Self Help: The good, the bad, and the ugly. Making good choicesIntroduction I have had a long career in mental health mostly good – at least it kept me off the street. But suicide topped and tailed my career. I was the one who found someone who had ended their life – the last person to see them alive. The result was my career was marked by flashbacks and had I been more clever I could have used that experience to stop others ending their lives. Now at the near end of my career a young man I had been treating ended his life after completing what was a successful round of therapy. He was found by young boys and I can only imagine their shock. I was very privileged working with this young man and his lovely family who like many people in the same situation wondered what they could have done differently, and the answer is probably nothing but whether my reassurances replace the guilt is questionable. Similarly, they want his life not to be in vain and so do I. Maybe then, at the very least, I can dissuade similarly suicidal young people by illustrating the impact of suicide on me and on family. One of the criticisms of my care was that I discharged him with a range of options for self help but did not spend enough time on explaining their functions so that he felt more confident in using them. The critics have a point. There are so many self help choices out there that it is easy to get lost, as I frequently do, and there needs to be better signposting to those that are credible, research or evidence based and appropriate. But there are some ways that you can be better assured that what is out there meets the criteria above (maybe there are better criteria to apply). Nice Guidelines for various conditions may help you recognise what approach works for conditions such as anxiety and depression and psychoses etc. This requires that you are clear as to what your symptoms are. Peter Fonagy and Anthony Roth produced a marvellous book on what type of psychotherapy is best for what condition but is now long out of date (2005) and I am not sure it will be revised which is a shame. First my definition: Self help is taking action to start or maintain recovery with either minimal help or with some oversight by a helper professional or peer. It may be done as self initiated package or as part of more formal therapy. Self help can be as small as listening to inspiring words or music when our mood is low or anxiety is high or applying mindfulness or relaxation exercises through to engaging in on line packages with or without a professional guide. Regardless, lets see whether we can first look at the benefits of self help and then look at the disadvantages of self help. Benefits of self help Lets have a list of benefits of self help. Lets list the disadvantages Where do we find self help? I’m a bit of a magpie when it comes to resources, but unlike magpies I share what I find. Where have you found self help or what have you found that works for you? The Reading Well Series https://reading-well.org.uk/books/books-on-prescription/mental-health#self-help The Reading well series have a range of fabulous books mostly written by experts in the field such as Melanie Fennell and Overcoming Low Self Esteem or Colin Espie and “Getting a Good Nights Sleep”. One of the best books is David Burns “Feeling Great” Book. So much so that it could be made into a six week Better Mental Health Reading Book Club, if anyone is interested? Other self help material on line Some very good self help material can be found here: https://www.nhs.uk/mental-health/self-help/ https://www.annafreud.org/selfcare/ Books to inspire and console A great podcast is the “Start the Week” podcast on the 10th January about reading as consolation. https://www.bbc.co.uk/programmes/m00138fq Like others, I have found consolation in books as have others. What books bring you consolation? Music can have an inspiring and uplifting effect, try Katy Perry “Resilient” What about Pink If Apps are your bag!
