the wellbeing course€¦ · these examples are very simple. but hopefully you can see that the way...

© Copyright 2015 The MindSpot Clinic v4.0

The Wellbeing Course

LESSON 2: 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 2 DIY Guide

We hope you have had a chance to read through the Lesson 1 materials (Lesson, DIY Guide, Resources and Case Stories) a couple of times. In Lesson 2 we discussed the unhelpful thoughts and their role in the Cycle of Symptoms and our emotional wellbeing. We learnt the importance of challenging thought symptoms using the technique of Thought Challenging. People who are anxious or depressed tend to have a large number of unhelpful thoughts. This Guide will give you more information about how to tackle these thoughts. This DIY Guide summarises the information in Lesson 2 and provides a lot of examples and more key information. We hope it is helpful. 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

About Unhelpful Thoughts ..................................................................................................... 3

How Our Thinking Can Be ‘Biased’ ....................................................................................... 6

About Thought Challenging ................................................................................................... 6

Jo and Glenn’s Thought Challenging Examples ..................................................................... 8

Helpful Vs. Positive Thinking ................................................................................................ 11

A Special Note .................................................................................................................... 12

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

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

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

Worksheet 1: Thought Challenging ..................................................................................... 14

Prof Nick Titov

Dr Blake Dear

mailto:[email protected]


About Unhelpful Thoughts

Thoughts are the things we say to ourselves in our heads and the beliefs we have. They may come in the form of words, phrases, images or memories. Thoughts happen all the time. Some thoughts are deliberate but many occur more automatically. Even though we may not always be aware of our thoughts, they are always there – even when we sleep. Our thoughts often change when we experience symptoms of anxiety and low mood. Research tells us that anxiety and depression put people at greater risk of having lots of unhelpful and negative thoughts. Unhelpful thoughts are important because they have a big impact on our emotional wellbeing and keep the Cycle of Symptoms going. This is often because they lead us to do things that are unhelpful and they can stop us from doing things that are helpful. Learning how to manage thoughts is, therefore, a very important skill.

The 3 Kinds of Thoughts …

Importantly, negative unhelpful thoughts can appear almost automatically. So, we often don’t question them and instead assume they are correct or helpful. Unfortunately, the negative and unhelpful thoughts that people with low mood and anxiety experience are often untrue and they can be very destructive.

Let’s look at some examples …

Negative Neutral Positive


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Example 1: The Café

Imagine yourself walking down the street. Imagine you see some people sitting outside a café chatting to each other. Imagine that one of those people takes a look at you as you walk by, turns back to their friend and then says something quietly under their breath. Now…

If you thought … You may feel … You may …

‘I wonder what she’s smiling at?’ Neutral Thought

Do nothing.

‘She must like my new dress.’ Positive Thought

Wear the dress more.

‘She thinks I look like an idiot!’ Negative Thought

Avoid going out, stop wearing the dress, etc.

Example 2: The Bus Stop

Imagine yourself sitting at a bus stop with a number of other people. Imagine that a bus that you have been waiting for 15 minutes arrives. But you soon find out that it’s full. You are told by the bus driver to wait for the next bus. The driver says the next bus will be around 15 to 20 minutes. Now…

If you thought … You may feel … You may …

‘Oh well… I’ll just have to wait for the next one’ Neutral Thought

Wait for the next bus.

‘Excellent… I didn’t have to get on that crowded bus’ Positive Thought

Wait for the next bus.

‘This shouldn’t happen! They’ve ruined my plans. It’s ridiculous!’ Negative Thought

Get angry at the driver, call off your plans, etc.

Nothing

Happy

Self-conscious, sad or anxious

Nothing

Happy

Frustrated, anxious, angry


These examples are very simple. But hopefully you can see that the way you think does affect the way you feel and what you might do. In both examples the situations were the same; however, different thoughts lead to different feelings and different behaviours.

This is important because anxiety and low mood can lead people to have more unhelpful and negative thoughts, which in turn can keep anxiety and low mood going.

Thought (what I think)

Feeling (how I feel)

Behaviour (what I do)

I’m going to have a heart attack

Frightened and panicky Avoid all physical activity, make appointment to see multiple doctors, focus on getting multiple scans, etc.

There is no point in life Sad and depressed Withdraw from friends and hobbies, give up on trying to cope or doing

things that might help, etc.

I can’t cope and no one can help me

Anxious, hopeless and helpless

Stop seeking help, give up on trying to manage, stop usual daily activities,

etc.

I’ve done a good job today Proud and happy Reward self with doing something nice (which further increases energy,

motivation and mood).

