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.

• How thoughts affect mood: Thoughts affect the way you feel and what you do: We cannot control our thoughts however we can learn to respond differently to them
• Thinking traps: How they contribute to vicious cycles and strategies for managing them
• Using metaphors to create distance from thoughts
• Self-compassion and internal self talk
• Supportive statements to help with bad days

Transcript

These are the topics that we introduced last week.

We discussed that thoughts affect the way we feel and affect what we do: Thoughts are automatic, no one can control their thoughts however we can learn to become more aware of them and respond differently to them.

We discussed thinking traps and sent a handout on thinking traps with the slides

We also discussed how metaphors can help us see things from an alternative viewpoint.

We also touched upon the benefits of self-Compassion and using supportive self talk.

Hopefully, you will have found something that was helpful.

If you have any questions or comments from these, we’d love to hear from you at the end.

• Adapting activities using values
• Benefits and challenges
• What we do affects how we feel

As we go through the different themes and information listen out for anything that is relevant 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.

• Health symptoms affect your ability to engage in your usual activities
• Changed activities can lead to changes in your emotional wellbeing
• Doing less rewarding and meaningful activities can mean you have fewer positive experiences
• Making changes to what you do can improve the way you feel
• Using adapted valued activity can increase positive experiences

Transcript

To cope with challenging health symptoms, reducing your activities is often required.

This may help you manage your physical symptoms however it can have a negative impact on your emotional wellbeing.

It is often the enjoyable, fun or relaxing activities that get cut out first. This can lead to a lack of positive reinforcement and enjoyment in your day-to-day life.

Adapting your activities using your values can help increase the opportunity for positive experiences.

Incorporating your values into your  activities can help you see the positive benefits from engaging in them.

Everyone’s values are different; there is no right or wrong

The aim is to pick one or two things you value doing

The principles of value-based behaviour work can help you learn ways to adapt your previous activities

This means you can still do activities that have your same values albeit in different ways

Transcript

Having to stop your previous activities often leads to life feeling aimless, with less direction.

The aim of values-based activities is to help you connect your activities with your values or with things that really matter to you. This can give you an increased sense of purpose and meaning in your day-to-day life.

This diagram is a Values flower. The different values are on the edge of the petals. There may be other values too. Everyone’s values are different, there is no right or wrong There may be lots of things you value about an activity

This values flower puts you in the middle and what you value on each petal. The aim is to adapt activities to help you move closer to doing more of the things that you value.

Values are different from goals. Values are like the direction we want to travel in. Values keep going

Goals are the things we achieve on the way. Goals can be achieved or crossed off

Transcript

All these are some examples of the differences between values and goals.

Values are like directions, they drive our behaviours.

Values are different from targets or goals, these can be achieved and ticked off a list.

On the left we have an example list of values, there are others.

On the right is an example of the goals or actions that may come from following our values.

So: If your value is to be an active parent a goal might be reading to your child or monitoring their homework, doing some Lego with child

If your value is being a good friend a goal might be messaging once a week to stay in touch or meeting up once a month

If your value is health and physical wellbeing a goal might be going to an aqua aerobics or Tai chi class

This involves several steps:

1. List the activities that you are not doing and cannot do at present: Choose one activity to focus on
2. Identify the value behind that activity: What did you value about that activity? Why did you do it?
3. Next: Find alternative activities that you can safely do with the same or similar value underpinning them.

The aim is to increase the activities in your life that may be different or adapted but still have the same or similar values underneath them

Value

• Being an active or involved parent

Previous behaviour underpinning value

• Playing football with child

New, adapted value or guided goal

• Short walk with child and playing hoop ball
• Watching football with child
• Playing card, board and football-based game

Outcome

• Still having regular valued interaction with child

Transcript

There are several stages to values-based work.

1. List the activities that you are not currently doing/cannot do. Then choose one activity to focus on.
2. Identify the value behind that activity: This is a skill but gets easier with practise and reflection. Ask yourself: What did you value about that activity? What did you like about it, why did you do it?
3. The next step is to find alternative activities that you can safely do with the same or similar value underpinning them. Again, this gets easier with practise and reflection. Ask yourself, What other activities could you do to that may incorporate the same or very similar value into your day to day.

Because of your health condition activities often need to be adapted however they can still have the same or similar values underneath them

Valued activity:

• leads to positive reinforcement
• decrease feelings of lethargy
• promotes cognitive functioning
• gradually improves confidence and mood

Valued adapted activity need to be paced within your ‘safe limits’

Helps you refocus from thinking about what you used to do or what you would like to do

Focus on what is realistic for you right now

Small steps can make a significant difference

Transcript

When we use the phrase “valued activity”, we are referring to activities that give you positive reinforcement or a sense of wellbeing in your day-to-day life. There are many activities we do out of habit, necessity or obligation, not necessarily because we want to do them.

Although you may not be able to do as many activities or do the activities that you used to, it is important that you find some ways of doing things that you value and are important to you.

Doing this can bring multiple benefits, it can help you feel emotionally better, feel more confident and contribute to your physical wellbeing.

