The Stress Umbrella

'Change the way you think'

After my anxiety stepped up to a new notch of feeling shaky every day and wanting to avoid going to work I knew I needed a little bit more help. I went to the GP and told her how bad I was feeling. She referred me to a service in my area run by Leeds Community Healthcare Trust. Completely free on the NHS, the service offers an indispensable six week course which focuses on the stress umbrella. This features depression, anxiety, overcoming fears, sleep, medication, coping mechanisms and more. I was a little sceptical I have to say – an avid reader with two science degrees and a lot of self help books, I wondered what this course could give me that was new information.

However I cannot praise the course enough. It is divided into different modules and each come with fantastic booklets full of advice and activities to last a life time, and useful homework to apply what you have learned to your week. Every week you complete a questionnaire on how your feeling, confidentially, and this is used to assess the improvements or changes in your mood so that you can get further help where necessary and monitor yourself. This course ended with many people hanging round at the end just to sing and shout their praises. I did not know things like this existed on the NHS, but it motivated me to take hold of life by the horns again. Not only am I feeling over the moon now, but the useful pack and CD are for life, I feel I can refer back to it whenever I need!

Here I break down the course with some of my opinions about it and try to answer your potential questions as a service user.

But when could I even attend?

Leading a very busy work and life schedule I was sceptical about when I would even be able to attend. The course organisers are understanding and exceptionally flexible. There are day-time or evening sessions. When I couldn’t attend one of my Thursday night sessions due to work, they easily swapped me on to a Wednesday session who were up to the module I was up to, and there were a variety of convenient locations in Leeds, including the Cosmopolitan hotel in the heart of the city centre and West Yorkshire Playhouse, opposite the bus station with abundant transport options. If you did miss a session there was opportunity to swap, or catch up via the course booklets. However, it is best you do attend all the sessions for your own benefit. As I said, the course was invaluable to me; it gave me a magnificent boost!

Who else was going, will I have to talk?

The course is not like going to group therapy. In fact, I’d liken it most to attending a lecture or classroom lesson. Each session is around 90 minutes to two hours and always features a brain/drink/toilet/chat break of five minutes or so in the middle. There are usually two speakers so as to engage your listening further (we all know focus is near impossible for two hours of just listening!). You can further prepare for each session with the booklets given out in advance of that session, so you can get a good over-view before you attend. But you absolutely do not have to talk at any point if you don’t want to. The shy and anxious among you, please be reassured, there are barely any verbal questions asked that aren’t rhetorical, and no one has any pressure to answer anything. What you do find however is some members start to recognise each other and even make friends through the course. You also have the opportunity at any time to talk to the speakers in private about further questions. There is absolutely nothing intimidating in turning up and you are always greeted to sign in and grab a drink and weekly questionnaire then sit wherever is most comfortable by very friendly experienced faces.

Now I have to be honest, I thought in the original state I was in, “right, I need CBT, I need one-on-one therapy, it’ll cost loads, and I’ll probably need it for the rest of my life, I’m such a mess”. And so I was sceptical about attending a ‘group session’. I realise now, one of the biggest boosts was attending a group session. For a start, it shows that actually there are so many in the same boat. In fact, I could not believe how helpful that was to me or how many people kept attending. The age range was phenomenal, a perfect cross section of age, race and gender in fact. And there were no qualms in me bringing along my partner or a friend (subject to space on the week’s course). This was most helpful in fact, when I couldn’t relax at 3 am in the morning and my boyfriend would wake up and talk me through the relaxation techniques leant like a prize yoga teacher!

I must say, my problems were quite specific, relating to a couple of things that happened to me in my work life that had made me very anxious in work. I was convinced the course would be far too generic to help. How wrong I was! And, it is a tribute ironically to that old proverb ‘your problems are no worse than anyone else’s. Because while I was thinking my problems were worse, or too specific – actually the thinking cycles involved in depression, stress and anxiety are highly generic. By breaking the way I perceived past situations and upcoming problems I have successfully overcome the pessimistic and over-paranoid thinking patterns.

Course Breakdown

As I mentioned, the course is split across six weeks, and each week also comes with a matching booklet in advance with more information and activities. I have taken here the official module descriptions outlined in the invitation letter and added footnotes about my experiences from the course:

Week One: Information about stress

You will find out what stress is and what it is not, the main signs, the vicious circles that keep it alive and how Stress Control works. We will show you a video of people talking about how stress affects them. We will give you a pack to keep future course materials in and encourage you to start to apply the learning between classes.
An introduction to the stress cycle. Here you will realise how low self esteem, depression, anxiety, panic, poor sleep, anger, addictions and phobias can all be linked and feed each other in a powerful cycle. You will learn how to assess your own personal stress cycle and where the points are you can cut it! I left this class feeling so proud of myself for taking a step myself to self-recovery and also feeling so normal surrounded by so many others. You will see the cold hard facts about how many people are suffering, as well as the full room around you. You will also realise, therefore, it is not you, and you are not stuck like this, and you will learn to remove yourself from the stress so it cannot feed itself.

