The Wellbeing Course. LESSON 5: DIY Guide. The Wellbeing Course was written by Professor Nick Titov and Dr Blake Dear

The Wellbeing Course LESSON 5: DIY Guide The Wellbeing Course was written by Professor Nick Titov and Dr Blake Dear Copyright 2015 The MindSpot Clinic v4.0

Welcome to the Lesson 5 DIY Guide Welcome to the final DIY Guide. We hope you have found the material in this Course helpful. This Guide aims to help you sustain and continue to make improvements in the weeks, months and years after the Course. Our research and experience show that everyone needs to manage their emotional wellbeing, every day. We know that managing emotional wellbeing means changing habits and routines, which is challenging, takes time and involves lots of Prof Nick Titov Dr Blake Dear hard work. It also means learning to manage lapses and setbacks, which a normal part of our lives. The majority of people in our Courses find the information and skills described here really helpful for improving and staying well over the long term. We hope you find this lesson helpful. Professor Nick Titov, Dr Blake Dear and the MindSpot Clinic Team If you have any questions technical difficulties, please let us know. Email: contact@mindspot.org.au Contents About Lapses... 3 Staying Well and Relapse Prevention Plans... 4 Creating a Relapse Prevention Plan... 5 Jo and Glenn s Relapse Prevention Plans... 6 The Future and Quality of Life... 10 About Goal Setting... 11 Jo and Glenn s Examples of Goal Setting... 13 What People Have Told Us... 15 Summary... 16 This Week s DIY Tasks... 16 Worksheet 1: Relapse Prevention Plan... 17 Worksheet 2: Goal Setting... 18 Copyright 2015 The MindSpot Clinic v4.0 2

About Lapses Think about the last time you learnt a complex skill. It probably took you some time and multiple attempts before you felt comfortable with it and started to see some improvement - learning is never a smooth process. It is the same with learning to manage of emotional wellbeing. It is very common for people learning to manage their of anxiety and depression to experience occassional increases in their. These are called lapses. Many people first think that their should improve quickly and permanently after learning and practicing the skills taught in this Course. See Figure 1. Excessive Figure 1. Unrealistic Change Borderline Healthy Symptoms decrease quickly with practice of the skills Symptoms stay low thereafter Time But, most people find their fluctuate over time based on what s happening in their lives and what they are doing or not doing to manage. See Figure 2. Excessive Borderline Figure 2. Realistic Change Healthy Symptoms drop as a result of skills practice But, the decrease is usually with ups and downs. Time Copyright 2015 The MindSpot Clinic v4.0 3

Because of this it is essential to have realistic expectations about learning to manage and lapses. This is because lapses are common and if people do not understand what a lapse is, they can fall into the trap of thinking that they have failed and that they will never succeed. It is important to recognise that managing our emotional wellbeing can be challenging, especially at the most difficult times. This is why we all need to manage our emotional wellbeing on a daily basis. When do lapses occur? Lapses occur for different reasons and in lots of different situations. But, research tells us that most tend to occur when: 1. When we are physically unwell, sick or tired. 2. Something major, unexpected or stressful happens. 3. We stop practising the skills or trying to manage our emotional wellbeing. Even though there are many things in our lives that are beyond our control, research tells us that using the skills taught in this course can make the difference between good emotional wellbeing and poor emotional wellbeing. The main trick is to use the skills regularly by integrating them into our lives and having a plan for when we start to notice the signs of a lapse. And, if we start to experience a lapse, it is important to get on top of managing your as quickly as possible and to focus on things you can do to help you recover and get better. Staying Well and Relapse Prevention Plans Maintaining our emotional wellbeing is very much like maintaining our physical health. In order to keep in good physical health, we know we need to monitor our physical health and do certain things (e.g., eat well, exercise, sleep) each day to maintain it. The aim of this treatment Course has been to teach proven skills for getting your of anxiety and depression into the healthy range. See Figure 3. Copyright 2015 The MindSpot Clinic v4.0 4

