Transcript Foundation Programme

Anxiety and Depression
Foundation Programme - Session 1
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Foundation Programme Overview
• Session 1 – Understanding Stress, Fear and Sadness
• Session 2 – Behaviour, Emotions, Sensations and Thoughts
• Session 3 – Goals and Action Plans
• Session 4 – Panic, Anger, Futility and Other Strong Feelings
• Session 5 – Healthy Relationships – Communication and Belonging
• Session 6 – Staying Well and Healthy Living
First, a little housekeeping (next slide) ...
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Housekeeping
• In case of fire!
• Taking a break
• Groundrules
• Anything else?
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Why Treat Anxiety and 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’re 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 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 thanks’
• 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 Contents
• What is Stress?
• Sadness and Depression
• Fear and Anxiety
• What Helps Most & What Helps Least?
• Stigma and Shame
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Stress
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What is Stress? (1 of 4)
• Stress is a normal part of life
• Most of us get stressed when we have to:
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Sit an exam
Make a speech
Start a new job
Lose our job
Move house
Have relationship problems
• We expect our stress to reduce when we things get better ...
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What is Stress? (2 of 4)
• 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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What is Stress? Yerkes - Dodson Curve (3 of 4)
• Some stress helps us perform some tasks better ...
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What is Stress? (4 of 4)
• 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 – this 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 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 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 Bucket
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Depression and Sadness
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Depression and Sadness
• Differences Between Sadness and Depression
• When Does Sadness Become Depression?
• Recognizing Depression
• What works well and what doesn’t
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Sadness
• Sadness is a normal reaction to loss
• The loss may be personal, a relationship or perhaps a hope or an
expectation
• Sadness is transient, it doesn’t last very 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 and 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 futility, 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)
• Crying
• Pessimistic thoughts
• Brooding about past unpleasantness
• Preoccupation with feelings of inadequacy
• Feeling resentful, irritable, angry
• Physical symptoms not caused by physical illness
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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)
• 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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Why Do I feel Like I Do? (2 of 6)
• 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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Why Do I feel Like I Do? (3 of 6)
• 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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Why Do I feel Like I Do? (4 of 6)
• 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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Why Do I feel Like I Do? (5 of 6)
• Women may get depressed or anxious more often than men (or are
more 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,
discrimination, relationship difficulties and domestic abuse
differences between sexes
• 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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Why Do I feel Like I Do? (6 of 6)
• 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 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 Most
• What Helps Most
– Mindfulness
– Exercise
– Work
– Helpful Relationships
– Talking
– ‘Sticking with it’
– Optimism and hopefulness
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Anxiety
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Fear 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 Anxiety
• Fear is a natural reaction to something which threatens our safety.
It is a combination of a physical response; 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?
• Anxiety is a disproportionate response – our reaction is too strong
for the level of threat
• Anxiety can:
– Prevent us from enjoying life
– Getting on with work
– Affect our relationships with others
– Stop us sleeping and make us worry all the time
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Different 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 Anxiety
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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 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 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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Vulnerability
• 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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Stigma
• 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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Shame
• 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?
• There’s sometimes 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 ‘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 Help
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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 Summary
• Stress
• Sadness and Depression
• Fear and Anxiety
• What Helps Most & What Helps Least
• Stigma and Shame
• Getting Help
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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 Message
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 1
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Foundation
Programme Session 2
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Programme Overview
• Session 1 – Understanding Stress, Fear and Sadness
• Session 2 – Behaviour, Emotions, Sensations and Thoughts
• Session 3 – Goals and Action Plans
• Session 4 – Panic, Anger, Futility and Other Strong Feelings
• Session 5 – Healthy Relationships – Communication and Belonging
• Session 6 – Staying Well and Healthy Living
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Contents
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Recap from Session 1
The ‘four buttons’
The thoughts / emotions connection
The thoughts / physical feelings connection
The thoughts / behaviour exercise
Challenging negative thoughts
What ‘s a thought and what’s a belief?
Unhelpful beliefs
Conclusion
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Recap - What We Did Last Session
• Stress
• Sadness and Depression
• Fear and Anxiety
• What Helps Most and What Helps Least
• Stigma and Shame
• Getting Help
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Overview
• 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’
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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…
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For example, what we think about affects our emotions, the
feelings in our bodies, and can alter how we behave
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The good thing is, when we change one thing, we begin to change
them all!
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The ‘Four Buttons’
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Physical 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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Emotions
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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Thinking
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…
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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Influences
Events
Thoughts
Leads to
Influences
Emotions
Leads to
Results in
Behaviour
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Physical Feelings
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Depressive response
Relationship
break-up
Influences
I must be worthless
I’ll never find another
I’ll be lonely for the
rest of my life
Leads to
Depression
Anger
Influences
Leads to
Moping, slowed down
Avoidance, tearful
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Results in
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Tiredness, lethargy
Tension, aches & pains
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Neutral response
Relationship
break-up
Influences
I feel sad but I can cope
We were just different
I am not without value
Leads to
Sadness, normal grief
acceptance
Influences
Leads to
Socialising,
Optimistic behaviour
Forward planning
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Results in
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More relaxed
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Beliefs
• 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 Belief
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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)
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?
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Everyone should always love and approve of me
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I should always be able, competent and successful
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It’s terrible and very disturbing when things don’t go my way
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Bad luck (or other factors outside my control) cause my
unhappiness
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I should worry all the time when things don’t go well
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Examples of Unhelpful Beliefs (2 of 2)
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It is easier to avoid difficult situations than it is to face up to them
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I need someone to be with and to lean on
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I can’t do anything about my problems as I’ve had them a long
time
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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
and 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 We 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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Session 2 Summary
• 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...
