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Worry and Sadness


Welcome to the Worry and Sadness Program! Congratulations on having the courage to improve
your emotional health and wellbeing
explain some of the techniques involved in learning to manage sadness, low mood and worry. Of
course, your own experience will be very personal, but you may find that you relate to some aspects of
their stories.
This program involves four lessons to be completed over a four week period. Here is an overview of
the four lessons in this Program:
Lesson 1

Learning about low mood and anxiety, and tackling physical


Lesson 2

Learning about thoughts, and tackling low activity

Lesson 3

Tackling unhelpful thoughts and facing your fears

We have prepared a lesson summary (like this one) for each of the three lessons in the course, which
includes the key information taught in the lesson, and exercises that can help you put the skills into
practice in your daily life. By practicing the skills, you will get the most benefit out of the program.

stage of this program, by email or by telephone 02 8382 1400.

Good luck!
The Team from THIS WAY UP | 2

Topics Covered In This Summary

Here is a list of the topics we will cover in this Summary. Tick these off as you go:
1. The Consequences of Low Mood and Anxiety for You
2. What Do You Want to Achieve Here?
3. About Depression and Anxiety
4. Thoughts, Physical Symptoms and Behaviours
5. Exercise
6. Fight or Flight Response Explained
7. Controlled Breathing
8. Your Checklist
9. Summary

1. The Consequences of Low mood and Anxiety for You

What areas of your life does low mood and anxiety interfere with?
Tick the boxes that apply to you:
It interferes with my personal life
It interferes with my employment/education/career
It affects how I get on with others
It affects how I feel about myself
It affects how I feel about other people
It affects my health
Note down other areas here: | 3

2. What Do You Want to Achieve Here?

What do you want to achieve during this Program?
(What are your goals? What things would you be able to do if you had better
emotional health and wellbeing?)
We have listed some common general goals below. Tick the boxes that apply to you:

Have better control over my thoughts

Learn how to manage low mood and anxiety

Feel better about myself

Be more independent/less dependent on


Feel more physically relaxed

Feel in control without feeling too worried and


Feel more secure in myself

Along with more general goals, write down any other specific goals you want to achieve
during this Program below.

What You Should Know:

The Worry and Sadness Program is not a treatment. It is an educational self-help course that has
been specifically designed to teach you practical skills that may help you to improve your emotional
health. These skills have been shown to help others to worry less, and to feel less sad and down.
Many people who suffer from feelings of depression and other mental health problems feel suicidal at
times. If you are suicidal and feel at serious risk of self-harm you should immediately call
emergency services (Ambulance/Police) on 000, or call your local hospital mental health crisis
If you are highly distressed, you may need additional support to get better. If you are feeling very
distressed, depressed or anxious, it is recommended that you consult with your general practitioner,
and see a mental health professional (Psychiatrist, Counsellor or Psychologist) who can assist you. | 4

3. Depression and Anxiety Explained

Everyone feels anxious and depressed from time to
time. They are normal human emotions, just like
feeling fearful, worried, sad, happy, frustrated, and
disappointed. Anxiety is experienced when we feel
threatened, worried or frightened. We often feel
depressed following a loss, disappointment or




Although everyone feels anxious, sad and

depressed sometimes, for many people these
feelings are temporary. However, for some people,
symptoms of depression and anxiety turn into a
problem because their symptoms become:






Excessive and severe

Too intense

Difficult to control

Interfere with day-to-day functioning

Pervasive (occur in many situations)


(Tick the boxes that apply to you)

Feelings of sadness, numbness or low mood that last for most of the day for at least 2 weeks
Lack of interest or difficulty experiencing pleasure or enjoyment for at least 2 weeks
Low energy, feelings of fatigue and exhaustion
Sleeping problems (either sleeping too much or too little)
Feelings of worthlessness, and hopelessness about the future
Suicidal thoughts | 5

There are also different types of anxiety that people experience. We have provided a list for you to
explain what these labels mean.

Generalised Anxiety Disorder (GAD): People with GAD usually experience excessive worry
that is persistent, usually out of proportion (or about lots of everyday things), and difficult to control.
They also experience irritability, fatigue, muscle tension, insomnia and other problems.

Social Phobia: People with social phobia fear social situations (e.g., being the centre of attention,
public speaking, meeting new people) because they are afraid that they will be evaluated negatively
by other people. This often causes them to avoid many social interactions or experience high levels of
anxiety in social situations.