Figure 3. Aim of Treatment Excessive Borderline Healthy Symptoms still there and fluctuate But, don t go into the unhealthy ranges. Time The aim of treatment is not to completely remove or cure of poor emotional wellbeing because it is not possible to get rid of them altogether. Mild of stress, anxiety, low mood and depression are a normal and important part of life. However, research shows that it is possible to keep within the healthy ranges using the information and skills in this course. However, one important part of keeping our within the healthy ranges is to develop a Relapse Prevention Plan. These are plans for effectively managing significant increases in our. People have told us that relapse is a process and does not occur overnight - instead, it often occurs over time. This means there are things we can do to prevent relapses and this is where Relapse Preventions Plans are critical. Creating a Relapse Prevention Plan The goal of a Relapse Prevention Plan is to help us to notice when our are getting worse and to help us start manage them before they get into the excessive range. Usually, they are short personal plans and include information about: 1. Your own early warning signs (i.e., what puts you at risk?) 2. The situations you need to look out for (i.e., how will you know that you are at risk?) 3. The skills you will use if your symptom levels increase (i.e., what skills you will use to help manage?) 4. What you will do about your (i.e., what will you do to help maintain your emotional wellbeing?) Copyright 2015 The MindSpot Clinic v4.0 5

Jo and Glenn s Relapse Prevention Plans Let s see Jo and Glenn s Relapse Prevention Plans... Step 1: Risks for Lapsing (What puts me at risk?) 1 Getting sick / kids are sick 5 Working too many shifts 2 3 4 Not solving problems and avoiding things Not doing enough things that I enjoy Attending a really bad accident at work 6 Not looking after my health 7 Family gatherings with certain people 8 Step 2: Signs for Lapsing (How will I know I am at risk?) 1 Doing less e.g., stop exercising, playing with kids, seeing friends etc 5 Excessive tiredness despite 6-9 hours sleep most nights 2 When my thinking is negative 6 Having more nightmares 3 Drinking more than I should 7 4 Getting irritable / not talking 8 Step 3: Useful Skills I Can Use (What skills can I use to help manage my?) 1 Stop and challenge unhelpful thoughts 5 Graded Exposure to increase exercise and tackle avoidance 2 Problem solving, even small things 6 Using Sensory Grounding and breathing exercises to help me in the moment 3 Scheduling pleasant things 7 4 Scheduling regular exercise 8 Copyright 2015 The MindSpot Clinic v4.0 6

Step 4: What Will I Do (What I can do to help maintain my emotional wellbeing?) 1 Grab my diary and ask myself what I am worrying about. 2 3 4 5 Then I will make sure I have something nice planned that day and look after myself by getting some daily exercise. I ll sit down and work out what is bothering me, and make a plan for dealing with it. I will find a quiet place to do my Sensory Grounding exercises and be kind to myself until I feel calm again. Look through the Course notes and speak to my GP if things are really bad and I don t start to feel better after doing everything above Copyright 2015 The MindSpot Clinic v4.0 7

Step 1: Risks for Lapsing (What puts me at risk?) 1 Not mixing socially with friends and family 5 When I m doing well and stop using the skills 2 3 Not maintaining good sleep habits to increase my chances of sleep When there is a lot to do at work and at home 6 Not monitoring my thoughts 7 4 When I m sick or unwell 8 Step 2: Signs for Lapsing (How will I know I am at risk?) 1 Stress, tension and headaches 5 Thinking about things over and over 2 3 Avoiding people, going out less, etc. When I start worrying a lot or have trouble letting go of my worries 6 7 4 Worrying I ve let people down 8 Step 3: Useful Skills I Can Use (What skills can I use to help manage my?) 1 Thought challenging for worries about work and social situations 5 Planning my week down to the day 2 Practice Assertiveness and Problem Solving skills 6 3 Worry Time and Problem Solving to tackle worry 7 4 Controlled Breathing to reduce tension and tackle physical 8 Copyright 2015 The MindSpot Clinic v4.0 8