App GuideThe apps on here are researched and some professionally reviewed and you click on the label that best fits such as mood disorder or phobias or stress or sleep and it recommends an app.Calm Harm: A Professional ReviewSome inspiring Podcasts All in the Mind https://www.bbc.co.uk/programmes/b006qxx9/episodes/player Who would have thought nasal breathing especially using your left nostril would be a stress buster: https://www.bbc.co.uk/sounds/play/m0012scb Training Looks like some great training on offer at Bury Adult Learning. As an example: Self-Care Sanctuary- Starts Tuesday 11 January, 7.00pm-9.00pm for 5 weeks. This course introduces you to the importance of self-care practice for living a healthier, happier and more productive life. Creative Writing for Wellbeing – Starts Wednesday 12 January, 1.00pm-3.30pm for 5 weeks. This course aims to give you the outlet to be able to express your thoughts and emotions and develop your writing skills to release your creative potential. Greater Manchester Mental Health Recovery Service has a good download on Mindfulness: https://www.gmmh.nhs.uk/download.cfm?doc=docm93jijm4n7062.pdf&ver=9600 What about the Creative Living Centre and their Courses https://www.creativelivingcentre.org.uk/courses.html Articles/research Repper and Carter (2011) recommend researching any self help group initiative. • Repper J, Carter T. (2011). A review of the literature on peer support in mental health services. J Ment Health, 20, 392 – 411 • Kählke, F., Berger, T., Schulz, A., Baumeister, H., Berking, M., Cuijpers, P., Bruffaerts, R., Auerbach, R.P., Kessler, R.C. & Ebert, D.D. 2019, "Efficacy and cost-effectiveness of an unguided, internet-based self-help intervention for social anxiety disorder in university students: Protocol of a randomized controlled trial", BMC psychiatry, vol. 19, no. 1, pp. 1-12.Link • • • Riva, G., Bernardelli, L., Castelnuovo, G., Di Lernia, D., Tuena, C., Clementi, A., Pedroli, E., Malighetti, C., Sforza, F., Wiederhold, B.K. & Serino, S. 2021, "A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up", International journal of environmental research and public health, vol. 18, no. 15, pp. 8188.Link • Bond, B., Wright, J. & Bacon, A. 2019, "What helps in self-help? A qualitative exploration of interactions within a borderline personality disorder self-help group", Journal of mental health (Abingdon, England), vol. 28, no. 6, pp. 640-646.Link • Muntingh, A.D.T., Hoogendoorn, A.W., van Schaik, Digna J. F, van Straten, A., Stolk, E.A., van Balkom, Anton J. L. M & Batelaan, N.M. 2019, "Patient preferences for a guided self-help programme to prevent relapse in anxiety or depression: A discrete choice experiment", PloS one, vol. 14, no. 7, pp. e0219588-e0219588.Link • Zwerenz, R., Baumgarten, C., Becker, J., Tibubos, A., Siepmann, M., Knickenberg, R.J. & Beutel, M.E. 2019, "Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial", Journal of medical Internet research, vol. 21, no. 10, pp. e13655-e13655.Link • Gaudiano, B.A., Davis, C.H., Miller, I.W. & Uebelacker, L. 2020, "Pilot randomized controlled trial of a video self-help intervention for depression based on acceptance and commitment therapy: Feasibility and acceptability", Clinical psychology and psychotherapy, vol. 27, no. 3, pp. 396.Link • Al-Alawi, M., McCall, R.K., Sultan, A., Balushi, N.A., Al-Mahrouqi, T., Ghailani, A.A., Sabti, H.A., Al-Maniri, A., Panchatcharam, S.M. & Sinawi, H.A. 2021, "Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help Internet-Based Therapy for COVID-19–Induced Anxiety and Depression: Open-label, Pragmatic, Randomized Controlled Trial", JMIR mental health, vol. 8, no. 2.Link • Cerga-Pashoja, A., Doukani, A., Gega, L., Walke, J. & Araya, R. 2020, "Added value or added burden? A qualitative investigation of blending internet self-help with face-to-face cognitive behaviour therapy for depression", Psychotherapy research, vol. 30, no. 8, pp. 998.Link • Soucy, I., Provencher, M.D., Fortier, M. & McFadden, T. 2019, "Secondary outcomes of the guided self-help behavioral activation and physical activity for depression trial", Journal of mental health (Abingdon, England), vol. 28, no. 4, pp. 410-418.Link • Mitsopoulou, T., Kasvikis, Y., Koumantanou, L., Giaglis, G., Skapinakis, P. & Mavreas, V. 2020, "Manualized single-session behavior treatment with self-help manual for panic disorder with or without agoraphobia", Psychotherapy research, vol. 30, no. 6, pp. 776.Link • Gaudiano, B.A., Davis, C.H., Miller, I.W. & Uebelacker, L.A. 2019, "Development of a Storytelling Video Self-Help Intervention Based on Acceptance and Commitment Therapy for Major Depression: Open Trial Results", Behavior modification, vol. 43, no. 1, pp. 56.Link • Chang, S., Sambasivam, R., Seow, E., Tan, G.C., Lu, S.H., Assudani, H., Chong, S.A., Subramaniam, M. & Vaingankar, J.A. 2021, "“We Are All Trying to Find a Way to Help Ourselves”: A Look at Self-Help Strategies Among Psychotherapy Clients", Frontiers in psychology, vol. 12, pp. 621085-621085.Link
Author: moodcoach
I am an accredited cognitive behavioural therapist with particular interest in working alongside people with depression. I am privileged in my work in the NHS with children, adolescents and their parents/carers. I am committed to improving access to psychological therapies. I do this through helping people link with accredited therapists. I help people prepare better for therapy so as to reduce premature endings and to maximise early gains. I also work with a very small number of clients in therapy and offer therapy at an affordable price.