No one else suffers like me Lonely and self-conscious Don’t learn how other people manage symptoms, give up on

doing pleasant activities, etc.

It’s tough, but not the end of the world when my symptoms are bad

Hopeful and energised Use strategies to help you manage symptoms, problem-solve ways of

doing things, seek help from others, etc.

They’re doing this to spite me

Angry, bitter and defensive Fight and argue with family members, health professionals, self-

sabotage to ‘show them’, etc.

I’ll always be anxious Helpless Avoid looking for ways to manage and improve symptoms, etc.

The world is a cruel place Jumpy and scared Always on the lookout for danger and threats.


How Our Thinking Can Be ‘Biased’

We know from a lot of research that being in a challenging situation or experiencing stress, anxiety, low mood and depression can affect our brain and how we think in important ways. Specifically, they can automatically ‘bias’ our thinking so we are at greater risk of having unhelpful, negative and unrealistic thoughts. Research indicates that there are some common ways our thinking can be affected: • All or nothing thinking: Where we tend to think in terms of extremes only. • Overgeneralized thinking: Where we generalize from one thing to a number of others. • Mental filter thinking: Where we filter out positive information and focus on negative information. • Discounting the positive: Where we dismiss or ignore positive aspects of a situation. • Jumping to conclusions: Where we make conclusions without sufficient evidence. • Magnification: Where we exaggerate the degree that something is important. • Emotional thinking: Where we think something is true because we feel it is true. • Personalised thinking: Where we think things are related to us or about us when they are not. • Catastrophised thinking: Where we think things are significantly worse than they really are. • Guessing: Where we tend to guess what others are thinking or what will happen.

Importantly, these biases to our thinking often occur automatically. In Lesson 1 we covered how anxiety and low mood are designed to let us know that something may be wrong and to keep us safe. These ‘biases’ are one way that our brain lets us know something may be wrong, and keeps us safe. But, the challenge is that these ‘biases’ to our thinking are not always triggered at the right time and they are not always helpful.

About Thought Challenging

While it is near impossible to change the way you feel by telling yourself not to feel something, research tells us that it is possible to change the way we feel by challenging unhelpful thoughts. Challenging thoughts is one of the most effective ways of tackling unhelpful thoughts. Thought Challenging is difficult to do at first, but it is a vital skill that everyone should learn and should be used in even the most challenging and difficult situations. Thought Challenging counters the negative and unhelpful thinking caused by being in very difficult situations and by anxiety and depression. It helps you to see the world, yourself and others in a more balanced and helpful way. It is an essential skill for maintaining good emotional wellbeing.


The 3 steps …

The 3 steps of Thought Challenging are:

1. Recognise the Thought

Everybody has unhelpful and unrealistic thoughts from time to time, especially at the most difficult times. Most of us also never think about or pay attention to our thinking. When trying to recognise their thoughts, people often tell us:

• It is helpful to check their thinking when they notice a drop in mood or an increase in their anxiety. These are times when most of us experience an increase in unhelpful and negative thoughts.

• Start thinking about a previous situation where they felt depressed or anxious and try to think about what they were thinking. This helps to recognise common negative thoughts

• It is okay if you cannot identify the exact thought. You can guess what you might be thinking. Guesses are often pretty accurate and challenging the thoughts is a helpful start.

2. Examine the Thought

Most people do not consider whether their thoughts are helpful or unhelpful – we just accept them and treat them as true without looking at the evidence. This can become a problem in anxiety and depression because they can lead to more negative and unrealistic thoughts. People with anxiety and depression often find they say things to themselves they would never say to someone else. When examining their thoughts, people often tell us:

• It is helpful to consider whether they would be happy for someone they cared about to have the same thought. And, to consider: Is it a helpful thought? Is there strong evidence for the thought? Is it a fair thought? Is the thought accurate?

• It can be really helpful to examine thoughts using the list of 10 Thought Challenging Questions – see below. This is especially true when first doing Thought Challenging and when struggling with really difficult thoughts.

3. Do Something Helpful

This is the most important step. If the thought is unrealistic, then think of something more helpful you could say to yourself instead. Do something helpful to help yourself feel better and to cope with whatever you’re struggling with. When challenging their thoughts, people often tell us it is helpful to:

• Directly challenge unhelpful thoughts with more helpful and realistic thoughts. • Take action to solve or reduce the underlying problem. • Do something, even something small, to help you cope or feel better.