Step 4: What Will I Do (What I can do to help maintain my emotional wellbeing?) 1 As soon as I start to feel stressed, tired or sad, I know I need to act. 2 I will practice my breathing whenever my phone rings. 3 I ll make sure I am giving myself some me time and ask myself what I m worried about and whether I really need to worry. I ll then make a plan for dealing with the problems 4 Read the notes from the Course 5 I ll see my GP if needed. Copyright 2015 The MindSpot Clinic v4.0 9

The Future and Quality of Life At the end of our Courses most people have made good progress and are more confident that they can learn to manage their. But, most are also still learning how to use the core skills and how to manage their. This is normal because managing emotional wellbeing is hard work and takes time. It is important that no-one expects themselves to have mastered the skills by the time they have read this lesson, or even in the weeks immediately after the Course. However, at this point, many people often start to think about the future and how they can continue to improve their emotional wellbeing and overall quality of life Our research and clinical experiences tell us that the people who make lasting changes in their emotional wellbeing and quality of life are those who: 1. Continue to practice and make the core skills a part of their day-to-day routines. 2. Start to set themselves important personal goals in the different areas of their lives. 3. Use the core skills to make their life as full as possible and to achieve their personal goals despite their conditions. What areas of life are important One of the major challenges of anxiety and stress, low mood and depression is that they can impact all areas of our lives in real and significant ways. People often talk about four broad areas that makeup our lives (see figure 4) and which are affected by our emotional wellbeing: 1. Work and Vocational Involvement. This area involves having something to work on with others and contributing to something you think is important. This can be paid or unpaid work or involvement in family, social or community activities. 2. Hobbies and Recreational Activities. This area is made up of activities you do to relax, stimulate and enjoy yourself. These can be things you do by yourself or with other people. 3. Relationships and Social Activities. This area is influenced by the quality of your relationships with a partner, children, friends and broader society. It includes how much time we spend building relationships with others. 4. Health and Personal Growth. This area includes your overall health and how you look after yourself with things like exercise, sleep and eating well. This can also include spiritual and religious involvement and all activities that drive personal growth. Copyright 2015 The MindSpot Clinic v4.0 10

Figure 4. Areas Affecting Quality of Life Work & Vocational Involvement Physical Symptoms Hobbies & Recreational Interests Emotional Wellbeing Relationships & Social Activities Unhelpful Behaviours Unhelpful Thoughts Health & Personal Growth About Goal Setting Goal Setting is an essential skill for everyone, but it is especially important for people who experience difficulties with their emotional wellbeing. Goal Setting helps people to tackle the effect of poor emotional wellbeing can have on the different areas of their lives. The most obvious goal for people who experience anxiety, stress, worry, depression and low mood is staying well. However, many people also tell us that it is important to maintain the different areas of their life, as much as it is possible, despite their in fact, many people tell us that one of the biggest risks is to put important areas of their life on hold because of their. This is where Goal Setting is very helpful. The aim of Goal Setting is to identify areas of our life that we would like to improve and identify helpful things we can do each day to improve them. There are 3 key steps to Goal Setting: Copyright 2015 The MindSpot Clinic v4.0 11

1. Identify areas of your life you would like to improve Most people have areas of their lives they would like to improve, especially people who have experienced low emotional wellbeing for a while. A general rule is that we should be happy with at least two areas of our lives this helps to give us quality of life and protects our emotional wellbeing. Tip: You can rate your satisfaction for each of the four areas out of 10 to figure out which to work on. 2. Identify specific long-term and short-term goals We often only think about long-term goals. But, all goals are made up of smaller short-term goals and knowing that these are is essential - they are what lead us to achieve our long term goals. So, always break-up long term goals into short-term goals. Short-term goals are the things we can do in the next couple of hours, days or weeks towards our long-term goals. Remember: Long-term goals are things you might achieve in months or years. Short-term goals are things you can do in days or weeks. Be creative! Your short-term goals should be small steps toward your long-term goals. Don't expect too much too quickly! 3. Schedule something you can do each day toward your goal Once you know what things you can do each day, it is essential to write down what you will do and when you will do them. The act of writing down goals and keeping that list in an obvious place helps us to achieve our goals. Tip: If you are not doing something (and you want to do it) it s probably too hard, so pick something easier to do or more aligned with your values and needs right now. With time things will get easier to do and you will find yourself doing more and getting closer to your goals. Copyright 2015 The MindSpot Clinic v4.0 12

