Choice,

Responsiveness,
Integration &
Shared Care
Choice, Responsiveness,
Integration & Shared
Care
Isaac Maddox House
Shrub Hill Road, Worcester
WR4 9RW
Tel: 01527 488 000
www.worcsmhp.nhs.uk
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Welcome to
Managing Low Mood
And Anxiety
SESSI ON 2
Choice,
Responsiveness,
Integration &
Shared Care
Review of last week :
Understanding the CB Model
Thoughts
Behaviour

Physical feelings

Emotions
Situation/
environment
Choice,
Responsiveness,
Integration &
Shared Care
Homework Review

Identifying your own thoughts, feelings,
physical symptoms, behaviours

What did you notice?

Setting goals
Choice,
Responsiveness,
Integration &
Shared Care
Myths about depression
What is Depression? signs & symptoms
Understanding depression using CB model
Reversing the vicious cycle and increasing
activities (Behavioural Activation)
Positive logs
Todays Session: Understanding &
Managing Depression and low mood
Choice,
Responsiveness,
Integration &
Shared Care
Changes in our mood and feeling low from time
to time are normal parts of everyday life.

Sometimes these feelings may begin to last for
a couple of weeks or more and begin to effect
other areas of our life, how we feel physically
and what we do.
What is Depression?
Choice,
Responsiveness,
Integration &
Shared Care
Myths About Depression

If you get depression, you will always
be prone to it, and it will affect
you for the rest of your life
Depression is no different from
getting the blues and this is
just a normal part of life
People who have
depression are just feeling
sorry for themselves
Depression can only be cured
by medication
People who say they are
depressed just need to pull
themselves together
Depression is not a
real medical illness
Depression is a normal part
of getting older
Choice,
Responsiveness,
Integration &
Shared Care
Depression..
1 in 4 people have a mental health difficulty
1 in 6 people experience depression (N.I.C.E)
Affects any one, at any time
One off or re-occurring episodes
Different contributing factors
3rd most common reason people see a GP (N.I.C.E.)
Can be successfully treated and managed
Choice,
Responsiveness,
Integration &
Shared Care
Emotions
Low
Anger
Irritable
Guilt
Shame
Anxious
Unhappy
Stress
Sad
Lonely
Upset
Numb
Despair
Down
Choice,
Responsiveness,
Integration &
Shared Care
Expecting the worst to happen
Nothing is going to work out
Losing confidence in yourself
I wont be able to do this
Gloomy thoughts Nothing ever goes right for me
Everything seems hopeless Its hopeless
Negativity towards yourself I never get anything right
Negativity towards the world No one can help me
Thoughts of self harm Life isnt worth living
Thoughts
Choice,
Responsiveness,
Integration &
Shared Care
Physical Changes
Tearful
Loss of energy/lethargy
Sleeping more or Sleeping less
Changes in appetite
Changes in Weight
Difficulty concentrating
Problems With Memory
Reduced sex drive
Restlessness
Aches and pains





Choice,
Responsiveness,
Integration &
Shared Care
Behaviours
Difficulty making decisions
Putting things off / Procrastination
Not doing things you used to enjoy
Using food, cigarettes, alcohol, caffeine, drugs
etc to escape
Less self care E.g. Not getting dressed
Not answering the phone or opening letters
Staying in bed
Stop seeing friends/family
Not doing everyday tasks
Self harm
Rumination
Choice,
Responsiveness,
Integration &
Shared Care
Genetics
(you inherit genes that make you more likely to develop depression)
Living environments/ Relationships (a family may
have a high rate of depression because of the way people behave
towards each other, rather than because of the direct effect of genes)
Biology/ Body
Difficult life experience
Early experience
Life events
Ongoing stress

Often, a combination of these factors are responsible
What can contribute to Depression?
Choice,
Responsiveness,
Integration &
Shared Care
When people are depressed they can feel
physically unwell and may reduce the
frequency and type of activities that they do

For example:

Reduce interactions with friends, colleagues and family
Make little effort to do things that they previously enjoyed
Avoid necessary activities e.g. paying bills
Reduce or stop routine activities e.g. cleaning the house,
ironing, washing up.
Disrupted routines like meal times, the times they go to bed
and get up.

Choice,
Responsiveness,
Integration &
Shared Care
Life can often lack:



A sense of achievement

Feelings of enjoyment/pleasure

A feeling of closeness to others

Choice,
Responsiveness,
Integration &
Shared Care
What are the benefits of increasing
activity?

