Being mindful of your mental health

Stress, depression, anxiety can affect anyone. One in three of us regularly feel stressed. One in four of us feel anxious One in five of us feel depressed.* 

Sabina, Dave and Berni all recognised they were struggling to control their stress. Signs of stress can vary by person but common signs include feeling on edge, angry, unable to switch off, tearful, having poor concentration. 

Each of them reached out to Leeds IAPT, either through their GP or by referring themselves by calling 0113 843 4388. To help manage their stress, anxiety or depression, it was recommended they attended the 'Stress Control' course. This runs for six weeks  at venues across Leeds, at times in the day or evening. Each session has a different focus, from learning to control your thoughts to controlling your body to helping you get a good night's sleep.

In these short films, they have described how the course has helped them:

If you feel like you need help with managing stress, you can get in touch with our Leeds IAPT team on 0113 843 4388. Find out more about Leeds IAPT - www.leedscommunityhealthcare.nhs.uk/our_services_az/leeds_iapt/

*Mental Health Foundation

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

  

Three ways to get in to helpful thinking

And so we're a month in to the new year already. Whilst you were contemplating your New Year’s resolutions in the run up to 1 January 2015, did you consider doing something that is without a shelf life? Did you have a ponder on some of your thinking styles?

It's easy to get caught up in the hustle and bustle of life and people forget about themselves but why not prioritise something that (unlike most resolutions) is going to last forever…Your mind! 

Often in times of stress or low mood we can begin thinking in a way that is unhelpful for us and this just keeps us in a cycle of anxiety or sometimes low mood.

Three ways to get into helpful thinking are: 

• 1)      Spot unhelpful thinking in its tracks and challenge the thought!

It often feels strange to get into a habit of challenging thoughts as “I’m thinking them so they must be true right??” Not always! Sometimes we can be believing things (generally negative) about ourselves that are just not true, get into a habit of challenging those thoughts and trying to wheedle out the truth.

• 2)      Be in the moment!

Often we make ourselves so busy that we forget to be in the moment and enjoy! All the efforts we put in to making life meaningful can sometimes mean we forget to just… be. Sometimes we can be too busy worrying about the future or caught up in the past, try and shift your attention to the here and now so as not to miss out on the current.

• 3)      Try and let go of worries that we can’t affect.

Often we are worrying about things that may never or have never happened, often they are based in the future and we have no control over them. Think about the time and energy it costs you to think about something you have no effect on, think of all the things you could be doing in the here and now and attempt to make a shift to doing something that really matters to you!

Here’s to a year of HELPFUL thinking!! 

Aimee Robinson, Low Intensity Worker in Leeds IAPT 

Stress Control - is it for me?

When I first saw the flyer I remember thinking what a great opportunity for staff to have that kind of support. Having worked in the NHS for over twenty years I am aware that the pressures staff are working under are unprecedented and I could think of a few friends and colleagues who might want to access the classes. I didn’t immediately think it was for me.

 As I reflected on the fact that I was experiencing a number of difficult things at work, namely increased work load and lacking the job security that I had always taken for granted I began to realise that a number of things on the flyer really did apply to me. I was feeling anxious, not sleeping and intermittently struggling to eat (not me at all!) and I was worrying about what the future held for me and my family. It struck me that I could possibly benefit from the stress control classes. It struck me again and again but for some reason I didn’t ring.

I am really fortunate that I have some great colleagues and friends that I can confide in and I was able to share with a trusted friend, that I felt I would benefit from going to the classes, but was worried about ringing. My friend is a very intuitive honest and caring person and she just asked, ‘what’s really stopping you?’. I became quite tearful which was a surprise and when I really thought about it there were two things; that I felt like I was saying I couldn’t cope and the ‘stigma’ of accessing a mental health service. I have been a nurse for over 20 years and to hear myself say that was quite something, a revelation. If I could think like that as someone who has been supporting patients and their families for many years, then how difficult might it be for someone without the insight and experience I have had to access the service? It really made me think.

And what I thought was, that the things that were causing me stress were not going away and the ways I normally managed difficulties didn’t seem to be helping, so I would have to do something different. I picked up the phone and made the call. It was lovely to speak to someone on the end of the line who was sensitive and explained that they needed to take some details before putting me through to someone else. I was treated with care and respect by both the people I spoke to and I was offered a place on a six week stress control course.

That was 3 weeks ago and I have now just completed the first session of the course. I was a little apprehensive and I guess slightly anxious as I made my way to the West Yorkshire Playhouse but I was also looking forward to it. As I arrived I was greeted warmly by the two course facilitators who explained how the course would run. The clear informative delivery was interesting, engaging and inclusive. There was real acknowledgement that taking the steps to get to the session was achievement in itself particularly when you are feeling stressed. I think there were a few metaphorical pats on the back at that point!