Week Two: Controlling your body

We get down to tackling stress in this session. You will learn how your body signs feed stress. We look at why we get stressed and how the body reacts to it. You will learn three skills – breathing, retraining, exercise and progressive relaxation and look at caffeine. There is a relaxation CD to take away and we would like you to try to start to use this regularly.

I really enjoyed this session; we learnt not only breathing strategies but physical muscle exercises for instant relaxation. We had a go at doing them as a class and also received the invaluable relaxation CD which takes about 30 minutes to complete. The tracks from the CD are also available to download as MP3 online for those who would rather play through their phones or tablets. The strategies to controlling caffeine were very useful to me as it made me aware of my intake, I’m a bit of a coca-cola and tea addict but working out what time to drink it and how to count it is beyond helpful if your prone to sleep issues, nervousness or palpitations. 

Week Three: Controlling your thoughts

You will learn how your thinking feeds stress. We will teach you ways to ‘think your way out of stress’ – first of all by ‘building the foundation– ‘Wait a minute’. Then you will learn ‘The Big 5 Challenges’ and, finally, you will learn a way to nip stress in the bud – ‘Breaking stress up’.

This is quite possible the best feature of the course. Learning to challenge thoughts. You will learn to be able to strip back nervous and sad impulses and begin to think in a clear, logical way. This will vastly improve your ability to make effective decisions, think with a clear head, and remove “tunnel vision”. The key is not to avoid difficult thoughts, but rather to acknowledge them, and challenge them with the cold hard facts. Thus you will overcome self destruction and insecurity. This aids much more than your happiness, it aids your self-esteem and self-belief. 

Week Four: Controlling your actions

This session looks at how the way we act feeds stress. You’ll learn ways to face your fears and a great skill called ‘Problem Solving’. Also we will look at why some people, who seem to be doing all the right things, still don’t get over their stress. We will then teach you how to overcome this (‘Getting out of the Safety Zone’). These skills are really useful for building up self-confidence. You might start to see the big picture in this session – seeing how all the skills you have learned so far fit together.

Again, a great thing about this session is it actually builds on your confidence to go for things. It teaches you behaviours such as avoidance, why it happens, and how to avoid it. Realising this is natural and part of the ‘fight or flight’ response will help you to realise that you are actually well evolved to avoid things. You will realise therefore the behaviour is not strange but instead how to remove yourself from it – you can overcome these feelings. You will also learn about when you’re avoiding things without realising and thus how to combat oncoming factors. This means you can nip a bout of depression in the bud before it spirals out of control.

 Week Five: Controlling your panic, using your breathing to control stress, prevention skills and Medication

Panicky feelings are part and parcel of stress. This session teaches you ways to control them. We will teach you about using your breathing to calm your body and, hence, your mind. We will also look at some great ways to prevent stress. We will look at tablets used for stress and, if you feel these may help you, how to get the best out of them.

Some really useful information here about panic attacks, how to prevent them through both breathing and productive thinking. Various medications are discussed for anxiety and depression, as well as a review of the famous herbal remedy ‘St John’s Wart’, and you can discuss what drugs are incompatible with each other or suit your other problems best.

 Week Six: Controlling your sleep, Wellbeing and Controlling your future

Poor sleep is often a result of stress. It also keeps stress going as you don’t recharge your batteries. So, in this session, we will look at skills to help you get a good night’s sleep. Wellbeing starts the final set of skills as we look at ways of staying on top of stress.

Learning to completely re-set your sleep patterns is invaluable. I used to have every issue; bad dreams, waking at all hours, restlessness, oversleeping, messed up patterns. When I went into shift work this was even more compounded by my ongoing anxiety. The most useful tips in this session are those that teach you how to make your bed a haven for sleep and how to re-set your cycle so you can get back on track. However by this point, you may have found your problems significantly diffused! And to finish there is an overall summary of everything covered, further advice for moving forwards and a plan for further actions with the service and beyond. 

What happens after?

So what happens to you after you complete this course? Well, there is absolutely the option to re-attend any session if you need. But further to that there is the option to go on to one-to –one help if required, and you will have built up a collection of useful information, numbers and websites through the course. If your questionnaires still rate you as at any risk to yourself or your scores are still quite high for depression or your life is being affected you will be automatically rung for a further discussion.

How do I get on to this service?

This service is run by Leeds IAPT. The service is part of the national Improving Access to Psychological Therapies (IAPT) programme – see www.iapt.nhs.uk for more details.

