the wellbeing course · i’m worthless people are going to think that i’m stupid i don’t fit...

© Copyright 2015 The MindSpot Clinic v4.0

The Wellbeing Course

LESSON 1: DIY Guide

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

2 © Copyright 2015 The MindSpot Clinic v4.0

Welcome to the Lesson 1 DIY Guide

We are very pleased to have you on board. The Wellbeing Course contains five lessons. Each lesson has its own DIY Guide which summarise the key messages in the lesson and provides examples to help you apply the skills described in that lesson. Please also take a look at the Additional Resources and Case Stories, which provide more helpful information based on other people’s real-life experiences. We believe that everyone can learn to manage anxiety and low mood, but research and our clinical experience tells us that the practice of a few core skills is the key to success. So, in each lesson, we introduce one or two core skills for managing symptoms. We find that that people who practice the core skills, which are described in the DIY Guides, get the most benefit from this course. Good luck!

Professor Nick Titov, Dr Blake Dear and the MindSpot Clinic Team

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

Contents

An Introduction to Anxiety, Low Mood and Depression ......................................................... 3

What Causes Anxiety and Depression? ................................................................................. 4

Treatment and the Wellbeing Course .................................................................................... 5

What Are The Symptoms? .................................................................................................... 6

What People Have Told Us ................................................................................................. 10

Summary ............................................................................................................................ 11

This Week’s DIY Tasks ....................................................................................................... 11

Worksheet 1: My Symptoms ............................................................................................... 12

Prof Nick Titov

Dr Blake Dear

mailto:[email protected]


An Introduction to Anxiety, Low Mood and Depression

Anxiety and low mood are normal human emotions. Anxiety occurs when we are threatened or frightened by something, such as an upcoming job interview or threats to our health. Low mood occurs when we experience loss or disappointment, like losing a loved one or being dissatisfied with an important part of our lives.

Feelings of anxiety and low mood are an inevitable part of life. They are also an important part of life; they let us know when something may be wrong or may need our attention. However, if they occur too often or start to impact on our everyday life, they become what we call ‘disorders’ and can start to impact on our emotional wellbeing.

When do anxiety and depression become a disorder?

This is a hard question to answer. Basically, we call them a ‘disorder’ when they occur too often, are too severe, or occur at the wrong times. That is, when they start impacting on people’s quality of life and their ability to do the things they want to do.

However, most people experience some symptoms of anxiety and depression at different points throughout their life, especially when faced with difficult or challenging situations.

How many people have anxiety or depression?

Anxiety and depression are very common:

1. About 1 in 5 Australian adults experience clinical anxiety or depression each year.

2. About 1 in 2 Australians experience clinical levels of

anxiety or depression at some point in their lives. 3. And, because they are normal human emotions, milder

levels of anxiety and depression affect many more people.

Are there different types of anxiety?

There are several types of anxiety. These include:

• Panic Disorder (PD) is when people are fearful of having panic attacks or panic-like symptoms. Many people with panic disorder also experience agoraphobia, which is a fear of places where panic might occur. Panic disorder affects about 3% of Australians.


• Social Anxiety Disorder (SAD) is when people experience excessive anxiety in social and performance situations. They often avoid social events or public places because of fear of embarrassment or humiliation. Social anxiety disorder affects about 5% of Australians.

• Generalised Anxiety Disorder (GAD) is when people worry excessively about many different

areas of their lives, including work performance, relationships, their health and their family. GAD affects about 3% of Australians.

• Post Traumatic Stress Disorder (PTSD) is when people develop symptoms of anxiety and depression as well as other symptoms like flashbacks, nightmares, and intrusive memories following a traumatic event. PTSD affects about 6% of Australians.

It is common for people to struggle with more than one type of anxiety. Many people with anxiety also struggle with depression and vice versa. In fact, research suggests that at least 40% of people who experience clinical levels of one anxiety disorder or depression will also experience clinical levels of another anxiety disorder.

The good news is that the skills and strategies that are required to overcome depression and the different types of anxiety are very similar. We will teach you these strategies over the coming Lessons.

What Causes Anxiety and Depression?

Research tells us that most people experience their first episode of anxiety or depression when they are young. But, this isn’t always the case. Research also tells us that early episodes of anxiety and depression often occur in response to events and experiences, including loss and traumatic events. But, some people develop symptoms without experiencing any obvious loss or any significant event. We know that for some people there is a genetic or family component to symptoms. That is, we may learn or inherit a vulnerability to anxiety or depression from our family.

However, regardless of the cause of symptoms, a large body of research clearly shows that people can successfully learn to manage symptoms of anxiety and depression. That is, what we know and what we do can make a big difference. Learning to manage symptoms is hard work and takes time. But, the good news is that anxiety and depression are some of the most treatable conditions.


What does the research tell us?