Choice,
Responsiveness,
Integration &
Shared Care
Increasing our activity levels can make an
enormous impact on our mood by:



Motivating us to do more
Esteem building- making us
feel better about ourselves
Making us feel less tired
Alternative focus- helps us
think about something
other than focussing on our
unhelpful thoughts

Using up the adrenaline
resources created by anger
and anxiety
Giving us a sense of
achievement & enjoyment
Being with other people
Stimulating the body to
produce natural anti-
depressants

Choice,
Responsiveness,
Integration &
Shared Care
Understanding Depression:
Vicious Cycle
Depressed
Mood
Increased guilt,
hopelessness,
ineffectiveness
Decreased activity,
neglect of
responsibilities
Low energy, fatigue,
decreased interest,
Negative thinking

Choice,
Responsiveness,
Integration &
Shared Care
Patricks Story
Choice,
Responsiveness,
Integration &
Shared Care
Monday Tuesday Wednesday Thursday Friday
6-7
Sleep Sleep Sleep
7-8
Sleep Sleep Sleep
8-9
Sleep Sleep Sleep
9-10
Sleep Sleep Drs appointment
10-11
TV - downstairs Sleep/TV
11-12
Eat TV
12-1
Watch
TV
TV/ Eat
1-2
Shops
2-3
3-4
Sleep Eat
4-5
Sleep TV
5-6
Sleep/ Snack Games/ internet
on the computer
6-7
Potter in the
garden
7-8
8-9
TV Snooze
9-10
Eat Eat
10-11
Computer TV
11-12
Computer TV
Choice,
Responsiveness,
Integration &
Shared Care
What do you notice about Patricks week?
Are there patterns in his sleep?
In his eating?
In the way he spends his day?

What changes could he make?
Choice,
Responsiveness,
Integration &
Shared Care
Reversing the vicious cycle
and increasing activity

CBT uses an intervention called Behavioural Activation to
work on changing unhelpful behaviours.
Improved Depression
Increased Activity,
Fair and Realistic
Thinking

Feeling hopeful, more
confident, less guilty
Greater energy &
motivation
Choice,
Responsiveness,
Integration &
Shared Care
Step One:What do you stop doing when you
feel low?

Routine activities

Get up
Shave
Brush hair

Pleasurable activities

Exercise gym
Pub with Darren
Read a magazine
Watch a film

Necessary activities

Check e-mails/ answer e-mails
Open post
Respond to post
Choice,
Responsiveness,
Integration &
Shared Care
Step Two: Make a hierarchy of activities

Put your lists in order of difficulty, mixing up the different routine,
pleasurable and necessary activities

THE MOST
DIFFICULT

Pub with Darren
Go to the gym




MEDIUM
DIFFICULTY
Respond to e-mails
Respond to post/ bills
Open post



THE EASIEST

Shave
Brush hair
Check e-mails
Read a magazine
Watch a film
Choice,
Responsiveness,
Integration &
Shared Care
Step Three: Plan Activities
Start with the easiest activities
Small regular activities are better to begin with
Build them up gradually
Detail precisely: what, where, when and who
with. Keep it S.M.A.R.T
Plan a reward

Act according to your schedule rather than
your mood

You may not feel like doing something but it may help to take a step away from
your feelings and do it anyway
Choice,
Responsiveness,
Integration &
Shared Care
Activities Schedule
Mon Tues Wed Thurs Fri Sat Sun
Morning When
What
With who
Shave
Brush
hair
Shave
Brush
hair
Shave
Brush
hair
Shave
Brush
hair
Shave
Brush
hair
Shave
Brush
hair
Shave
Brush
hair
When
What
With who
Open
post
Sort
bills

Open
post
Afternoon When
What
With who
Read
mag. At
home
for 30
mins
Watch
a film
Read
magazin
es
When
What
With who
Check
e-mails
Check
e-mails

Evening When
What
With who
Watch
film
with
Darren
Choice,
Responsiveness,
Integration &
Shared Care
STEP FOUR: Review Progress

Remember progress may be sporadic and
may not always go completely to plan.
Give time for reflection.
Problem-solve any difficulties experienced.
Choice,
Responsiveness,
Integration &
Shared Care
Not everyone experiencing low mood notices a
reduction in activitiesSome people may feel
overwhelmed by the amount of things they
have to do and this may be highlighted when
reviewing your weekly record.

You might need to look at using the record to
bring more balance to your daily activities.

We look at this more in future sessions on
Stress Management
Choice,
Responsiveness,
Integration &
Shared Care
The Core Principles of Behavioural Activation

Principle 1: The key to changing how we feel is changing what we do.