Jo and Glenn s Examples of Goal Setting Let s see Jo and Glenn use Goal Setting... Step 1: Identify areas of your life you would like to improve Rate your satisfaction out of 10 for each area of your life (where 10 = excellent). - Work and Vocational Involvement: 8 / 10 - Hobbies and Recreational Interests: 6 / 10 - Relationships and Social Activities: 3 / 10 - Health and Personal Growth: 5 / 10 I d let a lot of different areas of my life go over the last year or two for good reason. But, my life was getting pretty empty in a sense I ve withdrawn a lot. I want to be more social again. Being social is hard but, it s important to me I was using Graded Exposure to build my comfort levels up again. But, I also wanted to make being more social a concrete goal. Step 2: Identify specific long-term and short-term goals - Long-term goals are things you might achieve in months or years. - Short-term goals are things you can do in days or weeks. - Be creative! Your short-term goals only have to be small steps toward your long-term goals - I want to do one nice thing like dinner, lunch, a movie, etc., with my wife or a mate each week... - Going out with family (for family time) at least once a week even just to the park, or for a walk. - Meeting one or two mates for coffee once or twice a week so, that rules some things out. - Talking with people on the phone each week, sending emails to friends and family, etc. Step 3: Schedule something you can do each day toward your goal - Find something you can do each day or week towards your goals. - Write down when you will do it, tell other people and use reminders! - If you are not doing something and want to do it, it s probably too hard or not worthwhile right now so, pick something easier to do or more aligned with your current values. My goals weren t really long-term. Most were things I could do now if I really wanted using some of the other skills I have learned. To ease myself into things, I started to call at least one friend on a Monday and another on a Wednesday. I scheduled to try and organise coffee with at least one friend on a Sunday. And, we organised for my sister to mind the kids once a fortnight while my wife and I go out for a cheap dinner we also offered to mind their kids other fortnights so they could do the same thing. Copyright 2015 The MindSpot Clinic v4.0 13

Step 1: Identify areas of your life you would like to improve Rate your satisfaction out of 10 for each area of your life (where 10 = excellent). - Work and Vocational Involvement: 7 / 10 - Hobbies and Recreational Interests: 8 / 10 - Relationships and Social Activities: 4 / 10 - Health and Personal Growth: 7 / 10 I had a couple of important goals... I want to get back to dating if I can, but if not, I want to be doing something where I m meeting new people I know it s important for me. Step 2: Identify specific long-term and short-term goals - Long-term goals are things you might achieve in months or years. - Short-term goals are things you can do in days or weeks. - Be creative! Your short-term goals only have to be small steps toward your long-term goals - So, my long-term goal is to start to put myself in situations where I m meeting more people and maybe register on an online dating website. - Some shorter term goals I had were to volunteer a bit at a local organisation, help friends with things they need done, help out with my friend s café. Step 3: Schedule something you can do each day toward your goal - Find something you can do each day or week towards your goals. - Write down when you will do it, tell other people and use reminders! - If you are not doing something and want to do it, it s probably too hard or not worthwhile right now so, pick something easier to do or more aligned with your current values. - Talk to some different local charities this week and contact my friend. - I scheduled to contact a couple of family friends on Saturdays to see if they are free to catch up in the next week. - Look at different online dating websites and ask friends who have used them about their experiences. Copyright 2015 The MindSpot Clinic v4.0 14

