Managing the emotional challenges: Week 2

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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.

• Adapting to change: Benefits and challenges
• Vicious cycles
• Circle of control: Focusing on what you can control
• Rumination and refocusing attention: Benefits and challenges
• Peer support

Transcript

These are the topics that we introduced last week.

We discussed how adapting to change is a process and there is no right or wrong length of time for achieving this. Using the information and techniques can help you move along this process.
We discussed the vicious cycle and how the physical health condition can contribute to changes in the way we think, how we feel and what we do. We discussed how we cannot control the thoughts that come to mind; however, we can learn to become more aware of unhelpful thoughts and respond to them in a different way.

We talked about the circle of control. When you focus on things that are out of your control this increases feelings of frustration. Focusing your time and attention on things that are in your direct level of control or influence can help you move along the stages of acceptance and adaption.

We also discussed the effects of rumination on mood and how refocusing your attention can be beneficial into bringing more helpful activities into your present day.

We acknowledged how refocusing attention can be challenging. No one has perfect attention all the time. Learning to refocus your attention is a skill that takes time and practise to build up.

We hope that you found something that was helpful from last week. At the end please do share if there is anything you tried even if you found it challenging.

• Worry and anxiety
• Present day focus
• Uncertainty

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.

• Rumination tends to be about loss or past events.
• Worry involves the same internal repetitive process as rumination.
• The key difference is rumination involves dwelling on the past
• Worry is usually involves dwelling on the future. What if…
• A health condition contributes to a cycle of rumination and worry
• We often call this: Too much past; Too much future; Not enough present.
• Meaning you are either In the past over the future and not getting any enjoyment from the present day
• Trying to focus on your present day and seeking some enjoyable activities is important
• This helps you cope or live better alongside your health condition

Transcript

Last week we discussed rumination. This week we are discussing worry. Worrying has a similar repetitive, unhelpful process just like rumination.

When you ruminate your thoughts are on the past.

When you have worrying thoughts, this is usually about the future.

Constant overthinking and worrying means your mind is constantly active, it does not get chance to rest which exacerbates your emotional and cognitive fatigue.

We all worry from time to time; indeed, worry can be helpful if it helps us identify a problem and then take steps to deal productively with it.

It is common to experience an increase in anxiety when you have a health condition, however it is important that you take steps to manage the impact this worry has on you.

• When we worry, we are thinking about problems that are either happening currently or might happen in the future
• Sometimes worries can be a combination of actual current real event problems and things that might happen, hypothetical worries,
• Current or real event worries can lead to solutions
• Hypothetical Worries are known as what if… worries
• Excessive worry fuels your anxious feelings, it can lead to physical symptoms of anxiety
• People often change what they do as a result of feeling anxious and worried

Transcript

Everyone feels anxious at some point. Anxiety is an automatic response. We cannot remove it. It is an essential part of our survival as it helps us detect threats and situations where we have to act.

Understanding the process of anxiety and learning to deal with worries productively can help reduce anxiety and build up your confidence and resilience.

Excessive worrying without taking any productive steps to manage the worry leads to the vicious cycle of anxiety and stress.

1. I need to speak at a work meeting tomorrow. What if I forget what to say.
2. I might become stressed and anxious in front of everyone. People might laugh at me.
3. My boss might think I can’t do my job anymore
4. What if I lose my job. What if I can’t pay my rent. I’ll be homeless.

Can you recognise how this common worry becomes excessive

It creates a chain of worries where you just feel more anxious and worried

Although experiencing brain fog is challenging the worry itself may affect your performance

Transcript

Worrying is also something we all do from time to time. Sometimes our worries relate to a problem that is currently happening.

Sometimes worry can be helpful if we respond to it by taking practical steps that will help us feel more in control and prepared.

For example, being anxious before a job interview can help you to realise you need to research the job and prepare for the questions you may get, you may decide to get an early night to help you feel more alert and ready for the interview.

However, if you do not try to find solutions to this type of worries and just spend more time worrying  a vicious cycle of worry and anxiety starts and maintains.

You just spend an increasing amount of time worrying which impacts your cognitive fatigue.

Thinking of the worst-case scenarios means worries can often snowball.

Can you see how this person’s worry about speaking at a meeting has created a chain of other worries, this is likely to impact sleep, appetite and contribute to anxiety attacks

This spiral or vicious cycle of worry can have a significant impact on your daily life making it much harder to manage your health condition.

