Health conditions: Managing the emotional challenges week 1

These are the requirements of participation. An important requirement is maintaining confidentiality, this allows everyone to feel safe to share and chat if they wish to.

Aim

Please aim to log in 5 to 10 minutes prior to the workshop starting. This can help address any I.T problems

Try

Please try to ensure your settings are on mute until the end.

Maintain

Please maintain confidentiality, who you see and what is shared here should not be discussed elsewhere.

Please

If you didn’t sign in with your full name, please put your first name and last initial in the chat this ensures you are recorded on the register, and the material is sent to you afterwards.

Support and listening services

Please contact:

• Samaritans is always open to talk about whatever you’re going through. Open 24/7. Call 116 123 (free phone)
• West Yorkshire 24-hour mental health helpline offers support, advice and information for anyone in Leeds. Open 24/7. Call 0800 183 0558 (free phone)
• Connect helpline is a survivor-led service offering emotional support to people in Leeds. Open every night 6pm to 2am. Call 0808 800 1212 (free phone)
• Connect BSL helpline is on Mondays at 7pm to 11pm, facetime, skype or glide with BSL trained staff. Call 07500 870 987
• Shout text service struggling to cope? Text SHOUT to 85258 (free) any time 24/7 for support Messages are anonymous and won’t appear on your phone bill
• Contact 111 (click option 2) to speak with the mental health team

We do encourage you to use these support lines if you feel you need emotional support as they are a useful way to offload and manage distress.

• Group introductory booklet
• Week 1: Cicious cycles adapting rumination and refocusing
• Week 2: Anxiety and uncertainty present day focus
• Week 3: Thinking traps self compassion
• Week 4: Doing more of what you value
• Week 5: Peer support. Share challenges and coping resources
• End of group practice booklet

Transcript

The overall aim is to provide therapy information and techniques that with time and paced practise can help you live better with your health condition.

Topics include:

• Information to help with adapting to change
• Circle of control
• Rumination and attention refocusing
• Managing worry
• How thoughts affect mood: Understanding thinking traps and applying self compassion
• Adapting your activities using your values
• Health conditions and the benefits of goal setting
• Peer support

Week 1

• Vicious cycles
•  Adapting to change
• Circle of control
• Rumination and refocusing

As we go through the different themes and information, listen out for anything that might apply to you

Ask any questions and share your thoughts at the end.

Transcript

This is what we will be covering today.

As we go through the information listen out for anything that you feel applies to you.

You can ask questions, chat, share challenges, your own coping strategies at the end.

Physical symptoms of health condition

• Fatigue and exhaustion
• Coughing or feeling breathless
• Cognitive effective: Concentration and brain fog
• Digestive problems
• Headaches and migraines
• Sore throat and acid reflux
• Feeling dizzy or shaky
• Constant pain and tension discomfort

Emotional challenges of health condition

• Anxiety and catastrophising
• Feeling isolated and misunderstood
• What if… (worrying)
• Avoiding people, places and things
• Feeling embarrassed
• Reduced confidence
• Feeling irritable or overreacting
• Feeling low or isolated
• Sleep changes

Transcript

We know that living with health conditions brings emotional challenges.

If you look on the left of this slide there are some examples of different physical symptoms, we know there are others too. Everyone here will have own physical symptoms of your health condition.

Additionally, everyone may have different ways you experience the emotional challenges that can happen from living with your health condition.

On the right of the slide, we have placed her some of the most common emotional challenges that people can experience.

As we read them out, think about the emotional challenges that you experience, ones that are either directly caused by your health condition or made worse by living with your health condition.

1. Anxiety, catastrophising or thoughts that immediately go to the worst-case scenarios.
2. Feeling isolated or misunderstood.
3. Excessive worrying.
4. Avoiding people, avoiding places, or avoiding doing things.
5. Feeling embarrassed.
6. Experiencing reduced confidence.
7. Feeling irritable, frustrated, overreacting.
8. Feeling low in mood.
9. Changes in your sleep associated with feeling low or anxious.

All these emotional challenges can make it harder to manage your physical health.

Aiming to manage these emotional challenges is important as this helps you to manage both your physical and emotional wellbeing.

1. Challenging health symptoms and experiencing additional stressors can lead to:
2. Experiencing anxious and negative thoughts
3. These thoughts contribute to emotions such as of  low mood, anxiety and feeling discouraged
4. These feelings contribute to behaviour changes such as withdrawal from others, doing too little, doing too much, lack of beneficial activities, demotivation and procrastination
5. You may experience stress symptoms such as palpitations, upset stomach, changes in sleep, appetite, etc
6. These stress symptoms can impact your health condition symptoms, making it even harder to manage

Transcript

This vicious cycle demonstrates the link between thoughts, feelings, and behaviours.

There is a constant interaction between all these areas.

