The Wellbeing Course - MindSpot Clinic€¦ · Worksheet 2: 100 Things To Do ... Dr Blake Dear ©...

© Copyright 2015 The MindSpot Clinic v4.0

The Wellbeing Course

LESSON 3: DIY Guide

The Wellbeing Course was written by Professor Nick Titov and Dr Blake Dear

© Copyright 2015 The MindSpot Clinic v4.0 2

Welcome to the Lesson 3 DIY Guide

We hope you have had a chance to read through the Lesson 2 materials a couple of times. In Lesson 2 we discussed unhelpful thoughts and their role in the Cycle of Symptoms and our emotional wellbeing. In Lesson 3 we discussed the Physical Symptoms of anxiety and depression. This DIY Guide will help you learn to recognise these symptoms and we will also introduce some simple, but very effective, strategies for overcoming them. Tackling Physical Symptoms is challenging and takes practice with the skills. Good luck!

Professor Nick Titov, Dr Blake Dear and the MindSpot Team

If you have any technical difficulties, please let us know. Email: [email protected].

Contents

About the Physical Symptoms .............................................................................................. 3

About Under-Arousal (Physical Symptoms of Depression) ..................................................... 5

Tackling Under-Arousal with Activity Scheduling .................................................................... 7

About Over-Arousal (Physical Symptoms of Anxiety) ............................................................. 9

Tackling Over-Arousal with Controlled Breathing ................................................................. 11

What People Have Told Us ................................................................................................. 12

Summary ............................................................................................................................ 13

This Week’s DIY Tasks ....................................................................................................... 13

Worksheet 1: Activity Schedule ........................................................................................... 14

Worksheet 2: 100 Things To Do .......................................................................................... 15

Prof Nick Titov

Dr Blake Dear

mailto:[email protected]


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About the Physical Symptoms

Anxiety, worry, stress, low mood and depression can cause different Physical Symptoms – more than most people realise. Physical Symptoms vary a lot between people – no two people are the same. However, because anxiety and low mood often occur together, a lot of people experience the symptoms of both. The Physical Symptoms fall into two broad categories.

• Under-Arousal Symptoms • Over-Arousal Symptoms

Anxiety and stress trigger the over-arousal of the brain and body, which can result in panic and tension. Low mood and depression trigger the under-arousal of the brain and body, which can cause fatigue and exhaustion. However, it is important to recognise your Physical Symptoms caused by stress, anxiety, low mood and depression. This is because they can have a massive effect on the way people feel and our emotional wellbeing, especially over the long term. These symptoms keep cycles of anxiety and low mood going.

Using the skills … … to tackle … … the symptoms

Activity Scheduling

(i.e., light physical and regular pleasant activities)

Under-Arousal Symptoms

(i.e., fatigue and exhaustion caused by low mood and depression)

Controlled Breathing

(i.e., using the 3/3/3 rule)

Over-Arousal Symptoms

(i.e., physical stress and tension caused stress and anxiety)

Example 1: The Café

Imagine yourself walking down the street. Imagine you see some people sitting outside a café chatting

A key message of this lesson is that we can manage the Physical Symptoms of over-arousal and under-arousal by carefully and gently doing the opposite. This means maintaining our day-to-day activity levels as much as possible and regularly using Controlled Breathing to slow our brain and bodies down. A large amount of research shows this is essential for maintaining good emotional

wellbeing. The aim is not to get rid of these symptoms altogether. Rather, it is to try and limit them so that they aren’t affecting your emotional wellbeing and quality of life.


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What are the common Physical Symptoms of over-arousal?

Thoughts Physical Symptoms Behaviour

Thoughts of losing control or falling over

Shortness of breath and difficulties breathing

Increased breathing

Fears of dying or going crazy Skipping, racing or pounding heart

Holding your breath

Fears of what other people might think

Hot flushes or chills Tensing muscles

Thoughts about something being physically wrong

Sweating, trembling or shaking Focusing on Physical Symptoms

Thoughts about fainting, passing out or others bumping you

Chest pain, pressure or discomfort

Avoiding Physical Symptoms at other times

Thoughts about not being able to cope or manage

Nausea, stomach problems and diarrhoea

Avoiding situations where you might experience symptoms

Thoughts about other people judging you

Dizziness, light-headedness or feeling faint

Focussing on Physical Symptoms e.g., checking if your face is going red.