• Real event worries are:
• Worries that are happening now or are going to happen
• Worries you might be able to do something about
• Worries where you have some element of control over the outcome
• Worries that can often be dealt with to create a practical solution

Transcript

We often break worry down into two different types.

The first type is a real event worry so practical or current worries. These are things that are happening in the here and now, existing real-life problems or something that is due to happen soon.

You can learn to deal with these worries productively and try to find a practical solution. Doing this helps to reduce anxious feelings.

An example of a current or practical worry might be, having a meeting with your employer next week.

A problem paying a bill.

Being unable to get to an appointment due to transport or childcare difficulties.

Real event or current worries usually (but not always) have potential solutions; you usually have some level of control with current worries.

For it to be classified as a real event or current worry, it would have to be something you can do something about, either by making a plan of action or by completing the plan.

Sometimes people can worry excessively about real event worries without taking steps to deal with them. Doing this increases the vicious cycle of anxiety.

There is usually an element of control over real event worries, sometimes, despite trying, you may not be able to find a practical solution to a real event worry.

If this happens and you have done everything you can to deal or try to find a solution and you have no more control over a real event worry, then continuing to worry about it would not be a beneficial use of your time and energy.

• Hypothetical worries are:
• Worries that usually start with what if…
• Worries that are future based
• Worries about what you fear might happen
• Worries where you have limited or no control over
• Worries that have no definite answer however how hard you try
• Worries that drain your energy and affect your mood

Transcript

Hypothetical worries often start with what if…

Hypothetical worries are defined as worries about events that have not happened or may never happen, you have no control or influence over them.

Hypothetical worries often involve going immediately to the worst-case scenario.

They often involve overestimating the likelihood of disaster

For example, You may have hear rumour or gossip at work about possible restructuring.

You begin to start worrying that you will lose your job. This worry can set off a chain of further worries, for example, “What if I lose my job, what if no one else will employ me, I won’t be able to support my family, I’ll lose my home etc.

Hypothetical worries drain your energy and contribute to cognitive fatigue

Because the hypothetical (what if… worry) is in the future and may never happen, it is difficult to make an action plan to deal with it, so worrying about it is an unproductive use of your time and cognitive energy.

Have a think about your worries, how many of them start with what if…?

• Hypervigilant state maintained
• Impacts
• Fight or flight, dysautonomia
• Impacts sleep/appetite/relaxation
• Affects self-confidence and self-esteem
• Impacts engaging with life

Transcript

Hypothetical worries lead to increased stress. This triggers the fight or flight response.

If the worry becomes constant or excessive this fight or flight response may be sustained, meaning you are in a constant or chronic state of emotional and physical stress.

The person on this slide is having a fast heartbeat or palpitations, they feel shaky and dizzy with a wobbly feeling in their legs.

They have a constant state of dread hanging over them. In addition to this they may also have a churning stomach, they may feel hot or clammy.

There are many other symptoms of the fight or flight stress response.

When you add these distressing symptoms of anxiety to the challenging symptoms of his health condition you can see why it becomes important to try to manage your stress.

• What if I’m late for my appointment?
• What if there’s nowhere to park?
• What if the traffic is bad?
• What if I can’t find it?

• Stomach churns
• Palpitations
• Frustration or irritable
• Pacing

Barry still get to appointment on time.

However, he feels exhausted and stressed.

Transcript

This is Barry. He has received a letter for a 9am appointment for the following week at a clinic on the other side of Leeds to where he lives, somewhere he has never been before. As soon as he has read the letter, he starts to worry and experiences anticipatory anxiety.

What if I am late for my appointment, what if I cannot get a parking space, what is the traffic’s really bad, what if I cannot find the building.

This leads to an increase in his physical symptoms, his stomach starts to churn, the night before the appointment he struggles to sleep, he experiences palpitations.

In the morning, he becomes increasingly frustrated and irritable, he starts pacing around and he feels as though he needs the toilet. He feels flustered as he rushes around to find his keys. Finally, after worrying all week he manages to get to the appointment with time to spare, however he feels exhausted and stressed.

Feel free to show a thumbs up if you have ever experienced something similar!

We are now going to move on to some ways to manage worry or reduce the time you spend worrying.

Transcript

We are now going to move on to some ways to manage worry or reduce the time you spend worrying.

The worry tree can be used to help manage worry.

The worry tree helps you distinguish between current and hypothetical worries.

The first step is to clearly identify your worry, ask yourself ‘What exactly am I worried about’ or ‘What is going through my mind right now’ Be specific.