What I saw and experienced was a group of people of different age’s genders and race sitting together and beginning to understand an ever present issue of life. It was good to know that I wasn’t on my own. We’ve only just started but I left with a real sense of anticipation (not anxiety!) and I am looking forward to relaxation in week 2. I know that the things I learn and refresh will help not only me, but my colleagues’ friends and family.

I feel fortunate to be able to access the group and while it doesn’t change the situation that may have precipitated my feeling stressed, I hope that this positive input will help me build my resilience to cope with what’s in front of me. I’ll keep you posted!

LCH Staff member December 2014

Change The Way You Think

Recently I went along to one of our Improving Access to Psychological Therapies (IAPT) service’s stress management classes to see for myself what they were about and see if I could change the way I think. After all, we have pre-conceived ideas about things especially if it is something unknown. The service said to me that people have misconceptions about the classes; that people will expect you to speak as though you’re at an Alcoholics Anonymous class i.e. ‘Hello my name is Andrew and I’m stressed’ – you don’t.  And nor do you have get on a sofa and talk about your childhood.

The session I went to took place during the evening at Leeds college of music. On arriving, there was a discrete sign by the front desk and a friendly receptionist directed me to the first floor room where the session was held.

The start of the class felt like any training I have been to in my professional life. The two facilitators, who led the session, greeted people as they arrived, checked them in and passed on an evaluation form. There was some nice gentle guitar music playing and jugs of water were available if you wanted to grab a drink.

With the session being the sixth course in the series there was a brief re-cap of what had been covered so far by Jake, one of the facilitators. The main theme for this session was sleep, and how to get a better night. There were lots of practical tips like not using laptops and phones just before bed to help you drop off (something I maybe need to remember).  We were also given advice on the things like the temperature of the bedroom and having blackout blinds. One of the interesting tips that the other facilitator, Alice, gave was setting aside worry time. This is the idea that if you are a worrier you stop yourself from doing it all the time and set aside 30 minutes to reflect on your problems and stop worry from dominating other things.

There are more details of who’d benefit from the courses and how to access them online at LeedsIAPT.com. The courses run on a regular basis so new ones are starting all the time.

Andrew Carver, Communications officer, Leeds Community Healthcare NHS Trust

Unfreezing the brain - recovering from post traumatic stress

Monday mornings are a morning of EMDR (Eye Movement, Desensitisation and Reprocessing), my favourite. As an EMDR therapist my job is to work with people who are struggling with PTSD (Post Traumatic Stress Disorder) – as a result of any kind of trauma: being in a war zone; rape; accidents; assaults; torture; really any kind of trauma that can happen to you as an adult. 1 in 3 people after a traumatic event can develop PTSD, it’s a horrible thing to have to live with – flashbacks to the events, nightmares about the trauma, feeling constantly anxious and like you’re under attack. Like a walking, talking burglar alarm, always on alert for danger. And sometimes not being able to face certain things related to the trauma e.g. can’t go to the place where it happened, and then this escalates and can stop you getting out of the house, can’t stay in your house… You get my drift. 

The clients I am seeing this morning don’t really fit the norm for our bread and butter EMDR work. The first lady I’ve been seeing for a couple of months and she’s doing really well, we’re almost done. As a result of a number of traumas through childhood and adulthood, she has a phobia of choking and hasn’t eaten solid food for six months, living off Complans, you know liquid food drinks. We’ve been working through a long list of ‘small’ traumas (these don’t feel small to her of course) and now cheesy chips and bacon are featuring prominently in her recovery.

Because life is never straight forward, this client also has checking behaviours (Obsessive Compulsive Disorder) and if I thought about it hard, would also fit the diagnostic criteria for GAD (Generalised Anxiety Disorder) and as we treat the traumas / phobia these other issues are also getting better. Working with this case has been an absolute joy for me, the client is so lovely, we have a good laugh although we are dealing with some difficult stuff and I get the pleasure of watching someone recover, enjoy eating again (what’s not to like about that) and also make other positive changes in her life.

So to EMDR. Eye Movement, Desensitisation and Reprocessing, it’s a bad title I know and it’s hard to spell. Let me try and explain what it is us EMDR therapists do. Most of the time your body copes with new information and experiences without you being aware of it. It is believed that this happens whilst we are asleep, particularly during rapid eye movement sleep. When something out of the ordinary occurs you can become traumatised by the event or by being repeatedly subjected to distress.

These experiences then become frozen in the brain and are stored in the limbic system, which is the primitive bit of our brain that deals with senses, emotions and it’s all raw. It’s the caveman / cavewoman bit of our brain – fight, flight, freeze. And when information gets stuck here – it gets re-triggered all the time usually with the symptoms of PTSD. I think of this bit of our brain as our downstairs brain (above the back of your neck). Your ‘upstairs brain’ is where we process information and experiences so they become a memory or part of our past, also known as the pre frontal lobe, (front / top of your head) which deals with reasoning, problem solving, emotional intelligence, all that kind of thing.

