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Overcoming Stress, Worry and Low Mood Course · PDF file 2) Changes in Thinking 3) Changes in...

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    Overcoming Stress, Worry and Low Mood Course

    Participant Workbook

    Workshop 1

    • To introduce leaders, participants and set group rules. • To increasing understanding of stress, worry, low mood, anxiety and

    depression. • To outline the CBT model of anxiety and depression • For each participant to score their levels of anxiety and depression. • To teach progressive muscle relaxation

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    Section 1: Introduction On this course we discuss overcoming stress, worry and low mood. Some of you will feel this is a good way of describing how you feel in the past/now. For others, their feelings may seem more extreme. It is important to understand we are all vulnerable to these feelings and many people will feel overwhelmed by them at some point in their life. We do not discuss the causes of low mood, anxiety and stress in detail on the course, this is because regardless of cause, there are many things you can do to gain control and manage these feelings in a way that improves your quality of life. The first workshop is mainly about recognising anxiety/ low mood and in the forthcoming 5 weeks we will be teaching you how you can overcome them.

    The Continuum of stress and low mood Everyone experiences low mood and stress from time to time, in fact this is totally normal. Many people find that at some point in their lives this becomes more overwhelming and distressing, possibly resulting in depression or anxiety. It is important to understand that many others will also feel this way. Stress overwhelming anxiety Low mood clinical depression

    1. What is Low Mood -Depression? Depression comes in many forms and has many causes. For many people that experience depression, things are not as simple as feeling low or down- they will also feel stressed, tense, nervous or anxious. Depression is often, but not always associated or triggered by a difficult life situation, for example:

    • Major life events, particularly around loss e.g. death of a loved one, job loss, relationship breakdowns.

    • Limited social contact and socially isolation • Stress at work, in relationships or with poor physical health e.g. long term or

    painful illness

    However there is a great deal which is still poorly understood about depression, particularly about the causes and the reasons why the same difficult life situation will trigger depression in one person, but not in another. You do not really need to know the causes of depression to effect positive changes.

    Recognising the signs and symptoms of depression If you are clinically depressed you would have at least two of the following symptoms for at least 2 weeks.

    • An unusually sad mood that does not go away • Loss of enjoyment and interest in activities that used to be enjoyable

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    • Tiredness, fatigue or lack of energy

    And at least 4 of the following symptoms:

    • Loss of confidence in themselves or poor self-esteem • Feeling guilty when they are not at fault

    • Suicidal/self-harming thoughts (Wishing you were dead), plans or acts • Difficulty concentrating or making decisions

    • Moving/speaking more slowly or, sometimes becoming agitated and unable to settle • Having sleeping difficulties (e.g early morning wakening) or, sleeping too much • Loss of interest in food or, sometimes eating too much (weight loss or gain)

    In addition to these, people who are depressed often have other symptoms such


    • Pessimism or hopelessness about the future • Feeling bad about yourself

    • Decreased sex drive • Mood variation during the day (often worse first thing in morning)

    • Worry, anxiety and rumination

    • Feelings of worthlessness or low self-esteem • Anger, irritability and frustration

    • Being overwhelmed and feelings of not being able to cope This list of symptoms allows us to recognise depression, however in order to understand depression and the impact it has on us it can be useful to put these symptoms into four categories. These are:

    1) Changes in Behaviour

    2) Changes in Thinking 3) Changes in Emotions 4) Changes in Physical symptoms

    This way of understanding depression comes from cognitive-behavioural therapy or CBT which is the approach taken in this course. CBT believes that our thinking affects our behaviour, which in turn impacts upon our emotions and physical state (or physiology). Making positive changes in one area will impact upon other areas as well.

    Thinking Behaviour

    Emotions Physical change Depression has an impact on all these areas, however these changes also maintain the depression. This causes a vicious cycle of inactivity, low mood, isolation, fatigue and negative thinking, which can feel like it is spiralling beyond your control. The longer it goes on the more you feel like you cannot get out of the trap. Start somewhere to do something differently and it can help to make you feel a bit more in control and break out of the depressive vicious cycle. The diagram below demonstrates this vicious cycle.

    The vicious cycle of depression

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    loss isolation conflict stress

    THOUGHTS PHYSICAL/BODILY REACTIONS negative thinking changes in brain chemistry harsh self-criticism low energy unfair/unrealistic thinking altered sleep EMOTION BEHAVIOUR sadness social withdrawal anxiety reduced activity level despair poor self care discouragement limited pleasure numbness If we take these areas one by one: Thoughts • Each of us is affected differently by situations, depending on how we think about them.

    • Evidence has shown that depressed individuals have very negative ways of thinking about themselves, others and the world.

    • These ways of thinking can trigger, and worsen the experience of depression. Imagine a phone call that is expected from a close friend that does not happen, for example: Mr X may regard this as evidence that the friend does not want to speak to him or is bored of his moaning about being overwhelmed by feelings of despair. He feels hurt, upset and fearful of reaching out to anyone else in case they are also bored of him. His thinking is negative, unrealistic and makes him feel more depressed and behave in an avoidant way which does not give him the opportunity to find out that his thinking is faulty. Mr Y, on the other hand, may be curious about the missed call but think that the friend was busy or had forgotten. He would call the friend themselves to have the conversation that was planned and his mood would be unaffected. Emotion • When depressed we can feel not just sad but overwhelmed by feelings of despair. • A profound feeling of anxiety and often sense of impending doom can accompany these

    depressed feelings, others feel numb and detached. • In the same way as your thoughts can become overwhelming and negative, your

    emotions can too. Physical • Depression can lead to big changes in your physical health. • One important change is in sleep, ie sleeping too much or too little, or early morning (4

    am) wakening. If sleep does not restore you a vicious cycle of exhaustion, low energy and worry about not sleeping can cause further depression.

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    • The physical changes experienced with depression make it harder to cope with the demands of life. It certainly makes it hard to have the energy to do a self-help programme like this. Some people find that antidepressant medication is helpful to lift mood and can help you regain sleep and appetite.

    • The changes in brain chemistry associated with depression have been demonstrated in research. However, we are still not entirely sure what comes first, for example does depression cause changes in the brain’s chemistry or vice versa.

    Behaviour • Depression can have a big impact on how you behave. • It can make you withdraw from your family and friends, • stop you taking care of yourself, • stop you doing things you used to enjoy • stop you getting on with your daily duties.

    • Example of how these changes in behaviour can impact on you:

    Not doing the things you used to enjoy Examples Not doing hobbies Not having any fun Stopping doing something you used to enjoy Likely result Inactivity becomes a habit You stop receiving personal satisfaction.

    Depression can be seen as a “ vicious cycle” that people get stuck in……………. BUT by changing the way you think and behave you can recover from depression and reduce the likelihood of relapse. We will be spending the next 5 workshops of the course showing you how to do this.

    Coping with low mood or depression

    • Avoid sitting or lying about doing nothing

    • Identify things you used to do regularly and things which you used to enjoy

    • Plan to gradually increase the routine of pleasant activities

    • If a task seems too difficult, try breaking it into a series of small steps

    • Above all reward yourself for yo

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