morning

• Asking ‘what’s the point’?

• Avoiding social situations

• Feeling unable to deal with problems

• Feeling everything’s too much trouble

Are you aware of any other ‘early warning signs’?

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Example Relapse SignatureExample Relapse Signature

1. Feeling tired

2. Waking early

3. Finding things pointless

4. Becoming preoccupied with worries

5. Staying in bed

2

1

3

4

5Depression

146

Feeling tired

Waking early

Finding things pointless

Becoming preoccupied with worries

Staying in bed

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Early Warning Signs ExerciseEarly Warning Signs Exercise

• Talk about your own ‘early warning signs’ with a partner

and / or think about your own

‘early warning signs’

147

2

1

3

4

5

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My Contingency PlanMy Contingency Plan

• A contingency plan is a series of things to do should things not work out as you had hoped

• It’s wise to prepare should things go wrong - contrary to superstition, planning what you’ll do if there’s a problem doesn’t make bad things any more likely to happen!

• Why not talk with a partner / think about some of the things you could do – there’s a list on the next slide to give you some ideas …

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Balancing EnergyBalancing Energy

• Here’s a useful way of thinking about the amount of energy we take in, and the amount we give out – see handout and next slide for details …

• Take a typical day and use the chart to help you identify times when you feel as though you’re giving out, or taking in, energy. Take a look at any patterns there might be. Consider whether over the day you’re taking in more, giving out more, or whether overall ‘energy in’ balances ‘energy out’

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Balancing EnergyBalancing Energy

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SummarySummary

• What does it mean to be ‘well’• The lethargy spiral• Exercise and inactivity• Eating well• Sleeping well• Relapse• Balancing energy

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What We Did …What We Did …







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Congratulations!Congratulations!

• Thank you very much for taking part!

• Questions and next steps …

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Anxiety and Depression Foundation Programme - Session 1

Documents

Transcript of Anxiety and Depression Foundation Programme - Session 1