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
|

Welcome to
Managing Low Mood
And Anxiety
Session 1
Choice,
Responsiveness,
Integration &
Shared Care
Housekeeping
Fire alarms
Toilets
Smoking
Breaks
Parking
Mobile phones (turn off unless
expecting urgent call)

Choice,
Responsiveness,
Integration &
Shared Care
Agreed Sharing
Punctuality
Confidentiality is a must at all times
Not talking over others
Respecting others opinions
Respecting others beliefs, views, culture
Respecting others experiences
Turn off mobiles
Feel free to take time out
If you leave the session and do not return, one of our facilitators
may follow to see how you are
Please call us on 01905 760118 if you are unable to attend a
session
Is there anything you would like to add?
Choice,
Responsiveness,
Integration &
Shared Care
Course Overview
Week 1: Introduction to the programme and to the CB approach
Week 2: Understanding & Managing Depression and Low Mood
Week 3:Understanding Anxiety and Panic
Week 4: Managing Anxiety and Panic
Week 5: Challenging Negative Thoughts
Week 6: Stress Management and Well-Being
Week 7: Maintaining Your Progress




Choice,
Responsiveness,
Integration &
Shared Care
What to Expect


Facilitators are like personal trainers.!

Education on the signs and symptoms of anxiety and
depression

Introduce techniques to manage anxiety and depression

Informal group discussion using examples

Individual activities outside the group Homework

PHQ-9 and GAD-7 questionnaires

Choice,
Responsiveness,
Integration &
Shared Care
Please take some time to fill
out a questionnaire .....
Choice,
Responsiveness,
Integration &
Shared Care
Self harm and Keeping Safe
Fleeting thoughts are not uncommon when people are
feeling low and distressed.
Fleeting thoughts are thoughts that come into our heads
and go out again without dwelling on them.

Choice,
Responsiveness,
Integration &
Shared Care
Self harm and Keeping Safe

However, Persistent thoughts of harm to yourself or others
are those that involve actively planning, feeling hopeless
and feeling like there is no other way out.
What to do:
Talk to your GP as an urgent appointment requirement
Go to A & E or out of hours GP clinics
Ring Samaritans on: 08457 90 90 90
Get a friend/family member to stay with you
Choice,
Responsiveness,
Integration &
Shared Care
Treatments : Medication

Take as prescribed

Side effects
You may experience some side affects initially when you start taking your
medication but these usually subside within a few weeks. Follow the advice
within the packet and speak to your GP if you have any concerns.

6 months post-improvement
It is usual for the GP to advise you keep taking your medication six months
after you start feeling better. This is because evidence has shown this has
greater long term effects. When it is time to reduce your medication your GP
will usually discuss options for reducing this gradually.

Choice,
Responsiveness,
Integration &
Shared Care
Keep talking to your GP
We are not able to offer individual advise on medication
as part of this course. Our advice would be to keep
talking to your GP about any queries you may have.

Treatments : Medication continued
Choice,
Responsiveness,
Integration &
Shared Care
What are your hopes or fears about
the group
Choice,
Responsiveness,
Integration &
Shared Care
Todays Session

Understanding your difficulties
What is cognitive behavioural therapy?
How can a CB approach help us understand our
difficulties?
How are our thoughts, emotions, physical
feelings and behaviour (what we do) linked?
Goal setting
A breathing technique

Choice,
Responsiveness,
Integration &
Shared Care
What is a Cognitive Behavioural
Therapy Approach?
Cognitive behavioural therapy looks at the
way in which our thoughts can be
connected to our moods, the things we
do, and the way we feel physically and
emotionally.


Choice,
Responsiveness,
Integration &
Shared Care
Cognitive Behavioural Model of Depression
and Anxiety
Behaviour
Emotions
Physical
Symptoms
Thoughts
Cognitions:
Thoughts,
beliefs,
attitudes and
images
Behaviour:
What we do,
how we
behave

Emotions:
How we feel,
our mood
Physical
Symptoms:
How we feel in
our bodies,
bodily
symptoms/
sensations
Choice,
Responsiveness,
Integration &
Shared Care
Win The
Lottery
Thoughts
Emotions
Behaviour
Physical
feelings
What would you do?
Choice,
Responsiveness,
Integration &
Shared Care
The Traffic Accident

When there's a traffic accident, police ask for witnesses to come forward and
describe what happened. They like to have as many witness statements as
possible so that they can build up enough evidence to give them a broader,
more realistic version of events. The drivers of the cars, the passengers and on
lookers will all have slightly different perspectives, depending on where they
were, how far they were, how good a view they had, what else was going on,
how much danger they felt they were in, how the accident affected them, what
the accident means to them.
It's the same principle with everything - each situation, event,
conversation, means something different to all those involved,
and also to those not involved.