EMDRs job is to help move the information from a trauma from downstairs to upstairs in your brain, which given we normally do this whilst asleep, is a natural healing process. There’s some controversy at times in the world of psychology / research about how EMDR actually does work. I really don’t care, it just does and I get to see it happen.

We start off with a thorough assessment, then prepare for treatment. Then we ask specific questions about a particular disturbing memory and use either eye movements or theratappers (which buzz alternately in either hand) to replicate what happens whilst we are asleep. With repeated sets of this, the memory tends to change so it loses the distress associated with it and becomes a neutral past memory. Sometimes this can happen in one session, other times it takes longer but what is great is seeing people not only get rid of those negative symptoms of PTSD but also seeing positive benefits for clients in other areas of their lives as well. It’s a real privilege. 

Enough theory, my next client is struggling with Obsessive Compulsive Disorder (OCD) and I am seeing her as part of a research trial. She is doing well, although she has had OCD for years and years and years, not been able to work, and has been stuck in her flat, not seeing many people. She struggles to see sometimes how well she is doing and today was one of them days. I was (hopefully) top cheerleader today and she managed to achieve something in the session today, that in our first session she told me she could never even contemplate doing. Go Girl! 

Afternoon is being on duty for the service. Psychological Wellbeing Practitioners (PWPs) are on the phones taking self-referrals as they come in. My job is to be on call to give advice and support them in making decisions about treatment options etc., deal with any other new referrals coming into the service from other professionals, crisis calls, whatever. I think there’s a bit of snobbery sometimes from other professionals about PWPs, but I’ll tell you they do a really hard job really well and I’m always impressed by how good they all are on the phones.

Zoe Marsden – Senior Mental Health Practitioner and EMDR Therapist, Leeds Community Healthcare NHS Trust

 

Helping peple feel less alone

Alice Curling, who facilities our stress control classes, blogs about her work as part of the Leeds IAPT service.

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"I have been interested in mental health ever since studying psychology at A-level about 10 years ago and since then I have studied, worked or volunteered in or around the field of mental health.

I have worked for the Leeds IAPT service for just over a year now and am really enjoying my job. Of course there are difficult days when things haven’t gone as well as you would hope or when sessions are difficult, but the good days; when you can see people improving, really make up for it.

My job is also really varied; I do face to face and telephone assessments, one to one treatment sessions and have recently begun to facilitate a stress control class. The class was definitely outside of my comfort zone, but I’m really pleased that I put myself forward for it. The classes cover very similar material to what we would usually use in one to one sessions but you are able to reach more people in a shorter space of time. We also get to cover a range of interventions which we sometimes don’t have the time to do in the one to one sessions. The course material has also taught me new things and techniques which I have incorporated into my one to one sessions.

Facilitating the class has definitely improved my understanding of stress and has improved my one to one practise at the same time. I would certainly encourage other workers to facilitate the groups. Although you don’t get the same immediate feedback from people that you get from one to one sessions, you can see the improvement in many people. I would also definitely encourage people who think they would benefit from attending the class to contact the service. Many people fear a group or class situation but once you come you will see it’s not as bad as you think! People are also surprised at just how many people are going through similar difficulties as them which can help people feel less alone.

I am learning all the time, not only from my colleagues but from people accessing the service as well. No day is ever the same, and I hope I can continue to learn and grow so that I am constantly improving my practise."

Alice Curling - Stress control class facilitator

5 Tips to manage stress

Sally Poyser is a Psychological Wellbeing Practitioner at Touchstone one of the partner organisations in the Leeds IAPT service. To mark stress awareness day Sally gives five easy tips to help manage stress.

Stress affects everybody, but high levels of stress can affect our ability to cope with the demands that come up in life.

So, it’s important that we try to look after ourselves by taking steps to manage our stress levels.

1) It can be easy to feel overwhelmed if we have a lot of things happening in our lives. We naturally focus on the negative things in life such as the things we can't do. Try to focus on the things that you can do something about. This will help you feel more in control.

2) It can be easy to only do the things that we need to do in life and we forget about the pleasurable things. Don't let stress get in the way of the things that you enjoy, arrange to see that friend that you have not seen for a while; pick that hobby back up that you have neglected or do something that you have always wanted to do.

3) We all need help from time to time, talk to a friend about what you are going through so you can get some support from others. 

4) It is a natural human response to avoid things that are uncomfortable, but we know that avoidance makes stress worse in the long term so look at the things in your life that you are avoiding and start to tackle them by facing your fears.

5) Exercise is a natural ‘antidepressant’, try to make small changes to be more active such as taking the stairs rather than the lift or go for a brisk walk.

If you feel that you need further help in managing stress our Leeds IAPT Partnership offers courses which run once a week over a six week period. These courses help learn coping strategies and techniques to help manage stress more effectively. You can call 0113 843 4388 to have an assessment the same day or see our service webpage for more details.

Sally Poyser. Psychological Wellbeing Practitioner. Touchstone.