Panic Disorder: People with panic disorder fear having panic attacks. They often develop
Agoraphobia, which is the avoidance of situations where they believe they will be unable to escape,
should a panic attack occur.

Post Traumatic Stress Disorder (PTSD): People with PTSD usually experience recurrent
and distressing memories, flashbacks and/or nightmares of traumatic events that they have witnessed
or experienced. They often avoid reminders of the traumatic event, and experience other problems
(e.g., irritability, numbness, insomnia).

Obsessive Compulsive Disorder (OCD): People with OCD experience distressing intrusive
thoughts or images, and also experience compulsive behaviours (e.g., checking).

4. Thoughts, Physical Symptoms and Behaviours

As you found out in lesson 1, thoughts, physical symptoms, emotions and behaviours are all related
and affect each other.
What runs through your mind

What you do or dont do

What you feel in your body | 6

When people experience low mood and anxiety, their thoughts, behaviours and physical symptoms
not only affect one another, they are also important in maintaining the problem (that is, they keep the
low mood and anxiety going).
are linked. As you

for long periods (behaviour). Unfortunately, he found that the

more he stayed in bed, the more down and low he felt, which meant he was even less motivated to
do other activities.
story, each of these experiences
affects the other experiences.

When I felt tired and stayed in bed,

Id worry that Ive got so much to
do, Im letting everyone down, I
cant cope

When I felt tired, Id stay in bed, rest

more often and avoid going out

I often felt tired and exhausted | 7

Another example:
which led her to feel very anxious, experience heart racing and sweating (physical symptoms) and
also meant that she checked whether he was ok again and again by calling his mobile (behaviour).
The more she checked her phone and tried calling him, the less confident she felt, and the more her
attention was focused on her fears, and the more anxious she felt!
When my heart raced, I thought Im
having a heart attack, and theres
something seriously wrong with me

I began to avoid activities (like

exercise) that would make my heart
beat fast

When I felt anxious my heart would


As you can see in these examples, low mood and anxiety involve a vicious cycle that can be hard to
break. All of the different parts (thoughts, physical symptoms and behaviours) interact with one
another as illustrated in the diagram above. You may relate to these examples, or may find that your
thoughts, feelings, behaviours and physical symptoms are slightly different, yet all interact with each
The good news is that if you make any small changes and improvements on any one of these parts of
your experience, it will have a positive impact on the others (because each one affects the others).
That is why this educational course is so important it helps you to dismantle the cycle so that the
physical symptoms, thought and behavioural symptoms improve. | 8

5. Managing Fatigue and Exhaustion Using Exercise

One of the most important steps in overcoming
low mood and anxiety is gradually increasing
your activity levels even though it might be the
last thing you feel like doing! Engaging in physical
activity is a very effective way of relieving nervous
tension, and can also help you tackle physical
symptoms of fatigue and exhaustion.

Why increase your activity?

Activity helps to improve emotional health and
wellbeing in several ways:

Activity makes you feel better

There is a lot of evidence that light aerobic exercise (e.g., walking or swimming) is an effective
way of improving wellbeing.
Your attention is shifted away from the worry and onto the task you are doing. Therefore, it can
take your mind off your distressing feelings and worries.
It can also give you the sense that you are taking control of your life again, and achieving
something worthwhile.
It can give you the opportunity to do things you enjoy, which you may have stopped because of
poor emotional health.

Activity makes you feel less tired

Normally, when you are tired, you need rest. When you are feeling low, the opposite is true. You
need to do more. Doing nothing will only make you feel more lethargic and exhausted. And doing
nothing leaves your mind unoccupied, so you are more likely to brood on your difficulties, and to
feel even more down.

Activity motivates you to do more

The less you do, the less motivated you become. However, the good news is that the opposite is
also true: the more you do, the more you feel like doing.