My qualifications also include a Diploma in Counselling, I also have the following qualifications:- RGN, RMN, RNLD, MSc, BEd (Hons).
My main area of interest is mood disorders and adopting a compassionate approach in my work with people who find therapy difficult.
Managing acute stress reactions – and managing panic
Stress Reduction comes in all shapes and sizes, so you have to find one that fits you.
You might like some of the ideas below right away, and others might grow on you, so don’t be put off by them before giving them time.
Lets start with easy ones first.
Distraction
This may help if you are prone to zoning out – going numb when you are anxious.
Doing something that captures your attention is also great. Try naming countries from A – Z is good fun – do it on your own or take turns – you can do the same with A – Z of animals or any other area you know a lot about
Noticing and naming things around you. Notice and name 4 things you can see. Notice and name 3 things you can hear. Notice and name 2 things you can feel/touch. Notice and name 1 thing you can smell. This technique can also help to ground you following a panic attack or when you go all “fuzzy headed” and become detached from reality.
Sport and other physical work outs especially if they require focus are a great way for finding a break from stress.
Sport and other physical work outs especially if they require focus are a great way for finding a break from stress.
Breathing
Bigger brains than mine have worked out that something as simple as slow breathing can help. Spend 6 minutes each day as well as before you get too stressed by breathing in for four and breathing out for six. Do this for six minutes for six days as an experiment – don’t give up and see whether it helps. If it helps, keep going.
Whilst slow breathing try saying some kind thoughts to yourself.
Using your imagination
Going to a safe place in your mind especially if this is done in a place where you feel safe may calm you.
Going to a happy memory and replaying this can help.
Remembering some nice things people have said to you may also calm you down.
Favourite reading
Are there any words you have read that always stick in your mind and have a positive effect?
Have a favourite book or sentences from a book that make you feel good or calm.
What about recording these on your phone.
Accepting yourself
If its difficult to change something why not try accepting it?
If you have words in your head that you use to beat yourself up with accept that they are there and see if they disappear.
Maybe write down the criticisms and then replace them with more kind thoughts. Why not record kind thoughts that you believe about yourself or what others believe about you on your phone for playing in an emergency.
Accepting stress and panic
Instead of fighting back stress and anxiety welcome it into your life as a friend.
Spend time thinking about stress and anxiety as a help and how it does this.
When the physical signs of panic start let them happen and see whether just by spotting them, they somehow start to get smaller.
If you can breathe slowly instead of breathing fast as panic begins to start, this may help.
Telling yourself that panic wont harm you might help. When anxiety is high we start to have thoughts we are in imminent danger, notice these thoughts, accept them, don’t fight them … but don’t believe them.
Accept that sometimes you may not be able to stop panic and that you are not a failure.
Stress first aid box
This is good to interrupt negative thoughts about past trauma or current high stress.
Why not collect things into a box that help remind you of things that calm you.
These might be photos. Photos of people who you love and care for you.
You may include souvenirs as reminders.
You may include words on cards ie kind words from yourself or others.
You may include inspiring words. Maybe words from a favourite song: “Cause I am resilient; Open to better; Won’t let the concrete hold me back, oh, yeah” (resilient by Katy Perry)
You may include a favourite smell such as perfume on a hanky/tissue.