Thoughts about vomiting, losing control of your bladder or bowel

Tingling or numbness in parts of your body

Excessive reassurance seeking from others

Fears about being unable to escape if you need to

Feeling that things around you are strange or unreal

Always needing a companion to do things

Thoughts about others’ noticing your symptoms

Headaches, sore neck and muscle tension

Excessive monitoring of body (e.g., checking pulse, etc.)

What are the common Physical Symptoms of under-arousal?

Thoughts Physical Symptoms Behaviour

Thoughts of being hopeless and worthless

Fatigue and exhaustion Increased sleeping and sitting

Thoughts about nothing being enjoyable or worthwhile

Tiredness and low energy Avoiding day-to-day physical and pleasant activities

Thoughts of being a failure Headaches, muscular aches and pains

Avoiding social situations and going outside

Critical thoughts about your abilities

Increased or decreased appetite Moving or talking more slowly than usual

Thoughts about not being able to cope or manage day-to-day

Difficulty concentrating and making decisions

Avoidance of day-to-day things that you can do


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About Under-Arousal (Physical Symptoms of Depression)

Low mood and depression have a significant impact on our everyday life. Low mood and depression cause many strong Physical Symptoms. For example, many people say it feels like their brain and body have slowed down. This often leads people to spend more time resting and stops them doing things they used to do.

Research tells us that the brain behaves differently when people are struggling with low mood and depression. These changes affect:

- Sleep and energy levels - Appetite and sex drive - Attention, concentration and memory - Decision making and critical thinking

These changes often lead people to spend more time resting and stop them doing all the day-to-day physical and pleasant things they used to do.

The Downward Spiral of Under-Arousal …

Many people who struggle with low mood and depression come to notice a pattern with the symptoms of under-arousal, where: 1. Trying to manage day-to-day challenges

leads to fatigue, exhaustion and tiredness.

2. This leads to unhelpful thoughts that

cause them to reduce and withdraw from their day-to-day activities and to increase their resting and sleeping.

3. This keeps the downward spiral going

and leads to more fatigue, exhaustion and tiredness, which leads to more unhelpful thoughts and so on.

4. And, over time, the spiral continues ...


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The good news is that research shows there are things we can do to tackle the Physical Symptoms of depression and to reverse the downward spiral of under-arousal. Unfortunately, many people are never told about the symptoms of under-arousal and how important it is to try to keep up day-to-day activities as much as possible.

An essential message of this course is that resting and inactivity in depression is not helpful. While resting when you are tired makes sense, doing less when depressed actually makes people feel even more tired, exhausted and unmotivated. Reducing your activity levels also means you stop doing the things that give you a sense of joy and achievement; the very things that will help to make you feel a bit better.

How do you know if your symptoms are a result of under-arousal? With time most people do get better at identifying whether their Physical Symptoms are a result of their depression and low mood. But, one trick is to see if a bit of extra rest or sleep over a couple of days does make you feel better. If it doesn’t and you struggle with low mood, it may be under-arousal contributing to

your symptoms.


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Tackling Under-Arousal with Activity Scheduling

Most people with low mood and depression can see how the physical symptoms of under-arousal have a destructive impact on the way we feel. These symptoms often stop people from doing the things that bring them a sense of purpose, achievement and satisfaction; the very things that will help to make them feel a bit better.

Overcoming the physical symptoms of low mood and depression means we need to gradually become more physically active, even if we don’t feel like it. Becoming more active helps to stimulate the brain and counter the under-arousal caused by low-mood and depression. That is, you need to fight the depression and do the opposite of what the depression wants you to do. Increasing physical activity is a proven way of tacking the under-arousal caused by low mood and depression. In fact, numerous research trials around the world have found increasing activity improves mood.

Research tells us that increasing activity helps because:

• Activity stimulates our brain and body. Normally, rest is important and helpful if you are tired. However, this is not always the case, especially if you struggle with low mood and are not doing much day-to-day. In this case, we need to stimulate our brain and body because the tiredness, fatigue and exhaustion are being caused by under-arousal.