You will need to be realistic and ensure that any activity is within safe limits for your health.

Finding alternative ways of achieving your valued activities can help with reducing the distress from living with your health condition.

• Benefits Of value-based behaviour work
• Values drive our behaviours, even those we may not particularly enjoy
• Every action has a reason behind it, whether it’s an enjoyable activity or a chore
• Undertaking valued activities leads to an increase in positive experiences
• Challenges of value-based behaviour work
• Finding the values that underpin activities is a skill, it gets easier with practice
• Adapted activity may not feel as good as the original activity at first
• It can take time to get used to adapted/ replacement activity

Transcript

Because many of our activities are automatic, we can struggle to understand and identify the value behind it.

Using an activity diary to log your daily activities and reflect on the reasons why you did them can help.

Ask yourself. Why is this activity important to me?

Be aware that at first it may feel disappointing when you start doing your adapted activity.

You may start ruminating that it doesn’t feel as good as your original activity.

It’s helpful to switch your thoughts from rumination and remember the positive aspects of engaging in the activity you are doing.

If this persists, go back to the values and explore other alternative activities that might be more enjoyable.

Example

Jock used to run every day, he really enjoyed his running

He identified that the value underpinning his running was physical fitness

Jock decided that doing some walking and swimming also underpinned his value of physical fitness

He realised he could do this using his pacing

Jock started these activities, but he just wasn’t enjoying them; he kept thinking about his running

Jock realises when he is walking, he is ruminating and not really present

He also realises he is engaging in all or nothing thinking

Transcript

This is an example of an adapted value activity.
Jock used to love running, he used to run at least 5K every day. He identified the value behind this activity was his physical fitness.

Due to fatigue and pain Jock could not run and was feeling very low.

He identified alternative activities that underpinned his value of physical fitness as doing some walking and swimming.

He started doing these using his pacing techniques however he wasn’t enjoying them and just kept thinking about his previous running.

What is Jock doing with his thoughts? What thinking trap might apply here?

• Jock acknowledges he is finding not being able to run distressing
• He realises that when he is doing his adapted or replacement activity, he is ruminating on not being able to run
• This keeps him in the past and spoils his enjoyment of the present walk or swim
• He realises he is in the past or future with his internal thinking and not paying attention to what is around him
• He acknowledges he has a self-critical narrative running through his mind
• Jock decides to practise seeing the benefit of the activity and he tries to focus on the present and uses the rumination exercise
• He realises that doing any form of activity is still a good, positive thing

Transcript

Jock realises he is ruminating on his past activity of running, he recognises that when he is swimming or walking, he is not in the present moment.

This rumination prevents him experiencing any enjoying any positive benefits from his swimming or walking.

Jock also realises he is applying a self-critical mind and beating himself up for not being able to run (he is feeding the bad wolf from last week)

Jock decides to practice the task concentration exercise and refocusing his attention on what he is doing whilst he is swimming or walking. This allows him to experience more positive feelings and enjoy the activities more.

In a way he has realised he may have been caught in the all or nothing thinking trap.

As the saying goes, “Don’t let perfection be the enemy of the good” (or the good enough or now)! Jock reassures himself that doing any form of activity is still a good positive thing and is meeting his value even if it is not the activity he would have liked.

Martha used to like reading, because of deteriorating vision she has been unable to do this

What did Martha value about reading?

• Is it because she enjoys reading?
• Does she value the fun aspect that comes with that?
• Or does she value the kind of escapism that you get from reading?
• Does she value personal development from reading non-fiction?

If the value is personal development, how else could she receive this?

Could she listen to audio books, join a group, listen to YouTube videos or podcasts where she does not necessarily need to rely on her vision?

Transcript

Another example is Martha used to love reading, however because of her deteriorating vision she is now unable to do this.
Martha asked herself what she valued about reading.

Is it because she values the enjoyment and fun aspect, does she value the escapism she gets from reading, does she value personal development from reading academic or non-fiction material. If this value is personal development how else could she receive this?

Could Martha listen to audiobooks or join a group, could she listen to YouTube videos or listen to podcasts, anything where she does not necessarily need to rely on her vision.

Keith used to love attending book clubs:

The value behind this were:

• reading
• discussing the books
• mixing with others

Due to breathlessness and embarrassment about being breathless Keith felt unable to do this

His health professional had suggested singing groups

He had previously discounted this as ‘it’s not the same’

By looking at values-based behaviour work Keith realised that although the activity was different the value of taking part and mixing with others was similar

He gave it a go and found it was ok, he enjoyed it more the second time

He started to look forward to this activity and found it also helped with his breathlessness

Transcript

A further example is Keith used to love attending book clubs.

He identified the values behind this as reading, discussing the books, but most of all it was mixing with other people.

Due to his breathlessness and experiencing some embarrassment about being breathlessness he feels unable to do this activity at the moment. His health professional had suggested singing groups however Keith has dismissed this and said, it’s just not the same, I won’t enjoy it.