You may include fidgets or soft fabric you like (a favourite piece of material or maybe even a teddy or doll or action figure).
What else could you put in there?
Problem solving
When stressed we feel overwhelmed with problems – layer upon layer of them, so we don’t know where to start. Why not do something physical with your mind?
Outpour all your problems first onto a blank page and give them a hard stare. Then categorise your problems into things I can do something about, things I cant do anything about, things that I don’t care about or are way too far in the future.
Now start to look at the problems you can do something about and start with tackling the easiest on the list. By then, you may have the motivation to tackle some of the more difficult ones on your list.
Nutrition
Don’t forget about nutritious food. At the very least treat your body to rich nutritious supplements. A balanced diet especially with vitamins and omega oils may help your mental health. Maybe give yourself a blast of vitamin D through going out in daylight especially if it involves a good walk.
Helpline numbers if needbe
Its brave and courageous to call people if things get really difficult. Just knowing these are options may help. Make a list of people you would call when you are finding things just too tough. The following numbers may also help:
MIND has a great website with lots of emergency contacts
https://www.mind.org.uk/information-support/guides-to-support-and-services/crisis-services/helplines-listening-services/
Samaritans are excellent: Call free 116 123
For young people:
http://www.youngminds.org.uk/for_parents/parent_helpline
Bereavement helpline
0800 2600 400
Worried that a young person is vulnerable or self harming or suicidal, try Papyrus
http://www.papyrus-uk.org/
0800 068 41 41
A great website for supporting young adults
http://www.kooth.com
Young Minds is also a great place to start:
http://www.youngminds.org.uk
And for the parents https://mindedforfamilies.org.uk/young-people
Books and resources for teenagers and their mental health
Books
I am rather a magpie when it comes to resources, but unlike magpies I like to share my collections with others.
There are so many good books out there, that it is easy to get lost. This is my idea of which books will be helpful to teenagers, and in some cases younger children.
Jennifer Shannon’s books are a great start and in particular “The Anxiety Survival Guide for teens” is a wonderful introduction to working with feelings and thoughts. Regardless of the name, “Don’t Feed the Monkey Mind: how to stop the cycle of anxiety, fear and worry” is excellent for pausing the escalation of emotion. Both these books are produced by New Harbinger, and indeed these publishers also have other helpful books on exam stress, and stress in general for teenagers.
Most teens get intrusive thoughts, only some teenagers really get spooked by them. “Overcoming unwanted intrusive thoughts” by Sally Winston and Martin Seif is a well written book and the kids I have worked with have enjoyed it, if “enjoyed” is the right word.
For parents of younger children who have been through trauma, “The Simple Guide to Child Trauma” by Betsy de Thierry does what it says on the tin, and is full of helpful ideas to support quite young children. It is published by Jessica Kingsley.
And if you are a parent and would like to get your own stuff sorted, look no further than David Burn’s great new book “Feeling Great” published by PESI, it helps you understand the various unhelpful thinking habits we can all engage in. More than this, it suggests ways in which we can start to give up these habits.
Resources
The following are useful websites and Youtube episodes aimed at young adults and children.
Telephone helplines
www.youngminds.org.uk/for_parents/parent_helpline
Bereavement helpline
0800 2600 400
Worried that a young person is vulnerable or self harming or suicidal, try Papyrus
0800 068 41 41
A great website for supporting young adults
Young Minds is also a great place to start:
And for the parents …
https://mindedforfamilies.org.uk/young-people
What about some self help?
Great resources from the Anna Freud Centre
https://www.annafreud.org/selfcare/
More for teachers, but this website often looks at emotional regulation:
https://www.edutopia.org/social-emotional-learning
Good videos
A great video on emotions
A good video on losing your temper
A good video for teenagers on anxiety
A good video on anxiety for children from about 10 years upward
If your child is starting CBT this short video explains CBT
A good video on avoiding things that make us anxious
A good video on facing up to your fears with an emphasis on OCD
A good explanation of thought-action fusion as in OCD
A brief but effective video on mindfulness
What about some apps?