You will need to initially give your details over the phone (number at the end of this blog). You will then be emailed your initial questionnaire. Complete this in your own time and then you ring the service and go through it with them in a bit of detail. This initial screening can take up to an hour but there is an option to visit face to face if you would prefer. This will assess if the course is suitable and fully register you to the service. You can then discuss which sessions you can attend. The service also sends you useful text messages before each session to remind you of the time and location.

Summary

An absolutely fantastic course which is perhaps deserves more promotion. I hope it will successfully undergo re-tender and grow. I wish that people were more aware this time of thing existed. When I first went to my GP I thought I was going to be fighting on my own for a very long time. The course as successfully inspired me to continue to pursue my goals of becoming a teacher, beating past bad experiences and difficulties. I know where ever I go in my life or career this course is invaluable and in fact I would teach it to my staff/ students/ pupils if I was ever in the position to do so. I think if you’ve ever been stressed, you could benefit ten-fold from this course.

References

http://www.leedscommunityhealthcare.nhs.uk/our_services_az/leeds_iapt/

Please visit the official Leeds IAPT site for more information. Or call directly to self-refer:0113 843 4388

I encourage you if you are not from Leeds to discuss with your GP for equivalent services.

Dispelling the fear of hospitals

Nicci Issac 

Many children and adults with a learning disability and autism receive poor healthcare in our hospitals. Some die prematurely of preventable illnesses. There are a number of reasons for this. One of those reasons is fear.

Fear on behalf of the person with learning disability or autism not understanding what is going to happen to them in hospital and if it’s going to hurt. This makes them not want to go to hospital.

Fear on behalf of the hospital staff about how to explain things or about how somebody with a disability might behave when they are anxious or frightened. There have been many reports such as ‘Death by Indifference’ to try and change things in our hospitals but the effect has been very limited.

The trust has developed a project with Leeds Teaching Hospitals NHS Trust and Education Leeds to try and improve this situation. This is part of the ‘Get Me Better’ campaign. We worked with one of the Specialist Inclusive Learning Centre (SILC’s) and took a group of young people with learning disability and autism and visited some of the key departments in St James Hospital and Leeds General Infirmary such as A&E and where you go if you have broken a bone. 

This project helped reduce the anxieties and fear that the young people felt. We met and spoke to lots of hospital staff who really wanted to help. This gave the hospital staff a chance to meet real people with a disability in a supportive setting so that they build their confidence in supporting people with a disability. We plan to organise this on a rolling programme involving all the SILC’s in Leeds and the inclusion units in mainstream schools.  

Nicci Issac, Professional Lead for Children's Learning Disability Nursing

Seeds for the Future

I believe there is a real need for dreamers, poets and writers. These people – men, women and children – draw the pictures of what tomorrow can be. They offer maps and landmarks to the future. While some may see them as hopeless utopians they are actually the midwives of new possibilities. This article is about a book that helped changed the landscape.

The book is ‘The Citadel’ by A J Cronin. Cronin was a doctor and a very popular and respected author. The book written in 1937 tells the story of a young caring doctor Andrew Manson who works in Wales.  He works among the people and helps them. Later he moves to London and is tempted by money. He starts to seek money from the wealthy and this starts to corrupt him. He re-finds himself and despite major challenges walks ahead in his old values and commitment. The book was seen as a damning indictment on the old health system. Cronin stated that, “I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug … The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.”

The book was a bestseller and sold over 150, 000 copies in the first three months in Britain. It was also a hit in the USA and Europe. The book was made into a Oscar winning film in 1938. A Gallup poll in 1938 revealed that those polled said the book impressed them more than any other book apart from the Bible. Many people have argued that the book laid the foundations for the National Health Service in the United Kingdom. Both Cronin and Aneurin Bevan ( the Minister of Health from 1945 to 1951 ) had worked at Tredegar Cottage Hospital though at different times. Tredegar was used as a model for the NHS. The book showed the grave problems with the old system and pointed to something better. The foundation of the NHS was due to a number of factors including people after a World War wishing for and expecting something better. Cronin’s work filled the air with a critique and question that supported the foundation of the NHS. It was part of a movement, people and energy that birthed this service for the people.

There are a number of things that face us here. There is the power of ideas and the written word. Cronin’s book gave voice to the feelings and experiences of many. He became a voice for change. This teaches us that our words and what we share can shape the future. We may never achieve the effect of an A J Cronin but our voice and dreams can be part of a movement for the best care and culture for all. Ours may be a small cry and impact but together we can move mountains. Vincent Van Gogh the artist noted how ‘Great things are done by a series of small things brought together.’  The impact of ‘The Citadel’ tells us also that we will never know what our good actions and honest words will achieve. Cronin when writing his book would not have realised how his book would help a shift for the good and health of so many. To step forward and speak the truth, seek the best and create the vision is what we must do. Cronin’s work was a key element in a diverse movement hungry and visionary about change. This also tells us we need each other and diverse alliances around common themes.