What People Have Told Us Over the years we have worked with a lot of people with anxiety and depression 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 who have done this course. Make the skills routine. By the end of our Courses most people have made good progress, but no one has mastered the core skills and everyone is still learning how to use them. Many people say that one of the tricks after finishing the Course is to make the core skills a natural part of your life. The best way to do this is to find ways to use the skills in your daily routines. Manage expectations. A key issue for many people is challenging unrealistic expectations. For example, many people tell us that they struggle with expectations that they should or must be able to do things easily and perfectly. Also, people often expect much more of themselves than they do of others. So, it is important to always try to be realistic and kind to yourself, and to treat yourself how you would treat other people - that is, with dignity and respect. Tackle things before they get big. One of the key messages of this Course is to act proactively and to tackle problems before they get big. Many people find tackling small issues can lead to as much improvement as tackling big issues or problems. Even in difficult situations, solving problems proactively can help you to cope. Learning to identify and do even small things to help you is essential to maintaining your emotional wellbeing. Stay as active and involved as possible. Staying engaged in hobbies, social activities, light exercise and pleasant activities, all help people to manage their emotional wellbeing. The things we do every day are what provide us with pleasure and quality of life. Putting important things on hold and low activity levels makes it harder to get pleasure from life and have good quality of life. NOT EVERYONE IS READY FOR GOAL SETTING IMMEDIATELY. The Wellbeing Course is only short and most participants will still be experiencing significant at the end of it. Most people are still learning to use the skills and manage their emotional wellbeing. Because of this many people are not ready for Goal Setting at this point. However, in the months after the Course as people get more confident with the Core Skills, many start to find Goal Setting helpful for increasing their overall quality of life. Copyright 2015 The MindSpot Clinic v4.0 15

Summary We have covered a lot of important information. Let s review the key points: 1. Learning to manage anxiety and depression is a bumpy road with lots of ups and downs. The good news is that in time people find they get better and better at managing their. 2. One key challenge to staying well is managing lapses. Lapses are normal and do not mean we are back at square one. They are most likely to occur when: When we are physically unwell, sick or tired. Something major, unexpected or stressful happens. We stop practising the skills or trying to manage our emotional wellbeing. 3. Relapse Prevention Plans are helpful for managing lapses. They are short plans that remind us of the signs of lapses and what we can do if our start to increase. 4. Our research and clinical experiences tell us that the people who do best after our Courses are those who set themselves important goals and use the skills to make their life as full as possible despite experiencing of anxiety and depression. 5. Goal Setting helps people to systematically tackle the effects of poor emotional wellbeing on the different areas of their life. Final Words We hope you have found this Course helpful and that you will continue to review the Course materials and practice the Core Skills from here. But, if you feel that you would like more assistance, then please do speak to our team. You may also find it helpful to speak to your GP who will know of services available to you. 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 5 at least twice this week. Complete and use the Relapse Prevention Plan worksheet at the end of this DIY Guide. Complete and use the Goal Setting 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. Copyright 2015 The MindSpot Clinic v4.0 16

Worksheet 1: Relapse Prevention Plan Step 1: Risks for Lapsing (What puts me at risk?) 1 5 2 6 3 7 4 8 Step 2: Signs for Lapsing (How will I know I am at risk?) 1 5 2 6 3 7 4 8 Step 3: Useful Skills I Can Use (What skills can I use to help manage my?) 1 5 2 6 3 7 4 8 Step 4: What Will I Do (What I can do to help maintain my emotional wellbeing?) 1 2 3 4 Copyright 2015 The MindSpot Clinic v4.0 17

Worksheet 2: Goal Setting Step 1: Identify areas of your life you would like to improve Rate each area out of 10 if you are unsure. - Work and Vocational Involvement: / 10 - Hobbies and Recreational Interests: / 10 - Relationships and Social Activities: / 10 - Health and Personal Growth: / 10 Step 2: Identify specific long-term and short-term goals - Long-term goals are things you might achieve in months or years. - Short-term goals are things you can do in days or weeks. - Be creative! Your short-term goals only have to be small steps toward your long-term goals Step 3: Schedule something you can do each day toward your goal - Find something you can do each day or week towards your goals. - Write down when you will do it, tell other people and use reminders! - If you are not doing something and want to do it, it s probably too hard or not worthwhile right now so, pick something easier to do or more aligned with your current values. Copyright 2015 The MindSpot Clinic v4.0 18