Here I am not recommending apps, but will bring your attention to two websites which evaluate NHS apps, and this should give you some confidence in those you are considering using.
In the NHS: https://www.nhs.uk/apps-library/category/mental-health/
From the USA: https://onemindpsyberguide.org/apps/
“CUES” programme for ASD
I consider myself very lucky to get a place on this course. It is a new programme with content which has been subject to considerable evaluation. It was developed by people with a solid background in practical clinical research and therapeutic approaches with people with ASD.
Its aim is to help parents with children who have ASD, so that they can cope better with uncertain situations. It has been well received by parents and appears to have considerable benefit for their children. I now have the training manual and presentation slides and am ready to go (almost).
I was keen to go on the course because of the gap in provision for people with ASD and severe anxiety, and I wanted to help them and their parents cope better. It will be difficult deciding on where to run the course: hospital, local charity, college, or school?
This is just one of the decisions to be made. Given I am one of the lucky ones to get a place on the training, I want to make sure that I make the best use of the opportunity I have been given.
Why train in empathy when you can read Dickens?
I do like Christmas especially when I can balance giving to others and allowing myself some pleasures – and not just intake of food and drink.
Of course, family life brings its own pleasures (and stresses) but also it is one of the only times when I can get my nose into a good book. So, what better books at Christmas than Charles Dickens?
I had never read him before this summer when I read the magnificent David Copperfield. Charles Dickens must have had emotional intelligence by the barrowful to write something as emotionally moving as David Copperfield . So my question is: who needs training in empathy when you can read and engage with the powerful writing of a master whose books remain as relevant as when they were first written.
Thus, encouraged by my reading of the first book, I am now tucking into the slimmer Great Expectations. Although not as enthusiastic about this classic nonetheless it has some marvellous characters and descriptions. I don’t think I have ever been so saddened and yet so grateful to Dickens for capturing the possibility of unconditional love between people. It does, forgive the cliché, restore faith in humanity. Just a brief example from Great Expectations is that of the loss that Pip (the protagonist) predicts when separating from his adored brother-in-law (Joe) is on the cards.
“Joe laid his hand on my shoulder with the touch of a woman. I have often thought him since like the sledge-hammer, that can crush a man or pat an egg-shell, in his combination of strength and gentleness…… Oh dear good Joe, whom I was so ready to leave and so unthankful to, I see you again, with your muscular blacksmith’s arm before your eyes, and your broad chest heaving, and your voice dying away. Oh dear good faithful tender Joe. I feel the loving tremble of your hand upon my arm, as solemnly this day as if it had been the rustle of an angel’s wing!”
The classics can be relied on to capture and describe emotional experiences much better than the very best text books on emotion and emotional trauma. As good as Dickens, on description of complex emotion is D.H. Lawrence, who captures the defense of dissociation in the face of misery like no one before or since; the scene in the cowshed with his young infant is beautifully written.
There are some text books that are rich reading experiences, I have again picked up the late RF Hobson’s book “Forms of Feeling” and he masterfully uses literature (classic writing and poetry) to deepen our understanding of the privilege of working with people during difficult times. Such books, apart from being a joy to read, help shine a light on the importance of relationship and the value of striving to make a deep connection even when the other (or both) struggles with a process which they (and us) might find offers possibilities and joy and pain and loss. Training in empathy? Give me Charles Dickens everytime.
Mental Health Websites (Updated)
Mental Health Websites and apps
There are hundreds of websites out there for people to choose from. So its good that you can go on the NHS website who have the expertise to sift through the good, the bad and the damn right harmful. The first link takes you to the NHS website that recommends what to click on.
I have also collated those websites that have been recommended to me – mostly professional recommendations.
In addition, I have included other resources (some local) which can signpost people for help.