• Activity motivates us. People often think that they need to feel motivated before they can do something. While it is true that feeling motivated makes it easier to do things, research tells us that the reverse is also true – the more you do, the more motivated you become. So it is important and helpful to do some things even if you don’t feel like it.

• Bring enjoyment, confidence and achievement. Most people with low mood and depression want to experience pleasure, feel confident and achieve things. However, it is not possible to experience these things when we don’t do anything. This is where low mood and depression can become a trap – depression makes us think things are hopeless and stop us from finding new things we can do or new ways of doing things we want to do. That is, those things that will give us pleasure and a meaningful life.

How to do Activity Scheduling …

Activity Scheduling is a skill that many people find helps them to become more active. Activity Scheduling is a very simple, but effective skill, for tackling under-arousal.


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The 3 steps of Activity Scheduling are:

1. Create Your Plan

Set aside a regular day and time to plan the week ahead. Try to have a good balance between your daily responsibilities and activities that provide you with a sense of enjoyment and accomplishment. When creating their plans, people often find it helpful to:

• Think of new things they can do instead of the things they can’t do. See the 100 Things to do at the end of this Guide for ideas.

• Think creatively about how they can do things they really want to do. See the Structured Problem Solving and Worry Time Resource to troubleshoot solutions.

• Make sure their goals are safe and realistic. If unsure, always consult your GP, who can tell you if there are things that you simply should not do.

2. Review Your Plan

It is common for people to have high expectations or to set goals that are difficult to reach. Sometimes things change which means you will have to change your plan. When reviewing their plans, people often find it helpful to:

• Review what they have achieved and what difficulties they have encountered, which might have prevented them from sticking to their plans.

• Check that their goals are realistic and problem-solve potential ways they can do what they want to do.

3. Be Flexible

It is important to be flexible and try not to criticise yourself for deviating from your plans. If you have managed to stick to your plan, great, but even if you haven’t that’s okay. The trick is to learn from the experience and see if there’s anything you could do differently next time. When being flexible, people find it helpful to:

• Focus on trying to do 3 pleasant activities (no matter how small) and 1 or 2 physical activities (no matter how small) each day. It doesn’t matter what the activities are.


9

About Over-Arousal (Physical Symptoms of Anxiety)

Anxiety triggers over-arousal of the brain and body. It is common for people with anxiety to experience panic and to develop physical tension. Physical over-arousal can lead to lots of strong Physical Symptoms and can trigger the Fight or Flight Reflex when not managed. The Fight or Flight Reflex is an important biological reflex that everyone needs to know about. It is a reflex that is designed to help us stay safe and acts a bit like a smoke alarm. It is triggered when we think we may be in danger. Several important things happen in our body when the Fight or Flight Reflex is triggered – see Figure 2. These changes all help to defend against danger (fight) or get away from danger (flight). So, the Fight or Flight Reflex is critical. But, the Fight or Flight reflex can be triggered too often and at the wrong times – when we are not in immedaite or actual danger. This is where it can start to become a problem.

Our breathing speeds up to get more oxygen for muscles, causing us to feel

dizzy and lightheaded.

Our heart rate and blood pressure increases, causing

palpitations.

We start sweating to cool down the body.

Our digestion slows down as blood flows away from our stomach and to our muscles, causing us to get an upset or

queasy tummy.

Saliva production reduces, leading to a

dry mouth.

The mind becomes alert and scans for pain, strong Physical Symptoms, potential threats and possible injuries. It then

focusses on them.

Our muscles tense up to prepare us to fight or run away. This causes

different aches and pains throughout the body.

Stress hormones and different neurotransmitters are released, which

can affect our health over the long term.

Figure 2. The Fight or Flight Reflex


10

The Upward Spiral of Over-Arousal …

Many people who struggle with anxiety come to notice a pattern with the symptoms of over-arousal, where 1. Being in a challenging situation

increases their stress and anxiety levels, which leads to the Physical Symptoms of over-arousal.

2. This leads to unhelpful thoughts about ‘losing control’, ‘not being able to cope’ and concerns about ‘what their physical symptoms mean’.