Then ask yourself ‘” Is this worry a current or practical problem” or “Can I do something about this worry?  Or do I have some control over this worry” or “Is this worry based in the future, is it uncertain, am I predicting the worst”

You then decide whether your worry is a current worry (something that you may be able to deal with productively) or is a hypothetical worry.

If your worry is a real event or current worry, you can use the worry tree to help make a plan of action.

You think about what you can do to solve the worry, when can you do it and how can you do it.

You may want to brainstorm a few options before choosing an option that suits you best.

You decide whether you can deal with the worry there and then or if not make an action plan that you can follow when you are able to.

If you have made an action plan for a later time, you then recognise you have done all you can for now and refocus your attention from the worry.

The other side of the worry tree is used if you recognize your worry as a hypothetical worry.

If so, you acknowledge this as being unproductive worry, it is beyond your immediate control, you cannot do anything about the worry as it is uncertain and is based in the future.

You then make a deliberate decision and practice letting it go of this worry by refocusing your attention from the worry onto something external in your present day.

By using the worry tree and problem solving your real event worries you can build up your confidence and reduce your overall stress and anxiety.

Sometimes a worry can be a combination of a real event or current worry and a hypothetical worry.

If so, ask yourself, what part of it is a current worry and what part is hypothetical worry.

Then try to deal with the real event practical side of the worry by making a plan of action and try to practice letting go of the hypothetical part, the what if, part by refocusing your attention on something beneficial for you in the here and now.

• What is Barry specifically worried about?
  1. Being late
  2. Directions
  3. Traffic
  4. Parking

Using the worry tree try to categorise each worry  into real event or hypothetical:

• Would you advise Barry to refocus his attention?
• Why would you advise this?

Use the worry tree to help Barry make a plan to deal with his worries:

• What can he do about it?
• When can he do it?
• How can he do it?

Transcript

Let’s apply the worry tree to Barry’s scenario

Ask yourself: What is Barry specially worried about?

Is this a real event current or hypothetical worry? or break the parts of the worry down into real event or hypothetical.

Can Barry do anything about his worries? If so, what can he do? When? How?

Barry could have made a practical plan to manage this worry, he could have looked the venue up on google maps, phoned the reception or service for information re: parking, set off earlier, get someone else to take them or accompany him. All these practical steps would have helped them manage this worry.

Would you advise Barry to practice refocusing his attention?

What benefits would this bring to Barry?

• Ask yourself: What exactly am I worried about?
• Am I overestimating the chances of something bad happening?
• Am I overestimating how bad it will actually be?
• Am I underestimating my personal resources to cope?
• Am I underestimating outside resources?
• Am I falling into the vicious cycle of anxious thinking?
• Is there a more helpful or realistic way of thinking?
• What would I say to someone else?

Transcript

These are some questions you can use when you realise you have fallen into the vicious cycle of worrying.

Using these questions can help to reduce your anxiety enough to help you start to think in a more productive way or decide to use the worry tree.

• Ask yourself: What exactly am I worried about? Asking yourself this can help you realise whether it is a real event or a hypothetical worry.
• Am I overestimating the chances of something bad happening?
• Am I overestimating how bad it will actually be?
• Am I underestimating my personal resources to cope?
• Am I underestimating outside resources?
• Am I falling into the vicious cycle of anxious thinking?
• Is there a more helpful or realistic way of thinking?
• What would I say to someone else?

Rumination and worry leads to:

• too much past
• too much future
• not enough present

When your mind is full of anxious thoughts this will affect your emotional and physical wellbeing.

Aim to refocus your attention back in your present day.

Practise focusing on beneficial, safe activities even for a few minutes at a time.

Transcript

Look at the picture on this slide: We see a man taking a walk with his best friend. In this image his best friend is a dog, but it could easily be another human being!

Look at the man’s thought bubble. His mind is crammed full of anxious thoughts and worries. He is not paying attention to what is going on around him, his mind is full.

In contrast, we can see his friend is focused on what is going on around him, he is paying attention to the trees, the sky. His mind is not cluttered. He is being mindful.

No one can ever do this perfectly as our mind’s don’t work like that and some worries still escape, however with practice you can learn to refocus your attention and engage more fully with beneficial activities.

Next time you go out for a walk, try to refocus your attention from anxious thoughts and worries and pay attention to what is around you, the sights, sounds, smells, warmth of the sun, cool breeze on your skin.

If you can’t get out. Look at what is around you and describe it to yourself internally, or out loud.