By looking at the values-based behaviour work, he realised that although the activity was different, the value of taking part in a group activity and mixing with others was very similar.

He gave it a go and found it was okay- enough for him to go along a second time.

The second time he found himself enjoying it more, gradually Keith found himself starting to look forward to this activity. He even found that it also started to help him manage his breathlessness.

• Practice and self-reflection is essential
• Keep an activity diary for a few days
• Log every activity you do
• Each time you do an activity write down what you did- be specific
• Think about the value behind that activity or why it was that you did it
• This helps you identify the values behind your activities
• Ask yourself?
• What did you value about it?
• Why did you do it?

Transcript

This is how we usually do value-based behaviour work.

To help you develop the skill of identifying the values behind your activities try using an activity diary for a few days or even a day if that is all that is manageable at present.

Log your activities then reflect on the activities in your diary to help find the underlying values. Activities may have several values underpinning them so try not to get too hung up on this.

If you spend time on self-care, ask yourself, what was important about this? what did you like about it? why did you do this activity?
If you cooked a meal or spent time with your children what was important to you about this activity, what was the reason why you did this.

• Make a list of any alternative activities that may have the same or similar value underneath
• Use the examples to help you
• Any activity must be within the safe limits of your health condition
• Make a well-paced plan to spend more time on the things that you value
• Remember that staying active and achieving valued enjoyable activities is a positive step forward
• If you catch yourself ruminating or worrying, gently bring your attention back to the present

Transcript

The next step is to make a list of any alternative activities that may have the same or similar value underneath.

You may need to brainstorm doing this or ask someone to help and support you with this. Reflect on the examples on these slides to help you too.

Remember any activity you do must be within safe limits of your health condition; small steps are the best way to make any progress. Apply your pacing skills to increase the time spent doing the things that you value

If you find yourself ruminating on past activities gently bring your thoughts into the present using the task concentration exercise. Remember that staying active and achieving any valued and enjoyable activities is a positive step forward.

You may have reservations about making changes.

“I feel exhausted, in pain, how can I make changes?”

“It won’t work; I can’t face anything else”

Due to a combination of physical and emotional symptoms you may have fallen into the vicious cycle of avoidance

Avoidance might make you feel better in the short term, but it can make you feel worse in the longer term (vicious cycle)

Feel better but get worse

Transcript

You may have reservations about making changes and may be avoiding activities, situations or other people that are safe and beneficial for you.

You may have a fear of increasing your symptoms, you may feel embarrassed about doing things differently.

There can be many barriers to making changes, all of these can be valid and understandable for you.

Avoidance might make you feel better in the short term, but it can make you feel worse in the longer term as it can maintain your vicious cycle.

We sometimes refer to the vicious cycle of avoidance as ‘Feel better but get worse’.

Fear and anxiety can prevent you from engaging in any safe and beneficial activities and can contribute to physical deconditioning and emotional distress.

If you feel stuck in this vicious cycle, please do discuss this with your clinician as they can help you find ways out by taking gradual steps.

• Underactivity: Avoiding activities that might be helpful
• Overactivity: Pushing self beyond realistic limits
• Paced Activity: Knowing your limits and engaging in safe, helpful activities

Transcript

Underactivity and overactivity both add to the boom and bust cycle. They impact on your ability to manage both your physical and emotional health.

Worry about making your symptoms worse can contribute to underactivity, whilst thinking traps like should and musts contribute to overactivity.

You may experience some frustration at having to pace and plan, however taking this approach will help you achieve more activities albeit a little slower than you would ideally like.

Pace, prioritise and plan will be more beneficial for your physical and psychological well-being.

Remember the metaphor from last week. Going uphill in low gear. To get up the hill the cyclist has had to change his bike down a gear, doing this means he is able to reach the top of the hill albeit a little bit slower.

For people who are experiencing health conditions, goal setting is an important strategy.

Goal setting provides you with a sense of control, structure and purpose, this help improve your emotional wellbeing.

Goals can help you create a structured plan using the pacing principles.

Goals can help you feel more motivated and empowered despite the challenges you are experiencing.

Before next week’s session think about one goal you would like to set yourself.

We suggest this goal is a small short-term goal, for example, for the next hour, afternoon, day, week or fortnight.

Next week’s session is mainly dedicated to peer support.

If you wish to, you could share your goal, share your concerns, your challenges.

Share any helpful coping strategies or just come along and listen.

Transcript

For people who are experiencing health conditions, goal setting is an important strategy.

Goal setting provides you with a sense of control, structure and purpose, this help improve your emotional wellbeing.

Goals can help you create a structured plan using the pacing principles.

Goals can help you feel more motivated and empowered despite the challenges you are experiencing.

Before next week’s session think about one goal you would like to set yourself.

We suggest this goal is a small short-term goal, for example, for the next hour, afternoon, day, week or fortnight.

Next week’s session is mainly dedicated to peer support.

If you wish to, you could share your goal, share your concerns, your challenges.

Share any helpful coping strategies or just come along and listen.

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.