Very well mind is packed full of interesting mental health material:
They include some good resources on meditation like these guided meditations:
Side by side are help pages from Mind and include links to talk to people and support people and other information on mental health:
Website helping children who have had trauma:
Help for children who self harm with this useful app:
A good website to support parents with children who are having mental health difficulties:
Here is a local directory for the Bury area, helping people find support. Some of these here are also national helplines:
Catch it is a CBT based application that is currently being reviewed by the NHS
Words to beat ourselves up with
As is often the case, the Journal of Behavioural and Cognitive Psychotherapy (May, 2020 just arrived ) has some great articles. One of which discusses chronic depression and its treatment with rumination focused CBT. Ed Watkins is best associated with it and his book on rumination was a revelation. It helped me understand the process of over-general memory and its links with unhelpful labels. This explains how people can describe themselves in unhelpful ways like “I’m lazy” “I’m useless” “I’m a failure” and why helping people to be more descriptive starts to break down such mood lowering short-cuts.
I am on a mission at the moment to encourage the effectiveness of clinical supervision by blending compassion focused work with techniques that encourage descriptive reflection with the hope of reducing rumination, blame and guilt and ultimately the mental health of nursing staff.
For far too long nurses have been dismissive of the restorative power of clinical supervision which is often viewed with suspicion and considered as just another task to tick off the long “To Do” list. Now is the time to at least plan to learn techniques that stabilise the nursing workforce through a frequently side-lined activity.
Clinical supervision has lost its credibility resulting in the proliferation of alternative support processes which frequently fail to take off for the same reasons – its another initiative, we haven’t got time, its another management tool to get management off the hook. I think it would be a safe bet, to say that the people who are currently accessing effective support are the ones in least need – sophisticated and psychologically minded and committed to trying the techniques that might help.
Try getting a busy staff nurse, who arrives home after a gruelling shift and to a family whose lives are on hold, to sit down, relax and reflect. Oh, and fit in some mindfulness exercises whilst you are at it.
Nurses do need support but they also need the time to access a process that needs to mature and that in need of enhancement of its restorative value through adding techniques that work. Wallbank (2016) makes a good case for the restorative aspects of clinical supervision as one that enhances self compassion and compassion for others, and that cant be a bad thing. The majority don’t need additional and new support mechanisms that seem alien and imported, so lets be grateful for what we already have.
Reading
Wallbank, S. 2016, “Restorative Supervision Implications for Nursing”. In: A Hewiston & Y Sawbridge (eds.) Compassion in Nursing: Theory, evidence and Practice. Palgrave, London.
Watkins, E. & Moulds, M. 2005, “Distinct Modes of Ruminative Self-Focus: Impact of Abstract Versus Concrete Rumination on Problem Solving in Depression”, Emotion, vol. 5, no. 3, pp. 319-328.
Watkins, E.R. 2009, “Depressive Rumination: Investigating Mechanisms to Improve Cognitive Behavioural Treatments”, Cognitive behaviour therapy, vol. 38, no. sup1, pp. 8-14.
Watkins, E.R. 2016, Rumination-Focused Cognitive-Behavioral Therapy for Depression, Guilford Publications Inc. M.U.A, New York
Learning to find joy in pain
I get this and I have experienced this myself – granted, not as painful as some people have had it. In this podcast, Meehan Krist eloquently describes living with uncertainty and her difficulty in deciding whether to bring a child into a world that is both “more terrible and more wonderful”.
Its a great listen that celebrates being human and a capacity to survive through learning, creativity, and embracing diversity.
For my part, my resilience lies in my love of learning and the joy and pain of helping young people who feel lost and anxious. More than this, I am currently helping others to help others through my teachings and supervision or by just sharing information including signposting uplifting podcasts that help us think differently.
Children our best enemy
Photo by Romina Ordu00f3u00f1ez on Pexels.com
Hi
I have been invited to do a talk about my work with children for BIG a mental health charity working in Bury, Manchester (thank you BIG staff).
The focus is on how through working with children it has helped me work with adults. It discusses the importance of containment when helping children with difficult, often embarrassing, emotions.
I have attached a podcast which previews the talk – I hope you enjoy the thick accent.
Mood-Coach 