When A J Cronin wrote patients would have had no voice. Things are changing and we have – thankfully – a growing patients movement. Carers also would have had no real voice and today carers are often overlooked. We hope the voice of carers can feature more and more in the future and services. Today we have many voices on social media and elsewhere pointing out the faults and flaws in the systems we have. Do all these words connect? Do they generate change? My guess is that some do. The reasons why some words fall and some reach is an interesting one.

Healthcare is all about humans.  It will never be as perfect as we all would like.  Each generation needs someone or something for it to maintain it’s moral compass. The 19th century writer John Henry Newman spoke of ‘ to live is to change and to change often is to become more perfect.’ This is a good charter of how we must always seek change and innovation. We never reach Nirvana but we can improve things and help more people.

The message of A J Cronin is that one person can make a difference, that words and ideas when linked to wider forces can change the picture before us and that we need to keep on speaking the truth and seeking authentic renewal of our services. If we do this we will contribute to the dreams, poetry and writing of tomorrow. And not only contribute - we will help write and author them.

John Walsh, York Street Practice

This post arose through transatlantic dialogue and reflection. Sometime work with others brings  a freshness, wisdom and vision. This collaboration was and is one of those times. I would like to dedicate this blog to the three good people involved.The first is Marie Ennis O’Connor (@JBBC ) who connected people together for this to happen. The second is Dr Brian Stork an American  physician (@StorkBrian) who is writing on this subject in an American context for his blog. The third participant is @HealthIsCool who offered such kind and helpful advice about format, content and presentation. It is a joy to be connected to these friends. The blog is all about a message which linked to a movement changed history for the better. I hope that we all find our messages and movements and do likewise.  

Always look on the bright side of life – and yourself!

Do you remember that Monty Python song about looking on the bright side of life?

Here’s a bit of it..

‘Some things in life are bad,
They can really make you mad.
Other things just make you swear and curse.
When you're chewing on life's gristle,
Don't grumble, give a whistle,
And this'll help things turn out for the best, and...’

If you've remembered how the tune goes good luck getting that out of your head for the rest of today! It’s certainly a catchy one. Alternatively if you've never heard the song might be one to YouTube. I think looking on the bright side of life is a useful idea to keep in mind. Let’s face it there’s always plenty of bad stuff going on at any point in time such the state of the economy, Ebola, plight of the elderly, wealth inequalities, etc. It sure is easy to be negative about and focus on many things going wrong in life. If you had to think about five things you don’t like about work how easy would this be? On the other hand, it can be helpful to think how useful it is to focus on all of these realities too much. This is to say whether it helps anyone to feel better, or if you would just worse. Or in fact whether focusing too much on such events can change any of the unpleasantness of these situations.  

Indeed the same can be true for the habits people can sometimes get into of focusing on themselves and on the mistakes they have made at the expense of everyday ‘mini-successes’. This would be considered a thinking bias in cognitive-behavioural therapy (CBT). Let’s have a think about the impact this can have for people. If done often and in all parts of people’s lives, it can easily lower people’s confidence and leave people more vulnerable to depression. After all it’s hard for anyone to feel good about life if they are caught up with seeing the worst in what they have done all the time. This is the sort of problem that we see in CBT here at Leeds IAPT.

One example of this can be seen from a woman who shared this thinking bias and had difficulties with depression. As part of her job she completed a teaching session and evaluated this afterwards in her therapy session as being a ‘disaster’. On discussion of what had happened there was one issue she had not been able to deal with as fully as she would have liked. However, with further exploration many aspects of her performance had gone well. Overlooking the more positive aspects of her behaviour had been a typical thinking bias for her and contributed to a belief of being a failure. This can be the sort of difficulty we deal with through CBT.

Anyone can slip into this habit. Who can really say they have never slipped into this thinking bias to some extent? You know, overlooked the things you have done well in place of some small possibly irrelevant mistake. If we put thinking biases on a scale for everyone, at one end have people who do these less often, and at the other people who make these biases more often. People who make them more often are more likely to develop negative beliefs about themselves and be more vulnerable to depression or stress. Perhaps people who are half way up the scale could find themselves doubting themselves more, and having less energy and motivation to do their job. Where do you think you’d be on the scale?

The way I see it more or less everyone could do with being further towards the ‘good’ end of the scale. Here’s an idea for doing that. How about once a day taking some time to think about something you have done and what has gone well from your actions. Preferably something you wouldn’t normally recognise. Maybe it would be useful for someone you know to try this out. In any case, I hope we can agree there is some value in looking on the bright side of yourself.

Matt Garner, CBT therapist, Leeds IAPT