3. This then triggers more over-arousal symptoms and the Fight or Flight Reflex, which keeps the spiral going.

4. This can lead to high levels of stress

and tension. And, it can lead to panic attacks if left unmanaged.

The good news is that research shows that there are things you can do to manage the symptoms of over-arousal and to reverse the Upward Spiral of Over-Arousal.


11

Tackling Over-Arousal with Controlled Breathing

The Fight or Flight response is very helpful if we need to escape or protect ourselves from something dangerous. For example, when we seriously injure ourselves or are at risk of injuring ourselves, tensing our muscles to prepare for injury and focussing our attention on our injuries is very helpful. However, when we are in a situation that is not a direct threat to our survival, the Fight or Flight Reflex can be very unhelpful.

Research shows that prolonged or chronic symptoms of over-arousal can cause a lot of strong Physical Symptoms and changes in our brains and bodies, which can really affect our emotional wellbeing. So, it is essential to manage the symptoms of over-arousal.

The fight or flight physical symptoms can be very overwhelming. It is important to note that the feelings are not dangerous, but can be very overwhelming and very unpleasant.

How to do Controlled Breathing …

The key to tackling the Physical Symptoms of over-arousal is to do the opposite of the symptoms – slowing down the brain and body. Controlled Breathing is a very simple, but very effective, skill for slowing down the brain and body and tackling over-arousal symptoms. You can use the 3 / 3 / 3 Rule when doing Controlled Breathing:

1. Breathe in for 3 seconds 2. Breathe out for 3 seconds 3. Repeat this for 3 minutes

The best way to do Controlled Breathing is to breathe with your stomach muscles rather than with your chest. To check how you are breathing, place one hand on your chest and one on your stomach – you want your hand on your stomach to move rather than the hand on your chest. Many people experiencing physical symptoms of anxiety are sceptical about the helpfulness of Controlled Breathing and find it strange when first practicing.

This is understandable. But, those who practice Controlled Breathing regularly do start to notice a difference in their Physical Symptoms. The most important thing is to make sure that you practice regularly in situations where you are not too anxious. This means that you get used to using the skill so that when you find yourself feeling more anxious you can more easily manage your physical symptoms of anxiety. Please Note: If you have been through a traumatic event you may find that you experience very strong physical sensations of anxiety and stress. Please make sure you read the Resource Managing PTSD for extra tips for managing your physical sensations.


12

What People Have Told Us

Over the years we have worked with a lot of people and we have asked people to provide us with feedback about their experiences, and things they thought were important to keep in mind. In this section you will find some key messages from others. • It takes practice. Most people tell us that they find Controlled Breathing really helpful, but it does

take a bit of practice at first. However, the good news is that after a few days of consistent practice, Controlled Breathing starts to become automatic, that is, people start to do it automatically when they first notice tension.

• Do it early. People have told us that it can be very difficult to slow down panic when they are

already over-aroused. Therefore, it is important to do Controlled Breathing when you notice the first signs of anxiety.

• Set realistic goals. We have found that sometimes people become overly ambitious when activity planning and they plan too much, too quickly. It is important to be flexible and kind to yourself and set realistic goals.

• Don’t self-sabotage – give things a good try and use what’s helpful. Often we make decisions about what will and won’t help before we try them seriously. Or, we decide things aren’t helpful after a short period of time. Many people we work with have already been told about the skills we cover in the course, but only tried them once or twice. Whenever we have asked people to practice these skills for longer they do start to find them helpful.

• Give it time and practice. Most people find Activity Scheduling and Controlled Breathing take a

lot of effort and have limited benefit at first. This is normal. The good news is that after a few days of consistent practice Activity Scheduling and Controlled Breathing start to become easier and more effective.

• Combine skills to break the cycle. Physical Symptoms often lead to unrealistic thoughts and one way to start to break the Cycle of Symptoms is to combine the skills of Thought Challenging with Controlled Breathing and Activity Scheduling.


13

Summary

We have covered a lot of important information. Let’s review the key points:

1. Anxiety and depression trigger several Physical Symptoms.

2. Physical Symptoms fall into two categories:

• Under-Arousal Symptoms common in depression and low mood. • Over-Arousal Symptoms common in anxiety and stress.