Choice,
Responsiveness,
Integration &
Shared Care
Situation/
environment:
A friend Walks
Past you in the
street and
doesnt stop
Thoughts
?
Choice,
Responsiveness,
Integration &
Shared Care
Thoughts
Theyve ignored
me
I must have done
something wrong
They dont like me
anymore
Situation/
environment:
A friend Walks
Past you in the
street and
doesnt stop
Emotions

?
Choice,
Responsiveness,
Integration &
Shared Care
Thoughts
Theyve ignored
me
I must have done
something wrong
They dont like me
anymore
Situation/
environment: A
friend Walks
Past you
Emotions
Upset
Confused
Worried
Physical Affects/Feelings

?
Choice,
Responsiveness,
Integration &
Shared Care
Thoughts
Theyve ignored
me
I must have done
something wrong
They dont like me
anymore
Situation/
environment: A
friend Walks
Past you
Emotions
Upset
Confused
Worried
Physical Affects/Feelings
Tearful
Tired
Stomach Churning

Behaviour

?
Choice,
Responsiveness,
Integration &
Shared Care
Thoughts
Theyve ignored
me
I must have done
something wrong
They dont like me
anymore
Situation/
environment: A
friend Walks
Past you
Emotions
Upset
Confused
Worried
Physical Affects/Feelings
Tearful
Tired
Stomach Churning


Behaviour
Ruminate (think
about what
happened)
Avoid Friend
Avoid contact


Choice,
Responsiveness,
Integration &
Shared Care
Exercise: Susan is standing in a line at the grocery store and
thinks this always happens to me - I always pick the wrong
queue. I wish I had stayed at home. I dont know why I bother.

What mood do you think Susan will be in?
How do you think she will feel physically?
What do you think she will do?
How will doing this make her feel?
Choice,
Responsiveness,
Integration &
Shared Care
Situation/
environment
Thoughts
Emotions
Behaviour
Physical
feelings
What if you did
one thing
differently?
Choice,
Responsiveness,
Integration &
Shared Care
Exercise: Derek is standing in a line at the grocery store and
thinks I cant cope with this queue, everyone is looking at me
and I need to leave.

What mood do you think he will be in?
How do you think he feel physically?
What do you think he will do?
How will doing this make him feel?
Choice,
Responsiveness,
Integration &
Shared Care
Situation/
environment
Thoughts
Emotions
Behaviour
Physical
feelings
What if you did
one thing
differently?
Choice,
Responsiveness,
Integration &
Shared Care
Cognitive Behavioural Model of Depression
and Anxiety
Behaviour
Emotions
Physical
Symptoms
Thoughts
Cognitions:
Thoughts,
beliefs,
attitudes and
images
Behaviour:
What we do,
how we
behave

Emotions:
How we feel,
our mood
Physical
Symptoms:
How we feel in
our bodies,
bodily
symptoms/
sensations
Choice,
Responsiveness,
Integration &
Shared Care
Goal Setting
Goal setting is an important part of helping you get back on track
Goals give us an aim to work towards and help us plan how we can
achieve this goal (short term, mid term, long term)
Planning goals helps us know when we have achieved them or
what else we need to do to get there
Common goal: To feel better.
Ask yourself: How will I know I am feeling better?
What would I be doing differently to show that I am feeling better?

Choice,
Responsiveness,
Integration &
Shared Care
Goal Planning The Six Steps

Successful goals are specific to you and based on
what you value.

You could consider the following: life long goals? What activities
give you the greatest feeling of pleasure and achievement?
What have you always wanted to do but been afraid to
attempt?

1. List all the ideas that come into your head about what you
really want. Think in terms of Home/Family, Work and
Leisure/personal development.



Choice,
Responsiveness,
Integration &
Shared Care
The wheel of life


Fun, Leisure
and
Recreation
Personal
Growth and
Learning
Significant
Other /
Romance
Physical
Environment
(eg. Home)
Caree
r
Money
Healt
h
Friends and
Family
0
10
INSTRUCTIONS
Take the centre of
the wheel as 0 and
the outer edge as 10,
rank your level of
satisfaction with
each area out of 10
by drawing a straight
or curved line to
create a new outer
edge (see example
with hand out)

Choice,
Responsiveness,
Integration &
Shared Care
2. Re-examine these ideas make them SMART

3. Create an action plan outlining the steps you need to
take to achieve your goals.

4. Identify any obstacles and plan for them.

5. Build in rewards for when you complete stages and
achieve goals.

6. Visualise the end result, have a clear mental image of
what things will be like when you achieve your goal.

Choice,
Responsiveness,
Integration &
Shared Care
Where to Start
At home...

Try to identify your own cycle record on the handouts
Situations, Thoughts, Feelings, your actions/behaviour
consequences?

What would you like to change? How would you like things
to be different? Record some goals on your handouts. Try
the wheel of life for yourself.






Choice,
Responsiveness,
Integration &
Shared Care
Choice,
Responsiveness,
Integration &
Shared Care
Breathe out to the count of 11
Breathe out to the count of 11
Breathe
in to the
count of
7
Breathe
in to the
count of
7
It some times help to visualize breathing
round the square.
Choice,
Responsiveness,
Integration &
Shared Care
Any Questions?