The 10 Thought Challenging questions …

Over the years we have got very good feedback from 1000s of people about the questions they find helpful to keep their thoughts helpful and realistic:

1. What evidence (i.e., actual facts) do I have for this thought? 2. Is this thought helping me to feel better or do what I want to do? 3. Is this thought absolutely true in all situations and all of the time? 4. Will I be worried about this in 1 week, 1 month or 1 year’s time? 5. What would I say to someone else with the same thought? 6. Is the way I am thinking about this the only way to think about it? 7. Is the source of my information reliable? 8. Do I know for certain that my thought is true? Am I 100% sure? 9. Am I over-estimating how bad things will be? Or, how likely a bad outcome is? 10. Am I under-estimating my ability to cope? Or, how much help I can get?

Jo and Glenn’s Thought Challenging Examples

Let’s see how Glenn and Jo challenge some of their thoughts.


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Step 1: Recognise the thought

Ask yourself: - What is going through my mind? - What could I be thinking? - If I were to guess, what might I be thinking?

Step 2: Examine the thought Ask yourself:

- What is the evidence for this thought? - Is the thought helping me to feel or cope well? - Is this thought helping me to do what I want to do? - What would I say to a friend with this thought?

Step 3: Do something helpful

Do Something: - Make the thought more helpful and realistic. - Take action to solve the underlying problem. - Do something to help you cope or feel better.

I am a failure.

The first thing I realised was that it is hard to define what a failure is… I wouldn’t really call anyone a failure. And, while I wasn’t very good at everything, I was good at many things, e.g. I was a good father, friend and partner.

I decided to challenge this thought and remind myself that I am good at many things. I decided to tell myself, ‘I am not feeling successful in one part of my life, but other things are actually going well.

I am not a good father. I also tried to define what being a ‘good’ father means. I suppose it means loving my kids and providing them with good financial and emotional support. I know I have been a bit slack with them lately because I’m always tired …

I decided to challenge this thought and remind myself that I love my children and have always cared about them. I know that my tiredness is due to my depression but that doesn’t really mean that I am not a good father. I decided to spend more time with my kids by doing something good with them at least once a week.

I will always be depressed. I have experienced low mood in the past, but I have always managed to pull through. Depression is really tough… but I have started to learn about effective ways of coping with my symptoms. Research says that CBT is a useful treatment for depression…

This is not a realistic thought because I can’t really find any evidence to suggest that I’ll be depressed forever. I know that this thought is just a symptom of depression, and it’s not helpful for me to think this way. I decided to remind myself about realistic expectations and take one small step at a time.

The world is a cruel place. I started to think about all the things that have happened to people that I felt were cruel or unfair. I realised that nearly all of them were related to my work, or reports I had heard of on the news. I recognised that my job as a ‘first responder’ to accidents means that I am exposed to the worst situations that people ever have to deal with in their life. This is not representative of how often people are exposed to these things in day to day life.

There are cruel and horrible things that happen to people that seem really unfair, but I know that these are the exception rather than the rule as no-one I know personally has ever experienced something as horrible as the things I see at work. I guess that unfair things do happen in life, but probably not as often as what I have been feeling they do. Even in my job there are lots of times when people walk away unharmed with minimal damage.


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I can’t cope… I’m weak. When I thought about it, I realised I was a lot tougher on myself than I was on other people.

I realised I was actually dealing with some difficult things, and while it was tough, I wasn’t doing too badly.

I decided I would remind myself that things were tough, but I was coping okay. I then decided to focus on practical things I could do to help me cope better… I changed the thought to, “I’m coping okay, but it just feels different at the moment”.

People will see through my anxiety and think that I’m hopeless.

No-one has ever commented on my anxiety in the past.

I can’t actually tell what other people think of me, but I’ve seen other people being anxious and haven’t thought they were hopeless.

No one’s actually ever laughed at me in the past, and it’s unlikely people will think I’m hopeless for being anxious given how common social anxiety it. I certainly wouldn’t say this about another person suffering from anxiety.

I’m abnormal because I’m always so anxious.

The first thing I realised was that it’s hard to define abnormal. The only definitions I could come up with were “different, weird or odd”. I don’t think I’m weird or odd, and I certainly share many common interests with people I know, so I guess I’m not so different after all. I guess the important thing to remember is that I’m not the only person suffering from anxiety.

I decided that I would remind myself that there are many people suffering from anxiety, and that there are practical things I could do about my symptoms. I would also remind myself that it’s hard to define what ‘abnormal’ means. I would not consider another person with anxiety or depression to be abnormal.


Helpful Vs. Positive Thinking

The goal of Thought Challenging is to tackle the unhelpful thoughts that people with anxiety and depression often struggle with. Thought Challenging is, however, very different to positive thinking. Thought Challenging involves examining the evidence to check that our thoughts are not being biased by our brain and to make sure that what we are telling ourselves is helpful. So, while more positive thoughts can sometimes result, Thought Challenging is not about being positive or sweeping our problems under the carpet. Just thinking positively in a difficult situation is not always helpful and can often be very unhelpful. However, people have told us that having helpful and realistic thoughts can make the difference between coping and not coping. So, it is important to always check that your thoughts are realistic and helpful.