There are a couple of important things that research is now telling us:

1. Everybody benefits from learning about and how to manage emotional wellbeing.

2. It is essential for people with anxiety and depression to learn about emotional wellbeing.

3. Emotional wellbeing is something that needs to be managed everyday – by all of us.

4. It takes some time, practice and perseverance to learn to manage emotional wellbeing.

5. Most people are never provided with the information or taught the skills to understand and manage their emotional wellbeing.

Treatment and the Wellbeing Course

There are two main types of treatment for poor emotional wellbeing, anxiety and depression:

• Medical Treatments: These include prescription medications and other medical procedures. These treatments aim to act on different chemicals within the brain and body associated with anxiety and depression.

• Psychological Treatments: These teach practical, proven, skills for managing anxiety and

depression and maintaining good emotional wellbeing. The Wellbeing Course is a psychological treatment course. It aims to provide the same information and teach the same skills as face-to-face treatments – just via an online course. The aim of this Course …

This course aims to provide information and teach skills for managing symptoms and keeping our emotional wellbeing within the healthy range. See Figure 1.

Time

Excessive symptoms

Borderline symptoms

Healthy symptoms

Figure 1. Range of Symptoms


The goal of this kind of course is to provide the information and teach the skills that people find helpful for understanding and maintaining their emotional wellbeing. This gives people control over their own emotional wellbeing and its impact on their life. The goal is not to completely remove all symptoms of anxiety or depression or to always have excellent emotional wellbeing. This is not helpful or possible.

What Are The Symptoms?

Before you can manage your symptoms it is important to learn to recognise them. This is because being able to recognise them allows you to target them and reduce their impact using the skills we will cover during this course.

The 3 Kinds of Symptoms … These symptoms of poor emotional wellbeing can be grouped into three different categories:

1. Unhelpful Thoughts (i.e., how we think about things)

2. Physical Symptoms (i.e., what our bodies are doing)

3. Unhelpful Behaviours (i.e., things we do or don’t do)

The Cycle of Symptoms … A key message from this course is that these 3 kinds of symptoms affect each other to form Cycles of Symptoms. See Figure 2. This means one type of symptom can trigger other types and they can all interact to affect our emotional wellbeing. Importantly, the first step in learning to manage our emotional wellbeing involves recognising these symptoms and how they interact for us. Next are some examples of the common symptoms…

Unhelpful Thoughts

Unhelpful Behaviours

Physical Symptoms

Emotional Wellbeing

Figure 2. Cycle of Symptoms


Common Physical Symptoms

Chest pain or discomfort Dry mouth Muscle tightness, aches or pains Clammy hands or sweating Shaking or trembling Blushing or hot flushes Butterflies in the stomach, nausea Fatigue and exhaustion Difficulties with making decisions

Changes in appetite Tearfulness Headaches Panic and physiological distress Loss of interest in sex Insomnia Feeling jumpy or scared Feeling emotionally numb Other:

Common Unhelpful Thoughts

This anxiety will drive me insane The world is a dangerous place I’m going to make a fool of myself I’ll fail if I don’t plan ahead Everyone will know I am not coping People will judge me for being anxious People are going to take advantage of me I’m always going to be anxious/depressed My opinions are not important There’s something wrong with me I’m going to have a stroke/heart attack I’m too old to manage this If I go out I will fall and injure myself

I can’t cope I’m worthless People are going to think that I’m stupid I don’t fit in I’m so weak I can’t do this I’m a failure The world is full of bad people Everyone dislikes me I don’t deserve to be happy Other:

Common Unhelpful Behaviours

Avoiding situations and people because of stress

Avoiding doing day-to-day things Letting family and friends do everything for you Avoiding people and social situations Sleeping during the day / Staying in bed when

awake Always focusing on physical symptoms Withdrawing from family and friends Being aggressive Using alcohol or taking drugs to help you cope Not doing things to look after your emotional

wellbeing Putting life on hold for something else

Letting other people make important decisions

Procrastinating / not setting goals Giving up hobbies / pleasant activities Excessive approval seeking Excessive planning Not maintaining a regular routine of

daily tasks Saying no to going out with friends

and families Little or no physical activity Not asking for help when it’s needed Sleeping / napping during the day Other:


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Unhelpful Thoughts

(what I think to myself)

Physical Symptoms

(what I feel in my body)


(things that I do or don’t do)

a) I can’t cope

b) I’m useless and I’ve let my family down

c) I’m a failure

d) I’m lazy and stupid and weak

e) Things are hopeless and I’ll always be depressed

f) The world is a dangerous place

a) Sweating hands

b) Putting on weight and increased appetite

c) Palpitations

d) Not being able to sleep at night

e) Feeling easily tired and exhausted

f) Feeling jumpy and scared

a) Not doing things I used to enjoy

b) Staying in bed all day on bad days

c) Not doing any physical activity

d) Turning down invitations to go out

e) Comfort eating and drinking

f) Avoiding playing with the kids

g) Focussing on my physical symptoms

h) Calling in sick to work

Cycle of Symptoms (how my symptoms interact)

1. When my mood is bad I often think that “I’m a failure” and “I’ll never amount to anything or do anything worthwhile”…

2. …Because of these thoughts I’d avoid doing any physical activity or anything that I would usually enjoy – I’d just lie in bed, sleep during the day and avoid things. At those times I’d start to question whether there was something seriously wrong with me and if I was going to get worse and worse.

