Foundation Programme for Anxiety and Depression: Understanding, Managing, and Healing

1. Anxiety and Depression Foundation Programme - Session 1 1 2 3 4 5 6 1 1 2 3 4 5 6

2. Contacts SERENE.ME.UK/HELPERS #SERENITYPROGRAM SERENITY.PROGRAMME serene.me.uk/helpers/#SERENITYPROGRAMfacebook.com/serenity.programme This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.

3. 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) ... 1 2 3 4 5 6 3 1 2 3 4 5 6

4. Housekeeping • In case of fire! • Taking a break • Groundrules • Anything else? 1 2 3 4 5 6 4 1 2 3 4 5 6

5. 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 1 2 3 4 5 6 5 1 2 3 4 5 6

6. 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! 1 2 3 4 5 6 6 1 2 3 4 5 6

7. Session 1 Contents • What is Stress? • Sadness and Depression • Fear and Anxiety • What Helps Most & What Helps Least? • Stigma and Shame 1 2 3 4 5 6 1 2 3 4 5 6

8. Stress 1 2 3 4 5 6 1 2 3 4 5 6

9. 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 • We expect our stress to reduce when we things get better ... 1 2 3 4 5 6 1 2 3 4 5 6

10. 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 1 2 3 4 5 6 1 2 3 4 5 6

11. What is Stress? Yerkes - Dodson Curve (3 of 4) • Some stress helps us perform some tasks better ... 1 2 3 4 5 6 1 2 3 4 5 6

12. 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 1 2 3 4 5 6 1 2 3 4 5 6

13. 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 1 2 3 4 5 6 1 2 3 4 5 6

14. The Stress Bucket 1 2 3 4 5 6 1 2 3 4 5 6

15. Depression and Sadness 1 2 3 4 5 6 1 2 3 4 5 6

16. Depression and Sadness Differences Between Sadness and Depression When Does Sadness Become Depression? Recognizing Depression What works well and what doesn’t 1 2 3 4 5 6 16 1 2 3 4 5 6

17. 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 1 2 3 4 5 6 17 1 2 3 4 5 6

18. 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 1 2 3 4 5 6 18 1 2 3 4 5 6

19. 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 1 2 3 4 5 6 19 1 2 3 4 5 6

20. 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 1 2 3 4 5 6 20 1 2 3 4 5 6

21. 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 … 1 2 3 4 5 6 21 1 2 3 4 5 6

22. 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 1 2 3 4 5 6 22 1 2 3 4 5 6

23. 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 1 2 3 4 5 6 23 1 2 3 4 5 6

24. 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 1 2 3 4 5 6 24 1 2 3 4 5 6

25. 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 1 2 3 4 5 6 25 1 2 3 4 5 6

26. 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 1 2 3 4 5 6 26 1 2 3 4 5 6

27. 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 1 2 3 4 5 6 27 1 2 3 4 5 6

28. What Helps Depression Most • What Helps Most • Mindfulness • Exercise • Work • Helpful Relationships • Talking • ‘Sticking with it’ • Optimism and hopefulness 1 2 3 4 5 6 28 1 2 3 4 5 6

29. Anxiety 1 2 3 4 5 6 1 2 3 4 5 6

30. 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 1 2 3 4 5 6 30 1 2 3 4 5 6

31. 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 1 2 3 4 5 6 1 2 3 4 5 6

32. 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 1 2 3 4 5 6 1 2 3 4 5 6

33. 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) 1 2 3 4 5 6 1 2 3 4 5 6

34. Symptoms 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 … 1 2 3 4 5 6 1 2 3 4 5 6

35. 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 1 2 3 4 5 6 35 1 2 3 4 5 6

36. 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!) 1 2 3 4 5 6 36 1 2 3 4 5 6

37. 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 1 2 3 4 5 6 37 1 2 3 4 5 6

38. 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 1 2 3 4 5 6 38 1 2 3 4 5 6

39. 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 1 2 3 4 5 6 39 1 2 3 4 5 6

40. 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 1 2 3 4 5 6 40 1 2 3 4 5 6

41. Getting 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 1 2 3 4 5 6 1 2 3 4 5 6

42. Session 1 Summary Stress Sadness and Depression Fear and Anxiety What Helps Most & What Helps Least Stigma and Shame Getting Help 1 2 3 4 5 6 42 1 2 3 4 5 6

43. 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 1 2 3 4 5 6 1 2 3 4 5 6

44. 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 1 2 3 4 5 6 44 1 2 3 4 5 6

45. End of Session 1 1 2 3 4 5 6 45 1 2 3 4 5 6

46. Foundation Programme Session 2 1 2 3 4 5 6 46 1 2 3 4 5 6

47. 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 1 2 3 4 5 6 47 1 2 3 4 5 6

48. Contents 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 1 2 3 4 5 6 48 1 2 3 4 5 6

49. 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 1 2 3 4 5 6 49 1 2 3 4 5 6

50. 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 1 2 3 4 5 6 1 2 3 4 5 6