Principle 2: The clues to figuring out what will be antidepressant for a
particular person lie in what they used to do and enjoy.

Principle 3: Structure & schedule activities that follow a plan, not a mood.

Principle 4: Change will be easier when starting small.

Principle 5: Take on activities that are naturally reinforcing.

Principle 6: Use a problem-solving approach, and recognize that all results
are useful.

Principle 7: Dont just talk, do!

Principle 8: Troubleshoot possible and actual barriers to activation.
Choice,
Responsiveness,
Integration &
Shared Care
Action before motivation!

Dont wait for the motivation,
take action and the rest will follow.
Choice,
Responsiveness,
Integration &
Shared Care
If you do what
youve always done,
youll get what youve
always got
Deciding to change...
Choice,
Responsiveness,
Integration &
Shared Care
Making changes
what are the costs & benefits

Staying the same (no change)
what are the costs & benefits
Motivation...
Choice,
Responsiveness,
Integration &
Shared Care
Imagine your life 6 months from now and that nothing
has changed; you have not taken steps to address your
problems. Consider how you would feel, what you would
do and the impact on your life.


Group Activity

What are the costs and benefits of not making changes
and staying the same?
Motivation staying the same
Choice,
Responsiveness,
Integration &
Shared Care
Imagine your life 6 months from now and that you have
made changes; you have taken steps to address your
problems. Consider how you would feel, what you
would do and the impact on your life.


Group Activity

What are the costs and benefits of making changes?
Motivation making changes
Choice,
Responsiveness,
Integration &
Shared Care
When we feel low in mood, we often
focus on the things that we havent done.

We filter out and ignore the positive
things such as what we have been doing.

It is like we are wearing a pair of
gloomy specs.
Mental Filter
Choice,
Responsiveness,
Integration &
Shared Care


For example, if someone criticizes you, youre more
likely to accept it as true. But if someone pays you a
compliment, you manage to discount the positive
comment completely.

Then, without meaning to, you are quite likely to forget
it happened at all. So all that is remembered are the
negative things, and the general picture that gets built
up is overwhelmingly negative.
Mental Filter
Choice,
Responsiveness,
Integration &
Shared Care


This technique can help breakdown focus on the
negatives which in turn can help reduce some of the
negative feelings.





Positive Log
Choice,
Responsiveness,
Integration &
Shared Care
Use a notebook that you like the look of.

Ensure it is a size that you can carry around with you.

Fill in anything positive as it happens. Do not wait till the end of the
day.
Things you managed to get done
Something you do goes to plan
Something you go goes better than expected
You do something worthwhile
Somebody contacts you
Somebody compliments you

At the end of the day read the whole notebook.

How to use a positive log...
Choice,
Responsiveness,
Integration &
Shared Care
The aim is to develop a more fair, realistic and
positive view of yourself and your situation.

This may be quite hard at first, and the things
being recorded may seem silly or trivial.

It is important to write them down anyway.

Over time, you may realise that there are more
positive experiences that you once noticed and
many that you previously ignored

Choice,
Responsiveness,
Integration &
Shared Care
Negative Thinking
Depressed mood also leads to an increase in negative
thoughts, which then go on to worsen our mood further.

We will focus on the unhelpful thinking styles
associated with both depression and anxiety in Session
5.

Problem Solving
When feeling low, problem solving ability can reduce
severely. This is because of feeling tired & lacking
energy, concentration problems, loss of confidence in
decision making, low motivation

Dealing with problems make us feel more effective,
hopeful and encouraged. We will focus on Active
Problem Solving in Session 6


Choice,
Responsiveness,
Integration &
Shared Care
Lastly...

Reward yourself for your accomplishments and any
positive changes you notice about yourself.

Finding a way to give yourself positive rewards is
important as when you are treated well, you feel
better.
Choice,
Responsiveness,
Integration &
Shared Care
What depression is and how it affects you
physically, cognitively and behaviorally.

The significance of inactivity in the cycle of
depression and how to reverse this cycle using
Behavioral Activation.

The role of a negative focus in depression and
how a positive log can help.



Session Summary
Choice,
Responsiveness,
Integration &
Shared Care
Follow the Behavioural activation steps 1-3 and
plan your weekly diary in advance.


What do you notice? Are there any links
between how you feel and what you are doing?




At home...
Practice keeping a positive log.
Choice,
Responsiveness,
Integration &
Shared Care
Any Questions?