Activity improves your ability to think

Exercise improves focus and attention. Once you get started increasing your activity levels,
problems which you thought you could do nothing about come into perspective. | 9

Despite all of these advantages to exercise, we know that it is not easy to become more active,
especially if you are feeling sad or worried a lot of the time. This is because you may feel too drained to
exercise into your day. It is also because unhelpful thoughts stand in your way. When you are sad and
you are faced with something you would normally do before being sad, like going for a walk, you may
do less and
less. This means:

Avoiding activity will only increase feelings of lethargy and exhaustion

It will stop you from taking action, and keep you in the vicious cycle of low emotional wellbeing.
Pick an exercise you enjoy and do it at least three days this week.
We recommend that you do light physical exercise at least half an hour a day, three days a week. We
also recommend that the exercise you do be cardio exercise. Cardio exercise is the type of exercise that
rk really hard to get benefits from exercise.
You need to make a specific plan about when, where, how you will do it, what might get in the way, and
how you will deal with what might get in the way. Making specific plans makes you much more likely that
you will succeed in your plan and succeed in reaching your goal. If you keep it general, its unlikely that
youll stick to the plan. | 10

6. Fight or Flight Response Explained

Another physical symptom common with anxiety is panic and tension. In order to learn how to tackle
this physical symptom,

In this lesson, you learnt about the fight or flight response. When our brain detects possible danger or
threat, our body reacts with an automatic biological response called the fight or flight reaction. The
fight or flight response is a series of normal biological reactions that are designed to keep you
physically safe in the face of possible danger.
The brain becomes focused
on danger
. causing you to concentrate
on your distressing feelings,
making it hard to concentrate
on other things
Breathing speeds up
. causing dizziness, feeling
unwell, or lightheaded

Blood is diverted to the

muscles so your muscles
tense, ready for action!

Saliva decreases
so your mouth becomes

Heart rate and blood

pressure increase causing
your heart to pound and
leaves you feeling tense
Digestion slows down so
you feel sick and nauseous

Sweating increases so you

feel uncomfortable

A number of things happen to our body when this reaction is triggered. These include:

Our breathing rate and heart rate increases to get more oxygen to our muscles
Blood is diverted from non-essential organs (e.g. stomach) to more essential muscles
Our muscles tense up in preparation for activity
Our bodies start to sweat to cool us down
Our brain focuses on any potential dangers (making it hard to concentrate) | 11

7. Controlled Breathing
As well as engaging in regular exercise, another way of improving your emotional
health and wellbeing and to reduce stress is to regularly use controlled
breathing. Controlled breathing can be useful to reduce the symptoms caused by
the fight or flight response. The aim is that once you get good at being able to do
controlled breathing you can use it at times during the day when you notice you
are starting to feel worried.
It is important to practice, practice and practice the controlled breathing task
and then practice some more!

STEP 1: A normal resting breathing rate is 10

12 breaths per minute. What is

yours now? Use a watch with a second hand (or timer) and count the number of
breaths you take over one minute. Write it here:
_______________ breaths per minute

STEP 2: Sit comfortably in a chair.

Use a watch with a second hand to time

yourself. Breathe in and out gently through your nose. Rest your hands on your tummy to check that
you are using your stomach muscles (and therefore, your diaphragm) to drive your breathing rather
than your upper chest.

STEP 3: Now, do the following exercise:

Breathe in for 3 seconds
Breathe out for 3 seconds
relax to yourself)
Do this for 3 minutes and notice the difference in your tension.
Try counting your breathing rate for one minute before and after the exercise.
Does the rate drop afterwards?
Write it here:

_______________ breaths per minute

SUMMARY: The controlled breathing exercise can be done at different times throughout the day.
At first you may need to find a quiet, relaxing place. With practice, it becomes easier and you can use it
whenever and wherever you need to.
The more practice you d
that it takes time to master this skill,
technique at least 3 times per day every day. | 12

8. Your Checklist
Your tasks to do following this lesson are:
Review lesson 1 again
Print out and re-read this lesson summary
Get active! Schedule light physical exercise at least 3 times per week for at least 30 minutes
Practice controlled breathing at least 3 times per day, each day
Reward yourself for completing lesson 1!

9. Summary
Congratulations on completing Lesson 1.
copy it.

-read this, so feel free to print it or

The main points from this summary are to begin to:

Recognize how anxiety and low mood affect your life
Recognize how THOUGHTS, PHYSICAL SYMPTOMS, and BEHAVIOURS affect anxiety
and low mood in your life.
Pick an exercise you enjoy and do it at least 3 times/week. This will help you to start
to reduce feelings of fatigue and nervous tension.
Practice the controlled breathing at least 3 times a day. Learn how your breathing
changes when you feel worried, and learn how that makes your worry harder to
Great work, you have now completed the first Lesson! Remember, you can come
back whenever you like and re-read Lesson 1.
Please schedule a time to complete Lesson 2 in your diary. It is important that
you read this lesson summary and complete the homework tasks before you go
onto lesson 2.
Good luck!
The Team from THIS WAY UP | 13