Experience a health condition whilst coping with challenging physical symptoms can affect the way you think.

Many people report that they have noticed their thoughts becoming more negative, or anxious.

Negative or anxious thoughts can affect the way you feel and how you feel affects what you do. You may also experience physical symptoms caused by your mood, this mood related physical symptoms can impact your health condition.

This demonstrates how the vicious cycle can start and be maintained.

No one can control the thoughts that come into your minds, but you can start to recognise any unhelpful thinking patterns and learn different ways to react to them. Doing this helps to improve the way you feel.

We will be helping you to disrupt your own vicious cycle by providing tips and techniques that can help you start to make some changes to your own vicious cycle.

With time and paced practise this can gradually improve the way you feel.

Adapting to the changes a health condition brings is challenging: It can impact your usual levels of resilience

Constantly feeling stressed, anxious and frustrated with your health contributes to physical cognitive and emotional fatigue

Adapting to the changes in your life is a process, it takes time, there is no right or wrong length of time, everyone is different

Recognize that you do not have to like your health condition to start adapting to it

You can still maintain hope of your health condition improving

Adapting to the changes means you still use your rehab activities and therapy techniques to help you manage and work towards improving your health & wellbeing

The main aim of adapting to change is to improve your quality of life whilst living with and working on improving your health condition.

Transcript

Adapting to the changes a health condition brings is challenging: It can impact your usual levels of resilience.

Even the changes we view as more positive such as a new job, wedding, baby, house move can mean we need to adapt.

However, adapting to the changes a health condition brings is more challenging: It can impact your usual levels of resilience.

Adapting to change is a process. There is no right or wrong lengths of time for people, everyone is different.

Adapting to change is not giving up or losing hope.

It is about recognising adaptions are needed to help you manage the emotional challenges of your health condition as it is at the present time.

Doing this can help you live better with your health condition.

• Aim to keep a daily routine with activities that provide a sense of enjoyment, connection & achievement, include your active rest into your daily routine
• Maintain some social contact with others: Have plan A, B, C, to cover changes
• Communicate your needs to others: Provide literature on your health condition and the effects
• Try to focus on your present day, and not what might happen in the future

Transcript

These are some tips that can help you adapt to change:

Keep to a routine, however small.

Health conditions can disrupt or change usual routines and having a routine, however small this is, can help you to maintain a sense of control in your day.

This routine may be as small as having a cup of tea at 11am every morning, listening to the radio every lunch, doing active rest at a certain time every day.

Routines are individual and important for everyone.

Think of your own ways maintain your contact with others.

If you are spending more time at home, it is easier to become isolated.

Think of how you could maintain or increase your social contacts, this might be from being in online groups, text messaging, peer support groups, or accessing social prescribing services.

Try to keep your focus on your present day and not what might happen in the future.

All the above are useful ways of coping.

• Aim to focus on the things you can control
• And what you may be able to influence
• Try to let go of things you have no control over

Transcript

There are some things over which many of us have no control over.

Feeling a loss of control over your health condition is understandably frustrating and upsetting.

Focusing on things that are outside of your control increases feelings of frustration.

This results in experiencing more emotional fatigue which has a further impacts your emotional and physical health.

Try to focus your time and energy on areas where you have some control or influence.

For example, you have no control over what other people think or what they do. However, you have control over your communication with them to express your needs, physically and emotionally.

You might provide literature on your health condition or direct them to a web site; this might influence their understanding of your health condition and the support they offer you.

However when you have done all the things that are within your control then it is important to recognise this and refocus your attention if you recognise feelings of frustration building up.

Repeatedly thinking about painful symptoms, thoughts and feelings maintains the vicious cycle of low mood

Rumination interferes with your ability to think clearly, contributing to brain fog and emotional and cognitive fatigue

Ruminating makes it more difficult to focus on any possible positive aspects of life or to take any actions to improve your situation

Rumination can also mean you do an activity physically, but you are not fully present, it leads to a lack of positive reinforcement

Disrupting the vicious cycle of rumination involves: Recognising when your mind is ruminating and then refocusing your attention onto an external beneficial activity

Transcript

There are many words to describe rumination, such as dwelling, turning things over.

Rumination happens when our attention is internally focused on negative thoughts or feelings.

We all ruminate from time to time; the problem occurs when rumination becomes habitual, forming a vicious cycle.

Rumination can be exhausting; it leads to low mood and contributes to doing less beneficial activities.

You may be ruminating on your health condition, the loss of any roles or valued activities.

You may be stuck in a ruminative loop that keeps you focused on the past and prevents you focusing on any beneficial activities in your present day.

Rumination may also mean you are doing things without being fully present.

Have a think about how much time you might be spending ruminating.

• Rumination worrying
• Attention is focused on past & future
• Depressed and anxious
• Rumination worry increases
• Feel worse

Transcript

Can you see yourself on this cycle?