• Learn about change
• Examine the importance of having clear goals
• Think about having a personal action plan
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Take-Home Message
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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End of Session 2
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Foundation
Programme Session 3
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Programme Overview
• Session 1 – Understanding Stress, Fear and Sadness
• Session 2 – Behaviour, Emotions, Sensations and Thoughts
• Session 3 – Goals and Action Plans
• Session 4 – Panic, Anger, Futility and Other Strong Feelings
• Session 5 – Healthy Relationships – Communication and Belonging
• Session 6 – Staying Well and Healthy Living
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Recap - What We Did Last Session
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The ‘four buttons’
The thoughts / emotions connection
The thoughts / physical feelings connection
The thoughts / behaviour exercise
Challenging negative thoughts
Challenging negative thoughts
Thoughts and beliefs
Unhelpful beliefs
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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 Changes
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Thinking 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 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 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 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 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 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!
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)
• 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:
b) ‘Cost’ of the change
a) Gain by making the change
Meeting old friends
1
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)
• 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 Goals
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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)
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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Setting ‘SMART’ Goals (2 of 4)
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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Setting ‘SMART’ Goals (3 of 4)
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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Setting ‘SMART’ Goals (4 of 4)
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 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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Session 3 Summary
• 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...
• Examine panic, anger, futility and other strong feelings
• Learn how to deal better with strong feelings
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Take-Home Message
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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End of Session 3
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Foundation
Programme Session 4
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Programme Overview
• Session 1 – Understanding Stress, Fear and Sadness
• Session 2 – Behaviour, Emotions, Sensations and Thoughts
• Session 3 – Goals and Action Plans
• Session 4 – Panic, Anger, Futility and Other Strong Feelings
• Session 5 – Healthy Relationships – Communication and Belonging
• Session 6 – Staying Well and Healthy Living
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Contents
•
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?
•
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?
•
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
•
Making time and space for self
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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 Panic
•
Two ways
–
learning to manage our feelings
–
Learning to manage panic attacks
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Learning to Manage our Feelings
•
Learning to manage our feelings by …
•
Accepting them, even welcoming them (we intensify the 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 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)
•
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)
•
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 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 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 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)
•
And now a grounding exercise …
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Grounding - 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 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 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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Take-Home Message
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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End of Session 4
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Foundation
Programme Session 5
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Programme Overview
• Session 1 – Understanding Stress, Fear and Sadness
• Session 2 – Behaviour, Emotions, Sensations and Thoughts
• Session 3 – Goals and Action Plans
• Session 4 – Panic, Anger, Futility and Other Strong Feelings
• Session 5 – Healthy Relationships – Communication and Belonging
• Session 6 – Staying Well and Healthy Living
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Contents
•
•
•
•
Healthy Relationships
Communication
Ineffective Communication/ Effective Communication
Relationships and Belonging
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Recap - What We Did Last Session
• Understanding the nature of strong feelings
• Learnt ways of dealing with strong feelings
• Learnt about grounding
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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 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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Communication (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)
• 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 nonspoken
• 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 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 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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Belonging
• 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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Summary
• 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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End of Session 5
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Foundation
Programme Session 6
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Programme Overview
• Session 1 – Understanding Stress, Fear and Sadness
• Session 2 – Behaviour, Emotions, Sensations and Thoughts
• Session 3 – Goals and Action Plans
• Session 4 – Panic, Anger, Futility and Other Strong Feelings
• Session 5 – Healthy Relationships – Communication and Belonging
• Session 6 – Staying Well and Healthy Living
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Contents
•
•
•
•
•
•
•
What does it mean to be ‘well’
The lethargy spiral
Exercise and inactivity
Eating well
Sleeping well
Relapse
Balancing energy
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Wellness
• 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)
• 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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The Lethargy Spiral (2 of 2)
Thoughts
There’s no point
trying
What’s the point
I can’t be bothered
Behaviour
Become less
active
Avoid situations
Avoid people
Mood
Feel discouraged
Feel inadequate
Feel worthless
Feel guilty
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Feeling 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 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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Exercise
• 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 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 Well
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)
• 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)
• 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
•
A brisk walk
•
Aerobic exercise
•
Cycling
•
Gardening
•
Swimming
•
Walking to the shops
•
Walking up and down stairs
•
Yoga
What else can you think of?
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Relapse
• 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)
• 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)
• 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 Signature
1. Feeling tired
2. Waking early
3. Finding things pointless
4. Becoming preoccupied with worries
5. Staying in bed
Staying in bed
5
Becoming preoccupied with worries
4
Finding things pointless
3
Waking early
2
Feeling tired
1
1
2
Depression
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Early Warning Signs Exercise
• Talk about your own ‘early warning signs’ with a partner
and / or think about your own
‘early warning signs’
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My 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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Things To Do …
Here’s a list of things some people do to help get you started:
• Contact your GP | Contact your Psychiatrist | Contact your mental
health professional | Contact a user group | Think! | Contact the
Samaritans | Take exercise | Meditate | Begin a course | Talk to a
friend | Practise breathing exercises | Do the grounding meditation
| Go for a walk | Do something you enjoy | Practise or learn yoga or
tai chi | Get a massage | Take a bath | Do some gardening | Make
plans to do something enjoyable | More …
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Balancing 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 Energy
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Summary
•
•
•
•
•
•
•
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 …
• Session 1 – Understanding Stress, Fear and Sadness
• Session 2 – Behaviour, Emotions, Sensations and Thoughts
• Session 3 – Goals and Action Plans
• Session 4 – Panic, Anger, Futility and Other Strong Feelings
• Session 5 – Healthy Relationships – Communication and Belonging
• Session 6 – Staying Well and Healthy Living
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Congratulations!
• Thank you very much for taking part, and for your commitment to
being here!
• Questions and next steps …
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