3. It is possible to manage the Physical Symptoms by doing the opposite, using:

• Activity Scheduling to tackle the fatigue and exhaustion caused by physical under-arousal. • Controlled Breathing to tackle the stress and tension caused by physical over-arousal.

4. Both of these skills are very simple and also very effective. But, research shows they are skills that take practice and some time to work best. And, that they are skills that all people can use to use to manage their emotional wellbeing.

Please log back into www.mindspot.org.au again and review Lesson 3. Please revisit the website as often as you like to re-read any of the lessons and check when Lesson 4 becomes available.

This Week’s DIY Tasks

Our experience tells us that those who benefit the most from the course do the following: Re-read the Lesson and DIY Guide for Lesson 3 at least twice this week. Start practicing Controlled Breathing a couple of times a day for at least 1 week. Complete the Activity Schedule worksheet at the end of this DIY Guide. Check the 100 Things to do list at the end of this DIY Guide. Have a look at the Case Stories and Additional Resources.

© Copyright 2015 The MindSpot Clinic All rights reserved. You may use and/or copy this information for personal reference only. The MindSpot Clinic endeavours to ensure all information contained in this material is correct at the time of inclusion. However, the accuracy of the material cannot be guaranteed and people using the information do so entirely at their own risk. The information may not be reproduced or published in any other way or by any means without the prior written consent of The MindSpot Clinic.


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Worksheet 1: Activity Schedule

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

6 – 8 am

8 – 10 am

10 – 12 pm

12 – 2 pm

2 – 4 pm

4 – 6 pm

6 – 8 pm


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Worksheet 2: 100 Things To Do

At Home Things Away from Home Things 76. Brisk walking

1. Reading 39. Get a massage 77. Golfing

2. Work in the garden 40. Go to the beach 78. Washing the car

3. Play a musical instrument 41. Get a facial 79. Walking the dog

4. Make a card 42. Go to an auction 80. Basketball / football

5. Listen to music 43. Go to church 81. Fishing

6. Write a letter 44. Buy yourself a present 82. Tennis

7. Woodwork / carpentry 45. Browse at a garage sale 83. Water aerobics

8. Write an email 46. Go to the spa 84. Aerobics

9. Drawing or painting 47. Help a friend with something 85. Fly a kite

10. Spend time with your pet 48. Go to the zoo 86. Dancing

11. Cook a meal 49. Have a sauna 87. Bowls / bowling

12. Bake a cake 50. Go to the library 88. Vacuuming

13. Craft work (pottery, beads, etc.) 51. Get a haircut 89. Stretching

14. Make a present for someone 52. Go on a picnic 90. Tai Chi

15. Mechanical work (e.g. on the car) 53. See a movie

16. Look after your houseplants 54. See a play Social Things 17. Do a project around the house 55. Watch a sporting match 91. Phone a friend

18. Say prayers 56. Go to a museum 92. Give someone a massage

19. Knitting / crocheting / embroidery 57. Go to an art gallery 93. Host a party / gathering

20. Sewing 58. Go to a café or restaurant 94. Go to a party

21. Practice or Develop a Skill 59. Volunteer somewhere 95. Organise a play date

22. Photography 60. Browse in a book shop 96. Go to a bar / club

23. Meditate / relax 61. Go to the park 97. Invite a friend over

24. Redecorate a room 62. Go to the markets 98. Joining a community club

25. Sit in the sun 63. Enrol in a course 99. Spend time with children

26. Take a long bath 64. Go to a concert 100. Cook for someone special

27. Surf the internet 65. Make something

28. Having a coffee or glass of wine 66. Go camping Other Things 29. Listen to the radio 67. Go for a drive 101.

30. Make food to sell or give 68. Go to an exhibition 102.

31. Do a jigsaw puzzle 103.

32. Write in a journal Active Things 104.

33. Plan a trip or holiday 69. Yoga 105.

34. Play a computer game 70. Cycling 106.

35. Start a project 71. Horse riding 107.

36. Watch a DVD 72. Gentle Martial arts 108.

37. Rent a movie 73. Water activities 109.

38. Listen to a relaxation CD 74. Go to the gymnasium 110.

75. Swimming 111.

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