Anxiety, depression and low mood

Everything biological, social, environmental and psychological factors and all interlinked with each other and with your mental health.

If someone has a physical problem following their stroke this impacts their biological state. This may then limit their social interactions as they can’t get out which affected their mood and mental health.

Biological Factors

• Physical health
• Neurochemistry
• Metabolic disorders
• Genetic vulnerability
• Immune and stress response
• Comorbidity
• Mental Health
• Drug effects
• Diet and lifestyle
• Emotions
• Response to reward

Psychological Factors

• Emotions
• Response to reward
• Self-esteem
• Attitudes and beliefs
• Perceptions
• Temperament
• Coping skills
• Social skills
• Mental health
• Emotions
• Response to reward
• Interpersonal relationships
• Trauma
• Grief

Social and environmental Factors

• Peer group
• Work
• School
• Socio-economic status
• Culture
• Family
• Life circumstances
• Mental Health
• Drug effects
• Diet and lifestyle
• Interpersonal relationships
• Trauma
• Grief

For example,

Mary has had a stroke which has affected her mobility and independence, and she suffers from increased fatigue and low mood.

Mary used to attend a weekly social group at a local church followed by lunch with her friend, and attended a chair based exercise group in the local leisure centre.

Mary has 5 steps from her house to access the street, this is the only exit from her home, and she is unable to complete stairs without significant support. Mary has no close living family or friends that are able to help. As a result of this Mary is experiencing low mood due to lack of opportunity for social participation and is unable to complete her usual routines and feels a loss of identity.

Can you relate to this?

Anxiety and depression can affect anyone at various points in time throughout their life, in different ways and severity.

“One in two survivors of stroke will get depression. One in four survivors will get anxiety. Depression and anxiety can happen at any time after a stroke” Stroke Foundation.AU

50%  of stroke survivors experience depression and  25% experience anxiety.

Points to consider for care givers

43.9% of the stroke caregivers had anxiety symptoms

53.9% of the caregivers had symptoms of depression

Caregiver equals unpaid family member or friend

Carers may experience anxiety and depression due to changes in their role, relationships and lifestyle.

For both the stroke survivor and carer.

Emotional

• Feel very worried or anxious a lot of the time.
• Find it hard to calm down.

Cognitive

•  Overthinking
• Replaying events in your mind.
• “What if? What if? What if?”
• Find it hard to make decisions.
• Have trouble concentrating.

Physical

• Feel tired all the time.
• Have tense muscles.
• Find it hard to get to sleep or stay asleep.

For both the stroke survivor and their carer.

• Feeling sad or down in the dumps.
• Feeling worthless, helpless or guilty.
• Feeling hopeless or desperate.
• Feeling anxious or worrying a lot.
• Losing confidence.
• Losing interest in things you used to enjoy.
• Lacking energy or motivation.
• Not going out or avoiding other people.
• Finding it difficult to concentrate or make decisions.
• Having problems sleeping or sleeping too much.
• Losing your appetite or eating too much.
• Losing interest in sex.
• Thoughts that life is no longer worth living and suicidal thoughts/actions.

Think about

• What activities help to boost your mood?
• How could you try to integrate these into your daily routine?

• Recognising the symptoms
• Being kind to yourself and each other (compassion and criticism is part 3)
• Seeking social connection and accepting help
• Trying to engage in activities, set small goals
• Trying to focus on the ‘here and now’ rather than ‘before’ and ‘future’
• Mindful exercises, for example, breathing and grounding
• Using what’s out there, for example, Stroke Association, Different Strokes and Carers Leeds
• Speak to your GP, 111 for immediate advice, Samaritans

Can be used when tired, for sleep, to to help manage anxiety

• Deep breathing
• Breath focus
• Progressive  muscle relaxation

Resources: Headspace app, Youtube, Aura app, Calm app, Mindwell, Smiling mind, Lumosity

Deep breathing

Get comfortable. You can lie on your back in bed or on the floor with a pillow under your head and knees. Or you can sit in a chair with your shoulders, head, and neck supported against the back of the chair.

Breathe in through your nose. Let your belly fill with air.

Breathe out through your nose.

Place one hand on your belly. Place the other hand on your chest.

As you breathe in, feel your belly rise. As you breathe out, feel your belly lower. The hand on your belly should move more than the one that’s on your chest.

Take three more full, deep breaths. Breathe fully into your belly as it rises and falls with your breath.

Breath focus

While you do deep breathing, use a picture in your mind and a word or phrase to help you feel more relaxed.

Close your eyes if they’re open.

Take a few big, deep breaths.

Breathe in. As you do that, imagine that the air is filled with a sense of peace and calm. Try to feel it throughout your body.

Breathe out. While you’re doing it, imagine that the air leaves with your stress and tension.

Now use a word or phrase with your breath. As you breathe in, say in your mind, “I breathe in peace and calm.”

As you breathe out, say in your mind, “I breathe out stress and tension.”

Continue for 10 to 20 minutes.

Create a worry bin and list: Somewhere you can write down and throw away a worry or store it and come back to it later.

Keep a worry diary to help identify triggers for your negative thoughts and low mood.

Set a worry hour: Set aside a period of time in the day, perhaps an hour in the evening to go through your worry list or diary. You don’t need to think about the worry until this time slot. If the negative thought comes into your head before then, acknowledge it and try to let it pass you by.

Use the worry tree: When confronting a worry or negative thought, decide whether there are any actions you can take, if not try to accept the worry, or let it go.

People who have experienced a stroke have an increased risk of experiencing anxiety and (or) low-mood.

People caring for a loved one who is recovering from a stroke are also more likely to experience anxiety and low mood.

Biological changes, psychological changes and social changes can all influence how these develop.

Integrating some simple strategies can help to ease feelings of low mood and anxiety.

• Leeds Mental Wellbeing Service: Refer yourself
• Touchstone: Inspiring communities, transforming lives
• Leeds Mind
• Live Well Leeds: Referrals

Phone and tablet apps

• Calm supports the reduction of stress, less anxiety, and more restful sleep with our guided meditations, Sleep Stories, breathing programs, masterclasses, and relaxing music.
• Headspace mindfulness, stress reduction, improve sleep.
• Mindwell mood and sleep lab.
• Smiling Mind meditation program.