Benefits

• It helps reduce emotional fatigue
• Helps you feel calmer and more relaxed
• Helps you to experience enjoyment from activities you are doing
• Helps to reduce the fight or flight response and helps manage your emotional and physical wellbeing

Challenges

• We all ruminate and worry
• Refocusing your attention is a skill and takes practise
• Managing uncertainty and hypothetical worries takes time and practise
• Rumination and worry can occur more when experiencing health conditions

Transcript

There are many benefits of focusing your attention onto beneficial activities in your present day.

It helps reduce emotional fatigue and helps you feel calmer and more relaxed

You can start to experience some enjoyment from activities you are doing.

It helps to reduce the fight or flight response and helps manage your emotional and physical wellbeing

Learning to be more in the present is important for everyone, more so, when coping with a health condition.

Refocusing your attention can be challenging and is a skill, you will never be able to do it perfectly, the aim is to keep practising and build up the time slowly.

The benefits of practising refocusing on your present activities outweigh the challenges

• Everyone needs to live with a degree of uncertainty and unpredictability
• Feeling uncertain about your health is distressing
• Being able to live with a healthy degree of uncertainty can help you feel less stressed and anxious
• Ask yourself:
  • Is it possible to be certain about everything in life?
  • Are you predicting worst case scenarios just because things are uncertain?
• Practise the present moment focused techniques
• Does worrying about things that are uncertain lead to answers, or does it cause more stress?

Transcript

Everyone needs to live with a degree of uncertainty and unpredictability. Uncertainty about your health can be particularly distressing and challenging.

Experiencing symptoms that fluctuate would naturally contribute to anxiety.

Try to practise being kind and compassionate to yourself.

Try to have plan B’s and communicate your needs.

If you do experience fluctuations, try to prevent your thoughts leaping to worst case scenario’s.

List the steps of progress you have made however small these have been.

• The weather is a simple example where we all live with uncertainty
• We cannot stop or control the weather, it would be futile to try
• We must learn to adapt to it
• We choose our clothes according to the weather
• We choose what items to take with us according to the weather
• Regardless of what we do, the weather will change
• Upsetting thoughts and feelings are like the weather, they come, and they go
• We cannot control or stop them, but we can learn to react to them differently
• Just like the weather the storm of thoughts and feelings will pass

Transcript

The weather metaphor uses a very simple analogy to help us adjust in small ways to living with uncertainty.

No one can control the weather; we must learn to adapt to it.  When there is a storm, wind or rain, we can put a coat on for instance, but we cannot stop the wind or rain, and it would be foolish to try.

Regardless of what we do, the storm will pass, the weather will change.

Our anxious thoughts and feelings are like the weather, they come, and they go.

We cannot control or stop them, but we can learn to react to them differently.

If we give up the futile struggle to try and stop or control it, the storm of thoughts and feelings will pass.

We can check the weather forecast to help us prepare. However, the weather forecast isn’t 100% accurate all of the time.

You can learn to manage uncertainty by using the therapy tools, they are like your coat, umbrella, hat, gloves.

• Create a regular routine or structure in your day, focus on small activities at first, radio at lunchtime, walk at 2pm.
• Use the worry management techniques.
• Practice bringing your anxious thoughts back from worst case scenarios.
• Practice present day focus and attention refocusing techniques.
• Plan some activities in your day that you can enjoy doing, however small.
• Seek support from others, do not withdraw from other people.
• Be reasonably selfish, look after yourself as you would look after someone else, try not to take on extra pressure when dealing with uncertainty.

Transcript

These are some tips that can help you cope with uncertainty:

1. Create a regular routine or structure in your day, focus on small activities first, radio at lunchtime, walk at 2pm.
2. Use worry management techniques.
3. Don’t jump to worst case scenarios.
4. Practice present day focus and attention refocusing techniques.
5. Plan some activities in your day that you can enjoy doing, however small.
6. Seeking support from others, do not withdraw from other people. Think about ways to keep involved with people.
7. Be reasonably selfish, look after yourself as you would look after someone else. Try not to take on extra pressure when dealing with uncertainty.

• What one thing can you take away from today?
• Was there one thing you felt you could particularly relate to?
• Is there one thing you could do before next week?
• Read slides again?
• Use the worry tree?
• Practice refocusing in your present day (for 5 to 10 minutes at first)
• Implement a few routine things to help you feel more in control

Transcript

We are at the end of today’s session.

• Just reflecting on the information, we have covered 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 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?
• 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 and 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.