When you are ruminating this leads you to feel lower in mood or feel more anxious,

Feeling lower in mood then causes you to ruminate more.

You then spend more and more time ruminating and become stuck in the vicious cycle.

The vicious cycle of rumination can be broken by refocusing your attention onto external things.

Doing this for just a few minutes at a time at first, can be just enough to bring some relief.

This can be enough to help you choose a more beneficial thought or choose to do something more beneficial.

When you find yourself ruminating say STOP to yourself:

Visualise a STOP sign

Ask yourself the following three questions

1. Have I made any progress towards solving a problem?
2. Do I understand something about the problem that I haven’t understood before?
3. Do I feel less self-critical or less depressed than before I started thinking about this?

Recognise the vicious cycle of rumination?

Make a decision to refocus your attention

Aim to switch your internal focus onto an external task

Choose to do something different, anything that will help you feel better

Just do it for a few minutes at first: Increase the length of time as you practise

Transcript

Here is an exercise that can help disrupt the cycle of rumination.

When you notice the cycle of rumination starting, mentally say STOP to yourself or imagine a STOP sign.

Ask yourself these three questions:

• Have I made any progress towards solving a problem?
• Do I understand something about this problem that I have not understood before?
• Do I feel less self-critical or less depressed than before I started thinking about this?

If the answer is no, then acknowledge you are ruminating and this will increase your distress.

Then make an active choice to refocus your attention onto an external task.

Have some things prepared beforehand that will help you refocus your attention. A jigsaw, art book, audio book, model railway, or aircraft.

Refocus your full attention onto any external activity that will be more beneficial to you in that moment.

Refocusing your attention is a skill that takes practise.

If you start ruminating again that is ok, no one has a perfect attention span. Just keep trying the exercise and keep practising refocusing for a few more minutes each time.

It does get easier with time and practise.

Five things

• Pause
• Look Around
• Notice 5 things you can see
• Notice 5 things you can hear
• Notice 5 things you can touch
• Clothes fabric
• Chair
• Watch and ring
• Feet on floor
• Fingers or ears

Transcript

Some quick ways to refocus your attention are:

• List five things you can see or hear around you, describe them to yourself, what is their shape, colour, or texture?
• Sing a few lines or verses from a favourite song to yourself.
• Recite a nursery rhyme or poem that you remember.
• Look around you: Name the different makes of cars? Say them to yourself. Count the cars or the number of green cars.
• List five different food items starting with A, B, C, for example, bread, bananas, biscuits.
• Count backwards from 200 or 100 in sets of seven or three etc. Don’t worry about getting it wrong, it’s doing the exercise that matters.
• Have a think about anything that you already do that helps you focus your attention externally.

Your attention will wander: When you notice this happening, slowly bring your attention back and refocus again

Rumination becomes a problem when you get stuck in a vicious cycle and it affects your mood

Refocusing attention is a skill that with time and practise gradually becomes easier

Practise this every day, it will help when you do get caught up in rumination and worry

Attention is like a muscle, it can become weak

Be compassionate towards yourself and practice refocusing just for a few minutes at first and build it up

Transcript

Here are some of the common barriers we may come across with refocusing attention and some possible solutions.

Refocusing can be challenging to begin with especially if it’s new to us or we worry or ruminate a lot.

Your attention will wander, that is ok, everyone’s attention can wander.

When you notice your attention has wandered, just gently acknowledge it and then practice bringing your attention back onto a external task.

No one has a perfect attention span, a wandering mind can feel frustrating. Let these feelings of frustration pass by. Give yourself credit for trying.

Refocusing attention is a skill and a habit that needs to be practised and developed over time.

Our attention span may have become weaker however with practice, you can learn to strengthen this.

• What one thing can you take away from today?
• Is there one thing you felt you could particularly relate to?
• Is there one thing you could do before next week?
• Read the slides again?
• Think about what is in your own vicious cycle?
• Practice using the rumination technique?

Transcript

We are at the end of today’s session. You will be sent the slides from today.

Just reflecting on the information, we have covered today, what one thing can you take away from?

Is there one thing you felt you could relate to?

Is there one thing you would like to try before next week?

We do encourage you to read the slides again when these are sent out.

Could you think about what is in your own vicious cycle?

Or practice using the rumination technique?

You know yourself best so whatever you decide is up to you.

Everyone here is experiencing a health condition:

• Being with others who have similar experiences has been proven to be beneficial
• Do you have any questions or comments from today?
• Do you have a challenge to share with others?
• Do you have a coping strategy to share?
• Share or listen: It’s your choice

Transcript

Everyone here is experiencing challenges, we have heard many people say listening & chatting with others can be helpful.

There is no pressure to chat but if you do feel able that’s great,

You can chat with your camera on or off or just use the chat function, whatever is your own personal preference.