Structured Problem Solving …

Sometimes we have negative thoughts that are very realistic and have a significant impact on our emotional wellbeing, especially if we are in a very challenging situation. When this is the case people still do find it helpful to keep their thoughts as helpful as possible and focus on what they can do to cope better and do what they need to do. This is because unhelpful thoughts are always unhelpful.

However, in many situations, it is also important to problem-solve solutions to the underlying problem and to look for things you can change or do differently, which are helpful. Many people find that problem-solving can make a big difference – even solving small problems and doing the simplest things. Because of this we recommend reading the Structured Problem Solving and Worry Time Resource in the Additional Resources section.

Worry Time …

Despite doing all the right things and challenging unhelpful thoughts many people do find that the same unhelpful thoughts keep coming up and that they cannot stop worrying – this is a really common problem, especially early on. Because of this we recommend reading the Structured Problem Solving and Worry Time Resource in the Additional Resources section.


A Special Note

Challenging thoughts can be particularly hard when you have been through something which is truly awful, like an attack or assault, or an accident. It is important to remember that after an event like this it is normal to feel like the world is an unsafe place, that terrible things happen to people and that you do not have much control over what happens to you.

Changing this way of thinking will take time and will be difficult. Please be kind to yourself and give yourself time to repair the damage that has been done. Keep trying to challenge your thoughts even when you feel that it’s not making an immediate impact. We know that over time it will really help. We have a special resource for people who have been through something traumatic which might be useful for you called Managing PTSD available in the course, which we recommend that you take the time to read.

What People Have Told Us

Over the years we have worked with a lot of people with symptoms of anxiety and depression and we have asked them 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 our people who have done this course …

• Stick in there! Most people find Thought Challenging a difficult skill to learn. Like any good skill it takes time to learn. Many people doubt its helpfulness at first. But, it is one of the most effective skills for maintaining good emotional wellbeing and we find that people who stick with it are glad they did.

• It gets more natural and effective over time. Many people find that Thought Challenging

feels odd at first. Most people also find that, even though they challenge a particular thought, they don’t always notice a change in the way they feel. This is normal. We find it often takes at least a couple of weeks before Thought Challenging becomes most helpful.

• It may stop things from getting worse. Many people, especially when in very difficult and challenging situations, find Thought Challenging may not always improve the way they feel. But, it does often help them to respond rather than react to the problems they face, which can help them to look after themselves and prevent them from feeling even worse.

• Stay aware for unhelpful images as well as unhelpful thoughts. Many people find they

struggle with unhelpful mental images as well as unhelpful thoughts. So, if you experience them, it is important to challenge unhelpful images as well. People find it is possible to challenge unhelpful images in the same way they challenge unhelpful thoughts – some people also find it helpful to change unhelpful images to more helpful ones.

• Don’t worry if you can’t always identify the thought. Sometimes it’s really hard to identify

our thoughts. Sometimes we just feel anxious or sad without knowing why. This is a common experience. In these situations, people tell us they often find it helpful just to guess what thoughts might underlie their feelings and challenge those.


• The difficulty is finding the time and remembering to practice. As with everything, some

people struggle to find the time to practice the skills. This is unfortunate because research shows that the more people practice, the better they do. Many people find it helpful to pair the practice of Thought Challenging with regular daily activities, e.g., when you have your breakfast in the morning. After a couple of weeks Thought Challenging then becomes automatic.

Summary

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

1. Research tells us that anxiety and depression put people at greater risk of having lots of unhelpful and negative thoughts.

2. Our thoughts are important and unhelpful thoughts can have a very significant impact on our emotional wellbeing. They affect how we feel and what we do.

3. Learning to identify and manage unhelpful thoughts is an essential part of managing our emotional wellbeing. Thought Challenging is a practical, proven, skill for managing our thoughts.

4. There are 3 steps to Thought Challenging:

• Recognise the thought • Examine the thought • Do something helpful

5. Thought Challenging is a very helpful skill. But, it takes some time and practice for us to become comfortable with it and for it to become helpful.

Please log back into www.mindspot.org.au again and review Lesson 2. Please revisit the website as often as you like to re-read any of the lessons and check when Lesson 3 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 2 at least twice this week. Take some time to identify and monitor their thoughts throughout the week. Complete the Thought Challenging 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: Thought Challenging







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