3. …These thoughts and behaviours made my physical symptoms worse. They’d mean I was tired during the day and would struggle to concentrate. Then, because I slept during the day and didn’t do any physical activity, I’d struggle to sleep at night because I wasn’t tired (and was made worse by nightmares). I’d also eat and drink too much, which then made me start to criticise myself again thinking that ‘things are hopeless’ and ‘there’s nothing I can do’.

Unhelpful Thoughts


Physical Symptoms

Emotional Wellbeing


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Unhelpful Thoughts

(what I think to myself) Physical Symptoms

(what I feel in my body) Unhelpful Behaviours


a) I will make a fool of myself and embarrass myself in front of everyone

b) I have to expect the worst

c) People will think I’m an idiot

d) If something bad can happen it will happen… I have to prepare for everything

e) I’m useless and an idiot

a) Blushing

b) Tension, stress and anxiety

c) Stuttering

d) Difficulty thinking, concentrating, etc

e) Not being able to sleep

f) Headaches, nausea, etc.

a) Avoid social interactions, talking in public and making eye contact

b) Excessive preparation and planning

c) Avoiding friends, physical activity, social activities and other fun stuff

d) Procrastination and staying in bed

e) Worrying, over and over, about things and not doing anything to reduce stress…


1. I’m stuck in a pattern where I’m always thinking “the worst always happens” and I “will make a fool of myself” by saying “something wrong or incorrect”. I also worry about social situations and all sorts of things going wrong.

2. … Then, when I get into any type of social situations, I start to blush, stutter and have difficulties thinking and concentrating. When I know a social situation is coming up such as a work presentation or social function, I get really tense and can’t sleep – my stomach gets in knots.

3. … All this makes me avoid social situations, talking publically and making eye contact – I’ll often look busy or do things to avoid looking at people or saying hi. Because of this, my thoughts and my worries, etc., just start spiralling all over again – keeping the symptom cycle going.

Unhelpful Thoughts


Physical Symptoms

Emotional Wellbeing


What People Have Told Us

Over the years we have worked with a lot of people who have provided us with feedback about their experiences, and things they thought were important to keep in mind. In this section you will find some key lessons and messages from others …

• Learning about anxiety and depression. Many people tell us that they were surprised to hear so many people struggle with anxiety and depression. Most people tell us they had previously found it difficult to get good information about anxiety and depression and how to manage it.

• Understanding your symptoms can be tough. Thinking about your symptoms can be quite a

confronting thing to do. It is normal to experience some low mood or anxiety early on. The good news is that this decreases as you begin to learn about ways of managing your emotional wellbeing.

• Learning to manage anxiety and depression is hard work and takes time. Learning to manage our emotional wellbeing takes a lot of effort and often involves ups and downs. Most people tell us they feel more confident in managing their symptoms and are coping better at the end of our courses. But, most say this is just the beginning and find that real improvements happen in the months after our courses. So, please be patient and set realistic expectations for yourself.

• Knowing isn’t everything – doing is. Reading the information in this course may be helpful.

But, most people find that it isn’t enough. Many people also already know a good amount of the information in the course. But, we know from 1000s of people that gentle and consistent practice of the core skills in the Course is what really helps.


Summary

We have covered a lot of important information about anxiety and depression. Let’s review the key points: 1. Anxiety, stress, worry, low mood and depression are normal human experiences.

2. Clinical levels of anxiety and depression are also very common. About 1 in 5 Australians experience clinical anxiety and depression.

3. There are three main types of symptoms of poor emotional wellbeing:

• Unhelpful Thoughts – what we think • Physical Symptoms – what we feel in our bodies • Unhelpful Behaviours – things that we do or don’t do

4. These symptoms work in cycles and can make each other worse – creating Cycles of Symptoms. The course works by teaching you skills for understanding and tackling each type of symptom. This helps to break the Cycles of Symptoms.

Please log back into www.mindspot.org.au next week to complete Lesson 2. Please revisit the website as often as you like to re-read Lesson 1.

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 1 at least twice this week. Take some time to identify their symptoms and some of their symptom cycles. Complete the My Symptoms worksheet 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: My Symptoms

Unhelpful Thoughts

(what I think to myself)

Physical Symptoms

(what I feel in my body)




Unhelpful Thoughts


Physical Symptoms

Emotional Wellbeing

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